Medical Examiner 7-7-23

WHAT IS

Don’t let that heart below fool you; nobody is feeling any love for chronic diseases. They are a terrible burden upon those who have them, and that is by no means a small number: the Georgia Department of Public Health says that 60 percent of all adults in the United States — roughly 150 million people — have a chronic disease, and 40 percent of that number have two or more.

What is a chronic disease? Broadly defined, the term describes any medical condition that requires ongoing medical attention, or limits activities of daily living (or both), and which lasts a year or longer. Chronic diseases like cancer, heart disease, and diabetes are the leading causes of death and disability in the US, and are at the top of America’s $4.1 trillion annual health care expenditures.

As suggested in the article to the right, avoiding chronic disease or delaying its onset is not necessarily a complicated proposition. For example, experts say that diabetes prevention, type 2 in particular, is truly as easy as one-two-three: eat healthy, be active, and lose weight. That’s it. Those three steps alone, pursued chronically, if you’ll forgive us for saying that, would prevent many of the 37 million cases of diabetes in the US, about 95 percent of which are type 2.

It’s amazing how similar the recommendations are for heart disease prevention: take the three preventive tips above or the four to the right and simply stir in knowing and controlling blood pressure and cholesterol levels. Taking those basic steps can help prevent heart attacks, stroke, hypertension, cardiovascular disease and the rest of the entire heart disease constellation.

The same holds true for cancer in all its various types. The Mayo Clinic’s top three ways to prevent cancer? Avoid tobacco, eat and drink in healthy ways, and keep weight under control by staying active.

No one is suggesting that these ultra-simple steps are all that’s needed to conquer chronic disease. But all by themselves they can prevent millions of cases, delay the onset of still others, and reduce the severity of millions more.

In short, keeping it simple means keeping it salubrious.

As pesky as chronic diseases may be, their causes are uncomplicated.

According to the Georgia Department of Public Health, many chronic diseases are caused by a very short and very preventable list of bad habits:

1

Smoking and exposure to second-hand smoke. 2

Poor nutrition, such as diets high in sodium and saturated fats, and short on fresh fruits and vegetables.

3

Excessive alcohol use.

Lack of exercise; long-term physical inactivity. 4

While other factors can be involved, these four basic triggers demonstrate how simple and uncomplicated preventive medicine and good health can be. It isn’t exactly rocket science.

PARENTHOOD

by David W. Proefrock, PhD

You bought a small swimming pool for your 3-year-old daughter, but when you tried to get her in the pool, she screamed and was obviously afraid of the water. What do you do?

A. Let her stand outside the pool and play with toys in the water. Allow her to get used to the water gradually.

B. Put the pool away until next summer when she’s a little older. It seems to be a bad idea for her now.

C. Put her in the pool and make her stay there until she isn’t scared anymore realizes that the pool is nothing to be afraid of.

D. Invite a couple of children close to her age to come over and play in the pool. She will join them.

If you answered:

A. This is a good plan. It allows her to approach the water in the pool at her own pace. It probably won’t take her very long to get over her fear.

B. Without further exposure to the water in the pool, there is no reason to believe that she will get over her fear.

C. It is unlikely that this will work and there is no reason to put her through the trauma.

D. This could work and it would be worth a try, but fears don’t respond to social pressure. It is just as likely that it wouldn’t work.

Fears are not always explainable, but they are real. A gradual approach to dealing with them is aways best.

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

SHORTSTORIES

AS A DOCTOR, HOW DO YOU FEEL WHEN A PATIENT DECIDES TO NOT SHOW UP FOR AN APPOINTMENT? Sometimes it’s not a decision. I was so worried about a patient not showing up once that I called the police to do a welfare check. They found him unresponsive on the floor with his oxygen not working. He ended up hospitalized for a long time, but he lived and eventually went home. He was very grateful. I went to see him in the hospital and he had just found my voicemail where I told him I was calling for the welfare check. He hadn’t until that moment had any idea how he’d been saved. For me, that was definitely a feel-good moment.

But more often, people just forget or their car breaks down or they have to take their sister to the ER; they don’t usually just decide not to come. My clinic calls to follow up. If they truly don’t want to come, that’s their choice. Either they aren’t invested in their health, which I do not have the skills or time to fix (other than perhaps referring them to mental health) or they don’t like me in particular, in which case everyone in my organization knows the process for requesting a new doctor.

When there’s a no-show I’ll think about my past interactions with the patient to see if there’s anything I identify that I could have done better, but that’s about it.

MEDICAL MYTHOLOGY

ABUSE IS A CHOICE

Domestic abuse and violence is an enormous problem in the United States. According to the National Coalition Against Domestic Violence (NCADV), “On average, nearly 20 people per minute are physically abused by an intimate partner in the United States. During one year, this equates to more than 10 million women and men.” In addition to verbal abuse, physical attacks range from slapping, shoving and pushing to severe physical violence such as beating, strangling, and burning.

There are many myths surrounding this plague of violence, among them:

• it’s the victim’s own fault

• why don’t they call the police?

• they should just leave

These and other domestic violence myths have one thing in common: they imply that the

victim is in control. They can stop the abuse by 1.) changing their behavior; 2.) getting cops involved to stop the abuse, or;

3.) leaving.

If only it was that simple.

The kind of person who physically beats or psychologically destroys another human being is not picky. They do this in every situation where it is to their advantage to do so. Conversely, they can pour on the charm in other situations where it is to their advantage to do so.

But domestic abuse, which is, after all, a prolonged, willful, physical and verbal assault against an intimate partner, is never “deserved” by the victim.

So why don’t these people simply call the police and put an end to the abuse?

