Medical Examiner 3-31-23

MEDICALEXAMINER

hazard.

UV radiation is a known human carcinogen. Solar UV radiation, as well as UV rays from indoor tanning beds, are the leading cause of two common types of skin cancer, basal cell carcinoma and squamous cell carcinoma. A history of severe sunburns, or just one blistering sunburn in childhood, increases the chances of developing skin cancer including melanoma, the most dangerous type of skin cancer.1,2 A sunburn provokes an inflammatory response.3 A tan is a sign that your skin cells have been damaged by too much UV radiation.4

Tools at Your Fingertips

augusta.edu/cancer/community

Golfers are not immune. Neither are caddies, the gallery, nor groundskeeping crews. They all share one thing in common: exposure to the sun’s ultraviolet (UV) rays. One in five people will get skin cancer in their lifetime in the U.S., and golfers are at higher risk for this leading cancer, given their early and constant exposure to UV rays. In fact, anyone whose job requires they work outdoors for six or more hours a day, particularly during mid-day when the sun is most intense, are subjected to this workplace

Besides providing the outside temperature, your smartphone weather app holds another important forecast, the UV Index. The colorcoded Index, a measure of UV intensity and exposure in your location, ranges from 1 to 11+ and offers corresponding sun safety tips (see below). Regularly checking the UV Index can prompt you to be smarter about protecting your skin from harm by taking action.

Be Sun Smart, Skin Safe

Avoiding sun exposure during the hottest parts of the day, wearing protective clothing such as wide-brimmed hats, long sleeved shirts, and Ultraviolet Protective Factor (UPF)

GOLF&THE SUN

“The C Word” is a newsbrief of the Georgia Cancer Center at Augusta University.

clothing, and seeking shade whenever possible can help reduce your risk of skin cancer. Regularly applying mineral-based sunscreen with a sun protective factor (SPF) of 30 or higher is another sun smart, skin safety tool. Be mindful that other surfaces such as water, snow, sand, and cement reflect UV rays and can contribute to UV exposure.5

What to Look for in Sunscreen

• Mineral-based – contains zinc oxide or titanium dioxide; is appropriate for sensitive

PARENTHOOD

by David W. Proefrock, PhD

Your 16 year-old son wants to get a part-time job after school or on weekends. He has always managed to get by in school but is not making the kind of grades you think he should be. You are afraid a job will lower the grades he is making now. What do you do?

A. Be glad that he wants to work. Let him get a job.

B. If he doesn’t have to work to help the family, there’s no reason for him to take time away from his studies. Don’t let him get a job until he demonstrates much better grades.

C. Arrange jobs around the house for him so he can earn extra money. Jobs at home are less likely to interfere with his grades because you control his schedule.

D. Allow him to get a job on the condition that if his grades drop below their current level, he will have to quit.

If you answered:

A. This is a good response if you add the condition that he will have to maintain his current grades in order to keep the job.

B. Working is good for kids, and they should be encouraged to work if they are able to maintain their grades. Figure out a way for him to work but to also maintain his studies.

C. Working at home does not teach the same lessons as working outside the home. Most of the time, the parent/child employee arrangement leads to problems.

D. This is the best choice. It recognizes both the importance of learning the lessons that employment teaches and the importance of education.

Real employment is almost always good for kids. It teaches responsibility, dependability, and positive relationship skills. Earning your own money contributes to self-esteem and confidence.

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

OUR NEXT ISSUE: APRIL 21

MEDICAL MYTHOLOGY

BITING FINGERNAILS IS A HARMLESS HABIT

Plenty of people would agree: biting nails might not be polite in public, but what’s the harm in private? Would it surprise you to learn that the habit of nail biting — or onychophagia as it’s formally known — is listed in the DSM-5, the bible for psychiatrists and clinicians who specialize in mental health disorders?

That doesn’t mean that every nail-biter is certified. There is a line between “normal” and pathological nail-biting that is not always easy to identify. Then again, quite often it is; the owner of these fingers (below) has clearly chewed and bitten far past any point that could be described as appropriate

or even rational. As with any other compulsive habit, however, the person responsible for this might steadfastly maintain he can quit anytime. The photograph proves otherwise, but so do research studies, which establish that at least 30% of all practicing nail-biters have tried to quit and cannot.

Some of the clues that simple nail-biting has progressed to what the DSM-5 would classify as a pathological obsessive-compulsive impulse control disorder include:

• a build-up of tension prior to biting followed by relief or pleasure afterward

• feelings of shame, guilt, disgust or embarrassment related to biting and the ap-

pearance of fingers, skin and nails

• strained family and social relationships from nail-biting • continuing the habit despite the social and emotional cost, plus damage to and infections of fingers, nails and cuticles.

The potential side effects don’t stop at the hands and wrists. As we have all learned during the course of the pandemic, our hands can be laden with bacteria and are very effective conveyors to whatever we touch. Constantly biting fingernails can transmit germs into the body, causing internal infections or gastrointestinal problems. Onychophagia can also result in fungal and oral infections and tooth damage (such as chipped teeth).

Although nail biting is associated with nervousness or anxiety in popular culture (and that is often a trigger), some people bite their nails when they’re lonely, hungry, bored, or when they’re mentally engrossed in some activity. The triggers vary from person to person.

Over the years a number of treatment options have been tried, with varying degrees of success. The simplest involve applying bitter-tasting products to the fingernails. Sometimes that works, although it seems to be least successful with the most hardcore nail biters.

Another barrier option is wearing gloves, mittens, socks, and oral barriers, but obviously those aren’t for most work settings.

Some medications prescribed for anxiety and depression have helped people break the habit. Another option is behavioral therapy provided by a psychologist or other therapist, which can help identify and address underlying issues that contribute to the habit.

