Medical Examiner 11-1-19 by Daniel Pearson

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NOVEMBER 1, 2019

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VACCINE INGREDIENT

FUNFACTS PART ONE

There is a constant stream of misinformation about vaccines and their safety swirling around in the online world. Vaccines contain poisonous heavy metals. They contain cells of aborted babies, along with antifreeze, weedkiller, and virus germs of the very disease they’re supposed to protect us from. What’s the real truth? We asked our resident pediatrician, Dr. Caroline, to sort through it all just for us. Here is Part One of her two-part series. Vaccines all contain an active ingredient, the component responsible for the primary immune response we want. The main ingredients in every vaccine are the inactivated, chopped up pieces of virus, bacteria, or toxin which essentially trick the body into thinking it has been infected with the organism. The body responds by launching an immune response that produces antibodies against the invader. Of course, there is no actual invader in the case of a vaccine, since it contains only deactivated — a polite word for dead — viral cells. However, courtesy of the data download provided by the vaccine, the immune system now has the enemy’s number and will remember that specific target should the body actually be exposed to the disease or virus down the road someday. This is why vaccines work, and why we give them. Getting a vaccine is basically like deep-cleaning your house in preparation for the in-laws coming for dinner, but then dinner gets rescheduled for another day. The house is still spotless, though, and ready for company. Please see VACCINE INGREDIENTS page 2

IT’S A LONG STORY n this very day 204 years ago, a baby boy was born a hundred miles up the road from Augusta. Nothing seemed particularly auspicious about this particular baby, but he would become a medical pioneer whose discovery has directly affected your life and mine. Who was this man? Well, he was born in Danielsville, Georgia, on the aforementioned November 1, 1815, if that helps. And he died at age 62 in Athens, Georgia, on June 15, 1878. Or something like that.

Actually, his Athens tombstone says he was born on Nov. 1, and a larger historical graveyard marker nearby says Nov. 3. As for his date of death, some sources say June 15, some June 16, others June 19. One thing we know for sure. He lived and he died. And in between, he became a doctor, one of tremendous importance. You’ve probably heard his name: Crawford Long. It’s a well-known name in these parts: for more than 70 years there was a Crawford W. Long

Please see LONG page 3

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD by David W. Proefrock, PhD

Your 5 year-old daughter is in kindergarten. She has been doing quite well in school. Her teacher has commented on how bright she is and has been giving her more challenging, work to keep her busy when she finishes her regular classwork. Recently, you have noticed that she is showing nervous behaviors like biting her nails and twisting her hair. There have been no changes in circumstances at home. What do you do? A. She must be bored with her regular classwork. Ask the teacher to give her even more challenging work. If she can’t be challenged sufficiently, look into moving her to a more academically accelerated setting. B. Once habits like this get started, she may never be able to shake them. Remind her with a gentle pat on the hand when you see her doing them. Ask her teacher to help with this too. C. Have a talk with her about what might be bothering her. If she’s not concerned about school, there might be something at home or in the neighborhood that you don’t know about. D. Talk to the teacher and ask that she stop challenging her so much. Let her color or look at books when she finishes her classwork early. See if the nervous habits let up. If you answered: A. This will likely make things worse. These are symptoms of stress, not boredom. They are likely due to her being pushed too much rather than left unchallenged. B. It is not a good idea to punish nervous habits even if is light, or “gentle” punishment. This adds even more stress to her life and is likely to make things worse rather than better. C. It’s always a good idea to talk to your kids, but a 5 year-old is too young to identify the sources of her stress. It won’t hurt to ask, but you are going to have to find the cause yourself. Too much stress due to extra challenges at school is the place to start. D. This is the best choice. These are nervous habits that are likely from stress. If they don’t get better when stress is reduced, consider taking her to a mental health professional for evaluation. Young children can be stressed at school just like adults can be at work, but they don’t have the tools to deal with stress that adults have, or sufficient communication skills to talk about it. You have to step in and manage the situation for them. + Dr. Proefrock is a retired child clinical and forensic psychologist.

NOVEMBER 1, 2019

VACCINE INGREDIENTS… from page 1

Like everything from salad dressing to corn flakes, ingredients in vaccines are listed in order of quantity. The most abundant ingredient is listed first, followed by the second-most, the third-most, and so on. The main ingredient in vaccines, that is, what is present in the syringe in the largest amount proportionally, is actually water. Yes, good ol’ water. To put a dose into perspective, the entire vaccine itself in all that water adds up to be about half a milliliter (mL). To put that into perspective, one milliliter equals about three-hundredths of a fluid ounce (0.033814). And the quantity of “active” ingredient within that is even more minute: a few micrograms (a microgram is 0.000001 of a gram). Everything else is water. Compare that to a single dose of Tylenol, something which parents regularly give to children. The typical dose for babies, 1.25 ml, contains milligrams (0.001 of a gram). Aluminum salts are added in very, very small amounts to vaccines to help improve the immune response. Aluminum is one of the most common metals present in the Earth’s crust; it is in the deodorant I use every day and the foil I cook with. But is it safe within the human body, especially an infant? It is already present in babies’ blood streams at birth (transferred from mom), as well as breast milk (which is about as natural as it gets). The body eliminates aluminum via the kidneys and it is not known to pose any significant health risk, especially at these levels. Formaldehyde is an ingredient found in trivial amounts in some vaccines as an inactivating agent, making any toxins produced by the bacteria incapable of causing disease. If you are a normal person, the mention of formaldehyde makes you think of funeral embalming and the cadavers medical students dissect in their anatomy labs. That’s a natural reaction. It’s my reaction, too. But here’s a genuine fun fact: formaldehyde is a naturally-occurring compound produced by the human body itself to enable synthesis of essential amino acids and DNA. If you were to draw the blood of a random 2-month old baby (including unvaccinated babies), you would find more formaldehyde naturally in that baby’s body than in any vaccine. That goes for you and me, too. Humans produce about 1.5 ounces of formaldehyde a day as a normal part of our metabolism. At any given time there is about 13 mg of formaldehyde in the average person. Contrast that level with the amount in common vaccines: • Less than 0.1 mg in the vaccine for Diphtheria, Tetanus and Pertussis • Less than 0.0004 mg in the vaccine for Hepatitis B • Less than 0.02 mg in the flu shot Far from being grounds for concern in vaccines, formaldehyde is common in nature. Apples naturally contain formaldehyde. A single pear contains 50 times more formaldehyde than any vaccine. + Part Two: what about mercury and tissues from aborted fetuses in vaccines? True? See our Nov. 15 issue. by Dr. Caroline, an MCG-trained, 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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Before Long... ome people say that the main antidote for painful medical procedures in centuries past was very simple and very effective: ear plugs for the doctor. Other than extreme situations (like battlefield injuries), when it came to planned surgeries, as long as people have been performing medical procedures on each other, they’ve had something on hand to kill the pain — or at least try to. The effectiveness of that “something” has varied considerably. Some people were lucky enough to get their hands on opium, cocaine, or marijuana. The Incas managed to drill holes in the heads of patients with relatively little pain by chewing coca leaves and then spitting into the wounds. Most patients, however, were not so fortunate. Drunkenness was a standard medical go-to, but the really unlucky people had to make due with folk anesthetics like mulberries and lettuce. Imagine being told, “I’m going to have to saw off your foot. Here, have some lettuce.” Saws used in amputations, incidentally, were no different from the rough-toothed handsaw a carpenter might use today to saw through lumber. Prior to about 1800, doctors used simple techniques to numb a limb, like compressing it to cut off blood flow and sensation, or numbing it with cold. Some preferred the direct approach and knocked people unconscious with a blow to the head. For the more delicate types, good surgeons offered unconsciousness by strangulation. That’s probably better than lettuce, but not by much. Still, when faced with the prospect of unanesthetized dental surgery or being held down while a wound was cauterized by a red-hot iron, the prospect of unconsciousness from a blow to the head was welcomed. Surgery really might not have been worth getting before the 1800s. Until then the most commonly used anesthetics in industrialized nations were alcohol and opium, and neither offered complete numbness. Opium, while a strong analgesic, had significant side effects of its own and was typically not powerful enough to completely eliminate pain; and the large doses of alcohol needed to produce stupefaction could just as easily cause nausea, vomiting and death instead of sleep. Women preparing for childbirth were routinely told to also prepare for death. In short, before Long, surgery was a last and desperate resort. Elective surgery was virtually unheard of. Reminiscing in 1897 about pre-anesthesia surgery, one elderly physician was quoted as saying he could only compare it to the Spanish Inquisition. He recalled “yells and screams, most horrible in my memory now, [even] after an interval of so many years.” So from all of us, thank you, Crawford W. Long. + Editor’s note: These two articles, with minor variations, were first published in the Nov. 1, 2013 issue of the Medical Examiner.