Again, it’s not that simple. The authority of police to remove someone from their own

home is legally limited, and reviews of actual cases demonstrate that fact, and that in many cases violence escalated as soon as police left the home.

The fear of escalating the situation that prevents some victims from dialing 9-1-1 seems justified: A 2014 study of intimate partner homicides published in the American Journal of Public Health found that 20% of homicide victims were not the domestic violence victims themselves, but family members, friends, neighbors, law enforcement, bystanders, or other persons who intervened.

What about just leaving? At the risk of redundancy, it’s a whole lot more complicated than that. As above, one study of men who killed their wives found that either threats of separation by their partner or actual separations were most often the precipitating events that lead to the murder.

So is it all completely hopeless? Not at all. The National Domestic Violence Hotline is just one of many resources offering a wealth of practical assistance. Visit thehotline.org or call (800) 799-SAFE (7997233). Another is Safe Homes of Augusta. Their contact info: (706) 736-2499 and online, www.safehomesdv.org

If you’re a victim, be assured you are not the guilty party. Escape from the situation may seem challenging, but it is possible.

WHAT IS “THE SPECTRUM”?

Once upon a time there were a number of related developmental disorders that were all diagnosed separately: autism, Rett syndrome, Asberger syndrome, and others. In 2013 the related conditions were collectively rebranded under the umbrella term autism spectrum disorder (ASD). Sometimes people diagnosed with ASD are referred to (or describe themselves as) “on the spectrum.”

ASD is diagnosed in people who may have difficulties communicating and interacting with others, who learn differently, and who may engage in repetitive, compulsive behaviors.

That word may is a key to answering the question above. Spectrum is the perfect word for this diagnosis because the variations from one person to the next can be extreme. One person diagnosed with ASD may be married and have a successful career, while the next person is non-verbal and is not (or was not) able to handle the social interactions of even a kindergarten classroom.

For that reason, “the spectrum” is a common place for confusion. Let’s say you know someone who has been diagnosed with autism, and you’re familiar with their behaviors. You might therefore view with skepticism someone else’s statement that their child is autistic because their symptoms or behaviors are completely different.

That is why it’s called a spectrum which, like refracted light, describes the gamut of various symptoms from A to Z, from one extreme to the other.

The variety also leads to self-diagnosis. To listen to parents these days, it seems like every third child has autism. That is often the result of the comparisons similar to the one described above: one parent describes their child’s behavior and diagnosis to another parent, and the second parent thinks, “That sounds just like my child.” And suddenly a new case becomes fact without the time and expense of a doctor visit.

Two more quick myths about autism and its spectrum in closing: it is not considered to be a mental health disorder; it is a neurological disorder, meaning that its cause is believed to be abnormalities in brain structure and neurotransmitter levels. Also there is no evidence linking autism to vaccinations.

Who is this?

SHORTSTORIES

Now here is a medical pioneer who needs no introduction, (but we’re going to give him one anyway).

This man, a household name around the world today, was born in 1845. Things were rough at first. For instance, a teacher intercepted a note he passed during class one day in high school that turned out to be a caricature of one of the teachers. It must have been quite unflattering, because it resulted in his expulsion from the school. It didn’t matter that it was drawn by someone else; he got the blame.

He found it almost impossible to be accepted to any university without a high school diploma, but he discovered that he could enter a Swiss university if he could pass an entrance exam, which he did, graduating from the University of Zurich in 1869. A series of academic positions at various universities followed, culminating in an appointment to the University of Würzburg in its physics department.

An experiment there one late Friday afternoon in November of 1895 eventually won this man the first-ever Nobel Prize in physics. The experiment was so intriguing that he spent the whole weekend in the lab, and the phenomena he discovered were so mysterious that he initially kept it all a secret, fearing it to be so unbelievable that his very sanity would be called into question if it became public knowledge.

In fact, the discovery was so puzzling that he couldn’t even give it a logical name; he had to settle for a name that conveyed the unknown: X — as in X-rays.

Yes, this is Wilhelm Roentgen (also sometimes spelled Röntgen), the father of an entirely new branch of diagnostic medicine based on his discovery of X-rays. He published his findings in late December 1895, and the world medical community quickly jumped on the sensational discovery.

Anna Ludwig, the woman who would become Roentgen’s wife (and the subject of the first X-ray image), entered the picture decades before his notable discovery. Roentgen’s father was against the romance due to Ludwig’s age (she was six years older than her suitor) and her social status (she was the daughter of a Zurich café owner). Although the elder Roentgen cut off his support for his son when they married anyway, he had apparently softened his views to the extent that when he died he left two million Reichsmarks to his son. For primarily ethical reasons (and perhaps because he could then afford to), Roentgen did not seek a patent for his discoveries, believing that the advancement should be available to all without charge. In fact, he donated all of his Nobel Prize winnings for research at the University of Würzburg. Alas, inflation following World War I left him impoverished and bankrupt. Considering the then-unknown dangers of unprotected exposure to X-rays, it’s amazing that Roentgen lived to age 77 and his wife to age 80 (they died in 1923 and 1919, respectively).

A complete list of honors, prizes, medals, honorary doctorates and honorary memberships of learned societies in Germany and around the world conferred upon Roentgen would fill the rest of this page. +

YOU SEE SOME HORRIBLE THINGS IN THE ER I have been an ER doctor for 25 years and have seen several very sad scenarios. I’ll tell you about a few of them: One was a little two year old girl who had been found on the bottom of a swimming pool. It was a typical scenario of a pool party where everyone thought that someone else was watching the kids, so no one was watching the kids. Her older sibling had been the closest to watching her, but he became distracted. He himself was a young child. She was pulled out of the pool by her father and brought in by ambulance, barely alive. We worked on her for quite a while but could not get her back. When I pronounced her dead, the trauma room was full — nurses, respiratory

therapists, techs, a pharmacist, as well as both parents and several other relatives that had been at the party. The parents were devastated as were the other adults in the room. I still recall the unabashed screaming and wailing. All of us were crying. There was not a dry eye in the room.

