Medical Examiner 11-18-22

THECHANGE

The debate has been raging for decades: should we keep changing clocks twice a year, or go with either standard or daylight saving time year-round?

Historically, changing clocks was a wartime measure. First introduced in this country near the end of World War I to save energy, daylight saving was repealed just six months later when the war ended, only to reemerge during World War II with the support of the US Department of Defense. It was nicknamed “war time,” and people spoke of Eastern War Time, Central War Time, and so on. It was again put to rest when that war ended.

Lest we forget, it was Richard Nixon (not Benjamin Franklin) who brought us daylight saving time, signing it into law in 1973 for a 2-year trial run. The exper iment was not considered a success, and President Gerald Ford signed legislation ending the trial period just 13 months later.

As we all know, however, it’s been back for some time. Opinions about it, like time zones, are all over the map. The majority vote seems to be in the Permanent Daylight Saving column. Major supporters include the travel, tourism, recreation and retail industries. They all believe that daylight saving will make their bottom lines more profitable. The general public also agrees, but for different reasons: we associate longer daylight hours with vacations, barbecues, picnics — in short, baseball, hot dogs and apple pie. We forget that we won’t be doing those things in winter no matter what the clock says (especially up north). It’s more about the thermometer.

Significantly, the medical community — mental health and sleep experts in par ticular — is one of the biggest supporters of year-round standard time. From the standpoint of biology, sleep experts say that for those who experience problems

It’s been a minute or two since we’ve had an installment of this long-running occasional series. In fact, want to hear something funny? The last installment of Body Parts appeared in our January 10, 2020 issue, intended to be the first in a year-long series about the human eye. After all, how many times does the year 20/20 roll around during an average lifetime, right?

Unexpectedly, a different health subject stole our attention for all of 2020, 2021, and a huge chunk of 2022. But we’re slowly getting back on track.

The topic for this Body Parts installment is shown above, both its chemical name and molecular structure. Those may not be huge clues to its identity, so here is some more information that may be similarly unhelpful:

This body part can be extremely dangerous. In fact, it can be lethal at high levels, but despite that awareness it is almost impossible to reduce or control. Any ideas what it might be? Find out on page 3.

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 12 year-old daughter is such a perfectionist that it is beginning to worry you. Everything in her room is exactly placed, and she gets upset if anything is moved. She won’t come out of her room in the morning until she is convinced that her clothes are perfect. You have seen her take as long as 15 minutes to get her shoelaces tied just the way she wants them. Recently she told you that she could not hurry to finish her dinner because she had to chew each bite exactly 36 times. Her grades, of course, are excellent, but if she makes a small error or misspelling, she will start the entire assignment over again. What do you do?

A. Some people are just perfectionists, and it looks like she’s going to be one of them. Don’t worry about her.

B. This sounds like a serious problem. Have her evaluated by a mental health professional.

C. Tell her that she is just being silly and that she needs to stop worrying so much about everything.

D. She’s just got too much free time. Get her involved in activities to take her mind off all her little quirks.

If you answered:

A. These behaviors, which are occurring in almost all areas of her life, are more than the harmless quirks of a perfection ist. They are signs of serious mental illness and she needs to be evaluated.

B. These are classic symptoms of an obsessive-compulsive disorder. You are right to take her to a mental health profes sional.

C. She is not being silly, and it is extremely unlikely that she could stop just because you tell her to. Actually, calling her silly may make the problem worse. She needs to be evalu ated by a mental health professional.

D. Activities are good for children, but this is more serious than having too much time on her hands. These are symp toms of serious mental illness. She needs to be evaluated.

It is sometimes difficult for parents to tell the difference between personality quirks and symptoms of mental illness. These behaviors are so extreme that she should be evaluated Dr. Proefrock is a retired local clinical and forensic child psychologist.

SUGAR MAKES

Parents have seen the evi dence with their own two eyes: fill their kids up with Halloween candy or birthday cake and they will be bouncing off the walls.

But medical scientists have eyes too, and they look at the slew of double-blind random ized trials investigating the link between sugar and hyperactivi ty and they say there is no link.

Let the battle begin.

A pediatrician might tell a parent, “Your belief in this link ignores a mountain of evi dence.” The parent might reply, “Your disbelief in the link ig nores a mountain of evidence.”

This type of standoff should come as no surprise. We’ve been watching opposing factions deny or question the beliefs presented by others since at least March of 2020. There

MY KIDS CRAZY!

is a definite “I don’t need your facts. I already have my own” thing going on, and it is not common for people to abandon their old “facts” after seeing new “facts.”

So take the following with a grain of salt (or sugar).

One professor of psychiatry who has extensively studied the subject called any connection between food and behavior “the biggest myth of all.” Others say the most convincing evidence against a food/behavior con nection is specific to sugar. Extensive studies have provided children with “well disguised dummy diets” created with and without sugar, running for extended periods of time, yet failing to observe or identify any connection between diet and behavior. One such study lasted

three weeks and used only pre-school and grade school children that had been identi fied by parents as sensitive to sugar. Despite that, no clear ev idence of any behavioral or test score differences surfaced that could be linked to high-sugar or low-sugar diets.

Many studies employ place bos to help ensure honest and impartial findings, and studies looking for hyperactivity links to sugar are no exception.

In one such example (there are many), parents observed their kids playing after they (the kids) had eaten candy and drank sugary beverages. Sure enough, the kids were hyper and a half, far more than nor mal as judged by the parents. The truth, of course, was that the drinks and candy were all sugar-free.

Experts say most children get too much sugar in their diets as is, so no one is advocating a give-kids-all-the-sugar-theywant approach. It’s not going to hurt anyone to reduce their sugar intake.