Everyday life shouldn’t be a nail-biter, and help is available if it is.

skin; is eco-friendlier to aquatic life and reefs. Also referred to as physical sunscreen because it provides the skin with a physical barrier that deflects the sun’s rays.

• Sun Protective Factor (SPF) 30 or higher – daily use helps protect from sunburn.

• Broad Spectrum – shields against two kinds of UV rays – UVA (associated with skin aging) and UVB (associated with skin burning).6

• Water Resistant or Very Water Resistant. This is a measure of how long sunscreen will adhere to wet skin (up to 40 or 80 minutes). Water resistant sunscreen can be effective for 40 minutes in the water, according to the American Academy of Dermatology (AAD).7 Sunscreens are not waterproof.

• Check the expiration date and discard if it is past that date.

• Slather it on. Be generous. Apply liberally and evenly. Apply 20-30 minutes before going out into the sun. Reapply about every two hours or after sweating or swimming.

Justin Thomas, golf-pro and melanoma cancer survivor, offers sound advice, “It’s time to raise your sun protection game.”

SOURCES:

SUN SAFETY MYTHS

MYTH: A “base” tan is a safe tan.

FACT: There is no such thing as a safe or healthy tan, according to the Skin Cancer Foundation. While both UVA and UVB rays cause the skin to darken, UV radiation exposure increases the risk of skin cancer.

MYTH: Sunscreen can protect my skin 100%.

FACT: Nope. No sunscreen is 100% protective. The smart way to care for your skin and reduce your exposure to UV rays is to use a combination of methods.

MYTH: You don’t need to use sunscreen on a cloudy day.

FACT: UVA penetrates cloud cover, so safeguarding your skin from UVA rays even on cloudy days is a smart move.

MYTH: UV rays don’t penetrate glass.

FACT: UVA rays do pass through glass. Consider UV window screens on your car’s side windows to help filter those UV rays. For sunglasses select a UV 400 rating to help protect eyes. Check the label on your sunglasses.

MYTH: Sunscreen that contains insect repellent is a bigger bang for the money.

FACT: Think about it. Sunscreen needs to be applied liberally and often. Insect repellent should be applied sparingly and less often, according to the American Academy of Dermatology (AAD). They recommend looking for another sunscreen when faced with that choice +

1. The Skin Cancer Foundation. Skin cancer facts and statistics. What you need to know. www.skincancer.org/skin-cancerinformation/skin-cancer-facts.

2. Wu S,* Cho E, Li W-Q, Weinstock MA, Han J, and Qureshi AA. History of Severe Sunburn and Risk of Skin Cancer Among Women and Men in 2 Prospective Cohort Studies Am J Epidemiol. 2016 May 1; 183(9): 824–833. Published online 2016 Apr 3. doi: 10.1093/ aje/kwv282 PMCID: PMC4851991 PMID: 27045074 ncbi.nlm.nih. gov/pmc/articles/PMC4851991

3. Inflammatory response – National Cancer Institute (NCI). Sunburn. Cancer Trends Progress Report. April 2022. progressreport. cancer.gov/prevention/sunburn.

4. Department of Health, Victoria State Government, Australia. Skin cancer – tanning. Better Health Channel. betterhealth.vic.gov.au/

health/conditionsandtreatments/skin-cancer-tanning#bhc-content

5. American Cancer Society –Ultraviolet (UV) radiation. cancer.org/ healthy/cancer-causes/radiation-exposure/uvradiation. html#:~:text=Reflection%20off%20surfaces%3A%20UV%20rays,an%20 increase%20in%20UV%20exposure.

6. UV Radiation & Your Skin: The facts. The risks. How they affect you. Skin Cancer Foundation. skincancer.org/risk-factors/uvradiation/#:~: text=Ultraviolet%20A%20(UVA)%20has%20a,is%20 associated%20with%20skin%20burning.

7. American Academy of Dermatology. How to decode sunscreen labels. aad.org/public/everyday-care/sun-protection/shade-clothingsunscreen/ understand-sunscreen-labels#:~:text=What%20 is%20water%20resistant%20sunscreen,you’ll%20need%20to%20 reapply.

Need a breast or cervical check-up? but you can’t afford it, or have no insurance?

The Georgia Breast and Cervical Cancer Screening Program (BCCP) is a comprehensive Public Health Program that provides uninsured/underinsured women with FREE breast and cervical cancer screening services.

SCREENING SERVICES OFFERED:

• Clinical Breast and Pelvic Exams

• Mammogram Referrals

• PAP/HPV Testing

• Transportation assistance

• And much more!

For more information, please call LisaAnn Wheeler

BCCP Patient Navigator:

If you are a Georgia resident, 21-64 years of age, uninsured or underinsured, and your household income is no more than 200% of the Federal Poverty Level, our services to you may be FREE!

Unless you’re the exception to the rule, the answer to this question is the same for just about everybody: less. Less than you are currently using. Probably way less.

Where have every one of us received our video tutorials about how much toothpaste to apply? In TV commercials produced by the makers of toothpaste. Naturally they show a beautiful, toothbrush-long ribbon of paste artfully curved, up and one end, down at the other. No wonder: they’re in the business of selling toothpaste, and they’re doing a fine job.

The dental community, on the other hand, is not, and they have a different story to tell. We don’t need that much toothpaste. Read the label on just about any tube of toothpaste and it will recommend a pea-sized amount, specifically for children under 6. For adults, that or just a little bit more is still an appropriate amount. Consider: many dentists recommend electric toothbrushes for optimal cleaning. Their brush head only accommodates about a pea-sized squirt of toothpaste anyway. The benefit of brushing is dual: removal of food particles, and the introduction of fluoride to protect and strengthen tooth enamel. An overabundance of toothpaste provides no more protection from fluoride than a moderate amount.