The second memorable horrible case was a mother who piled her kids and several of their friends into a car that she decided to drive while intoxicated. They got into a horrible accident in which two of the children were killed. I don’t remember whether they were her kids or their friends. The surviving kids had injuries which varied in severity. The drunk mom had minor injuries. I talked to one of the kids who described to me how scary it was to be

in that out of control car. I had to hold back the tears. Then I had to take care of the mom’s minor injuries, which was really difficult for me.

OK, here’s one more. Recently I saw a man in his early 60s who was near death with end-stage liver disease. He was jaundiced, emaciated with sunken eyes, very dry mouth, and a big swollen belly due to fluid accumulation. He was barely conscious.

His mother, who was a healthy, robust woman in her mid 80s, was quietly sitting next to his bed, stroking his cheek while tears streamed down her face. I had some time so I entered the darkened room and chatted with her a bit. I asked if she had other children. Yes, she did, she said, “but he is my baby.”

FRIENDS DON’TLET NOT READTHE FRIENDS

MEDICALEXAMINER

Middle Age

Our Behavioral Health Mission

BY J.B. COLLUM

It has been far too long since we’ve had a new installment of our “you might be middle-aged” series. Long enough for some new entries to arise and for updates on some previous ones. So without further ado (except for our usual apologies to Jeff Foxworthy), let’s get back to it.

• If you have met your health insurance annual out-of-pocket maximum before Independence Day for the third year in a row, you might be middle-aged. Yep, that would be me once again. I’m on a roll. Of sorts.

• If you keep a cane in your car and another by your bed because you never know when you will randomly need one, you might be middle-aged. I used one to hobble to this chair to write this in fact

• If you are watching more videos on YouTube about deciding the best time for you to retire to maximize your return vs your life expectancy and less about travel to exotic places or your hobbies, you might be middle-aged. Our favorite current strategy is for my better half to retire at 62 and work part-time to stay under the cap, and for me to wait until 67, but that really depends on how my health goes. Math is never fun, but when you are calculating this kind of stuff, it can be quite macabre.

• If any of your children are starting to consider — or are already — coloring their hair to hide the gray, you might be middle-aged. Don’t tell my oldest daughter about this one.

• If you had to buy yet another, even larger, pill organizer because you needed one that had four compartments per day instead of three, you might be middle-aged. I will probably go ahead and buy a backpack to haul this thing around next, or maybe a pack mule. It’s so big, I hope the county doesn’t see it

because they might charge me property tax on it.

• If you and your spouse argue daily about what the other one said because you are both now hard of hearing, you might be middle-aged. Don’t tell my wife I said that. I share it here as that is the best way for me to be sure she doesn’t know I said it because she also needs new glasses but won’t book an eye appointment. Which reminds me…

• If you and your spouse argue about getting a doctor’s appointment for some ailment one of you has been complaining vociferously about for a while, you might be middle-aged. And by the way go ahead and make that appointment.

• If half your conversations with your spouse involve you or them saying that you already talked about this subject just a few minutes ago, you might be middle-aged. It used to just be me, but lately, more often than not, it has been her. I’m not worried about her reading this because even if she gets new glasses, she never remembers to read my column.

If you see yourself in any or all of these categories, don’t fret. You are not alone. We are your fellow travelers on this great adventure on our way to our so-called golden years. So, whatever happens, take it — and your medicine — with an extra dose of humor and a heaping dose of patience and love for yourself and your friends and family. After all, you may have to count on them more than you want later and it doesn’t hurt to start buttering them up early.

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.co

To provide individuals and families in our community with the best patient-centered mental health and chemical dependence services that respect cultural differences and foster hope, strength, self-determination, and dignity

Behavioral Health Services

Benefits of Counseling

Improved communication, problem-solving, and conflict resolution skills • Improved relationships • Ability to decrease use or refrain from using alcohol and other drugs

Our Approach

Medical Associates Plus takes an integrated approach to primary care. Our mental health/substance abuse program is results driven. We provide long-term recovery through individualized and customized mental health and addiction services to meet each patient’s goal. Our approach is to treat each patient as a whole person with the understanding of the impact of these conditions on individuals, families, and our community and society as a whole.

Our Treatment Team

Qualified, caring staff champions a common understanding of the physical, psychological, and sociological aspects of mental health and addiction. Our dedicated medical providers, psychiatrist, addiction counselor and licensed clinical social workers work closely to assist individuals to gain the skills they need to lead productive lives. We partner with our patients on their road to optimal health. The treatment team consist of the following:

Psychiatrists • Therapists • Primary Care Providers Drug & Alcohol Counselors • Nursing Staff

We accept most major insurances including Medicaid & Medicare. All patients are eligible to apply for our sliding fee discount, which allows you to pay a reduced cost based on your income and family size.

the “Patients”

THINGS I WANT MORE OF

Music concerts that cost less than a pair of shoes.

People with more laugh lines than frown lines.

People who rescue dogs and cats. It can only help us to have pets who loves us despite our defects.

Kids who graduate with real skills. In Baltimore, 80% of grade school kids cannot perform math and reading at grade level. School should teach the 3 Rs, not worry about what gender kids are. Doctors and nurses figured out how to do that at birth.

