Medical Examiner 02-19-21 by Daniel Pearson

MEDICALEXAMINER

WALK! TM

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

FEBRUARY 19, 2021

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

Dueling definitely observes the 6-foot distance recommendations for limiting the spread of COVID-19, but it did not make our list of suggested activities.

TWENTY-ONE IDEAS FOR THINGS TO DO WHILE STILL PHYSICALLY DISTANCING Some among us are going stir-crazy as the isolation resulting from the pandemic continues on into the indefinite future. As 2021 rolls ahead, here are 21 possible antidotes for cabin fever. • On foot or by car, check out the many new sculpture installations in downtown Augusta. • Take a leisurely drive up to Clarks Hill Lake. Drive across the dam. Pack a picnic lunch and enjoy the scenery and the peace, solitude, and serenity. • Make a list of friends and relatives and every day, call one or two of them to see how they’re doing and to let them know you’re thinking about them. In other words, practice physical distancing but not social distancing. • Go for a stroll along the Savannah River and the Augusta Canal.

• Take your bike to the North Augusta Greeneway and go for a ride. • Start writing the history of your family. Contact relatives for information and do genealogical research. • Celebrate Black History Month by checking out the dozens of historical markers commemorating noteworthy difference-makers in Augusta’s history as you walk along Laney-Walker Boulevard. • Reread favorite books you enjoyed years ago.

If your goals for new salubrious habits in 2021 have already fallen on hard times, we have good news for you. There is a simple, inexpensive and effective fix to get your goals back on track. In fact, we could summarize it in a single word. Walk. That’s it. One word. As promised, it’s easy. It’s free. It’s simple. It’s available everywhere, unlike swimming, for instance, which requires a pool or lake to be handy. More importantly, of the dozens (or hundreds) of ways a person could choose to become more active, walking has the lowest dropout rate. And despite its ease and simplicity, walking offers a plethora of significant benefits, according to the American Heart Association. Among them: • reduced risk of heart disease and stroke • improved blood pressure • improved blood sugar levels and reduced risk of type 2 diabetes • reduced risk of osteoporosis • reduced risk of breast and colon cancer • improved chances of losing weight Best of all, these benefits don’t require miles and miles of walking (although how far you walk is up to you). These benefits are available from a mere half hour of walking (see the “23-1/2 box” on page 15). That means just 15 minutes of walking, followed by turning around and walking back to where you started. Or you can break up your 30-minute daily walk into three 10-minute walks. That’s definitely doable. In conclusion, if you have already faced your 2021 goals and announced “I quit!” that’s totally okay. Stick with that. Just change the target of your quittage: how about, “I quit being so inactive!” This year, walk all over your old inactive lifestyle. +

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FEBRUARY 19, 2021

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

THE RISE AND FALL OF THE LOBOTOMY, PART 2 by guest columnist Justin White

Between 1949 and 1956 around 50,000 people in the U.S. had been lobotomized, and the procedure’s #1 proponent, Dr. Egas Moniz (see part 1 in the 2/5/21 issue), had spawned a cottage industry among other doctors. One of them, Dr. Walter Freeman, was responsible for as many as 5,000 of the 50,000 total. Moniz, Freeman and others held the belief that lobotomies could treat such ailments as schizophrenia, depression, chronic pain and other mental and physical conditions. Freeman developed the so-called ice pick lobotomy (see illustration) that could be performed through the eye socket. The first such prefrontal lobotomy by Freeman was performed on a woman named Ellen Ionesco in 1946, described by her daughter as being “violently suicidal.” The daughter would later say of the results that “it was like turning a coin over. That quick. So whatever he did, he did something right.” Another woman named Patricia Moen was lobotomized with similar results in 1962. She “just started living again” her husband said, adding that he was “delighted at the way it turned out.” But positive effects from this procedure were not always seen and people were often disappointed with their results. In 1960 Dr. Freeman performed a lobotomy on a 12 year old boy. The reason: even though he showed no symptoms of mental illness, his “defiant” personality was becoming a problem for his stepmother, who wanted Dr. Freeman to change his personality. Although not informed about the procedure until after it was done, the boy would later say “the surgery damaged me in many ways. But it didn’t ‘fix’ me, or turn me into a robot.” He was institutionalized for a decade. The list of negative results from the procedure was slowly growing and public opinion was gradually turning negative. In 1953 Dr. Freeman performed a lobotomy to cure a patient’s postpartum depression. Her daughter would later describe her mother as “there but not there,” and as a result of the procedure she spent the rest of her life in institutions. Another patient, this one diagnosed with schizophrenia. was similarly assessed by her daughter: “There was no change in her behavior other than she lost her higher intellect. She could not read anymore. She could barely write. She had no long-term memory.” The contention that lobotomies could cure illnesses like schizophrenia was beginning to come under fire. Neurologist Dr. Elliot S. Valenstein would say on the subject, “There were some very unpleasant results, very tragic results and some excellent results, and a lot in between.” Schizophrenia is a disorder of thought, he noted, yet a lobotomy alters emotional state, not cognitive abilities. With the results of this procedure varying from one extreme to the other why was it so popular? The answer is a portrait of psychiatric care at the time.

PARENTHOOD by David W. Proefrock, PhD

Dr. Walter Freeman, center, demonstrates lobotomy technique on a patient. The Psychiatric Landscape When lobotomies first came onto the scene in the 1930s psychiatric care was limited. For instance there was no treatment for schizophrenia. Doctors would attempt to use drugs like sedatives which would suppress their nervous systems but really offer no lasting effect or help. Schizophrenics were often subjected to hydrotherapy in the form of hot or cold baths for hours at a time. Then there was shock therapy which included electroconvulsive therapy (think “One Flew Over the Cuckoo’s Nest” or “A Beautiful Mind”). These therapies would often induce seizures in patients, and many doctors believed that patients would be “shocked” out of their illness. Since many people suffering from mental illness went in and out of hospitals or were lifetime patients, lobotomies initially seemed like a godsend. Times were desperate and so were the people. Hospitals in the United States were overcrowded. By 1940 average daily U.S. hospital census was 1 million, a number that was increasing annually by 80%. Conditions were bad as well, mostly due to a lack of funding during the Great Depression. Public hospitals being understaffed often left patients without any treatment. The climate was right to embrace any surgery that would claim to fix or cure their sick. Hopes rode particularly high for treating mental illness, a completely different animal compared to, say, fixing a broken arm. However, over time it became clear that lobotomies generally didn’t work. But criticism around the procedure was beginning to grow and as people began to see lobotomies for what they really were there was a drastic decline. Plus with the advent of new medications it left the surgery rather obsolete. The End Arrives In 1950 a huge advance in the treatment of schizophrenia emerged, a drug called chlorpromazine, also known as Thorazine. It was the first in what would become a long list of antipsychotic drugs. With the advent of this drug, lobotomies began to disappear. Please see LOBOTOMY page 16

