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MARCH 15, 2013
THE RAW POWER OF
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f there is any one subject in the entire fascinating world of medical science that stands alone in the realm of the extraordinary and the sublime, it might very well be the placebo effect. This article will explore a tiny fraction of the magic and the mystery — and how this amazing phenomenon can be put to use in everyday medicine.
Take two
The most powerful drug known to mankind Know what it is? Ironically, it’s the inert “medicine” that offers no therapeutic effect whatsoever. That, if by chance you were unaware, is the definition of a placebo. Despite that description, placebo lives up to its name, Latin for “I shall please.” Not that placebos always please. More about that in one second. Placebo has earned a lofty perch in the pantheon of medicines, and it got it the oldfashioned way: it earned it. Pharmaceutical companies spend billions of dollars every year developing new medications, and what do they measure their effectiveness against? To a significant degree, against placebos. Such studies typically pit new drugs against placebos. Half the group is taking the next wonder drug and half are taking an inert placebo, perhaps a concoction of cornstarch or sugar. It must be disconcerting to be a pharmaceutical researcher who has spent years developing a new drug only to have placebos produce better results, but that’s exactly what sometimes happens. For every placebo, there can be its corollary: nocebo, the onset of negative symptoms, also caused out of thin air by inert pills, injections or creams. Nocebo means “I shall harm.”
and call me in the morning.
It gets complicated The preceding paragraphs were merely an introduction to the subject for the uninitiated. Let’s get into some of the placebo research into this fascinating topic. The January-February issue of Harvard Magazine caught our attention and got this idea off our idea list where it has been for a couple of years. In the magazine, researcher Ted Kaptchuk recounts his randomized clinical trial for patients with severe arm pain. Half the patients were given pain pills, the other half acupuncture treatment. In short order, about a third of the 270 people in the study were suffering from acute side effects: some of the patients were experiencing abnormal swelling and redness at the acupuncture sites; some of the pain pill patients reported that the drug made them so sluggish they could barely get out of bed in the morning. For the two-thirds majority, however, the results were better. They pain pills gave them genuine relief, and those who received acupuncture treatments reported even better results. Given the context of this article, you might expect what’s coming: both groups got placebo treatment. The pills that offered relief and caused terrible side effects were made of cornstarch. The acupuncture was also fake. It was performed with retractable needles which never pierced the skin. Researchers didn’t conduct this study simply to humiliate 270 people. Then why do it? Please turn the page.
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MARCH 15, 2013
AUGUSTA MEDiCAL EXAMINER
PLACEBO… from page 1 What’s the point? There are research applications of course, but also real-life, non-laboratory, everyday ways the placebo effect can be harnessed for healing. For starters, the point should be made that no physician or medical researcher with two brain cells to rub together thinks a malignant tumor or a broken leg can be cured by the power of positive thinking. There are legitimate ethical concerns over deliberately deceiving patients by offering “fake” medicine. Enrolling a patient with asthma into a placebo study, for example, would be viewed as unethical in many quarters. However, medical scientists have been able to identify and measure real physical and physiological reactions caused by placebo treatments. For example, decades ago researchers found that by blocking the release of certain endorphins — natural pain relievers released by the brain — they also effectively blocked the placebo effect. The obvious conclusion was that placebo treatments can and do spark the release of endorphins just as effectively as real medicines do. Yes, the brain is what puts the “effect” in placebo effect. And it isn’t all in the mysterious inner workings of the brain, either. Some of its effectiveness comes from learned behaviors. For instance, all other factors being equal a placebo injection will be more effective than a placebo pill. A placebo with elaborate packaging will “work” better than the same inert drug in plain packaging. And patients who are told that a medication is very expensive will experience more beneficial results and fewer nocebo effects than patients given the same drug — a placebo in both cases — and told the drug costs pennies. Perception is reality — sometimes Obviously, it would be a shame to waste the tremendous power of the placebo effect. Scientists are continuing to study exactly how it can be harnessed. In the meantime, how can a doctor tap into this power — starting today? Harvard Magazine reports on a study Ted Kaptchuk conducted about ten years ago that gave him an epiphany into the application of placebo in everyday medicine. In the study, 262 adults with irritable bowel syndrome (IBS) were divided into three groups: the control group, who got no treatment but were told they were on a waiting list for treatment; a second group who received fake acupuncture and limited interaction with the study’s practitioner; the third group also received sham acupuncture, but with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care — “I’m so glad to meet you,” “This treatment has provided excellent results.” “I know how difficult this is for you,” Group 3 practitioners were required to touch the hands or shoulders of patients in
Editor’s note: Healthcare is a whole new ballgame with the passage of the Patient Protection and Affordable Care Act (PPACA). How will healthcare providers be affected? What about patients? And how about employers who provide health coverage as an employee benefit? How will Medicare and Medicaid recipients be affected? Look to this column for the answers.
HEALTHCARE REFORM & YOU by Russell T. Head, CBC, CSA
THE INDIVIDUAL MANDATE
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any people are wondering how Health Care Reform or the Affordable Care Act (ACA) affects them on an individual basis. Most Americans will be required to be covered by some type of health plan for themselves and their families. Penalties will apply to those who do not comply with this legislation. This regulation has been titled the Individual Mandate. To begin with, the ACA, federal government, state governments, insurance companies, employers and individuals all have shared responsibility to reform and improve the availability, quality and affordability of health insurance. In 2014, the individual shared Russell Head provision (Individual Mandate) requires that each person have in place minimum essential coverage for each month, qualify for an exemption, or pay a penalty on their annual federal income tax return. Here are some highlights that you need to know: 1. The provision is effective January 1, 2014. 2. The Individual Mandate provision applies to individuals of all ages, including children and senior citizens. 3. Exemptions to the Individual Mandate penalty include: • Individuals who cannot afford coverage (those for whom a required contribution would cost more than 8% of their household income) • Taxpayers with income below the filing threshold • Members of Indian tribes • Hardship • Those that experience a gap in coverage for less than a continuous 3 month period • Religious conscience objectors • Members of a health care sharing ministry • Incarcerated individuals • Individuals who are not citizens, nationals or are in the United States unlawfully 4. Exemption Qualifications: • The religious conscience and
the hardship exemption are available only by going to a Health Insurance Marketplace (Exchange) and applying for an exemption certificate. • Members of Indian tribes, health care sharing ministries and incarcerated individuals can apply on a Health Insurance Marketplace (Exchange) for the exemption certificate or can claim the exemption when filing their federal income tax return. • Exemptions for unaffordable coverage, short coverage gaps, and unlawfully present individuals can be claims only as part of filing a federal income tax return. 5. Minimal Essential Coverage includes at a minimum all of the following: • Employer -sponsored coverage (including COBRA and retiree coverage) • Coverage purchased in the individual market • Medicare (including Medicare Advantage plans) • Medicaid • Children’s Health Insurance Program (CHIP) coverage • Certain types of Veterans health coverage • TRICARE Minimal essential coverage does not include specialized coverage such as vision or dental plans, workers’ compensation, disability plans or coverage only for a specific disease or condition. The information provided in this article is a summary of the provisions of PPACA. The following websites provide detailed information on PPACA. • www.healthcare.gov • www.irs.gov • www.hhs.gov NEXT ISSUE: MORE ON THE INDIVIDUAL MANDATE + Russell T. Head is a Partner and Chief Visionary Architect with Group & Benefits Consultants, Inc., Augusta’s largest, privately held employee benefits consulting firm. He can be reached at 706-733-3459 or rthead@gandbc. com. Visit Group & Benefits Consultants at www.groupandbenefits.com
Please see PLACEBO page 6
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MARCH 15, 2013
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AUGUSTA MEDiCAL EXAMINER
FUTURE DOCTORS ASK CURRENT DOCTORS
When do they use emergency helicopters?
