Medical Examiner 8-4-23

by guest columnist Jeff Annis Augusta, Georgia

I am not a qualified medical professional, so please don’t take this as medical advice. Seek credible medical advice and do your own research. I’m a longtime consumer of healthcare with some observations that I hope might bring value.

I’m startled by what appears to be widespread non-compliance when it comes to heeding the advice of doctors and medical professionals. Apparently, education and motivation provided by our doctors isn’t enough, even when it’s a matter of life and death. Permanently changing one’s lifestyle to maintain good health remains an elusive goal.

Non-adherence often results from patients who feel powerless, overwhelmed, defeated or confused. Many of our silent killers have few if any acutely noticeable or visible side

effects, and the damage can be hidden for years or decades. Degradation of our organs and nervous system due to chronic disease is not always in plain view. Type 2 diabetes, high blood pressure, kidney disease, and heart disease are common examples of silent and invisible illnesses. Obesity is linked to those conditions, but it sneaks up slowly.

Obesity rates are climbing at alarming rates even though weight gain over years of aging is one of the major causes of disease, death and diminished lifestyle.

Heart attacks, strokes, diabetic retinopathy, kidney failure and amputations are real possibilities, as is the increased risk of dementia or Alzheimer’s disease. Heart disease, paralysis, dialysis, blindness and amputations will definitely change your lifestyle forever.

We frequently resolve to cut out bad eating habits and be more active, but statistics show it rarely sticks with us for long. When a medical professional discovers something is wrong and recommends changes in lifestyle or prescribes a prescription drug, how often do we heed the advice or take the medicine as prescribed? Far too often compliance is partial, or non-existent. Mindsets common in non-adherence:

1) Denial (partial or complete): “this won’t happen to me”

2) Distrust of medical science: “doctors and Big Pharma are just in it for the money”

3) Feelings of invincibility

4) Doctors, medicines and supplies are too costly or otherwise unavailable

5) Forgetfulness, procrastination, lack of

PARENTHOOD

by David W. Proefrock, PhD

Your 7 year-old son still wets the bed. Sometimes he wets three or four times a week and other times just once or twice. Up until now, you haven’t said anything negative about it to him, but you are concerned that he is just too old to be wetting the bed. You’ve already tried not letting him have anything to drink before he goes to bed, but with only limited benefit. What do you do?

A. Report the bedwetting to his pediatrician. See if there might be a medical reason he is still wetting the bed.

B. Make him take some of the responsibility for changing and washing the sheets.

C. Begin taking away privileges when he wets the bed and giving a small reward for dry nights.

D. Be understanding and supportive of him. Don’t punish, scold, or belittle him.

If you answered:

A. This is the best idea. Seven is much too old to be wetting the bed this regularly. However, before taking other actions, make sure there is not a physical reason.

B. This can be a good response for bedwetting, but at his age he should be checked medically first.

C. Again, this can be a reasonable response, but he should be checked medically first.

D. Being supportive and understanding is essential, but at this age it is not enough. Have him checked by the pediatrician first.

A child this old wetting the bed with this frequency could very well be a medical issue instead of a behavioral or emotional one. It should be explored before trying other things.

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

MEDICAL MYTHOLOGY

MEDICINE MYTHS

See what we did there? Medicine, not medical. There is a difference. On the other hand, medicine myths are just as plentiful as medical myths. Here’s one we have all heard, and perhaps believe: package dosage instructions are merely suggestions. For example, the label says “take two for pain,” but your pain is pretty bad so you take three. Or the directions are “Take one tablet every 8 hours for pain.” Again, because your pain is beyond the realm of anything previously experienced in recorded medical history, you pop your second pill after 6 hours. These common actions have a certain superficial logic: if I take a bigger dosage than recommended or take it on an accelerated time line, I’ll get better quicker.

Nice try, but that logic is indeed superficial. The dosage instructions on medicines, whether Rx or OTC, are careful calculations based on years of research, clinical testing and real world experience. Ignoring those instructions increases the risk of side effects, in some cases with serious results.

Think of it like this: instead of waking up in severe pain you wake up incredibly hungry. Would you wolf down a larger than normal breakfast, and follow that up an hour later with lunch? Of course not. Medicine is no different. For optimal benefit, stick with the plan.

Now that we’re square on taking medicine as labeled, let’s move on to Chapter 2: how to swallow a pill.

Do not adjust your Medical Examiner! This is actually a

legit topic. We would not lie to you.

There are people who sometimes wash pills down with beer or other alcoholic beverages. Or so we are told. Not a good idea, since alcohol can interfere with how the body absorbs medication. The same is true for some medicines with grapefruit juice. Usually these are labeled as such, and as we have already discussed, labels should not be ignored. When in doubt, ask your doctor or pharmacist.

When it comes to taking pills with water, some of us pop the pill and swallow it with a sip of water. It’s better to make sure enough water is involved to be certain the pill reaches the stomach. A little sip and it could get caught halfway down. It could dissolve at that location, which might not be good at all, or it could cause a big time coughing jag, what in medical terminology is known as a hack attack.

Sometimes people cut pills in half. Perhaps they are trying to stretch their pharmacy budget, or they have trouble swallowing pills due to their size. The issue there is that most pills have a coating which is designed to dissolve slowly over time, in effect offering time-release dosage. Short-circuiting that creates dosing that is not what the manufacturer intended. Ask your pharmacist for easier to swallow options.