But the scientific evidence seems to be saying that sugar is getting the blame for behaviors that perhaps could be controlled with a time-out, or that could be evaluated by a pediatrician or mental health professional.

Or it might be just happy, boisterous play with no connec tion to diet whatsoever.

THEMWORD

That molecule on page one is melanin. We are all, every one of us, people of color thanks to the natural pigment known as mela nin that everyone has in varying degrees. Mel anin gives our skin its color, and is also why other select body parts like hair, lips, nipples, and the iris of our eyes have their own unique colors different from our main skin tone.

There are numerous types of melanin, each with it own unique structure and capabili ties. For example, the molecular structure of eumelanin, the most common type, makes it extremely effective at absorbing UV (ultravio let) light, thereby preventing UV radiation from damaging other cells. Pheomelanin, on the oth er hand, offers its UV protection by reflecting harmful rays. In effect, one type of melanin gathers in UV radiation and smothers it, while the other safely bounces it away.

Everyone has roughly the same amount of melanocytes, which are the cells that manu facture melanin, but not all melanocytes are created equal. Some people’s melanocytes pro duce almost no melanin, a condition known as albinism (alba being the Latin word for white). Generally speaking, more melanin means darker skin, eyes and hair; less melanin means fairer skin and lighter hair and eye colors.

While melanin production, and therefore the colors it produces, is largely genetic, melanocytes react to sun exposure by making more melanin. That’s a good thing since, as mentioned, melanin offers protection from harmful UV rays. Studies have connected more melanin and the resulting darker skin tones with lower rates of skin cancer. Melanin alone is not enough, however. One of the reasons is the lag time between sun exposure and tanning. The prudent course is wearing sunscreen and ap propriate clothing when exposed to the sun, and the longer the exposure, the more important additional protection becomes.

Variations in melanin can sometimes be classified as disorders. Vitiligo is once such condition, in which melanocytes completely stop production, but only in patches. Vitiligo affects people of all races, but it’s more ob vious in people with darker skin. Melanoma, the most serious type of skin cancer, grows in melanocytes. Exposure to UV radiation from the sun and tanning lamps and beds increases the risk of melanoma.

Even though a lack of melanin presents serious health risks, an abundance of melanin can create a completely different set of problems. People get killed

for having lots of melanin. They get nervous during traffic stops. Sometimes their job and loan applications are rejected and the reason isn’t their qualifications. Studies show that people with lots of melanin don’t get the same quality healthcare as people with less of it. They often suffer injustice from the justice sys tem. A particularly heinous example: a Florida jury in 2018 awarded 4 cents to the family of a black man shot and killed by police in an incident stemming from the man playing loud music in his garage. After talking to police who responded to the noise complaint, he went back in his garage. The officer fired the fatal shots through the man’s closed garage door. Or think about the almost 9 minutes during which George Floyd was asphixiated (as determined by a jury) on camera by a Minneapolis police officer.

And now think about that simple molecule of melanin on page one. It’s truly amazing that something that tiny — microscopic, actually — can be that powerful. Of course, a lot of that comes from you and me. We’ve given it that power; we can take it away too. +

OPEN ENROLLMENT? WHY?

It might seem illogical to allow people to sign up for medi care for only a few short weeks every year. Someone might think, “I wish I could do that, and then just go on vacation for ten-plus months every year.”

This year, open enrollment began on October 15 and ends on December 7. Here’s why that doesn’t work for a taco stand but it does work for Medicare.

Insurance is a unique business because its usefulness de pends upon a huge customer base, all making regular premium payments when they have no need for the services covered by their insurance. That pool of money is what the insurance company uses to pay $217,463.18 in medical charges that you ran up having surgery last month.

Open enrollment establishes a stable, fixed pool of premi um payers, allowing the insurance company’s experts (called actuaries) to calculate the statistical expectations of risk and then determine a premium rate based on the size of their cus tomer base that will allow them to pay for all the gallbladder removals, heart transplants, newborn babies, and broken arms expected over the coming year.

In a world without a fixed period of enrollments that lock in policyholders for a year, this is what would happen: peo ple would save money by not having insurance. If they start ed to feel a new ache or pain, they would sign up for health insurance and head to the doctor. After the doctor identified and repaired their medical problem for the aforementioned $217,463.18, they would cancel their insurance.

Preexisting conditions are not the issue they once were, so without the restriction of the enrollment periods we have, peo ple would sign up for insurance on an as-needed basis.

Even without medical issues in play, it’s not at all difficult to imagine masses of people dropping their insurance coverage when the economy is going south or when inflation is going north. “It’s either food or insurance right now.” Which one would you choose?

Paying for insurance isn’t exactly fun, but when millions of people do it, all those total strangers are putting money into a pot that will pay your medical bills. That’s actually pretty cool

MEDICALEXAMINER

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Who is this?

When you consider the size of viruses, it’s amazing that anyone could discover them without the aid of the most advanced high-tech tools of today. After all, it has been said that if people were the size of viruses, everyone in America could fit on the end of two pencil erasers —with plenty of room to spare.

And yet the gentleman above, Russian botanist Dmitri Ivanovsky, pulled off the feat in 1892. He was investigating a disease threatening tobacco plants when he discovered that sap from infected plants still carried the disease even after passing through a filter designed to remove even bacteria — the smallest then-known living organism. With that experiment came the discovery of viruses and the no doubt shocking realization that there are unimaginably small living things.

Ivanovsky’s discovery of submicroscopic infectious agents was nameless for about five years, until Dutch microbiologist Martinus Beijerinck replicated Ivanovsky’s experiments, infusing water through unglazed porcelain and coming out on the other side with water that still contained a pathogen. He dubbed the unseen agent a virus (from Latin, literally “slimy liquid, poison”) to describe the pathogen and to distinguish it from bacteria; he also formally labeled it contagium vivum fluidum, or contagious living fluid.