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his question shows you understand the difference between a regular ambulance and an emergency rescue helicopter. In the last column, you learned about the equipment in an ambulance, and how it needs to come in different sizes. You also learned why it is important to move cars out of the way to let an ambulance get to the hospital. Well, an emergency rescue helicopter is very similar to an ambulance, except for one key factor: it gets you to the hospital FAST! In emergencies there is what is called a “golden hour.” This means that if the patient can get to the hospital within one hour of the accident or other severe health problem, there is a much better chance of that patient getting well again. This is where helicopters can be very useful. Helicopters are used for situations where it would be a long drive to the best hospital. As you may know, not all hospitals provide all services, so if the patient is taken to the closest hospital but that hospital can’t take care of the patient’s injury (say if the patient needs brain surgery), a helicopter can take them to the right hospital fast. There are times when someone could be hiking in the mountains and get hurt. They would not be able to walk, and there are no
from Todd B., 1st Grade, C. T. Walker Magnet School roads nearby, so they might need to have a helicopter bring rescue people to put the patient on a stretcher and have the helicopter lift the stretcher in the air to a place where emergency medical people can take care of him. The helicopter would then take the patient to the hospital. The folks who work in a rescue helicopter are specially trained pilots and emergency medical workers. Remember, helicopters can go places where a regular ambulance cannot, so the helicopter staff needs to be able to do different things – such as working on a mountain cliff. Rescue helicopters also will fly in almost any kind of weather since a patient’s life is at stake. This means that not only do they have to be ready to rescue people 24 hours a day, they must be able to fly in snow and rain, and even in the middle of the night. + Written by the physicians of Pediatric Partners, with offices in Evans and Augusta. They can be reached at 706.854.2500 and at www.pedpartners.com. TEACHERS! PARENTS! Send us your kids’ questions, whether they’re in high school, kindergarten, or somewhere in between. Mail them to Dan@AugustaRx.com or to Ask the Doctor, Medical Examiner, PO Box 397, Augusta, GA 30903-0397
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Nearly all of us — even doctors and nurses — are sometimes patients. Perhaps you were recently injured playing your favorite sport, or years ago you somehow got hurt without even leaving your favorite recliner. Maybe you were diagnosed with a dreaded disease, mugged in a dark and lonely parking lot, or you stubbed your toe in the safety of your own bedroom. On the other hand, perhaps you needed medical attention 5,000 miles from home. Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale, bylined or anonymous. We’ll publish your encounters with the medical profession as often as we receive them. + Send your submissions for Medicine in the First Person to the Augusta Medical Examiner via e-mail: info@AugustaRx.com or to PO Box 397, Augusta, GA 30903-0397. (The Medical Examiner reserves the right to accept, reject, or edit any submission at its sole discretion.)
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MARCH 15, 2013
AUGUSTA MEDiCAL EXAMINER
Hope IS Possible
Mental Health and Leadership
Helen Blocker-Adams
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housands of books have been written over the years on the subject of leadership. One common denominator you may notice is the word “responsibility.” There are many ways a leader can take responsibility, but there is one that leaders should make a concerted effort to improve on. In order to effectively serve others, leaders must take responsibility for their emotional-well being or mental health. People follow leaders who at least appear to be confident and have something going for them. There have been studies regarding political candidates and how they are perceived
by voters - and why voters cast their ballots for them. Have you noticed there are very few extremely overweight politicians? However, there are many who would be considered attractive or handsome. On a deeper level, there is a certain level of responsibility that leaders should possess because they are in the public eye – being watched constantly – and that responsibility is what people expect of them. So often that expectation and hope is crushed because we’ve seen too many of our elected officials fall from grace for corruption, infidelity or other misdeeds. Our emotional well-being can be affected, and it can show up in our behavior, facial expressions, attitude, demeanor, public and private actions, and in our treatment of others. Do you think leaders spend as much time working on their mental health, which is not typically visible, as they do their physical health and appearance? I sure hope so. There are many ways leaders can focus on and work on their mental health. First of all, it’s critical for leaders
“I exercise for my mental health.”
not to be concerned with the negative stigma that exists in this field of medicine (mental health, that is). Leaders should also communicate with experts in this field when needed, especially when public policy is involved. Leaders must lead by example. Taking responsibility for one’s emotional well-being is paramount. I chose to do something for my mental health almost a year ago: exercising three days a week and changing my eating habits. That’s right. I’m exercising for my mental
health. Not only have I lost many pounds and inches, I feel fabulous and healthy. Dr. Sally Spencer-Thomas discusses topics in depression, leadership and mental health - especially with high school students. She believes the mental health of leaders is clearly a leadership issue. She says that leaders face an enormous amount of stress as they tackle the tasks and the tremendous responsibilities of their leadership positions. As men and women lead, they must consider the impact they’re making on other people. Certainly if they do not take care of their own personal and mental health they cannot provide effective guidance, motivation and inspiration for others. Leaders should understand that taking responsibility for their mental health takes willpower, dedication, planning and foresight. What is exciting about my new healthy lifestyle is how I feel. I’ve always been a change agent and a person who prefers to walk the walk. I am one of the most optimistic and positive people one will ever meet, but even my attitude has been
enhanced since losing the pounds and inches. Being a public figure it’s important for me to lead by example. I read the labels on virtually everything I buy and pay attention to the amount of carbohydrates, sugar and protein in each serving. My weight loss specialist and personal trainer once told me that everything that says fat-free or sugar-free is not necessarily healthy for you. He is right. Leaders must make their emotional well-being and mental health a priority. I’d like to challenge all leaders — and readers — to make this change in their mindset and in their professional and personal lives. + Helen Blocker-Adams is Executive Producer/Host of “The Helen Blocker Adams Show with Co-Host Sammy Lilly”, which airs Monday through Thursday 1 p.m. – 3 p.m. on 103.7 FM/1600 AM WKZK The Spirit. She is also Founder of Unlikely Allies Emerging Leaders Conference. You can contact her at hba@hbagroup-intl.com or visit her at www.helenblockeradams.com
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MARCH 15, 2013
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AUGUSTA MEDiCAL EXAMINER
WHAT EVERYBODY OUGHT TO KNOW
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ABOUT EXTRASENSORY PERCEPTION
e have a tiny Yorkie. We had her “fixed.” I can’t afford to pay for Csections for puppies. We named her Fidget. She is lazy and specializes in taking naps. She is good at it. She was the runt of the litter when we got her, but I have failed in limiting her food intake, so now I fear she is a pound or so overweight. (I looked on the internet, but could not find a Body Mass Index calculator for dogs.) Fidget rules our household. We rescheduled our activities to revolve around her bowel habits, and rightly so. And that’s all I’m going to say about that. Fidget’s sharp ears let me know whenever someone or something so much as steps in our yard. She charms guests the moment they walk in. When my granddaughter stays overnight Fidget sleeps on the foot of the bed . She knows to leave me alone when I do not feel
“
like scratching her back. She knows when I feel like letting her nap in my lap during Wheel of Fortune and Jeopardy. When we mention the word “bath” in the same sentence as her name, she dives under the couch straighter than a Tiger Woods putt on the 18th green at the Masters. I can understand her recognizing the word “bath.” So we resorted to spelling out the word b-a-t-h. She solved that ploy in no time flat and under the couch she goes. Right now, she is hiding under the couch because I started thinking about giving her a bath. I did not utter or spell the B word. How does she know what goes on inside my cranium? Witnessing such extraordinary perception amazes me. But really, it should not. Cops use dogs to sniff out drug shipments, weapons, and explosives. Hunters have dogs to smell out rabbits, quail, deer, hogs,
E
TH
Best ‘coons, and the like. But with that in mind, it should not amaze us that from time to time we see articles in the paper about a dog trained to detect cancer. Does the dog smell cancer? Or does the dog sense cancer? We don’t really know. We even have dogs that can detect an oncoming seizure in epileptics. Certainly, Fidget does not smell that I am about to give her a bath. I think she “senses” it. If that is correct, and if you have a troublesome ache in the gut and you go down to MCG
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for some help, why doesn’t MCG use dogs rather than a CAT scan to detect or rule out cancer? Well, there are several reasons. First off, Medicare does not have a code for DOG scan and it does have one for CAT scan. Next, it doesn’t sound cool for your doctor to say, “I considered ordering a CAT scan, but since you don’t have enough insurance, I want you to go down to the kennels and let a mutt sniff your navel. A new study out of Nigeria shows a DOG scan is not inferior to a CAT scan. Besides, we need to test the insurance system to see if you’re covered for a DOG scan. “ You immediately protest: “I have the same rights as everyone else. I want one of those cool CAT scans. I don’t want a DOG scan. I am entitled to a CAT scan.” And therein lies the problem. Everybody wants to look and sound cool. We are worried about style points
instead of what is actually needed. We are worried about what a committee in a far off city decides your doctor can order. We worry about the incidentals when we should worry about more expeditious and fiscally sound medical treatments. And if we did use trained dogs to detect cancer, the Society for Prevention of Cruelty to Animals would have conniptions about dogs being forced to sniff sick people all the time rather than chasing balls in the grass and napping on the couch. And certainly you would not want to depend upon Fidget to sniff out your cancer. You could die from old age waiting for her to come out from under the couch for a bath. After all, we cannot expect Fidget to work without a bath. And without that bath, OSHA would never approve of such unsafe and inhumane working conditions. Your cancer would just have to wait. + Bad Billy Laveau is a retired MD with a pointed sense of humor. Bad Billy speaks and entertains at public and private events for audiences not subject to cardiac seizure secondary to overwhelming laughter and glee BadBilly@knology.net or 706306-9397
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MARCH 15, 2013
AUGUSTA MEDiCAL EXAMINER I N
T H E
F I R ST
P E R SON
A total stranger saved my life
am a cancer survivor. Even so, I do not feel quite right in claiming the honor. You’re about to see why. One morning about 21 years ago I was in Body Talk Gym and had just finished my workout and my shower. A gentleman I had regularly seen at the gym came up and said, “Excuse me. I am a doctor and you need to have that mole on your shoulder seen by a dermatologist.” I said, “Oh, I keep an eye on it and it hasn’t changed in several years.” “Sir,” he charged on, “I see these things regularly and you need to have that looked at today if possible.” I thanked him and did make an appointment with Dr. Peter Yount for that very afternoon. I fully expected him to say, “We will need to keep a watch on that.” Instead, he said, “Dr. Avis needs to look at that.”
