Medical Examiner 9.20.19 by Daniel Pearson

MEDICALEXAMINER

HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

SEPTEMBER 20, 2019

AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

IS VAPING GOOD? Vaping is one of the year’s biggest healthcare stories. It was the hot new thing just a few short weeks ago, but then a sudden wave of serious and mysterious vape-related respiratory illnesses erupted across the country (36 states, including Georgia and South Carolina), killing six. The jury is still out — or should we say the smoke hasn’t cleared yet — and already defenders are lining up on both sides of the battlefield. The President announced plans to seek a ban on flavored e-cigarettes, a decision the Washington Post calls “stupid.” In an editorial entitled, “Treat vaping like the crisis it is,” illustrated with a malevolent skeleton handling an e-cigarette to a baby, the Orlando Sentinel opined, “It’s past time the government got serious about the dangers of e-cigarettes.” But opinions in defense of vaping continue to come from sources as diverse as the American Council on Science and Health (“CDC Insanely Warns Smokers Against E-Cigarettes”), The Economist (“The facts have gone up in smoke”), and Britain’s National Health Service (Headline: “E-cigarettes 95% less harmful than smoking”). It seems that Aeschylus had a point when he said, “In war the first casualty is the truth.”

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But what is the truth? It appears to be somewhere between the opposing lines of battle. On the one hand, there is scientific evidence that e-cigarettes are a useful aid in helping smokers quit their deadly habit. And lest we forget, “deadly” is an understatement when it comes to tobacco: An estimated 100 million deaths worldwide were attributed to tobacco during the 20th century. The tobacco death toll this year alone as of today (Sept. 20) is some 341,900. That figure is based on the CDC estimate of 1,300 deaths in the U.S. caused by tobacco-related illness every day. So far vaping has killed six. Does this remind you of our recent issue with the “Keeping in focus” cover story? It said cardiovascular disease kills 635,260 people a year, an average of 1,740 people a day, while mass shootings kill an average of less than 2 people per day. Yet which gets more headlines? Thinking calmly, rationally and humanely, there is no cause of death which should be ignored, whether it reaps a dozen victims each One difference between vaping and cigarettes: the density of vapors permits year or hundreds of thousands. The hysteria surrounding the vaping mystery tricks like this one, called a waterfall, where smoke is simultaneously exhaled and inhaled. But is it worth the risk of permanent lung damage? Please see VAPING page 3

AUGUSTAMEDICALEXAMiNER

SEPTEMBER 20, 2019

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

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by David W. Proefrock, PhD

Two men have just moved in next door to you. They are clearly a homosexual couple. They seem nice enough, but you are worried about what to tell your 8- and 10-year-old children about them. What should you do? A. Wait until they mention it or ask you about the new neighbors before you tell them anything. B. Don’t tell them anything, but start making plans to move. These men present a threat to your children. C. Tell them that the new neighbors are sinful and will be going to hell. Make sure your children stay away from them. D. Talk to them about alternative lifestyles and respect for the views of others. If you answered: A. It’s best to wait until they ask. They probably know more about the situation already than you think. B. I don’t often get to say a response is ridiculous, but this one is. There is absolutely no evidence that a homosexual couple would present any more threat to your children than a heterosexual couple. C. If this is what you believe, there’s not much point in trying to change your mind. However, you should be aware that it is that response which has made your neighborhood less welcoming and less secure, not the fact that a homosexual couple has moved in. D. This is a good response, but again, it’s best to wait for them to ask before going into detail.

♦ Are 18 to 50 years of age ♦ Experience painful symptoms due to endometriosis ♦ Have monthly menstrual periods ♦ Had surgery in the last 10 years to look for endometriosis ♦ Additional requirements apply

Please call 706-210-8890 or visit www.myspiritstudy.com for more information and to find out if you may be eligible to participate in the study. If you are eligible, you will receive study medicine and study-related care at no cost to you and may be compensated for time and transportation.

Tolerance, respect, and a positive sense of community are what makes a neighborhood safe. Race, ethnicity, and sexual orientation have nothing to do with it. + Dr. Proefrock is a retired child clinical and forensic psychologist.

