Medical Examiner 12-2-22

Considering the seemingly endless ways the simple act of taking medicine can go south, it’s nothing short of a miracle that “only” 100,000 medication errors are reported to the FDA in an average year.

We would run out of space if we tried to list them all, but consider just a few: the wrong medication is accidentally prescribed; the right meds are prescribed but at the wrong dosage; the completely correct prescription is filled improperly at the pharmacy; the patient fails to take the medicine as prescribed; the patient fails to refrigerate a drug that needs to be; the patient never fills the prescription in the first place.

ERRORS MEDICATION

IT REALLY IS HEARTBREAK

by guest columnist Dolores Eckles Evans, Georgia

The chronic skin condition known as psoriasis is not just a skin condition. It is far more. There is a reason that ads in the 1960s and 70s used the phrase “the heartbreak of psoriasis.”

My daughter, Rhonda, who lives in Charlotte and has pso riasis, knows the truth of that statement. I visited her recently and listened to her story, one that may help others to cope with their struggle with this disease.

Rhonda first noticed her skin condition in high school, but psoriasis wasn’t officially diagnosed until she was in her early twenties. By then, her condition was severe and covered about 85% of her body.

Within each of these erroneous ways there are countless variations. For instance, not taking a medication properly might mean forgetting to take it altogether, cutting pills in half, taking meds with meals instead of on an empty stomach (or vice versa), or stopping the regimen against doctor’s orders.

Prescribing errors can be not taking into account (or even knowing) drugs the patient is already on, their allergies, or other conditions they have and are (or are not) being treated for.

Every year between 7,000 and 9,000 Ameri cans die as the result of medication errors.

What are some ways to improve medication safety? See page 9.

Psoriasis may be genetic. Her father and sister have had itchy elbows; I may have a minor scalp infection. According to the National Psoriasis Foundation (NPF) web site, more than 8 million of us in the United States have the disease.

People can have it in little patches or all over their body. There is no cure, and psoriasis is not contagious.

Nearly one-third of those with psoriasis will develop psoriatic arthritis, which leads to a metabolic syndrome defined by mayoclinic.org as a cluster of simultaneously occurring con ditions that include increased blood pressure, elevated blood sugar, excess body fat around the waist, and abnormal choles terol and triglyceride levels. These conditions increase the risk of heart disease, stroke, and type 2 diabetes

Rhonda remembers the embarrassment (and heartbreak) she has endured: wearing long sleeves or coverings to hide skin lesions; relationships being affected; concerns about passing

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 3 year-old daughter has always been a little shy, but you are becoming concerned that she seems to be getting even more shy and withdrawn. She is an only child and will interact minimally with her cousins, but she will not play with, or even talk to, other children. You are worried that when she starts pre-K she won’t be able to get along with the other children. What do you do?

A. Have her evaluated by a mental health professional who specializes in children. She may not be ready for the social aspects of school.

B. Once she starts school she will probably make a good adjustment after a few days. Most children do. The school will let you know if there’s a problem.

C. Drive her by the school occasionally and begin talking with her about how much fun it will be to go to school with the other children.

D. Start her in a Mothers’ Day Out program or part-time daycare to begin to get her used to being around other chil dren.

If you answered:

A. It is probably not necessary to begin with an evaluation. Try her out in programs with other children her age a little at a time and monitor her adjustment first.

B. This is what you would hope for, but it is probably better to start her out in situations with other children her age to get her used to social interactions.

C. This certainly won’t hurt anything, but it is not the same as really spending time with other children her age. It would be better to give her opportunities to spend time with other children in a structured setting.

D. This is the right thing to do. She needs to be given the opportunity to spend time with children her age in a struc tured setting. You will be able to monitor her response and see if anything more is needed.

Children don’t naturally have social skills. They need to be developed. The only way to do that is to spend time with other children.

EGGS ARE BAD FOR CHOLESTEROL

That does seem to be the popular belief, doesn’t it? If your cholesterol levels are high, you need to stay away from eggs.

But please note the title of this recurring feature: Medical Mythology

First of all, cholesterol needs to hire a new publicist. Not only is cholesterol not bad per se (Latin for “by itself” or “intrin sically”), but it is an absolute necessity for salubrious living. DoctorsForCholesterol.org isn’t something you’ll ever see, but that’s not cholesterol’s fault.

Cholesterol is found in prac tically every cell in the body, so to be on the safe side we manufacture the stuff, although we get about 20% of the cho lesterol we need from dietary sources.

But don’t get this far and stop reading, thinking you can go out and eat a bucket of fried chicken and a couple of greasy burgers to boot. Cholesterol is one of those Goldilocks ele

ments: too little is bad news, but too much is too. When cho lesterol levels are in the middle, they’re just right.

Of course, very few of us are suffering from low cholesterol. That’s rarely the issue, and when the contributors to high cholesterol are listed, it’s easy to see what the problem is.

We are more likely to have high cholesterol if we are overweight or obese, have little physical activity, and consume a diet high in saturated fats, as is the case with fast food offer ings. Other risk factors include smoking, a family history of high cholesterol, and having diabetes, kidney disease, or hyperthyroidism.

Notice the three letters that are absent from the list: e-g-g.