Together, Ivanovsky and Beijerinck are considered to be the founders of virology, but their discovery — viruses, that is — remained unseen for nearly half a century, awaiting the development of something stronger than a microscope. The very subject initially under investigation by Ivanovsky in 1892, tobacco mosaic disease, was first viewed by electron microscope in 1939, and was not established as a solid particle (rather than a “contagious living fluid”) until x-ray crystallography analysis in 1941.

In fact, viruses are not only not fluid; they are not living (but they are contagious...at least they got that right). Viruses are not independently living organisms; they only grow and reproduce inside the host cells they invade. Outside a host, a virus exists in a dormant state waiting for its next hijacking victim, whereas bacteria are independently living organisms that can generate energy, reproduce, move, and live just about anywhere. Bacteria are also frequently beneficial, while viruses live up to their etymology as poisonous and, well, pretty slimy too.

Here’s why: bacterial infections are usually localized, confined to just one part of the body (examples: ear infections, strep throat, urinary tract infections). If viruses also worked that way, someone might say they have the flu in their left shoulder, or perhaps AIDS, Ebola, or COVID-19 in their right lung. Instead, viruses cause systemic infections, making us miserable from head to toe. Viruses can even infect bacteria. These nasty little critters most often enter the body through the mouth and nose, or a break in the skin. All the more reason to wear masks when viral infections are raging, and to disinfect and cover cuts and scrapes. +

ON THE ROAD ON THE ROAD TO BETTER HEALTH

A PATIENT’S PERSPECTIVE

note: Augusta

by Marcia Ribble

Ph.D.,

I talked with my daughter today and she told me that she already had put her Christmas decorations up. She said the bright colors and twinkling lights help with the depression from it being dark so early. I laughed because I leave my tree up year round for the same reason. Whatever time of year it happens to be, it feels good to be able to take a few seconds from life’s craziness to simply enjoy something. What that something is usually is less important than the fact that it lifts one’s spirits without any (or only minimum) effort.

There is also the fact, for me at least, that my great granddaughter has loved seeing my tree since she was tiny. She learned her colors from the colors of its lights. She is allowed to take ornaments off and move them around. Now she is almost six and she still notices the tree every time she comes to visit. She still loves the balls, the angels, the crocheted snowflakes. The tree makes me happy and it makes her happy too.

I was lucky during the long lockdown to be an introvert who learned at a young age to value silence and to find enough things in my home to keep me contented most of the time. I can happily spend time just noticing how the wind often doesn’t move all the trees simultaneously but plays among them, stirring one branch or one tree before moving on to other trees and other branches. I can watch to see how the clouds cast shadows on the ground and then move on. One time I wrote a poem about how it seemed that the shadows were swallowing cars and spitting them out. The other day when it was raining so hard, I

watched as the water ran down the street and wondered if it would capture the trash cans and send them scurrying down the street in a row.

That actually happened a number of years ago when my granddaughter Sara and I were sitting on her front porch watching it rain, and suddenly a whole line of trash cans paraded down the street in front of us. There must have been five or six of them, like tall green soldiers, marching on their wet parade grounds. We sat there snuggling against the wet chill in the air and giggled.

Life is like that, isn’t it? Here we were sheltering from the storm when nature threw a parade of trash cans into our view and set us laughing.

It was definitely hard to be quarantined, like it was hard for her to be restricted from running and playing by the downpour. But if we pay attention, life will throw unexpected delights in our direction.

Yesterday I noticed that what was only a wee smidgen of a tree last year had not only grown much taller over the summer but was sporting a profusion of canary yellow leaves. This year, thanks to the rain we’ve had, my trees haven’t just turned brown and fallen off the trees, there are actually colors in them. That’s a real treat for a former northerner used to spectacular fall colors.

So find a little joy in the everyday, the ordinary, the commonplace, because there is true value and delight there.

Editor’s note: This installment of A Patient’s Perspective appeared in a previous edition of the Medical Examiner.

Editor’s

writer Marcia Ribble,

is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com

M. Beijerinck, 1851-1931

BY J.B. COLLUM

Middle Age

The last time we visited in this column I shared that, like most folks who reach middle age, I sometimes have lapses of memory and I lose things. I saw a T-shirt the other day that I liked. It said, “I fix things, and I know stuff.” I thought that described me pretty well, but I think maybe a better T-shirt for me would say, “I lose things, and I forget stuff.”

As I mentioned in the last issue, I lost a really nice new Milwaukee multi-bit screw driver and ended up buying a replacement. I have a follow up. This past week while looking for another tool I came across my estranged screwdriver. It was a joyous re union. According to my wife, it was in the one place I was most likely not to find it. My toolbox! Yes. In the toolbox I carry under the backseat of my truck. Before you ask, yes, I did look there! At least three times! How did this hap pen? Let me explain further.

way it was in there or perhaps had ever been in there, only to have her sigh, drop what she is doing, stomp over to the fridge, find it im mediately, and then gently and kindly, slam it down on the island, giving me a look that is probably illegal in some countries and most likely lethal to lesser men, but I’ve become immune to it.

On Sept. 29 the Georgia Primary Care Association (GPCA) named one of the Medical Examiner’s sponsoring advertisers, Medical Associates Plus (MAP), as the winner of the Com munity Health Center of the Year Award during GPCA’s 45th anniversary annual conference.

“Medical Associates Plus,” said GPCA in a press release, “has been one of the fastest-growing — if not the fastest — Federally Qualified Health Centers in Georgia for the past few years.” Since 2015, notes GPCA, MAP has expanded from one clinic to 16, plus two mobile units, one of which provides dental, medical, and behavioral health services to students at local schools, the other providing COVID-19 testing and vaccinations to the community. During the same 6-year peri od, MAP staff numbers grew from 36 to more than 250 and patient visits surged to almost 86,000 from a previous level of 18,000.

