Medical Examiner 8-18-23

MEDICALEXAMINER

THECWORD

Along with being National Back to School Month, August is National Immunization Awareness Month, making it a wonderful time to get your children caught up on their vaccines. According to the World Health Organization, we now have vaccines that prevent more than 20 life-threatening diseases,1 including certain cancers caused by the Human Papilloma Virus (HPV).

HPV and Cancer

HOWOLD ARE YOU?

“Age is just a number,” goes a stale old quip, “and mine is unlisted.” Maybe that line was already stale twenty years ago, but age is just a number is a profound truth. That number — whatever it might be for any one of us — has no particular bearing on anything. One person in their 40s or 50s might be out of breath as they hobble painfully around on wobbly knees, while for someone else in their 70s it’s no big deal to walk 5 brisk miles every morning.

The perfect Exhibit A might be the two men above, Kentucky senator Mitch McConnell and Rolling Stones lead singer Mick Jagger. We won’t tell you which one is which, age-wise, but one man is 80 and the other is 81. They may be

contemporaries as defined by date of birth, but if you’ve seen them both at work, their ages might as well be decades apart.

Remember when you thought 40 or 50 was absolutely ancient? When you reached those milestone ages you may have realized how wrong you were: “old age” was still far into the distant future. Or maybe you were right after all and at 40 or 50 you really did feel ancient. What makes the difference? It’s the investment each of us makes in our health throughout life. Living a salubrious lifestyle pays handsome dividends, especially after investing for years. But even for those who get a late start, the payoffs are still there.

The CDC estimates 85% of people will get an HPV infection in their lifetime.3 HPV can cause cancers of the cervix, vagina, and vulva; penis; anus; and back of the throat (oropharyngeal). It is also responsible for genital warts. It is spread through skin-to-skin contact and is the most common sexually transmitted infection in the United States.2 Fortunately, an effective and safe vaccine is available that can protect your children against the virus and dramatically reduce their risk for HPV associated cancers later in life.

The Amazing HPV Vaccine

augusta.edu/cancer/community

The HPV vaccine is highly effective in protecting against nine of the highest risk strains of the virus.4 For people vaccinated before being exposed to HPV, the vaccine is more than 90% effective at protecting against HPV associated cancers and almost 100% effective at protecting against genital warts.4 Most HPV transmission happens when people first become sexually active, so it is best to get vaccinated early before sexual contact occurs. For this reason, the recommended age for HPV vaccination is 11 to 12, but the series is routinely given to anyone ages 9-26 and is approved for people up to age 45.5 When children are vaccinated before the age of 15,

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 10-year-old son simply refuses to keep his room clean. If you don’t check several times a day, you will find old food, half-finished drinks, various toys, and dirty clothes completely covering the floor. You feel like you have tried everything, but he doesn’t seem to mind living in a mess. You end up cleaning his room yourself to prevent your house being condemned by the health department. What do you do?

A. Choose a reasonable consequence and stay with it. For example, if you say no TV or computer until the room is cleaned, make sure that it happens. It may take several weeks to show some improvement.

B. Get him to clean his room when you can, but don’t make a daily battle of it. Come to terms with the possibility that your son might just be a slob.

C. Shut the door to his room and don’t clean it no matter how bad it gets. If you wait long enough, he will get tired of living in a mess and clean it.

D. Tell him that it is his responsibility to clean his room and that if you have to do it for him, you will charge him from his allowance for your time. Hitting him in the wallet might bring him around.

If you answered:

A. This is probably as good a response as any, but remember that you have to be completely consistent for it to work.

B. It could be that this is what you will end up with, but it’s probably better to try some other things before you give up completely.

C. This is what most child psychologists and “experts” recommend, but I have never encountered a parent who could outwait a messy kid. Good luck if you try it.

D. This is a reasonable response and also as good as any. Don’t count too much on it working though.

Messy rooms are probably one of the most difficult things to change when raising a child. Most things don’t work at all and none work very well.

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

CRANBERRY JUICE CURES UTIs

Who hasn’t heard this myth? Answer: no one hasn’t. It is one of the standbys of do-it-yourself medicine and natural cures.

Oh, if only it was true.

That’s not to say drinking cranberry juice is harmful, and it’s not to say it might not help just a little bit when it comes to UTIs (urinary tract infections). But anyone who has such an infection wants a definite cure, not a maybe cure.

According to a 2012 review of some two dozen studies of the effectiveness of cranberry juice, it offers just a 14% lower risk of UTI compared to no treatment or placebo, and study authors cautioned that was an especially optimistic number.

And a 2011 European Food Safety Authority examination of the “claim on cranberry fruit products” pertaining to reducing the risk of urinary tract infections in women “has been assessed

with an unfavorable outcome.”

It’s no accident that the European study spefically mentioned the risk among women, who are far more likely than men to get infections. About 1 in 3 women will have a UTI before the age of 24. By comparison, only about 1 in 2,000 men will have a UTI in that same span.

What specifically about cranberry juice was historically thought to help fight UTIs? It was believed that the acidic nature of the fruit (specifically

benzoic acid, citric acid, malic acid, and quinic acid) helped kill bacteria. More recently the medical concensus is that cranberry juice will help you flush out the bacteria, but it doesn’t affect the growth rate of E-coli bacteria that is the source of UTIs.

So even if cranberry juice doesn’t help much (or at all) with preventing UTI’s directly, drinking more fluids when you have a UTI is helpful for flushing out bacteria, and the proanthocyanidins and flavonols in cranberry juice may well help a bit in that process. It just won’t specifically cure the infection.

Even so, drinking cranberry juice is a good thing even with nary a UTI in sight. Several studies have shown that those flavonols in the juice might be helpful in preventing cancer, among other health benefits of drinking cranberry juice.

Of course, it’s not necessary to have (or want to prevent) any medical condition in order to enjoy cranberry juice. The stuff is delicious in its own right.

AVOID PAGE 13 IF POSSIBLE

they only need two doses of the vaccine. After age 15, a three-shot series is required to ensure protection.