Good moral character. The Lord’s Prayer and Pledge of Allegiance at the beginning of each school day. We all make more than our share of mistakes, even with good understanding of moral behavior. Removing moral teaching from schools does not make for a better grade of citizen … regardless of the individu-

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy Laveau

al’s particular religious belief (or lack thereof.)

Honesty in the media. CNN and MSNBC lean heavily to the left. Fox leans to the right. Everybody wants to be a journalist. Nobody wants to be a reporter. Just tell me what happened, and let me decide what I think.

More reporters and fewer journalists. Don’t tell me what the news means. Tell me the news and let me make up my mind without their help. Why can’t we have more Walter Cronkites and less political activists posing as agents of fair news?

Better Quality of life. It diminishes as inflation increaseds taxes. 3 years ago, I paid $3 for a pound of blueberries. ($0.37 per oz.). Recently, I paid $6 for 10 oz. ($0.60 per oz.). That is up 62%. That is bad enough, but the local 7% sales tax went from $0.21 to $0.35. That hits the rich and the poor alike.

Councilmen who don’t need OJT (On the Job Training). Remember a local councilman trying explain away his travel expense by saying: “If you don’t go you won’t know.”

People who say ma’am, sir, and please, and less people who flood the world with profanity. Afterall, profanity is a tool used when you can’t think of proper words to express your meaning.

Fewer people who are offended by everything and complain about everything.

We need happy people working to make a better world.

Leaders who entertain as they educate us. People like President Reagan. And if they can’t do that, be more like President Calvin Coolidge who said almost nothing.

Political ads that say something positive. Brother Dave Gardner said, “Tell me something you believe in. I got enough doubts of my own.”

We need more likeable cops who always solve crimes quickly, cops like Oliva on “Law & Order Special Victims Unit” or Andy Griffith and Barney Fife, or Clint Eastwood’s Dirty Harry (he only killed really bad guys that needed killing.). We don’t need cops smuggling drugs into jail or beating up wives and girlfriends. Criminals do more of than enough of that without cops trying to crowd them.

Comedians who entertain without ugly words. Brother Dave Gardner and Jerry Clower did not need profanity to make tears run down my face. They had more clean funny jokes than a scalded house cat has got running gears. Somehow, I am not entertained by derogatory comments about the women in my family. You can say what you want about me, I don’t care. But

I do care about our women folk. Defame my women and I will challenge you to a duel. Your choice of weapons. Toothpicks at 20 paces. Or cannons at 6 feet.

Comedians, politicians, and sane people who love America even though we are the worst country in the world … except for all the others. What other country has 10,000 people a day crashing their border to get in? People crash into good countries.

More people who adhere to the Ten Commandments regardless your religious belief. If you don’t believe in Christianity, that is fine with me. Just live by the Ten commandments. It will not harm you and will make our country safer.

Colleges that teach and promote true freedom of speech and diversity of thought. College is supposed to broaden thought, not control thought. There is something in the Constitution about that.

More jokes on the internet. Like celebrating National Buy Mom a Goat Week. A good daily laugh is a good thing.

Slow-growing and drought-resistant grass for my yard. I like a green yard, but don’t like mowing. And my Homeowners Association discriminates against goats.

GREEN BEAN AND POTATO SALAD

This Tea Time at the Masters salad is delicious and a perfect match for any summer outing.

Ingredients:

• 2 lbs red skinned new potatoes cut into thick wedges

• 3 cups of fresh green beans, trimmed and cut in half

• 6 tablespoons of extra virgin olive oil (Kim’s change:

Use 4 Tbs. olive oil)

• 2 tablespoons balsamic vinegar

• 2 teaspoons crushed garlic

• 1/2 teaspoon salt

• 1/2 teaspoon pepper

• 1 tablespoon Dijon mustard

• 3 green onions, chopped

• 1 cup chopped fresh basil leaves

Instructions:

Cook the potatoes and green beans separately in enough water to cover just until tender, 6 to 7 minutes. Drain and rinse, then combine in a large bowl. In a small bowl, whisk the olive oil, vinegar and garlic together. Whisk in the salt, pepper and Dijon mustard. Pour over the potatoes and beans. Add the green onions and basil and toss gently to

mix. Cover and chill for 2 hours before serving.

Yield: 8 Servings (Serving size: ¾ cup)

Nutrition Breakdown: Calories 190, Fat 11g (1g saturated, 8g monounsaturated), Cholesterol 0mg, Sodium 170mg, Carbohydrate 21g, Fiber 4g, Protein 3g, Potassium 657mg, 75mg.

Percent Daily Value: 10% Vitamin A, 25% Vitamin C, 4%

Calcium, 8% Iron Carbohydrate Choice: 1 ½ Carbohydrate

Diabetes Exchanges: 1 Starch 1 Vegetable, 2 Fats

This recipe was used with permission from the Junior League of Augusta and the cookbook Par 3 Tea-Time at the Masters®, a true Augusta Classic and can be found at many local gift shops as well as the Augusta Museum of History, and Augusta Regional Airport.

ASK DR. KARP

The latest data shows that edamame and tofu are very healthy sources of protein, fiber, vitamins, calcium and other minerals.

NO NONSENSE

NUTRITION

Heather from Boston asks:

“Are there any negatives to eating edamame beans or tofu? Specifically, soy? What does the latest scientific data show?”

Edamame, by the way, is the name for immature green soybeans. You can find edamame (pronounced eduh-MAH-may) in the veggie section of your supermarket, conveniently packaged for snacking. You can also find them in the frozen food section, and in the dishes of many Asian restaurants. The beans can be added directly to salads, soups and noodles. Edamame and snap peas are very similar, except that snap peas are sweeter tasting and their pods, not just the beans, are edible. The pods of edamame, by contrast, are not edible.

