MedicalExaminer 10-18-19 by Daniel Pearson

MEDICALEXAMINER

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

OCTOBER 18, 2019

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PARIETAL BONE

OCCIPITAL BONE MASTOID PROCESSS

The brain is often called the most sophisticated and complex structure in the known universe. And each of us owns one! The design of the human body seems to understand the brain’s importance: an article about the mechanics of head injuries in The Lancet reported that the skull is one of the least deformable structures found in nature. It takes the force of about 1 ton to change the diameter of the skull by so much as a single centimeter, according to FRONTAL BONE The Lancet. The skull is so strong that brain injuries are seldom the result of an injury that penetrates the skull; more frequently the cause is trauma that bounces the brain around within its secure confines. Confines is the appropriate word because intracranial space is highly limited. Swelling of the brain causes pressure that has nowhere to escape. In centuries past, this pressure would some times be relieved by drilling a hole in the skull, a procedure known as trepanning. While it may sound hopelessly primitive, a similar procedure is done today to relieve intracranial pressure to prevent traumatic brain injury or to attempt to relieve it. TEMPORAL BONE The skull has more than 40 bones at birth, but in an adult multiple bones have fused together for a final total of 22, eight of which form the cranium along with fourteen more intricate bones which make up the facial structure. A notable exception to the fusions which transform a soft ZYGOMATIC baby skull into “one of the least deformable structures found in BONE nature” is the jawbone or mandible. Its hinged design allows for eating, speech, and other important things like yawning and going to the dentist. The mandible is like a car door wired MAXILLARY through its hinges to keep all its functions intact whether it SPHENOID BONE BONE is open or closed. Stripped of skin and hair (not recommended) it would be easy to see that the skull and mandible are sheathed in muscles (see illustration below). These muscles permit facial expressions, speech, chewing, and wiggling our ears to amuse small children. This is the barest snapshot of the MANDIBLE skull and its amazing intricacies. Hopefully it will spark your interest in doing additional research. In closing, here is a quote from the Skull Owner’s Manual: “Always protect the skull using a helmet appropriate to activities like football, biking, and motorcycling.” Good words to try to get through our thick skulls. +

THE HUMAN SKULL BODY PARTS: THE OCCASIONAL SERIES

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

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OCTOBER 18, 2019

PARENTHOOD by David W. Proefrock, PhD

Your 13 year-old son has begun spending a great deal of time alone in his room with the door closed. You know that most of the time he is reading or listening to music. He used to enjoy spending time with the family having meals and watching television together. Now, he comes out of his room only to eat or when he is ordered to, but he prefers to be alone. His grades have not fallen, and he has not been in trouble. What do you do? A. Limit the time he is allowed to be alone in the room with his door closed. Make him spend more time with the family. B. He may be depressed. Take him to a mental health professional to see if there is a problem. C. Don’t worry too much about it unless it becomes worse or you see other signs of trouble. This is just part of being 13. D. Have a talk with him and let him know how important family time is. Tell him you all enjoy his company and want to spend time with him. If you answered: A. This is a good way to start a battle over something there is no need to battle about. Spending more time alone is normal and appropriate for 13 year-olds. B. If his isolation becomes too serious or if you see other signs of depression, you will need to do this, but it shouldn’t be your first response. C. This is the best response as long as he eats with the family, spends time when asked, and keeps his grades and friendships up. If that changes, there may be a problem that should be addressed. D. There is nothing wrong with this response and it is a good idea to have serious talks with your children. However, don’t expect it to work. At about age 12 or 13, children begin the process of separating themselves from their families and figuring out who they are. This includes their preferring to spend more time alone or with friends. It is a perfectly normal and important part of growing up. + Dr. Proefrock is a retired child clinical and forensic psychologist.

ROTH IRAs - The Front & Back Door The Roth IRA was established by the Taxpayer Relief Act of 1997 and is named for its chief legislative sponsor, Senator William Roth of Delaware. Since 1997, the popularity of Roth accounts has exploded because of the tax advantages it offers. Although a Roth IRA does not give you a tax deduction when you put contributions into the account, the account allows your money to grow tax-free for life. That is very powerful, but putting money into a Roth IRA can be tricky depending on your income situation. For 2019, the Roth IRA contribution limit is $6,000

per person, or $7,000 if you are over 50 years of age. A Roth IRA does have income limits, which is where the front and back door come into play. If you make under the modified Adjusted Gross Income limit of $203,000 for joint filers or $137,000 for single filers in 2019, you can use the front door: just put the money directly into your Roth IRA each year. You have until April 15, 2020 to make your 2019 contributions. If you make over the income limits, you can still put money into your Roth IRAs, but you will have to use the back door. The back door lets you put money into your Roth IRA with an extra administrative step. Below are the steps; 1. Put money in a traditional IRA account. Since you are over the income limits the contribution will be considered non-deductible for taxes. 2. Convert the account to a Roth IRA. This will move the money from your traditional IRA to your Roth IRA. 3. Make sure your tax preparer reports the transactions properly on your tax return. It is best if you work with a CPA when doing this. There are a few rules Roth IRAs must follow. The most important rule to understand for this strategy is the IRS pro-rata rule. To avoid complications, make sure you do not have any other traditional, SIMPLE,

or SEP IRA accounts with balances. If you do, the IRS will make you pay taxes on the percentage of pre-tax money you have in the other open accounts when you do the Roth conversion in step number two. The pro-rata rule is one of the reasons we recommend you discuss this with a financial planner before doing it. If you do have other IRA accounts with balances, there are strategies you can consider that will consolidate the accounts and allow you to use the back door Roth IRA option. However, for some people the extra complexity may not make sense. Financial planners routinely help their clients navigate the backdoor Roth strategy. It is amazing to watch couples use this strategy. Using a 6% average return, a couple over 50 can save almost $200,000 in Roth IRAs over 10 years. We find that couples in retirement with Roth accounts have increased flexibility with the withdrawal strategy which helps minimize taxes in retirement. As an added bonus, Roth IRA accounts are great for legacy planning. + by Clayton Quamme, CFP® a financial planner with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