Money Doctor

Because wallets should be healthy too

PLANT A TREE

Remember the old proverb about planting a tree? It asks: when is the best time to plant a tree? The answer: 20 years ago. And when is the second-best time? Today.

We aren’t in the business of dispensing horticultural advice at our sprawling Medical Examiner World Headquarters here in Augusta, but even so, planting a tree today is an excellent idea.

Of course, it’s going to be a good while before the tree offers any benefits like apples, peaches, or shade on a hot summer day.

But there is a very similar proverb once uttered by none other than the Medical Examiner that has been passed down for generations. It’s very similar to the other one:

When is the best time to take steps to live a more salubrious life? 20 years ago.

And when is the second-best time? Today.

Not to brag or anything, but the Medical Examiner maxim is actually better than the one about planting a tree, attributed by some to have originated with Confucius.

After all, salubrious lifestyle changes can have nearly immediate benefits, but unlike tree-planting, there is no way a person would have to wait decades to enjoy major benefits. The fruitage of change may begin to ripen within just a few days, with benefits continu-

ing to increase over time.

As discussed in the cover article of our July 7 issue (“It’s Not Rocket Science”), big results don’t necessarily require big changes. Big things can come from very small changes.

Just one example: exercise, which all by itself can offer huge benefits.

“Hold on. I thought you said small changes. Joining a gym or buying all kinds of exercise equipment is not small change.”

Please re-examine your Examiner. This article does not mention joining a gym or even hint at buying exercise equipment. Neither is required to get exercise. Just walking around the block is a great start, and if even that’s too much, walk to the end of your driveway and back. Maybe you can work up to going there and back twice, then three times, then four. Every time a commercial comes on TV, stand up and walk in place until the show comes back on. If you have to stop sooner, that’s ok, but if you keep it up, pretty soon you’ll be able to do more. And that is a key: don’t make exercise a one-day-and-done thing.

The other day we heard someone encourage a smoker to quit. The smoker, an older man, replied, “Well, something’s gotta kill me.”

A better answer would have been, “You know, today is a great day to plant a tree.” +

THE “A” OF Q & A

Questions are a vital part of getting the best possible healthcare. But there is something even more important than questions: answers. Just as a well-worded question can invite a thorough and complete reply, good answers should deliver the most accurate and useful information possible.

The good news: there is more information at our fingertips than at any time in human history.

The bad news: there is more information at our fingertips than at any time in human history.

It’s not just the overall volume of information that is the problem; it’s the amount of false or misleading information which needs to be sifted through to find the good stuff.

But there’s more good news: doing “proper” research cuts down the amount of false or misleading information to practically zero. Sifting through mountains of data that might be inaccurate is not an issue.

The question then, is what is “proper” research”? Some people would tell you to stay away from “Dr. Google,” but that would be a total waste of a massive and deep resource. The internet is a tremendous repository of information, although there is an undeniable need for caution. It’s full of people who are self-appointed health and diet gurus, with little to no education and training. Despite that, they might have hundreds of thousands (if not millions) of followers who hang on their every word.

How do you sort out dispensers of accurate, legitimate information from the hacks and quacks?

Do the obvious: seek answers from reputable sources who know what they’re talking about. It’s not complicated. For example, do you have some kind of bladder problem? Go to the website of the American Urological Association. Heart symptoms? Look for answers on the American Heart Association website. Sore hips, achy knees? Search for the American Academy of Orthopedic Surgeons and get information at their website.

Keep in mind that there is often no substitute for a face to face appointment with a doctor. A website symptom checker might serve up a diagnosis of something potentially fatal when what you really have is extremely minor.

Accurate information can be life-and-death valuable, and it’s out there. Just go to the right sources.

30903-0397 (706) 860-5455 www.AugustaRx.com • E-mail: Dan@AugustaRX.com

HERBAL

Who is this?

LISTENING

concern

from page 1

6) Lack of support or sabotage from those closest to you

7) Overall confusion; inaction ensues

8) Lacking the knowledge or mental capacity to understand and act appropriately

9) Avoidance and fear: “can’t handle the truth”

10) Being a “know-it-all” thinker

Pictured here is one of the greats in medicine, a leading surgeon in America and the South during the 19th century who made outstanding contributions to the field, pioneering more than a dozen new operations to this country. He published more than 500 articles in medical journals, and held the Chair of Surgery at five different medical schools.

Do you think you know who he might be?

He was in Paris for post-graduate medical training when the July Revolution of 1830 broke out there, giving him his first experience in treating battlefield casualties. A few months later the November Uprising erupted in Poland, and he immediately traveled to Warsaw to volunteer as a battlefield surgeon. He viewed his service there as the repayment of a personal debt to the people of Poland and to the memory of Polish officer Casimer Pulaski, who died in 1779 at just 34 years of age during the siege of Savannah while leading a charge against British forces attempting to quell the American revolution.

Although our subject wasn’t born until 1806, Pulaski’s heroic feats remained oft told tales. And they all happened not far from his home. After all, he was born and raised right here in Augusta, the youngest of 11 children born to Oswell and Aphra Eve. They named him Paul Fitzsimmons Eve.

Captured in Prussia in 1831 when Warsaw fell, Dr. Eve contracted cholera, but was able to return to Georgia in 1832 thanks to the intercession of his friend in Paris, the Marquis de Lafayette. He was appointed professor of surgery at the recently established Medical College of Georgia, where he served on the faculty for 17 years. He was elected the first vice president of the American Medical Association in 1847 and as its president for the 1857-1858 term.