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MY WIFE GAVE ME A LOOK THAT WOULD BE LETHAL TO A LESSER MAN

Earlier, when I was overturning everything in my quest to find the wayward screwdriver, the first place I looked was in the aforemen tioned toolbox. It is really more of an open, stiff-sided tool bag really. It has a rigid handle that runs across the top from one side to the other, and beneath that, it is an open contain er for tools. Around the edges, are little pock ets to put things into. Things like wrenches, pliers, and yes, screwdrivers. I found the runaway screwdriver in one of those pouches, on the opposite side of the door that I usually open to get to the toolbox, the driver’s side rear door. I had reached over there before and felt around for it, but somehow managed to miss it every time. Now that I was looking for something else entirely, of course, I found it. Don’t get me wrong. I am glad I found it and now I have a really nice multi-bit screwdriver in my toolbox in my truck, and I put the replacement one in the camper. If I can’t find either at some future point, at least I have improved my odds of finding a screwdriver. Come to think of it, I believe that the next time I can’t find a tool, I will hire one of the leading trackers in the world, my wife.

I must admit, once I found out that behind the beautiful exterior of my better half lurks a steely-eyed, no-nonsense, real-life tracker, I sometimes give up on a search a little early and allow her to flex her search muscles. Why not? After all, she is so amazing at it. I can’t tell you how many times I have looked through the refrigerator for something and been convinced that there was absolutely no

I have found that there is an upside to los ing things. Let me explain. Last week, while we were camping up at Amicalola Falls State Park near Dawsonville, Georgia, I kept dropping my phone and other things down between the cracks of my recliner (a recliner in a camper? I know). Anyway, I’m not sure why it happens to me so much lately, but perhaps it is the fact that my belly is nice and round and so offers no impediment to arrest the fall. If I had a six-pack abdomen, the ridges would perhaps stop this from happening, but I like good food, so that is not likely to change. Ah, but I digress. The first time this happened on our camping trip, I got down on the floor with the footrest of the recliner up and a flashlight in my hand, and I retrieved my phone. While doing that, I spotted a small flashlight I had lost on our very first camping trip in this RV. When we got home from that trip I retraced my steps looking for that flash light so many times that I wore a rut in the grass between the house and the camper. I thought it must have fallen out of my pocket, and I was right, but it had happened while in the recliner, not while walking. I charged the little flashlight up and was tickled when it worked as good as new. Now I can lose it again somewhere else later.

Well, that is all we have space for this issue. I hope all of you and your families are doing well, and I hope your journey into, through, or past middle age hasn’t left too many lost things along the way, but if it has, don’t worry about it too much. They’re just things, and you can probably buy more. Instead, focus on the loved ones in your life. When they are gone, you can’t just go buy another. Unless they are goldfish, you can al ways buy more of them, but how would you lose a goldfish? Hold my beer!

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

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In short, the emphasis at Medical Associates Plus definitely seems to be on the Plus.

CHANGE

from page 1

from Seasonal Affective Disorder or SAD (depression associated with shorter days and lack of light in winter) or other related mood disorders, morning light is more effective in treatment. In other words, daylight saving and its light periods provides more light late in the day when it is less effective, and less light early in the day when it would be more therapeutically effective.

Of course, it isn’t necessary to have a diagnosed disorder of some kind to experience sleep disruptions caused by our twice-yearly clock changes. All of us get a little disoriented in sleep-wake cycles when time changes. Many body systems have direct links to circadian rhythms and sometimes without even be ing aware of it, we change our habits. For example, people tend to eat more during colder months, and sometimes we take as many signals from light as we do from the thermometer. It might still be 75° outside as it was just last week, but it’s already dark by suppertime and we perhaps subconsciously lapse into hiber nation preparation mode: loading up on calories in anticipation of those long, dark, cold winter nights.

That phenomenon highlights something else about the time change: being indoors more this time of year cuts down on the amount of exercise many people get. We’re indoors more, where drier, heated air helps promote ideal conditions for cold and flu season, along with closer proximity to others, since we’re all indoors more.

When everything is added up, this time of year can (and does) spell sleep disruptions, fatigue, overeating (with a significant assist from holidays), weight gain, reduced exercise, peak season for colds and flu, Naturally, all of these factors can’t be blamed on either standard or daylight saving time. They’re just one more ingredient in a time of year when we might have to work a little harder than normal to stay salubrious.

Times are uncertain, liter ally and figuratively. Inflation worldwide is rattling individu al security. Excluding migrant population (which is growing by a few thousand per day), the US population is aging because seniors are living longer. That has been the case for a few decades. But con trary to expectations, for the first time in decades projected life expectancy in the US has decreased by about 4 years over the past decade. Sooner or later, we must hit a top life expectancy. I can almost hear our heads bumping the ceiling.

Why has this happened? The answer is not simple. It is not because we lack med ical knowledge. Or medical facilities. Or trained personnel. Or effective therapeutic drug availability. We have the best in the world in all of these.

One of our problems is the availability of savory foods, but these may not be the most appropriate foods to consume for longevity. Most of us, me included, prefer foods that “taste good.” I prefer cake

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy Laveau

over biscuits. Fruits are good for us. So is milk. And grains and nuts. But somehow, I pre fer the addition of sugar and cream converting it to straw berry short cake. That is good to me, not good for me.