Your 11 year-old son has seemed to be depressed during the past few weeks. He doesn’t get excited about things he used to enjoy doing, he seems listless and bored, and he’s lost his appetite. You’ve asked him and he says that nothing is wrong and that nothing is bothering him. You know that he’s not himself. What do you do? A. Take him to his pediatrician and describe what you’ve noticed. Have him checked out. B. All kids are stressed and worried during this time of coronavirus. Don’t worry too much about it. He’ll be fine. C. Take him to a mental health professional for an evaluation. D. Try to talk to him again. Let him know that you are worried about him and that you know something is wrong. If you answered: A. This is the best response. What looks like depression might actually be a sign of a physical condition. If it turns out that there is nothing wrong with him physically, ask his pediatrician to recommend a mental health professional. B. Kids are especially stressed during this time, but that is all the more reason to have him checked out. Start with his pediatrician. C. This is not a bad choice, but it would be best to have him checked by his pediatrician first. D. You have already tried this. There’s no reason to believe that he will tell you what is bothering him this time. If he is depressed, there is a good chance that he won’t be able to put the problem into words. This is a very stressful time for children and adolescents and he may not be able to verbalize what’s wrong. It’s almost always best to begin your search for an answer with a physical exam and then proceed from there. + Dr. Proefrock is a retired clinical and forensic child psychologist.

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FEBRUARY 19, 2021

21 IDEAS… from page 1

• Walk (or jog if you’re up to it) as many laps as you’re comfortable doing at the walking track nearest to your house. They are everywhere across the CSRA, and they’re smooth and level: Aiken’s Odell Weeks Activity Center; by the Wheeler Road Y and in front of Grovetown’s Steiner Y; across the street from Warren Road Elementary; at Columbia County’s Blanchard Park; off Mayo Road; at Diamond Lakes; and at dozens of other places convenient to each of us. • Get a couple of jigsaw puzzles (500-piece is good) for hours of quiet but focused activity. • Take a walk down the Greene Street median in downtown Augusta (generally between 5th and Sacred Heart) and read the many historical markers found there. • Actively focus your mind on positive things. Pray and meditate about good and upbuilding things, including even some of the unexpected benefits that have resulted from the pandemic. • Establish a daily or weekly routine to go for walks in your neighborhood. • Rearrange the furniture in one or more rooms in your house or apartment for a fresh look and a brand new feel. • Take advantage of the controlled climate in Aiken and Augusta Malls to walk even when it’s hot, cold, or raining. • Get a dog. You will be forced to go for daily walks (plural), which you will quickly come to look forward to and enjoy. And you’ll benefit from the companionship provided by your pet. • Search YouTube for instructional videos on virtually anything you’d like to learn: baking bread, playing the guitar or another instrument, learning to paint or speak French, knitting, home repair, and thousands of other pursuits. • On a regular schedule (daily or weekly),

Should I take a painkiller before (or after) getting my vaccine shot?

• Take a walk through one of Augusta’s historic cemeteries, like downtown’s Magnolia Cemetery (above, where a firefighter’s final resting place is memorialized) or the smaller but still historically significant Summerville Cemetery on Johns Road at Cummings Road. send a greeting card with a brief personal message to friends or relatives, or co-workers you no longer see because of working at home. • Do little projects in your yard each day: rake leaves, trim shrubs, sweep your sidewalks, porches and decks, plant flowers. • Resurrect a hobby you once enjoyed but haven’t practiced for years, or start one that you always dreamed about doing if you had the time. +

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Here’s what the CDC says on the subject (we have added italics to emphasize their message): “If you have pain or discomfort, talk to your doctor about taking over-the-counter medicine, such as ibuprofen, aspirin, antihistamines, or acetaminophen, for any pain and discomfort you may experience after getting vaccinated. You can take these medications to relieve post-vaccination side effects if you have no other medical reasons that prevent you from taking these medications normally. “It is not recommended you take these medicines before vaccination for the purpose of trying to prevent side effects, because it is not known how these medications may impact how well the vaccine works.” Painkillers can interfere with the very thing the vaccine is trying to accomplish: generate a strong response from the body’s immune system. As we have noted in the Examiner before, inflammation is often misunderstood as something that’s universally bad. We sometimes forget that defenses rushing to the site of a wound or infection will naturally cause swelling, fever, and muscle aches. That is a sign that the immune system is working, or in a specific case like we’re discussing, that the vaccine is working. Doctors and pharmacists say if you’re already taking ibuprofen (sold under brand names like Motrin and Advil), you shouldn’t stop taking them before getting the vaccine unless your doctor has advised you to do so. As for post-vaccination soreness, the CDC recommends applying a clean, cool, wet washcloth over the area and to use or exercise the arm in which you got the shot. To reduce discomfort from fever the CDC says to drink plenty of fluids and dress lightly. Remember, some site soreness, muscle and headaches, and fever are normal, particularly after the second shot. Experts say if you can avoid taking a painkiller after the shot, by all means do so. If you need one, acetaminophen (Tylenol) is safer because it does not affect the body’s immune response. For acute, severe or long-lasting side effects, promptly call your doctor or 9-1-1. +

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FEBRUARY 19, 2021

AUGUSTAMEDICALEXAMiNER

#133 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com by Marcia Ribble

very year hundreds of thousands of Americans benefit directly from the innovations brought about by this man, and it would be no surprise to learn that only a tiny handful have ever heard of him. Let’s change that right here. We would like to introduce to you Sir John Charnley. If you have had a hip replacement, you’re looking at the man who made it possible. Initially considering a career in cancer research, Charnley’s medical school professors discouraged that pursuit. He ended up focusing his medical attention on surgery and orthopedics beginning in the late 1930s. In short order, World War II intervened, and Charnley spent a good portion of the war years in Cairo, treating British soldiers injured in North Africa as well as inventing or improving various orthopedic instruments and devices. Returning to the civilian practice of medicine in early 1946, Charnley wanted to focus increasingly on research, a choice that ultimately led to a semi-mothballed hospital becoming a center for hip replacements under Charnley’s direction. Not that anyone really knew how to perform a successful hip replacement at that time (1958). But that was the whole point: Charnley thought the objective was worthwhile, but only a focused, dedicated effort would bring about the desired result. The challenge was great: design, build and safely implant an artificial joint that was strong, durable, and biochemically inert. By the middle of the 20th century, people had been trying and failing to do what Charnley was attempting for more than a hundred years. After general anesthesia began to be used in 1840, doctors had been trying to fix friction issues in worn-out hip joints with everything from wax to gold foil. Nothing worked until Charnley tried creating hip prosthetics with Teflon-lined sockets. Early results were good, and within a year more than 300 patients were walking around England with new hips. But by the end of that first year, the earliest recipients began to report hip pain, swelling, redness and heat at their surgical sites. Teflon was wearing away, and the body attacked the resulting debris as it would any other foreign invader. That setback led to another material, a very hard and dense polyethylene which, when tested in Charnley’s lab, showed less wear in three weeks of testing than Teflon did in one day. An innovation in bone cement further improved the success of implants, and Charnley developed significant innovations in infection control during hip replacement surgeries. Charnley’s innovations have been borrowed by other surgeons who have applied the same techniques to knee and shoulder replacements. Worldwide, literally millions of people are the beneficiaries of his work. One source said that “Charnley’s contributions to orthopedic sciences and surgery are so vast that it would be difficult to do [them] justice. Charnley was knighted in 1977. He died in 1982 at age 70 after experiencing two heart attacks. +