s
“I had one of the worst kinds of cancer.” She took one look and said, “I am reasonably sure that is melanoma. It will have to come off today.” She had my attention. I had heard that word before. I asked in all seriousness if I was going to lose my arm. She assured me that she felt that it was not that far along. She put me on her table and removed the mole that was about a 3/8- x 1⁄2-inch oval. That was on Monday and she said that she would send the specimen for analysis and she would probably be able to call me with results by Wednesday. Since I was a realtor at the time and had one of those marvelous high-tech 5 lb. bag phones, I gave her
that number. On Wednesday afternoon she called and said that it was melanoma but that she got all of it. She scheduled for me to come back so that she could remove “margin,” some surrounding tissue as insurance that there were no stray cells lurking about. I never had another occurrence. The reason I said that I do not feel quite right claiming the “honor” of being a cancer survivor is that, while I had one of the worst kinds of cancer, I only had to worry about it for about 48 hours. Most survivors have weeks, months and even years of worry. I am very grateful to the Drs. Yount, and especially to that one very observant doctor who sent me running. I have thanked him many times for caring enough to speak up. + — Submitted by Don C. Hancock Augusta, Georgia
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PLACEBO… from page 2 the third group and — get this — with each patient spend at least 20 seconds lost in thoughtful silence. The results were not surprising, says Harvard Magazine: the patients who experienced the greatest actual relief from their IBS symptoms were those who received the most personal attention — even though no actual care was administered. “In an age of rushed doctor’s visits and packed waiting rooms,” said the magazine, “it was the first study to show a ‘dose-dependent response’ for a placebo: the more care people got—even if it was fake— the better they tended to fare.” Amazingly enough, Kaptchuk has blown the lid off placebo studies without affecting the results. One of his more well-known studies was born one day when he thought, “What if I told people up front they were taking placebos?” And so that’s exactly what he did. Two groups of IBS sufferers were compared. Group One got nothing. Group Two participants were told they would be taking fake, inert drugs, and indeed they were, given to the patients in bottles marked “placebo pills.” However, they were also told that placebos sometimes have healing effects. After all, that is what the placebo effect is Thirty young, healthy volunteers participated all about, right? in the study. The first group was trained to Sure enough, in results perform “mental contractions” of little finger that came as something of a abduction; the second group performed mental shock to researchers, Group contractions of elbow flexion; the third group was Two people who knew they not trained but participated in all measurements were taking placebos reported and served as a control group. Finally, six symptom relief as good as the volunteers performed training of physical finger improvements seen in trials for abductions. The study lasted 12 weeks (15 min real IBS drugs. per day, 5 days per week). At its conclusion the You can see why it can finger group had increased their finger abduction be such a challenge for strength by 35%; the elbow group augmented pharmaceutical companies to their elbow flexion strength by 13.5% both develop real drugs that are through mental exercises alone. The physical consistently more effective than training group increased the finger abduction fake drugs. strength by 53%. The control group showed no In fact, that brings up significant changes in strength for either finger another realm of medical abduction or elbow flexion tasks. Researchers research. As mentioned above, concluded that the mental training employed by scientists have been able to this study enhances the cortical output signal, block the release of endorphins which drives the muscles to a higher activation and in so doing, stop the level and increases strength. + placebo effect. Since then, gene sequencing Source: Department of Biomedical Engineering/ has led to the identification of ND20, The Lerner Research Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH a gene variation linked to the 44195, USA. release of dopamine that makes some people more susceptible to the placebo effect. If those people who are predisposed to the placebo effect can be identified and eliminated from clinical drug trials, investigators say many false results from the placebo effect can be prevented. That could significantly reduce the size, costs and duration of clinical trials, potentially “bringing cheaper drugs to the market years earlier than before.” That would be a major breakthrough that could benefit us all. +
NO CARE WAS ACTUALLY GIVEN
Can the mind alone build muscle strength without physical exercise?