Long ago, legend has it that Britain’s Earl of Sandwich was so addicted to gambling that he refused to leave the gam bling tables. They brought him food ensconced between two pieces of bread. He ate without his hands transferring grease to gambling chips. Problem solved. Thus, the invention of the “sandwich.” Sandwiches became the standard for the New World. We make sand wiches of everything: meats, fruits, vegetables, jellies. As kids, my brother and I ate syr

up and rice sandwiches. Em pires are built upon sandwich es. McDonald’s. Sonic. Arby’s. Burger King. No dishwashing needed. Paper plates and cups, plastic single-use spoons and forks. Even “sporks.” We seem to be committing “sandwich suicide.”

World War II addict ed soldiers, and later their families, to beef as a major dietary component. That was good and bad. Good source of protein. Good taste. Easily preserved. Fits in thousands of recipes. Longevity increased. Our government was forced to respond. Moved Medicare retirement age from 65 to 66.5. But cholesterol levels gradually elevated in our population. So did heart attacks. And strokes. All at a later age.

We seem to have hit a peak of longevity. Quality of life is a factor. Good medical care can keep you breathing longer, even past the point of active life. No one wants to die. No one wants their elder to die. We want to hold on “as long as possible.” Certainly I do.

As our population increases (both internally and from im migration), there is a great de mand for additional food. The food supply chain is a prob lem. We need more chicken houses. One family who has been in the chicken business for 70 years has nine chicken houses, each one home to 20,000 chickens producing over 1.5 million pounds of chicken every 8 weeks.

Regulations have pushed the cost of a new chicken house to over $250,000. Per house. Millions of chickens create an expensive waste management problem. The same is true with the beef industry. Australia is imple menting a “cow burp tax” (a euphemistic term for sure) due to the amount of methane gas produced by the cows. Governments tax everything as if that is a solution. I wonder if we will soon have a “Chicken Litter tax.” Another euphemistic term.

One solution is for our population to eat less food. And healthier foods. When I grew up, we only had des sert after lunch on Sunday. One pie or one cake for two

adults and two growing boys … for the week! It does not cost more money to eat less. The intake of purified sugar will go down. Food budgets will decrease. Waistlines will decrease. Obesity will de crease. Premature deaths will decrease. Quality of life will increase. No one in his right mind is against any of that.

Recently I saw a 1950s crowd photo of about 50 people (of all ages, from no teeth to not teeth) on the boardwalk in New Jersey. Something was really strange. Then it hit me: there was not one overweight person in the photo. Not one.

Back in the 60s, the hippies had one thing right: Think Globally. Act Locally.

We must act locally. We must act to improve person ally. We must eat properly. Eat less. Save your money. Improve your health. Enhance your quality of life. Diminish your perils. Drive less. Walk more. Biscuits over cakes, for heavens sake.

This is money in the bank, literally and figuratively, in these hard times of uncer tainty +

TRYTHISDISH

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

Here is a fun one to get you into the holidays. This chili recipe comes together quickly and then cooks all day for even more flavor.

Ingredients

• 1 teaspoon extra-virgin olive oil

• 1 small onion diced

• 2 tablespoon minced garlic

• 1 small bell pepper diced

• 2 jalapeno peppers seeded and diced

• 1 lb ground turkey breast

• 1 14.5 oz can Great northern beans drained and rinsed

• 1 14.5 oz can pumpkin puree

• 1 4 oz can diced green chilies drained

• 2 cups low sodium chicken broth

• 1.5 teaspoon cumin

• 1 teaspoon cinnamon

• 1 teaspoon chili powder

• 0.5 teaspoon dried oregano

• 0.5 teaspoon coriander

Directions

In a large sauté pan, heat the oil over medium high heat. Add the onion and garlic and cook until onion is soft, about 3 minutes. Add the bell pepper and jalapeno pepper, cooking for an additional 3 minutes. Add the ground tur key breast and cook until brown and no longer pink. Stir often to crumble.

Transfer turkey mixture into the

by Ken Wilson Steppingstones to Recovery

“…Catch a tiger by the toe, If he hollers let him go, Eeny Meeny Miny Moe!” Remem ber? The process of elimina tion using luck of the draw. No IQ necessary.

I’m reminded of the game sometimes when the phone rings at the office and I hear “I’m trying to find an inpa tient treatment program for my husband – can you please help? I’ve been calling places for days! He really needs inpatient!”

We’re literally inundated with such queries and are always glad to help. Most of the callers are prepared to admit their loved one to the first place that will take them – luck-of-the-draw style.

Unlike getting a standard flu shot at any drugstore,

substance treatment is the Wild Wild West of the medi cal field. “Rehab” has dif ferent meanings to different people. I’ve had people say “I just got out of rehab,” when they really mean “I was just discharged from the hospi tal after a 3-day detox from alcohol.” To others, “rehab” means a year-long sober living experience. What is “rehab” anyway?

Regrettably, unlike most standards — for minutes, inches, gallons, etc. — there is no go-to for such a defini tion.

And who knows? Maybe your family member doesn’t even need “inpatient” rehab. Maybe you’re the one who needs them to be gone for awhile! I get that. Living with an addict or alcoholic is not a pretty picture sometimes.

First, I’d suggest that you

find a qualified (did I say qualified???) professional to complete an evaluation with the affected person using standardized (tested & proven) diagnostic questions asked in a professional and non-judgmental manner. I really shouldn’t have to say that, but I really do have to say that. In an ideal world that would mean a medical doctor who is informed about substance abuse disorders or a certified/licensed counselor with education and experi ence, or a person in longterm recovery who has been there/done that.

Though your loved one might not consent, it is always helpful to a therapist to have input from a family member on the diagnostic questions. I’ve interviewed, for instance, many an alco holic in the past and recom

mended “No Treatment,” or attendance at support groups only — until I spoke with their spouse! Whew! Are we talking about the same person here?

This scenario illustrates a key fact – the primary earmark of alcoholism or addiction is Denial – not a lie because by definition denial is subconscious.