The gold standard in medical research — randomized con trolled trials — noteworthy for their ability to produce results free from bias, has provided lots of evidence that egg consump tion does not raise cholesterol

levels. In fact, one study of peo ple with diabetes who ate from 6-12 eggs per week showed it actually increased their levels of HDL cholesterol, aka “good cholesterol.”

Other research found that there is a connection between high egg consumption and high er cholesterol levels than those who don’t eat eggs (or eat fewer eggs), but much of the blame was discovered to be in high cholesterol foods that people traditionally eat alongside their eggs. Sausage and bacon come to mind for some reason.

Subjects like this are always under further study, but the consensus is that eggs have minimal effect on cholesterol in most people.

The American Heart Associa tion issued an advisory in 2020 saying that healthy people could include 1 or 2 eggs in their daily diet without fear of adverse consequences.

Also in 2020, The American Journal of Clinical Nutrition published a study of 177,000 people in 50 countries that found no link between egg intake and cholesterol levels, death rates, or cardiovascular disease events.

A 2019 study in Circulation likewise found no connection between egg consumption and heart disease.

Of course, everyone is differ ent. What applies to most peo ple may not apply to individu als. Anyone who has questions about their personal connection between cholesterol and egg consumption should check with their doctor.

Dr. Proefrock is a retired local clinical and forensic child psychologist.

IS GOING BRALESS UNHEALTHY?

Many people think so, and for a variety of reasons, so many that this article could have appeared across the page as an exam ple of medical mythology.

The question is an especially timely one considering how many people still work from home these days and therefore may not be wearing a bra as often as they did PC (pre-COVID).

Health magazine had a story about this subject back in October, and it turns out to be a bigger deal than many might imagine. For example, they addressed the question of whether wearing (or not wearing) a bra has an impact on cancer risk. It does not, accord ing to the American Cancer Society.

Some people believe that not wearing a bra contributes to or accelerates sagging (known medically as “ptosis,” with a silent p). That may be true for larger, more dense breasts, but doctors say for most women going braless will have a very small if any effect on sagging. Conversely, wearing a bra does not prevent ptosis. That being said, women’s health experts recommend bras for running and vigorous exercise. The lack of support when exercising can result in micro-tears to Cooper’s ligaments, the breast’s supporting ligaments. A 2007 study found that so-called encapsulation sports bras (that is, those with two separate cups) are more effective at controlling movement than compression-type sports bras. Overall, however, other sag factors are much more significant than bra wearing, chief among them, believe or or not, smoking, which significantly depletes elastin, a protein which promotes elasticity and helps give skin a youthful look. The risk factor list continues with number of pregnancies, heredity, weight gain, simple aging, and higher body mass index. Oh, and gravity.

One significant absence from the list: breastfeeding. Research ers say there is no long-term link between breastfeeding and ptosis.

There is a camp which believes that wearing a bra teaches breasts to be bra-dependent, thereby increasing sagging when a bra isn’t being worn. Based on this belief, going braless trains breasts to support themselves. The result: perkier breasts. Even a quick anatomy lesson would disprove this theory, since breasts are largely fat and glandular tissue. They can’t be trained and strengthened the way muscles can.

Ultimately, to wear or not to wear is a personal decision based on comfort and in many cases social propriety, but the scientific evidence says that for most women it is not a health issue, nor one that causes or prevents our new word of the day: ptosis.

Who is this?

Pictured here is one of the most towering figures in the history of modern medicine. His name is associated with nearly every major medical discovery or advancement in research, diagnosis, or treatment in the past century and more.

But having died in 1896, he wasn’t around to see any of it.

He figured out a way to live on, however, and it wasn’t through medicine; money was the key.

You may have deduced by now that this is a profile of Alfred Nobel, the inventor of dynamite. With multiple applications in mining, construction, farming, and military situations, the market for dynamite was enormous, and Nobel became one of the wealthiest men in all of Europe. But not without many bumps along the way.

And that was a big problem, because dynamite was developed from nitroglycerin, and in its pure form it will explode with tremendous force by being dropped, shaken, or simply jostled. A bump in the road could be fatal, and often was. Knowing its danger and instability, Nobel built his first three factories in an isolated rural area. He built three because the first two were blown to smithereens. In 1866, several crates were shipped to California to be used in blasting a railroad tunnel through the Sierra Nevada mountains. Instead, they blasted through a Wells Fargo office in San Francisco, killing 15 people. In 1869, two large wagons loaded with nitroglycerin exploded as they were being drawn through a village in North Wales. The horses were never found.

It’s amazing that Nobel’s enterprise — and Nobel himself — survived, but they both did, in large part because he devised a number of safe and stable variations on the nitro theme, including dynamite; gelignite; a predecessor of cordite; and ballistite, a powder explosive still used as a rocket propellant.

Despite all of the deafening construction and destruction accomplished with his products, Nobel himself was said to be a calm man with pacifist ideologies. That would explain the Nobel Peace Prize and its relatives in Physics, Chemistry, Literature and Medicine (and relatively recently, Economics).

The story is told that when Nobel’s brother, Ludvig, died in 1888, a French newspaper mistakenly thought it was Alfred, and announced, “the merchant of death is dead,” describing him as a man who became rich by devising ways to kill more people faster than anyone in history. Nobel was appalled to realize the legacy awaiting him upon his death, and decided to do something about it, leaving his entire estate (after taxes and a few small bequests) to establish the Nobel Prizes. His neices and nephews were dismayed to discover they were not in his will, and millions of Swedes were angry that the awards were open to people from any country. But things have calmed down considerably over the past 120 years and the prizes are respected and coveted around the world.