The father of placebo? In the mid to late 1700s, Franz Mesmer was a German physician who believed in energy transfers between animate and inanimate objects, also known as animal magnetism. His practice of therapy using magnets on patients who swallowed a preparation containing iron led to great popularity and his nomination as a member of the Bavarian Academy of Sciences. In 1784, however, a blue ribbon panel appointed by King Louis XVI found no scientific or medical basis for Mesmer’s mesmerizing practice, and concluded that whatever benefit his treatments produced was chalked up to “imagination.” One member of the 4-man blue ribbon panel, incidentally, was Benjamin Franklin. +
MARCH 15, 2013
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AUGUSTA MEDiCAL EXAMINER
by Ross Everett
THE HIGH COST OF NOT KNOWING COSTS
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here are several things I’d just rather not know the cost of. How much money I’ve costs my parents over the years. The bar tab at my wedding one day. Exactly how much money I owe Uncle Sam for financing my medical education‌ And another thing I would probably not ever wish to know is how much money I’m going to cost you as your future physician. But don’t you think I should? It’s going to be a lot, I’m sure. Hear me out, though, and, please, don’t get mad. Would you believe me if I said it wasn’t my fault? Yea, I wouldn’t really care either if it were my money. Steven Brill effectively reminded us all in the last couple of weeks that medical bills are killing us and he highlighted several costly systems we keep in place to keep these costs high. I encourage you all to read it. Yet, while his article in Time magazine focused on just how much various devices, pharmaceuticals and tests cost, I want to focus on some of the reasons these salubrious aids are being called for by physicians. As Mr. Brill notes, it’s not really the doctors that are profiting off of them. Now, this may not hold as true in the private and group practices across the country. Still, the financial motive is certainly not a reason for me to spike your bill anytime soon. The same goes for many of the practicing physicians out there, too. This is particularly true in the hospitals Mr. Brill discussed. You may believe in trickle down economics, but rest assured that in the hospital, the trickle dries up pretty fast. A commonly cited reason for all of these tests that has some validity is the defense idea. Lawsuits are something we began discussing our very first semester of medical school. They are a definite reality. I’ll pass along a story from a friend of a friend at Harvard Medical School. On his first day, a professor addressed the entire class of young M1’s. “Study hard,â€? he said, “because there’s students across campus [Harvard Law] studying just as hard to sue you if you ever mess up.â€? And mess up we will—it’s inevitable. But even when physicians don’t make mistakes, sometimes diseases just don’t play fair. Thus, many physicians over-order tests just to cover themselves. Tort reform could reduce costs here, no doubt. But that is an entirely different topic for discussion at a later date. There is another reason that not many people mention — my peers and I have no idea what anything costs. It’s just not something we talk about much. Sure, we have a basic idea. An MRI costs a lot more than a CT scan, which costs a lot more than a regular X-ray‌ And sure, I can look up a generic drug as well as the next person. But the problem persists because it’s just not something ingrained in us. We’ll learn a sequence of sorts for differentiating diseases and what tests need to be done, but there’s no emphasis on price. Emphases are put on the “gold standardâ€? for diagnostics. There isn’t much mention of a “silverâ€? even if it’s one-quarter the price. As cases are discussed, we’re constantly asked which test we’d like to order. Uh, all of them! Let’s shotgun it with a CBC, urinalysis, X-ray, lumbar puncture, CT, EKG, a couple cultures, and a colonoscopy, you know, for good measure. Why not? When your patients are just words on paper, there isn’t much harm in it. Heck, we’ll order every test they make and then wait around on each of their results before moving forward with treatment. The transition to the living, breathing, paying patient can take some getting used to. We probably need to be reigned in a little. Perhaps we all need to be reminded of what is necessary versus what is desired. I’m not blaming my teachers, though. My textbooks don’t offer anything, and online sources I’ve used from other schools are no different. This problem seems to hold true for general medical education. Granted, I am just a second year medical student, still entirely confined to classroom learning. Maybe things will change next year when I get into the hospital.>>
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Maybe Iâ&#x20AC;&#x2122;ll learn in residency. Still, I am convinced that the earlier these thoughts are instilled in students, the stronger they will keep hold in their minds. If medical students can be conditioned to think about the costs of frivolous lawsuits beginning in the first year, Iâ&#x20AC;&#x2122;m confident the same could be done for the costs of frivolous tests. +
Ross Everett is a 2nd year medical student at the Medical College of Georgia. He grew up in Buford, Georgia and graduated from the University of Georgia in 2011. In addition to his coursework, he is very interested in health policy, health systems and health management. Please contact him at wideeyedwhitecoat@gmail.com and â&#x20AC;&#x153;Likeâ&#x20AC;? him on Facebook at Wide-Eyed White Coat.
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AUGUSTA MEDiCAL EXAMINER
P harmacy 411
OUR NEWSSTANDS Medical locations: • Department of Veterans Affairs Medical Ctr, 15th St., Main Entrance • Dept. of Veterans Affairs Medical Center, Uptown Div., Wrightsboro Rd., main lobby • Doctors Hospital, 3651 Wheeler Rd, ER Lobby Entrance • Doctors Hospital, 3651 Wheeler Rd, Employee Entrance (near the Joseph M. Still Burn Center entrance) • Eisenhower Hospital, Main Entrance, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • GHSU Hospital, 1120 15th Street, South & West Entrances • GHSU Medical Office Building, Harper Street, Main Entrance • GHSU Medical Office Building, Harper Street, Parking Deck entrance • GHSU Hospital, Emergency Room, Harper Street, Main Entrance • GHSU Children’s Medical Center, Harper Street, Main Lobby • GHSU, Laney-Walker Boulevard transit stop, Augusta • Select Specialty Hospital, Walton Way, Main entrance lobby • Trinity Hospital, Wrightsboro Road, main lobby by elevators • Trinity Hospital Home Health, Daniel Village, main lobby • University Health Federal Credit Union/ University Hospital Human Resources, 1402 Walton Way, Main Lobby • University Hospital, 1350 Walton Way, Emergency Room lobby area • University Hospital, 1350 Walton Way, Outside Brown & Radiology/Day Surgery • University Hospital - Columbia County, 465 N. Belair Road, Main Lobby • University Hospital Prompt Care, 3121 Peach Orchard Road, Augusta
Around town: • Barney’s Pharmacy, 2604 Peach Orchard Rd. • Birth Control Source, 1944 Walton Way • ASU Student Bookstore • Blue Sky Kitchen, 990 Broad Street • Columbia County Library, main branch lobby, Ronald Reagan Drive, Evans • Enterprise Mill (North Tower), 1450 Greene Street, Augusta • Daniel Village Barber Shop, Wrightsboro Road at Ohio Ave. • Hartley’s Uniforms, 1010 Druid Park Ave, Augusta • International Uniforms, 1216 Broad Street, Augusta • Marshall Family Y, Belair Rd, Evans • Mellow Mushroom, 12th and Broad Streets, Augusta • Southside Family Y, Tobacco Road, Augusta • Surrey Center, Surrey Center Pharmacy, Highland Avenue, Augusta • Top-Notch Car Wash, 512 N. Belair Road, Evans • Wild Wing Cafe, 3035 Washington Road, Augusta
MARCH 15, 2013
Very little if anything about healthcare is inexpensive, and that includes medicine. Tiny pills can command large prices. Over-the-counter medications may be less expensive, but are they also less effective? Find the answers to lots of your drug store questions in this column written by Augusta pharmacists Chris and Lee Davidson exclusively for the Medical Examiner.
CAN WE GET BETTER WITHOUT ANY MEDICINE AT ALL?