LONG… from page 1

Memorial Hospital in Atlanta. Ten years ago that hospital was rechristened as Emory University Hospital Midtown. What did Long do to merit such an honor? He was the first physician to use inhaled ether fumes as anesthesia during surgery. Long’s discovery arose from what we would probably call huffing today. At all the cool parties in the 1840s, huffing ether fumes was the rage. People would stagger and reel and fall down, and were sometimes probably arrested for RUI (Riding Under the Influence) on their way home. As the well-known story goes, Long noticed people could unwittingly inflict all kinds of pain upon themselves while under the influence of ether fumes without really feeling it. Coincidentally, an acquaintance of Long’s, one James Venable, had been putting off the excision of a tumor from his neck. Long convinced Venable to let him administer ether and take care of the tumor once and for all, and without pain. And the rest, as they say, is not history: Long failed to realize the importance of what had happened, with the result that others claimed the limelight. Despite that, the verdict of history is in, and it is that Georgia’s Crawford W. Long was the first physician to make a surgical procedure a pain-free experience through the use of ether. Want to learn more? Visit crawfordlong.org for information about the Crawford Long Museum in Jefferson, Georgia. +

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HOW OFTEN DO PEOPLE SWALLOW THEIR TONGUE? We have up-to-the-minute statistics on this phenomenon. If you imagine it’s fairly rare you’re somewhat on target. As of October 29, 2019, the number of cases nationwide so far this year stands at exactly zero. Does that surprise you? It might be even more surprising that the number this century also is zero. Tongue-swallowing is widely believed, but it is a complete myth. It is physically impossible. The main reason is the tongue’s structure and anatomy. Although the tongue enjoys plenty of mobility, it is quite well anchored. The main defense against tongue swallowing is the lingual frenulum, that thin strip of tissue extending from the floor of the mouth to the underside of the tongue that keeps this important organ in place. It is possible for the tongue of a sleeping or unconscious person to fall back toward the back of the oral cavity, especially when a person is lying on their back. This is a common cause of snoring and sleep apnea. Belief in tongue swallowing would be a harmless myth except for the fact that it can have some serious consequences that are anything but rare. When someone has a seizure, well-meaning bystanders may take action to help the person avoid swallowing their tongue. Sometimes they’ll try to grab the tongue with their fingers or put something in the victim’s mouth to keep the tongue from going down the hatch. Either strategy can have dire consequences for the “rescuer,” the victim, or both. Someone having a seizure can bite off or severely injure those well-meaning fingers; an object inserted into the mouth can be chomped down on and broken, and the pieces can be aspirated or swallowed or choked on. The best help strategy for someone having a seizure is keeping the area around them clear. A person lying on their back could aspirate vomit; rolling them onto their side is a simple but very effective way to avoid that potential complication. But there’s no need to fear they might swallow their tongue. It’s anatomically impossible. +

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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NOVEMBER 1, 2019

#102 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH

s a measure of this man’s impressive influence, consider that he wrote a book published in 1555 that has rarely been out of print since then. If you haven’t read the book, join the club. But it’s a slam dunk guarantee you’ve heard of its author. Another guarantee: you have not heard of the aspect of this man’s career on which this article is focused. Instead, his fame centers around his reputation as a visionary who accurately predicted events as recently as this century. Have you guessed that our subject is Nostradamus? That book he wrote in 1555, Les Prophéties, is believed by many to have predicted everything from Hitler’s rise to power and the atomic bomb to the September 11 attacks. Most scholars are not among the believers. Their view is that believers have been taken in by “retroactive clairvoyance,” or postdiction, the opposite of prediction. In other words, taking a vague statement devoid of specifics and making it fit actual events after they occur. Other scholars blame sloppy or deliberately altered translations of Les Prophéties for its alleged accuracies. So if we aren’t endorsing Nostradamus’ prophecies (which would seem out of place in a health-oriented publication even if we were), why are we profiling him? A forgotten entry on Nostradamus’ résumé is his work as an apothecary, a job we usually call “pharmacist” these days; he later earned a medical degree. His overall interest in and knowledge of medicine is underscored by his admiration for Galen, the 2nd century physician whose medical skills in some areas were centuries ahead of their time. Nostradamus even translated Galen’s work. Unfortunately for Nostradamus, he lived at a time when plague was a frequent and lethal visitor all across Europe. His first wife and two daughters died of bubonic plague in the 1530s. (Side note: buboes, pronounced BYOO-bohs, are swollen, inflamed lymph nodes, and they are the source of the word bubonic.) At a time when “cures” for the plague were ridiculous at best and disease-spreading at worst, Nostradamus, perhaps influenced by some of Galen’s far-sighted teachings, advocated a number of effective anti-plague measures. In an era where people wore the same clothes for an entire year, no one thought that changing linens was a thing, even if they were on the bed of someone who had died from bubonic plague in that very bed. Nostradamus taught otherwise. He recommended boiling water to kill bacteria. He advocated burying corpses of plague victims instead of throwing them in open pits (or leaving them lying in the streets). Nostradamus was a proponent of bathing daily, not twice a year, which was the average among people in the mid-1500s. Nostradamus lived in Provence, in southern France, and entered the University of Avignon at age 14 to study medicine. When all classes were suspended a year later due to a plague outbreak, Nostradamus traveled the countryside researching herbal remedies. He later put his knowledge to good use during the plague, concocting and distributing a “rose pill,” a lozenge made from rose hips, a rich source of vitamin C. Overall his cure rate was impressive, employing techniques that are Medicine 101 today, but which were highly progressive and cutting edge in the 1500s. +