Life as usual is interesting. This week I finally received my first Moderna vaccine shot. I already feel very relieved and relaxed in a way I haven’t been since last March, probably even better since back then I was still healing from a broken hip. My year of isolation was worth it because I have stayed Covid-free, which at my age is a really good idea. To report my side effects is very easy. My arm was sore for about 8 hours and that was about it. If they had been significant I would have reported that to you. I did get the shot in my right arm: I’m right handed, so that forces me to use it no matter how sore it is. Next time I’ll get it in my left arm, which I also use a lot. Good news for all you folks who don’t have access to someone to drive you to the places you would like to go. It is easy. Just dial 211 and tell them you need rides to go places. I haven’t tried to use it yet, but I’ve been told it can be used for many errands. Grocery store. Doctor appointments. Church. Beauty salon. All these are possibilities. But I am sure there are many more ways in which having transportation will mean the world to those like me currently without it. It’s likely that I won’t try venturing out into the world until I’ve had both vaccine shots, but right now it’s helpful just to dream of the many possibilities. When the pandemic is finally at a point where we can see society opening up again, I can imagine using this service to go to the movies for the first time in years. What fun it will be to go out to eat without having the food delivered! So many times I have ordered food from restaurant delivery only to find that my fish is missing

tartar sauce, or some other expected side is missing. The wait staff does not seem to understand (because we’re not there to complain to their boss in person) that the customer they don’t really care about will, as I have, just stop trying to order from them. They could lose their jobs if enough of us bail. I can imagine how fun it will be to go to the grocery store and find what I want. Ordering online puts a middleman between me and what I want. Sometimes I get part of an order. Sometimes they bring me as many as five times what I wanted. Once I ordered a single bunch of tomatoes. They brought me five bunches, and of course I had to pay for them all. Another time I ordered two rotisserie chickens and received four of them. I don’t mind sharing with others, but I do mind having to pay for things I didn’t want and couldn’t possibly consume by myself. Friday, I ordered two boxes of sugar-free chocolate chip cookies. I got zero cookies. I’d love to be able to pick my own steak, one that has just the right size, the perfect amount of marbling, the best thickness for what I want to do with it. Soon it will be warm out and farmers markets will open again. I’d love to go and pick out a perfectly ripe beefsteak tomato for my BLT. A bunch of radishes with the warmth of the soil still on them. A couple of perfectly plump ears of corn. A bunch of beets with the greens intact because I like the greens as much as I like the beets. Ah, and homegrown Swiss chard, so succulent and healthy. Then there are the activities, the fairs, the concerts, the ball games. After being homebound for nearly two years, just being able to get out of my home and see and talk with others will be awesome! +

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age BY J.B. COLLUM

as he strained to remember. After a few moments, he said, “you’re a good cook.” He’s still a charmer with the ladies, even when he can’t remember their name. He remembers that she brings delicious meals to him a couple of times a day, and his enfeebled mind can hold on to that, so we’ll take it.

Covid-19 with the Spanish Flu outbreak of 1918. Despite his condition, he still holds on to some old memories, like when his grandmother told him stories about the Spanish Flu and how funeral homes in Augusta had bodies stacked on their porches like cord wood. His eyes got big and he adjusted his mask a little tighter when I told him that one. Of course, that lasted all of two minutes when he took it off again. It wasn’t just questioning though. He acted out like a three-year-old. I would turn away for a second to look at my phone and then look back to see the mask pulled down, or even completely off and stuffed in his shirt pocket. When he did that, it usually managed to snatch his hearing aid out and it would either be tangled up with the mask in his pocket or flung somewhere on the floor. Each time, I’d put everything back in place and explain again why he needed to keep it on, and each time he would nod or say he understood. This literally happened at least forty times. I admit that it tried my patience. This is another area that age helps though, I think. I have far more patience now than I did as a young father dealing with a petulant child. Age does have some benefits. Several times, he got fidgety and said he wanted to go home. He asked why we were even there. He asked why it was taking so long. The questions were endless. He took off his mask to cough and I explained that this was the primary reason to keep it on. Once we were out of the communal waiting room and in a room alone, but were still waiting on the doctor, I let him take the mask off. That is when some new behaviors started. He grabbed some of the tools that were sitting on the counter beside him and played with them, like the hammer used for testing reflexes. There was a tissue box there too, so he kept getting more tissue and blowing his nose. To be fair, his nose had been running since we first got out of the car. He would then put the used tissue down on top of the medical in-

THE

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Role reversal — a close friend of mine used those two words after I talked to him about a difficult time I had with my father at his neurologist appointment this week. He’s right. Many of us find ourselves taking care of our parents as they age, and in some cases, like with dementia sufferers, we even have to wield parental authority over them. My father’s Alzheimer’s now has him at about a three- to fiveyear-old mentality, and according to his neurologist, he will only regress more from here. The good news was that he will still have good days from time to time, when we can see my father in there. You have to look forward to and enjoy those times and try to forget the rest. If you’re like me, you also look for the humor, even in these situations. It is a survival mechanism. One of the problems with role reversal is that when I was a kid, my parents were young. They were in their twenties and thirties and had energy and stamina. My wife and I are in our fifties and have far less of either than we did in our twenties or thirties. We also have our own health issues that hinder us. Fortunately for us, we still have my mother here and she is still able to take care of herself the vast majority of the time, but she has serious health problems of her own. She still manages to make sure dad takes his meds and that he mostly stays out of trouble, and at present, she can bath him with some help from my brother or another family member. It helps that we moved them in with us so that we can help as needed. We’ve gotten into a good routine for the most part. My better half makes breakfast most days, as well as supper. She makes sure the diet meets our nutritional needs and that they are tasty as well. They say the way to a man’s heart is through his stomach. Well, I am here to tell you that the way to his brain (even with Alzheimer’s) is also through his stomach. Just this week, my father didn’t know who my wife was. She asked him again if he could remember her name and his eyes narrowed