Next issue: Part II, the amazing story of nitroglycerin’s medical applications.

Note: The obituary story is disputed in some quarters, but as Smithsonian Magazine noted, “sometimes a neat morality tale is just too good to pass up.”

ON THE ROAD ON THE ROAD TO BETTER HEALTH

A PATIENT’S PERSPECTIVE

by Marcia Ribble

Christmas is less than a month away. Many people have their decorations up and their presents at least ordered, if not already at home and wrapped. I am thinking about sending Christmas cards, but I am wondering if mail I send now will arrive before St. Patrick’s Day. The Post Office seems to be having problems.

Lots of us still write cards and letters like we always have. I use social media like Facebook and e-mail, but for some nothing can replace receiving a real live piece of mail that is not a bill. Let me tell you a few instances in which a letter or card is so much better.

Little children are absolutely thrilled to receive the first piece of mail that is specifically just for them. I have seen munchkins lug that beloved piece of mail around with them until it is tattered and worn. Some hug and kiss it where a Grandma wrote their name in print they could read. They show it to everyone nearby and proclaim that they got “real mail, just for me!” Some treat it like an important treasure, put it in a box with other treasures, and keep it long past when they are grown. That card or letter is tangible proof that when they were small someone took the time and energy to make them important. Some look to see if it has money in it and quickly discard it. But even then, they often remember it years later. One of my aunts gave my young children an envelope with a single, brand new dollar in it. They still remember that fifty years later.

I have people who send me a card with a photocopied letter detailing their lives over the past year. The best ones include the less

happy events with the happier ones. Some send pictures of their children as they are growing. I treasure those pictures. And even at my advanced age I still get excited when I receive a piece of real mail whose sender I can see even though they may be hundreds of miles away. They have sent me tactile proof of our long and lasting connection. It is real. It doesn’t disappear into the ether like social media messages tend to do.

Because I love getting mail, I try to remember to send mail. There is one woman I spent time sharing a room with during a session of rehab. She is very old, but still very aware and bright. I try to hold her in my thoughts for a while at least once a month. We were together long enough for me to know that she loves the Atlanta Braves and enjoys watching their games. I can still see her exclaiming in wonder about how many people were in the stands cheering for them. This year the Braves didn’t go all the way as repeat champions, but they had a really good year anyway. Sending her a card takes little time, but I know she keeps things like that in her walker basket, so it’s time well spent. Since more than a year has passed, she may not even remember me anymore, but I remember her.

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 +

Young or old, we need to have people who remember and think enough of us to send a card or letter, and the same is true for us remembering others. A few minutes of our time can bring a sense of connection to those we remember with love. The cost of postage is inexpensive in comparison with the happiness we are spreadi ng.

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

BY J.B. COLLUM

I learned a valuable lesson about tak ing care of my health from a much younger person this past week. My wife and I took the opportunity to spend a long weekend visiting our son in Myrtle Beach and he made an ob servation that, while a little embarrassing, has turned out to be very good for me.

As some of you already know, I have type 2 diabetes, and among other things, with that come problems with your feet. My better half has complained for years about how my dry and crusty feet pick at her nice sheets and comforters, and at times have even ended up cut ting the sheets. She begs me to apply lotion to my feet, but I just can’t stand the feeling of it.

This past Saturday, as I sat on the sofa with my bare feet up on my son’s ottoman, he kept furtively looking over at my feet and sighing. I knew it was coming soon, but I was going to make him say it. Finally, he said something, but it wasn’t what I expected him to say. As he got up and left the room, he said, “Dad, I am about to show you how much I love you.” He came back into the room with gloves on and a bottle of lotion and he ap plied it to my feet. It was a very nice gesture. Then he proceeded to lecture me about taking care of my feet. He brought out a neat little battery powered tool for removing dead skin and callouses and told me that I needed to get something like this and use it regularly on my feet like he already did. No, he wasn’t about to use his on my feet, and I can’t say that I blame him. If you saw my feet, you’d understand. Let me try to describe them. Imagine a mud dy patch of ground that dried up some time back in the Pleistocene era and has hardened into cracked rock-like formations with sharp edges. When you tap on it, it doesn’t give in softly like skin should, but sounds like you are knocking on wood. Yeah, kind of gross, I know, but it didn’t happen all at once; it snuck up on me, so to speak. With all of that cal loused dead skin, I don’t have much feeling in my feet, and I have just gotten used to it. If I’m being honest, I think the reason that tipped the scale in getting me to actually do something about my feet was finding out that I could buy a power tool to make it happen. Just ask my wife, if she wants me to do some work around the house, she usually takes me to Home Depot or Lowe’s after our date night and mentions the task we need to do and suggests that maybe there is a tool to make it easier. Of course, she has already done her research and makes sure that she has brought me to the aisle where the power tool we need is. She knows that once I have my eyes on a power tool with the real chance to buy it with her endorsement, I will agree to any home improvement project to secure that tool. That quality of mine had gotten me into a lot of

trouble, but at least I have a pretty nice and growing tool collection.