Everybody else can see the facts, but the affected person cannot and will not as the mind’s mechanism for pro tecting itself is in full bore. And coming out of denial is not a pretty picture ei ther – when the mind finally realizes the bald truth and is brutally shamed by the facts.

Maybe you don’t want to go through this work and want to hire someone to help you with it. There are professional, certified inter ventionists that can be found online or who network with many inpatient treatment centers who will come to your city and meet with you

and significant individuals in your loved one’s life and gather information, and in the course of 2-3 days will help you do an Intervention for your loved one.

“Intervention” – to stop in one’s tracks to avoid progres sion into a worsened medical condition. Almost like an arrest.

Once again, we’ll need to take this up again where I’m leaving off today so you can be better equipped to do your loving job. This is a matter of life and death, not just using or not using.

Or you could just play Eeny Meeny Miny Mo and see what you end up with.

the blog spot

NOT LISTENING CAN BE LIFE & DEATH

Paula came to my office a few months after burying her hus band. She and John had been inseparable. They were both my patients, so I knew John had spent the last six months battling lung cancer. They had been married forty-five years when John died. I sincerely offered Paula my condolences on that Monday afternoon. She shared how she missed John terribly.

When Paula came in for a follow-up appointment sometime later, I happened to be short on time. I had a full schedule of patients to see. As usual, I was tired, in my mid-career focus to keep the practice afloat. I was polite but a little conde scending when she told me she was planning to run a marathon to honor John’s memory. I didn’t take much notice when she shared her intentions. I figured they were just that, intentions that would not materialize.

My skepticism was not without reason. Paula had never run before in her life. She never exerted herself physically much at all. Cynically, I didn’t think there was any chance she would make it. I could not imagine that a woman over sixty could suddenly find her passion for exercise and running, particularly in a full-length marathon.

A few months passed before I heard from Paula again. She looked youthful, reinvigorated. She had finished a marathon. In fact, she was running all the time now.

After telling me about her marathon, Paula suddenly paused and became serious. She told me that she didn’t really run to honor her husband’s memory. She was determined to run a marathon as a way of killing herself by exerting herself beyond her tolerance.

Paula had grown severely depressed after her husband’s death. Suicidal, she’d grown up religious, and frankly, she was scared to kill herself in a violent way. She thought if she just pushed herself too hard physically, without any training, her body would give out, and she could end her life.

I had missed all the signs. Paula had come to me, her care giver, and I had cavalierly brushed her aside because I was too busy and too tired to care. Of course, I was polite and examined her joint pains, but I wasn’t really listening to my patient. I couldn’t see what she was going through, and I should have.

These days, it is easy to get burned out as a physician. We rush from one appointment to the next, checking the boxes, too distracted to look beyond the chart. A patient’s pain is more than the physical pain they report to us on a scale of one to ten. In fact, we might be the only person in their lives with whom they have confidence in sharing their struggles.

In our profession, we must make time to listen to every patient and show empathy. Somehow, we must find the time to communicate the message that life is worth living and that there is a purpose in life, even when we lose a loved one. We should try to see their sadness even as they try to hide it from us. Let’s make sure we, as physicians and caregivers, take the necessary steps to recognize the signs and symptoms of depression to help our patients avoid becoming victims of that state. It is critical and relevant that those patients can feel safe asking for help.

Thankfully, Paula didn’t kill herself running a marathon with out any training. She finished by sheer force of will and unex pectedly gave herself new purpose. She continued running well into her seventies and got healthier and happier. But the fact remains that this story could have ended differently and tragi cally. The nature of our work makes it easy at times to remain at a superficial level with our patients—to be polite without really being human. I think it is our duty to take the intentional approach and strive to really listen. We won’t hear everything, of course, but there will be those times when we understand the real cry for help and make a difference.

Francisco M. Torres is an interventional physiatrist

Excerpts from Amazon.com reviews of this book

READER: This book is amazing from every angle! Anyone who’s searched through Amazon or any bookstore knows there are mountains of self-help books out there. How do you choose? As a practicing psychotherapist (and someone who’s had years of my own therapy), I’ve tended to steer my clients away from self-help books because they usually oversimplify issues and promote unrealistic expectations which actually sabotage growth. At last, here’s a self-help book I can heartily recommend to clients, friends, family, or anyone who asks! This is a one-of-a-kind book which addresses the depth and complexity of human psychology in astonishingly clear, graspable language which the everyday reader will relate to. Along with providing a pretty fascinating review of the most powerful ideas in psychoanalytic thought, it also gives the reader concrete and effective exercises that promote growth and change. The book keeps getting better as it goes on. It ends by giving

the reader a picture of what it is to be “healthy,” as opposed to “perfect.” Dr. Burgo goes out of his way to show the reader that a person never arrives at personal perfection. He acknowledges change is hard work, but that the rewards of getting out from under the oppression of one’s defenses are well worth the effort. Likewise, you’ll find this book is well worth the read!

READER: As a practicing psychoanalyst, I found that this book tackles complex matters of the human condition and the workings of our minds in a highly sensitive and forthright way. Its pages are full of clear and detailed understanding of the many extraordinarily human ways we undermine our own emotional growth

and instead adhere to selfdeceptions. Dr. Burgo brings much compassion as well as a gentle but firm nudge to take any new self-understandings gleaned while reading, and with his helpful and probing questions and exercises, to actually develop in new ways. The candor and wisdom found in this well crafted and jargonfree book will be an immensely useful tool for growth as an adjunct to those already in psychotherapy or for those who can not access or afford quality treatment.

AMAZON REVIEW: Why Do I Do That? is a self-help book for people who don’t usually buy self-help books. Instead of offering cognitive-behavioral techniques for dealing with anger, or affirming strategies to boost self-esteem, this self-help book adapts the basic methods of psychotherapy to a guided course in self-exploration, highlighting the universal role of defense mechanisms in warding off emotional pain.