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 medical issues that had brought the patients in that day. Doctors’ offices make a difference for I’ve had lovely discussion about knitting, patients. On a gray, gloomy day recently I holidays, good vs less functional walkers, had an appointment at one of my doctor’s picnics, sporting events, and an enormous offices. The minute I walked in I could feel my variety of foods. I use a walker and the doors mood improve positively. I had are heavy, so almost always never really noticed the lighting Good lighting in a doctors someone gets up to help me before. I’m just guessing, but negotiate the doors. People will I think they had a good 50 office makes a definite ask, “Don’t you have someone percent brighter lighting than with you to help you?” I tell difference. I’ve seen in any other doctors them no, and can tell they feel offices before, maybe even more I need their support, whether than that. I do or not. That support is precious to me, The walls bounced the light all around because I feel less alone, more connected to the waiting room. I realized I could read the the whole of the loving human race when it’s newspaper better than I could at home, and offered. my home is well lit to combat my seasonal My intuition, that the light in the office affective disorder. It was only a couple of makes a real difference, is something that years ago that I realized the connection would probably need a clinical study to between dim light levels and a significant confirm, but for me the difference is real. loss of motivation, more hours of sleeping, It’s palpable, not just in people’s actions and and a lack of willingness to engage with the reactions, but through the fact that many world around me. In the Northern winters people are there for serious illnesses, but I was becoming a hermit, going out only almost never act like they have profound when I had to. Before moving to Georgia, I problems. It’s a setting where one might compared the number of days of sunlight almost expect gloomy faces, walled off from here and in Ohio. Georgia was the winner, others, but that’s not the case at all. by far, in the number of sunny days. The receptionists know us by name when Moving here helped a lot, but winter we walk in. The lab folks greet us with and stormy days still affect me; however, I smiles and laugh when several of us have didn’t realize that indoor lighting affected walkers or wheelchairs in a small space, me, too, until that day at the doctor’s bumping into one another. office. In previous visits, I had noticed that There’s a wonderful line by the poet everyone there, the doctors, nurses, tech Robert Frost, “There’s a place, where, when staff, and patients, were usually quite open, you have to go there, they have to take you friendly, and willing to help one another. in.” It refers to an old, dying farmhand who Conversations between strangers were more goes back to the farm where he worked for frequent than in other doctors’ offices, and, years, just to end his life where he belongs. interestingly, they were hardly ever about The office feels like that home. + by Marcia Ribble

The Medical Examiner is what is known as a

GOLDILOCKS PUBLICATION. At 16 pages every issue, we’re just right.

NOVEMBER 1, 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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hen you approach a doctor - especially one you’ve never met before - you come with a knowledge of your disease that they don’t have, and a knowledge of the doctor’s limitations that few other patients have. You know more about your disease than most of us do. Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing’s disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder can be something most of us don’t regularly encounter. Even doctors who specialize in your disorder don’t share the kind of knowledge you can only get through living with a disease. It’s like a parent’s knowledge of their child versus their pediatrician’s. You see why you scare doctors? It’s not your fault, but ignoring this fact will limit the help you can only get from them. I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient ever will. You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously. Even so, you have depth of knowledge that no doctor can possess. So let me be so bold as to give you advice on dealing with doctors: 1. Don’t come on too strong. Yes, you have to advocate for yourself, but remember that doctors are used to being in control. All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-asgod illusion. That’s a good thing in the long run, but

few doctors want to be greeted with that reality from the start. Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that. 2. Show respect. I say this one cautiously because there are certainly some doctors who don’t treat patients with respect - especially ones like you with chronic disease. These doctors should be avoided. But most of us are not like that; we really want to help people and try to treat them well. But we have worked very hard to earn our position. Just as you want to be listened to, so do we. 3. Keep your eggs in only a few baskets. Find a good primary care doctor and a couple of specialists you trust. Don’t expect a new doctor to figure things out quickly. It can take me years of repeated visits to really understand some of my chronic disease patients. The best care happens when a doctor understands the patient and the patient understands the doctor. This can only happen over time, but there is something very powerful in that. 4. Use the ER only when absolutely needed. Don’t expect emergency room physicians to really understand you. That’s not their job. They went into their specialty to fix problems quickly and move on, not to manage chronic disease. The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible. 5. Don’t avoid doctors. One of the most frustrating things for me is when a complicated patient comes in after a long absence with

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a huge list of problems they want me to address. I can’t work that way, and I don’t think many doctors can. Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made. It’s OK to keep a list of your own problems so things don’t get left out - I actually like getting those lists, as long as people don’t expect me to handle all of the problems. It helps me to prioritize with them. 6. Don’t put up with the jerks - unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you. Some docs are just not cut out for chronic disease, while some of us like the longterm relationship. Don’t feel you have to put up with doctors who don’t listen or minimize your problems. At the minimum, you should be able to find a doctor who doesn’t totally suck. 7. Forgive us. Sometimes I forget about important things in my patients’ lives. Sometimes I don’t know you’ve had surgery or that your sister comes to see me as well. Sometimes I avoid people because I don’t want to admit my limitations. Be patient with me - I usually know when I’ve messed up, and if you know me well I don’t mind being reminded. Well, maybe I mind it a little. As a patient with a chronic condition you know better than anyone that we docs are just people - with all the stupidity, inconsistency, and fallibility that goes with that - who happen to doctor for a living. I hope this helps, and I really hope you get the help you need. It does suck that you have your problem; I just hope this might decrease the suckishness a little bit. +

AUGUSTAMEDICALEXAMiNER M E DIC I N E

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Doesn’t healthcare include care? I have put off writing this article for several months, mostly because I wanted to digest what I observed and be sure I was able to write without sounding like an emotional mother. The story I’m about to relate happened to my son, so I did feel a lot of emotion around his ordeal. But most of all, I want to make people aware of the potential lack of “care” in healthcare. In early spring of this year (2019) my son fell and hit the back of his head hard enough to knock him out for several minutes. His friends called 911 and he was taken by ambulance to the emergency room. My son is a grown man, and I did not get the message about his injury for

I was astounded that I had to ask. a few hours. When I got to the ER, I found him sitting up and talking with his friends, who had waited for me to get there. The ER personnel had already done a PET scan and knew that he had some blood in the fluid covering his brain and were going to keep him for observation in the Neurology ICU. I felt the goose egg knot on his head and asked the doctor if an ice pack would help. The doctor looked at my son and asked him if he would like an ice pack.

