Medical Examiner 5-5-23

WHAT WILL IT TAKE TO BURN OFF THE MEAL SHOWN?

BICYCLE FROM THE 8TH STREET POST OFFICE TO DOWNTOWN WAYNESBORO

KAYAK (OR PRETEND TO) FROM AUGUSTA MALL AROUND BOBBY JONES COUNTERCLOCKWISE TO I-20 AND THEN TO THE GROVETOWN WALMART

HORSEBACK RIDE FROM I-20/I-520 TO THE I-20 BRIDGE OVER LAKE OCONEE

WHAT WILL IT TAKE TO BURN OFF THE MEAL SHOWN? IT’S

You have your choice of attractive options as shown (left). Do you prefer swimming, bicycling, walking, or some other means of exercise? Whatever your preference, the goal is to burn a total of 1,850 calories and 107% of the daily recommended limit on fat intake from the lunch above.

PARENTHOOD

by David W. Proefrock, PhD

Your 8- and 10-year-old sons don’t seem to be able to get along with each other in spite of all your efforts to encourage them to cooperate and enjoy each other’s company. In fact, the situation has gotten worse recently. Not only do they seem to be fighting constantly, but their fights have become more violent. What do you do?

A. Fighting between brothers is normal at this age. There is no need to interfere. This stage will pass in time,

B. Decide on a reasonable consequence for fighting and make sure that you enforce the consequence every time the kids get into a fight.

C. At this point, it seems that every effort to make them get along has failed. Strong discipline is needed. Spankings for fighting are probably best.

D. This is serious. Seek professional help. Family therapy might be the answer.

If you answered:

A. It is true that fights between siblings are normal, but it is not true that they should be ignored. These fights have become more frequent and more violent. You must intervene with consequences.

B. This is the best choice. However, make sure the consequence de-escalates the fight. Sending them to separate rooms until they calm down is a good possibility. You should also add that they have to be able to tell you a better way they could have handled the situation before the consequence ends. It is important that you give the consequence every time there is a fight.

C. This is never the best response. Using violence to reduce violence does not teach the right lesson, only that you are a better fighter than they are at this age. That’s not going to last.

D. You may end up having to do this, but trying consistent consequences that reduce aggression and encourage cooperation should be tried first.

Dealing with this situation is actually more complicated than this brief overview. In order to enforce the consequences you’ve chosen, you are going to have to determine when an argument (possibly without consequences) escalates to a fight (with consequences). Make sure that the determination is yours, not theirs, and that they can’t argue their way out of it.

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

MEDICAL MYTHOLOGY

CHOLESTEROL: MYTHS ABOUND

Let’s establish one thing right off the bat: cholesterol is bad news.

And that, friends and neighbors, is Cholesterol Myth #1. In fact, it’s essential for life. Much like pizza, we couldn’t survive without it. But also like pizza, too much of it is not good.

Even that last statement is a bit mythological in that the complete picture is not how much cholesterol we individually have, but what type of cholesterol it is.

As you’ve heard there are two kinds of cholesterol, abbreviated HDL and LDL, short for high- and low-density lipoproteins. HDL is the better of the two because it describes cholesterol which, after doing its job, is transported back to

the liver and from there is processed out of the body. LDL, on the other hand, continues to circulate until eventually it builds up inside arteries (see illustration), impeding blood flow and elevating the risk of cardiovascular disease.

Some people think they have good cholesterol levels because they don’t have any symptoms, or because their weight is at a healthy level.

Those are myths.

High cholesterol levels don’t necessarily result in symptoms — at least not at first. Unchecked, the symptoms will come, and by the time they do they are likely to be severe: things like heart attacks and strokes.

Similarly, who ever said

weight and cholesterol are the same thing? They are not. Someone of healthy weight can have high cholesterol, while an overweight person may have perfect cholesterol.

Cholesterol levels can be affected by diet, genetics, exercise, medications, sleep habits, how much alcohol a person consumes, whether or not they smoke, and still other factors.

That same list is also the checklist for controlling cholesterol: eat right, get regular exercise, quit smoking, don’t drink excessively, maintain a healthy weight, and choose your parents wisely. Your doctor can help you with specifics. Most of them anyway.

Some people who are on cholesterol-controlling medications (like statins) think they can eat whatever they want. Too bad that’s a myth. A pill does not relieve us of the responsibility to take care of our bodies.

Yet another myth: checking cholesterol is for old people. There are various opinions about when routine screening should begin, but some groups (like the American Heart Association) recommend cholesterol screening as early as age 20.

In summary, the subject of cholesterol is an important one, but the topic is riddled with mythology. Getting accurate information about your cholesterol health promote better health and longer life.

When he’s on your case he’s on their case.

SHORTSTORIES

THE MAJOR ALARM THAT TURNED OUT TO BE FALSE...MOSTLY Sometimes in these cases the patient is absolutely c razy with panic and pain, and everyone withina hundred yards knows it. This particular time was different.

I was the triage nurse and it wasn’t the patient freaking out, but her father certainly did, and so did our staff.

I was standing in front of the ambulance entrance late one summer evening when a father ran in shouting for help, cradling his silent and bloody 4-year-old daughter. She was wrapped in a formerly white sheet that was very nearly dripping with blood. Her face was covered and I absolutely did not want to be the person who unwrapped her.

However, I was the triage nurse, after all, so I stepped forward with my arms extended, and he quickly placed her in my arms. I turned and ran toward the nearest trau-

ma room. I was met by staff from every department—respiratory, lab, x-ray, and still more nurses and doctors. We rapidly removed the sheet and the nurses had a wash basin ready.