So, I did what I do and ordered the tool for my feet. When it came in, I took it into the bathroom and got to work. Let me provide a warning here. I think I should have gotten the industrial model because I went at my feet with that thing for about an hour until it ran the battery completely dead, and I wasn’t even halfway done. So, I charged it up and went back at it the next morning. I didn’t run the battery dead this time, but I did it until I was tired. At this point, the transformation, while not 100% complete, was still life-changing. My feet didn’t look like they belonged to a 150-year-old man from a third world country who had never worn shoes in his life. They actually looked pretty nice and healthy. I could even feel the floor and I was no longer considered armed and dangerous when I slipped my feet under the covers in bed. Once I was done, I also applied some lotion to them, and the difference was stag gering! I’ll never go back to letting my feet get like that again. I’ll regularly use the tool and lotion to keep them in good shape. I will also do it outside next time, because even though my wife was happy that I had taken care of it, she wasn’t pleased with the thick layer of skin dust that had settled down all over the bathroom. If anyone walked in there, their first thought would be that we had just been sanding down some sheet rock. I expected to hear a foghorn at one point when I looked up. Come to think if it, I probably should have worn a dust mask and goggles.

I grew up in a time when men didn’t use lotion and didn’t exfoliate, but times change, and aging can make you change too. Even stubborn, old-fashioned me. Who knew that all they had to do was make a power tool to make me willing to take care of my feet. Maybe that is the solution for my other health issues. I need to look for tools and gadgets to treat my ills that make it more interesting or fun to do what is right for my health. Maybe next I’ll get that blood sugar monitor that you keep attached to your arm so you can read your glu cose levels with your smart phone at will.

I credit my son for making me aware of this solution to my problem and finally getting me to do what I should have done long ago. It just goes to prove that although wisdom can come with age, it can sometimes come from the young too, and we need to be wise enough to listen to it when it is good advice.

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

Psoriasis can manifest itself in patches of inflamed, red skin, itchiness, soreness and pain, skin flaking, and permanent scars and lasting skin changes

the disease along to her future children; avoiding black clothing and furniture because of embarrassment at leaving behind a trail of skin scales; no swimming in a bathing suit; fingernails which have pits and ridges. Psoriasis causes physical, emotional and financial pain.

People with psoriasis often have flare-ups that make their problems even worse caused by various triggers (such as stress, injury, infection (such as strep throat), alcohol, smoking, cold weather, warm weather, medications, or piercings and tattoos). These flare-ups tend to come and go, flaring for a few weeks or months, then subsiding for a while.

Is there treatment for this chronic inflammatory disease? Doctors can prescribe steroid creams or ointments which reduce itching and inflammation.

From years of research, interactions with organizations and support groups, and personal experience, Rhonda has become quite knowledgeable. She learned that many people believe the Dead Seas is a natural source of healing. Fortunately, travel has always been a passion of hers, and she has been to the Dead Sea three times to enjoy the benefits of heliotherapy, a therapeutic use of sunlight. As Earth’s lowest point (on dry ground at least) — 1,300 feet below sea level — the shores of this lake have a combination of high atmospheric pressure and maximum atmospheric protection from the sun’s ultraviolet rays. And (according to Wikipedia and Rhonda) for those with psoriatic arthritis, actually getting into the water helps.

If you or someone you know suspect you might have psoria sis, you can find some preliminary information at healthtalk.org and psoriasis.org.

Rhonda stresses the importance of educating yourself and being your own advocate. You and your doctors — whether primary care physician, dermatologist, or rheumatologist — can all be on the same team to keep you healthy as you live with psoriasis.

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The medical dictionary calls it Obsessive Compulsive Disorder. OCD is difficult to live with, so some say. You can take medicine for it. Or you can live with it. There are good arguments either way. It seems more women have OCD than men. In case you are not fully cognizant of the disorder, here are some OCD events that might help you focus in and recog nize it.

Spoons and forks are alternated in the dishwasher to prevent “spooning” and therefore providing equal washing on all sides.

Dirty dishes are handwashed before putting them in the dishwasher. We don’t want suboptimal dish clean ing.

Front porch lights are on by 7 pm, regardless of the season. We don’t want bur glars to target our home.

All downstairs door locks

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy

Laveau

are physically checked three times before lights-out each night. No self-respecting bur glar would kick in a thrice locked door. Everybody knows that. It has worked perfectly for more decades than my wife will let me ad mit because that would hint at her birth decade.

Pillow cases are ironed daily. No one needs addi tional facial wrinkle marks. It’s unbecoming.

Socks are washed after each wearing. Toe nail fun gus is ugly.

When driving, avoid left turns. Less wrecks.

Drive tall cars. You see bet ter, and you are seen more easily by idiot drivers. Tall cars keep you out of the ER.

Carry dental floss and mouthwash with you at all times. Root canals hurt and cost big money.

Salt shakers are always to the right of the pepper shak er. Easier to reach for right handers. That is why it is always “salt and pepper” and never“pepper and salt.”

Toilet paper is rolled off from the top and front of the roll, never from the back or bottom. Grandmother said so. Grandmothers never lie.

Gas tanks are refilled at or before half empty. To have and not need is better than need and not have.

All bills in your wallet or purse are turned in the same direction. It shows orderly respect for past presidents and Ben Franklin.

Reline wastebaskets with used grocery bags. Recycling is the Christian thing to do. And it saves money. Even atheists are in favor to that.

Read the Bible each day. It will not hurt you and might keep you from thinking bad thoughts, even when you watch cable news.