It is worth emphasizing that all children, not just girls, should be vaccinated against HPV because it prevents infections that can cause all of the cancers listed in paragraph two. In 2021, only 61.7% of 13-year-olds were up to date on their HPV vaccinations, leaving a large percentage susceptible to cancer.6 Researchers have theorized there are several reasons HPV vaccination rates lag behind other routine vaccines, including disruption to routine healthcare caused by the COVID-19 pandemic and caregiver’s concerns.

Addressing Caregiver’s Concerns

Every caregiver wants the best for their children, and it is normal to have questions

about their health care. Two of the more common questions pediatricians address pertaining to the HPV vaccine relate to its safety and effect on sexual behavior. Fortunately, extensive research addresses both.

Safety: The HPV vaccine is backed by over 15 years of monitoring and research.7 It has no long-term side effects and has an excellent safety record.7 The HPV vaccine does not cause fertility problems, but some cancers caused by HPV require treatment that can limit a person’s ability to have children.

Sexual behavior: Numerous research studies completed in populations of adolescent girls as well as college-aged women and men have concluded that getting vaccinated against HPV does not make them more likely to start having sex or increase any other sexual risk-taking behaviors.8-10

Bottom Line

Making the decision have your children vaccinated against HPV before they are exposed to the virus provides them with “safe, effective, and long-lasting protection against cancers caused by HPV.”7 Because the HPV vaccine is not required for school entry by most jurisdictions, you may have to bring it up with your children’s pediatrician. Start the conversation as soon as you can. Your decision to vaccinate your children now can save them from cancer later.

“The C Word” is a news brief of the Georgia Cancer Center at Augusta University. For cancer information, visit: augusta.edu/cancer/community. To request exhibits or speaking engagements, contact Maryclaire Regan at mregan@augusta.edu or 706-7214539. Virtual presentations are also available.

Sources:

1. World Health Organization- https:// www.who.int/health-topics/vaccines-and-immunization#tab=tab_1

2. Planned Parenthood- https://www. plannedparenthood.org/learn/stds-hivsafer-sex/hpv

3. https://www.cdc.gov/hpv/parents/ vaccine/six-reasons.html#:~:text=HPV%20vaccination%20is%20cancer%20 prevention,attendance%20for%20a%20 baseball%20game

4. The American College of Obstetricians and Gynecologists- https://www.acog. org/womens-health/experts-and-stories/the-latest/what-i-tell-every-patient-about-the-hpv-vaccine#:~:text=The%20vaccine%20is%20 very%2C%20very,that%20could%20 lead%20to%20cancer

5. Centers for Disease Control and Prevention- https://www.cdc.gov/hpv/

hcp/schedules-recommendations.html#:~:text=HPV%20vaccination%20provides%20the%20most,vaccinated%20 when%20they%20were%20younger

6. Centers for Disease Control and Prevention- https://www.cdc.gov/mmwr/ volumes/71/wr/mm7135a1.htm#:~:text=Coverage%20with%20≥1%20 HPV%20vaccine%20dose%20in%20 2021%20was,1%20MenB%20dose%20 was%2031.4%25

7. Centers for Disease Control and Prevention- https://www.cdc.gov/hpv/ parents/vaccinesafety.html

8. American Journal of Preventative Medicine- https://doi.org/10.1016/j.amepre.2011.09.024

9. Canadian Medical Association Journal- https://doi.org/10.1503/ cmaj.140900

10. BMC Public Health- https://doi. org/10.1186/s12889-019-7134-1

Who is this?

SHORTSTORIES

IF A COLONOSCOPY IS PAINLESS, AS DOCTORS WILL OFTEN SAY, WHY DO THEY SUGGEST SEDATION? WHY DO THEY THINK A PAINLESS PROCEDURE NEEDS ANESTHESIA?

When the photograph above was taken, this woman would never have dreamed that she would become the center of a worldwide debate about medical, legal, theological, ethical, political, and social issues that would eventually include Congress, the White House, and even the pope. The ramifications of her case echo to this day, and include questions about the most fundamental aspects of life and death. As one small example, there was and still is debate about whether she died at age 26 or at age 41. Crazy, right?

Some things about her case are black & white facts: she was born Theresa Marie Schindler on December 3, 1963. Just a few weeks before her 21st birthday she married Michael Schiavo, and in 1986 they moved to Florida. There, in the early morning hours of Sunday, Feb. 25, 1990, Terri Schiavo collapsed in a hallway of their apartment in St. Petersburg. Her husband called 9-1-1, but did not perform CPR, a significant lapse since (whether he knew it at the time or not) she was in full cardiac arrest. As a result of oxygen deprivation from the time of her collapse until paramedics resuscitated her, she suffered massive, irreversible brain damage and was left comatose. About 10 weeks after her collapse, doctors determined she was in a persistent vegetative state (PVS), an important distinction since patients can and often do awaken from comas and recover completely, while PVS in nearly all cases is marked by total and permanent loss of cognitive ability.

Despite the PVS diagnosis just weeks after the initial event, the Schindlers contested that finding tirelessly, asserting that their daughter was in a minimal state of consciousness — even responding to visual and sound stimuli and trying to speak — and could be rehabilitated. They filed dozens of legal challenges in local, state, and federal courts to prevent actions that would be the norm in PVS cases.

For instance, at some point doctors and family members usually conclude that further treatment of any kind, including feeding tubes, is pointless in situations where there is virtually no hope of recovery. Terry Schiavo’s husband (also her legal guardian) came to that realization after four full years of treatment, both basic and experimental, but his inlaws were granted dozens of temporary stays to prevent the stoppage of Terri’s life sustaining treatments. They lobbied for the passage of “Terri’s Law,” a Florida statute that was designed to make it harder to withhold nutrition for people in situations like Schiavo’s. The law was quickly determined to be unconstitutional, but no fact or obstacle was too great for the Schindler family: after Terri’s death at age 41 in 2005 (although some contended she died in 1990 at age 26), her autopsy established that she was blind and severely brain damaged, her brain measuring only half the weight expected for a female of her age, height, and weight. Even so, that and every other medical finding was disputed by the Schindler family, which still maintains a website (terrischiavo.org) contesting everything determined by doctors.

