Medical Examiner 10-4-19 by Daniel Pearson

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OCTOBER 4, 2019

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

IS THIS MAN STILL ALIVE?

or the record, we’re happy that Keith Richards of the Rolling Stones is alive. We hope he lives another ninety years. (Just kidding! He’s only 50! He just looks old.) But his longevity (all kidding aside this time: he is 75 years old) does raise a few issues. Why do some people who truly live a healthy life succumb to disease and maybe even death while still in their 20s and 30s? Meanwhile, other people are overweight, get zero exercise, smoke two packs a day and regularly abuse drugs and alcohol, have lived a licentious lifestyle and have basically been hell-raisers for decades, and they live into their 70s, 80s and beyond. For the record (Part II), this article is not saying Keith Richards is guilty of any specific breaches of healthful living. For all we know the cigarettes he is always pictured with are just props. They might be photoshopped in. But the curious and common pairing of non-salubrious lifestyles with lengthy lifespans leads to all kinds of strange reasonings: • “Quit smoking? Why should I? My grandfather smoked five cigars a day starting when he was 8, and he was 93 when he died.” • “Quit smoking? Why should I? My dad never took a single puff in his whole life and he died of lung cancer at age 30.” • “Quit drinking? Why should I? My grandfather finally quit drinking after listening to my grandmother nag him about it for 50 years, and three weeks later a tree fell on him and killed him.” • “Quit doing drugs? Why should I? My buddy never took so much as an aspirin tablet, and he was struck by lightning. So how did that benefit him?” For the record (Part III), one person, even if it’s your best friend, your neighbor, or your own flesh and blood, is a statistically insignificant sampling. What happened to one person is 100% meaningless in its ability to predict how it will affect you or me or anyone else. When a young person who has never smoked gets lung cancer and a geezer who has been a 2-pack-a-day smoker for decades doesn’t, they are both anomalies. The truth about how smoking (or any other vice) affects the majority lies somewhere in the middle. No one ever says, “Of course I let my kids play in that busy road. After all, sooner or later something’s gotta kill ’em.” Yet many people brush off actions that are similarly risky with a shrug, basing their reasoning on the same dark viewpoint. “I might as well [fill in the blank with the vice of your choice]. Something’s going to get me eventually.” Heaven forbid you live too long. Speaking of heaven, there is a whole other branch of fatalism which always invokes the creator in time of tragedy. “The Lord needed another angel.” Let’s ignore the fact that our unfortunate victim was driving 90 mph on the wrong side of the road at the time of his heavenly calling. And that in His infinite

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PEDIATRICS101 TIPS, TRICKS & TALKS TO KEEP TOTS TO TEENS HAPPY AND HEALTHY

IS IT STREP?

PARENTHOOD by David W. Proefrock, PhD

Your 6 year-old daughter has recently become very emotional and overdramatic. She sometimes cries for no apparent reason and seems to exaggerate all of her feelings. When she is happy, she is happier than the situation calls for. When she is sad, she goes overboard with it. What do you do? A. Ignore her emotional outbursts. These are attention-seeking behaviors. They will go away if you ignore them, but will get worse if you reward them. B. This is probably just a phase she’s going through. Watch her and reassure her, but don’t worry too much about her unless her emotionality persists. C. Punish her when she overreacts to things. She must learn that these emotional outbursts are inappropriate. D. Excessive emotionality is a sign of an underlying emotional problem. Take her to a mental health professional for an evaluation. If you answered: A. This response will be impossible for most parents and is not the best thing to do anyway. It is best to reassure her briefly, but not to pay too much attention. B. This is the best response in this situation. Children do go through phases as they try to learn to deal with the world around them. C. You can punish behaviors, but it is very dangerous to punish feelings. She should be reassured, but not punished or overindulged. D. If this kind of over-emotionality persists, she should be seen by a professional. However, it is best to monitor her and see if it passes on it’s own. Growing up involves a huge amount of learning and we tend to place much more emphasis on learning to read, do math, and express ourselves than we do on learning to deal with our emotions. Children will go through phases trying to learn emotions on their own. You can help by being there for them and giving them gentle guidance. + Dr. Proefrock is a retired child clinical and forensic psychologist.

Is it strep? Or does my child just have a cold? Here is a basic overview of the doctor’s approach to a sore throat, and when antibiotics are actually needed. It’s a very common scenario: the school-aged child who wakes up one day with a sore throat. Or a child gets sent home from school for having a fever. “It must be strep,” mom thinks. She quickly calls the family pediatrician to schedule an appointment to make sure things are caught in a timely manner. Also common: the tendency of parents to automatically assume it’s strep. An abundance of caution is not a bad thing in many situations, but let’s just go through what a typical strep throat infection actually entails. Typical streptococcal pharyngitis (aka sore throat), caused by the bacterium Streptococcus pyogenes is classically characterized by: • Fever • Headache • Sore throat • Abdominal pain/vomiting • Swollen lymph nodes in neck • Swollen tonsils, possibly with pus pockets (however, disclaimer: the worst pus/ tonsils situations can be seen in viral infections, especially mono/Epstein Barr virus). Fun fact: Many children can have a specific stinky breath that experienced docs can identify just by getting a whiff while examining the throat. Many other children can also get a classic “strep rash”

(aka scarlatina) which diffusely covers the body and is coarse in texture, reminiscent of sandpaper. Disclaimer: if your child exhibits a rash like this in the absence of other symptoms, he/she should be evaluated by a health care provider to ensure complete safety Things that a strep-infected throat do not classically cause (and which should, theoretically, steer a clinician away from throat swabs and the like) include nasal congestion, runny nose, excess snot, coughing, wheezing, and “croup.” Strep throat can be confirmed in 5 minutes in clinic (or an urgent care/ER) with a rapid strep swab. If positive, the practitioner will proceed accordingly. If negative, the swab will often need to be sent for a culture (which can take 48 hours to result). Never fear, though: waiting 48 hours to confirm a strep infection (or confirm absence of strep infection) is not dangerous. Next fun fact: Strep throat can resolve on its own without antibiotics. Why do we treat it then? The rare but greatly feared complication of rheumatic fever (and its association with heart disease later in life). So yes, it is very important to confirm whether a child

OCTOBER 4, 2019 does in fact have strep in order to prevent complications later in life. The key is documenting true infection! Evaluation by a clinician is key. And swabs help a great deal. Giving a child leftover antibiotics from a previous prescription or another child or sibling before a diagnosis has been made is dangerous because it interferes with swabs/ culture accuracy. Parents, be wary of the temptation to do this when your child gets sent home with a fever! It will always cause more harm than good to give antibiotics to a child without prior healthcare evaluation or prescription. Strep throat classically affects school-aged kids; after all, where else would they get it? Of course, siblings of schoolaged kids (and sometimes parents) can fall prey to the nefarious strep by association (i.e. they drink after each other, don’t wash hands, etc). And really, anyone can get sick just by venturing out in the world. How clean are supermarkets and grocery stores, really? There are atypical presentations of strep, like the kids who swab positive but without the classic array of symptoms, or who have just fevers alone, and variations that affect the younger age groups (1-2 years old) but these situations start getting a little complex and are best managed in a pediatric office. + by Dr. Caroline, an MCGtrained, board-certified pediatrician. This article is not intended to substitute medical advice and is merely to be used as a tool of education. If questions arise or you have concerns about your child, please consult a medical care provider accordingly and avoid any delay in treatment, as all children deserve treatment on an individual basis.

