Medical Examiner 5-19-23

THE C WORD SPECIFICALLY, ESOPHAGEAL

CANCER

Trouble swallowing, chest pain, weight loss, hoarseness, chronic cough, and vomiting are the more common symptoms of esophageal cancer.1 Additional symptoms such as bone pain (if the cancer has spread to the bone) or dark stools due to blood passing from the esophagus through the digestive tract can also occur. According to the American Cancer Society, esophageal cancer is often diagnosed at an advanced stage. The chance of getting esophageal cancer is 1-in-125 for men and 1-in-417 in women. In 2023, in the U.S. an estimated 21,560 new cases of esophageal cancer will be diagnosed, and 16,120 deaths may occur.2

Esophageal Cancer

Esophagus Esophageaal tumor

Stomach

The esophagus is a hollow 10 to 13-inch-long muscular tube connecting the throat to the stomach through which food and liquids pass. The two main types of esophageal cancer are squamous cell carcinoma and adenocarcinoma. Esophageal cancer often begins in the inner layer of the esophagus wall, which is lined with squamous cells and spreads through the outer layers. Adenocarcinomas consist of mucous producing cells.3

Risk Factors4

Age and gender are esophageal cancer risk factors in that older people and men get the disease more often. Obesity and being overweight also increases the risk. Using tobacco and drinking alcohol are known modifiable risk factors. The Human Papillomavirus (HPV) is a risk factor for squamous cell esophageal cancer as is drinking very hot liquids on a regular basis. Prolonged gastroesophageal reflux disease (GERD) or reflux irritates the lining of the lower part of the esophagus and can led to adenocarcinoma of the esophagus. Eliminating tobacco, not drinking alcoholic beverages, eating a diet high in vegetables and fruits, regularly engaging in physical activity, and keeping a healthy weight helps reduce the risk of esophageal cancer.

Detecting Esophageal Cancer

When it comes to depression, there is a difference. A huge difference. Someone can feel depressed without being depressed.

Consider a scenario or two. The first person is depressed. His wife announced that she wants a divorce. He was passed over for an expected promotion at work and then fired. The water heater flooded the house. The transmission went out. A close friend stabbed him in the back (figuratively). His dog died. No wonder he’s depressed.

The second person, by contrast, just got engaged to her childhood sweetheart. The day before that she won $250,000 on a scratch-off ticket. This week she paid off her car two years early — and that was before the scratch-off. But for some reason that even she does not understand she’s not enjoying any of it. She can’t shake the feeling that she doesn’t deserve any of it. She’s depressed too.

Can you see the difference between feeling depressed and being depressed? Feeling depressed, as the first person is, usually has a reason. The feelings are logical and natural. Being depressed, as is the second person, is not only without reason, it persists despite big reasons for not being depressed.

The difference: depression is not a feeling; it’s an illness. Most people who deal with depression have been told more than once, “You have a great life. What do you have to be depressed about?” Or maybe, “I know exactly what you’re going through. I’ve had bad days myself.”

Those are no doubt well-intentioned comments, but they belie a complete lack of understanding about depression. When everyone grasps the all-important distinction between feeling depressed and being depressed, we’ll all be better off.

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD

by David W. Proefrock, PhD

Your 10 year-old son has become increasingly shy and fearful over the past few months. He doesn’t play with his friends anymore, he has to be forced to go to school, and he cries when he is separated from his family. He was never an outgoing child, but the situation seems to have gotten out of hand. What do you do?

A. It is not unusual for kids to go through phases of being shy. Give him a while to get through it.

B. These are rather serious behavior changes, but there is not much that can be done about it. Encourage him to become more socially involved,

but he may always be shy and fearful.

C. If you don’t get tough with him now he may grow up to be anxious and fearful. Force him to become actively involved with other children his age. Don’t cater to his fearfulness now or it may be there forever.

D. Behaviors this severe are possible signs of emotional disturbance. Take him to a mental health professional.

If you answered:

A. It actually is very unusual for a child to go through a phase this severe. He has already been given time to get

over it, and it is getting worse. He should be seen by a mental health professional.

B. You are correct that these are serious behaviors, but wrong in thinking nothing can be done about them. He should be seen by a mental health professional.

C. You can force a child to do many things, but you cannot force him to not be anxious or afraid. He should be evaluated by a mental health professional.

D This is the correct response. These are serious symptoms that have not only persisted, but have become worse. A mental health professional will be able to diagnose and treat the problem.

There are many effective treatments for children who are anxious, fearful, and withdrawn. This is no reason for him to suffer when they can be easily accessed.

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

TIRED OF WAITING?

Who is this?

MEDICAL MYTHOLOGY

SLEEP DEPRIVATION

As we often say at Medical Examiner world headquarters here in Augusta — you probably say it too — abusus non tollit usum. As we all know, in the Latin-free version that’s “Abuse does not take away use.” In other words, the misuse of something is not an argument against its proper use. The gentleman above would probably quote that Latin maxim often if he was still alive, and so would millions of patients around the world. But countless others would beg to differ, and do so quite loudly.

You see, the man in the photo is Dr. Paul Janssen, the founder of Janssen Pharmaceutica. You might recognize that name if you’ve already read this issue’s edition of “This Is Your Brain” on page 8. There it notes that Dr. Janssen is the inventor of fentanyl, which was approved for use in the US in 1968. The drug gets plenty of bad press these days as the #1 cause of drug overdose deaths in the US. For 2021 alone that number stood well north of 71,000. That is an appalling toll.