Nobody comes to the breakfast table until your bed is make and your bedroom is straightened up.

Keep a box of Kleenex on the toilet tank in case your nose is runny or you sneeze. (Toilet paper is for your other end.)

I am blessed to live with such an OCD woman, bless her heart. She still keeps me around even though I often fail to maintain behavior up to her standards. I frequently blame my shortfalls on “Old Timer’s Disease” (OTD, not OCD. I thought that was funny; she didn’t). She will sometimes accept, “I for got.” But more often than not, I just get tired … and I am a bit lazy to boot. (Men do things like that.) I like to think she gains some degree of pleasure from correcting

me. It comes from the moth erhood section of her brain. (Long live motherhood.)

Besides, her untreated OCD has done me no harm … other than a bit of fraz zled nerves now and then, but I’m tough. I can take it. It is small price to pay for a tidy home, perfectly cooked meals, and color-coordinated clothes laid out daily for me. Let’s not overlook the addi tional value of a dependable and reliable wife who still hopes to reform me some day … soon.

Given the option of her being medically treated and cured, I think prefer the non-treated version. This decision, if widely accepted, would send shock waves throughout the behavioral medicine world, but I don’t care.

The only thing I really have to worry about is: Will she keep me with my mod erate non-OCD manhood disorders?

Hopefully her OCD won’t let her give up on me just yet, and I can keep benefiting from her medical disorder.

Maybe God planned it this way. Maybe God gave Eve OCD, knowing Adam needed a lot help. Maybe God was just looking out for you and me. +

TRYTHISDISH

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

This soup is designed to be simple and comforting. The light sweetness from the corn pairs easily with the creamy potato and smoky poblano garnish. This soup pulls in freezer convenience to deliver homemade flavor.

Ingredients

• 2 tablespoons extra-virgin olive oil, divided

• ½ (12 ounce) bag of mirepoiux mix (or ½ to ¾ cup chopped on ion & celery & carrots)

• ¼ teaspoon salt

• 2 garlic cloves, minced

• 1½ pound red potatoes, small ones cut in half, larger ones cut into quarters

• 2 cups frozen corn, divided

• 4 cups organic vegetable broth

• 2 poblano peppers

• Lime slices (give each serving a squeeze of lime when serving)

Directions

Preheat the oven to 450°. Line a small sheet pan with aluminum foil and roast the pepper for 15 minutes. After 15 minutes add ½ cup corn to the pan and mix with ½ tablespoon olive oil. Roast for 5 more minutes.

Meanwhile heat 1½ tablespoons olive oil over medium heat in a large saucepan; add the mirepoiux and salt. Cook stirring occasionally

until the vegetables become soft (3-5 minutes). Add the garlic and stir for one more minute. Add in the potatoes, 1½ cup corn and broth. Bring to a boil and then reduce heat to a simmer for 20-25 minutes or until potatoes are cooked through.

Blend 2 cups of the soup in a blender until smooth and add back to the pan. Stir to combine. Dice the poblano pepper and use as a toping with the roasted corn when serving the soup. Squeeze in the lime juice right before eating. Yield: 6 Servings (serving size 1 cup) Nutrition Breakdown: Calories 200, Fat 5g, Sodium 200mg, Carbohydrate 32g, Fiber 5g, Protein 4g. Diabetes Exchanges: 2 Starch, 1 Vegetable, 1 Fat

NO NONSENSE

NUTRITION

Kim, from North Au gusta, asks: “I’ve noticed many foods claiming to be better because they are higher in pro tein. Is this an issue? Should people be concerned about not getting enough protein in their diets?

Kim, thanks for asking this question. Americans seem to be on a protein binge these days. Overall, people are eating way too much protein. This protein may be eaten as supplemental powders and shakes, as protein-enriched foods or as excessively large servings of meats and eggs. For example, the other day, I drove by a breakfast omelet place that advertised a 10-egg omelet for one person (not ten people)! It is not unusual to see 10 oz or 12 oz steaks on a menu or bucket-sized pieces of chicken. The fact is that, besides being expensive, eating all this protein is unnecessary. It does not lead to a healthier life, bigger muscles, better athletic performance or healthier skin, hair and nails. For a large majority of Americans, eating too much protein is simply not healthy or prudent.

You might be surprised if you knew how little protein you need to be healthy and how small portion sizes of protein-rich foods are. For example, a healthy piece of steak, fish or chicken is only 3 ounces, 2-3 times less than the average size found on an American’s plate. One serving of eggs is 1 egg or 2 egg whites, while a serving of

beans is only ½ cup. A serving of milk is an 8 oz glass of milk. Now glasses and cups are so big, they are usually 2-3 times this amount, if not more.

The fact is that every major type of food needs to be present in your diet, in the proper proportions. Each type of food serves important purposes in your body. Balance is key, not thinking that one food is “superior” to another. Most of the calories in your diet, more than half, should come from high quality, whole grain and fiber-rich carbs (the modern “low-carb” fad is nutritionally problematic). As it turns out, protein is not a metabolically superior source of calories. For one thing, protein

contains the nitrogen atom, which carbs and fats do not. That means that your body must rely on a special way of getting rid of this nitrogen. The end products of protein nitrogen in your body are urea and ammonia; both can be found in your urine. Too much urea nitrogen and ammonia place a stress on our environment. Did you know that nitrogen “pollution” is a major issue in wastewater treatment? It can lead to algae blooms and pollution of our air and water. The surprising fact is that most of the nitrogen entering our waterways comes from us eating too much protein. We used to think that high-nitrogen fertilizer runoff from our farmlands was

the only major source of this excess environmental nitrogen. Recently have we come to understand that such a large part of wastewater nitrogen is the result of us eating too much protein. Another way of thinking about this is that the high protein foods we are choosing to buy and eat “upstream” are creating quite an environmental issue “downstream.” Fascinating, unfortunate and, also, avoidable.