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for several years and had been maintained perfectly on lactose capsules containing pure milk sugar. Such trickery would happen today because computers have made it difficult if not impossible to delete the name of the medicine from the label. These days the only time a prescription is not labeled is during a blind drug trial and occasionally during a doctor-ordered blind trial to assess if a medication is truly needed. The last I saw of this type of study was for Attention Deficit Disorder. A doctor would have the pharmacy give a week each of placebo, medication number one, and a second, active medication to assess if the patient actually responded better to medicines and could therefore be diagnosed as having attention deficit disorder. The patient or caregiver would report back at the end of each week to the physician’s office with a report of how that week went. Only the pharmacy had a record of which week was placebo and which weeks were active medicines, and this was disclosed to the physician after the trial was over. There is a body of professionals who claim that homeopathic medicines are nothing more than placebos. In homeopathic medicines an active ingredient is repeatedly diluted, then shaken or otherwise agitated before the process is repeated. After the required number of dilutions the product may or may not have any active ingredient left in the bottle you buy off the shelf. The supporters of homeopathic medicines maintain that the active ingredient has left a memory impressed on the water or dilutent by the successive agitations during the dilution process. The question is can water carry an action when no active ingredient is left, or is this a placebo effect? No matter what your opinion is, a positive mental outlook is good for the body and the soul so be optimistic about your healthcare and you will likely have positive experiences. Remember that expectations can carry a lot of weight with medications. Placebos in drug trials always have a list of side effects similar to the active medication as well as a lower percent of effectiveness when compared to the active drug. In blood pressure drug trials placebo tablets could be counted on to lower the blood pressure to a certain degree even though we know that is theoretically impossible. So always be positive that things are SERVICES WE PROVIDE: going to get better and that • Coordinated care driven by the patient and family’s wishes medicines will help you get • Case management and care in the patient’s setting there. + • Symptom management with primary focus on physical comfort • Durable Medical Equipment to enable ease of care Questions about this article • Intensive support services — psychosocial, spiritual and or suggestions for future bereavement care — for the family columns can be sent to us at cjdlpdrph@bellsouth.net
hen drug companies start developing new drugs, one of the steps along the path to testing, approving and marketing the product is a clinical trial to determine if the new product actually works better than a placebo. “Placebo” is a pill or medicine that is touted to patients as being a cure but that has no medicinal value whatsoever. The pill could be milk sugar or other inert ingredient put into a tablet or capsule that looks like a real drug. This helps measure the real drug against the placebo effect, which is the mental and physical healing effect a patient gets simply from believing they are being given a medicine to make them better. It has been proven that the mind can influence a prescription medicine’s efficacy (or lack thereof). Your expectation of how well a product will work can ultimately determine if the product will work acceptably for your condition. This is not to say that a medicine’s effect is totally in one’s mind, but if you believe a product is not going to work there is a greater chance that you will have an unsatisfactory experience. The opposite is true: a positive outlook can enhance your state of wellness and allow a more complete recovery from a given disease. The mind has a great deal of power over the body and your ultimate health level. Not too many years ago doctors would write prescriptions for a placebo which, of course, would not be labeled as such. This means the name of the medicine would be left off of the label so that the patient could not have a preconception about the effects of the medicine. In one case I had a doctor that would call the pharmacy for a patient about every six months when the patient would complain that the capsules this person received were not working as effectively as they usually did. Since this new prescription was “stronger,” we in the pharmacy would pack a larger capsule with the same placebo and make up a new name to go on the label with a little stronger warning about using sparingly or to take only after trying another medication for pain. This would make all the pain go away for months and the patient would get their refills on time for four to five months or more and communicate with the physician about the effectiveness of this new medication he had prescribed. The patient had not been on real pain medicine
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MARCH 15, 2013
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AUGUSTA MEDiCAL EXAMINER
Don’t Lick the Beaters and other interesting food facts
is now
by dietetic interns with University Hospital’s Augusta Area Dietetic Internship Program
A
FREQUENT FLYER MEALS
re you familiar with how far your food has traveled to be on your dinner plate? Or even how your food traveled to your city and how that process may impact your overall well being? After all, it’s not like our produce and butchered meats have arms and legs to walk, drive, or fly to us. Even if that was remotely possible, my imagination tells me that they would not be screaming, “eat me!” Imagination aside, it does seem as if our food would do ANYTHING to get to us. So, let’s take a closer look at “food miles.” The average distance most conventional food items travel ranges between 1,500-3,000 miles. As most frequent flyers know, you are typically allowed to have one carry-on and one personal item. The carry-on item for our food of choice might be a suitcase filled with air pollution: whether by trains, planes or trucks, 1500 miles is a lot of fuel between field and market. The personal item may be a heavy coat covered in pesticides and preservatives to keep the food fresh. Let’s
not forget, travel isn’t cheap, so our little food travelers are packing plenty of travelers’ checks and cash. So, who are we in this scenario? Well, we are the taxi drivers, family and friends of food that are picking them up after their travels. Those visitors sure sound like bushels of fun… or not. This whole food travel process may have negative implications on our environment, heath, and economy. Whether our food travels by truck, train, plane, or ship, each method requires fuel and releases greenhouses gases into the air we breathe, which has an impact on global warming.
According to the Natural Resources Defense Council, “In 2005, the import of fruits, nuts, and vegetables into California by airplane released more than 70,000 tons of CO2, which is equivalent to more than 12,000 cars on the road.” Air pollution could also affect our respiratory health and increase the incidence of asthma and missed school days by children. Our society is quite ingenious though. In efforts to support the industrialization and distribution of produce, large-scale farmers have used science to specifically pick plant varieties that produce higher yields and are transported with ease in order to protect their investment. They may also try to protect their crops and make their produce travel well by spraying pesticides and herbicides onto the crops. Small local and familyowned farms, by contrast, tend to choose plant varieties with an emphasis on taste and high nutritional value. They also tend to lean toward more sustainable farming principles which minimize chemical use.
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AUGUSTA MEDiCAL EXAMINER
MARCH 15, 2013
even allow you to visit with your family and pick your own produce, making for a great learning experience for the family. Next time you are in the grocery store, think about the food you choose. Where has it traveled from and what is your food packing? If you are interested in supporting your local community, check out Augusta Locally Grown for meat, farm fresh eggs, produce, and other goods from within the CSRA and surrounding areas. +
NEW COL UMN MED ! ICAL E X E XC LUS AMIN I V E ! ER
LOCAL… from page 9 There is no exact definition for local food, but one definition says that local and regional food is grown within a 400-mile radius, or within the same state. The most commonly noted radius for local food is 100 miles. In addition, local foods usually are picked closer to their peak ripeness since they have much less travel time. For that reason, local food tends to be fresher than conventionally distributed and well-traveled food. It also should be noted that fruits and vegetables contain more nutrients when allowed to ripen properly. Local food systems support local economies since small family farms are more likely to spend their profit back into the local community. When
FREE
local food is distributed within the local community it helps to generate jobs and stimulate the local economy. By supporting the local food movement, you can meet the farmers yourself and they can share with you more details regarding their farming methods. Some local farms
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MEDICARE MATTERS +
“MEDICARE & YOU” - THE BOOKLET
E
very year the federal government sends Medicare beneficiaries a “Medicare & You” book. It is the official Medicare handbook. Within its pages is a wealth of information; You will learn what is new for the upcoming year, what Medicare does and does not cover, health and prescription drug plans for your geographical area; most anything you may need to know about the health care program is in this booklet. Unfortunately, a lot of people do themselves a great disservice when they don’t read it; some just throw it out. Here’s a sample of what you could have learned: Medicare will pay for a “Welcome to Medicare” preventive visit to your doctor. During the first 12 months of your original enrollment in Part B, you may call your doctor to schedule a “Welcome to Medicare” preventive visit. You pay nothing for this as long as your physician accepts Medicare assignment. If you have had Part B longer than 12 months, you are still entitled to a yearly “Wellness” visit during which, along with your doctor, you can create a personalized plan to prevent and reduce risk factors based on your current state of health. Again, you will pay nothing for this visit as long as your health care provider accepts assignment. Be aware that your first yearly “Wellness” visit can’t take place within 12 months of your enrollment in Part B or your original “Welcome to Medicare” visit. But you don’t have to have a “Welcome to Medicare” visit before your yearly “Wellness” visit. There are many preventive services covered by Medicare and you will want to discuss with your physician which are right for you. While these covered services can change at any time, the list is significant and can be found on page 50 of your ”Medicare & You” handbook. Remember there is no cost for these services, but if your doctor or other health care provider performs additional tests or services during the same visit that aren’t covered under these preventive benefits, you may have to pay coinsurance and the Part B deductible may apply. It’s also helpful to know what Medicare will not cover. These services include Long-Term care/custodial care, routine dental care including dentures, cosmetic surgery, acupuncture, hearing aids and the exams for fitting them, and routine eye care (however, Medicare will cover cataract surgery and provide one pair of glasses following this surgery). This is just a small sample of what lies between the covers of the “Medicare & You” book. Please take the time to read it. By doing so, you will be able to make the best use of what Medicare has to offer and to dispel any misconceptions about what is and is not covered. You can save money, be provided needed services you were not aware are offered, avoid inconvenience and delay in receiving those services, and be better educated to deal with what may arise concerning your future health care. + Author: Trisha Whisenhunt, Certified Medicare Counselor, Area Agency on Aging. Source: Medicare & You
NEED REFERENCE MATERIAL? Visit www.AugustaRx.com and click on “Study Hall.”