As is typical of my son, he said “whatever.” The doctor proceeded to fill out paperwork and never asked for ice. Since the staff was hooking him up to monitors and doing their normal routine, I felt it best that I not interfere. I was sure he needed to drink water to keep hydrated, but they said no because he may end up having some kind of surgery. This was very difficult for me because I know how important water is to the body, and I hoped the fluids in his body were working to clear out the blood around his brain that the doctors were concerned about. I also noticed a circular wound on my son’s chest that was raw and oozing a

NOVEMBER 1, 2019 little blood. I asked him what happened there, and he said he had no idea. No one in the ER ever cleaned off that injury, nor did they ever clean off the wound on the back of his head. After several hours, he was taken to a private room in NICU. The nurses hooked him up to even more monitors and gadgets. He was given two more PET scans to make sure the blood was dissipating around the brain. Since it was, they never had to operate. The next day they kept debating whether to let him go home or not. Late that afternoon, we finally got permission from the doctor for him to leave and they started unhooking him from all the equipment. I finally decided I had to step in and ask that they clean up his wounds. I knew how many people have gotten staph infections in the hospital, and I did not want him to leave without getting his wounds properly cleaned. He still had matted blood in his hair

around the goose egg knot, and his chest was still raw. This is not the kind of “care” that I expect from healthcare. My son and I were astounded that I had to ask for this routine care. I hate to think that healthcare has only become about how much they can charge for their care. I know for sure they could charge for every single tube, sensor and monitor they hook up, but actually touching and caring for the patient is not a billable act. I may be an emotional mother, but I certainly would love to have CARE back in our healthcare system. As a side note, I had a veterinarian who cared for my dog for years. When the dog was dying, the Vet took X-rays and explained to me what was happening. As I left his office in tears, they told me there would be no charge. That is caring more about care than money.

IT’SYOURTURN!

— Submitted by Anonymous Augusta, Georgia

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.

NOVEMBER 1, 2019

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GARDENVARIETY

These soft and chewy Ginger Molasses Cookies are the perfect warm spiced holiday cookie. They are gluten-free, low sugar, and can be made vegan, which is ideal for company or a quiet night home. I grew up in the Fort Wayne, Indiana, area, and one of my favorite things to do as a child was visit the Archway cookie plant in town. Their cookies were a staple in our home. We would load up our cart with all kinds of favorites, but I especially liked their molasses cookies. They were soft and chewy, always the perfect kick-off for the Christmas holiday season. Now that I am primarily vegan and my husband is diabetic, I wanted to recreate a molasses cookie I grew up with to fit our diet. I wanted my cookies to be vegan and not loaded with sugar, but packed with flavor. These ginger molasses cookies do just that! First, I used a gluten-free baking flour, which is more suitable for me since I try to avoid fructans. Then I used coconut sugar as a sweetener. Coconut sugar has Ginger Molasses Cookies a bit lower glycemic index than plain white sugar; every little bit helps when Icing it’s time for a sweet treat. The cookies • 1/2 cup powdered sugar get their flavor from a touch of molasses, • 1 tablespoon of almond milk cinnamon, ginger, and nutmeg. They can be made vegan by following my recipe Instructions for a flax egg, or you can use a regular Preheat oven to 375°. Line a cookie pan with egg. The cookies are simple to make and parchment paper. wonderful with a big glass of plant-based Combine the flour and baking soda in a mixing milk or hot coffee. stand bowl. Add the rest of the ingredients and mix on medium-low until all ingredients are combined Ginger Molasses Cookies and smooth. With a cookie scoop drop even sized dough balls Ingredients onto the cookie sheet. Flatten slightly with the • 2 cups gluten-free flour blend. I use bottom of a glass or a spatula. Pamela’s Gluten Free All Purpose Flour Bake for 10 to 12 minutes. Remove from oven and Blend. Or you can use all-purpose flour. allow to cool completely. • 1 teaspoon baking soda • 1/2 teaspoon salt Icing • 3 teaspoons ground cinnamon Place powdered sugar in a small bowl and add • 2 teaspoons ground ginger the almond milk a little at a time, whisking until • 1/4 teaspoon ground nutmeg you have a thick creamy icing. Drizzle • 3 tablespoons melted butter flavor over cooled cookies. + coconut oil by Gina Dickson, an Augusta mom • 1/3 cup coconut sugar to six and Gigi to ten. Her web site, • 2 tablespoons molasses intentionalhospitality.com, celebrates • 1 egg or 1 flax egg (mix together 1 tablespoon flaxseed meal + 3 tablespoons gathering with friends, cooking great healthy meals and sharing life together around the table. Also on water, mix and let set for 10 minutes) Instagram @intentionalhospitality • 1/2 cup almond milk

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ASK DR. KARP

NO NONSENSE

NUTRITION

Dan, a Facebook friend from Montana, asks: “Do kids have the same nutritional requirements as adults?” One of the most significant advances in children’s health and well-being in the last 100 years has been the realization that kids are not simply small adults. Children have their own unique emotional, psychological, physiological and…you guessed it, nutritional needs. This realization has led to major changes in the approach to children’s health, including the growth of children’s hospitals and the emergence of medical disci-

plines like pediatrics, pediatric dentistry, and pediatric nutrition. If you simply check charts of recommended daily dietary intakes, they are always broken down by age and gender, recognizing the distinct nutrition needs of children. To be prudent, one cannot automatically apply adult nutrition principles to children, yet I see parents doing this all the time. The word “children” encompasses a broad range of ages from toddlers to preadults. Children of different ages have differing nutritional needs. For example, let’s consider the nutrients necessary for weight gain throughout childhood. In contrast to most adults, children have nutritional needs for growth and development. An adult who reaches a healthy body mass index (weight) in their early twenties should not continue to gain weight throughout adulthood, in contrast to children, who normally gain weight throughout childhood. Pregnant women and some medically compromised adults (burn patients, anorexia patients or post-surgical patients) have the need for growth, too, but most adults do not. This may come as a surprise since these days many adults continuously gain weight, mostly as fat, as

they get older. Consider this fact: you don’t gain weight simply as a result of getting older. It is just the opposite: being overweight ages your body. However, when it comes to kids, especially kids going through a growth spurt, they need extra calories, vitamins and minerals to support this growth, which should come from healthy food, not supplements. Most adults realize that children have growth spurts, but usually think of the teenage years only. Growth spurts occur at other times, too. For example, between the ages of 3-5 years, children usually gain around 5 lbs. per year. At puberty, major growth occurs; for girls, puberty typically begins between the ages of 1011, and is usually finished by 15-17 years; for boys, puberty starts around age 11-12, and is finished around age 16-17. The