A number of thoughtful analyses of the Schiavo case and the lessons it offers can be found online. Here is a link to one of the better ones: https://www.mayoclinicproceedings.org/ article/S0025-6196(11)61439-0/fulltext.

One general takeaway: very few of us have completed an advance medical directive document; that should change. +

I’ve been a nurse for almost 20 years, 17 of which have been in GI. I do colonoscopies and endoscopies all day, every day, and for the most part I can really say I love what I do. Since that’s been my home for so long I feel like I can help answer this question. I always tell my patients a few basic things. #1-the prep is the worst part. #2-the IV is the 2nd worst part. #3-the sedation is the best part. It works fast, you wake up fast, and generally you feel pretty good! We almost always use propofol and it is very safe and very comfortable for patients. Colonoscopies really aren’t terribly painful because you don’t have nerve endings in your colon like you have in, say, your fingertips. So you don’t usually feel sharp pain there. But what you DO feel is pressure. We fill the colon full of air and water and that allows us to expand it to see the wall. We need a good view because we need to look for polyps or other causes of concern, and when it’s collapsed in on itself we just can’t see. So it makes you feel a “fullness” like you need to go to the bathroom or pass gas. It isn’t particularly comfortable for most people, especially feeling that they’ll empty their bowels on the stretcher or all over your doctor. We see the entire large intestine and where the small bowel empties into the large intestine. Naturally, things go the opposite direction to flow out, not in, so it does feel pretty uncomfortable. Once we reach the extent of our scope and start moving the way your body naturally flows, it’s much easier and we can cut back on the sedation and start the wake up process. So while I’ve done several patients unsedated, most people want some light sedation just to make it all more comfortable. But we do not insist on sedation. If you feel you can manage we are willing to try with no sedation. It’s not very common but it sometimes happens when people don’t have a driver to get home since we absolutely will not perform the procedure with sedation if you don’t have someone to take you home. The medications generally wear off in 15–20 minutes and you can be on your way to lunch in half an hour (as long as you’re not the one driving!). We also try to remove some of that air when we are on our way out to make you more comfortable, but there will still be some to pass, and we encourage you to let that out for your own comfort and so we know things are moving as they should.

SHORTSTORIES

AS AN EMERGENCY ROOM DOCTOR OR NURSE, WHAT WERE SOME INJURIES YOU’VE SEEN PATIENTS ENTER THE HOSPITAL WITH THAT STILL PERPLEX YOU, EVEN AFTER THEY WERE TREATED? I once had a patient that had a chain saw injury across the top of his thigh. These injuries need to be assessed quickly for vascular and/or nerve injury. Everything was intact and there was just a bloody mess where the chain saw had morselized the top of his thigh and blue jeans. I was just reaching the point where the initial stress of the assessment and course of treatment were over and I could entertain additional thoughts. I started to think “This is weird. I just had one of these four weeks ago.”

At that very moment the patient said “Remember me, Doc? You stitched up my other leg about a month ago.” Same injury but the other leg.

I told him “No offense, my friend, but you need to find yourself another hobby.”

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Middle Age

BY J.B. COLLUM

Welcome to part three of the saga of me going from an overweight, sickly, middle-aged guy who is so out of shape that he gets winded just looking at a set of steps, to the future me, who is still a middle-aged guy, but is much healthier, weighs a lot less, can actually walk a couple of miles without sweating a river and sucking all the oxygen out of a house. It will not be a short trip, thus the use of the word saga earlier. I have already regaled you with the changes I have made to my diet, and even some changes I have not made, but am merely considering. If you haven’t read parts one and two yet, I’ll give you a few minutes to go do that, but if you already have, or just don’t care about the diet portion of my plan, feel free to move on now

WHEN THEY SAY 1/4 MILE, THEY MEAN TWICE THAT

I mentioned in the closing portion of the last installment that I had joined a gym, and a friend was meeting me there three days a week. Having a buddy to do this with helps in a lot of ways. If I don’t want to get up at 5:30 on a particular day to drive for 20 minutes and sweat, just knowing that I will let a friend down makes me do it anyway. Of course, the fact that this friend, Louie is his name, would also never let me hear the end of it if I skipped a day, is also incentive. Men can be really tough on each other sometimes, but in this case, it is tough love. I would do the same if the roles were reversed. We both recognize the urgent need to get in better shape as both of our gas gauges are below half-empty, if you know what I mean. We are on the downhill portion of life, but it feels more and more like I am walking uphill. Oh wait, that is because I am walking uphill.

The first thing we do each trip to the gym is to warm up on the treadmills with the rolling hills option that randomly inclines the treadmill at various angles to help us get our heart rates up. We do that for at least half an hour, and then move on to various exercises that were laid out for us by the trainer. He based the exercises on our age, physical state, injuries, etc. I half expected him to take one look at us and say we should just walk for a couple of years and then come back to discuss the next steps, but I am happy to say that he even had a plan for my sorry physical state that included a well-rounded list of exercises to stretch muscles, build them, increase stamina, lose weight, and provide cardiovascular benefits. It also includes things to do on the days I don’t go to the gym, though these are mostly of the walking and stretching variety.

Exercise doesn’t mean being confined to the walls of a gym or your house. My wife and I have gotten back to camping again recently and one of her favorite things to do is to take me on hiking trails to see beautiful waterfalls that are located in places that you

can’t drive to. I need to talk to the designer and builder of these waterfalls about the poor placement of them. Imagine building something so beautiful so far from the road! What were they thinking? Just since the last issue, she took me to Tallulah Falls in Tallulah Gorge State Park, and we went down at least 3000 steps, though they claim it is “only” 310 steps. Of course, going down that many steps also meant we had to go back up that many steps. To be fair, she didn’t expect me to do that. She took me first to a quarter mile trail that allowed us to see some of the gorge and she was going to leave it that. When I told her that I wanted to attempt the longer hike, mostly because I knew she wanted to, she hesitated and asked me if I was sure. After confirming that she had upped my life insurance before the trip, I agreed, and we set off on our adventure. As I write this now, I think I might have been played, but I will leave that for another day and time. Besides the steps there was also a very steep trail. The steps were for the parts that got too steep. It was a beautiful walk, and though I had to take my time coming back up, I actually did much better than I had expected. It feels like my recent activity is making a difference.