Tofu, for the record, is made from soy milk, which is coagulated in much the same way cheese is made from cow’s milk. Tofu can have different flavors and textures, depending upon how it is produced, again, very similar to cheese. It is usually sold as small white blocks having a neutral flavor, so it can be used in many different foods and prepared in different ways.

Tofu was first made in China about two thousand years ago. It is a low-calorie but high-nutrition food. It contains a significant amount of fat, but the fat is present as healthier unsaturated fat, rather than the saturated fat of dairy products. Did you know that the United States, specifically Illinois, Iowa, and Minnesota, are a major source of the world’s

soybeans? The United States and Brazil combined account for about 60% of the world’s soybean production.

Soy has gotten a lot of undeserved negative press. Popular media is filled with stories about soy causing increased breast cancer risk and thyroid disease. Further research has shown that soy does not increase breast cancer risk or cause thyroid disease. It is true that soy contains estrogen-like compounds. However, the data shows that the estrogen-like substances in soy are metabolized in your body in a completely different way from human estrogen, and do not have the same biological effects. With regard to the relationship of soy to thyroid function, an excellent and exhaustive research review published in 2019 concluded that soy has no effect on thyroid function.

It is worth mentioning that soybeans do contain some antimetabolites. These are molecules that interfere with the normal way you use food in your body. The antimetabolites in soy include phytates, lectins and specific

enzyme inhibitors. However, be assured that the effect of these antimetabolites is only of concern if you are eating abnormally large amounts of soy products. If you are eating varied, different foods, like most people do, then these antimetabolites are not an issue. At very high levels, elevated intake of phytates and lectins can bind minerals like iron, zinc and calcium to form non-digestible complexes. Also, eating too much soy can interfere with protein digestion by inactivating two important protein-digestion enzymes. Again, be assured that on a normal mixed diet, these anti-metabolic effects of

soy are not a concern. There is a lot of marketing and advertising noise trying to get people to buy more expensive soy products (such as soy milk, etc.), rather than buying lower cost “regular” products. For example, taking the saturated fat out of milk turns skim or low-fat milk into an excellent source of protein, calcium and Vitamins A and D. There is absolutely no reason to think you must spend more money to buy soy milk, or that soy milk is healthier. It is not, and it is a poor use of your food dollar. Let the buyer beware.

What is the “No-Nonsense Nutrition” advice for today? Edamame and tofu are healthy foods that can and should be included in your diet. They are high-quality sources of protein, fiber, vitamins, calcium and other minerals. Careful studies have shown that eating soy does not increase your risk of breast cancer or thyroid disease. Furthermore, the antimetabolites in soy are of little concern when eating a mixed, varied diet.

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

IT’S BLUEBERRY SEASON!

by Nicole M. Moore, MS, RDN-AP, LD Augusta District Dietetic Association

Blueberries are fresh and in-season right now. They are also grown locally here in the CSRA.

These tiny fruits are a big source of vitamins, minerals and phytonutrients. A phytonutrient is a compound produced by a plant that has health benefits for the human body. For blueberries, the main phytonutrient is anthocyanin. Anthocyanin is the reason for the fruit’s signature color. As blueberries ripen they go from red to blue/purple due to the increase in anthocyanin. This phytonutrient has been shown to have antioxidant and anti-inflammatory properties. Antioxidants are able to delay or prevent some cell damage by free radicals. Your body produces free radicals when you break down food for energy and from exercise. We are also exposed to free radicals from the envi ronment, like cigarette smoke and air pollu tion. So a diet rich in antioxidants can be helpful to repair this natural damage. Due to these anti-ox idant and anti-inflam

matory effects, research has shown that anthocyanin makes blueberries great for reducing your risk or improving existing chronic disease like cardiovascular disease, type 2 diabetes mellitus, and neurological decline.

In addition to anthocyanin, blueberries come with other nutritional benefits. One cup of blueberries contain 80 calories, 4 grams fiber, 110 mg potassium, 15% daily value of vitamin C, 20% daily value of manganese, and 25% daily value of vitamin K. Fiber intake supports heart health and gut health. Vitamin C is important for our body’s immune system, wound healing, collagen production, hormone production, absorption of iron, and as an antioxidant. Vitamin K is used for blood clotting and bone building. Manganese is used by enzymes to break down our food, build bone and keep our immune

system healthy. Blueberries also have significant water and fiber content, so are also a filling food. So you can see how just one cup can pack quite the healthy punch.

There are many ways to incorporate blueberries into your meals and snacks. Try adding them to salads, oatmeal, cereals, yogurt, or smoothies. You can also make blueberry desserts and baked goods. Or you can also simply snack on them by themselves!

July is peak season for delicious sweet blueberries. Celebrate National Pick Blueberries Day on July 10. Head to a local You Pick blueberry farm or buy delicious local blueberries at your farmers market.

Store fresh blueberries in the refrigerator and wash before serving. You can also freeze by washing and drying berries, then laying them out on a sheet pan and freeze until solid, once frozen you can transfer to a freezer storage bag. This can be a great way to keep them at their peak flavor when you can’t eat them right away, perfect for smoothies or cooking with later in the year when they are out of season.

Tasty tips from registered dietitians with the Augusta Dietetic District Association

CRASH COURSE

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

This session of Crash Course is going to take us back to the basics. As you may have noticed, some drivers seem to have forgotten the most elementary principles of safely navigating the highways and bi-ways. So yes, some of this information might seem to insult the intelligence of anyone above 3rd grade, but really, anyone below 3rd grade level shouldn’t be driving anyway.