NOVEMBER 1, 2019 total average weight gain for both genders during puberty is 5060 lbs. The nutritional needs for this weight gain are not simply calories. Nutrients, including vitamins and minerals, must also be provided for optimal bone and muscle growth. Again, these nutrients need to come from a healthy food, not from supplements. For a variety of reasons, fad diets are of particular concern when it comes to kids. Most importantly, fad diets may limit the nutrients that children need for normal growth and development. Regimens such as the keto diet, the paleo diet, vegan and gluten-free diets and juicing can cause nutritional problems for children. Looking at vegan diets as one example, it is true that with supplementation, all the nutrient needs of a growing child can be met. In reality, however, here is what the data shows: vegan diets for children are too low in calories, vitamin B12, iron, calcium and vitamin D. The data shows that kids raised on vegan diets are usually deficient in these nutrients and do not grow as well as children raised on healthy, mixed-food diets. So, one piece of advice for parents is not to limit dairy and whole

grains carbs. In addition, kids on fad weight reduction diets usually end up weighing more than their peers and may develop eating disorders, osteoporosis and anemias. Don’t forget, parents, that when it comes to nutrition, you are not just feeding your kids, but you are teaching your kids what to eat. When children are put on fad diets or supplements, it starts them down the road to a lifetime of nutrition faddism. What is the “no-nonsense” nutrition advice for today? Simply this: when it comes to food, diet and nutrition, children are not miniature adults. They have their own unique nutritional needs which must support growth and development. A good resource for nutritional needs of children during different development periods is the website of The American Academy of Pediatrics. In addition, remember that when you feed a child, you are teaching the child what to eat over their lifetime. When I see kids in restaurants at 11 pm on a school night, I think that we adults need to be better advocates for our children’s well-being. Among other things, we need to protect them against a lifetime of obesity, chronic disease and nutrition quackery. +

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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Ask a Dietitian

WHEN WE PLAY MONOPOLY, OUR FAVORITE PROPERTY IS

HAVE HEALTHY HOLIDAYS!

by Valerie Lively, RD, LD, CDE Charlie Norwood VA Medical Center Small changes=healthier recipes! Do you tend to cook the same recipes each holiday season? Do you always use lots of butter, sugar, salt, etc in order to make it taste really good? If so, you are not alone! This time of year, we tend to show off our cooking skills at family gatherings or potlucks at work. It can be very gratifying for someone to ask for your recipe or special secret to cooking success. However, many Americans battle chronic illnesses such as diabetes, heart disease and high blood pressure. Recipe substitutions allow you to make recipes that are still delicious but healthier. Try these simple changes to help reduce fat, salt and sugar. Then when someone asks you for your recipe for a fabulous dish—you can inform them it was a healthy one!

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AUGUSTAMEDICALEXAMiNER

Quick and Yummy Dip Ingredients • 1 cup low fat sour cream • 4 tablespoons Mrs. Dash Onion and Herb Blend Directions 1. Stir together all ingredients 2. Chill. Serve with baked chips or raw veggies. (from mrsdash.com) Happy cooking! Instead of the usual versions of items such as sour cream, whole milk or mayonnaise, use the item that is low fat, reduced fat or fat free. Use canned soups that are labeled light, reduced sodium, or sodium free. Substitute these when cooking casseroles. Make dips with fat free products instead of the regular item. Don’t buy regular salad dressings. Try the light or low

fat version. When making punch or coffee drinks, use artificial sweetener. Bring cut up fruit or crispy crunchy veggies instead of the usual chips and cookies to gatherings. Tiny Tastes Add Up... “Oh—It’s just a little bite” “I’ll just have one…” Have ever said these words to yourself when sampling a dessert? How about eating cookies off a plate in the breakroom? What about stopping to visit a friend or co-worker and taking a couple pieces from the candy dish? It may be time to get a new perspective on calories. Tiny tastes can add up! Before you eat that random snack or try just a taste—ask yourself a couple of important questions: 1. Am I hungry? Please see HOLIDAYS page 16

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined One of the principles that is basic to driving is that we share the road with every other driver out there. That includes slowpokes and lead foots, big rigs and buses and dump trucks as well as Mini Coopers, mopeds and motorcycles. The “share the road” principle could be (and will be) the subject of any number of topics to be covered in this space. But one of the most important (and simplest) is how the

road should be shared with emergency vehicles. It’s also one of the most ignored and/or abused traffic laws. That is definitely odd when you consider how many traffic laws are the subject of a catchy rhyming phrase to help you remember them. How many can you think of that fall under that description? We can only think of one: “Move to the right for sirens and lights.”

It’s not complicated, but you would never know it to watch motorists when an emergency vehicle enters the picture. Some people speed up. Some drivers promptly stop, regardless of whatever lane they happen to be in at that moment. Some go left and stop in the suicide lane. Others ignore the emergency vehicle altogether and just drive normally. Just this past Saturday (Oct. 26), a fire truck was coming down Columbia Road from the direction of Bobby Jones, close on the heels of an ambulance, both with lights and sirens activated. Following the ambulance, the fire truck pulled into the center lane to turn into the Spring Lakes neighborhood, but had to sit and wait for the driver of a black pickup truck that was barreling toward it well over the speed limit. Two cars in front of the pickup had ample time to stop. Had police witnessed the pickup, its driver would have been subject to a fine of up to $500 for failing to move over (assuming it was a first offense), 3 points on their license, plus court costs and other charges, to say nothing of the speeding violation and a separate citation for failure to yield to an emergency vehicle. It would have been a very expensive way to get to the traffic light in front of the Columbia Road Kroger (which was red), a full 20 seconds ahead of the vehicles which did lawfully stop. Let’s clarify the safe and legal responses to emergency vehicles in two situations: when they are traveling down the road en route to an emergency; and when they are stopped on the roadside. For a stopped police officer, fire fighter, tow truck driver, EMT or paramedic, the Move Over Law in Georgia does not specify left or right. It requires one of two options: 1. move into a lane not adjacent to the emergency vehicle(s), which could mean moving to the left if the emergency responders are on the right shoulder; or 2. if a lane change is not possible, slow down to a “reasonable and proper” speed below the posted speed limit appropriate to the traffic and situation. There is nothing wrong with doing both: move over and slow down. For responding emergency vehicles in traffic, “every other vehicle,” says Georgia law, shall promptly and safely move to the right and “shall stop” until the emergency or law enforcement vehicle has passed. In other words, “Move to the right for sirens and lights.” +