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wisdom He apparently chose this occasion to take three more innocent people in the oncoming car to heaven too. Or that in some other highway tragedy He used a drunk driver to accomplish the (allegedly) divine will. Add it all up and it can make it seem like trying to live a healthy life could be a lot of trouble for nothing. You might deprive yourself of a steady diet of the cigarettes and Twinkies you love and die young anyway. What’s the use? The answer To borrow a truth uttered by Martin Luther King, the time is always right to do what is right. The person who won’t return someone’s lost item unless a reward is offered is not a very decent person. They’re not going to do the right thing unless there’s something in it for them. That is a lot like refusing to live a salubrious life unless someone can guarantee you’ll live to a ripe old age, rich, fat and happy. Obviously no one can do that. There is no crystal ball — or app, for that matter — which can analyze the data of how much lifetime lard you’ve consumed versus how many alfalfa sprouts sandwiches you’ve eaten and accurately pinpoint your

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AUGUSTAMEDICALEXAMiNER

OCTOBER 4, 2019

disease-free those years will be. Wih the past unchangeable and the future unknown, it’s a dangerous roll of the dice to live unsalubriously.

projected lifespan. Even so, let’s not forget MLK’s borrowed maxim. It’s always a good idea to act in a way that protects health, our ultimate wealth. So maybe someone does live an exemplary life of healthful ways and comes down with a fatal disease anyway. Does that mean their efforts were wasted? Perhaps their untimely death would have come 5 or 10 years sooner if they had lived an unhealthy life. Who can say? We have neither accurate foresight nor hindsight about how long we’ll live or how pain- and

Things happen But why do they happen? There isn’t always an answer, but sometimes when the facts are analyzed closely enough, some possibilities emerge. Heredity plays a role in some maladies. Perhaps a job decades ago resulted in exposure to chemicals that eventually caused a problem. Speaking of which, we are probably exposed to thousands of things our parents and grandparents weren’t, ranging from industrial pollutants to various food additives and preservatives. Some people who are quite health-conscious overall nevertheless have some chinks in their armor: maybe they are habitually sleep-deprived or they drink lots of sodas every day or love a certain food that’s high in fat or sodium. In the final analysis, maybe we can’t all be Keith Richards (which is probably a good thing), but we all can all live the healthiest life possible. Maybe the result will be years of added life, as well as greatly improved quality of life in those years. +

WHAT DOES THE UVULA DO?

The uvula, that strange little appendage that dangles from the roof of the mouth, is something of a medical curiosity. Some source say its purpose is a mystery, but scientists suspect it might have this or that function. Other sources confidently list a number of its everyday roles in speech and eating. If we go with the former, this article ends here, so let’s side with the latter, the sources that seem to know what the uvula does. Here’s what they say: First of all, everyone can agree on the name, and it’s an interesting one. In Latin, the word for grape is uva, and that’s where uvula, the diminutive form of the word, comes from. It means “little grape.” Back in the day, an ancient Roman with a swollen uvula had a “uva,” the full grape. But under normal circumstances it’s just a uvula. So what does the uvula do other than hang around all day like a one-grape grape cluster? Its most important job is performed when we eat. The goal is to get food into the stomach, of course, and the uvula is part of a two-man special-assignment team designed to get that job done. Once we’re ready to swallow, there are two possible detours for food: one is down the trachea and into the lungs. Nobody wants that. A flap in the throat called the epiglottis prevents this from happening. The other possible detour is up into nasal passages. It can happen. Officially it’s known as nasal regurgitation. And nobody wants that either. During swallowing, the uvula closes off the nasopharynx, preventing food from being accidentally inhaled up into the nose. Thank you, you uvula, you! There are other jobs the uvula does, too. It produces saliva rather abundantly, and given its location, that is another aid in swallowing and preventing dry throat. It also plays an important role in creating various speech sounds, although that varies with the language: English not so much; languages with more guttural sounds like Hebrew and Arabic, it stays busy. Finally, and don’t hold this against it (because that can trigger a gag reflex), some people have an elongated uvula which is said to contribute to snoring in the loudest way possible. Surgical removal or reduction is sometimes recommended, but that procedure is not without its own set of side effects. Save the uvula! +

MEDICALEXAMINER

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www.AugustaRx.com The Medical Examiner’s mission: to provide information on topics of health and wellness of interest to general readers, to offer information to assist readers in wisely choosing their healthcare providers, and to serve as a central source of salubrious news within every part of the Augusta medical community. Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net www.Facebook.com/AugustaRX Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., nor its agents or employees take any responsibility for the accuracy of submitted information, which is presented for general informational purposes only. For specific medical advice, diagnosis, and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2019 PEARSON GRAPHIC 365 INC.

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OCTOBER 4, 2019

#100 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

here can be no mystery about the identity of the man pictured above. Unless, that is, you need the chart below. Yes, this 100th installment of “Who is this?” is about none other than Louis Braille. Braille was blinded at age 3 when he accidentally poked himself in the eye with one of his father’s awls. With one eye lost, an infection followed which spread to the other eye, and by age 5 he was completely blind. Refusing to live a life trapped by his disability, he attended school like any other child, and became well known in his small village east of Paris, navigating with a cane and echolocation, calling out and listening for sounds bouncing back from nearby walls. In 1819, at age 10, Braille was accepted as a student at the Royal Institute for Blind Youth. While it might sound elegant, at the time it was a severely underfunded facility housed in a former prison in one of the poorest neighborhood in Paris. While there (at age 12), Braille learned about a system of communication devised by French Army captain Charles Barbier called night writing which used raised dots on heavy paper. It allowed soldiers to communicate silently and in complete darkness, but soldiers had a hard time learning it. With personal encouragement from Barbier himself, Braille tried to learn the system, but he too found it to be difficult. From that starting point, however (along with inspiration from the dominoes he had played with as a child), Braille devised a simplified system using six dots arranged in two vertical rows of three instead of Barbier’s twelve dots. 1 4 After much work, Braille perfected his version by 1824. By then he was 15 years old. His invention 2 5 included not only an alphabetic and numeric system of communication, but also the hardware 3 6 that enabled even a sightless person to write braille in neat, uniform, straight and readable lines. The beauty of his system is its simplicity. Take a look at the braille alphabet below. Braille started with a base of ten letters, A through J. For the next 10, K through T, he simply added one dot in position #3 to the original ten. For the final six letters (with the exception of W), he added one more dot in position #6. It’s genius, which is probably why from 1824 through 2019 there has never been a Braille 2.0. Sadly, Braille, who died of tuberculosis at age 43, never saw his system put to use during his lifetime. After all, he was blind. +