She had run through an old glass door and had lacerations from head to toe. She was saturated with antibacterial soap and water and wiped down so we could see exactly where the problems were, remove the glass shards, and assess what was happening and what we needed to do. As we washed, then held pressure, the wounds began to stop bleeding. By this time she had an IV catheter infusing saline, and respiratory placed an oxygen face mask on her tiny face. She never even cried, she just looked scared.

Within twenty minutes, there was no overt evidence of any cuts that had been bleeding. We were stunned, and turned her side to side, searching for bleeding, but everything was completely

controlled. I would almost say it was a letdown, but we were so incredibly relieved that nothing could be further from the truth.

It was absolutely incredible that all of the wounds stopped bleeding. There was not one laceration that required stitching. Not a single laceration that would leave a permanent scar.

After an hour or two, she was released to return home with her father. Incredibly, a little girl who looked like she was going to break everyone’s heart had improved to the point where the only visible problem was a slightly oozing scratch here and there. But it was nothing. But how it had made us all jump into action!

In this case the patient did not freak out, but all the staff certainly did. Amazing what a bloody sheet can make a person imagine. A discharge she was definitely much less scary on the way home than when she had arrived in the ER in such a flurry earlier!

WHAT IS BRAIN FREEZE?

Let’s tackle this topic just in case it gets hot this summer and we need relief from slushies and ice cream.

If you happen to be uninitiated, a brain freeze, sometimes called an ice cream headache, occurs when that ice cold summer treat hits the palate and sudden pain radiates up through the skull and sinuses. It’s harmless, and the pain usually lasts only a few seconds, but they are not pleasant seconds.

The apparent irony of brain freeze is that the brain cannot feel pain, which always originates from sensory nerve fibers called nociceptors (no-sih-SEP-ters) located all over the body. There are exactly zero nociceptors in the brain, which is why some patients can be wide awake during brain surgery.

So why do we have any headaches, including ice cream headaches? The protective shield around the brain has nociceptors aplenty. When the nerves in the palate are suddenly shocked out of their nearly 100° normalcy by something ice cold, they send out an alert, causing arteries and blood vessels to react. Doctors sometimes say the pain is “referred” or transmitted to a specific area, like the forehead. The same nociceptors can register pain when no icy summer treat is involved, but unfortunately for headache sufferers, those reasons are not fully understood. It is a fact, however, that people who suffer from migraines are usually more prone to cold headaches.

There are strategies to prevent brain freeze, and to cut it short when it does happen.

Step 1 of brain freeze prevention (assuming we’re going to keep eating ice cream) is to eat cold stuff slowly. A good start would be a half-teaspoon of ice cream. Ease into it so your nerves are not suddenly jolted into DefCon-3. Keep taking small bites or sips, and take your time doing so. Letting those small bites warm up near the front of the mouth helps too, since the freeze triggering nerves are farther back.

If a cold headache strikes anyway, some people get relief by pressing their tongue against the roof of their mouth. Another option to try is drinking something warm as soon as you feel brain freeze coming on, alternating the icy with some warmth to interrupt the pain signals.

Maybe someday no one will scream for ice cream. Correction: from ice cream.

Who is this?

SHORTSTORIES

WHAT MOVIES GET WRONG ABOUT BEING A NURSE

Probably the most fallacious depiction of nurses is the portrayal of their relationship with physicians. Primarily, and most glaringly incorrect, is that the physicians are the ones who perform the procedures while the nurse serves as their “assistant” handing them instruments and running errands.

Nurses are also depicted as less knowledgeable. Everyone knows a physician goes through years of training before practicing medicine, but nurses also go through years of training before they are licensed to practice. The schools are different, but nursing is a highly skilled profession despite the media’s depiction of the nurse as a glorified handmaiden.

Chances are if you’re in the nursing profession you know exactly who this is. If you don’t know but you think the photo looks a little bit like a mug shot, you’re right on target.

This is RaDonda Vaught, the most famous (or infamous) nurse in America today. Correction: former nurse. You can’t be a nurse when you’ve been convicted of negligent homicide and gross neglect of an impaired adult.

Despite her felony convictions (she was at least acquitted of reckless homicide), professional organizations have lined up in her defense and support, ranging from the American Bar Association to the National Medical Association, the American Association of Critical-Care Nurses, the American Hospital Association, the Institute for Safe Medication Practices, and the American Nurses Association. After her conviction, a Change. org petition urging clemency for Vaught amassed more than 200,000 signatures practically overnight. Tennessee’s governor, where this case erupted, is on record as opposed to clemency.

It all started with the admission of 75-year-old patient Charlene Murphey to Vanderbilt University Medical Center on Dec. 24, 2017. Two days later, Vaught, a registered nurse, got orders to administer a sedating drug to Murphey prior to an MRI as an aid to help her lie motionless during the scan. By accident she gave the patient a paralyzing drug. Cardiac arrest quickly ensued, and although Murphey was resuscitated, she sustained brain damage and died the following day after being taken off life support.

Vaught immediately reported her error and was fired in January 2018. Then in 2019 she was arrested and charged with Murphey’s death, was further charged with infractions by the Tennessee Dept. of Health’s Board of Nursing, stripped of her nursing license, and fined $3,000. After COVID delays, her trial began in March of 2022.

Evidence showed that the hospital failed to report Vaught’s error to federal or state regulators as required by law, attributing the death to natural causes. Testimony established that Vanderbilt’s 2017 “upgrade” of its computer systems resulted in constant delays in accessing medications from automated dispensing cabinets, so nurses were instructed to use overrides to gain access to medications in a timely manner. While that may seem like a peripheral issue to the basic matter at hand — an inadvertent drug mix-up — it was central to the trail. A Tennessee Bureau of Investigation agent testified that Vanderbilt bore “a heavy burden of responsibility” for the error, but only Vaught was ever penalized. Her conviction resulted in a sentence of 3 years’ probation.