Of course, we can’t forget abusus non tollit usum. Fentanyl’s deadly ways are largely from illicit drugs manufactured and sold on the street. But in legitimate medical applications fentanyl racks up more than a million prescriptions annually in the Unites States alone, and it’s listed on the World Health Organization’s “List of Essential Medicines.”

What is it good for? Fentanyl is a potent painkiller, some 50 to 100 times more powerful than morphine, making it very useful for cancer patients and people suffering from painful after-effects of surgery and other medical interventions. In a perfect world, fentanyl’s potency would be a godsend, because even a tiny amount of it is effective. That’s what you want in drugs: minimal amounts that are maximally effective.

Fentanyl is an opioid, but significantly it’s a synthetic opioid. The roots of the word opioid can be traced back to opium. That may call to mind images of acres of poppies under cultivation to extract the plant’s active ingredient for use in making all kinds of pain killers: morphine, oxycodone, codeine, heroin and more. In the case of a synthetic opioid like fentanyl, however, those acres of farmland are not required. Its ease of manufacture in somebody’s garage makes it a readily distributed and abused drug, and its incredible potency makes casual use incredibly risky.

Even so, we still keep coming back to abusus non tollit usum. Dr. Janssen created a useful and effective drug; if its abuse caused it to be taken off the market, several groups of patients would feel the pain — literally. Fentanyl is an effective treatment for chronic pain, often using transdermal patches. The dosage can be controlled by the size of the patch.

Fentanyl is used in fields as diverse as obstetrics and combat medicine. It’s useful for epidurals because of its rapid effectiveness coupled with the speedy disappearance of its effects soon after administration. Combat medics sometimes use a fentanyl lollipop taped to the finger of a wounded soldier with the lozenge portion placed in his mouth. When enough fentanyl has been absorbed, its sedating effect generally results in the patient letting their hand drop, taking the fentanyl lollipop with it. It’s a simple but effective way to reduce the likelihood of getting too much fentanyl, even in a chaotic field setting.

Dr. Paul Janssen, incidentally, was born in Belgium in 1936, and died in Rome in 2003 at age 77.

It was widely reported last week that actor Don Johnson, due a hectic filming schedule at the height of the popularity of Miami Vice, did not sleep for five years.

Not “did not sleep well.” Not “had trouble sleeping.” Not “didn’t spend much time in the sack.” No. Quote: “I didn’t sleep for five years..” Period. Five whole years. Could someone actually go that long without sleeping?

The short answer is no. And so is the long answer. It is physically impossible to pull off a feat like that and stay sane, let alone stay alive. Most people have a hard time staying awake for a single day. In a 1989 study of rats, lack of sleep killed them dead

in at most one month, and often within 10 days or so.

There is a scarcity of research on extended sleeplessness in humans because it’s considered unethical to deliberately deprive people of sleep. In fact, deliberately keeping someone awake for an extended period of time is used

as a torture technique. There are a number of records, some considered legit and others not verifiable, which sprang from a fad in the early 1960s: radio DJs, most often, pulled these publicity stunts, staying on the air for ridiculous lengths of time, sometimes using a public place like a department store window as their temporary studio.

One of the longest sleepless stints that’s considered verifiable was the 1964 experiment by California high school student Randy Gardner. As a science project he managed to stay awake for...five years? no...four? ...a full year? Not hardly. He lasted 264 hours, which is 11 days. He was monitored by a doctor during the experiment.

Miami Vice may have been an exciting show back in the day, but there’s no way it kept anyone awake for five years.

an esophagoscopy in which a scope with a light is used to examine the esophageal lining, a biopsy (removing cells for examination under a microscope), and brush cytology or balloon cytology in which a brush or a balloon device captures esophageal cells for examination.3

Augusta University Health offers a noninvasive esophageal DNA test to check for abnormal cells. Using an EsoGuard, the patient swallows a tiny balloon-like device, about one-half the size of a multi-vitamin, attached to a thin tube that collects cells as it slides up the esophagus while being extracted.5

If cancerous cells are detected, the patients’ physician or the patient is contacted, and appropriate referrals are made. A multidisciplinary team of cancer specialists at the Georgia Cancer Center provides gastrointestinal cancer care and supportive services using a patient- and family-centered care approach.

“The C Word” is a newsbrief of the Georgia Cancer Center at Augusta University. For cancer information, visit: augusta.edu/cancer/ community. To request exhibits or speaking engagements, contact Christine O’Meara at comeara@augusta.edu or 706-721-8353.

Sources:

1. American Cancer Society (ACS) cancer.org/cancer/ esophagus-cancer/causes-risks-prevention/risk-factors. html

2. American Cancer Society (ACS) Key statistics for esophageal cancer. cancer.org/cancer/esophagus-cancer/

augusta.edu/cancer/community

about/keystatistics.

html#:~:text=The%20American%20Cancer%20Society’s%20estimates,men%20and%203%2C200%20 in%20women)

3. National Cancer Institute (NCI) Esophageal Cancer Screening (PDQ) – Patient Version. General Information about Esophageal Cancer. cancer.gov/types/esophageal/ patient/esophageal-screening-pdq#_19

4. National Cancer Institute (NCI) Esophageal Cancer Prevention )PDQ) – Patient Version. cancer.gov/types/esophageal/patient/esophageal-prevention-pdq#_80

5. Kaylor L. New, non-invasive DNA test focuses on early detection of esophageal cancer. Augusta University Health News. March 2022. news.augustahealth.org/2022/03/30/new-non-invasive-dna-testfocuses-on-early-detection-of-esophageal-cancer

Middle Age

BY J.B. COLLUM

When my wife and I looked forward to being grandparents many years ago, we never imagined it would be like this. We didn’t expect to be raising young children at our age. Instead, we imagined having them visit often, perhaps even spending some long stretches with us over school holidays or the summer. But we never envisioned it being full time. We wanted the grandparent package where you get to spoil them rotten and then send them home. Sadly, that never materialized. However, when their parents separated and realized that they couldn’t handle them individually, after some discussion we agreed to take all three until the end of the school year, to get some stability into their lives while their parents found their separate paths and stabilized their home situations.