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OCTOBER 18, 2019

MEMOTOAUSTINRHODES Somehow I missed the announcement this summer that the Department of Veterans Affairs would be outlawing smoking, vaping and other forms of tobacco use at all of its healthcare facilities and Veterans Administration hospitals nationwide, including the two VA hospitals here in Augusta. I discovered this by accident on the very day the ban went into effect. I turned on my car and the radio was tuned to the Austin Rhodes show. Austin was discussing the new rule and expressing his misgivings about it. He described himself as “torn.” He understood the rationale behind it, but couldn’t agree with the decision. After everything they’ve done for our country, he said (paraphrasing), and the sacrifices they’ve made, it’s a shame that they are being deprived of their right to smoke by the very agency supposedly dedicated to their care and welfare. He mentioned other places where smoking is permitted, such as smoking lounges in airports, and concluded the only portion of his program I heard that day by calling the ban “politically correct” when the decision should have been one that took into consideration what veterans have done for this country. Although at that moment I was really pressed for time, I decided to call the show. For some reason my call was dropped before anyone at WGAC answered. Rather than try again, I texted Austin. “Allowing smoking in an airport is way different than allowing it in a hospital,” I wrote. Trotting out one of my favorite analogies, I said, “That’s like having a designated drinking area in a Betty Ford Clinic. And it is in no way a ‘politically correct’ decision. Where have you been for the last 50 years? It’s a medically correct decision!” Austin replied the next morning: “I know you have been on a rampage about this for a while...

you want to come by and talk about it?” By “this” he was referring to the long-standing anti-smoking stance of this newspaper. I take some comfort in knowing that if this is a rampage, it is one I share with the American Cancer Society, the Centers for Disease Control, the Surgeon General, the World Health Organization (WHO), a number of major tobacco companies, ironically enough, who have spent millions on anti-smoking campaigns, and now, the Department of Veterans Affairs. It’s pretty decent company. The known local opposition consists mainly of Austin Rhodes and University Hospital, which welcomes smokers to its rather prominently placed designated smoking areas. Austin’s views are based on where his heart is, not on the overwhelming evidence of tobacco’s harm. For University Hospital, it’s a baffling position that is decades behind the times. In the year 2019, no healthcare organization worthy of the name should do anything that encourages or even allows tobacco use on its property. This is a drug that, although legal, could cause 1 billion deaths this century, according to worst-case projections by WHO. So to the VA we say, congratulations for putting the welfare of your patients first. To Austin Rhodes, University Hospital, and anyone else who thinks smoking has any rightful place in any healthcare setting, join the 21st century already! The Surgeon General’s report came out in 1964, for pete’s sake!

— Dan Pearson Medical Examiner publisher

PS: I told Austin I was considering his invitation and offered a few suggested dates, but I haven’t heard back from him yet. Perhaps I won’t. +

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WHY IS MY MEDICINE CAUSING WEIGHT GAIN?? There are a number of reasons for this annoying and frustrating phenomenon. While it’s true that virtually every medicine carries with it the possibility of side effects — some very minor, some potentially deadly — it’s especially vexing when a patient has little choice: the medicine is essential to life or having a good quality of life, yet it comes with a side effect that can spawn its own separate set of health issues. Here are a few of the reasons why a medication might cause weight gain. It’s an energy drain Some medications make the user drowsy, leading to lack of exercise, more sleep, and much lower daily calorie burn. If the pre-medication diet doesn’t change, weight gain will result. The same effects can be caused if a medication causes shortness of breath. That will sharply curtail activity too. It changes the body’s metabolism This can be especially frustrating: perhaps exercise and diet are unchanged, yet the pounds start to add up. Or the patient is actually exercising more and eating less, but weight gain still occurs. This can happen if a medication makes the body burn calories at a slower rate. It causes water retention The good news is this type of weight gain doesn’t necessarily mean an increase in body fat; the gain is in water or fluid. Even so, it’s an undesirable outcome. It increases appetite A number of antidepressant and steroid drugs increase appetite, while others interfere with appetite control. Both lead to more pounds showing up on the scale. It changes the body’s energy storage Diabetes medications can increase insulin production, lowering blood sugar levels. That triggers increased appetite. Insulin can allow glucose to enter the body’s cells instead of staying in the bloodstream. Excess glucose is converted to fat if it isn’t burned through exercise. There are other medications which do the opposite: they have the side effect of causing weight loss by various means. Your doctor knows the side effects of medications, but not how they will manifest themselves in individual patients. If your weight gain (or any other medication side effect) is a problem, talk to your doctor about it. +

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OCTOBER 18, 2019

#101 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 we halted that exercise after only five up and downs. We attributed the discomfort to my When is physical therapy not very helpful being out of shape from being hospitalized. or even worse, harmful? When you have But later that day, the pain intensified, multiple broken ribs and two fractured and a day later I woke up in pain that kept vertebrae (T-11 and T-12) that neither you nor growing throughout the day. In addition, my the therapist knows about. left leg was collapsing when As frequent readers may walked and only my walker The fractures were never Iprevented already know, I just got out of me from falling. By noticed despite an MRI mid-afternoon the pain was the hospital and rehab after being treated for an infection that very intense, and I used my and CT scans caused a necrotic lesion on my call button to summon help, an spine. What the hospital missed ambulance to take me to the in doing the MRI, CT scan and biopsy of my hospital. spine was the fractured ribs and vertebrae. Another CT scan was done, and the During the entire process, including what fractures were identified. Even morphine led me to go to the hospital in the first place and dilaudid were unable to calm the pain (which was excruciating pain in my lower in my back and hip. Nonetheless, they sent hip area exacerbated by being moved and me home. I cried. How was I going to take being laid flat on my back on gurneys and care of myself when the smallest movements scan tables), nobody noticed the fractures. threatened to drop me to the floor? I sat in In the hospital, the pain gradually subsided, my chair all night and in the morning called only to return with great intensity after I left my nurse. She came and helped me to the the hospital and entered the rehab setting. bathroom, made sure I had my meds and Some of the things they wanted me to do food, and then she left. I spent most of the in rehab, like standing up and walking, were day in my chair, only getting up to go to the fine and seemed to help. But one day, when bathroom. The threatening jolts of pain in the therapist asked me to do a standing my hip continued to occur all day, but by the up and sitting down exercise, I ended up next morning the pain subsided to the point needing morphine to even begin to ease where extra strength acetaminophen was the pain that movement caused. Up to that enough, and I was able to function almost point, the pain had subsided enough that normally. I could get up unaided, walk unaided, and At the hospital the doctor told me to tell I was beginning to envision being able to the physical therapists that they needed to come home and care for myself. But after realize I’m not like other folks and there are that I stayed in bed, not moving, the rest of just some exercises I should probably never that day and all the next day, and by then do, including anything which twists my the pain was controlled enough that I could spine or causes my spine to compress, like do a lot with the therapists, but not that one multiple times of repeatedly standing up and exercise. sitting down. I now realize that I have joined Shortly thereafter I was able to come the ranks of people who have wonky backs home, and everything was going great until and have to be careful of how they move to a new physical therapist asked me to do that avoid the consequences of a wrong move. repeatedly standing up and sitting down It has been a painful realization. exercise. It was causing some discomfort and Literally. + by Marcia Ribble