Predictably, the verdict result in a huge backlash, with the entire case labeled as a failure to recognize the basic difference between human error and reckless conduct, and dealt a severe blow to “just culture,” a philosophy designed to identify and correct systemic failures rather than blaming an individual Experts say the outcome of Vaught’s case, criminalizing human error, diminishes patient safety rather than improves it, and hurts the already short-staffed nursing profession. +

In a true life saving emergency, nurses will be doing the chest compression, starting the IV, giving the medications and operating the defibrillator (shocking the patient). The physician will be standing in the room directing the code. It is nothing like the depiction in film where the physician does everything.

Physicians write orders and the nurse goes and completes the order. The relationship is very professional and there is great mutual respect. In film, the nurses are depicted as subservient to the physician and at their every beck and call. There is no physician in their right mind that would command a nurse to go fetch them anything as an order.

In fact, another fallacy in the media is that the physician is male and the nurse is generally female. In the past

twenty years the number of female physicians has greatly increased as has the number of male nurses.

The TV stereotype of the cute female nurse flirting with the sexy middle aged doctor is greatly exaggerated but unfortunately still perpetuated by the media. Nothing could be further from the truth.

There are the occasional flings and affairs but in the modern world such behaviors are greatly frowned upon and could potentially destroy a career. It is very rare and when it does occur it generally ends in scandal. Sorry guys, the naughty nurse is just a Halloween costume!

The skill set of the two professions are very different but nursing requires a great deal of intelligence and critical thinking no different from a physician. In the media, it is the physician who saves the day and recognizes the diagnosis. In reality, the nurse recognizes and treats as many life threatening symptoms without accolades or recognition.

I have heard nurses say that the series Nurse Jackie is the closest representation of what a nurse truly does. Of course, she is depicted as a drug addict sleeping around on her husband, but the actual nursing work she performs is fairly accurate at times in the fictional depiction of the series. It’s still a long way from accurate but as movies and media go, Nurse Jackie is closer to accurate than most nurse depictions in the media.

WE

Middle Age

SHORTSTORIES

IT’S YOUR LIFE. PROTECT IT For one of my patients I repeatedly tried to explain why he needed a colonoscopy so many times I can’t count the number. And many times I provided him with the non-invasive card to check for fecal occult blood. He refused them all every single time.

BY J.B. COLLUM

It’s time to talk about colon health again. “Oh goody,” you thought, right? Maybe not. I hope you weren’t eating when you started reading this. I wouldn’t want to ruin your meal. Readers with too much time on their hands may be thinking that it is too soon for me to get another colonoscopy, and they would be correct. But it is long past due for my lovely wife to have one, and I have been haranguing her about making an appointment since about 2018. But she put it off, then the pandemic happened, and a lot of important stuff fell by the wayside.

THIS TIME IT’S MY WIFE

Well, she finally did it. She did the dreaded prep after semi-fasting the requisite days and resisting certain foods even before that.

I drove her to the Augusta Endoscopy Center in Evans early Thursday morning and got to be the supportive spouse for a change instead of the one getting the medical procedure. That said, I still managed to suffer of course. Even as I type this, I can see my wife rolling her eyes at my so-called suffering. I did not realize that once I got her there, I was not allowed to leave. I even had to sign a form to that effect. I had planned on quickly leaving to grab some breakfast while she was under, but those plans came crashing down. I thought I could have it both ways. I could be the supportive husband who didn’t eat before we left the house or even have a cup of coffee since she could not have anything. But then, after I dropped her off, I could head over to Waffle House for an endless cup of coffee, an AllStar breakfast with a double waffle, and still get back in time to pick her up and hope she didn’t smell maple syrup on my breath — although I’m sure there would have been some on my shirt anyway. I can’t seem to avoid it. I think it has something to do with how far my belly sticks out. It is just too much to expect that a fork can traverse that vast distance without dripping something along the way. Somebody should get to work on fixing that.

So I had to be patient and tell my stomach to stop grumbling. I am so used to being the patient that I got up when they called a name that sounded like mine. They first called our last name and both my wife and I stood up. Then they called my first name, and both my wife and I were confused. I looked at her with an accusatory glance, thinking that she had managed to fool me into some procedure with a ruse about it being for her. But it turned out they were calling someone named “Jean” with our same last name. We had a quick laugh, and then sat back down while Jean went back for her procedure. I went to talk to her husband, who, like me, was no doubt sitting there thinking about breakfast. I mean thinking about his wife, like me. Since we shared a last name, we tried to figure out if we were related, but as it turned out, we are not.

Not long after this, they called my wife’s

name and the real wait began. I played some chess on my phone, played with a little music maker I had brought along (with headphones of course) and before I knew it, they invited me back into the room as she was waking up from the procedure. The doctor said that it looked good. There was one small polyp that he didn’t think was serious, but they would be sending it off to be tested. (Side note: it is embarrassing how hard it was for me to figure out how to spell “polyp.” I was so far off even autocorrect had no clue what I was trying to say. ) After the doctor and nurses went over a few things with us, I was sent off to bring the truck around to pick her up. I could hardly hold back my excitement. I was finally getting breakfast and coffee at Waffle House, or so I thought. My wife had actually said this was what she wanted when I first visited her in the room after she woke up, but after talking to the nurses, she decided on something lighter. I was pouting until she set me straight and told me she wouldn’t have let me have a double-waffle anyway (she was reading my mind) and I would have had to use the sugar-free syrup even at that. I had to settle for a gravy biscuit, a chicken biscuit, and hash browns. Yeah, I know. I’m a spoiled brat.