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SEPTEMBER 20, 2019

VAPING… from page 1 (typical headline: “Inside the vaping health crisis that’s gripping New York” - New York Post - Note: none of the six fatalities have occurred in New York; the closest one was in Indiana) is therefore understandable. Also understandable are the well-meaning efforts on both sides of this current outbreak. Public health officials on one side of the issue want to help people employ a promising new way to kick the deadliest habit in human history, smoking. Their colleagues on the other side of the debate want to make sure people know that just because e-cigarettes and vaping are far safer than cigarettes doesn’t mean they’re harmless. Health officials have a number of concerns about vaping that have nothing to do with the current spate of unexplained illnesses connected to the practice. Here are a few: Nicotine Not all vaping is done with nicotine, but when it does it can pack quite a punch, and it’s worth remembering that nicotine is highly toxic. Juul, the leader in vaping sales, says just one of its e-liquid pods has as much nicotine as an entire pack of cigarettes. The FDA issued a warning about nicotine-induced seizures linked to e-cigarette use.

Cardiovascular health In June of this year the Journal of the American College of Cardiology published a study which showed that nicotine in e-cigarettes contributes to endothelial damage linked to cardiovascular diseases. Even nicotine-free versions of vaping devices can carry risks caused by particulate matter so ultra-tiny that it affects tissues deep within the lungs, passing by the normal defenses mounted in nasal and bronchial passages. Studies link these microscopic particles with heart attack, hypertension, and coronary artery disease risks. Respiratory health The literature suggests vaping is much less harmful than cigarette smoke. Again, that doesn’t mean vaping is harmless. A recent UK study published in BMJ found that vaping was associated with twice the incidence of wheezing and related respiratory symptoms seen in non-smokers/non-vapers, but

less than smokers. Explosions Batteries in vaping devices can explode, blowing holes in lips and cheeks and blasting out teeth, although half of all explosions in one study were thigh or groin, and onethird were hand injuries. Only about 20% were facial injuries. A BMJ study found that 2,035 e-cigarette explosions were presented to U.S. emergency rooms between 2015 and 2017. While vaping has been around a lot longer than most of us realize, it’s still new enough to lack conclusive evidence of its safety or its dangers. It sometimes takes decades for the complete story to emerge. The early returns favor it as a safer alternative to smoking, but what will the final outcome be? With all pro and con hype and hysteria out of the way, can anyone mount an argument to refute this statement: Breathing pure air is the best choice. By far. +

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WHAT ARE THESE SIGNS FOR?

These signs share several key characteristics: they’re very common, very easy to ignore, and very important. As you can see, they range from the bland black & white sign that’s pretty easy to miss to progressively more and more urgent messages. The signs also make it evident that their warning is associated with MRI scanning, an acronym that’s short for Magnetic Resonance Imaging. Some people are not comfortable with MRI scanning, and might conclude these signs are all the proof they need. The closer you get, the more danger you’re in. True? Yes and no. On the plus side, an MRI is a non-invasive imaging method that uses no radiation. On the negative side, they’re very loud, and they make patients with claustrophobia quite uncomfortable. The real dangers presented by an MRI system are what these signs are all about: restricting access to the area close to the machine. When rigorous access controls are in place, there is little to no danger from an MRI machine. Why restrict access? Due to the system’s super-powerful magnets. They can ruin your cell phone, erase the magnetic strips on your credit cards — all pretty minor — and (theoretically at least) pull metal plates and screws right out of your body or heat them to the point that burns result. The strength of MRI magnets are measured as gauss units, and can run as high as 20,000 gauss. By comparison, the Earth’s magnetic field measures 0.5 gauss. No wonder a metal gurney was sucked into a machine in Boston — with a patient lying on it at the time. Scissors, prosthetic legs, oxygen tanks, wheelchairs and a security guard’s service pistol have all been sucked into machines where strict access control wasn’t maintained. No wonder these signs are so important. +

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Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

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Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., nor its agents or employees take any responsibility for the accuracy of submitted information, which is presented for general informational purposes only. For specific medical advice, diagnosis, and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2019 PEARSON GRAPHIC 365 INC.