Dr. Eve’s service to Poland was a definite highlight of his life. He was awarded Poland’s equivalent of the Congressional Medal of Honor. In 1931, on the centennial anniversary of the Polish War of Independence, Poland issued a commemorative postage stamp in his honor.

The year before in Buffalo, New York, a group of doctors of Polish descent held a banquet to celebrate their group’s 25th anniversary. The featured speaker that night was the Polish ambassador to the United States, Tytus Filipowicz, and in his remarks he paid tribute to Paul Fitzsimmons Eve and urged the group to create an appropriate memorial for Dr. Eve. Buffalo’s Polish language daily newspaper, Dziennik dla Wszystkich, carried an article by Dr. Francis E. Fronczak summarizing the project. They raised $10,000 for a monument to be erected “in Eve’s home town of Augusta, GA.” The monument was unveiled by Dr. Eve’s great granddaughter on Nov. 14, 1931 with both Fronczak and Filipowicz in attendance.

The New York Times said of the event: “Many persons in the old city of Augusta, Ga., were surprised when they learned recently that the name of a native of their community is revered in Poland somewhat as the names of Pulaski and Kosciuszko, the Polish noblemen who held commands in the American Revolution, are revered in this country.” The plaque on the Greene Street monument says it was erected “by the Polish Medical and Dental Association of America.” +

In an ideal setting, nothing would stand in the way of a patient doing precisely what the doctor suggested. Imagine being the loved one of a person who needs to abide by doctors orders but won’t. I invite you to exercise compassion for your loved ones and yourself, and for others who have medical challenges.

If you fit in one or more of the 10 categories above or have other limitations to getting better, reach out for support. Ask those in your doctor’s office. Reach out to your network of friends, neighbors, coworkers, relatives, church members, and people inside your closest networks to find help. There are social service agencies

in most counties who may help you find the appropriate resources. Consider the use of your social media connections for suggestions. Information about health topics and weight loss are plentiful are plentiful on the internet, but it’s important to be wary of quick fixes and fads that all too often don’t work in the long run. 10, 20 or 30 years of lifestyle indiscretions slowly making you sick cannot be undone overnight. My experience is that quick fixes are

SHORTSTORIES

as quick to end as they are to start.

One other suggestion: adopting a mentor or role model who has already been down the path you wish to travel might help. No doubt most of us have a person in mind. Why not have a conversation with them about their journey?

I would like to thank the many friends and associates who took time to contribute their opinions on this subject. You are appreciated.

FREQUENT FLYER I was an intern working in the ER one night when a guy came in complaining of back pain. He could offer no reasonable history of how he got it, and he refused any workup. He just wanted something for the pain. My orderly motioned me aside and told me that this guy always came in at the beginning of the month when the new interns rotated through, and he would try to talk them into getting some drugs.

The orderly suggested I give the man a few placebos to take home. I gave the patient a mild OTC analgesic and a packet containing four placebo tablets. I told him to not take them until he got home and was safely in bed, then take no more than one every six hours as they were very potent.

He was obviously disappointed, looked at me askance and asked, “What are these?”

I said they were a new medication called “Groncagon.”

He shook his head and said he couldn’t take them. I asked him why not.

He said, “I’m allergic to Groncagon.” +

BY J.B. COLLUM

In our last conversation, I discussed the bad news about my diabetes and how I have fully resolved to fix it the best I can with diet and exercise. We discussed a lot about my new diet, and I thought I was done with that part and planned to discuss here today the second part of my regimen, exercise. But the passing of a couple of weeks has been enough for me to get more bad news about more things I can’t eat anymore. I think my “approved” list now consists of vegetables and fish, without salt. Oh boy.

Here are the details:

I had an eye exam earlier this week that was a follow up to something my annual eye exam had shown, but my primary physician was concerned about what he heard about that, so he referred me to a specialist who took a deeper dive into my eyeballs. After examining them closely he had some good news about glaucoma, which is what he attributed my occasional headaches to, in that though my ocular pressure was a little high, it wasn’t bad, and I would just need to keep an eye on it. Pun intended. As far as the tearing that the other eye doctor had seen, he said it also wasn’t bad and was consistent with my age and I didn’t need to worry about it. Now for the bad news. He showed me that the blood vessels in my eye had a significant amount of blockage from plaque and when I asked if that meant my vision would fail, he proceeded to explain to me the much worse news; namely, that he was concerned that this type of blockage was present elsewhere and because of that I was at high risk for a stroke. Like I needed one more item to add to my health bingo card.

After dropping the bombshell about potential strokes, he then started telling me how to fix it, and I truly believe that the cure might be worse than the disease. He told me to lose at least 50 pounds, and if I could, 100 pounds. I thought losing that much weight was a bit excessive; I think I would resemble a common decoration we are likely to see on or about October 31st, and I expressed that to him. His reply: “that would be fine.” That’s easy for him to say because he already looked skeletal himself. It seems like the doctors who are the most insistent on patients losing the most weight are those that, to me, look like they have gone overboard on the concept in their own life. But that is just my opinion.

Then the real shocker was revealed when he said that I should not eat any beef or pork, and I should stay far away from salt. I explained that I had already given up most carbohydrates, including sugar in most any form, and several other things I liked so much. I told him my diabetes doctor said to

eat a low carb, high protein diet that included lots of meat, including beef. Like Shania Twain says, that did not impress him much.