MARCH 15, 2013
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AUGUSTA MEDiCAL EXAMINER
The blog spot — Posted Feb. 16, 2013 at www.codeblog.com
IN PRAISE OF THE HUMBLE HOSPITAL BED I’ve encountered some interesting beliefs in my time as a hospice nurse. Before making visits or calls, we are expected to at least glance at a “basic information” screen about the patient. I’ve always been intrigued when I come across an entry that says some variation of, “Do not mention the word hospice in front of patient (and/or) family.” I can respect this. I’m more of a “let’s keep it real, yo” kind of person, but I know not everyone is. So I do my best not to mention the word “hospice” while providing care for these patients, and it’s never been a problem. But there are some patients that are so opposed to the entire concept (although they still come on service) that they also refuse any kind of equipment we offer them to make their lives easier while they are being taken care of at home. Hospitals have it all, right there – over-bed tables (which are nice because they have wheels and can be a tall, easily moveable surface for anything from meals to setting up supplies for a dressing change), bedside commodes (gotta pee, can’t walk, oh! There’s something we can put next to the bed! Genius!) — and hospital beds. In fact, the fancy-pants hospital beds we had at my job in CCU could translate phrases into like 15 different languages. We’d just pick one from a list (“Are you in pain?” “Please hold still,” etc.), choose the language, and the bed would speak the phrase you wanted. Need to tell someone “I am your nurse” or ask them to wiggle their toes in Mandarin? The bed would do that. It would have been a really helpful feature, but patients often could not hear what the bed was saying. Anyway, hospital beds, even those that can’t speak 15 languages, are pretty nice things to have when you’re sick. So part of me was always dismayed when I’d go to a house to see a patient in distress, only to find that they were still on the couch or in a regular bed. Look, I get it. Having a hospital bed in your house takes up a lot of room. It basically screams, “Hi! I’m sick and/or dying!” So for someone who can’t even tolerate hearing the word “hospice,” having such a huge reminder in the room can be distressing. But when the chips are down and you can’t breathe and you don’t have the strength to sit up? That bed can be a godsend. The head can be raised or lowered, the whole bed itself can be raised so that your loved ones (and visiting nurse! ahem) don’t break their backs bending over to provide care (turning, cleaning, boosting). The ability to raise the bed is actually pretty important for lay people who aren’t used to using proper body mechanics when moving patients. The bed rails can be really useful to use to help get yourself out of bed. So when I come visit because the patient is having a hard time breathing and I walk in to see them laying flat on a regular bed, I’m sad that their denial is causing them actual discomfort. There’s nothing more I’d love to do than push a button and raise the head of the bed so they can breathe more easily. There are wedges you can use on regular bed mattresses, and of course there are pillows you can jam behind the patient’s back, but those aren’t always very comfortable and it’s hard to get them in the right position. Not to mention having to try to get them all back in position every time the patient needs to change position or get out of bed. So if you find yourself or a loved one needing to be taken care of at home and your nurse brings up maybe getting a hospital bed, don’t dismiss it immediately. It can be a real asset for a sick person’s comfort, and that of those taking care of them. +
“ I hate to see a patient on a couch. ”
From THE Bookshelf Here we are nearing press time in a bit of a time crunch, so we’ll have to dispense with the reviews you’ve come to know and love, crafted right here in Augusta, and instead excerpt some comments from amazon. com about our chosen book du jour, inspired by this week’s Don’t Lick the Beaters column (see p. 9).
“When Alisa Smith and James MacKinnon learned that the average ingredient in a North American meal travels 1,500 miles from farm to plate, they decided to launch a simple experiment to reconnect with the people and places that produced what they ate. For one year, they would only consume food that came from within a 100-mile radius of their Vancouver apartment. The 100Mile Diet was born. The couple’s discoveries sometimes shook their resolve. It would be a year without sugar, Cheerios, olive oil, rice, Pizza Pops, beer, and much, much more. Yet local eating has turned out to be a life lesson in pleasures that are always close at hand. They met the revolutionary farmers and modern-day hunter-gatherers
tells the full story, from the insights to the kitchen disasters, as the authors transform from megamart shoppers to selfsufficient urban pioneers. The 100-Mile Diet is a pathway home for anybody, anywhere.
who are changing the way we think about food. They got personal with issues ranging from global economics to biodiversity. They called on the wisdom of grandmothers, and immersed themselves in the seasons. They discovered a host of new flavours, from gooseberry wine to sunchokes to turnip sandwiches, foods that they never would have guessed were on their doorstep. The 100-Mile Diet struck a deeper chord than anyone could have predicted, attracting media and grassroots interest that spanned the globe. The100-Mile Diet: A Year of Local Eating
Excerpt: Call me naive, but I never knew that flour would be struck from our 100-Mile Diet. Wheat products are just so ubiquitous, “the staff of life,” that I had hazily imagined the stuff must be grown everywhere. But of course: I had never seen a field of wheat anywhere close to Vancouver, and my mental images of late-afternoon light falling on golden fields of grain were all from my childhood on the Canadian prairies. What I was able to find was Anita’s Organic Grain & Flour Mill, about 60 miles up the Fraser River valley. I called, and learned that Anita’s nearest grain suppliers were at least 800 miles away by road. She sounded sorry for me. Would it be a year until I tasted a pie? + —From The 100-Mile Diet The 100-Mile Diet — A Year of Local Eating by Alisa Smith & J. B. MacKinnon, 272 pages, published March 2007 by Random House Canada
the
Clipping File “Nutritionally bankrupt” If you were a food, those two words would be the ultimate insult. And they were used by a dietitian writing in US News (March 6, 2013) to describe reduced-fat peanut butter. As careful label (and Medical Examiner) readers have noticed, many nutritional pluses come at a cost: the low-salt product has more fat than a sumo wrestler; the fat-free food has so much salt you could use it to thaw an icy sidewalk. Enter reduced-fat peanut butter. The label trumpets the reduced fat and the unwary, non-Medical Examiner reading shopper tosses it into their cart. The careful shopper, on the other hand, will note that reduced-fat PB has as many calories as its fat twin. “Reduced-fat peanut butter has fewer of peanuts’ heart-healthy monounsaturated fats and more of the refined carbs and sugar that spike blood sugar. It’s a nutritionally bankrupt swap if ever there was one.
This is a product that simply should not exist.” And that, dear readers, is what is called a scathing review. The Ultimate Cookie Truth in journalism preamble: we have only read this recipe, not tried it; unfortunately the entire staff of the Medical Examiner Test Kitchens Division is at a Wolfgang Puck retreat this week, so be advised. But here’s what we read: you can make healthy cookies with just two ingredients. Here’s the recipe: Mix two soft bananas with one cup of quick oats. That’s it. Plop dollops of this dough onto a greased cookie sheet and bake for 15 minutes at 350°. How easy was that? And not an unpronounceable chemical ingredient in sight. It’s too easy, you say? Feel free to complicate it by sprinkling in some cinnamon, honey, a few chocolate chips, or whatever you like.
Want better sleep? The prescription is simple, and it does not involve a prescription or a pill. This week is one of two each year when people aren’t sleeping as well as they normally do. The culprit in each case is Daylight Savings Time, whether it’s starting or ending. Results of a poll conducted by the National Sleep Foundation found one of the best and most effective keys to good sleep. One word: exercise. In case you’re wondering, they aren’t talking about spending an hour a day at the gym. “Adding a 10-minute walk every day could improve your likelihood of a good night’s sleep,” says the doctor who chaired the research. The payoff can be significant. True or False: “My sleep was very good or fairly good in the past two weeks.” Up to 83 percent of exercisers agreed, compared to only 56 percent of non-exercisers. +
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MARCH 15, 2013
AUGUSTA MEDiCAL EXAMINER
THE EXAMiNERS
THE MYSTERY WORD
+
What’s another word for adolescent?
by Dan Pearson
No, I need it to sound more medical.
How about young adult?
In that case, go with premature.
I’m being graded on this.
Juvenile would work.
The Mystery Word for this issue: GEPHANOT
© 2013 Daniel Pearson All rights reserved.
EXAMINER CROSSWORD
PUZZLE
1
2
3
4
5
6
7
8
9
10
14
15
16
17
18
19
11
12
VISIT WWW.AUGUSTARX.COM TO ENTER!
Click on “Reader Contests”
QUOTATION PUZZLE N D D C U I I V N R Y U H C A C E R W N H T O N O I E T O W E G E T U O T N T O A Y O G Y
A N A R
— Jason Randal
by Daniel R. Pearson © 2013 All rights reserved
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 only be used once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.