t is no understatement to say this man almost singlehandedly saved hundreds of millions of lives. His name is John Snow, and he was an English physician, born in York in 1813. He is considered one of the fathers of modern epidemiology. His medical advancements were accomplished through a hailstorm (figuratively speaking) of scientific ignorance and prejudice. His professional prime came during a period we might call The Era of Bad Smells. Living in a city of millions, London, without many of today’s modern conveniences (plumbing, for one), there was no doubt an abundance of bad smells. If we lived in a sewer, we too might suspect that breathing in foul odors was responsible for any medical problems we might have. These nasty vapors wafting through the air to deliver disease and death were called miasmas, and the only thing more pervasive than the miasmas of the day were the people who believed in them. Social reformer Edwin Chadwick spoke before Parliament in 1846 to inform the assembled, “All smell is, if it be intense, immediate acute disease... All smell is disease.” Florence Nightingale believed bad odors caused measles, smallpox and scarlet fever. This belief was killed by none other than John Snow himself, but it took some doing. A cholera outbreak had ravaged England and Wales in 1848, killing fifty thousand people. Snow was on the case, and by 1849 his research convinced him that people were ingesting cholera, not inhaling it. One of his clues was that a doctor living in a neighborhood with a massive cholera outbreak might die along with his neighbors, but doctors from other parts of London treating patients in that same neighborhood would rarely if ever get the disease themselves. Another clue: London’s East End stunk to high heaven during the outbreak, but was experiencing Cholera Lite. Eventually Snow isolated contaminated water from one particular community well as the source of the initial outbreak. He published a paper on his findings which was met with scorn. The London Medical Gazette sniffed, “Other causes, irrespective of the water, may have been in operation especially as the persons were living in close proximity. The facts here mentioned raise only probability, and furnish no proof whatsoever of the author’s views.” Fortunately or not, another cholera outbreak erupted in 1854 and Snow quickly traced it to a pump at No. 40 Broad Street. He persuaded town officials to remove the handle from the pump and, to make a long story short, Snow ended up being vindicated in identifying contaminated water as cholera’s carrier. While cholera is almost non-existent in the U.S., it is by no means eradicated worldwide. One recent outbreak occurred in 2010 following the devastating earthquake in Haiti. Some 800,000 people contracted the disease and more than 9,000 died. Another outbreak has been ongoing in Yemen since 2016. 1.2 million people have come down with cholera there, but the death toll is much lower, about 2,500 people. +

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Musings of a Distractible Mind

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my accountant is a patient of mine. He also, despite my urging, has been slacking on coming to see me. “I haven’t been taking care of myself,” he told me by email. “It feels like I’m going to the principal’s office.” I know how that feels. I did go to the principal’s office plenty as a kid. So I told him (my accountant, not the principal) that this was exactly how I felt each year during tax season. So we made a pact: I wouldn’t make him feel like an idiot, and he’d not make me feel like one. That’s easy for both of us, as we are used to seeing other people’s financial/ physical nakedness. His feelings about going to the doctor are very common. People often feel insecure and ashamed. Just the other day a woman with COPD bowed her head in shame when she confessed she was still smoking. “How stupid is that?” she said, “I have COPD and recently had pneumonia, yet I still can’t stop using these things! My kids are always on my case; I just don’t know why I can’t quit.” This is true with diabetes, obesity, alcohol consumption, and anything else that seems like it should be easily handled (or at least improved) by lifestyle change. People don’t know why they compulsively do bad things or compulsively avoid doing the right thing. This is why I often tell patients is that one of the best things about being a doctor is that I see that everyone else is as screwed up as I am. This is my biggest challenge: getting people to change their behavior. I have to somehow get people to pay attention to their health

when they’d rather ignore it, to be taking medications when they’d rather not, to be exercising when they don’t want to, to lose weight when they love cheeseburgers, and to be checking their blood sugars when they’d rather not know how high they are. After trying lots of things over the past 20+ years, the one thing I find almost never works is what is usually done: lecturing the patient. One of my patients recently went to the ER and got a lecture about her weight. Great. I am sure this will change her life.

Yeah, people make bad choices. Just like their doctors and nurses do. She probably loved being lectured by a total stranger when she was in the ER for something unrelated to her weight. She probably never even realized she was overweight until that moment. Everyone is getting lectured on their weight, smoking, exercise, checking their sugars, taking their medications, and “reducing stress” in their lives. How can you reduce stress when you are surrounded by a bunch of medical busybodies? The result I see is a bunch of folks who are like my accountant: afraid to get care because they are waiting for a lecture. Many lie to cover up their shame, while others just don’t come. So how can we create a system that promotes honesty and encourages engagement? We can’t just ignore these problems. I’ve had people who interpreted my lack of mentioning their smoking or morbid obesity as me saying it’s OK. People need us to be engaged in