The next day she promised to go easier on me. She even promised that we wouldn’t be hiking any trails. We were just going to drive over to Black Rock Mountain State Park near Clayton, Georgia, to scout out how it would be to pull our large rig up there. The host at our current campground was concerned that we were going to attempt it and suggested we go take a look on this trip. So we did, and I will say that I understand the concern about getting our camper up there and on the spot. The roads are narrow and very winding, so our 55-foot-long combo of truck and camper will be a challenge, but one we feel we can overcome. After that, we went to the top of the mountain to the visitor’s center and the view was spectacular. We sat down in the less humid and cooler air up there on some rocking chairs and just relaxed for a while.

As we left the visitor’s center in the truck with the AC blowing right on my face, I was really looking forward to getting back to the campsite and relaxing and then having a nice meal. However, as we passed the trailhead for a waterfall, she who must be obeyed wanted to park at a nearby overlook and enjoy the view. After we did that, she looked longingly at the sign for the waterfall trail that said it was only a quarter mile, although the guidebook said it was a strenuous walk. I never can resist when she really wants something, so we started down the trail. I think I know what went wrong here. When they say a trail is a quarter mile, that’s how far it is in the x

WHAT IS CORTISONE?

Many people with joint pain and inflammation are quite familiar with cortisone, a medicine that relieves pain and helps reduce inflammation (swelling).

Cortisone is actually a man-made version of a naturally occurring hormone called cortisol that is produced by the adrenal glands. Cortisone is a type of corticosteroid, a class of steroid hormones with a huge variety of applications in different formulations all over the body. Although corticosteroid is often shortened to “steroid,” corticosteroids are not the same thing as anabolic steriods, the kind athletes sometimes use to bulk up or to gain a competitive edge over their opponents.

Cortisone is often administered by injection directly into the source of the problem, be that a hip, knee, shoulder, spine, feet, hands, or elsewhere. Recipients are often dealing with tendinitis, various versions of arthritis, bursitis, carpal tunnel syndrome, gout, tennis elbow, trigger finger, or some other joint, tendon or bone issue.

Cortisone shots are slightly slow to act, but they make up for it over time. Relief from the injection may take a day or two (and perhaps up to a full week) to take full effect, but the benefit can last anywhere from a few weeks to several months. Sometimes a single injection is enough to provide permanent relief, since it can eliminate the injection site’s pain and inflammation long enough for the body to finish its own job of healing.

That’s a good thing because long-term cortisone use can damage bones and tendons around the injection site. For that reason doctors like to spread cortisone injections out over time. Some doctors prefer to limit cortisone shots to the same area of the body to perhaps three a year.

Injections are not the only route of administration for cortisone. There are oral and topical cortisone medications for treating everything from systemic inflammation and asthma to bug bites and poison ivy

Cortisone and its related adrenal cortex-generated hormone derivatives are so useful that the men who discovered and isolated them for medical applications earned the 1950 Nobel Prize in Physiology or Medicine for their work.

IS IT PARANOIA? OR REALITY?

Henry knew he saw things differently. But so did Einstein, Henry figured. Some folks thought Henry paranoid. Other said he was crazy. Nobody thought him a druggie. Clearly, he was not. Some strange things, he did physically. Others, he did mentally. He had thoughts different than others.

Late one night, Henry fired up his Apple computer and spliced it with his old 8-transistor radio, a CB radio stolen from a wrecked semi, a Motorola pager, a junk yard guitar amplifier, and a portable cardiac monitor … just before lightning struck his power supply. When the sparks settled down and the smoke cleared, things were different.

Next thing he knew, he was hacked into encoded communications between an alien sleeper cell scouting out the United States of America for a potential takeover. The info came in brief blurps and spurts intended

BASED ON A TRUE STORY

(most of the time)

A series by Bad Billy Laveau

for interpretation by superior intelligence. It went something like this.

Humans are obsessed with throwing various sized balls through assorted holes. They call it sports, with all sorts of rules about what they can and cannot do. Ball chunkers are paid huge sums of money and feel a need to tell everyone else what to think about everything.

Humans shoot each other during parties. They never seem to kill a thug, thief, wife abuser, dead beat, or some similar low-life. The unfortunate ones killed are always the best of society, heroes, saints, pillars of the

communities. TV reports make sure everyone knows that.

No country is happy with their neighbor and they frequently kill millions of them with bullets, mines, bombs, poison gases, or other implements of destruction. Everybody claims God is on their side. The winner is always right because they get to write the history.

The young stay up all night. The old sleep all day and all night. The young and the old each think the other is out of touch and misguided. They wear different clothing based on what they think is cool, but actually their decisions are made by marketing agencies.

TV is obsessed with mixed race couples. The actorsspokespersons get fatter each year. Each product is always greater than anything before. If you don’t believe it, some self-assuming celebrity will straighten you out. They have therapists

for every mental problem imaginable. No one is ever cured of the disorder they complained of to begin with. Every year the medical community comes out with a few new diseases that no one ever worried about before. Sometimes, it is just new names for old disorders. Example: First, it was “lack of moral fiber.” Then, it was “battle fatigue.” Then it was “nervous breakdown.” Now, it’s PTSD. I wonder what it will be next. The bottom line is that people get really upset about almost getting killed.

The wealthy go to these therapists. The poor go to church. Others take street drugs to change how they see things.

Most humans have a car and a cell phone, even the homeless.

Humans from all other countries want to come to America even if they hate American ideas on freedom and religion.