E
5
X A M I N E R
7
2 9 2 1 3 9 1 2
8
1 5
4
6 1
S
4
6
5 8 4 1 9 3 9
by Daniel R. Pearson © 2013 All rights reserved. Built with software from www.crauswords.com
U D O K U
DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.
Use the letters provided — one per dash — to create words to solve the puzzle. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving short words and entering unique and minimal choice letters (such as 5 thru 7 in this puzzle). A sample is shown. Solution on page 10.
1 1
J 1
2 2
3
2 4
3 I 5
4 6
1 1
2 2
3 3
4 4
5 5
6 6
’ 7
7
1 2 1
2
1 A 1
3
2
3
4
1.WPAAWITJB 2.EHINITOU 3.CTTSUE 4.NLHST 5.ODI 6.NUC 7.TT
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
by Daniel R. Pearson © 2013 All rights reserved
BY
All Mystery Word finders will be eligible to win by random drawing. We’ll announce the winner in our next issue!
13
20 21 22 ACROSS 1. Back of the neck 23 24 25 5. Before (in poetry) 26 27 28 29 30 31 32 33 10. Skin 14. Black (in poetry) 34 35 36 15. Standard for comparison 37 38 39 16. Fencing sword 17. Cried 40 41 42 43 44 18. Regions 45 46 47 19. Mend with rows of stitches 48 49 50 20. Wide awake 51 52 53 54 55 56 57 58 22. _____ Waters 23. Torn clothing 59 60 61 24. Of the ear 62 63 64 26. Printer’s measures 29. Long-tailed rodent 65 66 67 30. Wink or blink, technically by Daniel R. Pearson © 2013 All rights reserved. Built in part with software from www.crauswords.com 34. Lesser and Greater festivals after Ramadan 32. Tantalize 67. Seines 36. Dead 33. Double-______, as a sword 37. Sicilian volcano 35. Basic meteorology DOWN 38. Partially opened flower instrument 1. On-the-hour radio program 39. Male deer 36. Written demand for 2. First murder victim 40. Cancellation, annulment payment 3. Avenue in medical district 43. Camambert, for one 38. Resembling skeletal parts 4. Word on many doors 45. Town between Edgefield 41. Brain ___ 5. Dental filling and Aiken 42. Electrically charged atom 6. Land covered with trees 46. Type of flour, milk, 43. Twist 7. Lyric poems sauce, or bean 44. Augusta’s ______ Park 8. Argued 47. Blood cell type 46. Couch for two or more 9. Ernie, annual Augusta visitor 48. Mr. Sarazen 50. What some donors donate 10. Reducing enzyme 49. Prefix for -scopy. 51. Liquefy 11. Apple product 51. Letter opener (with Dear) 52. Largest continent 12. Dweeb 54. Public slob 53. Unpleasantly moist 59. Son of Isaac and Rebekah 13. Repudiate 55. Egyptian goddess 21. Medic intro 60. Prefix meaning tissue 56. Portend 22. Medical guinea pigs? 61. Departed 57. Group viewed as one 25. Twitch 62. TV journalist who had a 58. Obtains 26. Pulitzer Prize-winning baby on March 8 60. Health Sciences Bldg. film critic 63. Lindsey Vonn is one 27. Dura_____ 64. Mine entrance 28. From that time 65. Dave Brubeck’s ___ Five 31. Garden flower 66. Plague, beleaguer Solution p. 14
WORDS NUMBER
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
MARCH 15, 2013
ha... ha...
A
man went to see his doctor because he was suffering from a miserable cold. His doctor prescribed some pills, but they didn’t help. On his next visit the doctor gave him a shot, but that didn’t do any good either. On his third visit the doctor told the man, “Go home and take a hot bath. As soon as you finish bathing, throw all the windows in your house wide open and stand in the draft.” ”But doc,” protested the patient, “in this cold weather if I do that, I’ll get pneumonia.” ”I know,” said the doctor, “Pneumonia I can cure.”
A man goes to the doctor with a long history of migraine headaches. When the doctor does his history and physical, he discovers that this poor patient has tried practically every therapy known to man for his migraines and still has had no improvement. “Listen,” says the doctor, “I have migraines too, and the advice I’m going to give you isn’t anything I learned in medical school, but it’s advice that I’ve gotten from my own experience.
“When I have a migraine, I go home, get in a nice hot bathtub, and soak for a while. Then I have my wife sponge me off with the hottest water I can stand. Then she applies an icepack to my forehead. This helps a little. Then I get out of the tub, take her into the bedroom, and even if my head is killing me, I force myself to make love to her. Almost always, the headache goes away immediately. Give that a try, and come back and see me in six weeks.” Six weeks later the patient returns with a big grin. “Doctor! I took your advice and it works! It really works! I’ve had migraines for 17 years, and this is the first time anyone has ever helped me! Thank you!” “Well,” says the physician, “I’m glad I could help.” “And by the way, Doc,” the patient adds, “You sure have a nice house.” A very angry woman storms up to front desk receptionist for an eye surgeon. “Someone stole my wig while I was having surgery yesterday,” she loudly complained. The doctor heard the commotion and came out to try to calm her down. “I assure you that no one on my staff would have done such a thing,” he said. “What makes you think your wig was taken here?” “Because right after the operation, I noticed the wig I was wearing was cheaplooking and ugly. It definitely was not the one I came in wearing.” “Madam,” the surgeon explained gently, “I think that means your cataract operation was a success.” +
Why subscribe to the Medical Examiner? Because no one should have to make a trip to the doctor or the hospital just to read Augusta’s Most Salubrious Newspaper.
+ +
SUBSCRIBE TO THE MEDICAL EXAMINER By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house!
STATE
ZIP
Choose ____ six months for $16; or ____ one year for $32. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397
The Patient’s Perspective by Marcia Ribble
L
o and behold, after a bit more than two months, the Bell’s Palsy is retreating and I can smile with both sides of my face again. The corner of the left side of my mouth still isn’t very functional so I still do some dribbling, but I look normal again. I can also shut my left eye, so the frequent eye drops are less needed. Looking normal has been a real benefit because it allowed me to apply for and get a part-time job teaching for Virginia College. It is perfect timing, too, with my knee’s healing going well. I’ve talked to people recently who have had knee replacements recommended by their orthopedic surgeons, and who are very hesitant to have the surgery. I know the surgeries can be a problem sometimes, but those problems are becoming less frequent with new and better surgical and recovery methods being developed. In my case I was going to non-hospital physical therapy within a week of having my surgery. That meant I needed to get up and dressed and into the car for the drive to my PT location. My grandson drove me and picked me up when I was finished. Once there I exercised until I was soaking wet with perspiration. When I got home I was ready to ice my knee and get my legs up for a while. I was tired and fell asleep more days than I stayed awake, but one day at a time, standing up and walking became less and less frightening as I learned that I could rely on my new knee and old muscles and ligaments. Now, four months after surgery, I can get up and go shopping without any help, although help with bringing in the groceries is much appreciated still. My confidence with driving improves daily and I’ll drive distances I wouldn’t dream of at first. Most of us ask our doctors and our therapists “When will I be able to do some activity I want to do,” and the truth is that our specialists can’t answer those questions for us. It always
t ha n a Less
+
Talk is cheap. Not talking can be deadly.
depends on factors beyond their control. How much risk are we willing to take and at which point in our recovery? How much help will we need? How dedicated will we be to our physical therapy? Again, it differs from person to person. I had help for the first week after I got home. Then I was mostly able to take care of my own needs with minimal assistance. I could take a shower with no help a few days after arriving home. I could stand long enough to fix my coffee, get a snack, or do my laundry. I received Meals on Wheels. I ate toast with peanut butter for breakfast and a sandwich for dinner. What I can tell you is this: after quite a lot of healing I can walk without pain in my knee. My endurance is increasing, because I keep gently pushing the boundaries. I can walk the halls at work easily. I make sure I either walk or do other exercises every day, so I keep improving my mobility. The best is that activities I was sure I’d never be able to do again are now coming back in sight as probably do-able. The doctor couldn’t promise me that. Neither could my physical therapist. I had to make that promise myself and to myself. I’m giving me my life back. The doctor only gave me a new knee. + Marcia Ribble received her PhD in English at Michigan State and recently retired from the University of Cincinnati where she taught composition. She taught writing at the college level and loves giving voice to people who have been silenced. She can be reached with comments, suggestions, etc., at marciaribble@hotmail.com.
million people can’t be wron g.