There is a reason toothpaste labels specify pea-sized amounts for children under 6. Little kids are the population group most likely to swallow toothpaste. Deliberately. If enough fluoride goes down the hatch it can permanently discolor teeth. Prevention is pretty simple: start with small amounts of toothpaste as recommended. For toddlers, just a smear of toothpaste across the brush is enough. Stay with them while they’re brushing (or brush with them so you can set a good example), and make sure they spit and rinse instead of swallowing.

If a child does swallow a lot of toothpaste — like straight from the tube — they’re likely to get a stomach ache, and perhaps nausea and diarrhea. Giving them a snack of yogurt or milk should help since calcium will bind with the fluoride. An additional option is to call the Poison Control Center — (800) 222-1222 — for advice.

Who is this?

This eminent physician and researcher, landing here for the 186th installment of this Medical Examiner feature, suggests how many people have contributed to the state of medicine as it exists in 2023. The talent pool seems almost inexhaustible.

Students of medical history may very well recognize him. This is Robert Koch, who fathered more branches of medicine (at least three) than he and his wife did children (one).

Born in Germany in 1843 as the third of thirteen siblings, Koch was brilliant from the start. He had already taught himself to read and write before entering school at 5 years old. His university career began at age 19, where he embarked on the study of mathematics, physics, and botany, but after just three months he changed his major to medicine. Within a few semesters he was studying and performing research with notable mentors like Jacob Henle and Rudolf Virchow, probably unfamiliar names to most of us, but potential subjects for future editions of Who is this? in their own right.

Upon graduation in 1866, Koch began his career as a general physician, working at such institutions as the General Hospital in Hamburg and the Idiot’s Hospital in Langenhagen before becoming a volunteer surgeon for the German army in 1871 during the Franco-Prussian War. After the war, his wife gave him a microscope as a birthday present, and the rest, as the old saying goes, is history. That gift is the reason why many view Robert Koch (along with Louis Pasteur, with whom Koch had a frosty relationship) as the father of microbiology, and as one of the founders of modern bacteriology, specifically medical bacteriology. His discoveries paved the way for establishing germ theory as the cause of disease, and provided public health with an actual scientific basis upon which to build its policies.

It was Robert Koch who invented a standard means of studying bacteria in the lab: coating a glass slide or other surface with agar coated with a thin layer of gelatin, then introducing bacterial samples. The method is still used to this day, and enjoyed the additional enhancement of small shallow covered dishes that Koch’s assistant Julius Petri developed.

Through his studies, Koch was able to identify four basic principles (“Koch’s Postulates”) that enable clear connections between pathogens and diseases to be established or discounted. Using these principles in the investigation of disease, Koch was able to discover the cause of cholera, tuberculosis, and anthrax, findings that led directly to effective efforts to prevent and treat these deadly diseases.

World Tuberculosis Day has been observed every March 24 since 1982, the 100th anniversary of the day Robert Koch announced his discovery of the tuberculosis bacterium. For that accomplishment, he was awarded the Nobel Prize for Physiology or Medicine in 1905.

Koch suffered a heart attack in early April 1910 from which he never fully recovered. He died about 7 weeks later at age 66 +

Middle Age

BY J.B. COLLUM

There is an old analogy about a frog in boiling water. In short, it claims that if you put a frog in a pot of room temperature water, and slowly bring it to a boil, he won’t notice until he has gotten so hot that he will be unable to jump out of the water, and so he dies. Well, first of all, that would be really cruel. If you want frog legs to eat, there are better, more humane ways to go about it. I will get around to how this applies in this case, but you might guess it along the way. Does that mean we can call this a murder mystery? No, but only because nobody has died. Yet.

We took a camping trip last week to Elijah Clark State with some friends who camped in the spot right next to us and we had a great time together despite weather not knowing if it wanted to be spring or winter.

We had a good fire going most of the time and we brought warm clothes, so we were fine. My friend Chuck made an observation though. He was concerned about the toll that raising young children was taking on us. I agreed that it had been hard on us and even threw out the famous line from Lethal Weapon when Danny Glover, as the character Roger Murtaugh, said something about being too old for this. He was referring to the strain on his mind and body from the hijinks that he and his partner were involved in as they tried to catch the bad guys. In our case, it is trying to keep up with the varied needs of our three grandchildren while we are in middle age.

The kids range in age from 5 to 13. Two girls and one boy. The 5-year-old girl is also a special needs child. If I haven’t already told you, she has done thousands of dollars in damage to our house and its contents in the few months they have been living with us. That causes a lot of stress and strain in itself. The oldest girl, the teenager, is, well, a teenager. I will just leave it at that. And then we have the boy, the middle child of age 10.

The 5-year-old has to be watched as if you are a military sentry. You cannot, under any circumstances, take your eyes off her for more than a few seconds at a time. It amazes me that in less time than some folks take to blink, this tiny kid can go from lying under a blanket on the sofa to any number of dangerous or destructive acts. I have literally looked away for a few seconds only to look up and see her straddling the TV and banging on the screen. At other times I will catch her peeling the leather off a piece of furniture and I can’t get to her in time to stop her from putting it in her mouth. The good news is that I have learned that this means she is hungry. The bad news is that she is the pickiest eater since the dawn of man. What she likes today has little to no resemblance to what she liked yesterday, or even an hour ago. There are a few things that she will always eat, but if we only fed her that she wouldn’t get the nutrition she needs, so we struggle with trying to get her to eat a balanced diet. By the way, if she doesn’t like something, there is no mystery. She just throws it on the floor, or at you. Or she might start pinching or scratching you.

Her sleep habits are affected by the mental issues she is dealing with too. It is difficult to get her to sleep when she should, and sometimes she just decides she wants to sleep a few hours before her bedtime. When that happens we know that she will awaken in the wee hours of the morning, making enough racket to wake the dead, which is really bad because we live next door to a graveyard. From all of this you can understand how stressful it is to have to keep up with her 24 hours a day. My oldest daughter, Kate, their aunt, is amazing, and if it wasn’t for her, we couldn’t do this at all, as she takes on most of the responsibility. My lovely wife carries most of the remainder of the burden, if I am being honest.