unable to help him myself, she said he had dementia, which I later discovered was a lie. Aside from the food woes you’ve been So that kind of treatment of patients was not reading about (which came later during my a mistake or the result of them being extra stay), I don’t remember much from the early busy that particular night when I arrived. It days I was in the hospital recently except was a common practice and it occurred on for the pain. That I do recall, all shifts, not just at night. mostly by being glad it’s a After the policeman came, I couldn’t get a nurse to they memory, not a recurring reality. did come in and attend to come to my room, me, and they usually did come However, I do remember being at [a well-known local nursing but not always. Several so I called the police in, home which shall remain times I was left for as long as nameless] in its rehab section. three hours lying or sitting in When I arrived at 9 pm one night, the a pool of pee, which should not have been EMTs dumped me unceremoniously in a bed a surprise to them since I was on strong and left me with no call button, no water, doses of diuretics, and they were obviously no covers, alone. At that point I couldn’t do aware of that. Was it always that bad? No, much besides just lay wherever I was placed that was not usual, but it wasn’t acceptable, and wait. I couldn’t get up, couldn’t walk, and by that time I was coming out of the fog and I felt totally abandoned. No one came by of illness enough to recognize that I didn’t to take my vitals, bring me water, reassure deserve to be treated that way even once. me that it would be OK, or offer me anything The corporation that owns [the facility in the way of a welcome. I laid there alone where I was] recently fired its CEO for from 9 pm until 11 pm getting increasingly financial losses, so that’s one clue about upset by the minute. Not knowing what to do the problems causing staff to occasionally I called my sister, who usually has a solution ignore patients. While salaries for to any problem. “Call the police,” she told executives go up, salaries for staff are me. After a few minutes, I did just that. inadequate, and so are staff numbers. While keeping me on the phone so she At the time I was leaving they were could reassure me, the operator called [the interviewing people to come and work facility]. No one answered the phone, so there, so there is an effort being made to they sent a young police officer to check it increase staff, who are in a field they have out. He found me, just as I stated, dumped chosen driven by a desire to help people, to on a bed and left to fend for myself without care well for their patients, to meet patient even the basics of a call button or water. needs, and to foster the very best healing I discovered later that even in what’s environment they could create. I met some considered a very good nursing home or deeply caring, wonderful staff, who want rehab center, being ignored for extended their patients to heal, to get better, and to periods of time is common. One night the be able to go home. I was able to leave, to man in the room next to mine called for walk, to care for my own needs, after only help for hours and was never responded 20 days. to. When I told a nurse about how I hadn’t So I am thankful to all the folks who been able to sleep listening to him and helped me to achieve that goal! + by Marcia Ribble

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OCTOBER 4, 2019

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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got a phone call. It’s not the kind of call most people get; it was a call from someone who is dying and wanted to talk with me. “How are you doing?” I asked, not knowing exactly what to ask. “Pretty lousy. They say my cancer is spreading and the oncologist told me there wasn’t much more to do at this point.” There were a few seconds of silence, and I was about to say something when the patient said, with voice cracking, “I just want to thank you for all you’ve done for me over the years. You’ve been a good doctor, someone I can talk to when I needed it. Thank you for all you’ve done.” “Thank you for letting me take care of you,” I answered. “It really is an honor when people trust me with their care.” Another pause. “Just let me know if I can help in any way” I added, again not knowing what to say. ”I assume they’ve set you up with hospice. You are facing that time that we all will face someday. It’s just got to be weird when it’s actually happening to you.” “Yeah, doc,” the patient said. ”It’s not something normal, that’s for sure.” I thought about that conversation for the rest of the day. Someone had felt strongly enough to call me and thank be before they died. I was a person on their list that they wanted to contact before death. That’s amazing. It may not be the first time this has happened, but it was the first time I was acutely aware of its significance. We talked for a while after the things I chronicled above, talking about family, plans for wrapping things up, about whether quitting smoking had brought on the cancer (I didn’t debate the point), and about our shared experiences in my office. It

was hard to say goodbye, as it could easily be my last conversation with the person. This all got me thinking about a conversation I heard on sports radio about the definition of the word “heroic.” One of the hosts was complaining about the use of the word “hero” with reference to the amazing efforts of former Augusta Greenjacket Madison Bumgarner in that year’s

The patient did something that was heroic for me. World Series. Yes, it was amazing how he pitched five scoreless innings on two days’ rest, but would you truly call his efforts heroic? ”Shouldn’t we reserve the term for people who are true heroes,” the host asked, “like soldiers, firefighters, and doctors? This guy pitched in a baseball game; he didn’t save anyone’s life or find a cure for cancer. It just bugs me when people call this heroic” The part that caught my attention was his inclusion of doctors as heroes. This is something that has been said to me before, after I discovered someone’s heart disease, found cancer early, or helped a person gain control of their difficult disease. I can’t deny it: I have saved many people’s lives, but I resist any suggestion that what I do is heroic. It is my job to find cancer early, diagnose heart disease, and put people on the path to health. I am supposed to save people’s lives. I would consider myself a poor doctor if I didn’t do these things, just as a firefighter or soldier would deflect the title of “hero” for simply doing their job as they should. Are there jobs more noble than others? If so, does

having a noble job confer its nobility to the people who perform it? I must say, I’ve known many a doctor where the terms “hero” and “noble” would be far down on the list. Yet these people also save lives and help the helpless for a living. I think there is something in us that makes us want to make heroes. This is part of the attraction of sports and other entertainment. We want to see people doing things that are amazing, superhuman, and heroic. As a child, I imagined hitting the home run in the bottom of the 9th inning, or hitting the winning basket with no time left on the clock. I imagined the adulation and praise of my skill from the adoring masses. I dreamed of being a hero. But then, is the fact that Bumgarner plays a game and doesn’t save lives make his stellar effort less heroic? I tend to think this is an unnecessary distinction. It is the effort that is heroic, not the outcome. It is the person being in the place that matters when nobody else is able to do the task. It is when we are truly ourselves, when we are the only people who can make a difference. So in some ways, the fact that this person wanted to call me before they died, that fact makes me feel heroic. This is not the heroism that attracts outside praise from the masses. Really, I am not writing this to garner praise, but to say that we all can and should be heroes. Being heroic is to be who we are in the position we’ve been given. It isn’t sexy, loud, or earth-shaking. Being truly heroic is something solid which comes from ourselves, not from the opinions of others. In a strange way, this patient, by calling me and letting me know how much I’ve done, did something heroic for me. Thank you for being my hero. +

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SATURDAY, OCT. 5, 9 am

The CSRA Parkinson Support Group will host its 20th annual POP Walk for the People of Parkinson’s fundraiser on Saturday October 5, 2019 at First Baptist Church, 3500 Walton Way Ext. Augusta, GA. Registration opens and activities begin at 9 am, the walk starts at 10 am and ends by noon. The Walk is free but donations are greatly appreciated. Free t-shirt with a $25 donation while supplies last. Proceeds from the event are used predominantly in the local area to fund research grants, a respite program for caregivers, educational materials and events, and exercise and aquatics classes. For more information, to form a team, or to make a donation, go online to POPWalk.org, email us at info@parkinsoncsra.org, or call (706) 364-1662. Donations can also be mailed and made payable to CSRA Parkinson’s Walk, 6100 Northside Drive, North Augusta, SC 29841.