What is the “No-Nonsense” nutrition advice for today? All this high protein food you see advertised in the media or when you walk into a supermarket should be considered a food fad. The average American needs to eat a surprisingly small amount of protein to be healthy. Protein that you eat should come from high-quality food sources, mainly from plants. Other high protein sources are small portions of lean meats, baked chicken, fish, low-fat dairy and eggs. One day, you will look back at all the unnecessary and costly high protein foods you are consuming today and wonder, ”why did I fall for all the hype and waste my food dollar like that?”

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.

Dr. Karp

Gotta have those protein bars. Or do we?

As many-faceted as the problem of medication errors is (see page 1), solutions can often be found in simple, common sense responses. That is a wonderful thing because medicine and healthcare delivery is expensive enough as it is. And the greatest cost is the human toll. Aside from the 7,000-9,000 annual deaths caused by medication errors, the total number of patients affected each year in non-fatal incidents is estimated to be on the far side of 7 million, and dealing with the various repercussions of it all accounts for an expenditure of more than $40 billion.

Everyone in the chain has a role to play in medication safety: doctors, nurses, pharmacists and patients.

Making huge improvements doesn’t have to be complicated, but it does require attention to detail at every step along the way. There are hospitals and practices that have followed the lead of some law enforcement organizations who have stopped using tencodes. Instead of saying one of the dozens of ten-codes — which someone might not remember, or perhaps hear incorrectly due to static or other radio traffic — they say, “Ambulance needed” or “subject in custody,” not 10-43 or 10-58.

In similar fashion, some physicians have been encouraged to fully write out prescription instructions. Latin abbreviations may be time-savers, but QID (meaning four times a day) can easily be mistaken for QD (once a day). Spelling things out is a huge step in preventing medication errors. “Take as directed” is about as vague as can be, whereas “take two tablets by mouth every 4 hours for pain” provides a wealth of information, and might prevent someone from taking their diuretic for pain or vice versa.

Pharmacists have an array stickers that can cover a container with useful information. “Take with food.” “May cause increased sun sensitivity.” “Do not take with alcohol.” Doctors and pharmacists can and should collaborate on dispensing as much useful information as possible along with the meds they dispense.

Of course, it can all go for naught with a non-compliant patient. Some patients don’t bother to fill prescriptions, which is puzzling after spending the money for a doctor appointment. Sometimes they just can’t afford the medications they need. Another patient no-no is ignoring all the labeling and packaging info provided to ensure their own safety and the best outcome for whatever they’ve been diagnosed with. Example: the label on meds for a sinus infection tells the patient to follow the dosing instructions until the bottle is empty. But three days later they feel better and decide to save the rest of the pills for their next sinus infection. Bad idea. The only partly-cured infection can return with a vengeance and a strong resistance to the remaining meds.

Ultra-clear communication from prescriber to dispenser to patient is a fundamental to medication safety. As for patients, be conscientious and compliant, and borrow a principle from Homeland Security: if you see something, say something. If you don’t understand something, you suspect an error or have a question, speak up. It might save a ton of trouble.

“I perform in court, not in TV commercials.”

CRASH

COURSE

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

ell, don’t just look lively. Be lively. Be alert. Be attentive, on your toes, on your guard, observant, wide awake, on the ball, vig ilant, watchful, bright-tailed and bushy-eyed. Wait...reverse that last one.

Not that any of us have to display these qualities all the time. Within the context of this column, we’re talking about doing all of the above while driving.

It seems like something you would read and say, “Well duh. That’s obvious.”

And you would be correct. The problem is that people know it’s not a good idea to drive impaired but they do it anyway. “I’ll be okay. It’s only a couple miles. I could do it blindfolded.”

Be careful what you say. It might come true.

Actually, not might come true. Does come true: according to 2007 figures from the Na tional Highway Traffic Safety Administration (NHTSA), 8.6 percent of weekend nighttime drivers tested positive for marijuana. The same roadside survey conducted in 2013-2014 found 12.6 percent of drivers positive for marijuana, a 48 percent increase in less than 10 years. Those are the latest numbers NHTSA has posted, but do you imagine the numbers would be lower for 2022?

Hardly.

This would be a good time to take a weed sidetrip to address a common misconception about marijuana use within the Crash Course context. Many people think that not only does marijuana not contribute to impaired driving; it can actually make you a safer driver.

Clinical research suggests that — especially the even safer part — is pure nonsense. In a 2015 study published in the journal Clinical Chemistry, the authors reported, “Evidence suggests recent smoking and/or blood THC concentrations 2-5 ng/mL are associated with substantial driving impairment, particularly in occasional smokers.” (Italics ours)

Notice that the impairment is described as

substantial. And that it’s especially pronounced in people who take a toke only occasionally. That matters for safety’s sake — even yours and mine if we drive, even if we’ve never smoked marijuana. It also matters because cannabis is the #1 most prevalent illicit drug identified in impaired drivers.