NOVEMBER 1, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

WHAT IS SAID VS HOW IT’S SAID

You’re talking to someone when you see it start to happen: Their eyes glaze over, they look past you, they’re shifting their feet. When you pause, they start talking about something completely unrelated to what you were saying, or start making their way to talk to someone else. It’s the kind of communication breakdown we all experience—and it makes us feel absolutely terrible. It can also cause a lot of relationship problems at home, at work and in our social lives. Communication breakdown is a big issue that’s even bigger because of technology. Texts, emails and Facebook all are different opportunities for miscommunication. Think about it: One short email could lead to the entire office talking about how rude or aggressive you are. And that email was completely and totally misunderstood. Most of us want to communicate better. But before we can, we need to understand what communication really means. Breaking Down Communication Communication really is all about what you say and how you say it: In other words, it’s verbal and nonverbal. It has to include active listening and knowing when to talk and when to shut up. For example, if your spouse is already stressed, it’s probably not a good time to tell him or her that you really didn’t like what they made for dinner. How you talk also really does matter—is your voice high or raised, or are you just talking about yourself and not pausing to let the other person talk? The first can seem aggressive or like yelling, and the second can just seem rude. If you’re facing the person, if you’re making eye contact and if you have a relaxed arm position, those are all signals to the other person that you’re connected. A Lot To Talk About Fixing all of those parts of communication can seem a little overwhelming. So if you know you’re having problems communicating, start with just one or two things. And know this: Being self aware is a great start all on its own. One easy thing you can try is reflexive listening, which means that you repeat back, in your own words, what someone just said to you. That shows that you really are listening, which is an important part of communication that people sometimes forget since we can be so focused on making our own point. Also work on your eye contact. Don’t glance at your phone, don’t look around the room at every interruption, but focus— but not in a creepy way!—on the person you’re talking to. On the other hand, if you’re the one who feels that you’re not being heard by a family member or friend, think about what it would take for you to feel heard. Then, in a kind way, let the other person know, because no one can read minds. The hope and expectation is that they’re not trying to ignore you, but be prepared in case of pushback. Talk about the fact that you really want to make how you communicate better—which in itself is communication. Also think about this: Could it be partly your fault that you’re not being heard? For example, are you bringing up a work problem with your spouse when she or he is really focused on taking care of your child, or is doing other work where it’s hard to split attention? Waiting until the other person can pay attention can make all the difference. Finally, if you’re having trouble communicating, don’t let yourself fall in the trap of hiding behind technology. Sure, it’s easier to send that text, but it’s much better for you to practice communicating well, especially if communication issues are something that’s really bothering you. After all, trust and communication are the two things that you must have for a great relationship. +

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

NOVEMBER 1, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Dr. 99 on gomerblog.com, “Earth’s Finest Medical Satire Site”

BREAKING NEWS: CPR TO REQUIRE PRIOR AUTHORIZATON WASHINGTON, D.C. – In breaking news that will infinitely complicate the already difficult process of attempting to resuscitate a patient, cardiopulmonary resuscitation (or CPR) will now require prior authorization. The prevailing reaction to this news is best captured by a local critical care physician at George Washington University Hospital, Dr. Felicia Martin-Lowry, as she crumbled into a bumbling mess of defeat: “No… no… NOOOOOOOO!!!!” Much like prior authorization requests for medications or other services, health care professionals will only learn about the need for a prior authorization right when CPR is initiated. The insurer will block CPR from continuing and the health care professional will need to go through the lengthy prior authorization process. “We need to make sure that the health care team tried some other interventions before jumping straight into CPR,” explained a spokesperson for a major national health insurance company, who preferred to wisely comment under the condition of anonymity. “Expect us to ask questions like, did you try oxygen? did you try IV fluids? did you try an antibiotic? did you try bicarb?” The person went on to say that the checklist of questions will border on somewhere between 700 and 800 questions. Insurance companies understand that CPR can be a lifesaving measure. For that reason if the insurer finds that all the appropriate steps were taken prior to the patient’s death, then they will be sure to expedite the prior authorization as an urgent request, and make the decision on whether or not to approve CPR in no less than 14 days. “Time is of the essence,” the spokesperson added, before reminding everyone that prior authorizations for CPR will only take place weekdays from 9 AM to 5 PM.

“We need to make sure the health care team tried other interventions before jumping straight to CPR.”

PATIENT CARE CITED AS MAJOR HINDRANCE TO WORKFLOW ATLANTA, GA – In a new study by the Centers of Disease Control & Prevention (CDC), patient care as been cited as the single major hindrance to workflow and possibly the greatest contributor to health care professional burnout. “Think about the prior causes of burnout: charting, prior authorizations, electronic medical records,” explained Director of the CDC Robert R. Redfield. “What is the common denominator? Patients. If there were no patients, there would be no need for progress notes, charting, paperwork, or medical records. Perhaps we’ve been approaching burnout from the wrong angle.” Recent research has estimated that only 20% of a resident’s time is spent on direct patient interaction and education; the other 80% involved indirect patient care in the form of documentation. Theoretically, eliminating patient care would free up not only the 20% of time in direct care but also the 80% of time in indirect care that depends on patient interaction in the first place. Prior attempts at solving burnout either at the individual or system level have failed. “I mean, we need something to change,” complained an anonymous health care professional. “It’s almost like 100% of my day’s tasks are related to patient care. What gives?!” +

“It’s almost like 100% of my day’s tasks are related to patient care. What gives?!”

Gomerblog.com is a medical satire site.

This is not a book for everyone, and we can all be thankful for that. No Time to Say Goodbye caught our eye first because of a little misunderstanding. A description of the book included two words: surviving suicide. Ah. A book about what it’s like to view your life as such an utter failure that you attempt to end it — and fail at even that. But that isn’t what this book is about. It’s about what it’s like for the people left behind when someone takes their own life. Author Carla Fine, sad to say, speaks from experience: her husband, a physician depressed over the recent deaths of his parents, committed suicide in 1989 at the age of 44. Ten years after, Fine’s book was published, and to this day it stands alone among the library of books on this very sad subject. That isn’t to say there isn’t a plethora of books about suicide. There is. What sets No Time apart is the absence of sterile clinical data, dry research, psychological analysis fit only for degreed professionals, and cold, distant factual analysis of the problem and its possible solutions. And it is a problem, a rather

large one at that: U.S. suicide rates have been inching up year by year since 2000. The 2016 tally of medical costs alone for U.S. suicides was $93.5 billion. But rather than explore statistics, Carla Fine makes this a very personal exploration. She spends her pages talking about the full-colored spectrum of emotions experienced by those left behind: grief, of course, but also confusion, guilt, humiliation, anger, shame, depression, shock... the list is almost endless. We have all experienced the death of a friend or loved one, but it’s safe to say no one understands quite what it’s like to lose a family member or close friend by suicide except someone who has been through

it. Suicide is completely different. You know how hard it is to know what to say when someone has lost a loved one to old age or cancer? Multiply that difficulty by ten when the cause is suicide. No one blames you when your marriage mate dies of cancer, but let the cause be suicide and people wonder if you somehow drove the person to it. Or why you didn’t see it coming and do something to prevent it. Fine writes about the maze of conflicting emotions, overcoming the stigma associated with suicide, sorting through the legal and financial issues, how and where to get help, and many other practical considerations, including how to deal with the question that may never have an answer: Why? This is a book that, like a fire extinguisher, you hope to never need, but if you do, you’re very glad to have — or to give to someone else who does. + No Time to Say Goodbye — Surviving the Suicide of a Loved One by Carla Fine, 272 pages, published in 1999 by Three Rivers Press