After breakfast, I drove us home and doted on my bride for a couple of hours to make sure she was well taken care of before I returned to my work. It was nice to be the caregiver for a change instead of the care receiver, but next time I’m leaving early and going for breakfast first, or at least sneaking some granola bars in my pockets along with a thermos of coffee. It was also nice to not be the one passing the gas. That is something that I don’t believe my wife is normally capable of, while I, on the other hand, have raised it to an artform. I got quite a few chuckles as her body slowly worked out all of the gas they had pumped into her intestines. It started on the way home and then continued in our bedroom. She even brought in an industrial-grade air freshener to combat it. I laughed every time and if looks could kill, I’d be six feet deep right now.

If you are over fifty and you haven’t had a colonoscopy, then you need to get right on that. We were told that, depending on age and risk factors, a second colonoscopy should be no more than 5-10 years after the first. So if you are older than 50 and have had a colonoscopy but are overdue for your second one, you too need to make that call right now. In any case, consult your regular physician about getting this taken care of along with all of the other important health stuff you keep putting off because you never know. You could be running out of time.

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

Ultimately I ended up visiting him in the hospital until he went to the palliative care unit where he died of very painful colon cancer. If there is ever a test you SHOULD do, it’s a colonoscopy because colon cancer is silent, meaning you don’t have pain or symptoms until it’s too late to do anything except die. Doctors love to do surgery and chemotherapy for colon cancer, but the chances of remission after your latestage diagnosis is very low — about 17% — and that after all the pain of surgery and nausea, vomiting, hair loss, disability of chemotherapy, trips to doctors and hospitizations — all just because you refused a painless procedure, a colonoscopy. Follow your doctor’s advice and get your colonoscopy. If not for you, think of what your loved ones will have to go through with you. Save your own life! Get your colonoscopy!

CAN PREVENT not reading the

WHAT DID YOU SAY?

In 1931 Albert Einstein met Charlie Chaplin in Hollywood at the premier of Chaplin’s movie City Lights. Einstein told the actor, “What I admire about your art is your universality. You don’t say a word, yet the world understands you.” Chaplin replied, “Your glory is even greater. The whole world admires you even though they don’t understand a word you say.”

BASED ON A TRUE STORY

(most of the time)

lin entertained the world. Einstein changed the world.

A

series

by Bad Billy Laveau

On one thing we can all agree: each man in his own way was monumental. Chap-

Sir Alexander Fleming said, “That contaminating mold in our petri dishes kills bacteria. Let’s use it to treat infections.” (Yes, I put words in his mouth). That mold was penicillin. Before Fleming, up to 90% of pneumonia infections died. With the advent of penicillin, 95% survived.

John F. Kennedy said, “Ask

not what your country can do for you. Ask what you can do for your country.” It changed the US, at least for a few years.

Timothy Lear, Ph.D. said, “Tune it. Turn on. Drop out.” Out popped a few generations of drugged-out semi-zombies who did nothing to aid our country. Saprophytes at best. The opposite of Kennedy’s outcome.

The Wright brothers gave us airplanes which eventually led to rapid international travel. And that, Dear Hearts, gave us worldwide epidemics, first AIDS and then COVID. Not every bit of progress is perfect, regardless of how useful it is.

None of us know what is next. But we can be assured that some seemingly minor, but cataclysmic occurrences will rattle our cages again.

Therein lies the problem.

Who will be the one to utter what phrase? Not every spoken word is world shaking. Lesser spoken words can have local effects. What you say helps shape your family. Your community. Kind words nurture kind thoughts. Harsh words foster villainous thoughts. Clearly one is better than the other.

Be careful what you wish for. You might get it. Trite but true.

Brother Dave Gardner said, “Comedians say funny things. I say things funny.” And that he did. I saw him in 1960 at the University of Georgia Fine Arts Auditorium. He made me laugh until my face hurt. I can still remember some of his stories. His impeccable timing. His vocal inflections. His accent. I was never

the same afterward. I have written continuously since then. I must also give some credit to Marion Montgomery who taught me literature in English 102. He said, “A fine arts education teaches you to hate the money it prevents you from making.” That, I shall never forget. My bank account bears that out. Neither of these gentlemen remembers me, but I remember them. They live in my mind. To each I am grateful. Both men changed me. And neither have any idea of their profound effect.

I ask you, Dear Hearts, what have you said that profoundly altered the world? Nothing? Well, neither have I, but in some way almost everything we say (or do) changes someone in some way. As the Hippocratic oath of physicians proclaims, you must first “do no harm.”

Little things you say or do are important. Smile at a newborn child and you imprint his being. Soft voice tones please a child. You owe the child that much. It matters not what you think or feel. You owe the world that much. If you can’t do that much, even for a newborn baby, we don’t need you. Nobody does. Go crawl in a cave and come out when you are ready to be useful. The world will be waiting for you.

Truly, what you say matters. For better or worse, it matters. You need not be an Einstein nor a Chaplin nor a Gardner nor a Montgomery, but you are somebody and you know not your power. Waste it not. Use it wisely.

Think about yesterday. What did you say?

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist,

SLOW COOKER SALMON

A slow cooker is a perfect solution to “poaching” salmon in a no-fail sort of way. This is not your typical slow cooker recipe since it only needs to cook 2 hours or less, but the slow cooker does the work while you do whatever else you want to do. Note the leftovers are excellent on salads the following day.

Ingredients

• 4 slices medium onion (about 1/3-inch thick)

• 2 large stalks celery, each stalk cut into 4 pieces

• 1 pound salmon (skin on), cut into 4 equal pieces

• 2 teaspoon Jane’s Krazy

Mixed-Up salt

• 1 lemon, sliced thin

• 1-½ cups unsalted vegetables broth

• 3 tablespoons dry sherry (optional; alternatively use 1/4 to 1/3 cup of white wine)

• Water as needed to reach the top of the salmon

Directions

Begin by lining the slow cooker with aluminum foil.