We recently learned that their father is now homeless, and their mother is working hard but struggling to make progress toward having a home for them to return to in the near future. So it looks like this situation will be more long-term than we had anticipated. Along with this, my regular readers know that I face many health challenges common to middle age and exacerbated by neglecting my health issues for many years. Add to that, the fact that our youngest granddaughter suffers with intellectual disabilities and our situation might seem quite bleak. Indeed, sometimes it is overwhelming.

Despite these challenges, we are determined to do our best to provide a safe and loving home for our grandchildren. Our oldest daughter, the children’s aunt, has been a shining star in allowing us to handle the situation. When the kids moved in, she did too, and the three of us — her, my wife, and I — tag-team the situation, but if I am being honest, I am like the little guy in the corner mostly just cheering them on and occasionally chiming in to help briefly, only to be beaten up and rescued by them fairly quickly. I’m a real coward when it comes to dealing with some messes, and those two wonderful ladies bail me out regularly.

Our son is also helping, but from afar. His work has taken him to Europe for a while, and before that he was living about 4 hours away at the beach, but he has helped us financially in a very generous fashion, and when he is here he spends copious amounts of time with the children. My mother has also stepped up to the plate and is helping financially despite us insisting she not do it, but her generous nature wouldn’t allow that. She’s never been materialistic. Neither was my dad.

One other thing that helps is that our family is hard-wired to find the humor in everything and this helps us to cope. For example, when Freyja, our 5-year-old granddaughter, breaks something (a daily occurrence), we

try to find the humor in the situation rather than getting angry. “Well, I wanted a new TV anyway. That 75-inch model was feeling kind of small, and it is already over a month old anyway, so time to upgrade!” I’ll say.

You might think that the teenaged grandchild would be the most difficult, and she for sure isn’t easy, but our biggest difficulty comes from Freyja, who has Angelman’s syndrome. At only five years old, she has already endured countless doctor appointments, hospital visits, and therapies and has a regular regimen of medication to control her seizures.

Angelman’s syndrome is a rare genetic disorder that affects the nervous system, causing developmental delays and difficulties with movement, balance, and coordination. It also causes communication difficulties and can lead to seizures. We know that caring for our granddaughter requires even more patience and understanding than we are already giving, and we have been warned that although she may make some improvements here and there, we should expect increased difficulties as she gets older. So humor will continue to be needed in abundance

We make sure that Freyja receives the best medical care possible, but we also have to adapt to her specific needs at home. For example, we have to be extra careful with her safety, as she seemingly has no fear and will climb anything and put her hands into anything. She will also put anything in her mouth (except for the healthy food we want her to eat). We have to make sure that she has plenty of space to move around and play, but that the area is also safe and secure. She must either constantly be watched, or kept in a safe space.

We were encouraged by experts to have a room with no dangers in it that she can be kept in (locked into) for those times when we might have to turn our eyes to some other tasks, like cooking a meal, going to the bathroom, taking a shower, etc. However, we didn’t have an extra room in the house, and we didn’t like the idea of locking her away in a room away from people. So, we instead built a playhouse in the living room that is visible from the kitchen, most of the dining room, and even some of the den. So the living room has become her play area, and we designed the playhouse so we can see into it from any angle. We had hoped that we could keep her in the playhouse, but she has learned how to climb out, so we will continue to make it more secure. In the meantime I have also added a camera that will allow us to keep an eye on her if one of us is watching her alone and has to step away for a moment. We have added a special swing designed for someone with her intellectual disabilities. It is like a blanket, and she can climb in and

THE BEST LIE A PATIENT EVER TOLD ME I was a nurse working in triage when I called through an 18 year old girl whose presenting complaint was abdominal pain. Nothing unusual there. She was accompanied by her mum. Again, nothing unusual there. It was immediately apparent she was in pain, which appeared to be coming and going every few minutes. I started to take - or at least try to take - a history, when the mum starts shouting that her daughter is pregnant, to which the daughter is shouting back that she isn’t. I asked the mother to leave the room, which she did, glaring at her daughter as she left.

I then continued with the girl, asking her about contraception (she said was on the pill), periods (she’d been having withdrawal bleeds), etc. Vital signs, other than a slightly elevated pulse, were normal. She was wearing a fairly loose fitting top, and certainly didn’t look pregnant, but there was something I couldn’t quite put my finger on, something didn’t ring quite true about her story.

Either way, something was going on, so I took her through to a cubicle, then went to briefly discuss her case with a colleague. I trotted off back to triage whilst my colleague headed off in the direction of the girl’s cubicle.

A short time later, the same colleague appeared at the door of triage looking slightly wide eyed. “She had a baby,” she said in a hoarse whisper. My eyebrows shot up. She then went on to explain, slightly breathlessly, that she’d gone in to the cubicle to get the girl to change into a gown, get a urine sample (to do a pregnancy test) and so forth, but instead ended up delivering a baby.