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 4, 2019

GARDENVARIETY

Fall is upon us, and that means pumpkin spice to make everything nice. Just the aroma of cinnamon, nutmeg, and cloves can create a desire for crisp autumn leaves falling and sweaters needed as we head out in the mornings. The weather is not cooperating this year, but I am still going forward with my fall baking. I wanted to create a recipe that would evoke the feeling of fall. I envisioned being all cozied up with a warm mug of cider and a big slice of fresh-out-of-theoven spiced pumpkin bread. Eating healthy is important to me, yet I wanted a snack I could indulge in. It needed to be low sugar, glutenfree and fructan free, but packed with fall spices and a hint of chocolate. Cooking with pumpkin is also a great healthy choice. Eating pumpkin has been linked to several health benefits. It is said to improve vision, protect cardiovascular health, boost immunity, increase fertility, improve bone mineral density, and aid weight loss, among others. Also, with the addition of pumpkin seeds to this recipe, you are getting nutrients like protein, omega-3 Healthy Pumpkin Bread acid, manganese, calcium, potassium, magnesium, copper, phosphorus, zinc, flaxseed combined with 3 tbsp water) and iron. • 1/2 cup Lily’s stevia-sweetened chocolate chips I have discovered Lilly’s chocolate • 1/2 cup salted pumpkin seeds chips are a delicious way to add sweet chocolate flavor to my recipes. The chips Instructions are sugar-free, and a healthy choice to Mix flour, baking powder, baking soda, toss in the pumpkin bread since they are cinnamon, pumpkin pie spice, and salt in a large only sweetened with natural stevia. mixing bowl. Add pumpkin puree, maple syrup, vanilla, Healthy Pumpkin Bread melted coconut oil, applesauce, and flax egg. Ingredients Blend on with a mixer until all ingredents are • 1-2/3 cups Pamela’s Gluten Free Allblended smooth and creamy. purpose Artisan Blend (regular flour can Stir in by hand chocolate chips and be used if you prefer) pumpkin seeds. • 1 teaspoon baking powder Pour mixture in a non-stick bread • 1 teaspoon baking soda pan that is lightly sprayed with coconut • 1 teaspoon cinnamon oil. • 1-1/2 teaspoons pumpkin pie spice Bake in a preheated oven at 350 degrees • 1/2 teaspoon salt for 35 minutes or until bread is firm thoughout. + • 1 1/2 cups canned pumpkin puree by Gina Dickson, a mom to six and Gigi to 10 from • 1/4 cup mayple syrup Augusta. Her web site, Intentional Hospitality, • 1 teaspoon vanilla extract celebrates gathering with friends, cooking great • 1/2 cup butter flavor coconut oil healthy meals and sharing life together around the melted table. www.intentionalhospitality.com and IG: • 1/4 cup unsweetened applesauce @intentionalhospitality • 1 flax egg (1 tablespoon ground

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ASK DR. KARP

NO NONSENSE

NUTRITION A Facebook friend from Texas asks: “Is it true that tomatoes, peppers and eggplant increase inflammation?”

There is a lot of misinformation in popular magazines and on social media about so-called “nightshade vegetables.” What are some examples of these veggies? Common nightshade vegetables include tomatoes, eggplant, bell peppers, cayenne pepper, and paprika. I want to unequivocally state that for the vast majority of normal, healthy people, these are all healthy and safe foods to eat. It is also true that in rare instances, a specific individual may develop an intolerance or allergy to just about any food.

AUGUSTAMEDICALEXAMiNER What is the basis of the alleged need to ban these foods from a healthy diet? It comes from the idea that they increase your inflammatory state and therefore increase your risk of a heart attack, stroke, diabetes, Alzheimer’s and a whole host of other chronic diseases of aging. Based on that false premise, another faulty concept is that avoiding nightshade veggies is an easy way of decreasing your body’s inflammation and therefore decreasing your risk of disease. Not true. Inflammation is a normal, protective mechanism the body uses against pathogens or irritants. For example, think of that infected cut on your finger that starts to turn red, feels hot, starts swelling and hurts. Those are classic signs of acute inflammation. This serves to re-direct blood and all those bacteria-fighting blood factors to the problem area. However, chronic inflammation is related to many diseases, such as diabetes, obesity, high blood pressure cardiovascular disease, etc. The anti-inflammation diet with its focus on specific foods that supposedly increase or decrease inflammation is simply wishful thinking. What are some examples of this wishful thinking? One is that there is a simple, reliable, precise, specific and accurate blood test to monitor your inflammation; other “wishes” include lists of

specific foods to avoid or seek out. The anti-inflammation diet is a marketing approach, not a scientifically proven regimen. The idea that certain foods and dietary supplements may be used as if they are drugs to treat or avoid inflammation is just not supported by the data right now. Good “no-nonsense nutrition advice” is always to base your health behavior on the best possible evidence at the moment, not what is “ahead of the science” or evolving or transitional thinking. So: is there solid evidence that specific foods, like blueberries, green tea, or specific dietary supplements, like Coenzyme Q10, decrease your “inflammatory state?” No. Is there solid evidence that eating certain foods, like tomatoes, meat, dairy and eggplants, can increase your inflammatory state and are to be avoided? No. When it comes to your “inflammatory state,” your lifestyle, including your overall

OCTOBER 4, 2019

eating pattern and your activity level, is where the focus needs to be. The focus should not be on whether you are eating this food, using that herb (such as curry or ginger), taking a specific supplement or avoiding eggplants, tomatoes, etc. What are these lifestyle factors? Probably the most important are not being overweight/obese and controlling your blood pressure and diabetes. In addition, exercise has a big effect on health in many ways, one of which may be by lowering your “inflammatory state.” Uncontrolled and untreated gum disease and dental infections and smoking also can increase your chronic disease risk, perhaps through the inflammatory connection. After talking to your physician, you may be a person who should take a daily baby aspirin (if you are below 70 years old) and statin-based cholesterol-lowering medication as two more ways of reducing your chronic disease risk and

inflammatory state. Yes, statins reduce cardiovascular risk by reducing LDL (“bad”) cholesterol; however, they may have a second affect of reducing inflammation in the body. Do we know what the healthy diet is? We’re pretty sure we do. Will this diet decrease your risk of chronic disease, help you as you age, help your brain, your heart, and your kidneys and, by the way, perhaps decrease your inflammatory state? We’re pretty sure it will. Where do you find out about this diet? Research the DASH Diet, The American Heart Diet, The Diabetic Diet and The Mediterranean Diet, all great ways of eating. These diets agree with each other and are evidence-based, not urban legend or social media based. What’s the “No-Nonsense Nutrition” advice for today about nightshade veggies and inflammation? If you are worried about your inflammatory state and your risk of chronic diseases, then your emphasis should be on your overall eating pattern and lifestyle behaviors, not on demonizing tomatoes and other foods. P.S. Now that you have me thinking about eggplant, I’m going to make some eggplant parmesan tonight for dinner, with lots of tomatoes and peppers in it. A very healthy vegetarian meal. Thanks for the thought! +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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OCTOBER 4, 2019