And now we return to our analogy. Chuck noticed that my wife’s hair was showing a lot more gray than the last time they saw us. I hadn’t noticed since I am with her all of the time. But once he said that I took a look and thought about it and realized that he was right. It has given me a lot to think about and I am trying to come up with ways to take care of our obligation as grandparents while not killing and bankrupting ourselves in the bargain. I haven’t figured it out yet, but we are working on it. For one thing, we are trying to find activities and equipment that will allow us to not need to be as watchful. My wife bought a small trampoline yesterday that has a net enclosure and the door zips up so she can’t get out too fast without us realizing it. We are hoping that helps some. That said, on her first use of it she bit into and ripped out several pieces of the foam covering on the poles that hold up the net. It took us a few seconds to get in there to stop her, so her brand new trampoline now is adorned with a lot of duct tape, and I see more in its future. I have also ordered her a special musical keyboard designed for very young children that is supposed to be indestructible and yet full featured to allow her room to grow. It also sneaks in lessons beyond music, like the ABCs, colors, animals, etc. It is only available in Japan, so we will be waiting a few weeks for that. I did this because it seems like music soothes her. And she likes to bang on my musical equipment, so I want to give her an alternative.

I am going to do something selfish now and ask for help. If any of my readers have faced a situation like this regarding raising children and especially special needs children, especially while older, please share by emailing me at the address listed at the bottom of the column. I promise not to spam you or sell your email address. Well, unless they offer me at least a million dollars, but I don’t think you need to worry. I look forward to hearing from you. Thanks in advance.

+

WELL PLAYED A few years ago I had to go to the pharmacy and my doctor was right next door, so I thought I’d pop in and make an appointment instead of calling. The receptionist told me they don’t take walk-ins — but I didn’t want an appointment anyway — and they only make appointments over the phone. So I stood there, got my phone out, and called the number for the office. The phone was sitting right next to her. I made eye contact with her the whole time as she answered the phone and booked my appointment.

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

NUMBERS

Americans are obsessed with numbers. Phones. Bank accounts. Identification

Numbers. Social Security. Credit Cards. Bank Accounts. IQ. Batting Averages. WinLoss Records.

Health numbers. Blood glucose. Electrolytes. Weight and height combined in BMI (Body Mass Index).

Statistical numbers. What certain statistics say about us as a nation and society are somewhat frightening. Just this week I saw troubling statistics that weighs heavily on our future.

80% of the kids in Washington, DC live in single parent homes. Is that number important? Maybe. In that same school district, exactly zero percent of 5th graders were able to perform academically at their grade level. Are those acts related? Many think so.

80% of single parent

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy Laveau

homes are led by women. But let’s not focus on that area alone. Nationwide, 25% of children live in single-parent homes, whereas worldwide, only 7% of kids live in single parent homes. And we are supposed to be the most affluent nation on earth. By what measure?

In the US, 70% of teenage pregnancies occur in girls living in fatherless homes. And they have higher abortion rates than girls from two-parent homes.

Children reared in two-parent homes are less likely to go to jail. They are

less likely to enter the drug scene. Kids reared by fathers alone have the same incarceration rate as two-parent kids.

90% of homeless and runaway kids are from single parent homes.

63% of child suicides are from single parent homes.

85% of behavioral disorder diagnosed kids are from single parent homes.

Do these statistics tell us something? Do children from two-parent homes fare better in our world? Most likely. For thousands of years, two-parent homes were the norm. The world progressed. Societies grew. Countries gradually developed, but not without turbulent bumps along the way. We had wars. Famines. Genocides.

Then, during President Johnson’s War on Poverty, government workers went door-to-door asking if there

was a father figure or man living in the home. If not, the household got food stamps, rents paid, electricity and water paid as well Medicaid medical care. If a man or father figure was there, no help.

In short, the government paid if the men were absent from the household. Is it any wonder why we became a nation of fatherless homes? One doesn’t have to be a mathematician or an Einstein to see the connection. Just as clearly, the falling number of husbands or father figures is directly related to the downfall of our society.

There is an answer in numbers. Put one father and one mother in each home — before children arrive. Limit the number of children to whatever the family can financially and socially care for. Two children is usually a good number. Kids stay in school for 12 years. Public schools are paid for by the taxpayers. Become trained in one profession. (College or trade school or apprenticeship or

On Job Training.)

Children should not have children. Birth control is free at the Public Health Department. One visit to PHD every six months solves the unsupported pregnancy problem. Those are easy numbers to engage.

The bottom line is that if child bearing is postponed until a long-lasting, financially stable relationship is establish and fully committed, many of the perils of life are avoided. Personal income increases. Mental illness decreases. Incarcerations decrease. Drug addiction decreases. Poverty decreases.

At about the same time our numbers got out of whack, along came new terms: Baby-mama. Baby-daddy. The alphabet soup of new sexual identities. Recreational drug use. Drug addiction. Increasing school dropouts. High unemployment. Spiraling public debt. Falling individual net worth.

We must get our numbers right … while there is still time.

DEARREADERS

As you probably know, the Medical Examiner is normally published twice a month with issue dates of 1st and 3rd Fridays. Once in a while something interferes with that routine, like a certain golf tournament, for instance. Instead of publishing an issue dated April 7 (during tournament week), we’ll take advantage of this month’s five Fridays and do that issue on March 31. We’ll all pretend that’s our 1st Friday edition, then resume the normal schedule for the next issue, April 21, April’s 3rd Friday. Mark your calendars today!

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES

Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

MORNING BURST SCONES

Enjoy a delicious morning treat that provides antioxidants to boost your immune system.