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their struggles in ways that are truly helpful, or at least being a sympathetic ally in their battles. I want people to come to me for help, not to avoid me or hide the truth because they fear me. This, of course, brings me back to the idea of patient-centered care. How do we address issues like weight, smoking, and noncompliance in a way that is patient-centered? It’s harder to answer than you might imagine. Human beings are complicated. I’d be on Dr. Oz right now if I knew an easy way to help people lose weight, quit smoking, or fight their other personal demons. There is no easy way. But it helps a lot to have someone who is fighting with you, not making you feel foolish. I’ve recently lost 20 lbs by the magic formula of eating less and exercising. It’s simple, but it sure as hell hasn’t been easy. So the best approach I’ve found is to sympathize and encourage. I want people to tell me about their struggles and failures, not hide them. I’m realizing as I get toward wrapping this up that I’m not coming to some grand conclusion. This is not magic. It’s not a secret trick that can make things easy. Life is a struggle we all face, and it is best faced with good allies. I want people to come to me when they need help, not run from me fearing judgment and lectures. Somehow, despite the checklist culture of our current medical system, we need to keep care away from shame. Yeah, people make bad choices, but that doesn’t mean they are bad (or stupid) people. In truth, they’re just like their doctors and nurses. And, it turns out, their accountants. +

AUGUSTAMEDICALEXAMiNER

OCTOBER 18, 2019

The

Advice Doctor ©

Will he ever get one right? Probably not.

Questions. And answers. On page 13.

IT’SYOURTURN! Your turn for what? To tell the tale of your medical experiences for Medicine in the First Person. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. See our “No Rules Rules” below. Thanks!

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.” “We had triplets.” “He was just two when he died.” “The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.” “I sure learned my lesson.” “The cause was a mystery for a long time.” “The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.” “I thought, ‘Well, this is it’.” seven years ago.”

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

Everybody has a story. Tell us yours.

Here’s our “No Rules Rules.” We’ll publish your name and city, or keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.

OCTOBER 18, 2019

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Vegan Queso Ingredients • 2 cups raw cashew pieces • 2 cups boiling water for soaking cashews • 2 tablespoons olive oil • 1/2 cup chopped onion • 3 cloves of garlic minced • 1 medium jalapeño seeded and diced (more if you like it spicy) • 1/4 cup diced red sweet pepper • 1/4 cup fresh chopped cilantro • 1/3 cup fresh squeezed lemon juice • 1/3 cup nutritional yeast • 1/2 teaspoon smoked paprika • 1 teaspoon cumin powder • 1/2 teaspoon mild chili powder

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Vegan Queso • 3/4 teaspoon salt *almond milk if needed to make cashews smooth Instructions Bring 2 cups of water to a boil. Place cashews in a bowl and pour boiling water over them. Allow to soak for 1 hour. In a medium pan heat olive oil over medium heat, saute chopped onions, jalapenos, garlic, and red pepper until lightly browned, about 3-4 minutes. Stir in chopped cilantro and sautee one more minute. Take off heat and set aside. Drain cashews and place in a blender. Add lemon juice, nutritional yeast, paprika, cumin, chili powder, and salt. Blend until creamy and smooth. If needed add 1 tablespoon almond milk at a time if needed to make smooth. Pour cashew mixture into a bowl, stir in cooked vegtables and cilantro. Pour quaso sacue into a cast iron skillet and heat in 350 degree preheated oven for 10 minutes or until bubbly hot. Serve warm with chips. + by Gina Dickson, an Augusta mom to six and Gigi to ten. Her web site, intentionalhospitality.com, celebrates gathering with friends, cooking great healthy meals and sharing life together around the table. Also on Instagram @intentionalhospitality

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I admit I can get a little obsessed trying new Mexican recipes, especially ones that will accompany my chips. There is just something about enjoying chips with salsa and queso cheese dip over a great conversation that makes me very happy. I wanted to create my own guilt-free, queso that I could eat to my heart’s content. It needed to be nutritious and low in fat but give me that creamy, satisfying scoop that traditional queso does. For this recipe, I start with raw cashews soaked to soften and then pureed to a smooth, creamy texture. Cashews are a nut that is very versatile when cooking. Also, consuming a high proportion of plantbased foods such as cashews appears to reduce the risk of many lifestyle-related health conditions. The monounsaturated and polyunsaturated fatty acids found in cashews can also help reduce your LDL cholesterol and triglyceride levels. So enjoying this queso can help reduce the risk of strokes and heart attacks. What a bonus! Next, I lightly sauteed some red peppers, diced jalapeños, onions, and garlic. These will be stirred into the cashews along with seasonings and nutritional yeast. The addition of nutritional yeast makes this recipe dairy-free, yet it still has a cheesy flavor. For a fun way to serve this dip, pour it in a cast-iron skillet, heat until warm and bubbly. Top with diced red peppers, jalapenos, and some cilantro. Then serve with a big bowl of warm chips.

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ALL DRUG SCREENS ARE NOT CREATED EQUAL, PT. 3 Just because you passed a drug test doesn’t mean you passed a drug test! “What?” you say. I know, right? But it is possible to pass a drug test with drugs still in your body! Who would’ve thought?!!! Of course, I’m referring to a hair follicle drug test. I can go smoke weed or crack right now and give a hair follicle drug test tomorrow and pass! I can even take the test next week and pass! This is the way a hair follicle test works: the hair is not plucked from your scalp (and if you shave your head, it isn’t plucked from other places on your body with long hair, either! Ouch) but is rather cut very close to the scalp in an area that covers about the size of a pencil eraser and involves therefore a number of hairs. Hair is hollow and drugs get into the hollow of the hair, and no amount of bleaching or shampooing will get rid of the drugs hiding out there. But it takes about two weeks of hair growth to get to the scalp surface, so a drug test prior to that is running two weeks ahead of schedule! Then there’s a blood test. Although this works well for alcohol currently in the body, it isn’t as good as an ETG urine test that detects alcohol in the body dating back from 72 to 80 hours. A blood test will only detect drugs for a few hours anyway, whereas a urine test for drugs can be