The USA makes new laws almost daily and enforces all their laws strictly. Except for politicians and illegal aliens, who seem to be immune to these laws.

Humans are obsessed with movement. They have to be going somewhere all the time.

Whatever humans have, it is never enough. They always want more.

They demand movies glorifying illegal acts, car

chases, shoot-outs, blood and gore.

Everyone seems to agree you can’t kill a newborn baby. But half of them think it is OK to kill a baby before it is born. But if you kill a pregnant mother, you get charged with two murders.

Well, hearing all of this, Henry’s physician hung the diagnosis of paranoid schizophrenic on Henry and got paid for doing so.

While it is true the electronic conglomeration described above had no physical being and existed only in Henry’s mind … were his observations also imaginary? Were they paranoia? Or were these observations actually true and present in our society today?

Henry was treated with FDA-approved medications and he became a little less strange, according to his family and his physician. His electronic equipment was suddenly gone. So was the sleeper cell of aliens. Certainly, according to modern medical teachings, his paranoid schizophrenia is “under treatment and clinically improving.”

The problem is that when you and I look at our society, many of Henry’s paranoid observations seem to be actually correct and accurate. Does this mean all of us are a bit paranoid? Or does this mean that maybe Henry was not as crazy as we once thought?

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

If you think you don’t like Brussels sprouts give this recipe a shot. It will turn you into a Brussels sprouts eater in no time!

Ingredients

• 1 cup pomegranate juice

• 1 tablespoon honey

• Vegetable oil cooking spray

• 1 tablespoon extra-virgin olive oil

• 1 pound Brussels sprouts

• 1 cup julienned carrots (carrots cut into thin strips)

• ½ teaspoon salt

• ¼ teaspoon pepper

• ¼ cup toasted walnuts

Directions

Preheat the oven to 400 degrees.

Place pomegranate juice and honey in a small saucepan over medium-high heat. Cook for 15 minutes or until the juice is reduced to ¼ cup or less and a little “syrupy”. Meanwhile, line a baking sheet with aluminum foil for easy clean up. Coat the aluminum with cooking spray and add the oil; set aside.

To prepare the Brussels sprouts, remove the outer leaves and trim the brown stem end. Cut the small ones in half and the larger ones in quarters and place on the prepared baking sheet. Add

the carrots to the baking sheet and toss the vegetables to coat in oil. Sprinkle with salt and pepper and roast for 20 minutes turning halfway through cooking time to promote even browning. Once done drizzle with the pomegranate reduction and walnuts enjoy! Note you may not use all of the syrup.

Yield: 6 servings (serving size: 1/2 cup)

Nutrition Breakdown: Calories 130, Fat 6g (0g saturated, 1.8g monounsaturated), Cholesterol 0mg, Sodium 135mg, Carbohydrate 18g, Fiber 4g, Protein 4g Percent Daily

Value: 110% Vitamin C, 80%

Vitamin A, 6% Calcium, 8% Iron Diabetes Exchanges: 2 Vegetables, 1 Starch, 1 Fat

THE C&C DIFFERENCE

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FEAR NOT!

by Ken Wilson Steppingstones to Recovery

When I see the word FEAR, my adrenaline starts pumping and my anxiety rises! I’m waiting for the punchline! When it comes to recovery from addiction, however, the word is often used as an acronym: False Expectations Appearing Real. When this idiom is voiced in recovery circles it’s a reminder to not project certain outcomes in our brain as reality. A preplanned outcome can be a set-up for disappointment.

Often families in recovery expect a personality overhaul when their loved one quits drinking or drugging. They are tired of the Dr. Jekyll and Mr. Hyde effect – a lovely person when clean and sober but a real grizzly when using. Usually the newly recovering substance abuser is quite a different person after treatment. But not always so. You see, the issue isn’t chemical use. Recently I saw a Facebook post – I can’t find it now and don’t know who to give credit to - but it was a photo of a young man who said “One day I woke up in a hospital and the doctor asked me “What is your problem?” I replied “I am an alcoholic and an addict.” The doctor said, “No, that’s how you have been treating your problem!”

A mental picture of this concept might be looking at an iceberg with the label “Alcohol” on the 10-15% of the

mass that is visible above the water line, and the remainder of it below the water line labeled “my life problems.” If one stops drinking (top part) but doesn’t address the bottom portion of it he or she will drink or drug again, or will be that miserable person who is referred to in recovery circles as a “dry drunk.”

That’s what recovery is about. The first phase, of course, is cessation of drinking and drugging. A treatment program makes this phase much easier than trying to do it alone. Then comes the psychic change, a “spiritual” revolution. When the founder of the first 12-step program, Bill Wilson, spoke to crowds he rarely used the word “alcohol.” He spoke instead about a “return to sanity.” In fact, the word “alcohol” is only used once in the basic 12-steps of recovery. Step programs focus on this return to sanity. And results take time. The words used in the 12 steps for this focus is “character defects,” which newly recovering substance abusers dedicate themselves to correcting. It is a program of grueling honesty and often not a pretty picture. This is a never-ending lifestyle –those “working the steps” for 20 -30 years being just as dedicated to the task as they were at the outset.

A wife I knew many years ago was hoping her husband would spend more time with

THIS IS YOUR BRAIN

her at home after he completed a treatment program. She was surprised when he spent most evenings after work at his recovery meetings, and weekends with new recovering friends. He felt it was necessary to maintain his sobriety in early recovery. She expected him to be her whole life like he was when he was drinking heavily, when she would pour his drinks “one an hour” for him, get him to bed most evenings, clean up after him when he was sick from excessive drinking, call in sick for him on Monday mornings, and fib about his whereabouts when he didn’t show up to social functions. She did not feel needed like she used to feel, and sobbed to me, “I liked him better when he was drinking.” I pointed her to a companion group consisting largely of wives of alcoholics and she finally came into her own and became a whole person and a leader in the group. Their marriage still survives because of it.

You have a real treasure if you know someone in longterm recovery or even in early recovery.

FEAR not!