I think it is a violation of the Hippocratic Oath to take away both sweet and savory foods from a patient. But if they do it anyway, they probably should be required by law to refer you to a mental health professional to try to convince you that you still have other things left to live for besides good food.

As I drove home, I contemplated this news for a little while, and then called my wife to tell her what the doctor had said. After filling her in, she was quiet for a few moments as if she didn’t know what to say, but then she started talking about how she would adjust her cooking for my diet, though she didn’t say it with any enthusiasm. I interrupted her to tell her my plan instead. I told her that since I had already made major changes to my diet, and had even joined a gym that I have been going to three times a week to work toward getting healthy, I didn’t think I could adapt to this even stricter regimen, at least not right now. I felt overwhelmed. It’s like when you have a lot to do at work, but feel like you can accomplish it, but then the boss dumps a pile of work on you that you know you can’t complete on time. It doesn’t inspire you. It makes you want to quit. It might even make you want to “rage quit,” because we all have our limits. Change is hard. Changing too much all at once can make you want to give up and quit all the good habits you wanted to form.

So, that is now my plan. I am not saying it is the wisest strategy, and I am not even recommending it, but I think it is the best option for me. It is what I can do. It is probably all that I can do. I will focus on my diabetes, losing weight, and getting in shape with regular exercise. After all, you have to crawl before you can walk, and you have to walk before you can run.

Speaking of walking and running, I really will do my best to fill you in on the exercise portion of my lifestyle change in our next visit, but here is a preview: I got a friend to join the gym with me and he has faithfully met me there every Monday, Wednesday, and Friday morning. That has helped a lot and I am grateful for that. I’ll save the rest for next time. Until then, do your best to stay healthy, but don’t try to do more than you realistically can.

ONE NOTCH BELOW TERRIBLE

I feel one notch below terrible when I see or hear:

About another shooting in Augusta … or anywhere else, for that matter

Fewer and fewer school students can perform at grade level

Fewer traditional father-mother-child/children families.

Political leaders telling us the economy is good, as if they have never been to the grocery store

Inflation is way too high and is not likely to recede significantly anytime soon

Apocalyptic stock market predictions

A new strain of Covid is ricocheting around China and most likely will come our way

BASED ON A TRUE STORY

(most of the time)

A series by Bad

Billy Laveau

Illegal immigrants are here from 170 counties so far

College students getting degrees that will never make enough money to repay their loans

New taxes of any kind for any reason

News networks intentionally filtering/slanting news … left or right

Officials testifying before Congress, but refusing to answer any question with a simple “yes” or “no.”

Cars that go 140 mph when our top speed limit is

70 mph.

When I drive the speed limit and I am the slowest person on the road

Church attendance falling each year while population goes up

Men not holding open a door for a woman (regardless of age)

Profanity in public places … including radio, TV, and movies

Animals being mistreated in any manner

Drunk drivers not getting jail time

Drunks complaining about hangovers

Political candidates who low-rate other candidates. (Tell me something good. I got enough doubts already.)

Television preachers wanting more money

“Secrets to success” that involve me giving money to them

70% of my high school classmates are already dead

Over half of marriages end in divorce

50% of people are dumber than the average person

Education should produce equal outcomes. (Did someone forget to mention you have to work to succeed?)

The Ten Commandments are suggestions. And they’re out of date

Disarming honest, law-abiding citizens will end gun violence

It takes a village to raise a child. (Well, the village is clearly failing.)

US tax money going to illegal immigrants instead of veterans

250,000 unaccompanied children crossed the border and are “unaccounted for”

A dozen eggs cost more than 2 gallons of gasoline

Looters have more rights than store owners & victims

Congress members are exempt from Medicare, Social Security, and staff race/sex discrimination hiring

Perpetual victims looking for the next insult

Race, gender, or sexual orientation affecting business or educational decisions (positively or negatively, one is as evil and destructive as the other.)

A parent demanding a teacher give his child “partial spelling credit because only one letter was missed”

Hollywood actors lecturing us on how to think. (Don’t they make their living being someone they are not?)

American flags made in China (or any other foreign country)

Foreigners who come illegally to the US and want everyone to conform to their culture, beliefs, etc.

Wealthy athletes disrespecting our flag and nation Millionaires flying on private jets and telling us to use less petroleum hydrocarbons.

Children too young to vote or buy beer are capable of changing their sex.

You can laugh at these observations, but don’t get your hopes up that this listing will have any positive affect on the future. Life is like that these days. Logic seems to have fallen by the wayside.

Maybe one notch below terrible is the new norm.

TRYTHISDISH

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

SESAME BROCCOLI

Think you can only steam frozen veggies? Well think again! The frozen broccoli makes this super convenient ---but the flavor combination will have you wanting to double the recipe and eat MORE vegetables!

Ingredients

• 1 (15-ounce) bag frozen broccoli

• 1 tablespoon sesame oil

• 2 tablespoons sesame seeds

• 1 tablespoon reduced-sodium soy sauce

• 1 teaspoon honey

• ¼ cup dried cranberries

Directions

Prepare the broccoli for cooking by either boiling or steaming and then drain. Generally a 5-7 minute steam or boil is about right for crisp broccoli.

Heat the sesame oil in a skillet or wok for 15 seconds over high heat. Add the sesame seeds and the broccoli. Stir fry until heated through (about 1-2 minutes). Meanwhile, combine the soy sauce and honey in separate mixing bowl. Remove broccoli from the skillet or wok to a serving dish, pour soy sauce mixture over broccoli and add dried cranberries.