I processed this information for a few moments. “Well, guess we don’t need a pregnancy test now.” She nodded thoughtfully and left triage.

Midwives took her up the the labour ward after that, and I never did find out what happened to her or her baby.

EXACTLY WHAT WE WERE EXPECTING

VIRUSES ARE NOT STUPID

Let me repeat that: viruses are not stupid. They replicate inside cells, animal and human. Let’s just consider human cells.

When a new pathogenic virus breaks out, what can we expect it to do? The virus has a built-in desire to replicate itself, quickly and efficiently. All living organism have that hardwired. If not, they die off and are of no importance. There are probably,

BASED ON A TRUE STORY

(most of the time)

A

series

by Bad Billy Laveau

hordes of newly formed viruses that fail the massive replication mechanics and we never know about them.

Rapidly multiplying viruses gradually predominate. They need a host, a friendly home. Humans seem like a perfect prospect. We number almost 8 billion worldwide. A huge birth rate: 140 million yearly. Humans travel all over the world. 146 billion cars and ground vehicles. 25,000 aircraft with 100,000 commercial flights each day. 30 million boats, not counting

commercial and military watercraft.

Humans tend to live in close proximity to each other. They breath. They touch. They cough. They sneeze. They are not careful what they do. Such acts readily disseminate viruses.

Since we make it so easy for them, viruses get around something fierce. And there are lots of them. About 380 trillion viruses live in your body and mine at any one time. That’s ten times as many as the bacteria living in you. Scary, isn’t it?

What is the mechanical secret of how viruses live and proliferate in your cells? Viruses multiply in our cells, causing our cells to lyse, releasing the virus to invade another cell and start over. Let’s consider how aggressive and deadly viruses behave. The most recent and notable is COVID.

COVID attacked many weakened hosts: the sick, the elderly, the immune compromised. COVID killed hundreds of thousands. Shut down our business, our schools. Changed our society norms. COVID did not care how many died … until the number of vulnerable hosts started to decline. When a deadly virus kills its host, it has nowhere to live. This is a self-limiting behavior. If you burn down your house, you are homeless. The same goes for viruses.

Viruses are not stupid. They might make us sick, but as long as they don’t kill us, they have a place to comfortably live and multiply. Darwin’s theory of natural selection works

for them. The virus that becomes less deadly lives longer and multiplies. Less lethal viruses predominate. We used vaccines, education, sanitation, and good common sense to diminish the deadly effect of COVID. Meanwhile, the COVID virus mutated and adapted. The virus figured, as long as we just make humans sick but don’t kill them, we’ll have a place to thrive. Beats the heck out of being homeless.

We have developed herd immunity (which is not 100% effective, but very helpful) while the virus adapted. COVID is more “friendly” now. These days many people get COVID and don’t even know. I have had 5 vaccinations and COVID 2 or 3 times. Maybe I even “carry” the virus now. Hopefully my antibodies will win out when the next struggle erupts.

COVID-19 clearly has mutated and is more communicative (that is bad), but less deadly (that is good). COVID is probably with us forever, just like flu. We are adjusting to live with COVID … just as COVID is adjusting to live with us. As they say in the movies, “It’s a Mexican stand-off.” No offense intended toward Mexicans. I don’t want sign-carrying marchers outside my home. I’m having enough trouble appeasing my COVID virus inhabitants.

Whether you are an evolutionist or a creationist matters not. This is how we will have to coexist with COVID for a long time to come.

by Kim Beavers, MS, RDN, CDCES

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

WATERMELON BANANA SMOOTHIE

Quick, easy, and refreshing! Packed with immune boosting nutrients!

Ingredients

• 3 cups watermelon, cut into chunks

• 1 cup almond milk

• 1 medium banana

• 1 tablespoon chia seeds

• ¼ cup whole almonds

• 10-20 mint leaves

• ¼ cup crushed ice

Directions

Put all the ingredients into a blender and blend until smooth. Serve immediately. Garnish with additional mint leaves if desired.

Yield: 4 cups (Serving size: 1 cup)

Nutrient Breakdown: Calories 135, Fat 6g (3g monounsaturated fat), Cholesterol 0mg, Sodium 41mg, Carbo-

hydrate 22g, Fiber 4g, Protein 3g, Potassium 216mg, Phosphorus 72g

Carbohydrate Choice: 1 1/2 Carbohydrate

Diabetes Exchanges: 1 Fruit, ½ Milk

Inspired by: Sharon Palmer, RD at www.sharonpalmer. com

F-WORD EVERYONE’S

BUT NOBODY KNOWS ANYTHING ABOUT

by Ken Wilson Steppingstones to Recovery

I’m referring to Fentanyl. And well, maybe “nobody” is a stretch…but it’s hard to turn on the TV these days and not hear of yet another celebrity overdosing on the drug. They didn’t mean to. They just fell asleep and their lungs quit working, very slowly, and they never woke up to even realize their error in judgment. Some in posh hotels…some in a homeless tent. Fentanyl is no respecter of persons.

Tuesday, May 9, was Fentanyl Awareness Day here in the US, and all last week was Fentanyl Awareness Week. So you ask, “What is this stuff that on the one hand is so good, but on the other hand is so bad?”