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A monthly series by an Augusta drug treatment professional reliable for 1-3 days for most drugs and even longer for THC. So passing a blood test for drugs is reliable only for a short window of time – a user gets no pay increase for passing this one! Then there’s a saliva test. Yep, good ol’ spit. But…the sponge that absorbs the saliva has to be really wet with saliva to work well, and if there is or has been any other food/ gum/drink in the subject’s mouth 15 minutes prior to the saliva test, you guessed it – not reliable. Instructions for this test requires direct observation of the client/patient for at least 15 minutes prior to ensure a clean mouth. I’ve seen a client pass a saliva test (and most saliva tests only test for 5-6 drugs – quite a limitation these days) but fail a urine drug test the same hour. Then there’s Spice – a drug that is merely herbs that have been sprayed with chemicals — you don’t want to know which ones! — and then is cut and dried to be smokable. Of the thirty or so varieties of Spice, drug tests have only been developed for about ten of them, so it’s possible to have smoked Spice (or bath salts) and have a clean drug test. This is a dangerous chemical, sold in $4-7 dollar packages with labeling clearly saying it’s not for physical

consumption as a disclaimer. But that line might as well dare teens to try ingesting it! I’ve seen people become wheelchair bound for life after using this drug. After all, the FDA doesn’t exactly monitor it for quality control. When you’re sitting around the house watching paint dry sometime, just for kicks go to YouTube and type in “smoking spice” and see videos of kids using this drug — if you have a strong constitution to see what you’re going to see. Not a pretty picture. The same goes for Kratom, which comes from a tropical tree in Asia and is sold in tablet form in health and nutrition stores to calm the nerves, or to serve as a withdrawal medicine for opiate addiction. An addict is not going to pay attention to the directions on the package and might swallow 30-50 pills for a nice high! Testing for this drug requires LCMS or GCMS, very expensive testing compared to the usual drug test cup. (Having read the last couple of columns on this subject, aren’t you glad you know what those letters stand for!) I feel a headache coming just thinking about all this. Think I’ll pour myself a cup of my favorite brew and add Pumpkin Spice creamer to it. I really don’t care if I flunk a drug test for it. +

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with both conditions include bloating, diarrhea, vomiting, headaches, and joint pains. Self-diagnosing is potentially harmful and may lead to nutrient deficiencies. A 2013 study found that about 65% of American adults believe that gluten-free foods are healthier, and that 27% of American adults choose gluten-free foods to promote weight loss. In some instances, parents were providing a gluten-free diet to their children due to mood swings, bowel movement changes, diarrhea, autism, or family history of celiac disease without the child being diagnosed with gluten sensitivity or celiac disease. The growing misconception around gluten is its association with weight gain and feeling sluggish and the belief that eliminating it from the diet will improve one’s health and nutritional status. An individual who removes gluten from his or her diet makes it more difficult to actually be diagnosed with either celiac disease or gluten sensitivity. This is because a diagnosis requires examination of the GI tract to check for inflammation or damage. A person who has already

removed gluten from their diet will not exhibit any of the GI damage associated with the diseases. Removing gluten from the diet without reason can also lead to micro- and macro-nutrient deficiencies. A gluten-free diet is often lower in fiber, iron, zinc, potassium, B vitamins, and other trace minerals. Although the common thought is that switching to a gluten-free diet will help in losing weight, this is not the case. Gluten-free alternatives often have more calories and fat than their counterparts with gluten. Gluten-free products are also lower in fiber. Foods such as whole grains are rich in fiber. Fiber plays a very important role in the prevention and management of several chronic diseases such as diabetes, hypertension, and heart disease. One study demonstrated that individuals who switched to a gluten-free diet ended up increasing their intake of carbohydrates and fat. If any weight loss does occur after switching to a gluten-free diet, it is likely due to highly restricted consumption of carbohydrates rather than the removal of gluten itself. In conclusion, gluten is a very misunderstood component of our diet. It is essential in ensuring that we get all of the necessary nutrients to maintain a balanced diet. Removing gluten from a diet is commonly employed with the wrong intentions and can actually cause more harm than help. Let’s stay informed by following credible sources of nutrition and health. The Academy of Nutrition and Dietetics is the largest organization of trained and credentialed professionals; you can visit www.eatright.org for more information.

What is gluten and why all the chatter on gluten? Gluten is a type of protein that is found in wheat, rye, barley, and oats. It is often found in breads, pastas, cookies, and other baked goods. Gluten acts as a binding agent that helps to improve texture, moisture retention, and flavor in foods. In recent years, many new gluten-free products are on supermarket shelves, and an increasing number of people are avoiding gluten in their diets. Following a gluten-free diet is a medical necessity for people diagnosed with celiac disease or who have nonceliac gluten sensitivity. Celiac disease is a genetic autoimmune disorder that is estimated to occur in 1 in every 100 people; while non-celiac gluten sensitivity is a diagnosis used for individuals who are unable to tolerate gluten. These conditions must by diagnosed by a physician after the individual undergoes several medical tests and examinations. These individuals do not have the capacity to digest or tolerate gluten and must avoid gluten to prevent or minimize gastrointestinal and other symptoms. The common symptoms associated

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined In the past 24 hours, how many people do you think have died nationwide in crashes involving alcohol? Think about that for a moment. The answer is coming up. Impaired driving is a serious issue of public health that can potentially affect anyone, including people who have never had a drop of alcohol in their entire life. That includes hundreds of children who are killed each year by impaired drivers (214 during 2016). The magnitude of the issue is underscored by federal statistics which show more than 1 million drivers were arrested in 2016 for driving under the influence of alcohol and/or narcotics. Estimates of actual instances of impaired driving exceed 110 million per year. In other words, fewer than 1 percent of drunk drivers are stopped and arrested. What if you become a member of the 1 percent? What can you expect? In brief, a massive drain on

your finances that will last for years. Let’s break down some of the expense (there won’t be room for all of it). The first expense will be getting out of jail. Arrest is automatic for driving impaired. Bail for DUI will be at least $1,000. Unless you’re arrested at a roadblock, there will usually be additional charges for things like failure to maintain lane, speeding, running a stop sign, causing an accident, etc. Each additional infraction will increase the amount needed for bail. The money you post will be refunded when your case is resolved, but that could easily be a year or longer. Your case may involve some thorny issues, like major injuries caused to other motorists or pedestrians. You will need an attorney, and as they say, good lawyers aren’t cheap; cheap lawyers aren’t good. Your car, if you didn’t total it, will be towed away. The cost of the tow will be your responsibility. So will getting