Ingredients

• 2 cups white wheat flour (10 ounces)

• 1/3 cup sugar (+ 2 teaspoon to sprinkle on top)

• 1 teaspoon finely grated lemon rind (zest of about one lemon)

• 1 teaspoon baking powder

• ¼ teaspoon baking soda

• ½ teaspoon salt

• 4 tablespoons unsalted butter cut into chunks

• 1 cup fresh blueberries

• ½ cup vanilla yogurt

• ½ teaspoon almond extract

• 2-4 tablespoons fat free milk

• 1 large egg

Instructions

Preheat oven to 400°F. In the work bowl of a food processer, mix 2 cups all-purpose flour, 1/3 cup sugar, lemon zest, baking powder, baking soda, and salt. Next add the butter and pulse until well combined (~8-10 pulses). Transfer the mixture to a large bowl and stir in the blueberries.

In a small bowl whisk together yogurt, extract, and egg until smooth. Using a fork, stir yogurt mixture into flour mixture until large dough clumps form add in milk 1 tablespoon at a time until desired consistency is reached (you want the mixture just barely moist but not dry). Use your hands to press the dough against the bowl into a ball. (The dough will

be sticky in places, and there may not seem to be enough liquid at first, but as you press, the dough will come together.)

Place dough on a lightly floured surface and pat into a 7- to 8-inch circle about ¾-inch thick. Sprinkle with 1-2 teaspoon sugar. Use a sharp knife to cut into 8 triangles; place on a cookie sheet lined with parchment paper, about 1 inch apart. Bake until golden, about 15 to 17 minutes. Cool for 5 minutes and serve warm or at room temperature.

Yield: 8 servings (1 scone = 1 serving)Nutrient Breakdown: Calories 268, Fat 12.5g (7g saturated fat), Cholesterol 57mg, Sodium 273mg, Carbohydrate 34g, Fiber 1.3g, Protein 5.8g, Potassium 84mg, Phosphorus 78mg Carbohydrate Choice: 2 Carbohydrate

“I’m

One sure way to find out if you can eat the fish you catch in the Savannah River, or really any river in any state, is to check your state’s environmental agency website for the latest recommendations and advisories.

You can also put “Fish and Shellfish Advisories and Safe Eating Guidelines” into your web browser to be directed to the EPA. Of course, if you simply fish for sport and “catch and release” the way many people do these days, you don’t have to worry about the safety issue.

Looking at the Georgia guidelines for Lake Thurmond, if the fish is larger than 12 inches, the advisory is to have no more than one meal a week of largemouth and hybrid bass, because of the possibility of mercury contamination.

Advisories for eating fish in the Savannah River depend upon what part of the river you are fishing. There are no restrictions for eating fish in the Savannah River below Clark Hill Dam in Columbia County. If you fish in the Savannah River in Richmond and Burke counties, the advisory is to eat no more than 1 meal per week of largemouth bass. If you are fishing the river in Screven County, the advisory is for no more than 1 meal per week of bluegill sunfish, and at Ft. Howard and the Tidal Gate, the advisory extends to white catfish.

There are many other advisories for fishing in Georgia lakes and ponds, so make sure to check the advisories. For example, there are bright

red advisories (do not eat ANY fish) from Spirit Creek above Richmond Factory Pond, because the fish are contaminated with both mercury and thallium. Richmond Factory Pond is located about 3-1/2 miles from Hephzibah in Richmond County. Whether you live in Georgia or some other state, make sure to always check the advisories for the body of water you fish in.

ÂRelating to overall recommendations for all fish, the highest levels of mercury are found in king mackerel, marlin, orange roughie, shark, swordfish, tilefish and bigeye tuna. Avoid eating any of these fish.

It is important to mention that people in specific high-risk groups, such as those with immune diseases, pregnant women and young children, should avoid eating raw fish of any type. The prudent recommendation is that everyone, even you, eat only fish that has been cooked to flakiness, especially if you are eating fish outside the home. I know that these days it is considered very sophisticated to eat raw fish in sushi, or eat fish that is undercooked, such as ordering salmon seared on the outside but mostly raw on the inside. When we order salmon in a restaurant, we always make sure to say, “cook to flakiness,” even if

the waiter looks down her or his nose at us. Yes, we know it is not the “in” thing to order this way, but it is the prudent thing to do when you eat fish in restaurants. I choose the “better safe than sorry” option.

You see tilapia at the fish counter these days. What type of fish are these, and are they safe and healthy to eat? The term tilapia applies to about a hundred species of cichlid fish, not one fish specifically. These fish may be raised either on a fish farm or harvested from the wild, and there can be significant differences in the nutritional profile of the fish depending on the exact species and how they are raised.

Tilapia, like most other fish, is healthy to eat. It is low calorie, low sodium, low sugar, low fat, and is a great source of protein, but does contain a moderate amount of cholesterol. The fat in tilapia is not considered as healthy as the fat in salmon. That’s because salmon and many other fish contain high levels of omega-3 fat, whereas tilapia contains higher levels of omega-6 fats. Omega-3 fats (sometimes called “fish oils”) are healthier to eat than omega-6 fats. As an aside, the types of fat in tilapia are very similar to the types of fat in catfish.

What’s the “No-Nonsense Nutrition” advice about eating the fish you catch? Check your state advisories before eating the fish you catch. And particularly for our Southern tables, if you are eating fried fish with sides of macaroni and cheese, hushpuppies and fatback-and-salt green beans, you should worry more about your fat and your cholesterol profile than the fish’s.

question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/ AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

FOODISMEDICINE

Tasty tips from registered dietitians with the Augusta Dietetic District Association

Getting green in the kitchen

Did you know that Americans throw out 30-40% of their food? That is almost half! This is alarming, especially when you consider that translates into almost half of the energy, water, and land used for farming being wasted. Yikes!