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AUGUSTA MEDiCAL EXAMINER
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MARCH 15, 2013
AUGUSTA MEDiCAL EXAMINER
THE MYSTERY SOLVED The Mystery Word in our last issue was: CARDIOLOGY
...cleverly hidden (on the bricks) in the page 9 ad for WILD WING CAFE Congratulations to Alexis Raiford, who scores a $40 gift card from Scrubs of Evans, a $20 Wild Wing Cafe gift certificate, two free movie passes courtesy of Health Center Credit Union, a free Top Notch Car Wash gift card, and for coffee drinkers, a jar of Drug of Choice gourmet coffee. Win this stuff! The new Mystery Word is on p. 12. Start looking!
The Celebrated MYSTERY WORD CONTEST ...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then be the first to find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries you’ll score our goodie package: gift certificates from Wild Wing Cafe, Top Notch Car Wash, and movie passes from Health Center Credit Union! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (WInners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher.
The new scrambled Mystery Word is found on page 12
EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC. WEST AUGUSTA House for rent. 3 bdrm, 2 bath, 1500 sqft, 1-car garage, 3024 Sterling Road, located off Stevens Creek at Riverwatch Pkwy. $850/mo. Call 678467-7187. FOR SALE Brand new contemporary townhome/end unit in The Vista on Hwy 1, minutes from MCG. 1450 sqft. Two bdrm, two baths, office. Walk-in closets, lots of upgrades. Hardwood throughout, custom tiled kitchen/bathrooms. Floor to ceiling windows, pristine condition. Ready today. $125K - OBO. 803-5078991. HOMESBYOWNER.COM Buy • Sell • Rent Apartments available 706-564-5885
TOWNHOME 3 bedroom, 3 full bath townhome. 2 master suites, like new, end unit with extra parking, single garage, covered patio, $125,000. 706-799-0394
daily activities, prepare meals, light housekeeping, grocery shopping, doctor’s appts. I will meet you to discuss your specific needs. Call 706-833-9787
MISCELLANEOUS
BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673)
ENTERTAINMENT SHOPPING: Online penny auction, play and win for 80-95% off. Lots of fun. www.WorldwideOnlineBids.com Income positions available. Go to www. ExtraMoneyInterview.com MATTRESS We have a Queen Pillowtop Set that is new and still in the wrapping $150 Call or Text 762-444-7615.
SERVICES 1.1.13
TOWNHOME Great location, everything new, 2 master suites, sunroom, all appliances. $98,000 (706) 504-4023 WEST AUGUSTA Luxury 3 BR / 2 BA Townhouse, 1-car attached garage located off Pleasant Home Road $725 /mo 706-228-4655
FULL-SERVICE MOVER Anthony’s Professional Moving, 28 years serving the CSRA moving hospital equipment, offices, homes, apartments, etc. Estimates are FREE. Call 706.860.3726 or 706.814.8141 CAREGIVER Let me help you with your loved one. 24 hour care, very reasonable. Call 706-738-0851 CNA IN-HOME CARE I assist with
SPARKLING CLEAN Looking for offices to clean. No contract req. Husband & wife team have years experience and give FREE on-request estimates. Call 706.831.8552 or 706.831.8553 NOTICE! ATTENTION! If any current or past employer has failed to pay you min. wage or time and a half overtime pay, you may be entitled to an order from US Federal Court awarding you twice the amount of your unpaid wages plus atty. fees. For info, call Arthur H. Shealy, Attorney at Law, 803-278-5149, 1010 Plantation Rd, North Augusta SC 29841. You may be entitled to a similar award for unpaid wages if your employer required you to perform duties during your lunch hour, before clocking in, or after clocking out. LAWN SERVICE Commercial, residential. Call Vince: (704) 490-1005
GOT A CLASSIFIED? SEND IT IN TODAY! THE PUZZLE SOLVED
SENDING US A CLASSIFIED? WHAT’S YOUR DRUG OF CHOICE? USE THE FORM BELOW AND MAIL IT IN, OR GO TO WWW.AUGUSTARX.COM AND PLACE & PAY CONVENIENTLY AND SAFELY ONLINE. THANKS!
(OURS IS COFFEE)
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QUOTATION QUOTATION PUZZLE SOLUTION: Page 12: “I won’t eat any cereal that doesn’t turn the milk purple.” — Jason Randal
AD COPY (one word per line; phone numbers MUST include the area code): .50
F O R E S T
SEE PAGE 12
In case we need to contact you. These numbers will not appear in the ad.
.25
E A N M T A E P L R A G R A R A M A I S I N T O G E N A M U H G S E B
The Sudoku Solution
COFFEE IS GOOD MEDICINE VISIT DRUGOFCHOICECOFFEE.COM FOR YOUR REFILLS TODAY
5 9 1 2 4 6 7 8 3
8 3 2 1 9 7 5 6 4
4 6 7 3 8 5 2 9 1
2 8 9 4 6 3 1 7 5
3 7 5 8 1 9 6 4 2
6 1 4 5 7 2 9 3 8
1 5 6 9 3 8 4 2 7
9 2 8 7 5 4 3 1 6
7 4 3 6 2 1 8 5 9
WORDS BY NUMBER “It just wouldn’t be a picnic without the ants.” — Author unknown
Multiply by number of times ad to run: x Total submitted: $
The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 5 days prior to our publication date.
Thanks for reading!
www.AugustaRx.com
MARCH 15, 2013
15 +
AUGUSTA MEDiCAL EXAMINER
TH PA
VOTE
W
ho is the best doctor in our area? We hereby announce a search for that person, and a perpetual quest at that. Our invitation to vote is not one of those once-a-year propositions; it’s a never-ending poll beginning today. We have no ballot. We’re not looking for the man or woman who gets the most votes. The winner might get just one vote, because here’s what we’re looking for: not just that Dr. J. Doe is the best, but exactly why J. Doe, M.D. is, in your view, the best doctor in this corner of the world. We’re looking for a doctor who went (or goes) above and beyond the call of duty in service to patients. So we’re not looking for your votes in dozens of categories: Best Female Pediatrician, Best Male Pediatrician, Best Left-Handed Veterinarian, Best Bespectacled Ophthalmologist, Dentist With the Best Smile, and so on. We simply want to know who you say is great — and why. We have no idea what kind of response we’ll get from readers on this, but we would like to recognize these outstanding physicians often, perhaps quarterly. This program will evolve as we go along, but we’ll do our best here at Medical Examiner world headquarters to make this something area physicians can be proud of, that their patients will be aware of, and that will also bring some rewards to the patients who bring this all to light for us. Just drop me a line via mail or e-mail. Those addresses are in the box that’s on page 3. Be sure I have the information to contact you in return. Thanks in advance! + — Dan Pearson Publisher
Serving the Medical, Dental and Education Communities since 1976 Visit us at any of our 5 locations or at www.hccu.coop 706-434-1600
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EN
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®
OG
www.drugofchoicecoffee.com Drug of Choice Brand Coffee is available at Inner Bean on Davis Road.
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THE MEDICAL EXAMINER BLOG CAN BE FOUND AT WWW.AUGUSTARX.COM/NEWS WHATEVER YOU DO, DO NOT DENY YOURSELF THE SINGULAR PLEASURE OF VISITING REGULARLY.
HEY KIDS ! Do you have a question you’d like to ask a doctor? ASK THE SEE PAGE 3
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AUGUSTA MEDiCAL EXAMINER
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MARCH 15, 2013