Rule #1, as suggested by the illustration to the right: use your brain at all times when driving. You would think that’s a given, but no.

The reason auto makers are trending more and more toward driverless cars (or at minimum removing the human element from driving as much as technology will allow) is because humans are notoriously good at making bad choices behind the wheel. So if they can’t stop us from making TikTok videos while tearing down the interstate at 75 mph, the least they can do is build a car that will take over the driving while we post our next viral video.

Of course, so-called driverless technology has not yet achieved 100% driverless status, so we still need to — this may sound radical — pay attention to the road while we’re driving Note the illustration again. It only has three gears. Not 37. In other words, when driving, focus on driving. It’s extremely important. Want proof? Please refer to the subheading of this column above, the sentence right below the picture of the crash test dummy. It’s a shocking statement, but it brings home the reason for this column, and the message that safe driving is well worth our time and attention.

There are other safety basics that require the same level of brain power to achieve; that is to say, very little.

This would be the perfect place to preach a Thou Shall Obey the Speed Limit sermon, but who are we kidding? Nobody wants to be that one guy driving the speed limit. But it would at least be prudent to drive the same speed as everyone else. That’s safer than poking along at 30 in a 30 when everyone else is doing 45. And it’s a whole lot safer than doing 60 in a 45 too.

Another frequently observed roadway infraction is tailgating. In a stadium parking lot in October, tailgating is cool. But on any street or road any month of the year, it is not a smart move. Hence the oft-repeated maxim known as

The Examiner’s Corollary: “Tailgating is dumb.” It may very well be the Michael Jordan of all boneheaded driving stunts.

Let’s say someone needs a new car, and you just happen to be tailgating that very person. All they have to do is slam on their brakes — perhaps they thought they saw a turtle in the road — and not only will they have that new car, but in all likelihood they will also have a nice little bundle of cash to go along with it.

There are certainly other fundamentals usually covered on the first day of class: wear your seatbelt; drive defensively; don’t drink and drive; put away your phone phone at all times while driving (your GPS phone is permissable); keep your car (and its tires) well maintained.

All of these are important elements in safe driving, and each one requires roughly the brain power of a grasshopper to appreciate.

Just for fun (and for extra credit!), let’s harness the power of two grasshoppers for some additional Safe Driving 101 behaviors.

Embrace the Power of the Merge Lane It takes only two grasshopper brains to realize that interstate merge lanes are provided to allow drivers to reach the speed of the traffic flow on the main road before entering the main road Conversely, some exiting drivers brake while still on the main road, even though there is a half-mile long exit ramp stretched out before them. In short, merge lanes keep traffic flowing smoothly on the mother road — if we use them as nature intended.

Embrace the Power of the Blinker It takes one half of one tenth of one calorie to activate a turn signal. So although blinker use is not an effective weight-loss strategy, it is definitely a safe driving move. It magically lets other drivers know what you intend to do before you do it! That can prevent accidents. And road rage.

Sometimes our roving highway safety inspectors witness the failure to employ the two powers above, and it isn’t a pretty picture. It can happen when 3 lanes merge down to 2, or 2 merge into one, and someone in the lane about to end floors it to get ahead of others with the intention of cutting in at the last second. It’s already rude and a half, but they compound the rudeness by not even using a blinker. Shame!

Class dismissed.

FOOD FOR THOUGHT WHEN YOU HEAR ABOUT PEOPLE COMMITTING CRIMES RIGHT OUT OF PRISON... I served 18 years straight. I’d say somewhere around the 7 or 8 year mark my view of the situation changed. It was no longer prison, it was just my life. Nothing ever changed. Every day was the same. You get in a never-changing routine and before you know it 5 years go by, then 10, then 15. The real world becomes a fantasy. It’s something you see on TV or pictured in magazines, but it’s no longer real.

One day you look in the mirror and your hair is receding, and it’s turning gray. In your mind you’re socially stunted and in a lot of ways like a child , but you’re old.

I went in at 18 and came out a 37-year-old man who didn’t know how to do anything. I’d never used a cell phone or computer. I’d never driven a car or filed my taxes. The world was too big, too loud, too fast. My second day out my sister took me to Walmart and I had a panic attack and had to go outside and sit in the car by myself.

I could make a tattoo gun out of an electric razor, boil water with an extension cord, and sit for months on end by myself in a room with a sink, concrete bunk and metal toilet without breaking a sweat. But I couldn’t hold a job, operate any electronics without help, or go to Walmart without freaking out. I didn’t know how to cook or how to pay a bill. I sat home by myself for months, afraid to go anywhere or talk to people. A big part of me wanted to be back in prison where things made sense, where I thrived.

I’ve been out for over 5 years now, and while I’ve learned to do a lot of things, it’s still not easy. I dream a lot of being back in prison. Where’s it’s easy. No responsibility. And believe it or not, where there is less stress and anxiety. I’ve been in institutions my whole life, since I was a little kid. Foster homes, group homes, treatment centers, juvenile detentions. It’s what I know. It’s where I’m comfortable.

I don’t know if that will ever change.

ROLLED SANDWICHES • SOUPS • SALADS

the blog spot

— posted by Veronica Bonales, MD, on June 24, 2023

LIVING WILLS AND LAST GOODBYES

SHORTSTORIES

SOME THINGS START BADLY, THEN GET BETTER, THEN END WORSE THAN EVER

On windy days doors slam shut sometimes. It’s nothing unusual.