Over time, fewer and fewer states categorize marijuana as “illicit,” and more are sure to come. But really, what bearing does that have on anything? Who cares if someone is impaired by a legal drug or an illegal one? The people they collide with might end up just as dead either way.”

This time of year happens to be peak season for getting buzzed the old-fashioned way, too: with alcohol. Trips for family gatherings Christ mas parties. New Years Eve.

For whatever the reason, drunk driving/im paired driving/buzzed driving kills more than 10,000 people every year. Well over half (56%) of all drivers who arrive in trauma centers after being involved in fatal or serious injury crashes test positive for at least one drug.

The stereotype is that the drunk or impaired driver is never the one killed in these crashes; it’s always the innocent, sober other driver. Ste reotypes are sweeping, inaccurate generaliza tions, but for the sake of argument let’s assume this one is true.

Let’s also state as fact (not an assumption) that not one of the perpetraitor drivers — not a single one — (and yes, we misspelled that word on purpose) believed they would cause a crash. They all realized they were impaired to some degree, of course. But none of them imagined the tragedy and permanent grief they were about to unleash on unsuspecting strangers.

It’s especially sad considering that getting a ride home if you’ve been partaking of some thing has never been easier.

As NHTSA likes to reminds us, If You Feel Different, You Drive Different +

the blog spot

A PSA FROM AN EXHAUSTED ER DOC

I am writing this to ask for help. No, I’m pleading for help. This is a patently self-serving public service announcement (PSA), aimed at any physician or person sending someone to an emergency department. Because emergency departments across the land are overwhelmed. And as my patients have so often said, “something has to be done.”

I am addressing my supplications primarily to physicians and advanced practitioners who depend on the emergency depart ment as a back-up, a pressure-release valve for their practices. For my entire career I have been proud to be just that. To be available to help with situations that were medically, or just logistically, compli cated or dangerous.

Those of us in emergency medicine are good at managing patients who are complex, very sick, and whose situations may require that we marshal different specialists and arrange trans fers for specialty care. We like that role.

The problem is, we’re just out of space and out of staff. And frankly, we’re out of steam. All day long, patients walk in off the street or come to us via an endless line of ambulances, parked outside eagerly waiting to deliver their human cargo. There is apparently no limit to what we are expected to do.

We often have patients sent from medical offices who are told they should “get checked out,” or “go and be admitted,” or “I was told to come and get an MRI.” Some are sent from nurs ing homes because their altered mental status was more altered than normal and it was “just easier” for them to be evaluated in the ER. Others are told by medical offices that if they come to the ER, we can admit them and help them get into a nursing home or rehab. Still others are sent because of their history of addiction, “to get them some help.” Other times, it’s a post-pro cedure issue: “I had surgery last week and I have some pain, so my surgeon said to come here and get checked out.”

Frequently it’s urgent care sending patients. The urgent cares of America are very important and do great work. But too many are staffed with physicians or advanced practice providers without adequate experience who are uncomfortable making decisions. “You should go to the ER to make sure.”

What I want to say is that we want to help, we really do. We love being able to help make the diagnosis. But the line is long and the number of very sick and often contagious patients in the department is very high. A patient sent to the ER faces cer tain hazards. Not only exposure to infection but also significant cost that may be unnecessary.

The other enormous problem is that because of the lack of inpatient beds due to the lack of nursing staff (or physician coverage), patients are waiting days and days to leave the emergency department for inpatient beds. Sometimes, 40-50% or more of our emergency department beds are patients await ing admissions.

So we have no end of influx, no place for the truly sick (who are often parked in hall beds even in the ER). Frequently, the sick who require specialized care are also boarding in ER hallway beds as they wait for transfer...to another place in the same bed crisis.

All this is to say, if you are a physician or advanced practice provider sending someone to the local emergency department, and if it isn’t really an emergency, it might be wise to call ahead. Or to try to make some other arrangement to help treat, comfort, or reassure your patient.

The emergency departments of most hospitals are now di saster zones, best avoided if possible. We’ll still be here when you need us. But if you can, show a little mercy until the dust settles.

This PSA is brought to you by an exhausted emergency phy sician, speaking for the entire tribe.

Edwin Leap, MD, is an emergency physician

From the Bookshelf

If you have a body and you’re reading this newspaper — and we’re going to go out on a limb and guess that you probably qualify on both counts — you are going to like this book. There is no uncertainty.

For starters, you pretty much can’t go wrong with any book written by Bill Bryson. If you are among the uninitiated, you are in for many hours of reading pleasure. He has written a whole shelfful (that’s a word, right?) of books, and we here at Medical Examiner world headquarters have yet to read one that wasn’t thoroughly enjoyable and/or highly informative.

It’s not uncommon to hear people say the vast depths of the oceans are the last unexplored frontier left on earth.

Bryson wonders if it is instead the human body. “How many among us know even roughly where the spleen is and what it does? Or the difference between tendons and ligaments? Or what our lymph nodes are up to?”

Of course, answering those questions and a thousand more would be easy for medical professionals. But there are thousands more that even Nobel laureates can’t answer with anything close to certainty.