Ask a Dietitian

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AUGUSTAMEDICALEXAMiNER

IS FRUIT GOOD FOR YOU?

by Pam Brisky, MS, RD, LD Augusta University Medical Center Eat more fruits and vegetables! This is probably the world’s most common health recommendation. Everyone knows that fruits are healthy. They are real, whole foods. The idea of fruit being bad for us seems to be related to sensationalist media reports of its high sugar content. Fruit is high in a natural occurring sugar called fructose. Some studies have found fructose may have negative effects on the body, such as increasing blood pressure, impairing liver function or hindering insulin response. However, these effects were only seen to occur with excess fructose consumption from high fructose corn syrup. These studies did not study eating fruit. There is not enough fructose in fruit to cause harm. Another concern with the sugar content of fruit is its impact on blood glucose levels. The cellular structure of the fruit is important in terms of its impact on blood glucose levels. Let’s use an apple as an example. Sugars are effectively stored within its cell wall, which our digestive track must break down before the sugars are released. This takes time, so sugar is absorbed into the bloodstream slowly, which gives the liver more time to metabolize it and thus blood glucose levels remain more stable. Is Fruit a Satisfying Food? Whether a food is satisfying depends on several factors including how hungry you are, what you fancy at that moment, as well as when and how you eat. But there is some interesting research into the impact of different foods on our fullness and appetite. For example, some studies found that sugar affects the hormones that tell our brains that we are full, which can result in over-consumption of sugary foods. Consuming a fiber-rich fruit (such as an apple) takes a longer time to chew and is digested more slowly. As it takes the apple

longer to travel through the digestive tract, satiety (fullness ) hormones are triggered in the small intestine. The result is that you feel satisfied for a longer period when you eat a piece of fruit as compared to a low fiber, high sugar food like fruit juice or gummy bears. A study in 2009 investigated the impact of consuming apples in different forms – whole apples, applesauce, and apple juice with and without added fiber. These were consumed prior to a meal to compare how they influenced feelings of satiety and energy intake at a meal. Results showed that individuals consuming the whole apple had an increase in satiety compared to the applesauce or apple juice. The researchers also added naturally occurring levels of fiber to the juice, but this did not improve the feeling of fullness. Overall the results suggest that consuming whole fruit makes us feel fuller compared to pureed fruit or juice, and that eating fruit at the start of a meal may reduce how much we eat, a definite help for weight loss. Foods high in fiber, fat and protein are satisfying and keep us fuller longer. So fruit can be a great way of adding fiber to a balanced meal to make it more filling. A great idea for a satisfying snack is to combine a piece of fruit with a high protein food such as a handful of nuts, yogurt or a piece of cheese. Why is Fruit Juice Different? Although juice still contains the vitamins which are found in whole fruit, the fiber content is much lower. As explained above, this means that fruit juice is less filling than whole fruit. The juicing process also breaks down the cell wall and releases its sugars into the juice. This sugar is immediately absorbed in the small intestine and enters the bloodstream quickly. This causes a more rapid rise in your

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+ 10

AUGUSTAMEDICALEXAMiNER

CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined Speed limit violations are the most common way that traffic laws are broken. Speeding exceeds all other traffic violations combined. According to one source, the tally is 34 million speeding tickets a year in the U.S., some 93,000 every hour. That pulls $6 billion from the pockets of those drivers, a number disproportionately high here, since the National Highway Traffic Safety Administration says Georgia ranks #2 among all states for most speeding tickets. (Florida is #1 The so-called I-95 corridor is the suspected reason for these two rankings. It’s the only interstate in the country where drivers think the route number is the speed limit.) Speed is a vital to safety since it’s a factor in about 13 percent of all crashes, but most importantly, it contributes to one-third of all fatal crashes. What is sometimes overlooked in discussing speed is that each driver has a

certain reaction time that is their personal best. It doesn’t change in differing situations or at different speeds. In other words, if you’re driving along at 45 mph and someone pulls out right in front of you, your reaction time — let’s say it’s one second — is going to be the same if you’re going 65 mph and they pull out right in front of you. Two things do change based on speed, however: one is how far you travel each second, including that single second you have to react to a sudden hazard; and the other is how far it takes to stop once you do hit the brakes. The faster you’re traveling, the closer you’re going to get to that collision — whether it’s a dump truck or children in a school crosswalk — before your foot can apply the brakes, and the farther you’re going to travel after the brakes are applied. Right now all over the Aiken-Augusta area, voices

inside the heads of readers are saying, “Tell me something I didn’t already know!” That’s a fair criticism: everyone knows speeding is dangerous, even potentially fatal. And illegal. And yet we all do it. Why? Because it’s super-hard not to. If you’re late for work or school or a doctor appointment, it’s extremely difficult to just serenely sail down the road like you’re out for a Sunday drive. But the next time you’re late, have your brain pass the following sentence down to your foot: speeding is ineffective and illogical. If you have a destination 5 miles away and you drive 65 mph instead of the posted 45 mph limit, you will save 1.9 minutes according to AAA, the American Autombile Association. Note: that didn’t say 19 minutes. It said one-point-nine minutes. What if your destination is 2 or 3 miles away? Now we’re talking risking accident and injury, the potential for a very expensive traffic citation and a long-term increase in insurance premiums, possibly death (your own or someone else’s, or both) in order to arrive mere seconds earlier. Is speeding really worth all that? Of course not. But even if it was, it’s illegal. + Next issue: Lubrication

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OCTOBER 4, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

It’s the same every morning: “I just don’t want to go to school!” Your child looks at you with real tears. When you talk to teachers, they say your child is having a hard time adjusting and making friends (cue your heart breaking, right now). Whether it’s shyness, insecurity or social anxiety, what can you do as a parent to, well, parent your child through this situation?

HOW CAN I HELP MY KID MAKE FRIENDS?