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I got to see first-hand what my mother went through all the time

I experienced another aspect of role reversal at the doctor’s office this week. Because my mother wasn’t feeling well, I had to take Dad to an appointment. I got to see what my mother had already been going through on appointments she had taken him to on her own. He really was like what I imagine a three-year-old would be like if he was forced to wear a face mask. I put it on him when we got out of the car and he wanted to know why he had to wear it. I had anticipated this, so I had already explained it to him on the ride there. But he can forget what you tell him in seconds, so I wasn’t shocked. This was one of those occasions where I would have to tell him again and again during the almost two hours we spent at the doctor’s office. I tried to keep it simple and said that it was to protect him and other people from a bad virus going around. Sometimes that was enough, but at other times he wanted to know more. It took me back to when my children would ask all of the “why” questions. Fortunately, I know a little more now than I did when my children were young, so I’m getting pretty good at this game. I mentioned once before that when my father gets into one of these loops where he repeatedly asks the same question in a short cycle, I have a little fun and give him fanciful answers. He won’t remember anyway, so I have fun with it. This time I inflated the numbers of deaths and cases and equated

Please see MIDDLE AGE page 7

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WHEN ONE DOOR CLOSES

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

BAKED FISH WITH MEDITERRANEAN SAUCE The sauce is delicious and would work equally well with chicken.

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Ingredients • 2 tsp. olive oil • 1 cup chopped onion • 2 tsp. garlic, minced • ¼ c dry white wine • 1 (14.5 oz) can stewed tomatoes (chopped, undrained) • ½ tsp. oregano • 1 14oz can quartered artichoke hearts (packed in water) • ¼ tsp. salt • ¼ tsp. pepper • 24 ounces firm white fish (halibut, mahi mahi, cod) • ¼ cup black olives; chopped (optional garnish) Instructions Preheat oven to 400°. Coat non-stick pan with cooking spray and add olive oil. Heat oil over medium-high heat, add onion and garlic, cook till soft and translucent (3-5 minutes). Add wine, stir in tomatoes, oregano, and artichokes. Mix well and simmer for about 5 minutes. Arrange fish in baking pan that has been coated with cooking spray. Sprinkle fish with salt and pepper. Top the fish evenly with sauce. Bake 12-15 minutes until fish flakes with a fork. Sprinkle

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451 Highland Ave in Surrey Center • (706) 733-2256 • www.gentrymensshop.com with olives before serving. Yield: 6 servings Nutrient Breakdown: Calories 200; Fat 5g (0.5g saturated, 2.5 g monounsaturated, 500mg Omega-3); Cholesterol 35mg; Sodium 460mg Carbohydrate 9g; Fiber 1g; Protein 26g, Potassium 553mg, Phosphorus 261mg Percent Daily Value: 10% Vitamin A, 20% Vitamin C,

MIDDLE AGE… from page 5

struments, so I made a mental note to tell them so they could be cleaned. (side comment: I forgot to tell them) Each time he did that, I would get up, grab the tissue, carry it to the trash can and wash my hands with the hand sanitizer dispenser in the room and I would tell him not to do it, which he ignored within a minute or two. On the ride home, he got into a better mood and it seemed to improve his thinking ability too. We had a tender moment when we were almost home, and he was thinking at his best. He told me a story I had never heard about one of his favorite uncles who was an engineer for the Georgia Railroad. He was visiting with him at the station when another guy who was supposed to go with his uncle didn’t show up in time for the departure of the train, so his uncle asked if my dad could fill in for a run to Atlanta

10% Iron, 8% Calcium Carbohydrate Choices: 1 Carbohydrate Diabetes Exchanges: 1½ Vegetable, 3 Very lean meats Kim’s note: To easily cut the stewed tomatoes pour the can into a medium bowl and cut them with your kitchen shears right in the bowl. That way the only mess to clean up is one bowl. +

and they allowed it. The look on Dad’s face and how he talked about that beloved uncle and that train trip made the whole ordeal of taking him to the doctor worth it. I took that opportunity to tell him how much I loved him and how I appreciated the lessons he had taught me about loving God, my wife, and my children. I was happy to see that the message got through and he said that is what his mother taught him. The roles aren’t completely reversed. My father is still in there and there is still a little boy in me who looks at him as my hero. + J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.com

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Credit for my borrowed title goes to Spencer Johnson who wrote a book more than 20 years ago titled Who Moved My Cheese? in which he provided ways of thinking to change our fear of change. It seems we do fear it since often we’re not in control of how it comes to us. Prior to the book, in the late 70s, a behavioral model called “The Stages of Change” was formulated to study smokers who quit on their own and compared them with those who needed outside help to stop smoking. And for what it’s worth, it seems that quitting smoking is beaucoup harder than stopping drinking alcohol. The “Stages” model has been used by a multitude of disciplines who have adapted the specifics to other addictive behaviors, in much the same way that other inventors have used Henry Ford’s Model T to make their own version of an automobile. I briefly alluded to this in a prior column, but will explain each stage more fully here. Leaving out the mumbojumbo and technical terms of the study (which are only interesting to us in the behavioral health field), here is the progression: • PRECONTEMPLATION – in this stage people have no intention of taking action about something they’re doing because they don’t see

their actions as problematic. I hear all the time, “It’s my body – I’ll do with it what I want” and “I’m only hurting myself and nobody else.” In this stage people don’t see the benefits of change; they only see it as being very hard without seeing the benefit of (within our context here) stopping drinking. They get defensive when somebody asks them to change. Their mind cannot see the problem even though others around them can see it plainly. In the counseling field we call this “denial;” the unconscious mind not being able to see the truth. Interestingly, denial is not a lie; a lie is a conscious act. Nobody can be helped in this stage. Cotton in the ears. In fact, the resistance of an alcoholic/addict in this stage is many times more powerful than any effort to persuade him/her to change. Might as well save your energy. Best thing to do is: say nothing. I know, I know, not what you want to hear. But saying something just makes your loved one more defensive and more deeply entrenched in denial. He/she thinks that you are the problem, not them. (Is anyone out there nodding yes or raising your hand right about now?) The worst way to help someone you love get to the next stage of change is not to beat their head against the wall, or browbeat them, or harass them, raise your voice, or use manipulative