This will make it easier to lift the delicate fish out of the slow cooker later. First, place half of the onion and celery into the slow cooker on top of the aluminum foil. Then season the salmon with salt blend and layer two salmon pieces onto the veggies, and top with 2 lemon slices. Repeat the layers once more (onion and celery on top of the lemon, then seasoned salmon, and lemon slices).

Next add the broth and sherry. Add water until the liquid reaches almost to the top of the top salmon fillet (not over the fish but just to the top).

Turn the slow cooker on low for 1 ½ to 2 hours.

Check the salmon at the 1 ½ hour mark until you know how your slow cooker cooks this fish, the goal is to gently cook but not overcook the salmon. The fish is done when it is no longer translucent, but has turned opaque or has reached 145 degrees on a food thermometer.

Yield: 4 Servings

Nutrition Breakdown: Calories 120, Fat 4g (0.5g saturated fat, 2g monounsaturated fat, 300mg Omega-3 fatty acids), Cholesterol 55mg, Sodium 190mg, Carbohydrate 1g, Fiber 0g, Protein 21g, Potassium 421mg, Phosphorus 209mg.

Percent Daily Value: 10% Vitamin C, 2% Iron, 2% Calcium, 0% Vitamin A

Carbohydrate Choice: 0 Carbohydrates

Diabetes Exchange Values: 3

Lean Meats

Omega-3 in 3.5 ounces salmon: about 2100mg

Kim’s note: This type of slow cooker recipe serves each of us differently depending on the “season” of your life. For me as a busy mom of active children it means I can load the slow cooker --- drop kiddo 1 off at practice, help kiddo 2 with homework, pick up kiddo 1 and dinner is mostly ready—hurray!

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

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

Stan, a Facebook friend from Augusta, asks:

“A health-conscious friend of mine eats a handful of boiled kale or spinach six times a day. He says it provides nitric oxide that increases blood flow, lowers blood pressure and more. True?”

Thanks for the question, Stan. Emerging evidence does implicate the nitric oxide (NO) molecule as one of many factors that may reduce a person’s cardiovascular risk. In fact, it may be one of the reasons why fruits and veggies, which are rich sources of NO, are important in reducing the risk of cardiovascular disease (heart attacks, strokes, and peripheral vascular disease). As your friend says, NO is thought to increase the diameter of blood vessels and thus improve blood flow. As an interesting aside, Viagra (sildenafil citrate) is thought to work by increasing NO production and improving blood flow to the penis, thereby enhancing erections.

Having said that, there are several problems with your friend’s dietary approach. First, it is way too premature based on the present data, to run with the NO hypothesis. One group of people presently jumping on the NO bandwagon are athletes, under the premature idea that manipulating NO will increase athletic performance. It has yet to be proven.

Secondly, the dietary approach of searching for

molecules to eat, rather than foods, is naïve. It is your overall life, your overall di etary habits and your daily nutritional choices that are the most im portant. There is simply not a lot of research right now to support all the claims being made about NO.

It is always intrigu ing that some people’s idea of good nutrition is to fixate on a molecule that sounds important, seems to somehow make sense to them, and they simply run with it. I refer to people like this as “armchair nutritionists.” You cannot simply sit in an armchair, read some random articles and use these as a nutritional call-toaction. Armchair nutritionists are usually very adept at finding “this study” or “that study” to support their ideas. This is referred to as “cherry-picking” the data. The fact is that you can find information these days to support almost any way of thinking. Thankfully, this is not how nutrition science works. A good rule is to be at the cutting edge of science, right behind the data, not in front

of or ahead of it.

The reason your friend boils his spinach is because spinach has elevated levels of oxalic acid, which can interfere with the absorption of calcium and iron. Oxalic acid is broken down by boiling. The downside is that boiling spinach also leaches out soluble vitamins, such as Vitamin C and other soluble nutrients.

Should you worry about oxalic acid in the spinach you eat? If you are eating spinach now and then as part of a varied diet, it is not a problem. The time when oxalic acid becomes a big problem is when you eat lots and lots of spinach every day, like Popeye. Your friend is overdoing spinach, so that is an issue for him. If you eat a wide variety of foods in a healthy manner, then spinach is simply a nutritious food to eat, either raw, in salads, or cooked. One favorite meal of ours is to throw in some raw spinach and diced red pepper when making mushroom

pasta. It adds lots of nutrients

Focusing on one other issue related to your question, it is not possible to directly measure NO in body fluids. That means there is no direct way of determining if, in fact, you have increased your NO levels. However, we can measure nitrite and nitrate in body fluids, which are the metabolic end products of NO in the body. The problem here is that the measurement of nitrites and nitrates is fraught with difficulty. It is questionable how the results of nitrite or nitrate testing relate to the original blood NO concentrations.

What is the “No-Nonsense Nutrition” advice for today?

It should not be necessary to state something so obvious, but eat food, not molecules. Based on the present data, if you want to reduce cardiovascular risk, get your blood lipids measured, stay physically active, be within a reasonable body mass index (BMI), and follow the Mediterranean or DASH way of eating. Most importantly, if you do all these things and your cardiovascular risk is still high, follow the advice of your physician and take cholesterol-lowering medications such as statins. Statins have much more data behind them and are much more researched than the NO hypothesis.

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

Dr. Karp

FOODISMEDICINE

joyed fresh, frozen, or dried. They can be easily incorporated into your daily meal plan. They make an excellent addition to cereal, salads, or yogurt. Because of their natural sweetness, they can make an excellent dessert such as a low-sugar cobbler, pie, or parfait. You also can infuse them in water or just eat them plain.

by Karen W. Cota, RDN, LD Consulting Dietitian with Aiken-Augusta Holistic Health, St. John Towers and Carolina Nutrition Consultants

Spring has sprung in the CSRA and summer is just around the corner. That means it’s a BERRY good time for delicious locally grown berries.