Here’s What’s Happening Even if your child is going back to the same school, it’s normal to be nervous about moving to a new grade, starting new classes and meeting new people. Some kids may be at higher risk for social anxiety. Think back: Was your child always upset when you left him or her at daycare? Is your child on the quiet side around other kids? Or does your child tend to play around groups and not in a group? It can also happen sooner than you might think: Kids as young as 4 or 5 can have social anxiety. What You Can Do Up to a certain point, parents can do a lot to help kids overcome social anxiety and make friends. It could be as simple as talking to another parent at school: “Hey, want to come over for a playdate?” But for older kids? That would be really bizarre! And even some younger kids might not want you to do that. So here’s what you can help your child do: • Role play. When kids don’t know what to expect, they tend to get anxious. So talk about it. Start by making sure to go to the open house so your child can see the classroom, meet the teacher and meet some of the kids in their new grade. Then, talk about what they’re anxious about. If they’re nervous about meeting a bunch of new kids, role play. Say, “I’m a new kid. What would you say to me?” • Find a friend. It helps to have at least that one buddy to anchor them. My son, for example, was very anxious because most of his friends had been assigned to a different classroom. But I reminded him that one of his friends would be in a couple of classes with him. The first week was hard, but by the end of it, he was fine and had started meeting new friends. Sometimes, it’s also hard for younger kids to understand that it’s OK for them to have more than one friend. Girls also seem to find it harder to have friend groups of three—they’re more likely to split up into twos or fours. So make sure your child knows that it’s more than OK to open up and have a second or third best friend. • Find commonalities. Guys talk about sports—not necessarily because they’re that into sports—but because it’s an easy topic for most guys to talk about. You can help your child find that common ground to start a conversation—and maybe even a friendship—around. Maybe another kid has a folder with an image from a TV show your child likes; maybe someone is wearing a Pokemon shirt; or maybe someone has a hair accessory your child has been wanting to try. • Find an activity. Children (and adults) often seem to do better at meeting new people when there’s an activity involved that gives them something to talk about in a way that’s not forced. So make sure to talk to your child about activities he or she is interested in and sign them up. Try asking your child: “Do you want to invite someone to come to the movie/ Putt Putt/other activity with us?” Don’t be surprised if he/she would rather talk to someone else—anyone else—about this rather than you. So if you need more help, reach out to your school’s guidance counselor, a pastor, or other resources. +

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

OCTOBER 4, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Brooks David Kimmis, MD, on July 4, 2018 (edited excerpt)

DON’T TELL PATIENTS THEY LOOK GREAT...(EXCEPT IN THESE CASES) One of my colleagues sat on a wheeled clinic stool at the end of the examination table and told the patient, who in this case was an actor, “Everything looks great.” After, he swiveled around to face the instructor and the small group of onlooking medical students behind him. Our instructor also turned to us and said, “Very good job. But can anyone tell me what he did wrong?” He did everything correctly I thought, and the rest of the students must have felt the same way because they didn’t speak up either. I replayed the encounter in my head. Despite going over his examination again in my head, I couldn’t figure out what he had done wrong. To alleviate the awkward silence, the actor attempted to help us by hinting, “It isn’t anything he did. It’s something he said.” To which we responded with a collective, “Ahhhhhh!” Never say to the patient that anything “looks good” or “great” during a physical exam. Instead tell the patient that whatever you are examining looks “normal” or “healthy.” It is an important communication skill, especially when performing examinations that involve sensitive body parts such as the genitals. And it makes sense. To have a stranger say your private parts look “great” can have an uncomfortable sound to it, even if uttered out of naivety. But it can also be imprecise or even confusing. For example, “your heart sounds good” is not as reassuring as “your heart sounds healthy. I do not hear any murmurs or other abnormal sounds.” It is for both of these reasons that medical students are taught to avoid words like “good” or “great” and to instead use “healthy” or “normal” when discussing physical exam results. However, in my training in medical school, I have come across one important instance when using words like “good” or “great” may actually be of benefit to the patient: in the dermatology clinic. In my last year of school, I began rotating with several different dermatology programs. I was exposed to many amazing aspects of the field, and one that struck me most was the unique way that dermatologists interact with their patients. They made frequent use of those forbidden words. “You look great!” or “Your skin looks so good!” or even, “Your skin is doing so much better. You look amazing!” were not uncommon phrases used by many dermatologists I followed. The use of such language by dermatologists is quite purposeful. Many of the diseases of the skin are unlike any other in that they are often the first thing that is presented to the world and other people. Sometimes treatments themselves can draw unwanted attention in the form of scars, sutures, inflammation, dryness or other appearances that are undesirable to many people. Many people with skin issues feel self-conscious, and this, I believe, is where the importance of reassurance by a dermatologist can come into play. It’s empowering as a patient to hear from a skin expert that their skin has not only improved with treatment but is looking terrifi. Almost without fail, patients seemed to leave the clinic with a smile on their face whenever such phrasing was used. I have seen the influence of this clinical skill in adults, but especially in children. Whether a child with alopecia totalis was having impressive hair regrowth or a child with severe eczema was making only minimal improvements despite the use of systemic medications, whenever a young child was told their skin or hair or they themselves looked great, I would often see a sparkle in their eye and an ear-to-ear grin. There’s a power to that — helping a patient feel better about themselves. And dermatologists are privileged to have the opportunity to do just that in unique ways compared to other specialties in medicine. I was grateful watching dermatologists support their patients in such a truly profound way, and I cannot wait to be able to offer the same uplift to my future patients. +

“You look great!”

Brooks David Kimmis is a dermatology resident.

The dilemma of what treatment option to pursue is well known to doctors: the standard course is to begin with the most conservative and least invasive option. If that works, well and good. Everyone likes a happy ending. But it’s not always that simple. Take prostate cancer as one example. There are at least half a dozen recognized treatment avenues to take, each with its own unique set of advantages and disadvantages. The one determined to be the best option for Mr. A may not be best for Mr. B. The advantage of one option over another may rest entirely with clinical factors. But many other factors can enter the picture. Does the patient have an overriding fear of surgery? A distrust of pharmaceutical companies? Does he come across as skeptical of whatever is suggested, or is he willing to do whatever the doctor says, no questions asked? Are his religious views a factor in making the decision? Does his extended family — distant cousins and faraway inlaws — appear to have as much say in the matter as

he does, perhaps even more? What about the cost of the procedure and payment of the balance not covered by insurance? The husband-and-wife team who wrote this book (other books by Groopman have also been reviewed in the Examiner) address how patients can sort through the sea of conflicting options. It’s not always easy. And it hasn’t been made any easier in the Internet era. A couple of decades ago and before, patients took whatever their doctor said as gospel truth. Nowadays, we’re likely to Google everything from our symptoms to various Mayan

folk remedies. There is an endless flow of information out there. Even if all of it was accurate — which it isn’t — the sheer volume can be crippling, and certainly not conducive to good care. Do you take the medicine that has as a side effect of increased risk of causing a heart attack, or the one with a higher risk of causing internal bleeding? What if the one you didn’t choose is actually more effective in treating the primary condition you have? Well, the good doctors don’t have a crystal ball for their readers, but they do offer plenty of sage advice on how to make thorny decisions, as well as a simple formula that can help patients wade through all the conflicting advantages and disadvantages of any collection of medical advice. Maybe the book could have been entitled Your Made-Up Mind. + Your Medical Mind, How to Decide What Is Right for You, by Jerome Groopman, M.D. and Pamela Hartzband, M.D, 320 pages, published in September, 2011 by Penguin Press.