Yield: 4 Servings

Nutrient Breakdown: Calories 110, Fat 6g (0.5g saturated fat), Cholesterol 0mg, Sodium 180mg, Carbohydrate 13g, Fiber 3g, Protein 4g.

Percent Daily Value: Vitamin C 120%, Calcium 6%, Iron 6%, Vitamin A 0%.

Diabetes Exchange Values: ½ Fruit, 1½ Vegetable, 1 Fat

THE C&C DIFFERENCE

We are a family-run shop here to put you first with quality work backed up by our 3-year/36,000 mile repair warranty.

ASK DR. KARP

The important nutritional components in milk are calcium, protein, and vitamin

D. That means that the very first thing to focus on when you are deciding what type of milk to buy is making sure the product contains adequate amounts of these nutrients. For example, an 8 oz glass of milk usually contains 8 grams of protein, about 300 mg of calcium and 2.7 micrograms of vitamin

NO NONSENSE

NUTRITION

Sharon, a Facebook friend from Minnesota, asks:

“What is the best kind of milk to drink?”

D. Check the nutrition label on the container to see how the milk you are choosing compares to these values. It is also important to make sure you are not consuming an overload of saturated fat from milk, which is easy to do since whole milk contains abundant quantities of saturated fat.

These days there are many other things about milk being promoted. Be forewarned that most of the extras being added to milk are for promotional, marketing and advertising purposes rather than having proven nutritional benefits. It makes the milk much more expensive, but not healthier, and is an extremely poor use of your food dollars. Examples of these marketing approaches include “organic” milk, milk with extra protein, milk from “happy cows,” or “so-called” milk made from soy, almonds, coconuts, or oats.

For all the city slickers reading this column, you should know that it is impossible to hook up milking machines to almonds. The fact that these non-milk products are sold as milk is unfortunate and very misleading for the consumer. Beware.

One of the special and more expensive milks that might have a place in your home is lactose-free or low-lactose milk for people with lactose intolerance. Even then, the data shows

that fewer people have lactose intolerance than is popularly promoted. In addition, lactose intolerance is not an all-or-nothing phenomenon. It may be that you cannot drink a full glass of milk on an empty stomach, but adding milk to recipes (substitute the water for milk) or having cereal and milk may be very acceptable.

True, there are other ways of getting protein, calcium, and vitamin D, but the data shows that, especially for children, if you eliminate milk and dairy from their diet they are not meeting the requirements for these important nutrients in their diet. Those are the facts. Another important fact about milk is that for newborn babies, breast milk is best, followed by infant formula if breastfeeding is not an option. Cow’s milk does not meet the needs of human infants. I want to warn you all about the dangerous idea pushed on social media that unpasteurized cow’s milk is healthier than pasteurized milk. Never drink raw,

unpasteurized milk. It is downright dangerous. Raw milk contains disease-causing bacteria that can make you sick. In the early 1900s, when the pasteurization of milk became routine, deaths and diarrheal illness dropped precipitously, particularly in children. Another false claim that you hear these days is that whole milk is real milk and skim milk is “watered-down milk” and not as healthy. This could not be further from the truth. Skim milk has the identical protein, calcium, and Vitamin D content as whole milk. What is missing is all that saturated fat (and calories).

Reading the nutrition labels of different “milks” in the supermarket makes it clear which ones are worth your food dollar. Using taste alone as a deciding factor in which milk you choose is not a good idea, although almond “milk” is being marketed that way.

Let’s review the guidelines again. Buy milk that has at least 20-25% the Daily Value for calcium, at least 8 grams of protein per serving, is enriched with vitamins A and D, and is low in saturated fat.

I happen to have the nutrition labels of several different milks and so-called milks in front of me right now. Many of them do not meet these guidelines. For example, the oat milk nutrition label lists some calcium, but it is exceptionally low in protein. Rice and coconut milk may also be extremely poor sources of protein. Coconut milk, specifically, may contain large amounts of saturated fat, very little calcium, and almost no micronutrients. Going by the nutritional guidelines, you are usually left with a choice between soy milk and skim milk. Either one meets nutritional criteria for buying healthy “milk.” The next criterion I use is price. Do you really want to spend more money on a milk-like drink that is less healthy than skim milk? The other day at the supermarket I noticed that the skim “organic” cow’s milk costs twice as much as the supermarket’s own brand skim cow’s milk. Guess which milk I chose? I would be remiss if I did not mention the environmental and animal-treatment issues related to cow’s milk. They are substantial. To help the environment I do other things, like having an extremely low “carbon footprint.” Your choice might be to spare the cows and buy soy milk. Either choice, from a nutritional point of view, is acceptable, although soy milk is more expensive.

What is the “No-Nonsense Nutrition” advice about milk? If you want an inexpensive source of protein, calcium, and vitamin D, then buy store-brand skim or low-fat milk. It is a wonderful use of your food dollars. Milk from “blasé cows” is just as nutritious as milk from “happy cows.” And remember, oats, almonds and coconuts cannot be hooked up to milking machines.

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

he’s on your case he’s on their case.

FOODISMEDICINE

THE KEY TO SUMMER HYDRATION

by Ari Redcross MS, RDN Augusta District Dietetic Association

As summer progresses, it’s important to think about how to stay hydrated. The average adult is made up of one-half to two-thirds water. However, the National Institute of Medicine reports that only 40% of the US population meets their fluid needs. We absorb moisture from the food and beverages we consume, and excrete water through our urine, sweat, and breathing. Weather conditions can affect how much water we may need to use to cool us down.