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional

methods. Example: the parents and spouses who call my office to make an appointment for their alcoholic loved one and don’t tell that person the appointment is at a substance abuse treatment center! The worst blowups I’ve ever seen have been a loved one who finally realizes they’ve been conned! I haven’t had to call 911 yet, but have experienced these poor unfortunates yelling loudly as they hastily leave the room, throwing objects at the building on their way out, destroying my outdoor furniture, demanding a refund, and giving a bad online review. One step forward — or so we thought — but two steps back. The poor relative in pain often just doesn’t understand why they can’t pay me to change the mind of their addicted loved one! I think that would be called de-programming and it’s sometimes done when rescuing a teenager from a cultish group! Well, I’ve done it once again. Tried to cover too much imaterial n too small of a space. Guess I’ll have to continue next month with the next stages of change, and hopefully how to help your loved one get there. In the meantime, if you’re a loved one of an alcoholic, please: don’t take their beer. +

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DON’T LICK THE BEATERS Useful food facts from dietetic interns with the Augusta University MS-Dietetic Internship Program

WHAT IS byPLANT-BASED MEAT? Nicole M. Goltry, Graduate Student Intern, Augusta University

When many of us think of the word protein we automatically think of meat. However, studies have shown that too much meat, particularly red meat like beef and pork, is not good for us. Because of this, more and more Americans are exploring the world of plantbased meat products. These are products manufactured to look, smell and taste just like the animal-based product which appeals to many meat eaters. Products that have recently gained popularity include porkless pork rinds, plant-based tuna, chicken-free chicken nuggets, and “red meat” plant-based products like hamburgers and sausage. Many are sold right next to the meat in the local grocery store, and many fast-food restaurants have even added them to their menus. One of the fundamental differences between plant foods and animal foods is the type of fat present. In most plantbased foods, the fat or oil that is extracted is liquid at room temperature and is usually unsaturated. Animal fat is usually solid to semi-solid at room temperature and is considered saturated.

Saturated fat is the kind of fat we should limit in our diets in order to reduce the risk of cardiovascular diseases. It is also the kind of fat that most people choosing plant-based meat products are looking to avoid. Two of the top plantbased meat companies use coconut oil in their products to mimic the juiciness and flavor of animal products. Coconut oil is a saturated fat, however, so unfortunately there is not much of a beneficial trade-off there. Another fundamental difference in animal and plantbased products is fiber. Dietary fiber is not found in animal products, it is however found in plant-based “meats.” The fiber content of plant-based meat varies anywhere from 1-5 grams of fiber, whereas animal proteins do not typically have any fiber. Adult men should get 30-38 grams of fiber per day; adult women should get 21-25 grams of fiber per day. Americans typically only con-

Plant Animal Difference Calories 260 326 +20% Protein (g) 20 30.5 - 34% Fat (g) 18 21.8 - 17% Sodium (mg) 350 460 - 24%

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sume between 10-15 grams of fiber per day. Fiber has some significant health benefits, like helping with the regularity of bowel movements and maintenance of blood sugar control. So, are plant-based meat products healthier? Take a look at the analysis of similar sized “hamburger” patties on the chart below. While the plant-based product is lower in protein, it is also lower in Calories, fat, and sodium. Depending on your personal dietary goals, plantbased meats might be a better option. Eating whole plant foods, like a portabella mushroom in place of a hamburger patty, is recommended as a first choice. However, plant-based meat products are a great option for someone looking to reduce their red meat consumption and still get adequate protein. Remember these products are processed and manufactured in a way that removes them from their natural state in order to mimic meat. Due to this process consumers do not get the same benefit as they would if they were consuming the whole foods that make up the plant-based meat product. Additionally, consumers concerned about environmental impact should consider the manufacturing and distribution practices required for these products in their decision on whether to purchase plant-based meat or not. Plant-based meat products can be the small step that leads to big change, so don’t knock it until you try it!

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined

line while driving right next to another vehicle, also for miles. More about this in a moment. Another jerk move that many people don’t recognize is what

passing, and a host of other transgressions. In other words, some people respond to jerk moves by being jerks themselves, a true recipe for disaster. For the uninformed, in Georgia at least it is against the law to refuse to move over for traffic approaching behind you. It does not matter if you’re already driving 10 mph over the speed limit, so the guy behind you has no grounds for complaint. You could be driving 100 mph, but if someone wants to pass you, the law says you have to move over. But not every “jerk move” is a jerk move. Some should get air quotes because they are not always jerk moves at all. Take the situation where two lanes are merging into one, such as at a construction zone. Drivers are informed and instructed to merge, and most promptly obey. Then there are the jerks who ignore the signs, speed past all the crawling cars, and merge at the last minute. While this admittedly seems pretty jerky, traffic engineers agree with the move. Traffic flows smoothest and delays are kept shortest when both lanes have equal cars and all the merging takes place at the socalled last minute. Officially this is known as a “zipper merge,” and as we have written about before in this space, it is growing in popularity and is even the law in a few states. In summary, jerk moves are unsafe moves. They aren’t moves good drivers make. +

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ll of us can easily define the two words below — jerk moves — within the context of driving. We’ve been cut off; we’ve been tailgated; maybe we’ve been yelled at or gestured to in rude, vulgar or threatening terms. There are two big problems with jerk moves, at least for the purposes of this column. One is that they can be the tiny spark that sets off a huge and devastating chain of events. Simple little misunderstandings that should have been shrugged off, and which would not have been remembered even a day later, have resulted in things like prison sentences and death. In terms of how often road rage events happens per million miles driven, they might seem relatively insignificant. But they happen often enough that just about all of us have witnessed one or more such events, or we’ve been part of one (or maybe several). They aren’t rare. But while many jerk moves are borne of aggressive driving and short tempers, there is another category of jerk moves that comes from the other side of the spectrum. Their source is drivers who are calm, serene and oblivious to their surroundings and, yes, to the rules of the road. The hot-headed lead-foot knows he’s committing jerk moves. His opposite number has no idea, and therefore is likely a repeat offender. We have examples. Let’s start with the classic case: the dreaded left-lane Sunday driver (but they practice their craft 7 days a week). This person will happily and serenely sail down I-20 or Jefferson Davis Hwy or Riverwatch Parkway in the left lane (possibly below the speed limit) for miles. They don’t seem to notice that 12 cars are stacked up behind them, and if they do, it doesn’t bother them in the slightest. Neither do they seem to notice or care if they happen to monopolize the left