Dr. Paul Janssen developed it in 1959 (I was 8 years old! How old were you?) for surgery anesthesia, not for euphoria and pain relief

like on the streets today. I’ve been under its influence a couple times myself and it works marvelously when medically monitored. But so often these days, not so much…at least on the street.

Dealers have discovered that it’s cheap, easy to get because it’s synthetic (made in a lab), and packs a powerful punch. They are mixing it in with every addictive chemical known: marijuana, cocaine, meth, and so on. For a few cents it seems to boost the effect. Addicts like it, and dealers make more money. How good is that?

Actually, it’s not good at all. That “made in a lab” part... it’s not exactly a precision lab monitored by the FDA, and getting a few specks extra in a joint or pill could spell instant death. It’s a game of Russian roulette. Fentanyl is an opiate that is 50 times stronger than heroin and 100 times stronger than morphine. A million dos-

Post

It’s springtime

es would easily fit inside a shoe box. Sometimes dealers even use Carfentanyl, and a million doses of it can be put into a golf ball! That packs a hard drive! It is used as an elephant tranquilizer (literally) and if a human eats the meat of an elephant hit by it he’ll die. A single drop on human skin is fatal.

Why bother reading this info? Even though you may not be interested in the drug, I can assure you that if you don’t know a family affected by it today, you will before long. It is a rare day that I talk to someone who hasn’t known someone who died from an overdose with Fentanyl in the equation.

Knowledge is power. Someone who may need to know about this drug might listen to you, a friend, whereas they may think counselors or law enforcement officers are paid confederates who don’t know what they’re talking about.

I don’t want to just talk doom and gloom without telling you about a way out. Of course, the best way out is to never pick up, or get treatment if you already have. If it’s not too late for your family member or friend, please go to any pharmacy and buy some Narcan – it’s around $40 for a one-dose pack. If someone you love is on drugs these days, they may think they’re buying weed or meth and end up buying that drug laced with Fentanyl by a greedy dealer. If the user is lucky enough to be around someone with Narcan in their possession, if they do overdose a quick squirt in each nostril can bring them back to life if done in a timely manner. It works by knocking the opiates off the brain receptors and restoring breathing immediately. Sometimes 2 or 3 doses are necessary. Narcan (brand name for Naloxone) has saved thousands

of lives already. Police cars are equipped with it and all ambulances have it. It’s being advertised heavily on TV… perhaps you’ve seen the ads.

What it comes down to is this: It’s not about using or not using drugs anymore – it’s about living or dying. This information could save a life – maybe even yours.

Now you’re not one of those who are just talking about the F-word. You know about it.

The Future for Medical Technology and Patient Care

There have been many recent references to chatbot apps like ChatGPT, Bing Chat, and Google’s Bard. These new Chatbots are software programs that use artificial intelligence to generate language that simulates human conversation. You may think of chatbots as computers conversing with humans about an unlimited range of topics. AI is generally known as the ability of a computer to explore data, learn, craft language, and mimic human behavior. AI is now used in many applications, including robotics. Discussions about AI are beginning to dominate news shows, video, and print media. A quick Google search on artificial intelligence will yield more than a trillion search results. With this mounting interest, let’s take a moment to explore this topic.

Technobabble Zone

by Dr. Chuck Cadle

You may remember HAL, the supercomputer featured in 2001: A Space Odyssey, a film that pitted artificial intelligence against human intelligence. Since then, most AI-related movies have featured robots with superhuman intelligence and skills. The recently released Artifice Girl explores the ethics of assimilating artificial intelligence into mainstream reality. One Rotten Tomatoes movie critic, Romey Norton, wrote, “Probing ethical implications around the use of AI is current and, indeed, something we will see more of in our storylines. (Maybe they’ll even be written by an AI).”

Ethics is an angle all medical professionals and patients should be concerned about. How much reliance should we put on AI-generated assistance? A recent 60 Minutes interview featuring the CEO of Google and Alphabet revealed that AI had accumulated all human knowledge, discovered how to present empathetic responses to inquiries, and was trained to use predictions to provide the most compelling answers. The predictive example used in the interview was saying “peanut butter and...” the next predicted word would be “jelly.” Supercomputer AI programs have access to trillions of responses and are designed to learn and present the best predictive and emotive reactions to human requests. In other words, AI generates very convincing responses. In addition to inquiry responses, AI can create poems, essays, stories, and even videos. For example, AI was asked to create

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

The most common act of lawbreaking in the US, and probably the world at large, is speeding. It seems that just about everyone does it, and maybe sometimes they should. After all, if the speed limit on a certain stretch of road is 35 and everyone except you is going 55, you are creating the hazard. It would be safer for you and for other drivers if you sped up enough to join the stream. If you don’t you’ll experience a constant stream of tailgaters and impatient and annoyed passers. It would actually be safer to speed.

as we release our inner NASCAR driver.

• because, quite frankly, we’re more important than everyone else; like it or not, speeding and aggressive driving shows a level of disrespect for the law and for other drivers.

Naturally, all of us reading this are the exceptions to all the foregoing. What can we do when we encounter the reckless fools we just described? Let us count the ways:

US COUNT THE WAYS

Not that we’re giving general amnesty to speeders. We most definitely are not. Excessive speed is a factor in about one-third of all highway fatalities. That is one-third of a very large number: an estimated 42,915 Americans died in car crashes in 2021, more than a 10% jump from 2020.

Why is speeding so dangerous? Let us count the ways:

• losing control of the vehicle is more likely.

• crashing is more likely because stopping distance is increased.

• crash severity and therefore injury severity increases with increased speed.