People typically use thirst to guide how much they drink, but this signal is not always accurate to begin with, and can decline as we age. Decreased fluid intake can lead to dizziness, fatigue or confusion.

Lighter urine color can be one way to assess good fluid status, although certain medications and supplements can also affect urine color.

The general recommendations for how much wa ter one needs can vary daily depend

ing on activity level, weather, or even body size. About nine to thirteen cups or 72 to 102 ounces is appropriate for most individuals. Research about caffeinated beverages and how effectively they may or may not offer hydration is ongoing. However, a good rule of thumb is to aim for getting most of one’s fluid intake from unsweetened beverages without alcohol. Fluid is absorbed from both liquids and foods. Fruits and vegetables in forms such as soups, popsicles, smoothies, melons, and ice cubes can be ways to increase intake.

Drinking enough fluids and eating various foods should keep your body hydrated and provide essential electrolytes. Sports drinks are

and perspiration. They can be high in sugar and sodium. While drinking too much water is rare, the resulting fluid imbalance can cause water toxicity.

In summary, water is an essential nutrient for our health. You can get your water intake from both foods and drinking beverages. Aim to drink nine to thirteen cups of fluids a day. Consider spicing up your plain water by infusing it with fresh fruits and herbs like mint and basil with berries or slices of lemon and orange.

Resources:

“Electrolytes: Uses, Imbalance, and Supplementation.” Medical News Today, www.medicalnewstoday.com/ articles/153188. Accessed 29 July 2023.

III, James L. Lewis. “About Body Water - Hormonal and Metabolic Disorders.” Merck Manuals Consumer Version, 27 July 2023, www. merckmanuals. com/home/hormonal-and-metabolic-disorders/ water-balance/ about-body-water. “Water.” The Nutrition Source, 6 July 2021, www. hsph.harvard.edu/ nutritionsource/ water/#:~:text=General%20recommendations,1%20cup%20 equaling%208%20 ounces.

Tasty tips from registered dietitians with the Augusta Dietetic District Association

This space has been devoted to various aspects of speeding a few times since the inaugural installment of Crash Course (which was 3 years ago today).

Let’s launch the 4th year of the Course with a discussion of, frankly, how foolish speeding is. Of course, one aspect of this particular sin is the penalty that may be exacted by Caesar. Speeding tickets are not cheap all by themselves, but they can also add major bucks to car insurance premiums over a considerable time period.

Another aspect of speeding that we don’t plan to focus on is the potentially massive expense of collisions. In a mere second or two, tens of thousands of dollars, possibly even hundreds of thousands, can be lost in collisions that would never happen except for excessive speed.

Crashes can also cost far more than the direct cost of the collision. Sometimes citations are issued. Sometimes insurance rates go up. Sometimes lawsuits are filed, and millions of dollars can go up in smoke, again from a situation solely caused by driving too fast.

But instead of those specific aspects of speeding, we’d like to explain our earlier comment about the folly of speeding.

First, let’s be realistic. Just about everybody speeds. Nationwide, an estimated 112,000 speeding tickets are written every day. Speeding can be unintentional, or it can be deliberate: most of us go with the flow of surrounding vehicles, so if they’re speeding, so are we. Maybe we don’t even know what the posted speed limit is, just what the flow of traffic around us happens to be. Other times speeding is deliberate because we’re in a hurry. We’re that one person driving faster than everybody else, weaving between lanes as necessary to keep our pace.

That is the particular aspect of speeding we’d like to discuss. Human nature being what it is, if we’re late for an important appointment, a job interview, or the first day on a new job, it’s

practically impossible not to press it, pushing our speed as far as we think we can get away with, squeaking through lights that are no longer yellow, etc.

But here are a few numbers that expose the ridiculousness of speeding to save time.

Let’s say you have a 5-mile commute every day over roads that have a 45 mph speed limit. Assuming no red lights and smooth sailing all the way, that trip should take you 6 minutes and 40 seconds. Drive the whole way at 50 mph and you will save a grand total of 40 seconds. As we said earlier, maybe the flow of traffic will be 50 anyway since speeding is so common. So let’s assume that you push it farther, driving 55 mph the whole way. That will get you to your destination 33 seconds sooner than the person driving 50, and a whole 73 seconds quicker than someone who drove the speed limit the whole way. That’s not much.

The numbers are just as dramatic at higher speeds and longer distances. A 10-mile trip over a stretch of interstate posted at 65 mph will take 9 minutes and 14 seconds. Cover that same 10 miles at 75 miles an hour and you will get there in 8 minutes, a savings of 74 seconds.

It might be even more enlightening to enlarge the numbers. Drive down a straight road — no traffic lights, no construction, no school zones — that’s 1,000 miles long, and do so at the posted speed of 65 mph. It will take 15 hours and 23 minutes to cover that distance. Make the same journey at 75 mph at it will take you 13 hours and 20 minutes. Speeding 10 miles over the limit for a thousand miles only gives you a 2-hour payback? That just isn’t worth it, especially considering that the 2-hour gain might be offset by a speeding ticket or a crash. And when it comes to local driving, speeding offers dividends measured in seconds.