The food that ends up in landfills then creates additional methane gas (greenhouse gas) which is harmful to the environment.

What can we do to be more environmentally friendly eaters? Any good dietitian would tell you to focus on eating your produce instead of throwing it out --- it is good for both you and the environment.

Additionally, we can make every effort to not over-purchase food, and compost our waste. Composting recycles organic “waste” material (leaves & plant-based kitchen scraps) to produce compost. Compost is rich in nutrients and is a great gardening material that returns needed nutrients to the soil. Only 3% of people compost, so there is room for improvement. Some localities have composter bins available at reduced rates to encourage backyard composting (think summer project with the kids).

• In North Augusta: call 803-441-4240 or email compostbins@northaugusta.net to find out more or order a compost bin ($35.00).

• In other areas of the CSRA you need to get a compost bin at a local store or simply designate a compost area in your yard. For more information visit: www.bit.ly/compostga

In addition to composting, you can aim to use fruits, about to go bad, in smoothies. Also don’t forget to put the bananas in the freezer before they get too ripe. You can freeze them in the skin (best for use in banana bread) or peel, slice and then freeze (best for quick additions to smoothies).

Learn what other foods freeze well. For example, guacamole and hummus can be frozen for later. Soups and most casseroles, such as lasagna can be frozen in individual servings – for easy grab and go meals when needed. Foods that you don’t use up also freeze well; like that half a jar of marinara or half a box of chicken broth. Transfer them to freezer safe containers and freeze until needed. These suggestions help the environment and save money, a real win-win.

Lastly, learning to cook using whole foods is a great way to eat for the earth. Check out this root to stem cooking resource www.bit.

ly/root2stem

KALE SMOOTHIE

Easy and delicious sure to be a family favorite!

• 1-2 cups raw chopped kale

• 1 cup higher protein milk (such as Fairlife® or Carbmaster®-plain)

• ½ cup of frozen mango chunks

• 1 medium banana (previously cut into slices and frozen)

• 1 teaspoon fresh ginger minced

Place all ingredients and place into a blender. Blend until smooth and enjoy.

Yield: 2 servings

Nutrient Breakdown: Calories 172, Fat 0g, Cholesterol, 80mg. Carbohydrate 27g, Fiber 4g, Sodium 70mg, Protein 9g, Potassium 780mg.

Diabetes Exchanges: 1 vegetable, 1/2 milk, 1 fruit

Kim’s Note: This smoothie is easily turned into smoothie packets for the freezer. Simply put the kale, mango, banana and ginger into individual plastic zip-top bags and store in the freezer. When ready to make the smoothie place the contents of a packet into a blender with the milk and blend. Smoothie packets make morning smoothies a breeze to prepare.

Eat well, live well

— Kim

CRASH COURSE

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

There is tremendous risk afoot here in following up the previous Crash Course, entitled “Dumb Driving,” with another one here called “Dumb Driving Part II.”

The risk is that years from now we may be on “Dumb Driving Part LDCXVI.”

It could end up like the Super Bowl, where nobody even knows what the numbers mean anymore.

surprise that it can breed even more brainless activity in people who get too close to a tailgater.

DUMB DRIVING Part II

But before we get too far ahead of ourselves, let’s put all that behind us (literally) and talk about tailgating, one of the all-time stupidest driving habits ever invented — and we aren’t talking about just the tailgater either. Tailgaters can also breed stupidity among tailgatees. It’s a practice that is so intensely boneheaded that others nearby are often infected, even if they’re vaccinated and wearing a mask while driving.

Let’s address the obvious imbecile first, the one doing the tailgating. He (or she) has enough trust in the driving skills (and mental stability) of a complete stranger that he is content to follow behind that unknown driver so closely that any sudden slowdown or stop will result in a collision.

Depending on the speed involved at the time of the wreck, the consequences can range from a brief police report and insurance claims and repairs all the way up to massive fines and lengthy prison sentences. Yes, sometimes people die in rear-end collisions.

Why do people tailgate? Intense scientific research has determined that tailgaters are usually ignorant, entitled, impatient jerks. How else can you describe it? Oh, you would add irresponsible, thoughtless and foolish?

Points well taken. Of course, tailgaters would argue that none of those descriptors apply. It’s the people driving along at 35 in a 45 who are the idiots. Tailgating is meant to prod them into speeding up.

That hardly ever works.

Tailgaters are in a hurry. Everyone gets that. But tailgating is a great way to arrive at a destination sooner in the same way that sitting in first class will get you to your destination airport faster than sitting in coach. Entire seconds may be saved.

As infectiously moronic as tailgating is, it’s no

SHORTSTORIES

THE HARDEST TRUTH I EVER TOLD A PATIENT An older couple who had been married something like 50 years were my patients. They were both ill at the same time. They were on the same unit about 4 doors away from each other. Every day after breakfast I would walk the gentlemen over to his wifes room.

She was very ill with pancreatic cancer and her time finally came. She passed away at about 7:15 one morning.

He kept asking if he could visit her and nobody wanted to tell him. We cleaned her up, took out all of the IVs etc.. cleaned the room and I walked him down there. Just before he went in I told him his wife had passed away during the night. He sat at her bedside for 2 hours talking to her, saying goodbye.

He thanked me for telling him the truth and we both cried. He passed away three days later.

It can happen in a number of ways. The driver of the lead car can easily become distracted, so fixated on their rear-view mirror that they fail to notice traffic stopped in front of them. Seconds before they feared being rear-ended; now they are doing the deed. And by law it’s their fault.

In another common scenario the tailgatee can likewise transform himself from innocent victim to guilty perpetrator. Thats when he or she decides to “brake-check” the tailgater. “That will teach him to back off,” they think. They believe that the rear vehicle is always at fault, so even if a collision ensues, it will be the tailgater’s fault.