Strawberries started off the berry season in March/ April with blueberries in May/June and blackberries and raspberries following right behind. You just can’t go wrong with these darkhued fruits. Not only are they super nutritious, but they are low calorie, disease protective, and so delicious.

In our quest for healthy food choices, we should be looking for nutrient dense foods like berries. Nutrient

dense refers to foods that are packed with vital nutrients yet still low in calories. Berries qualify with only 80 calories per cup. You will also get 4 grams of fiber along with Vitamins C and K, manganese, calcium, potassium, and folate. Phytonutrients (color nutrients) or antioxidants are the bonus factor. Berries with their dark blue, red, and black colors are just loaded with antioxidants/phytonutrients which help neutralize free radical oxidation in our bodies to protect us against cancer, heart disease, aging, and chronic inflammation. With their low sugar, high fiber content, they are beneficial to control blood sugar, insulin levels, and blood pressure.

Blueberries, blackberries ,and strawberries can be en-

You can always find an assortment of berries in your local supermarket in the fresh produce or freezer section. Target even carries freeze-dried blueberries in the snack area and they are delicious.

If you are interested in supporting local farmers, you should check out our local online farmers market Augusta Locally Grown at https://alg.localfoodmarketplace.com/. If you want to pick your own organic blueberries check out Herb n Berries U Pick Blueberry Farm owned by Cathy and Ed Kvartek in Montimorenci, SC (near Aiken). Check their website for when berries are ready for picking at www. herbnberries.com They also sell already picked berries on the online market. Stock up and freeze them for later! Try this delicious, easy to prepare Blueberry Cobbler Recipe with mixed berries for a special treat.

BLUEBERRY COBBLER (AND/OR OTHER BERRIES!)

Combine in an 8x8 baking dish:

• 3 cups blueberries fresh or frozen (or 1 cup each of blueberries, raspberries, and blackberries)

• 3 tablespoons sugar

• 1/3 cup orange juice

Then combine and set aside:

• 2/3 cup flour (half whole wheat if you like)

• ¼ teaspoon baking powder

• a pinch of salt

Cream together:

• ½ cup softened butter (one stick)

• 1/3 cup sugar

Add in:

• 1 beaten egg

• ½ teaspoon vanilla.

Combine with flour mixture. Drop batter over berries and Bake at 375° for 35 to 40 minutes.

Serve with ice cream, whipped cream, or all by itself.

Tasty tips from registered dietitians with the Augusta Dietetic District Association

SHORTSTORIES

WHEN YOU REGRET SAVING A PATIENT A young boy was brought in who was so badly burned he was frightening to look at. Not to be gross, but as I changed his dressings, fingers would just fall off. His entire head was a horror mask. The contractures from scar tissue made his posture grotesque.

As if his medical situation alone wasn’t bad enough, his father was the one who had set him on fire. We all showered this boy with affection, but as for what he was going to look like when he would finally be able to be discharged...well, more than one of us nurses prayed that he would die quietly in his sleep.

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

Everyone knows that the internet can sometimes be a bit on the addictive side. Whether it’s cat videos or the endless stream of “fails,” it’s easy to let huge chunks of time slip past surfing internet videos.

One of the more popular (and addictive) categories on YouTube is police chases. It is disturbing to view dozens of these, often from the viewpoint of police car dashcams, and see how many motorists don’t have a clue about how to respond to an emergency vehicle approaching them from behind. And this is not just a YouTube thing. Our roving Crash Course investigators see this all around the Augusta area on a regular basis.

Let’s say an ambulance is screaming down the highway, lights flashing, sirens blaring. Many drivers will promptly pull over to the right lane or shoulder as they should. But a surprising number — very often drivers in the left lane for some reason — simply stop right where they are.

Picture yourself as an ambulance driver. You’re barreling down the road expecting cars to respond to your emergency signals by moving over. When a vehicle doesn’t, you may need to take an unexpected evasive maneuver in your boxy, top-heavy vehicle. These things aren’t exactly built like a Ferrari. Will you have to veer into another lane? Slam on your brakes?

To make matters even worse, your cargo isn’t exactly secure. According to figures compiled by the National Highway Traffic Safety Administration (NHTSA) and ems.gov, in serious ambulance crashes, 84% of the EMS providers in the back were not restrained at the time of the crash. And only a third of patients were secured with both lateral (lap) and shoulder belts. In 44% of the serious crashes investigated by NHTSA, patients were ejected from the gurney. Nationwide there are about 4,500 crashes

WIN A MUG!

And spending a Scrubs of Evans gift card!

involving ambulances every year (from 1992 to 2011), resulting in an average of 33 deaths each year. The two largest groups of fatality victims are occupants of the other vehicle (63%) and the ambulance passenger (21%), whether that is the patient or the EMS provider.

Many months ago this column discontinued the use of the word “accident,” choosing words like “crash” and collision” instead. That’s because nearly all such incidents are preventable. Rather than being an accident — by definition something that happens by chance and without apparent cause — they are instead nearly always the direct fault of a specific person.

When it comes to ambulance crashes, the fault might be multitasking and distracted driving by the ambulance driver; it could be a lack of training in operating heavy, unwieldy vehicles (see: two Augusta fire trucks overturned within a week back in January).

One thing it should never be, however: any “civilian” driver getting in the way of, or failing to get out of the way of, a vehicle on its way to save lives and prevent crime, injury, or death.

For the record, here’s the relevant Georgia law when an emergency vehicle comes up from behind: “...the driver of every other vehicle shall yield the right of way and shall immediately drive to a position parallel to, and as close as possible to, the right-hand edge or curb of the roadway clear of any intersection and shall stop and remain in such position until the authorized emergency vehicle or law enforcement vehicle has passed.”