“My barber is dumb.”

me backwards.”

The Money Doctor WHY YOUR SAVINGS RATE MATTERS

The past few months many headlines are shining a spotlight on some negative personal finance trends. Here are a few examples:

“Americans are pulling money out of their 401(k) plans at an alarming rate”

“Americans credit card debt hits a record $1 trillion for first time”

“Americans are saving far less than normal in 2023”

It has been a tough time with 2022 inflation running at the highest it has been in over 30 years. Now in 2023, many Americans are feeling the squeeze, but we are encouraging people to review their family savings rate to help stay on track.

How much should you be saving? Let’s take a deeper dive to help you understand the importance of your savings rate.

Your savings rate is the percentage of personal income saved based on your total gross personal income received during a period of time. A negative rate means you spend more than you receive. So, if you receive $5,000 this month and save $1,000 your personal savings rate equals 20 percent. For those in the accumulation phase, we like to see a 15-20 percent savings rate toward retirement. Your overall savings rate may be more than 20 percent when you include all other savings goals and debt payoff. Why the 15-20 percent savings rate?

The math behind reaching financial independence is fairly simple. By making a few basic assumptions, in this case a 5 percent real investment return and 4 percent real withdrawal rate, the following chart is the result.

Using the chart you can see how it works. If you make $100,000 per year and save

50 percent, then you only need your investments to provide $50,000 per year in income and you can reach that point after about 16 years. If you save 10 percent, t hen you need your investments to provide $90,000 of income, which would require 50 years of savings. For a person who starts working around the age of 18 to 22, saving 15-20 percent each year will help you reach financial independence in 36 to 42 years or between 55 and 65 years of ageld. When you are young, starting the saving habit from day one, doing it consistently each year and not touching the money are key. As your savings start to add up, working with a financial planner to help you understand all the other items you need to consider will help keep you on track.

It is important to note that the chart and example above oversimplify retirement planning, as it excludes pensions, Social Security, tax planning, long-term care planning, and many other factors that should be considered when planning for retirement or other saving goals. The numbers in the chart give you a feel for how important saving consistently over time

can be. They also demonstrate how living below your means and on a smaller part of your income helps you save more and reach future goals more quickly. Beyond reaching financial goals, saving money as part of your lifestyle has other significant benefits.

Psychologists have studied the impact of individuals’ financial habits on their overall health and wellbeing for many years. They have found that practicing good financial habits such as having a healthy saving rate will help you experience lower levels of stress.

In addition, children learn the majority of their financial habits from family and friends, parents in particular. It is especially important that we take the time to monitor our own saving habits, which will help us demonstrate and teach future generations the habits which will lead to a healthy lifestyle.

Savings rates are something we really enjoy helping clients evaluate and understand. The discussions we have with clients provide peace of mind, promote living a healthy lifestyle, and ensure they pass on positive habits to future generations.

This fall is a great time to evaluate your savings rate. You may be surprised by what you find! A few small changes can make a big difference over time, not just for your financial picture, but also for the health of all members in your family.

by Clayton Quamme, CFP® a financial planner with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

and y planes. It does not include the z plane, the up and down portion of the equation, because we walked for ages — far more than a quarter mile — and as we got to the very bottom, I stepped wrong and hurt the ball of my right foot. I was already suffering with plantar fasciitis in my left foot, so the thought of going back up the trail and especially up the steps struck terror in me. It was at this point that I started getting suspicious about the increased life insurance. I know, I am a little slow. Anyway, I demanded a helicopter for the trip back up, but she paid me no mind, so I had to go back up mostly using the ball of my left foot and the heel of my right foot. I assure you that the pain of the trek back up wiped out any of the humor I may have found in the situation, but that wasn’t true for observers of my torture. I think I remember hearing my better half calling it The Ministry of Silly Walks (Google it if you don’t know), but it may have just been heatstroke. I survived the trip, but I was considerably more winded this time despite the “shorter” trail with fewer steps. I think that was because of the odd way I had to make my way back up the trail. Feet just aren’t designed to work that way.

Once we got home from the trip, my lovely wife bought me a new pair of sneakers to better support my arches and they are making a big difference. I got back to the gym after the trip and seem to be fully recovered. The lessons from this story for me are manifold:

• Make exercise a part of your routine, and start now because now is better than tomorrow, and tomorrow is better than never.

• Find a reliable friend to exercise with and enjoy the mutual encouragement.

• Take time to walk the trails and see the sights of life with your loved ones while you can.

• Never trust your spouse when they promise no hikes that day

• Get good sneakers before exercising.

• Check with your physician before beginning an exercise regimen. (The lawyers made me add this one.)

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

OUR NEXT ISSUE DATE

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

This is a very short story about Amy Groves. When Amy was five years old she lived in Berlin, Germany with her parents and brother Billy. Her father was an officer in the US Army’s elite Berlin Brigade. The Groves family lived in a house at Bibersteig 2 on a large residential city block. Passing traffic sometimes moved very fast and Amy was not allowed to cross the street by herself.

The year was 1977 and the Cold War was indeed very much alive. Jimmy Carter was President and our relationships with countries behind the Iron Curtain, especially the communist German Democratic Republic (East Germany), were not very cordial to say the least. Berlin was 110 miles inside a hostile East Germany, so Americans were very isolated. No matter where you lived in West Berlin, you were never very far from the Berlin Wall and its dastardly implications.

Berlin is very far north, and in the summer full daylight comes very early, around 3 o’clock. Early one June morning, about 5 o’clock, Amy’s mother awoke with a strange

feeling — probably mother’s intuition — and discovered that Amy was not in her bed. The front door was wide open. She quickly searched the house. Amy was gone! She woke up Amy’s father and brother, and the search quickly moved outside as thoughts of every parent’s worst nightmare began to race through their collective minds. Was she kidnapped? Taken by East German agents? Did she just wander off into the Grunewald, a large wooded city park just down the street that was home to wild boar?