Not so fast. Cameras are everywhere these days. If it can be established with video evidence that you, the tailgatee, deliberately caused the collision (there are laws about “unsafe stopping,” for example), you can be held liable. Brake-checking is a form of road rage.

Even if the tailgater is found to be at fault, brake-checking is an extremely dangerous and immature stunt. The tailgater could be enraged by the collision (or near-collision) and have a gun in his car. Your car could be pushed across the center line into oncoming traffic. Your car could be demolished by the collision and insurance settlements will not be sufficient to purchse an equal replacement. Your injuries could be severe, with lifelong side effects. You and others could even be killed by an accident that you deliberately caused.

Tailgating will vanish forever if drivers do one simple thing: when the car ahead of you passes a marker — perhaps a crack in the pavement or the shadow from a telephone pole — you should be able to count off at least three seconds before you pass that same point. If not, back off a little.

The next time you’re tailgated — theoretically, it could still happen if some people don’t read this article — keep the focus on your safe driving. Slow down a little. Give the person an opportunity to pass. Pull over at a safe place if necessary. It won’t cost you a penny, or more than a few seconds. Even better, it will keep you from being a dumb driver.

SHORTSTORIES

3 THINGS TO NEVER TELL A PATIENT When I was in nursing school, the three main things we were told to never tell a patient:

“Everything will be all right.” This is false reassurance. How do you know everything will turn out all right? Lying to patients causes them to mistrust you and whatever you represent to them (the hospital, the doctor’s office, etc.)

Saying “It’s not going to hurt” when it is going to hurt. Again, lying to patients results in mistrust and it’s especially true with children, who carry the emotional scars of severe illness and hospitalization for the rest of their lives.

“I know how you feel.” No, as a nurse you have no idea how the patient/family feels. By jumping in and saying you understand, you’ve cut them off from actually talking about how they feel and getting some real reassurance rather than false reassurances. +

SHORTSTORIES

A LIFE-GIVING FUNERAL When I was eleven years old, my friend Denny drowned while swimming alone at a local lake. He was alone because I had persuaded a mutual friend who was supposed to go with him to instead come visit me at my house. I was grounded from leaving the house, but I could have a friend come over.

At that young age, Denny’s was the first funeral I remember attending, and I walked into the funeral home alone. I was terrified and overcome with remorse and shame. Not quite knowing what to do, I slipped in the back and sat in the first chair I saw with no one near it.

Almost immediately, Denny’s mother came over and sat next to me. She said, “This is not your fault. You did not kill Denny. Tragic accidents happen all the time, sweetheart. Don’t carry this through your life. If you do, that will be another tragic accident. When you leave today, leave any guilt you might feel right here so that we can bury it too.

Then she hugged me while I cried. I did exactly as she said, and I have never forgotten her kindness and grace. +

the blog spot

— posted by Anonymous physician on 3/25/2023 (edited for space)

ARE RESIDENTS PHYSICIANS?

I was unsettled by an email that our graduate medical education (GME) office recently sent out to all residents at my institution “sharing a friendly reminder that parking spaces identified as ‘physician parking’ are for attending physicians only,” and “residents and fellows who park in ‘physician parking spaces’ will receive a parking ticket.” I have parked next to only non-physician (including non-resident physician) staff in those spaces every day for four years. The entire hospital’s staff parks in the “physician parking,” but this week, residents are not worthy of physician parking and are banned from the labeled spaces.

WE MAKE ABOUT $13.50 AN HOUR

I understand that a resident is a physician in training.

I understand that a resident is practicing under a limited license and under the supervision of an attending physician. But our license refers to us as a physician. By definition, a resident is a physician who has graduated from medical school and holds a medical degree, usually MD or DO.

Resident physicians certainly are not paid as physicians. According to ZipRecruiter, the average resident physician in my state makes $53,000 and nationally, makes $65,000. When you divide $53,000 by 49 weeks in a year (3 weeks of vacation) and an 80-hour work week, residents make about $13.50 per hour. That is lower than the minimum wage in some states.

Although we are not treated as physicians, I can tell you all how residents are physicians. We are physicians when an abscess needs to be drained in the emergency room at 3 a.m. We are physicians when a chest tube needs to be placed emergently. We are physicians when a patient needs a gastric tube or a difficult foley catheter. We are physicians when any patient in the hospital needs a narcotic for pain at any time of the day or night. We are physicians when our institution does not want to pay for any additional coverage for any multitude of tasks that need doing: COVID-19 swabs, difficult IV access, or any kind of note in the computer for billing. We are physicians who diagnose and manage small bowel obstructions, appendicitis, diverticulitis, blunt trauma, brain bleeds, septic shock, etc., overnight without direct supervision.

We stay up all night as the physician who checks on their patients countless times to ensure IV bags are running, blood is delivered from the blood bank, labs are sent, and medications are started. We are the physician who is in-house. We are the eyes, the ears, the sweat, and the brains of the hospital most hours of the day. We adjust ventilators, vasopressors, and ECMO. We resolve tension pneumothoraces and urinary retention. This all happens in the night time hours while attending physicians do not have to get into their cars and do not have to use a parking space.

I understand that resident physicians are physicians in training. We cannot do everything, and we still require supervision. But we work hard. We save lives. We work the most hours out of any staff at the hospital. We don’t get paid enough. I believe we deserve enough respect to be called and treated as physicians. For the last four years, after I worked my 24 to 28-hour shift every 2 to 6 days, I returned to the same parking space on autopilot. I know that my car will be there to get me home. Today I am pleading with the GME, who is supposed to advocate for positive training program policies, to please not take this away from me

The author is an anonymous physician.

What’s for supper?