Research News Yogurt prevents lung cancer No, really. Vanderbilt University researchers say that people who eat one serving of yogurt per day lowered their risk for lung cancer by 20 percent compared to people who do not eat yogurt every day. Even better, they found that when a daily serving of yogurt is coupled with a high fiber diet, the risk of lung cancer is more than 30 percent lower. Their data analysis, published in JAMA Oncology, involved more than 1.4 million people. The Vanderbilt team believes the benefits come from probiotics found in yogurt and prebiotics found in high fiber diets. “Prebiotics,” says one article, “are a kind of fiber that is indigestible by the human body, and are food for probiotics.” Candy flavors part of epidemic A University of Southern California study published in Pediatrics earlier this week

(Oct. 28) identified candy- and fruit-flavored e-cigarettes as the type teens are most loyal to, and the flavors most likely to result in the heaviest vaping habits. Among teens who tried e-cigarettes, 90 percent chose fruit and candy flavors. Six months later the study found only about 43 percent of the smaller group who used menthol and tobacco flavors were still vaping. By comparison, over 64 percent who used fruit and candy flavors were still vaping. Regardless of the denials of e-cig makers and sellers that kids are not targeted by their marketing, the numbers in the USC study provide clear evidence of the appeal of fruit and candy flavors to young users. The flavors themselves offer additional evidence of who they are intended for. About Johnny’s bedtime... In a study released in the past week, the American

Academy of Pediatrics says fewer than half of school age children in the United States get enough sleep during the week. But among the kids who do get the amount of sleep they’re supposed to (47.6 percent of 6 to 17 yearolds), there is a significantly higher percentage who have a positive outlook toward school, learning, and even doing homework. They also display other signs of good social and behavioral health. Risk factors associated with insufficient sleep identified by AAP include lower levels of parental education, poverty, increased use of digital media, and the presence of adverse mental health conditions. AAP nightly sleep recommendations: • ages 13 to 18: 8 to 10 hours • ages 6 to 12: 9 to 12 hours • ages 3 to 5: 10 to 13 hours • ages 1 to 2: 11 to 14 hours • ages 4 to 12 months: 12 to 16 hours +

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AUGUSTAMEDICALEXAMiNER

The Examiners

NOVEMBER 1, 2019

THE MYSTERY WORD

Another day, another allegation of scandal in Washington.

What is it this time?

by Dan Pearson

The president supposedly If it’s true, threatened Japan’s fishing it sounds like industry unless their a clear case of prime minister helped him. squid pro quo.

Is this another It’s about a phone call to call like the one Japan’s prime minister. to Ukraine?

The Mystery Word for this issue: TURFECRA

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Pleat 5. Tear down 9. Subject for man on page 1 14. Woodwind 15. Anti (Dialect) 16. Rasp; shred 17. Ceremony 18. Tie up 19. Haggard 20. Unexplored or undiscovered land 23. Brain wave activity (abbrev) 24. Flash start 25. Experts; virtuosos 29. Boast 31. Romaine synonym 34. Cloth woven from flax 35. Voice of Princess Fiona 36. Quantity of medicine 37. Like sports in high school 40. Mondrian’s first name 41. Network of nerves 42. Fragrance 43. 2013 sci-fi film 44. Big party 45. Title of reverence for God 46. Clumsy person 47. Type of boat 48. Sharp spending cuts 56. Trunk of the human body 57. Meter prefix 58. Western state 59. Extraterrestrial 60. Partner of zeroes in code 61. Chip additives 62. 7 numbers above 12 63. Regard or consider 64. Jacob’s twin

E X A M I N E R

46 48

We’ll announce the winner in our next issue!

4 2 8 3 4

5 7 2 8 7 9

2 6 1 5

6 2

S 6 U D 1 O K U

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

DOWN 1. Kid’s cardboard structure 2. Off-Broadway award 3. Tolkien ltrs. 4. Animal on road signs 5. Viral disease afflicting dogs 6. We’re always doing it 7. Element in some skin ointments 8. Prefix meaning internal 9. Christmas drink 10. Distinguishing quality 11. High-class; elegant 12. Volcano in Sicily 13. Veteran’s abbrev. 21. Healthcare insurer 22. Muslim fighter (and “Ben” follower) 25. “A” of the Hebrew alphabet 26. Chicks adjective? 27. Word on many doors 28. Green bottle shampoo 29. Word before control or weight

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QUOTATIONPUZZLE

30. Infrequent 31. Part of the large intestine 32. Man killed on May 2, 2011 33. Inn for caravans 35. Membership fees 36. Former 5 peseta coin of Spain 38. _______ beer 39. Get something by begging 44. They’re used by conductors 45. Condition characterized by difficulty using language 46. Coworker of Kent and Lane 47. Number of rings in a circus? 48. Trunk of a tree 49. Great Lake 50. Apple music player 51. Mr. Sarazen 52. Au naturel 53. Inflammatory suffix 54. California valley 55. Old AU acronym 56. Make lace

E S I U A A O Y S I E T H T A N S R E S L A O G C E R I L U F B E I N G S R E L U N H A I

6 9 7 2 R 4 H 3 8 5 1

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— Fran Lebowitz

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

Solution p. 14

Use the letters provided at bottom to create words to solve the puzzle. 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.

T 1 2 3 4

1 2 3 1 2

1 2 3 4

T 1 2 3 4 5 1 2

C 1

O 1 2 3 4 5 4

1 3

2 1

U 1 2 3 4 5 6

3 2

A T 1 2

— A. Lincoln

1 2 3 4

1 . A A AT T T T T I C I B O F D 2 . O U A E I B N T T S H H H H 3 . AT M M E E Y E S O I 4 . U U T T N E E 5 . R G S T 6 . E

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

WORDS NUMBER

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, NOV. 11, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

boy is writing a paper on childbirth for school and asks his parents, “How was I born?” His mother awkwardly answers, “The stork brought you.” “Oh,” says the boy. “Well, how were you and Daddy born?” “The stork brought us, too, and Grandpa and Grandma.” The boy begins his paper, “This report has been very difficult to write due to the fact that there hasn’t been a natural childbirth in my family for three generations.” The four seasons were arguing about which of them was the best. Winter boasts, “Everyone knows snow is so beautiful. You can build snowmen. And Christmas!!! Everyone loves Christmas!” Spring laughs, “Sure, but come springtime, everything is so fresh and new! All the new flowers! It doesn’t get much better than that!” Summer says, “Yes, but I am the overall best season! Ice cream! Girls in bikinis! Nice weather! You can’t top me. What about you autumn, what do you have to offer?” Autumn leaves.