Why Do I Do That?, by Joseph Burgo, Ph.D., 242 pages, published in 2012 by New Rise Press

posted by Francisco M. Torres, MD, on Nov. 7, 2022 (Edited for space)

CRASH COURSE

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

ne of the things that always makes November special is...well, you already know what we’re about to say: Drowsy Driv ing Prevention Week.

Yes, DDPW is a big deal, and rightfully so. Thousands of Americans die every year in hundreds of thousands of crashes involving drowsy drivers according to the Nation al Sleep Foundation and the National Highway Traffic Safety Administration.

If a person is sleep deprived — or just simply sleepy despite their solid 8 hours last night — their risk of being in a collision triples Someone might be a raging crusader against drinking and driving, but if they drive while drowsy, they can have the same poor level of inattention, depressed awareness, and delayed reaction times as a drunk driver.

You know how some people can be so dumb that they have no idea how dumb they are (the Dunning-Kruger effect)? The same principle can arise in drowsy driving: people are too fatigued to recognize their level of fatigue.

It is a serious problem, and the very next drowsy driving crash just might involve the #1 perkiest driver on the roads today. A problem this big is bound to involve inno cent people — and it is big: it was mentioned above that there are hundreds of thousands of drowsy driving crashes in the US every year. The exact estimate (if there is such a thing) is 328,000, according to the AAA Foundation for Traffic Safety. Presumably, the vast majority of drowsy drivers manage to make it to their destinations without causing a crash. But if there are well over 300,000 wrecks, there must be millions of incidents of drowsy driving cases during the year. Of course, no one — not even the person who is driving home from a double shift or who was up all night with a sick baby — thinks they will be the one who causes a serious or even

fatal wreck. It’s always the other guy. Until it isn’t that is.

By survey, 95 percent of Americans think drowsy driving is dangerous (the other 5 per cent surely slept through the survey), but 62 percent of drivers admit to driving when they were so tired they had a hard time keeping their eyes open. And there is a supreme ly overconfident group who thinks they could drive safely even of they got just 2 hours of sleep or less the previous night. That is an example of the Dunning-Kruger effect.

The National Sleep Foundation says this in reference to drowsy driving: “We’ll go as far as saying that drivers who’ve only slept 3 to 5 hours in the last 24 hours are unfit to drive.”

Those are strong words, but they might be just the ticket to wake up (pun intended) those drivers who have a casual approach to drowsy driving.

What are some solutions to this serious threat to highway safety for everyone, wheth er well-rested or asleep at the wheel?

• As the song goes, “if you’re sleepy and you know it slap your face...” Stop at a safe place and splash some ice cold water in your face. Awareness is the first step toward awareness (the opposite of Dunning-Kruger).

• Along with recognition, face the fact that in some situations you simply cannot drive. Call in. Pull over. Take a nap. Whatever it takes. Arrive an hour or two later. Life will go on (literally).

• Talk to your doctor if you’re taking medi cine that causes or contributes to drowsiness. Find an alternative without that side effect.

• Employers can include the topic in safety training. Some encourage carpooling as a deterrent to sleepiness when driving.

• The best solution to drowsy driving might be the simplest and most obvious: get a good night’s rest every night. +

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THANKS ALSO TO OUR CONTEST CO-SPONSOR: LOOK FOR THE MYSTERY WORD IN EVERY ISSUE!

PATIENT HERO

by Samantha Bowick, MPH, Board Certified Patient Advocate

ALPHA-1 ANTITRYPSIN DEFICIENCY

November is Alpha-1 Antitrypsin Deficiency Awareness Month. Alpha-1 antitrypsin deficiency occurs when there isn’t enough alpha-1 antitrypsin protein in the blood. The alpha-1 antitrypsin protein is needed to help the liver and lungs function optimally.

Alpha-1 is a chronic genetic condition that runs in families. Someone who has alpha-1 has two Z genes (ZZ). There are also M genes involved, which means someone doesn’t have alpha-1 and S genes, which are deficient genes, but they don’t seem to be as deficient as Z genes. Along with ZZ, gene combinations include MM, MZ, MS, and SS. One parent passes on one of their genes to their children. This means if one parent is MM and the other parent is ZZ, the child will be MZ. This child is said to be a carrier, but more studies need to be conducted to determine

how carriers are affected. Someone who is MS is also a carrier.

Symptoms of alpha-1 antitrypsin deficiency can include shortness of breath and trouble breathing, low lung function, lower oxygen saturation levels, coughing, excessive mucus production, chest pain with breathing, wheezing, an increase in re spiratory infections, fatigue and tiredness, low energy, loss of appetite, weight loss, jaundice, fluid retention, as well as others depending on if the lungs or liver are affected. Some patients may only have lung issues while other patients may have liv er or lung and liver issues. It depends on each patient.

Alpha-1 is often misdiag nosed as chronic obstructive pulmonary disease (COPD), or emphysema. Without alpha-1 testing, symptoms of alpha-1 look like symptoms of other illnesses which are easier to diagnose. With

greater awareness, more people could have alpha-1 antitrypsin deficiency than are known. People can ask their doctors to test for al pha-1 antitrypsin deficiency and there are also other ave nues for testing like 23and Me that can detect a variant. Patients can have their lung function tested as well as liver testing to determine if they have lung and/or liver issues.

Treatment options for alpha-1 antitrypsin deficien cy include augmentation therapy, inhalers, nebulizer treatments, supplemental oxygen, percussion vest, pulmonary rehabilitation, steroids, diuretics, anti biotics, as well as others.