your car out of impound. Expect to pay $50 for every day your car is in storage somewhere. If it takes you more than 30 days to show up, the towing company is free to sell your car and keep the money. When your court date rolls around, expect to pay fines and court costs that can easily exceed $1,000. If you manage to avoid jail time and are put on probation, you’ll pay hundreds of dollars over the course of the coming year in probation fees. DUI School is part of many sentences. There goes several hundred more dollars. You will lose your driver’s license if convicted. Conditional driving permits for traveling to work and license reinstatement: hundreds more dollars. Company car? Gone. The big whammy is often insurance rates. Whatever you were paying for car insurance, expect: 1. to be dropped by your carrier, and 2. for your new insurer to charge you up to 4 times what you had been paying for the next three years. It’s a lot to pay compared to one Uber ride. What is the daily death toll from alcohol-impaired driving? According to the National Highway Traffic Safety Administration, the numbers average out to 29 people killed each day, which is more than one death per hour all day every day year-round. +

OCTOBER 18, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

HOW TO OVERCOME OUR FEARS

When a palmetto bug dives at you in the bathroom, you scream so loudly your spouse thinks someone is breaking in through the window. You have that dream again of being abandoned or alone and wake up with your heart racing. You just can’t face going up on that rollercoaster with your child. And hey, is that a clown hiding in your bushes?!? Most of our fears revolve around the unknown and things we can’t control. But here’s what’s really going on when we get scared. Here’s What’s Happening The part of the brain that handles fear and negative emotions is only about the size of an almond. But the amygdala can cause powerful responses to negative emotions, memories and fears— and it’s also the part of the brain that’s impacted if we have post traumatic stress disorder or depression. This tiny organ basically creates a pathway for fears directly to the front of the brain, which then activates our fear response. Fears can be both conscious (like running screaming away from a palmetto bug) or unconscious (that prickly uncomfortable feeling in the pit of your stomach that someone—like that clown—is watching you). But these fears aren’t all bad. Think about it: What else keeps you from walking down the street with a wad of cash in your hand at 3 in the morning? Sometimes you need negative emotions to help drive good behavior. The right amount of fear and anxiety is healthy and can keep you from doing stupid things or getting into unsafe situations. The problem comes when those fears are no longer driving us to make the right choices but are consuming us. Here’s What You Can Do Fear, anxiety, pain—all of these activate our sympathetic nervous system, which controls our “fight or flight” response. So for example, if you put your hand on a hot stove, your brain isn’t processing, “Oh, look, my skin is melting.” Your sympathetic nervous system kicks in to protect you so that you move your hand away as quickly as possible. But if your anxiety or fear are causing your sympathetic nervous system to be on alert all the time, that’s when you can’t control your thoughts, your muscles tense up and your blood pressure spikes to pump more blood to your legs so that you can get away from whatever it is that’s scaring you. But that doesn’t help you when you’re scared of your nightmare boss or you have to be the one to present on stage at the next conference or when you have to take the kids trick or treating and you hate crowds. But here’s what you can do: You can start changing the situation instead of worrying about what you can’t change. There’s always something you can change; at the very least, it’s your attitude. • For the nightmare boss, maybe it’s talking to coworkers that he or she gets along with about how to interact more positively. • For the presentation, maybe it’s practicing every day for a week, alone at first, then in front of people you trust. • For trick or treating, maybe it’s starting early and leaving early to avoid crowds. Also understand that the biologic reactions—the tight muscles, the sweaty palms and the fast heartbeat—typically come first. So they should be the first things you deal with. Focus on your body, breathe, maybe go for a walk if you can. Work on slowing down your heart rate to help stop your body’s reaction to what it thinks is an acute situation but isn’t. By doing this, you can help make sure your emotions don’t come into play, you can pay attention to what’s going on, you can have a thoughtful response and you can control your fear, instead of having it control you. +

Jeremy Hertza, PsyD, is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC in Augusta

OCTOBER 18, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Anonymous, on October 14, 2019

THE STAGES OF GRIEF WHEN A PHYSICIAN IS SUED It’s hard to describe the feelings I had when I received my first letter of intent to sue. I think I went through the Kubler-Ross stages of grief — denial at first, of course. This denial didn’t last long since the letter was clearly addressed to me — first, middle, and last name. Anger was almost immediate. I was immediately upset at the deceased patient’s family who were bringing the lawsuit; I automatically considered them selfish and money-hungry. I criticized our health care system that allows for seemingly frivolous lawsuits. I hated all lawyers and considered them evil. I skipped the bargaining step, but within an hour of receiving this letter, I was already sinking into a depression. I started thinking that I must be an awful doctor. I had only been in practice for about three years when this letter arrived. Some doctors practice for years and never get sued. I started questioning my decision to go into medicine. I thought about the hurdles I had gone through to get my MD, complete residency, and get board certified. I started thinking that maybe it wasn’t a good decision. Maybe I would be happier doing something else — anything else. I began to hate going to work. I started to see patients, not as an opportunity to make a positive change in someone’s life, but instead, I started triaging patients based on who seemed like the type to sue. I started to practice medicine defensively. I started ordering more tests. I started consulting more specialists. I started to cut conversations with patient’s shorter so I would have more time to document every last detail that was spoken during an encounter. I started to see my profession and my career as a job and not a calling. That first letter of intent to sue never went anywhere. Since then, I have been served papers, as my name was again brought into a lawsuit, and after about a year of correspondence with my malpractice carrier and the lawyers they referred me to, my name was dropped. Once again, last week, I received another letter of intent to sue. Since this is my third letter, it seems like it should be easier. I should know the drill by now, but it’s not easier. Every time this happens, I go through all of the same feelings once again — mostly anger and depression. And the questioning. Every time it happens, I question my decision about going into medicine. And then I read stories about physicians who don’t practice clinical medicine anymore. I read statistics stating that half of current physicians, if given the choice again, would not choose medicine as their occupation. Somehow, I don’t think I’m alone. I’m sure that when patients or their families bring lawsuits, they have good reason in their minds. Being on the other side of this lawsuit, this reason is rarely clear to me. I’m almost sure that these patients and families don’t know what a lawsuit does to all doctors. Whether the lawsuit is frivolous or not, the feelings are the same. Anger. Depression. Questioning. And then the outcome — defensive medicine. Ordering more tests. Consulting more specialists. Taking less time talking to patients and more time documenting everything said. This is not how health care should be. I’m not sure I’ll ever be able to complete the Kubler-Ross stages of grief with acceptance. Honestly, even with these challenges in medicine, I still enjoy what I do for a living. The science is interesting. My patients are my teachers. I love to read about mechanisms of disease and about new medications on the market. I like figuring out the reason for the problem. I work hard to do the best job I can. I care. For that reason, I can’t accept the accusation of “negligence.” +

I can’t accept an accusation of negligence.