It’s not complicated: don’t keep moving; don’t just freeze and stop wherever you happen to be. Pull over to the right and stop.

The sick or injured people waiting for EMS certainly appreciate your consideration. Plus you avoid the $500 ticket you could receive.

We didn’t allow mirrors on the unit, but one day he saw himself reflected in a window. He broke down and cried. That broke our hearts even more.

He did live and was eventually discharged with years of reconstructive surgery in his future. I don’t know what happened to him.

Sad to say, many nurses see extreme cases like this and pray - even though they’re giving their very best effort to save a life - that God will have mercy and call that patient home.

APNEA

the blog spot

— posted by Steven Reznick, MD on March 6, 2023 (edited for space)

SPENDING TIME WITH COMPUTERS

Recently I tried to log onto my hospital system’s electronic health record to check on the status of a patient. This patient is elderly, severely mentally incapacitated, and being cared for by physicians on the neurology service. Her son, a practicing physician at the same facility, had not received a return phone call from any of the inpatient physicians and wanted to know why his mom needed a lumbar puncture (spinal tap). As a member of the staff and her outpatient physician, I attempted to log into the system and answer his questions or at least find the contact information he needed to find a physician to talk to.

I WAS #16 IN THE QUEUE. WAIT TIME: 90 MINUTES

My local community hospital has recently signed on to be a member of a large regional not-for-profit hospital system. In the past I would access the hospital website and enter my user ID and password to log in. Now I must first enter the health system database using several levels of authentication to prove it is me and not some mercenary trying to introduce a virus or kidnap the system. If I enter my information correctly, a prompt is sent to an app on my mobile phone. I must access that app, and then, if I enter everything correctly, a new sign-in window appears from my local hospital.

I miraculously performed that task correctly, and the login screen appeared. I entered a different User ID and password and clicked on the “log in” tab. A new window appeared asking if I had downloaded a Citrix receiver. I clicked on the tab that said, “I have already downloaded a Citrix receiver.” It replied that it could not detect the receiver. So I chose the option “download Citrix receiver.” A new window appeared. I clicked on it, and suddenly I was inside the system.

I clicked on the patient electronic health record portal I always used, and a new question popped up asking what software app I wished to open this system with. It gave me a choice of six different ones. I didn’t know what to do, so I called the local hospital and asked for the Information Technology (IT) help desk.

Next, I was told by an automated system that I was #16 in line for the IT helpline. The expected wait time was 90 minutes. I hoped they would give me the option to leave a phone number and they would call me, but none was given. I hung up and returned to the computer screen that had given me a choice of six options. I chose number six, and the screen turned into unintelligible numbers and letters.

At that point, I quit. I turned off the computer, picked up the phone, and dialed the hospital main number. When the automated attendant answered, I pressed zero to speak to a live operator. I was connected with a different message and again pressed zero for an operator. A message came on saying all operators were busy. Several seconds later (which felt like minutes), an operator answered. I identified myself and asked to be connected with the neurology ICU. An actual human being answered the phone. I identified myself and asked for the nurse caring for that patient. She came to the phone, was pleasant and professional, answered all my questions, and promised to ask the patient’s in-hospital attending physician to call the patient’s son, who is a doctor.

What should have been a five-minute operation took at least 25 minutes, and I still need to learn how to get rid of program #6 that did not work and find which program will.

When I used to make hospital rounds pre-millennium, I would spend 10-20 minutes with a patient and a few minutes documenting the visit in the chart. I understand why hospital-based physicians complain that they have no more than five minutes to spend at the bedside because it takes 15 to 20 minutes to document those five minutes at bedside. There has to be a better way!

Steven Reznick is an internal medicine physician

From the Bookshelf

The subtitle of this book is, in par t, “The Making of a Medical Examiner.”

You might be thinking this is a fascinating book about the birth of this newspaper. So sorry to disappoint you. This is a book about the other kind of medical examiner, the kind, as the author puts it, “who cuts up dead people.”

It’s a unique calling. After all, most people get into medicine to prevent death, or at least delay it. Not everyone is cut out to handle a patient caseload that is approximately 100% dead on arrival.

Still, it’s an important and necessary specialty, and judging by decades of popular TV shows focusing on forensic medicine — both drama and reality — it is one many of us are fascinated by.

In the case of our author, Dr. Judy Melinek, surgery was her chosen career, but it soon became apparent that a life of surgery would be, well, a life of surgery: mere 12-hour shifts were a rare luxury. More than once she wielded a scalpel for 60 straight hours, relieved only

by a few brief stolen naps. 108-hour weeks were the norm, although 130-hour weeks were not uncommon. Her schedule included exactly one day off every two weeks.

Something had to give, and it did. She quit. But not before fainting at the end of a 36-hour shift and on another occasion performing surgeries while enduring a full-blown case of flu.

engaging, and the doctors seemed to have stable lives.”

In fact, the director of the pathology residence program at UCLA had tried to recruit her during her last year of medical school. Maybe she could direct her to a pathology position somewhere that would accept a failed surgery resident.

“Can you start here, in July?” the director asked.

Raised in the Bronx, Melinek left New York for UCLA and the promised pathology residency, then returned to New York City to ply her new trade.

This book details her two years of training as a newly minted forensic pathologist. Was this finally her ticket to the stable life she had abandoned surgery to find?

Sort of. Except that two months into the job September 11 happened. And then the ant hrax attacks. And then American Airlines flight 587...and then...

Taking stock of things in unemployment, she thought about the pathology rotation she had enjoyed so much in medical school: “The science was fascinating, the cases

MEDICALEXAMINER

+ + AUGUSTA’S MOST INFECTIOUS NEWSPAPER

You really need to work on your procrastination.

do. Why do you think I m so good at it?