Speeding can be expensive, but for all its cost it doesn’t give a lot of value back in return. +

AS A PATIENT WITH SOMETHING SERIOUS, WOULD YOU BE UPSET TO BE SEEN BY A NURSE PRACTITIONER INSTEAD OF A PHYSICIAN? My opinion: Nurse practitioner 100%. Here’s why:

In order to be a nurse practitioner, most programs require you to first be an RN for X amount of years. That means you are at bedside, full-time caring for patients with all sorts of ailments and properly managing their treatment. Patients think that doctors make all the decisions and nurses just follow them. But have you ever thought about how that doctor knows the right course of treatment if they only see you 5 minutes once a day? It’s because the nurses update your chart and assess you at least twice a day. It’s because nurses ask you all the personal questions and recommend treatment based on your symptoms and history. The doctors take the info provided from nurses and lab results to formulate the treatment plan. Then those nurses get tired of the abuse from doctors and decide to get their masters and become a provider themselves. They typically know more about your condition and treatment in real life not a textbook than a physician would.

Nurses never get the credit they deserve because no one really sits down to tell average people what a nurse actually does. But trust me, they are behind most the good medical decisions your doctor makes.

THINK INSIDE THE WRAP

ROLLED SANDWICHES • SOUPS • SALADS

the blog spot

— posted by Neha Gour on July 29, 2023 (edited for space)

MISINFORMATION’S DEADLY IMPACT

Turning into vegetarians can cure COVID-19. Birth control pills cause abortions. Eating ginger is 10,000 times more effective than chemotherapy at curing cancer. Those were some casually trending nuggets of health misinformation in the past year. What exactly is health misinformation, and why is it a serious public health concern?

SHORTSTORIES

WHEN YOUR DOCTOR’S DIPLOMA ISN’T FROM A “NAME BRAND” MEDICAL SCHOOL

here in the U.S., yet ended up being absolutely terrific doctors. Some even became department chairmen and top-level medical researchers.

Why?

QUESTION • ANALYZE THINK

Health misinformation means health-related information that is false, unverified, and lacking scientific evidence. It poses a significant threat to public health as it directly influences individual choices, collective decision-making, and societal behavior. During the COVID-19 pandemic, health misinformation emerged as a global crisis, and its impact has only continued to grow at an alarming rate.

Today, a large number of people rely on new media technologies such as online encyclopedias, social media channels, and mobile health platforms to access health-related information. While these platforms enable swift information exchange, their lack of accountability, ineffective gatekeeping, and inadequate content regulation contribute to the uncontrolled spread of health misinformation. Moreover, widespread health illiteracy, linguistic barriers, and gullible social media users who struggle to evaluate health information further facilitate the rampant dissemination of unverified, false, and anti-scientific health claims.

Another concerning aspect is the increasing influence of social media influencers who promote products on platforms like Instagram, TikTok, and YouTube, often spreading unverified, unscientific, and misleading health recommendations. The appeal of flashy photo filters, video editing techniques, and the constant pressure to produce new content to maintain followers contribute to the proliferation of visual health misinformation. In today’s digital age, a person’s perceived expertise often correlates with the number of social media followers they have.

For individuals who rely on new media for health information, the following recommendations are valuable: Always check the primary source. The credibility of the information source is crucial in assessing its accuracy, reliability, and trustworthiness.

Look for professional qualifications. Verify the expertise of the person sharing health advice. Do they possess educational qualifications or certifications? Do they consistently share reliable health information? It is advisable to rely on information from qualified health experts only.

Think critically. Adopt a critical approach to judge, question, and analyze health information rather than blindly accepting it. This mindset will help determine the authenticity and dependability of the information.

Be wary of conspiracies. Consider whether the information source or author has biases or prejudices that may contribute to the inclusion of health information within a conspiracy theory. Personal agendas can lead to falsehood and deception.

Look for fact-checking websites. The World Health Organization, Centers for Disease Control and Prevention, the National Library of Medicine, and the National Institutes of Health are the most authentic websites to check for facts and reliable health information. In addition, websites like FlackCheck, SciCheck, and Snopes analyze misinformation and are also good sources to double-check health information before acting upon it or sharing it further.

Neha Gour is a graduate student

I’ve met countless doctors over my thirty-five years of practice as an oral and maxillofacial su rgeon. What I’ve found is this: where a doctor went to medical school is far less important than two other factors — the quality of the residency that he or she did, as well as the quality and variety of their experiences, in practice, after the residency.

I’ve known people that went to top medical schools who ended up being mediocre doctors at best, bad ones at worst. The opposite is also true. I’ve known people that went to mediocre schools, or even to overseas medical schools because they couldn’t get into schools

It’s because there’s much more to being a good doctor than just making diagnoses and deciding on appropriate treatments. There are factors that are not necessarily teachable, nor even measurable, things like empathy, sensitivity, compassion, kindness, caring, devotion, loyalty (to patients as well as to colleagues and staff), tenacity, ingenuity, creativity... These qualities, the very human side of medicine, have nothing whatsoever to do

with which medical school you attended, nor even your residency. They are solely measures of your quality as a human being, of your ability to care for another person as if they were your own flesh and blood, your own family. That cannot be taught. But those that have such qualities in abundance will often make for a better doctor than someone who doesn’t have them, yet went to a “better: school or even a better residency. There have been many studies that have shown that patients who like their doctors very much more often than not do so because of their personality rather than their knowledge, IQ, or even training.

Uh oh. My new blood glucose monitor is not working.

+ by Dan Pearson

The one you just took out of the box 2 minutes ago?