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Jerk moves

we might call the Toe the Line driver. Perhaps you are one. Toe the Line drivers stay behind the “stop here” line in the left-turn lane at intersections. When the light goes green, they don’t ease forward into the intersection in preparation for their turn; they stay right where they are until a major gap in oncoming traffic allows them to turn safely. Another variation on this theme is when a left turn arrow ends and the protected left turn becomes a flashing yellow left turn arrow. Or there is a green light, but no longer a protected left turn. In these situations the Toe the Line Driver stays behind the line. Why is this a jerk move? Several reasons. First, it’s unnecessary. It is 100% legal to pull into the middle of an intersection awaiting a safe moment to turn. Ask any cop. (We asked Columbia County Sheriff Clay Whittle.) So toeing the line is a bit like driving 45 mph on a 55 mph road in the left lane. It impedes the flow of traffic. Toe the Liners will miss perfectly safe opportunities to turn left because they have to start their turn from so far back. That annoys other drivers. It makes them impatient. And what sometimes happens when drivers get frustrated and annoyed? See paragraph one. Returning as promised to the slow driver in the left lane for a moment, this is a habit that will light the fuse of many drivers. Whether the left-lane hog is oblivious or just plain stubborn doesn’t matter. His or her actions can be the catalyst for aggressive tailgating, reckless

FEBRUARY 19, 2021 In this, the month of love, February, we often contemplate the best way to show our love for those special people in our lives. In a prior column, I wrote about what love is: Love is a commitment, love is a decision, love is action. One way we show our love for those who are important to us is with our gift of time. This is particularly special to the elderly people in our lives. We live in a very busy and fast-paced era, when our How do I show my attention is diverted between loved one that I care work, the road, screens, etc. We often don’t focus on the about them? people right in front of us. The typical 90-year-old perby Amy Hane, a licensed Master son, who lives alone and is Social Worker in South Carolina still somewhat independent, and Georgia, an Advanced Profesoften does not leave the home sional Aging Life Care Manager much at all. They certainly and a Certified Advanced Social do not work or volunteer the Work Case Manager. way they might have 10, 20, or 30 years ago. Typically when you’re in your 80s and 90s, every day feels the same. So to have someone come and sit with you for 45 minutes or an hour and share a simple meal or just talk about old times or current times is such a gift. They will be glad to share stories. Yes, you may have heard them in the past, but just listen. Unfortunately, during this time of the COVID-19 pandemic we are all physically distancing ourselves, and this can be extra hard for the elderly loved ones in your life. Do not forget them and work to visit with them outside, wearing a mask if need be, or via FaceTime, Zoom, or some other video platform if they can navigate it. There are specific tablets created and programmed just for the more mature generation that offer video chatting and phone calling with ease. GrandPad is one such device. Don’t focus on your cell phone or your tablet when you’re physically with them. Unless you’re using it to show them pictures, put it away. They will always appreciate you calling them on the phone or making it a point to visit them in person. If you don’t have a lot to talk about with them, you can play cards or a game . Be sure you choose an activity that they can do wi feeling frustrated while playing. You can look at old scrapbooks together, as their memory for past events is probably much better than it is for current happenings. You will be giving them a precious gift and you will find that you are blessed in return. +

IT’S A QUESTION OF CARE

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The blog spot From the Bookshelf — posted by Brennin Brown, MD and Susan Friedman, MD, on February 15, 2021 (edited for space)

MORAL INJURIES UNDERMINE CARE In addition to the medical risks of COVID-19, the pandemic’s occupational hazards are numerous for health care workers. In the health care systems in which we practice, our patients’ health can often come before our own. This is a dynamic of selflessness and heroism that has carried on throughout the history of medicine as a field. The learning we complete in medical school prepares us for clinical care, but there is the hidden curriculum of doctoring that also affects the care we provide for patients. In the COVID setting [there are] moral injuries that represent a threat to care and are a hazard, not only to physicians’ health but also to their patients. Moral injury can occur when “clinicians are … expected to make choices that transgress their longstanding, deeply held commitment to healing.” We are all susceptible to this type of emotional transgression when we violate our values or personal code of ethics. Physicians around the world have been required to make health care decisions that threaten their value system and potentially undermine their oath to patients and themselves. Decisions have been made about the use of resources to treat populations, judgments about triage and visitation with dying family members. Additionally, the policy limitations and potentially lack of adequate resources (not only PPE, ventilators, and ICU beds, but also inability to treat patients with medical issues unrelated to COVID and our own fears of becoming infected) can lead to care falling short of our ideals. These changes can represent a mental and emotional challenge. In July 2020, the American Psychiatric Association released guidance for dealing with moral injury among health care workers caring for patients during COVID. This document provides health care leadership and administrators tools to combat and intervene when encountering moral injury. There is data that identifies burnout as a factor associated with adverse health outcomes. Recent research suggests that burnout is related to increased unconscious bias among resident trainees, potentially leading to disparate care of our patients who are from racial and ethnic minorities. Medical errors are costly in terms of patient morbidity and mortality and in terms of health care dollars. Our ability as doctors to identify burnout and mental health challenges, and to have support to seek appropriate treatment, is imperative to our patients’ health. The longused cliché compares caring for one’s self by putting on our own oxygen masks on airplanes before putting on a child’s mask. This perspective puts the onus on doctors to prioritize themselves, when historically the medical care system has devalued physicians’ senses of well-being. In order to affect real change, the identification of moral injury and burnout must be supported by cultural shifts— by actionable steps. The APA document describes: educating physicians and promoting discussion about moral injury, supporting decision-making, teamwork and cohesion as potential steps to decrease risk of moral injury. Health care administrators and leaders can create spaces for education and dialogue related to concepts of moral injury, well-being, and burnout prevention. The COVID crisis offers health care leaders an opportunity to support physicians by being pro-active about the risks of moral injury and burnout. +

Difficult choices can undermine our core values

Brennin Brown is a psychiatry resident. Susan Hatters Friedman is a reproductive and forensic psychiatrist.

Many people know that Elizabeth Blackwell was the first female doctor in the United States. Some of them might even be Medical Examiner readers, since we have profiled her in past issues. Not as many people may know that her sister Emily also became a full-fledged physician at a time when such a thing was unheard of. This book may well be the definitive history of their accomplishments and the struggles they overcame to achieve them. And those struggles were many, some of them in response to huge, systemic barricades, while others were the Blackwells’ answer to subtle and insidious prejudice. As examples of the latter, Elizabeth Blackwell was accepted into medical school by unanimous vote of the allmale student body of Geneva Medical College in New York, not because they were forward-thinking supporters of equal rights for women, but as a prank; they wanted to witness the humiliation of a woman who was striving for something unattainable for her or any woman. In another telling instance,

on her first full day at New York’s Bellevue Hospital Emily was the only woman in the operating theater when the teaching surgeon, clad in an apron stiff with dried blood, paused before beginning to ask the male students to move aside to afford Emily a better view of the proceedings. Was that a magnanimous and egalitarian gesture? Hardly. It was designed to create the most likely scenario to cause Emily to faint at the sight of blood. She wrote to a friend that the students watched her as much as they did the operation, while she never took her eyes off the surgery from the initial incision to the post-op bandaging.