No, what do they say? Well, you know what they say...

The early bird gets the worm.

by Dan Pearson

I ve noticed owls seem to be doing just fine.

THE MYSTERY WORD

The Mystery Word for this issue: EPANA

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

winner in our next issue!

ACROSS

1. Bowie hit

4. Mamie Eisenhower had one of these in Augusta

9. Trump cabinet member

13. Lyric poem

14. Holy place, as a church or sanctuary

15. Meadow

16. ______ lab

17. Uncovered

18. Spend the night with Elijah Clark

Dietary

Way

Georgia county named for U.S. president #4.

29. HPV is one

30. Exclamation of surprise

31. Gave food to

Type of code

__________ Mall, perennial site of new development

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

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.

Aman walks up to the circulation desk at the library and asks where he can find books about paranoia.

The librarian whispers, “They’re right behind you.”

Moe: Why did the computer get glasses?

Joe: I give. Why?

Moe: It wanted to improve its website.

Two hunters sitting in their kayak in the frozen wilderness of Alaska noticed the winds were picking up and the temperature was dropping rapidly. They decided to build a small fire which sunk the boat, proving once and for all that you can’t have your kayak and heat it too.

Moe: Pretty soon the year will be half over. How are you doing on your New Years resolutions?

Joe: Great. My goal was to lose 10 pounds.

Moe: And?

Joe: I’ve only got 15 pounds to go.

Moe: Scientists have discovered a way to communicate directly with bacteria.

Joe: How do they do it?

Moe: They use a cell phone.

Moe: My recliner is my best friend.

Joe: Seriously?

Moe: Oh yeah. We go way back together.

What I if told you that you read that wrong?

Moe: Ever notice that scuba divers always fall backwards off a boat?

Joe: Now that you mention it, yeah. Why is that?

Moe: Because if they fell forward they would still be in the boat.

Moe: What’s the worst possible punishment for someone with ADHD?

Joe: A concentration camp.

Moe: People can say whatever they want about Alec Baldwin, but personally, I stand behind him.

Joe: Really?

Moe: Well I’m sure not going to stand in front of him!

Moe: What do you call a camel that looks the same walking forward as it does walking backward?

Joe: That’s a tough one...a palindromedary?

Moe: I was going to tell you a joke about Jonestown, but I decided not to.

Joe: It’s ok. I don’t mind. Go ahead.

Moe: No, the punchline is too long.

Staring

The Advice Doctor

Dear Advice Doctor,

This is going to be a very delicate and tricky subject for you to give advice about. Yesterday my partner admitted to having an afffair. Naturally, my first thought was, “With who?” The answer: “I really don’t think you want to know. Give it 48 hours, and if you still want to know, I’ll tell you.” Any advice? — Unsure Now

Dear Unsure,

This is indeed a thorny question, and it’s surprising how many people struggle with the very issues you have raised. Unfortunately, many make the wrong choices, so thank you for giving me the opportunity to assist.

I completely understand the immediate reaction to ask “With who?” but fight that urge. Instead, ask “With whom?” Always use proper grammar, even in trying circumstances. After all, Ernest Hemingway didn’t write Who the Bell Tolls For, now did he? Whom may be mostly dead — and in most informal conversational settings you can nearly always use who — but for more formal usage (such as the written word) whom may be the proper choice. The easiest way to remember whether to use who or whom is to keep in mind that who does something (in sentence construction it’s a subject), while whom has something done to it (grammatically it would an object). To help decide which one to use, ask: who is doing what to whom

Now that that’s crystal clear, let’s move on to a few other poor choices people often make.

Contractions are especially perilous. To avoid the trap of improper use, simply uncontract them. If you’re about to tweet, “My dog has been chasing it’s tail for an hour! LOL!” stop and uncontract “it’s,” which is short for it is (or it has). Did you mean to say that your dog has been chasing it is tail? No. So you should tweet (or retweet) “...chasing its tail...” No apostrophe necessary.

People constantly run afoul of the triplets there, their, and they’re. They all sound alike. Let’s tackle the easiest: they’re If you uncontract it and the full “they are” still makes sense, you chose the right triplet. Use there for “in that place,” or “not here.” Their is possessive, as in “Their cat videos right there, they’re the best.”

I hope this answers your question. Thanks for writing!

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

THE MYSTERY SOLVED

Quotation QUOTATION PUZZLE SOLUTION There is no duty more obligatory than the repayment of kindness.

— Cicero

...cleverly hidden on the car in the p. 11 ad for C & C AUTOMOTIVE

THE WINNER: RICHARD DEAS!

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!

WORDS

Money

TheSUDOKUsolution SEE PAGE 12

BY NUMBER

— Leo Rosten

...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 D 3K BODY CONTOUR (NON-SURGICAL) WEIGHT LOSS/DETOX BYE BYE BELLY • Detox Juice/Tea 233 Davis Road Suite H Augusta GA 30907 706-403-7536

MYSTERY WORD CONTEST EMF PROTECTION Augusta Area Healthcare Provider 4321 CSRA Boulevard Augusta 30901 706-555-1234 CALL 706.860.5455 TODAY!

The Mystery Word in our last issue was: SUNBURN YOUR LISTING YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by thousands of patients every month. Call (706) 860-5455 for all the details! CALL THE MEDICAL EXAMINER (706-860-5455) TO BE LISTED HERE

Amir Azarniver, MD Endocrinology

Risha Malik, MD Endocrinology

Janaki Nadarajah, DPM Podiatry

Kaushal J. Shah, MD Vascular Surgery

Brandon Sur, MD

Alain Domkam, MD Vascular Surgery

Paul Butros, MD Salman Mufti, MD Sergei Sobolevsky, MD