Can you believe it? It s giving me a reading of 240! 104. See the picture right on the box? 104. What is it supposed to say?

Whoa. I hope you saved your receipt.

THE MYSTERY WORD

The Mystery Word for this issue: BLRHAE

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!

ACROSS

1. Congressional TV

6. How rubber can start

10. Product of 60-A at onetime Augusta factory

14. Like some summer afternoons

15. Continental currency

16. Its highest point is Kings

Peak

17. 11 through 15 19. Unit of type size 20. Large wind instrument 21. Leave

In the air when it’s cold

Pitcher’s stat

Beasts of burden

Faux pas

Arab version of shalom

66. Periods of history

67. Refined iron DOWN

1. Wooden containers

2. Warrior of feudal Japan

3. Having patches of two colors

4. Kristen Bell voiced her in Frozen

5. The Big Apple, in brief

6. Wild; untamed

7. Oz in full

8. Regions

9. Dead or death (Latin)

10. Cake container?

11. “As below” (in bibliographies)

12. Georgia follower, at times

13. Forms

18. Egg cell

22. Self-esteem

25. _____ Clinic

27. The Spanish ______

29. Small room; or a recess off a room

30. Diagnostic med pic

32. Non-Rx

33. Big tub

34. Trauma pt. destinations

37. Sorrowful 38. Conduit for electricity 39. ________ holiday

Savannah event

Make eggs

Regret

Fur of a mammal (Zool.)

Walton Way school (in brief)

Rhythm

A dinosaur’s end?

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

QUOTATIONPUZZLE

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line.

Solution on page 14.

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

One day a farmer got a visit from his brother, a priest, whom he had not seen in many years. He was justly proud of his farm, so he took his brother on a tour of the place.

“See this beautiful field of grain?” he asked proudly. “I grew this.”

“With God’s help you did,” said the priest. A bit further, he showed him a lush pasture with a herd of cows grazing contentedly.

“See those cows? I bred them!” he proudly exclaimed.

Again, the priest reminded his brother, “Yes, but only with God’s help.”

The brother felt insulted and stayed silent for the rest of their walk. Finally they came to a fallow patch of uncultivated ground, full of thistles and brambles.

“What happened here?” asked the priest.

“Here? I let God do the farming by himself.”

The circus owner and his Human Cannonball had been arguing for hours, and they were still at it when it came time for his big performance. Just as the Human Cannonball climbed into the cannon, he uttered a string of insults and obscenities at his boss.

He was fired on the spot.

Moe: What do you get if you eat 3.14 cakes?

Joe: Piabetes.

Moe: What sound does an Australian frog make?

Joe: Croakey.

Moe: What do you call a pigsty when it’s wintertime?

Joe: A pigloo.

Moe: Did you hear they arrested the devil?

Joe: No. What happened?

Moe: They got him on possession.

There once was a man From Cork who got limericks And haikus confused

Knock knock.

Who’s there?

Hike.

Hike who?

There once was a man From Nantucket who was not In a limerick

Although the new chatbot is clever, It cannot write poetry ever. Oh yes I can, you silly young man. It’s just that as a large language model I am not fully trained in rhyming and scanning. Please watch for future updates.

the MEDICALEXAMINER?

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

The Advice Doctor

SUBSCRIBE TO THE MEDICALEXAMINER

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

Dear Advice Doctor,

I’ve been given a new assignment at work. By itself I have no bone to pick with my supervisors. I’m happy to take on new responsibilities. The issue I have is that the job itself is based on a completely erroneous premise. The basic idea does not hold water, and when it fails it will be my fault. Your advice, please.

Dear Groomed,

— Groomed to fail?

What is commendable is simply that you brought this matter into the spotlight. When people can’t hold their water (often called incontinence, specifically urinary incontinence) they’re often too embarrassed to get treatment. They hope it will go away on its own — which can happen but probably won’t. Unfortunately, in their desire to avoid a little embarrassment they might almost guarantee greater embarrassment when the almost inevitable accident happens in some public setting.

One word of reassurance: doctors and nurses have seen it all and heard it all. Many physicians practice their craft in specialties, and for incontinence that specialty would usually be urology. Trust me when I tell you, every urologist has dealt with this condition a thousand times this year alone. They aren’t going to be embarrassed to discuss it, and neither should you. They are experts in helping people with this specific problem, and others like it.

Something else about seeking medical attention, even if it might be just a little embarrassing: most of us would gladly trade a few minutes of embarrassment for years of cure every day of the week. And doctors can definitely cure this condition in most cases. There are all kinds of treatment options available, often starting with exercise and physical and behavioral therapy. Medications and surgical options are usually not on the list of treatment options, at least not at first.

It is certainly not a rare problem, and when you think about it, every one of us was incontinent for the first year or two of our lives. We’ve been in this situation before and got out of it. We’re older now but maybe we can get out of it again. For instance, pregnancy is a common cause of incontinence, an obviosly temporary situation.

For readers out there with any other medical problem that might be a little delicate, please remember this article and its reminder that our doctors have seen it all. That statement applies to dozens of medical issues, so just relax and go get help.

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 sponsor logo in the p. 4 ad for CSRA MEGA BACK TO SCHOOL BASH

THE WINNER: MACKENZIE MERCER!

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 MYSTERY WORD

...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.

Alain Domkam, MD Vascular Surgery Paul Butros, MD Interventional Radiology Salman Mufti, MD Interventional Radiology

Risha Malik, MD Endocrinology

Sergei