It turns out that the sisters were pioneers beyond the medical arena too. In 1863 President Lincoln issued the Emancipation Proclamation, sparking the socalled Draft Riots in New York City, where the Blackwells operated an infirmary. The working-class rioters feared that newly freed blacks would flood the labor market and steal their jobs. At the clinic, white patients were in a state of panic, demanding the ouster of the lone black patient for fear she could be a magnet for racist rioters. Rather than consenting to those demands, the white patients were informed that they were free to leave; the black patient would be staying. This is an exhaustively researched book that any advocate of equal rights or student of medical history will enjoy and derive inspiration from. + The Doctors Blackwell: How Two Pioneering Sisters Brought Medicine to Women and Women to Medicine, by Janice P. Nimura, 320 pages, published in January 2021 by W. W. Norton & Company

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The Examiners

FEBRUARY 19, 2021

THE MYSTERY WORD

by Dan Pearson

I thought you told me your New Year’s resolution was to eat healthier. That’s right.

How’s that working out for you?

Awesome! See for yourself. My lunch right here is cheese and oranges.

Cheez Whiz and Sunny D?

The Mystery Word for this issue: LEARYGL

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

EXAMINER CROSSWORD

PUZZLE ACROSS 1. _______ center 7. Pretense 11. Grass, cut and dried 14. Like many insects 15. Windy City MLB nickname 17. James Brown venue (with “The”) 18. Excess nitrogen in the blood 19. Elder 20. Field official, for short 21. Wife of Jacob 22. Paradise 24. Baby powder 26. Island in the Bay of Naples 29. Type of bag 32. Hand operated implements 35. Small screen movie network 36. Having a tail (Anatomy) 39. Sign on many doors 40. It’s a div. of Verizon 41. _______ someone out 42. Gotta Get a Message to You Bee Gees song beginning 43. Climbing vine 44. Artist studio 46. Born 47. Cinemas’ name 49. Gehrig’s legacy? (abbrev) 50. Gardening tool 52. Type of code 54. Partner 56. Identical 58. _____26 61. Connected 65. _______ trial 67. Tube for oxygenated blood 68. Mountain range in Wyoming and Montana 69. Objects from everyday life 70. ______ Pack (of the 1960s) 71. “Who _____?”

20 22

29 36

E X A M I N E R

25 32

21 24

We’ll announce the winner in our next issue!

54 59

46 51

55 61

1 2 9 4 3 7

S 1 U D O 7 K U 3

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

72. Thawed DOWN 1. Start of The Night Before Christmas 2. What time sometimes is 3. Abbrev. after many a poem 4. More repellent 5. Tuneful 6. Love dearly 7. Quarrel 8. Faint cloud of smoke/vapor 9. In the air 10. Encountered 11. ________ Queen 12. Home of 50 nations 13. Casual synonym for yes 16. Common greeting 23. Queasiness 25. Consumed 26. Preside over 27. Overhead 28. Someone with more than one wife or husband

QUOTATIONPUZZLE

30. Idealized or picturesque scene 31. Intolerance of another race 33. Canal keeper? 34. Contemptuous smile 37. Appropriate 38. Definite article 44. The “A” of IPA 45. Former worker 48. Place of competition 51. _____ floss 53. Support for a cornice 55. _______ clock 56. Cut or burn leftover 57. Jessica of Hollywood 59. ______ sale 60. Talon 62. Salmon that has spawned 63. One of the Great Lakes 64. Something consisting of two elements 66. Annoy

R E T T

N O A E A L S F S E I H D B D T H S N R I E H N E E

S E A T E V E N R Y E T E Y E W N

8 9 2 4 T 7 1 A 6 5 3

1 4 3 6 5 9 7 2 8

— Helen Hayes

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

Solution p. 14

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

T 1 2 3 4 5 6 7 V 1 2 1 2 3 4

R F 1 2 3 4 1 2 1 2 3 4 5 D 1 2 3 4 1 2 3 4

— Andy Rooney

1.GPFINNIE 2.SNOOVIER 3.WITNEO 4.DREWNH 5.IT 6.N 7.G

SAMPLE:

1. ILB 2. SLO 3. VI 4. NE 5. D =

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MAR. 1, 2021

5 6 7 3 8 2 4 9 1

2 1 4 8 9 7 3 6 5

6 8 9 5 3 4 2 1 7

7 3 5 2 1 6 9 8 4

FEBRUARY 19, 2021

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

Moe: Use unprecedented in a sentence. Joe: Uh, let’s see...how about, “before Mount Rushmore was sculpted, it was unpresidented.”

The

13 +

Moe: How could the population of an entire state all have amnesia at the same time? Joe: What are you talking about? Moe: California. They said on the news that Californians are trying to recall their governor.

guy walks into a bar and tells the bartender to make a Jack & Coke. The bartender asks him, “Pepsi ok instead?” “Sure,” says the guy. So the bartender pours Coke and Pepsi into a glass.

Moe: It hurts me to say this, but... Joe: It’s ok. I can take it. Moe: I have a sore throat.

To help improve inmate morale, a prison in Japan invited a few sumo wrestlers to make a demonstration of their sport. As part of their presentation they asked if any inmates would like to challenge them in a match, and several of the biggest and fattest prisoners accepted the challenge. To everyone’s surprise, the inmates won every match. Which just goes to show that sometimes the cons outweigh the pros.

Moe: I was at the capitol riot. Joe: Seriously? I hope you weren’t injured in that melee. Moe: Actually, somebody threw a full can of soda that hit me right on the head. Joe: Oh wow. Did you have to get stitches? “Welcome to this meeting of Plastic Surgery Ad- Moe: Don’t you listen? I just told you it was a dicts Anonymous,” said the man to the members soft drink. of the group sitting in a loose circle. “I see several new faces this week,” he continued with a sigh, Moe: Hey, did you hear that joke about polio? “and that’s very disappointing.” Joe: Dude, no one gets that anymore. Moe: What was in that package on the porch? Joe: The little bottle of Wite-Out I ordered. But they messed up and sent me a gallon. Moe: Whoa! Big mistake!

Moe: You are certainly lazy. Joe: Being lazy is the way of nature. Moe: Where did you get that crazy idea? Joe: You’ve never heard of sedentary rock?

Moe: Hey, did you hear that joke about coronavirus? Joe: Dude, do you really think you should be spreading that? +

Why subscribe to theMEDICALEXAMINER? What do you mean?