Research News One toaster should be fine Families where one or more members have celiac disease sometimes have multiple kitchen appliances to prevent exposure to gluten for those with the disease. Research Washington D.C.’s Children’s National Hospital published this week (Sept. 30) in the journal Gastroenterology found no significant gluten transfer when items like toasters and kitchen knives were used for both gluten-free and gluten-containing foods. Researchers devised everyday kitchen scenarios involving both kinds of foods to measure the possibility of transfer. In one test, a knife was used to cut regular frosted cupcakes, and then the same knife was used to cut glutenfree cupcakes. Even with visible crumbs stuck to the icing on the knife, gluten levels on the gluten-free cupcakes were below 20 parts per million (ppm), or .002%,

which is the US Food and Drug Administration threshold for food to be labeled gluten-free. In another test, gluten-free bread was toasted in the same toaster as regular bread, and in multiple tests the glutenfree bread remained at less than 20 ppm, even when gluten-containing crumbs were present at the bottom of the toaster. In the final test, gluten-free pasta was cooked in the same water after regular pasta. Initially, the gluten-free pasta tested as high as 115 ppm, but if rinsed under running water after cooking, gluten levels returned to less than 20 ppm. Rinsing the pot with fresh water between cooking the two types resulted in undetectably low levels of gluten transfer. Red meat cold turkey? Eating more fruits and vegetables (see page 9) and cutting red meat are staples of dietary recommendations for improving health and cutting

the risk of disease. For people who are challenged by that advice, there is good news from a British study released this week. Published Sept. 30 in Food & Function, the University of Nottingham study examined red meats (pork, beef, lamb and veal) and their proven role in elevating LDL cholesterol and thereby contributing to the risk of cardiovascular disease and colon cancer. Study subjects reduced their red meat intake over a period of 12 weeks by eating fish, white meat or a meat substitute, or by reducing the portion size when they did eat red meat. Based on blood tests at the beginning, during and at the end of the study, researchers found that even a modest reduction in red meat consumption had significant results. The average drop in LDL cholesterol was 10 percent, and those with the highest levels at the study’s beginning saw the biggest drops. +

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AUGUSTAMEDICALEXAMiNER

The Examiners

OCTOBER 4, 2019

Is this your new braille book?

by Dan Pearson

It is. And I think something really bad is about to happen.

I bet it’s full of suspense!

Yes, it’s a murder mystery.

How do you know?

The Mystery Word(s) for this issue: FOSTHUL

EXAMINER CROSSWORD

PUZZLE

39 43

44 48

49 52

63 66

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, OCT. 14, 2019

We’ll announce the winner in our next issue!

E X A M I N E R

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

6 3

7 6 1 5 7 8 9 4 3 5

S U 1 D 2 O K 7 U

9 4 5

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

33. Province in Peru 34. Two-masted sailboat 35. Wicked 37. Short for a condition of abdominal pain, diarrhea, etc. 38. Morse element 41. What you’re reading now 43. No in Glasgow 46. Word used with contrasts and comparisons 48. Giant of Norse myth 52. Egyptian god of the afterlife 54. Common term for parotitis 55. Sheep cry 56. Hartford-based insurer 58. Concerning; about (archaic) 59. Playing marble 60. : 61. Castle material? 62. Size of type 63. Masters’ sport 64. Extinct flightless bird 66. Football field official (abbrev) Solution p. 14

QUOTATIONPUZZLE T S F E M S V H P I I M I T O T F R R I E P O T E E S H U A

T D E F Y R Y I T S T H O I I R

3 9 5 8 4 7 8 2 7 C6 1 3 6 5 9 4 2 1

— Jean de La Bruyére (1645—1695)

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. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

1 2 1

F 1 2 3 4 5

1 2 3 4 3

L 1 2 3 4

1 2

V 1 2 3 4

H 1 2 3 4

1 2 3 4 I 1 2 3 4 5 6

1 2

— Ben Franklin

1.WWHHHFRNLIT 2.NOOIAIAEHII 3.VVVTMALL 4.ASHLLEET 5.LES 6.LS 7.F

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

20 21 22 ACROSS 1. ____-It note 24 25 5. It often follows 10-D 26 27 28 10. Worry 14. Burn soother 33 34 35 36 37 15. Set ______; save 40 41 42 16. River in Switzerland 17. Doing nothing 45 46 47 18. Urge forward 50 19. Heart quivers, for short 20. Straighten up 53 54 55 56 22. Exude; radiate 61 62 24. Made a mistake 25. Synthetic textile fiber 64 65 26. “My lips” prefix 68 69 29. Masculine prefix 71 72 33. Affirmative vote 36. Aspirin, typically (abbrev.) by Daniel R. Pearson © 2019 All rights reserved. 39. Biblical home of Abram 40. Main part of a church or 73. British gun cathedral 42. Type of legend 44. Favorite Trump adjective DOWN 1. _______ College 45. Between (informally) 2. Wiser partner, often 47. Class composition 3. Plexus intro 49. ___ station 4. Be on the brink 50. Muslim God 5. Precipitation 51. Blood prefix 6. Doctrine, generically 53. Venomous African snake 7. Venomous snake 57. The son of Abraham and 8. Swelling Sarah 9. Pass on 61. Small spine (botany) 10. It often comes before 5-A 63. Foreigner (in Latin 11. Augusta VIP visitor of yore America) 12. Cleveland’s lake 64. Principal 13. Type of page 65. Downtown coffeehouse 21. Home of Adam and Eve 67. Housewives’ intro? 23. Ark builder 68. A single time 27. One of GRU and AU’s 69. Expert group predecessors 70. Division word 28. Challenge 71. 6th month of the Jewish 30. Medicine calendar 31. Muffin prefix? 72. Medical symbol (with 32. Singles snakes)

WORDS NUMBER

THE MYSTERY WORD

2 6 1 9 4 5 8 7 3

8 7 2 5 1 9 4 3 6

4 3 9 6 8 7 2 1 5

6 1 5 4 3 2 7 8 9

OCTOBER 4, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

The

Advice Doctor

Moe: How did the doctor cure the invisible man? Joe: He took him to the ICU.

Moe: I made a chicken salad today. Joe: That’s nice. Moe: That’s what I thought too. But the stupid bird didn’t even say thank you.

Moe: Man, I knew it was a mistake to flush my wooden shoes down the drain. Joe: Why, what happened? Moe: Now the drain is clogged.

Moe: I went shopping for cherries and a microphone today. Joe: How’d that work out? Moe: Bought a bing. Bought a boom.

Moe: I got a call from my loser identical twin brother this morning. He’s in jail. Joe: What did he want? Moe: He said, “Remember how we always used to finish each other’s sentences?”

hat I if told you that you read that first line wrong.