IT WAS AN IMAGE I COULDN’T SHAKE

As an emergency physician, I’m a strong proponent of living wills, POLST forms (Physician’s Orders for Life-Sustaining Treatment), and discussing uncomfortable topics with your loved ones. Even making decisions about your child being an organ donor, if, Heaven forbid, something happened. You never know when the “last time” might be. A recent case I had served as a reminder of this. The patient and their spouse came to the hospital for what was supposed to be a routine outpatient procedure. While the spouse was in the cafeteria, grabbing a coffee or a snack while waiting, the patient suddenly experienced a low heart rate and weak pulses. A rapid response alert was announced overhead. The rapid response team swiftly assessed the patient’s condition and determined the appropriate actions.

The team initiated intravenous fluids (IVF) and decided to transfer the patient to the emergency department (ED) for further evaluation. However, while they were in the elevator, the patient’s pulses ceased, and cardiopulmonary resuscitation (CPR) was initiated. I had been informed about the patient’s arrival in the ED but was taken aback when the elevator doors opened, revealing someone performing chest compressions on the gurney. We immediately called a code blue and commenced resuscitation efforts.

Meanwhile, the spouse had returned to the waiting area, noticing that the procedure was taking longer than anticipated. Concerned, he inquired about his spouse. Staff escorted him down to the ED just as I was observing a motionless heart on the ultrasound, double-checking my options for further intervention. When the spouse arrived, I gently asked if he was aware of what had transpired. He only knew that a complication had occurred. Inquiring about the presence of a living will or do not resuscitate (DNR) orders, I learned that the patient had a cancer diagnosis and had expressed a desire to avoid extraordinary measures.

I proceeded to explain the sequence of events, inviting the spouse into the room and calling off the resuscitation efforts. With the exception of the patient’s assigned nurse, everyone left the room. During this time, the spouse revealed that they had recently celebrated their 59th wedding anniversary. He spent a few moments in the room with the departed partner before eventually departing. I inquired about family, to which the spouse mentioned that all their children lived far away. I asked if there was anything else I could do, and the spouse graciously thanked me for my efforts before leaving the department.

For the remainder of my shift, I couldn’t shake the image of this elderly individual slowly walking down the hallway, carrying their spouse’s belongings in a hospital bag, heading to their car to drive home alone and enter an empty house. In the brief moments we spent together, I realized they had likely kissed goodbye before the routine procedure, exchanged “I love you’s,” and continued on, unaware that it would be their final interaction. This realization brings me some solace, and I hope it brings the same to them.

+

Veronica Bonales is an emergency physician.

But for the kid we treated with his index finger in the door-frame, it was a real nightmare. His painful howl made the entire neighbourhood scramble out for help. At that critical moment, despite the chaos and panic, his quick-thinking mom managed to put the amputated piece of the finger in a Ziploc bag along with some ice and brought it along to the ER. It was a wise move that surprised even the seasoned ER doctors.

The plastic surgeon on call attended the case and immediately went to work. The kid was anaesthetised and taken to the operating room. The cut piece of finger was

surprisingly well preserved in ice. Tendons were sutured, nerves reconnected, blood vessels stitched together. After a grueling 8-hour-surgery, the cut finger was reconnected. While the kid slept in the recovery room with his finger bandaged, the surgical team kept their fingers crossed as to whether or not the finger wouldlive and hold.

72 hours later, chocolates made the kid giggle, and his finger-tip movement made the surgical team smile and his mother cry.

Three days later the kid was discharged on antibiotics.

Not the end of the story.

At home like any other kid, he wanted to play. His dirty toys, rusty soldiers and water pistols were not something

that the mom endorsed. She was bothered by the possibility of infection to the repaired finger. To provide one more layer of protection, she put a “polyethylene cover” over the bandaged finger, and to prevent it from slipping off, she put a rubber band over it.

Two days later when she brought him for change of dressing, the finger had become black and gangrenous due to the arterial blood supply being cut off by the rubber-band; the comfortably snug rubber-band had become tighter because of the edema of the swollen finger.

The surgical team gasped in shock and blamed the mother. She sobbed silently, her image transformed from a sharp-thinking mom to an uncaring caretaker.

There was no other option: the finger was amputated. The kid’s wound healed and his physical debility would be minimal but the mother’s bruised psyche would never recover.

BINGEREAD

MEDICALEXAMINER

Probably not.

Didn t you and your wife just celebrate an anniversary?

Believe me, couldn t forget that day.

, She wouldn t let you?

Exactly. She left jewelry catalogs all over the house.

So what did you end up giving her?

A beautiful magazine rack.

THE MYSTERY WORD

The Mystery Word for this issue: BDDEIES

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

ACROSS

1. Hyper letters

5. Use it to stop

10. Kitty in an office wager

14. Hilo feast

15. Nimble

16. Running in neutral

17. Shakespeare was one

18. Collection of facts book 20. Large area employer 21. Matured 22. Pyromaniac’s deed 23. Go from first to second

Drug category, in brief

Type of pin

USC Aiken team 31. Liquid waste

Noted artist family

I Like _____ (50s political slogan) 36. Assemble

Local Orchard

Egg cell

NBC show

Aquatic possum

Over or under follower

Commercial in London

North American deer

DOWN

1. Hollywood’s

WORDS

11. Probability

12. Potpourri

19. Cabbage ______

21. Ceremony

24. Seize (archaic or poetic)

25. Solemn promise

26. Totals

27. James Brown is one

28. Quarter bushel

29. Major local artery

30. Cranium

32. Cried

33. Ming, once an NBA star

35. TV award

37. Riverwalk, for example

38. Home of Case Western Reserve University

40. Shouts 41. Walk in shallow water 43. Truth 44. In a very skilled manner

Word that can precede color 47. Unexplained death of a baby (acronym)

Make a sweater

Notion

Ballesteros, to friends 52. Monte’s last name?