Staring at my phone all day has had no Effect on ME!

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

Dear Advice Doctor, My wife and I have three kids. We love them all dearly and we do okay financially, but everyone has their limits. I have reached mine, but she wants another baby. I feel like we need another child like we need a hole in the head. Not to mention, twins run in her family. We’ve dodged that bullet so far, but we could go from three to five in one fell swoop. How can I convince her that three kids is enough? — Party of Five Already Dear Party of Five, You might be surprised to discover that centuries ago this was a much bigger issue than it is today. But as you know first-hand, it still comes up in the 21st century. As mentioned in “Brain Damaged” elsewhere in this issue, sometimes medical treatments that are advanced science in one century are considered primitive and ridiculous in the next. One of those is the very procedure you alluded to. Yes, at one time doctors would tell their patients they needed a hole in their head! Special tools were developed that would cut a disk from the skull, perhaps as large as a silver dollar. This was an accepted cure for issues ranging from behavioral problems to headaches, and it helped ward off evil spirits too. In those cases, historians have found evidence that people would then wear the bone disk on a necklace for additional evil spirits protection. Thousands of drilled ancient skulls have been discovered around the world by archaeologists, and the notable finding (other than their sheer numbers) is that the edges of the holes are smooth and rounded, suggesting this was not a fatal procedure. People survived the experience and their bones had time to heal. As primitive as this practice, known as trepanation, might sound to modern ears, it still has a place in medicine today. To treat a traumatic brain injury, for example, removal of a section of skull (the modern term is craniotomy) provides room for the brain to swell without damaging itself. The difference between then and now: these days the bone is replaced as soon as possible (or never fully removed in the first place). Another related application is trephination, the term for drilling a hole through that fingernail you hit with a hammer in order to relieve swelling and pressure. The word comes from trephine, the name of the tool used as far back as medieval Europe to drill holes in people’s heads. Thanks for writing, and I hope I answered your question. + Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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AUGUSTAMEDICALEXAMiNER

THE MONEY DOCTOR

ROTH IRAS – THE FRONT AND BACK DOOR The Roth IRA was established by the Taxpayer Relief Act of 1997 and is named for its chief legislative sponsor, Senator William Roth of Delaware. Since that year, the popularity of Roth accounts has exploded because of the tax advantages they offer. The Roth IRA does not give you a tax deduction when you put contributions into the account, but the account allows your money to grow tax-free for life. That is a powerful Roth selling point, so what’s not to like? Putting money into a Roth IRA can be tricky depending on your income situation. In 2021, the Roth IRA contribution limit is $6,000 per person, or $7,000 if you are over 50 years of age. A Roth IRA does have income limits, which is where the front and back door come into play. If you make below the modified AGI (Adjusted Gross Income) limit of $208,000 for joint filers or $140,000 for single filers in 2021, you can use the front door. Just put the money directly into your Roth IRA each year. You have until April 15, 2022 to make your 2021 contributions. If you earn more than the income limits, you can still put money into your Roth IRAs, but you will have to use the backdoor. The backdoor lets you put money into a Roth IRA with an extra administrative step. Below are the steps; 1. • Put money in a traditional IRA account. Since you are over the income limits, the contribution will be considered non-deductible for taxes. 2. • Convert the account to a Roth IRA. This will move the money from your traditional IRA to your Roth IRA. 3. • Make sure your tax preparer reports the transactions properly on your tax return. It is best if you work with a CPA when doing this. There are a few rules Roth IRAs must follow. The most important rule to understand for this strategy is the IRS pro-rata rule. To avoid complications, make sure you do not have any other traditional, SIMPLE, or SEP IRAs accounts with balances. If you do, the IRS will make you pay taxes on the percentage of pre-tax money you have in the other open accounts when you do the Roth conversion in step 2. The pro-rata rule is one of the reasons we recommend you discuss this with a financial planner before doing it. If you do have other IRA accounts with balances, there are strategies you can consider that will consolidate the accounts and allow you to use the backdoor Roth IRA option. However, for some people the extra complexity may not make sense. It is amazing to watch families use this backdoor strategy. Using a 6% average return, a couple over 50 can save almost $200,000 in Roth IRAs over 10 years. We find that couples in retirement with Roth accounts have increased flexibility with the withdrawal strategy which helps minimize taxes in retirement. In addition, Roth IRA accounts are great for legacy planning. + by Clayton Quamme, CFP® a financial planner with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

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FEBRUARY 19, 2021

LOBOTOMY… from page 2

The lobotomies had always had its critics, interested in bringing the procedure back. but the chorus gradually grew louder. In a In 1997 Harvard neurosurgeons published 1941 issue of the Journal of the American a report about using MRI scans to guide Medical Association the author noted: “No doctors in performing cingulotomies, a doctor can yet assert that this is or is not procedure where they burn a small hole in a truly worthwhile procethe cingulate gyrus, an dure. The ultimate decision area of the brain involved must await the production in emotional behavior. of more scientific eviWhile evidence suggests dence.” In 1953 the USSR that this can be effective, banned the procedure, especially for treatment saying that lobotomies of chronic and emotional “violate the principles of pain, the historical stigma humanity,” changing “an of lobotomies has to be insane person” into “an considered and overcome idiot.” Both European and A teaching diagram for a transif anything like it ever orbital lobotomy. American psychiatrists returns again. New drugs came to agree. and therapies keep the Social injustice is another chapter in the pool of candidates for any such potential lobotomy story. They were often given to resurgence small. criminals, usually against their will, in an The history of lobotomies is as fascinating attempt to curb their criminal tendencies. as it is deep. Initially hailed as an advanceWorld War II veterans were not immune ment that was Nobel Prizeworthy, it very to this procedure, and many patients who soon became synonymous with, and an couldn’t (or wouldn’t) consent to the surenduring symbol of, bad medicine. gery had family members make the decision It does make you wonder: what gold stanfor them. dard procedures do we have now that may Dr. Freeman performed his last lobotomy become obsolete in the future, and even in 1967 when a woman getting her third viwed as primitive and barbaric? procedure died from a brain hemorrhage. As science and medicine progress, the While still performed today, lobotomies are sudden rise and abrupt fall of lobotomies extremely rare. suggests that it’s not a bad idea to question everything; don’t blindly accept the opinions A Lesson for the Future of “experts.” Despite all the negative history associated Today’s amazing medical advancement with lobotomies, there are doctors who are might be tomorrow’s quack medicine. +

Michael Sharkey, MD Lauren Ploch, MD Caroline Wells, PA-C Chris Thompson, PA-C John Cook, MD, Emeritus GENERAL, SURGICAL & COSMETIC DERMATOLOGY

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