• with every mile per hour of additional speed, various occupant protection features become fractionally less and less effective. It all starts to add up.

This could be a controversial statement in some quarters, but we’re going to say it anyway: people in general have a decent level of intelligence. They know that speeding is illegal and dangerous, yet they (correction: we) do it anyway. Why?

Let us count the ways:

• because no cops are around; if there’s no one to officially document that we did something illegal, we didn’t.

• because unless we crash, it isn’t officially dangerous; there may have been the potential for danger, but we avoided it.

• because, well, traffic: congestion makes drivers impatient and aggressive, and we certainly have no shortage of congestion on CSRA roads. Have you been in Grovetown lately during a rush hour period?

• because we’re running late; everyone needs to help out by getting out of our way.

• because nobody knows it’s us; we may be a shy Sunday school teacher, but inside the steel and glass cocoon we travel around in, there’s a degree of anonymity that we take advantage of

• try to obey the law as much and as often as possible. A good start is knowing what the law is, then actually following it. For example, in both South Carolina and Georgia it is illegal to camp out in the left lane. Tooling down I-20 or Riverwatch, for instance, don’t stay in the left lane. Drive right.

• on a related note, don’t be a self-appointed traffic cop. Say you’re driving down Riverwatch. The speed limit is 55 mph. You’re going 70, and you’re in the left lane, where some moron is tailgating you. You’re already driving 15 miles over the limit, so you are not about to move over for this clown, are you? The answer: yes, you are. The law says move over; in most cases stay in the right lane unless passing. It is not your job to try to slow him down and enforce the speed limit law you’re already breaking. Don’t judge. Maybe the guy’s wife called him; she’s in labor. You don’t know; just move over.

• ixnay on the obscene gestures. The same goes for yelling, stare-downs, brake checking, getting out of your car at a traffic light, or “teaching him a lesson” by some slick driving maneuver. And for the love of all that is good and holy, never ever ever involve a weapon in a situation as supremely trivial as a traffic encounter.

• discard the ridiculous concept of “winning.” Many drivers get involved in meaningless contests with other motorists, as though driving is like some pick-up basketball game. It doesn’t matter who started it; what seems to matter is winning. Ignore the fact that Driver A is obsessed with defeating Driver B, who is a complete stranger whom Driver A will never see again. It’s all about the victory, even if it requires a dozen traffic infractions.

• don’t end a confrontation with an aggressive tailgater, for example, by driving home. Showing this maniac where you live? Not a good idea. Disengage in a shopping center, a fire station, or some other safe place with plenty of people and bright lighting.

• focus on staying alive.

out of it all by herself. Once she is in it, it wraps her up like a little taco and she swings and swings, giggling all the while, so we think we did well in finding this for her. It seems both comforting and fun for her.

Despite the challenges, Freyja brings so much joy and laughter into our lives. She has a beautiful, infectious, dimpled smile and a contagious sense of wonder. Even on the toughest days, she reminds us to find the joy in the small moments. When she giggles, which she does a lot, only a heartless person could resist smiling or even laughing themselves. We’ve learned to celebrate her achievements, no matter how small they may seem to others. She recently started using a fork correctly. Well, sort of. She will stab the item of food with the fork, bring it close to her mouth, pull it off with her other hand and stick it in her mouth. For now that’s close enough. When she says a word, which is rare, and isn’t always a real word, we make a big deal over it and clap so we can encourage her efforts to speak. She even said “papa” a few times. “Baby” and “daddy” are words she sometimes says too, though she gives no indication that she understands what she is saying, and indeed, we have been told not to expect her to ever learn to speak. That said, we aren’t giving up hope. We also learn to appreciate the small joys in life, like watching her play outside in the sandbox or swinging on her swingset in the yard. She is definitely an outdoor girl and loves walking in the woods and would stay outside all day, every day if we let her. I’m hoping to spend more time with her in these pursuits as she gets older.

One of the things we expected would help us with the kids this summer was our pool, but alas, a windstorm caused enough damage a couple of weeks ago to destroy it. We did get the good news that our homeowner’s insurance policy will cover it, but with depreciation it will cover less than half the cost to replace it, so we will be doing the work ourselves. Let’s hope that doesn’t necessitate another trip to the emergency room, but if it does, at least I will have another good story to share. The other bonus is that so many friends ask us what they can do to help, but we often don’t have an answer. I am about to make them all regret asking, because they will be my labor force to get this pool set up.

Until next time, enjoy the little things in life, and try to find the humor in everything.

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

the blog spot

HOPE FOR A SUICIDAL CHILD

Eleven-year-old Abby sat nervously in the emergency department, her eyes darting around the room as she clutched Patches, her beloved stuffed sheep. Her guardian sat beside her, anxiety etched on her face as she explained the situation to me. Abby had been diagnosed with depression at the tender age of nine after suffering years of abuse and neglect at the hands of her biological parents.

TECHNOBABBLE from page 9

a compelling story using keywords during the 60 Minutes interview. The tale it created even included book citations, which were all fictitious; however, their inclusion increased the perceived credibility of the story.

ChatGPT-related software. The META report highlighted that their security analysts had found new malware in ChatGPT and other tools since March of this year. The malware can pose as browser extensions designed to work with ChatGPT. The malicious activity prompted Meta to remove links to its Chatbot services within Instagram and WhatsApp. Meta also notified authorities and the industry about the malware incidents.