As her forlorn family stood in the front yard for a time period that seemed as if it were forever but was probably just a few minutes at most, Amy appeared in the distance. She was jogging! She had on her very stylish German jogging outfit and was just chugging along. She had gone around the block several times and was very surprised at her family’s welcome. All were very relieved that she was safe. Amy’s first words were, “But I didn’t cross the street!” And indeed, she had not.

+

— by Col. William C.

Groves

the blog spot

— posted by Yaacov Bergman on August 9, 2023 (edited for space)

MED SCHOOL AND DYSLEXIA

Sitting in class was always a terrifying experience, not knowing if I was going to be the next one called on to read. My mind would race ahead trying to figure out how to get out of it. I would excuse myself from the room or blame a sore throat, anything to avoid reading in front of my peers. With great effort and perseverance, I got through middle and high school with great grades and lots of hard work.

When I started college, my parents sat me down to have a pre-college conversation. My mother explained to me that I had dyslexia. From that moment, everything clicked for me. That was when I realized what I had been going through my whole life. Finally, I had a reason for the countless hours I spent with tutors learning to read. As I sat there in shock I asked my mother, “How come you never thought to tell me this earlier in my life?” Her response: “Your father and I decided that it would be best for you not to fault your difficulties on dyslexia. We wanted you to learn how to work hard despite it.”

At the time, I felt frustrated and upset with my parents for concealing my diagnosis from me all those years. How could they withhold this information from me, watching me struggle through school?

My college experience was indeed challenging. Taking premed courses was very demanding, and my time was limited due to class and lab time. Yet, I had known from a very young age that I wanted to become a doctor, and nothing was going to stop me from getting there. I would sit in front of my textbooks for hours on end, well past the time my classmates were done. Fortunately, I was able to do well in the sciences and graduated with honors.

After graduation, I started studying diligently for the MCAT putting most of my efforts on the CARS section, only to receive an underwhelming score. I was deeply hurt by my score, but with my wife’s support and encouragement, I got back on the horse and took the MCAT two more times. My MCAT journey taught me to never give up. Although my efforts to improve my CARS score fell short due to my dyslexia, I was adamant to work on my strengths and improve my science sections and did so successfully.

Learning about my dyslexia later in life actually was the greatest gift my parents gave to me. I can now confidently say that I would not be where I am today had they told me my diagnosis earlier in life. Growing up I had nothing to point to for my difficulties. Not having anything to blame for my “bad reading” required me to work extra hard to compensate for my slow and error-prone reading. Ultimately, I still shudder to think of those experiences in class, where I was terrified to read in front of my classmates. However, the diligence and determination that I developed over the years working hard to keep up and do well in school have given me the backbone to succeed in medical school. I was adamant that my difficulty in reading should not hold me back in any aspect of my life.

I am fortunate to live in a time where disabilities like these are no longer stigmatized. I feel empowered to fulfill my dream of becoming a doctor and help people overcome their own challenges. My unique perspective allows me to be able to empathize with and connect with individuals from many different backgrounds. I consider myself fortunate to become a physician with dyslexia and dedicate my life towards helping diverse individuals in the best way that I can. Yaacov

SHORTSTORIES

MY MOST MEMORABLE PATIENT I have seen lots of cancer patients, and I still sometimes remember them as clearly as yesterday.

One that I will never forget was a 44-year old woman I saw during my respiratory medicine rotations.

She had breast cancer and had undergone a mastectomy of her left breast, but the cancer was locally advanced and despite surgery and thirty-some rounds of radiotherapy and two or three rounds of chemotherapy, she was admitted to our ward.

Her tumor had infiltrated the pleura of her left lung, and with two chest tubes, it was my duty every morning to check how much effusion (fluid from her affected pleura) had accumulated overnight.

We wished that it would subside so we could perform pleurodesis, which is like gluing both pleura together, and it would increase her livelihood and decrease her pain, and we could then remove the chest tubes.

So, she was my regular patient. I started my rounds with her, and then I was very inexperienced and did everything by the book. I took the vitals, checked the effusion, auscultated her chest, and asked about how she had slept the previous night.

I felt uneasy to uncover her chest because she acted like she felt ashamed of her chest, and the flat space that once had been her left breast. And so I slid my stethoscope to listen. Sometimes it would hit one of the chest tubes and she would let a faint cry of pain, but that was all.

So, we had bonded quite a bit.

One day I asked her, almost absent-mindedly, about her family. With the enthusiasm of a mother that talks about her kids, her pale face brightened and told me about her boys. One was 14 and one was 11. She was telling about their schooling and how good was the elder one at drawing. I asked, in our morning small talk, while scribbling some notes into her file about overnight blood test, “Do your kids play soccer?”

It was the moment.

She answered: “Yes, and I would be the goalkeeper.”

I think it was during this little moment that she once again saw all of her family together, and realized she wouldn’t be much longer with them. She knew her prognosis, she knew all our efforts were palliative, but she knew it as a scientist knows a distant physical fact. But it hadn’t penetrated her yet as reality.

And at that moment, it did.

She spoke no more, and I didn’t ask more. A little pool of tears formed at the corner of her eyes, and a huge drop rolled her pretty face. And I quietly left the room.

Among thousands of patients and all their stories, this has stuck with me. I can still remember her face, the empty flat left chest, the sad eyes of her young husband whom I saw when she was discharged, and the elder son, the one good at drawing, who was quietly giving his mom a pep talk that doctors are gonna get you better. Teenagers hate doctors, and yet this little guy had faith in us. We, who had failed them. We had been defeated by the monster. The effusions never ceased, and we couldn’t do pleurodesis, and she passed away a couple of weeks later. But as I stood watching the trio leave the ward as she was discharged, the son pushing the mom’s wheelchair, a part of my soul left me and remained with them at that very moment forever.

I

LOVE THE MEDICAL EXAMINER!

Hey, I just saw you looking at your phone. I thought you told me you were going 100% phone-free. What happened? Yeah. My plan didn t work out.

Well, you know was always losing my phone, running around looking for it...