The author is an anonymous physician.

If you’re a fan of medical history, especially local medical history, this volume must be on your bookshelf. Segregated Doctoring takes an unflinching half-century (1902-1952) look at the medical profession from the perspective of Augusta’s black doctors. This is not one of those books that rewrites the past from today’s perspective. Read this history and you’ll have to get used to words like “colored” and “Negro.” It was the vernacular of the times. You’ll even run across that other N word. In telling of the turn of the century survey of southern medical schools’ black students conducted by writer, historian, and civil rights activist W. E. B. Du Bois (18681963), the respondent from the Medical College of Georgia stated, “There are no niggers in this school and there never have been and there never will be as long as one stone of its building remains upon another.” Another medical school replied, “never has and never will.” The dean of the Hospital College of Medicine in Louisville, Kentucky, wrote that the school would never accept a “coon” while he was dean. My how times have changed. By the way, if you’re wondering, MCG didn’t accept its first black student until 1967. As that factoid and the mention of a Kentucky school suggests, Augusta’s historical record from 1902 to 1952 includes many significant events outside local boundaries and long before and after its primary 50-year target. Nashville’s Meharry Medical College and Washington D.C.’s Howard University Medical School both figure prominently in early local medical history, inasmuch as black medical students were clearly not welcome at MCG. Fittingly, this slice of Augusta’s past was researched and written by a historian. Leslie J. Pollard, Sr. is retired Calloway Professor of History at Paine College, and it shows. Other than a few generic introductory and concluding comments in each chapter, nearly every sentence in the

entire book relates solid facts. A random sampling: there were 9 black physicians in Augusta in 1902 and 12 in 1930; in 1918 the death rate per 100,000 people was 24 for blacks and 13 for whites; Augusta’s budget for City Hospital in 1900 was $12,000, but $5,000 for Lamar (the hospital that treated blacks, not the later Lamar Wing); Dr. Collier was in his office at 9:00 a.m for one hour and returned at noon for two hours; the rest of the day he made house calls until returning to his office for evening hours from 7:30 p.m. to 9:00 p.m.; and so on. In one footnote he even lists what kind of cars half a dozen Augusta doctors drove in the 1920s. Segregated Doctoring is a treasure trove of facts, stories and personal portraits. Its nearly 400 supporting footnotes are fascinating reading in themselves. Included for additional reference are nearly 50 historic photographs, some 30 individual biographies of men and women who practiced medicine during the fifty years the book examines, an extensive bibliography, and a year-by-year timeline of noteworthy events in each year from 1902 to 1952. It is also a sobering tale of an era marked ignorance and prejudice and the untiring efforts of people far ahead of their time who fought against the tide. Barred from practicing at local hospitals? They opened their own hospitals. Excluded from national medical organizations like the AMA? They built their own associations from the ground up. They faced all the problems

Were you aware that the first school case heard by the U.S. Supreme Court after its landmark Plessy v. Ferguson decision of 1896 was 1899’s Cumming v. Richmond County Board of Education? Described as a landmark case, Cumming was decided in part based on the precedent established by the Court’s infamous decision in Plessy, which legitimzed and legalized “separate but equal.” In Cumming, the point of contention was the closing of an Augusta high school for black students to free up funds for elementary school students. The argument was that 300 children could be served using funds which had been devoted to just 60 high school students. In the words of Richmond County’s attorney in arguments before the Supreme Court, “It would be unwise and unconscionable to keep up a high school for 60 pupils and turn away 300 little negroes who are asking to be taught their alphabet and to read and write.” Although private high schools schools were available to the displaced students, Cumming et al. countered in part that the Board’s decision officially sanctioned the lack of higher education for black students. Richmond County was in effect saying, this segment of the population will just have to be content with a 7th-grade education. The high court ruled in favor of Richmond County, a decision which stood until 1954 when the court reversed itself in yet another landmark case, Brown v. Board of Education. +

and expenses intrinsic to their profession, Pollard notes, and when they finally became doctors they had to earn their living serving an impoverished community while battling prejudice and pernicious stereotypes. We owe each of Augusta’s many black medical pioneers a tremendous debt of gratitude. + Segregated Doctoring: Black Physicians in Augusta, Georgia, 1902-1952, by Leslie J. Pollard, Sr., 262 pages, published in 2018 by Palmetto Publishing Group

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The Examiners

OCTOBER 18, 2019

I need a new OB/GYN.

by Dan Pearson

Same here for a PCP.

What about your HMO?

Does it have to be an MD?

I have to check my PPO.

The Mystery Word(s) for this issue: RETAIDY

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Floyd County (GA) seat 5. Fragrance 10. Slang for house, apartment 14. Test 15. Delete 16. Employ 17. Cover with gold leaf 18. Number after 24, sometimes 19. Capital of Western Samoa 20. Lg. area employer 21. Drudgery; hard work 22. Involuntary muscle move 23. Most important 25. Allot 27. Antiquity (Literary) 28. Shivers, for example 32. Relating to waste matter 35. Middle East rug 36. Artists follower 37. Soon, in poems 38. Kidney adjective 39. Couch 40. Food label abbrev. 41. Boring? You might need this 42. Acts like a hot dog 43. Thick, dark brown syrup 45. Pale 46. AU head 47. Small sweet roll 51. Type of circus? 54. Its capital is Tehran 55. Feminine pronoun 56. Basic chemical element 57. Boredom 59. Grocery chain 60. Rebuff 61. Suit 62. Singles 63. Palm variety

46 52

27 32

54 58

DOWN 1. Cinemas starter 2. Rust 3. Its capital is Valletta 4. Ambulance wrkr. 5. ______ string 6. Former area D.A. 7. Mr. Grey of tea fame 8. Ft. Gordon tenant 9. Offensive in Vietnam 10. Hill in North Carolina? 11. Seacrest co-host 12. Eye part 13. Ray of light 21. Enterprise add-on 22. Brain ___ 24. Academic department head 25. Grinding tooth 26. Wicked 28. Dressed to the ______ 29. This task and the tool used

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, OCT. 28, 2019

We’ll announce the winner in our next issue!