A young man in a supermarket noticed a little old lady following him around. If he stopped, she stopped, always staring at him. She was just ahead of him in the checkout lane, and as they waited for the customer ahead she turned to him and said,“I hope I haven’t made you feel ill at ease. It’s just that you look so much like my late son.” Very touched, he answered, “That’s okay.” “I know it’s silly, but if you’d call out, ‘Goodbye Mom’ as I walk out, it would make me feel so happy.” The man gladly agreed, and she then went through the checkout while he absently looked at the magazine rack. As she started to leave the checkout lane, she turned back and the man said, “Goodbye Mom!” The little old lady waved and smiled back at him sweetly. Pleased that he had brought a little sunshine into someone’s day, he stepped up to pay for his groceries. “It all comes to $151.43,” said the clerk. “What? That’s a lot of money for just 5 items.” The clerk replied, “Right, but your mother said you’d be paying for her things, too.” Moe: Why did the duck cross the road? Joe: Because the chicken retired and moved to Florida. Moe: I’ve squirted an entire bottle of No More Tears in my baby’s face. And she’s still crying! Joe: Parenting is hard. +

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

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

The

Dear Advice Doctor, About a year ago my parents died, leaving me an inheritance that included their large house – some would call it a mansion – but not a large amount of money. After a lot of debate, we decided to sell our house and move to the McMansion. Here’s the problem: we’re in a neighborhood where everyone is quite well-heeled, but despite the house we’re ordinary poor people. We aren’t like them and they aren’t like us, and it’s frequently awkward. Should we stay, or sell the house we just moved into? — Out of Our Element Dear Element, It’s amazing how many questions I get that at first glance might seem unique, but which actually apply to millions of people. Your question is yet another. You’re actually fortunate to live among so many well-heeled people. The are more than two dozen bones, 33 joints, and over 100 tendons in the foot and ankle. With that many moving parts the potential for trouble is abundant. And the heel is one of the most common sites of pain. First, let’s talk about prevention so you can be as well-heeled as your neighbors. Rule #1: wear properly fitting shoes! And wear appropriate shoes for each activity you’re engaged in; don’t take a brisk walk around the block wearing heels or wingtips. Stretch muscles before exercising, and maintain healthy weight so your feet are not overloaded with every step you take. If heel pain or any other foot discomfort arises, don’t try to power through it. Get off your feet, apply ice for 10 to 15 minutes a couple times a day, and take the OTC pain medication that works best for you. If the pain doesn’t get better or go away altogether, you should seek a doctor’s care. Other red flags, appropriately enough, include redness in your foot or heel, swelling, and severe pain, especially pain that prevents you from walking. Diagnosis and treatment might include X-rays, prescriptions for medications that ease pain and reduce swelling, shoe inserts or braces to support your heel, foot and ankle, and physical therapy. Surgery is rare, usually a last resort for the worst injuries. 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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Why read the Medical Examiner: Reason #371

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

BEFORE READING

AFTER READING

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THE MYSTERY SOLVED The Mystery Word in our last issue was: DIETARY ...cleverly hidden on the dress in the p. 15 ad for WOMEN AND PARKINSON’S

THE WINNER: KELLY McDANIEL! 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!

NOVEMBER 1, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED F O R T

O B I E

L O T R

A L E P H

D I X I E

E N T E R

B E T O R A L I T E E

D E E R A E P T E N R A T B O A L T S O E N N S

R A B I E S

A G I N G

D C U R E A S F T I P O D

Z I N C B I R T H G E N E

E N D O G H R A A Z R I E A T U H T R I E S E M

E G G N O G

T R A I T

D C U A R D O G E N U D E

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C O L O N

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G H S U

SEE PAGE 12

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

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

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

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QuotatioN QUOTATION PUZZLE SOLUTION

“In real life I assure you there is no such thing as algebra.” — Fran Lebowitz

WORDS BY NUMBER

“The best thing about the future is that it comes one day at a time.” — Abraham Lincoln

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NOVEMBER 1, 2019

IT’S A QUESTION OF CARE How do I stay connected with my loved ones as they age? by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and a Certified Advanced Social Work Case Manager.

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AUGUSTAMEDICALEXAMiNER As the people we love age, their ability to interact with us in what we consider to be a quality fashion often decreases. This is typically because their vision, memory and hearing are beginning to be compromised. Here are a few steps we can take to counteract that • Walk down memory lane. It can be helpful to talk with them about the past: their childhood, their early years working or married life, what it was like to travel (if they were blessed enough to do that) and raise children. We know that as our memory fades, the most recent memories fade the soonest while our remote memory is intact for much longer. • Engage through games. You can ask them to engage in a game with you, but choose one you know they’ve played in the past, as it might be difficult for them to learn a new activity. An example of this might be

a card game they used to play regularly or chess or checkers, as these are common games they probably would find simple if they have a history of playing it. • Be their date to events. You can attend social events with them, whether it’s inside or outside their home. If they reside in assisted living, you can attend events at the assisted living community with them. • Attend church together. You can take them to church with you or take them to their church and be their guest. This is a great way to spend time with your loved one in an environment in which they feel comfortable. • Make a day of it. You can provide support and spend time with your loved ones by attending doctor appointments with them. Go out for lunch or dinner afterwards to make an outing of it. +

TO SUPPORT MEDICAL EXAMINER ADVERTISERS

PROFESSIONAL DIRECTORY +

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

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AUGUSTAMEDICALEXAMiNER

HOLIDAYS… from page 9

Tips for Healthy Holidays When you splurge, do so with the foods you really want. Then, have a small portion. Pay attention to what you eat and drink. It adds up quickly. Look for the joy of the season—without food! Start a tradition that doesn’t have food as the focus. Give gifts such as handmade items instead of homemade food.

Glazed Green Beans Ingredients • 1/2 cup water • 1 clove garlic, finely chopped • 2 lbs fresh or frozen green beans • ¼ cup orange marmalade • 1 tablespoon chopped fresh rosemary leaves • 1/2 teaspoon cornstarch • 1/2 teaspoon salt • 2 tablespoons reduced fat butter or margarine Directions In 4-quart Dutch oven, heat water and garlic to boiling over medium-high heat. Add beans; cover and simmer over medium heat about 15 minutes or until tender. Drain if necessary. In small bowl, stir together marmalade, rosemary, cornstarch and salt; stir into beans. Add butter. Heat to boiling over medium heat, stirring occasionally until done. (from bettycrocker.com)

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Remember:

Life by the inch is a cinch. Life by the yard is hard. — Anonymous Check out these websites for more recipes and information: www.NIH.gov www.nhlbi.gov www.eatright.org www.diabetes.org www.americanheart.org www.mrsdash.com

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Highland Ave.

Think about what you want to ultimately achieve. What is your big goal? Think of that as your intention. For

example: eat healthy in 2020. What steps will you need to take to get to your goals? This is the specific action that will get you to your goal. For example: eat healthier snacks. Set a time frame for making sure you put into practice your specific steps. For example: I will eat a healthier snack on Tuesdays, Thursdays and Saturdays. Measure your progress. Monitor your actions by the steps you set. As you meet your little steps—you will get that much closer to your big goals! Accomplish your individual steps to success... and you will be encouraged. Work on achieving those big goals with small steps!

Ohio Ave.

New Year… New YOU! For many of us, this is the time of year to start thinking ahead about New Year’s resolutions… This might also be the time of year when you start thinking about how much (or how little) progress you made on 2019’s resolution. Here are some tips to help you set an effective New Year’s resolution:

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2. Do I really need this? If the answer is no, try to keep going and skip the tiny taste! Avoid this potential holiday pitfall that can impact weight and health.

NOVEMBER 1, 2019