NOTE: The comic strip above is from an idea suggested by Examiner

PUZZLE

ACROSS

1. Ordinary Joe’s last name

6. Nasty fracture type

10. Male swan

13. Fox show (2003-2007) set in Southern California

14. Liver fluid

Dark Angel star

Word in North Korea’s

name

Park name

Peru

39. One is next to your nose 40. GA county named for Jefferson Davis’ VP

57. Saltpeter 58. Go ___; get crazy

59. Converts hide to leather

60. Ignore a sound or syllable (in speech) DOWN

by Dan Pearson

That was my whole exercise program! I ve gained 5 lbs since I gave up my phone!

THE MYSTERY WORD

The Mystery Word for this issue: YIADR

Simply unscramble the letters, then begin exploring our ads When you find the correctly spelled word HIDDEN in one of our ads — enter at AugustaRx.com

We’ll announce the winner in our next issue!

off, as a vein

6. US President #44

7. Middle Eastern bread

8. Inventor Whitney

9. Localized death of cells

10. Confidential; secret

11. Off-Broadway theater award

12. “Chrome-dome”

15. Invalidate

17. Former All My Children star

22. Genus of holly plants

23. Cedartown’s (GA) county

Thanks!

24. Uncovered

25. Feelings of hunger

26. Concerning

27. Put into geometric form

28. Notice of intended marriage (Old England)

29. Rule of _____ (in burns)

30. Elevate aloft 32. Article of food 35. __________ Home Road 36. Command to a horse 38. Clarified butter 39. Drug with a soft drink nickname

Cost

Augusta NPR call letters

Wharves

Conclusion, esp. in music

On the top of

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

PUZZLE

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.

1. Herpes, et al

2. Actor who played Rusty Dennis in Mask

3. Rope fiber

4. Sound from a pasture

5. Close

1. THYMAPNAPMAPHCMY 2. IOAIAHAHAOOOA 3. KURRVIAVAUKA 4. EEEENNLINI

THEBESTMEDICINE

Moe: What is the definition of stalking?

Joe: The best way I can explain it is that it’s when two people go for a walk, but only one of them knows about it.

A man took his wife out to a nice restaurant for dinner. When their order was delivered he was just about to take his first bite when she stopped him and asked, “Don’t we need to pray first?”

The Advice Doctor

Aguy walks into a bar and says to the bartender, “Hey b-b-b-bartenddder, gi-gimme a b-beer.” The bartender says, “One b-b-beer cu-cu-coming r-r-right up.” The guy says, “Hey, are are....you...ma-making f-f-fun of the w-way I t-t-talk?”

“N-n-no,” says the bartender. “I stuh-stuhstuh-stutter, t-too.”

A few minutes later another guy walks in and says with a booming, resonant voice, “Hey bartender, gimme a beer.” In an equally booming deep voice, the bartender says “One beer coming right up.”

The stutterer stands up and leans over the bar, “H-hey. I th-th-thought you s-s-said you w-w-weren’t m-making fun of the w-w-way I t-t-talk.”

“I’m n-not,” said the bartender quietly to the guy. “I’m m-m-making f-f-fun of hi-hi-him.”

A truck filled with Worcestershire sauce and a truck filled with quinoa crashed in front of the local charcuterie shop.

When asked by reporters what happened, an eyewitness replied, “Well, it’s hard to say...”

“That’s not necessary,” he said.

“But we always pray before we eat at home,” she replied.

“Yeah,” the husband said, “but this chef probably knows what he’s doing.”

Sir Isaac Newton, Steve Jobs, Adam and Eve, Snow White, and William Tell are having dinner together in a restaurant

A waiter approaches their table and asks: “Did someone order an apple?”

Moe: How’s your new girlfriend?

Joe: Ok, I guess.

Moe: You’re not sure?

Joe: Well, I invited her to meet me at the gym the other day and she never showed up. So I was thinking maybe we’re not going to workout.

Moe: What is literally the absolute worst thing there is in the whole world?

Joe: Exaggeration.

Moe: What do you call a sleepy feminist?

Joe: Snoozin’ B. Anthony.

Why subscribe to the MEDICALEXAMINER?

Dear Advice Doctor,

About a year ago our beloved next door neighbors put their house up for sale and moved to Florida. Our new neighbors seemed nice enough at first, but in the past couple of months they have gotten extremely cranky about anything and everything. They are so thin-skinned that the tiniest thing will launch them into a tirade that might last for a week. They called the cops on me one time for washing my car! We’re actually thinking of moving, but I wonder if you have any peace-keeping ideas first.

Dear Home,

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!

I’m glad that you chose The Advice Doctor for information and advice. The number of people facing the same problem you are grows literally by the day, so it’s an important issue to address.

The simple fact is that all of us are getting older. There’s no getting around that fundamental truth. Over time, just about everything in the body changes, and that certainly includes the largest organ in the body, our skin.

While you don’t specify how old your new neighbors are, describing them as “thin-skinned” is a clear indication that they’re getting up in years, and as such, thin skin is to be expected.

Older adults can simply bump their hand lightly against something, or reach between the cushions of their couch, and come away with broken skin.

— Home Cooking +

As we age the skin cells of our epidermis, the skin’s outermost layer, grow thinner. The number of cells called melanocytes (that is, the ones containing pigment) becomes smaller, leading to skin that seems more and more translucent. Blood vessels just below the surface are more fragile and have less protection from the skin to boot, which can lead to bruising. Finally, glands that provide oils that lubricate the skin are fewer and less active, leading to drier skin that’s easier to injure.

Despite the claims of cosmetic companies, there is no way to stop the aging process, but it can certainly be slowed down with a few prudent steps: Protect your skin from prolonged sun exposure using clothing and sunscreen with an SPF of at least 30. Use poisturizers to keep skin hydrated. Drink plenty of water throughout every day, and enjoy a balanced diet that includes olive oil, fresh fruits and vegetables, and foods righ in vitamin A. 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 the package in the p. 3 ad for MIRAKEL

THE WINNER: WINNIE BOAN!

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.