Whoever came up with that name has got to be the laziest, most unimaginative person in human history. Meatballs. You got a better idea? Sure, let’s go with those.

component

26. Soil component

27. Major area traffic artery

28. Northern borough of 5-D

29. Division of 27-D

What about something exoticsounding, like globules de carne or maybe bovine orbs?

THE MYSTERY WORD

The Mystery Word for this issue: UEIFGAT

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

We’ll announce the winner in our next issue!

30. Bandage type 32. Vigor in style or performance

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

QUOTATIONPUZZLE

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.

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.

2. Forced intercourse

3. Indigo dye

4. Gated area neighborhood

5. Site of WTC

6. Unit of energy

7. Indicate a political preference

8. Singles

9. Jim, noted athlete

10. Like some jackets

11. Large performance venue

12. One of twelve

14. Apple product

17. By mouth

23. Female sheep

24. Lyric poem

25. Soil

THEBESTMEDICINE

Chi Chi Rodriguez

My favorite shots are the practice swing and the conceded putt. The rest can never be mastered.

Lord Robertson

©

Afew memorable quotes about golf: I was three over today: One over a house, one over a patio, and one over a swimming pool.

George Brett

The only time I ever took out a one-iron was to kill a tarantula. And I took a 7 to do that.

Jim Murray

The only sure rule in golf is he who has the fastest cart never has to play the bad lie.

Mickey Mantle

Sex and golf are the two things you can enjoy even if you’re not good at them.

Kevin Costner

These greens are so fast I have to hold my putter over the ball and hit it with the shadow.

Sam Snead

I don’t fear death, but I sure don’t like those three-footers for par.

Chi Chi Rodriguez

Give me golf clubs, fresh air and a beautiful partner, and you can keep the clubs and the fresh air.

Jack Benny

Professional golf is the only sport where, if you win 20% of the time, you’re the best.

Jack Nicklaus

While playing golf today, I hit two good balls. I stepped on a rake.

Henny Youngman

If you think it’s hard to meet new people, try picking up the wrong golf ball.

Jack Lemmon

I never pray on a golf course. The Lord never answers my prayers there anyway.

Billy Graham

You can make a lot of money in this game. Just ask my ex-wives. Both of them are so rich that neither of their husbands work.

Lee Trevino

+

Why subscribe to the MEDICALEXAMINER?

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

Dear Advice Doctor,

One of my co-workers is always asking me for advice about all her problems. I don’t want to come across as critical, so I would try to gently suggest possible solutions instead of telling her she’s doing this or that wrong. Well, apparently I somehow touched a raw nerve because last week she suddenly clammed up completely. She barely acknowledged my presence all week. Should I ask her what I said wrong, or just be glad I’m not her amateur psychiatrist anymore?

Dear Enjoying,

I understand how uncomfortable this is for you, but it might ease your pain a little to know that nationwide more than 3 million people suffer from just one aspect of raw nerves, the one known as peripheral neuropathy.

The not-so-comforting aspect, though, is that this can be a chronic condition. Sometimes it manifests as sharp pain, sometimes as a burning sensation or a pins-and-needles feeling, and sometimes (thankfully, some sufferers say) as numbness.

Many cases of tingling nerves are idiopathic, meaning the cause is unknown, but the most common known trigger is diabetes. High levels of blood sugar can damage nerves, which is why it is so important for diabetics to regularly and frequently check their blood sugar and do the best job they can to manage and control their diabetes. Testing once a day can be just asking for trouble.

Sometimes neuropathy can be caused by poor diet (sometimes paired with alcoholism), injury, as a side effect of medications — especially chemotherapy drugs — or from diseases other than diabetes, like shingles, HIV, hepatitis C, rheumatoid arthritis, and lupus.

While it might be tempting to self-medicate or consult “Doctor Google,” anyone with peripheral neuropathy really needs to consult a physician to see if the cause can be identified. That offers the best chance of getting relief. You and your doctor can hopefully manage or even stop the underlying condition causing the neuropathy, and in the meantime offer pain-relieving medications and lifestyle advice that may help keep things from getting worse.

+

I hope this answers your question.

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

+

SUBSCRIBE TO THE MEDICALEXAMINER

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house!

NAME ADDRESS CITY STATE ZIP

BEFORE READING AFTER READING

THE MYSTERY SOLVED

...cleverly hidden in the bottom border of the p. 7 ad for AUGUSTA BARBER POST

THE WINNER: APRIL CAREY!

If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 3. The new Mystery Word is on page 12. Start looking!

The Celebrated

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package!

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

PROFESSIONAL DI

EMF Safe Homes Sheila Reavill Certified Building Biology Specialist 209-625-8382 (landline)

ALL THAT WORK UNDONE As a medical professional, I’ve seen some heart-wrenching cases in my career, but one patient in particular will always stick with me.

She had undergone major abdominal surgery and was in bad shape, but we had managed to stabilize her and the surgery had gone well. We informed her that she couldn’t eat for a while and explained why. She had agreed to follow our instructions and we had started giving her Total Parenteral Nutrition (TPN) to keep her nourished until she could gradually work her way up to eating solid food.

However, it seems that her husband had different ideas. Just 12 hours after the surgery, he brought in a big cheeseburger and gave it to her without our knowledge. She ate the whole thing and then went to sleep.

We didn’t find out until the next morning, and by then the damage had been done. The burger had caused a systemic infection which led to septicemia. Despite our best efforts, her condition deteriorated rapidly, and she passed away weeks later.

It was a tragic and avoidable loss of life, one that could have been prevented if her husband had followed the doctor’s orders. It was devastating to see a patient who had been doing so well suddenly succumb to a preventable illness.

But the experience taught me an important lesson - that as medical professionals, we can only do so much. The rest is up to the patient and their loved ones. It’s important to follow the doctor’s orders, even if they may seem inconvenient or difficult to follow. It could mean the difference between life and death.

FATIGUE