IT SEEMED SO UNJUST

A loving foster family took Abby in a few months ago, providing her with the safety and security she desperately needed. But Abby’s emotional scars ran deep – so much so that she began expressing thoughts of wanting to die. Yesterday she had been caught searching ways to end her life on a school computer. Later that evening, her guardian discovered a belt ominously wrapped around a bedpost.

As I spoke with Abby, she seemed hesitant to share her feelings, but we soon found common ground in our love for Taylor Swift. Abby’s eyes lit up as she talked about how much she wished she could see Taylor in concert, and how Fearless was her favorite album. She shyly admitted to sometimes having thoughts of killing herself but stressed that she didn’t feel that way right now.

The overwhelming sadness I felt for Abby was difficult to bear. It seemed so unjust that someone so young had experienced such hurt and despair. Needing to offer even the smallest of comforts, I retrieved a bag of Goldfish crackers from our snack storage and presented it to Abby. The brilliant smile that graced her face at that moment would stay etched in my memory for a long time to come.

That night Abby was voluntarily admitted to an inpatient psychiatric hospital. I spoke at length with the attending physician there, and we both acknowledged the arduous journey ahead for Abby. However, we also shared a glimmer of hope – hope that Abby would find the strength to heal from her past and embrace a brighter future.

Before my shift ended, I decided to visit Abby and her guardian in their hospital room. Her guardian had fallen asleep in a chair, weary from the day’s events, while Abby lay curled up with Patches in the hospital bed. As a parting gift, I left another bag of Goldfish crackers by her hand, whispering a quiet prayer for her before slipping out of the room.

Working in the ER is a potent reminder that there are many people in desperate need of help. Though the immediate care we provide can make an impact, the long-term outcome for our patients remains largely unknown. In these moments, we hold onto hope and compassion, trusting that our actions might spark a turnaround in lives like Abby’s.

As the days turned into weeks, I found myself thinking often of Abby. I hoped that she had gained the strength to walk the path towards recovery, and perhaps even find happiness in the simple joys of life – like the soft warmth of a stuffed sheep or the crunchy delight of a bag of Goldfish. Abby’s story served as a poignant reminder of the difference we can make, even in the face of immense sadness and adversity.

Ton La, Jr. is a physician

The 60 Minutes interview used other examples to present the power of AI. One such example was the 3D mapping of a protein. A point was made that the average Ph.D. student studying proteins would take five years to map a protein structure. Since there are 200 million proteins, this would equate to a billion years. AI mapped all 200 million proteins in just a year. These results were made accessible to the public, resulting in new malaria vaccines, antibiotics, and even enzymes that eat plastic waste. These are examples of using AI for good. Imagine using the deep learning capabilities of AI to work on solving cancer, Alzheimer’s disease, Parkinson’s disease, and other significant quality-of-life improvements. The benefits are too great to ignore the intelligence of AI; however, we must do what we can to minimize the risks.

As an educator, my first concerns about AI relate to detection. How will professors know what student information is created by AI? I guess we will now see new detection software developed for this purpose. Will all the software we currently use need to be redesigned and updated to account for AI intrusion? Are we reaching a point of technology saturation? How much new technology can we tolerate?

In November 2019, a Brookings Institute report entitled Risks and Remedies for Artificial Intelligence in Health Care by W. N. Price II, discussed relevant AI concerns about the potential for personal injury, discrimination, biased treatment, and loss of privacy. My experience with software also makes me wonder about malware, hacking, and programming mistakes. Facebook’s parent Meta recently warned about malware disguised as

The White House just announced the appointment of Vice President Kamala Harris as our Artificial Intelligence Czar to lead a task force overseeing the regulation of AI. This new role would be in addition to her Border Czar duties. This new task force will receive funding of $150 million. This funding may very well be a timely and wise investment, as the New York Times is reporting, “More than 1,000 technology leaders and researchers, including Elon Musk, have urged artificial intelligence labs to pause development of the most advanced systems, warning in an open letter that AI tools present profound risks to society and humanity.”

I do believe that AI could be a benefit for me. Maybe I will finally get over my tendencies to micro-manage things, or perhaps allow AI to instruct me on how to lose that extra five pounds without requiring dieting and exercise. The deep learning capability of AI is intriguing for medical discoveries; however, we should not ignore the medical ethics and risks associated with AI. Artificial intelligence will be in the future path for medical technology, education, careers, and patient care.

One thing is for sure; AI is here to stay. If this article does nothing more than enhance your awareness, understanding, and appreciation for AI, the goal of the Technobabble Free Zone has been achieved. If you have any comments on this article or suggestions for future topics, feel free to email me at drchuckcadle@ gmail.com.

— posted by Ton La, Jr., MD on April 30, 2023

How come you got called in to the boss s office?

ACROSS

Someone reported me to Child Protective Services.

For feeding my kids frozen pizza and chicken nuggets. Can you believe it? Are you serious? Why? That is unreal!

Well, lesson learned. No matter how busy am I need to pop them into the microwave first. ,

THE MYSTERY WORD

The Mystery Word for this issue: HSCTSTIE

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

next issue!