Augmentation therapy is an infusion that can be given at set intervals (weekly most likely) at home or an infu sion center depending on insurance and the patient. Patients may have a nurse give them the infusion or they may learn how to give the infusion to themselves.

Augmentation therapy is hu man plasma from donations

that has alpha-1 antitrypsin protein to slow the progres sion of the deficiency. It is not a cure as there is no cure for alpha-1 antitrypsin deficiency. Inhalers, nebu lizer treatments, and sup plemental oxygen can help with shortness of breath, low oxygen saturation lev els, and decreasing mucus production. A percussion vest can help with mucus production and coughing up mucus because the vest produces vibrations. Pulmo nary rehabilitation can help patients learn breathing techniques that allow them to use their lungs, help with lung function, and improve quality of life. Steroids, diuretics, and antibiotics can help with infections and exacerbations.

Personally, my mom has alpha-1 antitrypsin defi ciency and my uncle who passed away in 2018 had it. They are both ZZ. My dad is MM so my sister and I are both MZ carriers. My sister and I have been tested to see where our alpha-1 level is to get a baseline in case

we need some form of treat ment in the future.

People who have alpha-1 may not be able to be around strong smells and smoke. They may be on disability depending on the severity of their case. They may be hospitalized because of infections, breathing, and liver issues. Because this is not a well-known condi tion, patients may have to travel for proper care, which comes with barriers to re ceiving care. Patients some times also run into doctors who allow their egos to get in the way of treating patients, which is why it is important for patients to advocate for themselves by researching as much as possible.

Resources

alpha1.org The Alpha-1 Foundation

Living with Alpha-1 Anti trypsin Deficiency: The Com plete Guide to Risk Factors, Symptoms, and Treatment Options by Samantha Bo wick and Marie Bowick

THE

WORD

The Mystery Word for this issue: LORFVA 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

Solution on page 14.

EXAMINER CROSSWORD

EXAMINER CROSSWORD

THEBESTMEDICINE

Moe: Every country in the world eventually got coronavirus.

Joe: True, but China got it right off the bat.

Moe: My opthalmologist told me my test results were not good.

Joe: Did you ask if you could see the results?

Moe: I did. He said probably not.

MEDICAL EXAMINER DICTIONARY

Acat having a bad day walks into a bar and orders a shot of whiskey. The bartender puts it on the counter and the cat slowly nudg es the shot glass to the edge of the bar and over. The glass shatters when it hits the floor. The cat looks up at the bartender and says leave the bottle. I’m not done yet.

Moe: What’s the diff between grey and gray?

Joe: One is a color and the other is a colour.

Moe: 2012: Didn’t jog.

2013: Didn’t jog.

2014: Didn’t jog.

2015: Didn’t jog.

2016: Didn’t jog.

2017: Didn’t jog.

2018: Didn’t jog.

2019: Didn’t jog.

2020: Didn’t jog.

2021: Didn’t jog.

2022: Still haven’t jogged.

Joe: Uh, what are you doing?

Moe: It’s a running joke. Get it?

Joe: You mean a not running joke?

Abdicate (verb) to give up all hope of ever hav ing a flat stomach

Balderdash (noun) a rapidly receding hairline Coffee (noun) the person upon whom one coughs

Flabbergasted (adj) astonished by how much weight you have gained

Flatulence (noun) the specialized emergency vehicle that picks up people run over by steam rollers

Negligent (adj) absent-mindedly answering the door in a flimsy nightgown

Moe: Are you going to run the Augusta Iron man next year?

Joe: I’m flattered, but I don’t think I could organize and manage an event that big. But thank you for asking

Moe: Knock, knock.

Joe: Who’s there?

Moe: Europe.

Joe: Europe who?

Moe: Am not!

If you’re ever being chased by evil taxidermists whatever you do, do not play dead

Dear Advice Doctor,

The Advice Doctor

Earlier this year we had a new hire that I was tasked with training. After all the training was done, she quit! As if that wasn’t bad enough, they just rehired her yesterday — and I’m supposed to train her all over again on stuff that’s like riding a bike: once you learn it you don’t forget. It’s super simple. I feel like refusing, but I don’t want to get in trouble. Can you suggest a compromise?

Dear Train Wreck,

— Wanting to avoid a train wreck

This is an issue that most readers can relate to. You make an excellent point: riding a bike isn’t one of those things we unlearn. Once you know how, you know how for the rest of your life.

But somehow the years and the decades slip by, and pretty soon we haven’t been on a bike in years. And perhaps by a strange coincidence, we’re not too crazy about getting on a set of scales either. Yes, there can be a connection between the two.

There are many good reasons to get out and ride, and I’m particularly happy that you raised this question now, when we can enjoy outdoor recreation in cooler weather. It’s the perfect time to establish a good habit. Bicycling is an exercise that is infinitely customizable, meaning you can tailor the distance and speed to exactly what you’re comfortable with when first getting started.

Biking is a muscle-builder, but it’s considered low-impact, so it isn’t hard on joints. It is also an exercise that people can enjoy on the coldest, iciest day of winter and the hottest, sweatiest, rainiest day of summer — if they have a stationary or recumbent bike at home for indoor rides.

So we have established that bicycling is a doable exercise. What about the whys: why would someone want to start regularly bicycling, whether outdoors or in?

As alluded to above, it can help people lose weight. Hundreds of clinical studies have demonstrated that cycling can help lower bad cholesterol and raise good cholesterol. Cycling is linked to a reduced risk of cardiovascular disease and lower blood pressure. It improves balance, posture, and coordination.

It does have drawbacks: cars crash into cyclists sometimes, so wear bright reflective clothing and choose trails and neighborhood streets, not busy highways. Wear a helmet, and clothing that won’t get caught in the chain. Talk with your doctor about your twowheeled before getting started if you have health concerns.

I hope this answered your question.

Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

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