Moe: What do you get from a pampered cow? Joe: I give. What? Moe: Spoiled milk. Moe: You still working out? Joe: Dude, I’m such a stranger at the gym these days I call it James. Moe: How do you make a pheromone? Joe: Tell him to let your people go. Moe: I admitted to my wife that I’ve always had a thing for Beyoncé. Joe: How did that go over? Moe: She said, “Whatever floats your boat.” Joe: And? Moe: “No,” I explained, “that’s buoyancy.”

Mr. Dragon: I picked up a couple of knights for dinner on the way home. Mrs. Dragon: Honey, you know how I feel about canned food. A man found a magic lamp in the sand at the beach one day. He brushed the sand off and rubbed the lamp and instantly a genie materialized and offered the man three wishes. “I wish for a world without lawyers!” said the man. “Done,” said the genie. “That was your final wish.” “But you said I had three!” the man complained. “So sue me,” said the genie. +

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, Like a lot of your previous questioners, I have workplace issue I could use some advice about. Here’s the issue in a nutshell: I just want to do my job. Period. I love my job. I want to keep it. I don’t want to climb the ladder. I don’t want to be management. I want to stay put and keep doing an excellent job. But my bosses keep pressuring me to take the next step up. I say everyone can’t be a chief. You gotta have some Indians, right? — A stellar worker - and nothing more Dear Stellar, Congratulations! You sound like a truly outstanding employee, one any company would be proud to have on their team. And what I am about to say will help you continue to do exactly that. I think your focus should be on your point about climbing the ladder. According to the World Health Organization, the U.S. leads the world in ladder deaths. That grim statistic arises from more than 150,000 annual ladder-related emergency room visits. To underscore how important ladder safety is, most ladder deaths result from falls of just 10 feet or less. How do we avoid becoming a statistic? Let’s start with the ladder itself. Make sure it’s in good shape, that it is tall enough for the job at hand, and that it has non-skid feet to prevent sliding. An extension ladder used to reach a roof or platform should extend at least 3 feet above the platform. Next we proceed to the ladder user. When using an extension ladder, make sure to use it at the proper angle: the “4-to-1” rule recommends for every four feet of ladder height, move its base one foot away from the wall (or vertical). Don’t set up a ladder in front of a door unless it has been locked or blocked off. Always face the ladder. Maintain 3 points of contact at all times: two hands and one foot or two feet and one hand. Keep your center of gravity between the ladder uprights; don’t lean off to the side; move the ladder instead. Don’t carry items so heavy or bulky that it’s difficult to climb safely. Never climb so high on a ladder that it is no longer in front of your body. + I hope this answered your question. 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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By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY STATE ZIP Choose six months for $20____ or one year for $36 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

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

...cleverly hidden, appropriately enough, in the p. 9 ad for SOUTHERN COMFORT SHOES

THE WINNER: JUDY WHALEY! 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!

OCTOBER 4, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED P A I N E

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

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

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FRUIT… from page 10

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blood glucose levels, which can be followed by a drop in blood glucose levels. Conversely, blood sugars tend to be more stable after consuming a piece of whole fruit. The nutritional benefits of fruit Fruit has many proven health benefits. Regular fruit consumption has been associated with a lower risk of strokes, certain types of cancer and heart disease. Fruits are packed with essential nutrients such as: • Vitamin A • Vitamin C • Vitamin E • Folate • Potassium These nutrients are important for maintaining several body functions, including blood pressure, vision, gut health and normal functioning of the nervous and immune systems. Fruits like berries are packed with antioxidants which help fight free radicals and reduce oxidative stress on the body. As stated previously, whole fruit is full of fiber. The daily reference value for

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Highland Ave.

by Leah Klein, LMSW, MPH, an Aging Life Care Manager and Medical Social Worker, and has worked in the fields of skilled nursing, hospice, and home health.

Daniel Village Barber Shop

A common contributor of stress to the family of those with a dementia diagnosis is the experience of disorientation to time and place. This disorientation often presents as a regression to times past. Caregivers and loved ones of those with dementia often struggle to deal with these inaccuracies because correcting these thoughts often leads to arguments and tears, but ignoring the misconceptions feels dismissive or mean-spir-

their dinner. Therefore, staff could alternately say, “Dorothy, Duke called about 15 minutes ago to say he was held up at work and to go ahead eat without him. Now, why don’t we go have some supper and then we will come back up and wait for him.” The result of this interaction would hopefully be for Dorothy to go to the cafeteria, eat her dinner, and forget that she was waiting for Duke in the first place. Redirecting rather than correcting disoriented thoughts and behavior is a way of meeting our loved ones where they are. Although it seems counterintuitive to fib, it does not serve the individual with dementia or their loved ones to argue over whose perception of reality is correct. Over time, redirecting and reframing becomes second nature as we recognize that we are contributing to a more calm and less anxious environment. +

Ohio Ave.

Redirect. Don’t Correct

ited to lie. Consider the following example: Dorothy, an 86 yearold female with Alzheimer’s disease has lived in a nursing facility for 9 years. Every day between 4:30 and 5 pm she heads straight for the front door. She is certain that her husband Duke will be picking her up in his red pick-up truck and taking her straight home to prepare dinner. The staff is well aware that Dorothy’s husband passed away 10 years ago, a fact well known by the nursing facility staff. How should they handle this behavior? To those that have not worked with dementia patients, the obvious answer might be to delicately tell Dorothy that her husband passed away 10 years ago and she lives in the nursing home now. This may result in Dorothy becoming angry or upset, because in her mind her husband is alive and this is not her home. The nursing facility staff knows that Dorothy’s husband used to pick her up from her job at the mill in his red truck every day, then they would drive home and she would prepare

Scratched lenses • Temple covers • Bridge pads • Broken frames • Loose hinges • Missing screws • Bent frames • Poorly fitting glasses • And much more!

Honey Yogurt Berry Salad Ingredients • 1-1/2 cups sliced fresh strawberries • 1-1/2 cups fresh raspberries • 1-1/2 cups fresh blueberries • 1-1/2 cups fresh blackberries • 1 cup (8 ounces) reduced-fat plain yogurt • 1 tablespoon honey • 1/4 teaspoon grated orange zest • 1 tablespoon orange juice Directions Place berries in a glass bowl; toss to combine. In a small bowl, mix remaining 4 ingredients. Spoon over berries. + dietary fiber is 14 grams per 1000 calories per day. However, research has shown the average adult consumes less than half that amount. Fiber is essential for the health of our digestive system. Research has also shown a reduced risk in de-

veloping bowel cancer, heart disease, stroke and even type-2 diabetes with an increase in fiber consumption. So yes, fruit is an extremely healthy food, and most people would benefit from consuming more fruit and vegetables daily. +

We’re only a few minutes from the river up the Aiken-Augusta Highway next to Aiken Regional Hospital.

We welcome former customers of Murphy & Robinson.

Fitzpatrick Opticians & Hearing Aids 410 University Parkway, Suite 2700 in Aiken Medical Center next to Aiken Regional Hospital

(803) 649-1430 aikenearandeye@yahoo.com

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

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