1. Ward beginning

6. Vietnamese New Year

9. Venomous African snake

14. Newest state greetings

15. Major baseball stat

16. Hip bone

17. Cadaver stiffness (in brief)

18. NBC staple

19. Aromatic herb of the daisy family

20. Not true north 23. Relieve 24. One of AU’s previous abbreviations 25. Surplus 29. Black Sea peninsula 32. Science of rotating bodies 35. 1960 Pulitzer Prize winner 37. Small secluded valley 38. Star Wars’ character’s middle name? 39. Trudge

Instant

DOWN

1. Up to (or not up to) ____

2. Jim’s nickname?

3. Exercise method for health and relaxation

4. Hosp. on Harper St.

5. Type of racing involving horses

6. Exams

7. Tennessee’s Ford?

8. Baby powder

9. Cell division

10. Formal term for a call to arms

11. Money-making plant

12. Field on the outskirts of Augusta

13. Grant born in Augusta

21. One of four compass points

22. Drug agent, in brief

25. Breakfast staple

26. “Wood” in Greek

27. Statement of belief

28. Very long period of time

29. Home movie (in the UK)

30. It’s between Broad & Greene

31. Even longer than 28-D

33. Askew

34. Cigarette by-product

36. Tense; irritable

39. Letter in Greek alphabet 41. _________ market 42. Region 43. Capital of W. Samoa 44. Collided

Evans has one

One-celled protozoa

Jane Austen title word

Respiratory organ of fish

Taro plant

Ne on the periodic table

He won the Masters in 1988 55. Heroic; impressive

Stiff bristle (zoology)

It can follow murder

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.

THEBESTMEDICINE

“I don’t appreciate the way you introduced me,” said the baboon. “You couldn’t have called me Brother Bobby?”

Moe: A pun, a play on words, and a limerick walk into a bar.

Joe: No joke.

Moe: My doctor took one look at my big fat belly and refused to believe that I work out.

Apreacher on a mission trip to Africa discovered a baboon that could talk. He bought it, brought it back home, and took it to church every Sunday. The baboon sat silently week after week, taking it all in, and the preacher spent his days secretly teaching it to pray, preach, and sing all his favorite hymns.

The baboon rapidly progressed behind the scenes from the few words it knew in the African village to be an accomplished preacher.

One Sunday the preacher decided the baboon was ready to make his debut in the congregation. He strode to the pulpit and announced, “Today the baboon will open our services with a word of prayer to the Lord.”

The baboon sat in his usual spot and didn’t move a muscle.

The preacher tried again. “Let us give our attention to the baboon as we bow our heads.”

The baboon gave no indication that he understood a word the preacher said. The preacher had no choice but to shrug it off and move on.

Later, after the congregation left, the preacher indignantly asked, “Why didn’t you pray when I asked you to?”

Joe: What did you do?

Moe: I listed all the exercises I do every day: jump to conclusions, climb the walls, drag my heels, push my luck, make mountains out of molehills, bend over backward, run around in circles, put my foot in my mouth, go over the edge, jog my memory, stretch the truth, run late and beat around the bush.

Moe: Why are jails for amoeba so small?

Joe: They’re single-cell, right?

A Möbius strip walks into a bar, sobbing. The bartender asks, “What’s wrong, buddy?” The Möbius strip replies, “Where do I even begin?”

Moe: I’m about to be rich!

Joe: How do you figure?

Moe: I have discovered the cure for insomnia.

Joe: Do tell.

Moe: When you go to bed tonight, lie as close to the edge of the bed as possible.

Joe: How is that supposed to help?

Moe: Trust me, it works. Before long you’ll drop right off.

Why subscribe to the MEDICALEXAMINER?

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

stare at their phone all day.

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

Choose six months for $22 or one year for $40 . Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903- 0397

The Advice Doctor

Dear Advice Doctor,

My wedding is coming up in just three weeks and I’m having cold feet! This is a terrible situation! What should I do? Help!

— I Am a Horrible Person

Dear Horrible,

Now, now. Don’t be so hard on yourself. You are certainly far from the first person to experience cold feet before their wedding day. It’s just part of the human experience. In fact, many people continue to experience cold feet after their wedding day (to the annoyance of their mates). What is the cause? And what can be done about it?

There are a number of potential causes, but one thing they all have in common is poor circulation. The big question is why? For example, in cold climates the circulatory system automatically restricts blood flow to the extremities to protect vital organs like the brain, heart and lungs.

Of course, that’s not much of a problem in this part of the country and this time of year.

Other reasons might be high stress levels. When the body injects adrenaline into the bloodstream, it narrows arteries, restricting blood flow. Smoking has the same effect, narrowing arteries and impeding circulation. The result can be cold feet. Reason #647 to quit smoking, right?

Those causes could all be self-diagnosed and selfcorrected. But there are other possible reasons that your doctor can accurately diagnose and help treat. For instance, being anemic means you don’t have enough healthy red blood cells, and they are the oxygen carriers to every cell in the body. Insufficient carriers can result in cold feet. Ditto for an underactive thyroid, which can slow metabolism, yet another possible cold feet cause. Both type 1 and type 2 diabetes are known contributors to poor circulation, particularly in the extremities. Have your blood sugar checked, and also get checked for peripheral neuropathy. There are other possible medical causes, but something very basic that may be overlooked is simply exercising. Get blood flowing. Stretch, take a walk, ride a bike. Get moving and blood flow will follow.

I hope I answered your question. In closing, congratulations for not letting cold feet interfere with your wedding plans

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.

Why read the Medical Examiner: Reason #516

Because try as they might, no one can

THE MYSTERY SOLVED

...cleverly hidden on the pole in the p. 10 ad for AUGUSTA BARBER POST

THE WINNER: EDWARD SMITH!

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.

J. Shah, MD Vascular Surgery

Alain Domkam, MD Vascular Surgery

Risha Malik, MD Endocrinology