Lyft competitor

Entry level nurse (abbrev)

Music genre

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.

Jessica

2. Couple or pair (poetic)

3. Longest-serving mayor in Atlanta history

4. A flop

5. Appease; placate

6. The Nile flows through it

7. Gaming cubes

8. Entirely

9. Zodiac sign

10. Georgia county named for the 14th US president

13. Containing little fat

THEBESTMEDICINE

Super Bowl. He did attend, though, and before the service the minister offered his condolences.

“I’m so sorry for your loss,” he said to Bill. “Is there anything I can do for you?”

“Can you give me the Wi-Fi password for this place?”

“You do realize we’re about to bury your wife...” began the minister.

“Is that all lower case?” asked Bill.

The Advice Doctor©

Three friends are fishing from the shore of a beautiful lake when they see a bearded man in a long flowing white robe walking toward them across the surface of the water. He reaches the men and the first one speaks up immediately. “Lord! I know it’s you! Please help me. I broke my ankle as a child and it never healed properly. I’m in pain every day. Please heal me.”

The Lord touched his ankle and the man was instantly pain-free for the first time in 50 years.

“Dear Jesus,” begged the second man, “a firecracker blew out my eardrum when I was just a boy. I’ve been deaf in that ear ever since. Will you help me too?”

Jesus gently touched his ear and the man’s hearing was instantly restored to perfection. He then looked kindly toward the third man and asked how he could help him.

“Don’t you dare touch me!” screamed the man. “I’m on Workman’s Comp!”

Bill and his wife had such a stormy marriage that when she died some of his friends wondered if he would even show up for her funeral. Plus it was held on the same day as the

“Daddy, I want a pet elephant!” said the spoiled brat.

“I’m sorry sweetheart, but we can’t do that,” said her father. “We couldn’t afford to feed such a huge beast.”

“Then get me one from the zoo, daddy!”

“What difference would that make?” her father asked in exasperation.

“You’re not supposed to feed those elephants!”

Moe: Did you hear about the suicidal geologist who threatened to jump off a cliff?

Joe: No, what happened?

Moe: It was actually a bluff.

Moe: I wish I could write my autobiography.

Joe: What’s holding you back?

Moe: I hate to admit it, but I haven’t done anything worth writing about. I’m all about good intentions with no follow-through.

Joe: You could write an oughtobiography.

Moe: Do you know how to make gold soup?

Joe: Never heard of it. What’s the recipe?

Moe: Start with 24 carrots...

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!

Dear Advice Doctor,

Ever since the pandemic, my husband has gotten more and more paranoid. He was and is anti-vax, of course, and did not believe there ever was a pandemic. He views global warming as a hoax too. But those were all national and global issues. These days it’s up close and personal: he thinks our house is bugged. How can I convince him that’s not even logical?

— Looking for a little sanity

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

Dear Looking,

Thank you for sending me this question. I hope the answer will be beneficial to many people.

Your point of view is plainly evident from the tone of your letter, so I know I am about to disappoint you: your husband is absolutely right to be concerned.

And it isn’t just me saying this, either. Many health organizations warn about the dangers of bugs. The Environmental Protection Agency (EPA) has an A to Z information directory that runs the gamut from bees and bed bugs all the way to ticks and fleas. Just think about the common bugs that spread disease: flies, ticks, roaches, mosquitoes and more; and the list of diseases they spread is even longer: Lyme disease, Zika, dengue fever, malaria, yellow fever, plague (yes, even in 2023), Eastern equine encephalitis, West Nile virus, and numerous others.

We happen to live in a semi-tropical part of the world (at least it feels that way this time of year), so bugs can be more of an issue here than they might be in a northern climate. However, most areas of the world have their own particular brand of pests, and summertime travelers should be alert to any insect dangers at their vacation destination.

The EPA website has a list of safe and effective insect repellents for all populations, including women who are pregnant and breastfeeding, and (with certain precautions) babies and children. One word of advice they offer: if using sunscreen (highly recommended), apply insect repellent after applying sunscreen.

It’s not enough to simply acknowledge that your husband wins this round; it’s important to take action. Make sure there is no standing water in the yard — or inside, such as saucers under houseplants — where mosquitoes can breed. Change water in bird feeders and fountains at least once a week. Get rid of those bugs!

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

THE MYSTERY SOLVED

...cleverly hidden on a package in the p. 7 ad for PARKS PHARMACY

THE WINNER: SHYANNE GREEN!

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.

I DIDN’T FAINT IN THE DELIVERY ROOM, BUT... I’ve witnessed the birth of four kids, each birth worse then the other. I’ve never fainted, however I definitely got a bit lightheaded with OUR last one.

My first child took forever to come out, not uncommon for a first time mother. Our second child involved back labor, and was very stressful. The third had the cord around its neck. Those three were all stressful in their own way. But the 4th came close to breaking me.

Once we were in the hospital and labor was coming along, the doctors found two things, ironically a combination of the previous two. My wife was having a second back labor, and the cord was around the babies neck. She had to go through most of her labor on all fours because whenever she laid down, the baby’s heartbeat would slow, evidently an effect of the cord strangling its ability to breathe.

When the baby was finally born, it took the doctors three minutes to resuscitate it. Doesn’t sound that long until you consider the idea of waiting 180 seconds for your baby to either take a breath or be pronounced dead.

When my son finally started crying, I had to stabilize myself on the birthing table because my legs had turned to jelly, and I too was bawling like a baby. In that moment I was definitely not the emotional rock my wife had come to depend on.

J. Shah, MD Vascular Surgery

Alain Domkam, MD Vascular Surgery

Risha Malik, MD Endocrinology

Sergei