E X A M I N E R

8 3 5 7 8 6

3 9 6 4

1 4

4 6 2

1 1 5 9 7

S 4 U D 2 7O 9 K U

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

64. 1865 assassin 65. Decline

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

to do it are the same word 30. Some drinks are this 31. Brief it was 32. Team in baseball 33. Prefix for within 34. Carbonized fuel 35. Pelvic exercise 38. Deceptive ploy 39. Monte ______ Ave. 41. Out on the ocean 42. Physical or mental distress 44. Arms can be this 45. Apparition 47. Rumor; report 48. Red ________ 49. Summerville street 50. Uneven 51. Transit prefix 52. Sicilian volcano 53. Mr. Barnard 54. Knowledge, in short 57. Flow back 58. Natal intro 59. To yield

Solution p. 14

4 9 2 7 5 1 I I 7T 2 N S 8T 5 O G 3 6 W U 6 3 9 4 1 8 — Edmund Burke

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

1. 2663 (body part) ____

6. 84242 (body part) _____

2. 97478 (body part) _____

7. 33687 (body part) _____

3. 26553 (body part) _____

8. 7283552 (body part) _______

4. 35269 (body part) _____

9. 7837686 (body part) _______

5. 75855 (body part) _____

________

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

EDITOR’S NOTE: The first issue of each month will contain a “Words by Number” puzzle in this space; the 10. 25284253 (body part) second issue will contain a “Text Me” puzzle.

TEXT

THE MYSTERY WORD

8 6 3 9 4 1 2 7 5

3 5 9 1 7 2 8 6 4

6 1 8 5 9 4 7 2 3

7 4 2 6 3 8 1 5 9

OCTOBER 18, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

n Jamaica, a slice of pie costs $3.75. In the Bahamas, the same slice of pie costs $4.50. These are the pie rates of the Caribbean. Moe: What do you get if you apply tremendous pressure and heat to Pringles? Joe: Fission chips. Moe: I bought a bottle of coconut shampoo the other day. Joe: So? Moe: So when I got home I realized I don’t even have a coconut. Moe: You know what Bill Gates is doing with his foundation that he was unable to do at Microsoft? Joe: Not really. What? Moe: Prevent viruses. A mime gets into a fight at a bar, breaks his left arm and is arrested. He still has the right to remain silent, though. A man and woman are passengers on a train. Their seats face each other, and as the woman

The

Advice Doctor

reads a magazine, she occasionally looks up and catches the man looking at her. Each time he smiles and immediately looks away. “Every time I see you smile I feel like inviting you to my place in the city,” she finally says. “Are you single too?” asks the man. “No,” she says. “I’m a dentist.”

Moe: What do you call it when pigs lose their memory? Is there a word for it? Joe: Yes. Hamnesia.

Moe: I was reading about Cardi B’s sister. Joe: Is she a rapper too? Moe: No, she’s an aerobics instructor. Joe: What’s her name? Moe: Cardi O.

Moe: I watched my best friend die today. Joe: I’m so sorry. That is terrible. Moe: It truly was. As he died he handed me something to remember him by. Joe: What was it? Moe: Well, it’s kinda weird, but he gave me his Epi-Pen. Moe: What’s it called when you’re having a waffle on the beach in California and you accidentally drop it? Joe: Sandy Eggo. Moe: Where are you staying while you’re in Augusta visiting your relative in the hospital? Joe: At the Ronald McDonald House. Moe: Oh, you mean the McCrib? +

Why subscribe to theMEDICALEXAMINER? What do you mean? Staring at my phone all day has had no Effect on ME!

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

Dear Advice Doctor, I’ve been single for so long that I finally made peace with it recently. I no longer stressed about it and decided I was ok with never marrying. Naturally, a month later I met the man of my dreams. He’s already hinting at a long future together. I know he’s going to pop the question, and I know I’m going to say yes. But the thought of getting married scares me to death even though I really love him. Any advice? — In Love But Scared Dear In Love, Congratulations! And please be assured it’s perfectly normal to feel this way. You’re asking a question that people have pondered for centuries: can someone literally be scared to death? First, the bad news: yes, it is not only possible; it happens. The good news is that it is extremely rare. More good news: scientists who study these things (yes, there are such researchers) say that being scared to death is not the kind of thing that happens when a friend jumps out from behind a bush and yells “BOO!” or throws a rubber spider at someone with arachnophobia. And although it seems like a no-brainer that being scared to death would be linked to preexisting conditions like a history of heart attack or cardiovascular disease, that’s even rarer than the already rare event of dying of fright. How is a phenomenon like this accurately studied? The ideal research scenario (unfortunately) is a major earthquake. Within seconds, millions of people are simultaneously swallowed up in a terrifying event. Once the shaking stops and the dust settles, public health researchers meticulously comb through records of resulting fatalities. Another scenario: take a country massively obsessed with a sport - soccer is the ultimate - and measure sudden death records around the time of a huge game that was dramatically won or lost. The trigger researchers have identified is not arteriosclerosis or obesity or a history of chest pain or smoking. The trigger is the sudden jolt of adrenaline that comes from an intensely emotional event, whether positive or negative. We all get those jolts. Rest easy: it’s very rare to die from one. I hope this advice helps. Thanks for writing! + 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.

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THE MYSTERY SOLVED The Mystery Word in our last issue was: FLU SHOT ...cleverly hidden, in the bottle of the p. 9 ad for NATHAN H. BRANDON, M.D.

THE WINNER: MICHELYN HUNTER! Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

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...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

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