As Bryson notes early on in the

book, “You could call together all the brainiest people who are alive now or have ever lived and endow them with the complete sum of human knowledge, and they could not between them make a single living cell.” We are just a collection of inert elements, he says, the same stuff you would find in a pile of dirt, and yet we are living, breathing, sentient creatures. “That is the miracle of life.”

The mystery should be fully expected. After all, it takes 7 billion billion billion (7,000,000000,000,000,000,000,000,000) atoms to make up our 37.2 trillion cells, both numbers scooped up from the book, and

both numbers that any honest scientist will admit are just educated guesses. Our own composition, at least numerically, is virtually uncountable.

That goes for what goes on inside us. “Every second of every day your body undertakes a literally unquantifiable number of tasks - a quadrillion (and more) - without requiring an instant of your attention.”

In just the last second, for instance, the body has manufactured a million red blood cells and sent them off to work.

That’s the kind of gee-whiz facts that sprinkle this book in chapters that address everything from skin and hair to nerves, the immune system, digestion, the heart, lungs, and brain of course, and less mainstream topics, like how we maintain our equilibrium, and what happens when we get sick, even with something dreaded like cancer, and how medicine works.

But Bryson notes that the World Health Organization recognizes some 8,000 diseases that can kill us, and ultimately we defeat all of them but one. That’s pretty good odds.

The Body, A Guide for Occupants by Bill Bryson, 464 pages, published in October 2019 by Doubleday.

posted by Edwin Leap, MD, on Nov. 15, 2022 (Edited for space)

EXAMINER CROSSWORD

EXAMINER CROSSWORD

THEBESTMEDICINE

preferred.

Joe: So which one did he pick?

Moe: It was the strangest thing. He stared at the sandwich, then at the $5 bill. He looked at the sandwich again, then back at the cash. After darting his eyes back and forth between the two, he finally just threw up his hands and ran away.

Joe: That is weird. Wonder why he did that?

Moe: I couldn’t figure it out at first either, but then it came to me: beggars can’t be choosers.

Ablonde calls Delta to ask a question: “How long is a flight from Atlanta to California?”

“Just a minute...” says the Delta employee. “Thank you,” says the blonde, then hangs up

Last spring, two blondes were found dead in their car at the local drive-in movie theater. They had gone to see “Closed for the Winter.”

Moe: Who’s in favor of bringing Roman nu merals back into use?

Joe: I for one.

Moe: Did you know that Australia’s biggest export is boomerangs?

Joe: Boomerangs are their biggest import too.

Moe: This homeless guy approach me as I was leaving the deli today with my lunch. He asked me if I had $5 to spare.

Joe: Did you give him the money?

Moe: I was about to, but then I realized I was holding a $5 foot-long I had just bought, so I held up both the cash and the sandwich and told him he could have whichever one he

Moe: What did the turkey say to the hunter before Thanksgiving?

Joe: I’m guessing “Quack quack.”

Moe: Why did the snowman go out into the vegetable garden?

Joe: So he could pick his nose.

Moe: How does a gingerbread man make his bed?

Joe: With a cookie sheet.

Moe: You’re the first person I’ve ever heard of who has a pet termite. What do you call him?

Joe: His name is Clint.

Moe: No last name?

Joe: His full name is Clint Eatswood.

Jesus and the twelve apostles walk into a restaurant. “Can we have a table for 26 please?” asks Jesus.

“But there are only 13 of you,” replies the hostess.

“True,” says Jesus, “but we all like to sit on the same side of the table.”

Dear Advice Doctor,

We had a situation at work a few months ago that I was aware of as it happened and did nothing about. I won’t get into the details here, but it was at the very least a violation of company policy if not downright illegal. I wasn’t involved in any way other than knowing about it. At the time I just looked the other way, but my conscience is still bothering me about it. I asked a friend what to do and the advice I got was to let sleeping dogs lie. Easy for them to say. They aren’t the one losing sleep at night. What would you suggest?

— The Keeper of Secrets

Dear Keeper,

In my opinion your concern is justified. This is not a situation where you want to act hastily or make any sudden moves. I happen to know this from personal experience: one time I startled a sleeping dog and ended up with six stitches in my arm.

That’s the bad news. The good news is that stitches might be the worst thing you have to worry about: the last reported case of rabies in a human in Georgia was in 2000. In fact, the Georgia Department of Public Health says that from 2003-2013 only 34 cases of rabies were reported in the entire United States. In 33 of those cases the source was identified, and the most common culprit was bats. Mandatory vaccinations of all dogs, cats and ferrets has all but eliminated domestic pets as a source of rabies. Bats, raccoons, skunks, coyotes and foxes pose a greater threat than dogs and cats.

Having said that, nothing is guaranteed, and in fact, local laws leave a little wiggle room that could cause problems. Both Georgia and South Carolina state that rabies shots are mandatory for dogs and cats (and, in South Carolina, ferrets), but Georgia law does not require any visible proof of that. South Carolina, by contrast, says that a “metal license tag at all times must be attached to a collar or harness worn by the pet for which the certificate and tag have been issued.” It’s a state matter in South Carolina; in Georgia the implementation responsibility belongs to each county’s Board of Health, so it could be a patchwork that varies from place to place.

Left untreated, rabies is always fatal, so anyone who is bitten by a wild animal should take the matter very seriously. Thoroughly and immediately clean the wound with soap and water and call your doctor, 9-1-1, or the Georgia Poison Center (800-222-1222) without delay. Fatal outcomes are entirely preventable.

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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