SEPTEMBER 20, 2019

AUGUSTAMEDICALEXAMiNER

#99 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com

et’s pretend for a moment that you are a prolific inventor, a genius in your field, advanced electronics. Your name, let’s say, is Edward Irving. You thought up e-mail and created e-commerce and a number of other innovations, each of which has a name that begins with “e” in recognition of your first name and your role in their development. In addition, you invented the iPhone, the iPad, the iMac and more, and all have an “i” before their names in your honor. In a way, that situation describes the gentleman pictured above. He was a giant in his field, yet he is remembered, if you can call it that, only by the first letter of his last name. Even his full name, Theodor Escherich, is largely unknown outside a small slice of people who spend the majority of their time peering into microscopes in research labs. Escherich was born in November 1857 in Ansbach, Germany. His father was a physician and noted medical statistician whose focus of concern was high newborn mortality rates. Theodore kept the family tradition going, not only becoming a doctor but specializing in pediatrics, a branch of medicine that was still in its infancy at the time. Being concerned with the health of infants and children, Escherich found a position in 1882 working as an assistant to Professor Karl Gerhardt in a hospital in Würzburg, Germany. Gerhardt had a keen interest in pediatrics and served as editor of the first German Handbook of Pediatrics, a 16-volume work. Under Gerhardt’s supervision, Escherich’s doctoral thesis addressed cholera among infants. His interest led to a research trip to Naples, Italy, in late 1884 to study a major cholera outbreak there where his skills in the emerging science of bacteriology came to the fore. Collecting and studying stool samples of cholera victims, coupled with his long-term interest in improving pediatric health led to further studies where Escherich established what is normal bacterial flora in the intestinal tract of infants. It was Escherich who demonstrated that meconium, the dark green first feces of a newborn, was sterile, and that bacterial colonization of a newborn’s intestines occurs within hours of birth. Through his studies, Escherich isolated 19 different bacteria in infant stool samples (previously it was believed that there were only two), including the common intestinal bacteria that came to be known as Escherichia coli, nearly always known as E. coli. E. coli (Sorry, Theodor. E is a lot easier to type than Escherichia) is a little bit like nuclear waste: in a safe place nobody worries about it too much, but let it get out and there’s going to be trouble. Safely within our intestinal tract, E. coli is harmless, even beneficial. But let someone use the bathroom or change a baby’s diaper and then forget to wash their hands before handling food or shaking hands and the genie is out of the bottle. In developing countries, open sewage can contaminate ground and water; flies can travel from feces to food and drinking water with fever, diarrhea, vomiting and more as the result. The simplest defense against E. coli infections: basic sanitation and simple hand washing. +

HOSPITAL FOOD ETC, PART II by Marcia Ribble I have more to say about hospital food and other adventures that I recently experienced — or should I say endured — during a recent stay at a major local rehab/nursing facility. At one meal I was served something that looked like a cross between, to be positive about it, canned dog food and to be negative about it, vomit. I could not identify what it was at all, and neither could the nurses. After just looking at it I was done, even though I was weak and hungry. I asked for something supplemental like Glucerna, which they did have, and they sent me some kind of protein powder mixed in warm water. Not hot water, not cold water. Lukewarm water. It smelled vile, and that was as close as I could get to swallowing it. Fortunately for the kitchen staff, the food was brought to us by our CNAs. I couldn’t very well throw it at them. It wasn’t their fault. You don’t want to kill the messenger. Sleep is another huge issue for patients. One day I had been started on an IV at 10 am which took over 8 hours to finish, that meant I was wearing it from 10 am until 6 pm. I had a one hour break, and then was put on another IV that took from 7 pm until 9 pm followed by another IV that lasted from 9:30 until 1 am. I finally got to sleep about 2 am and at 4 am a CNA strolled into my room with a Hoyer lift to weigh me. I repeat: at 4 am! Bet you can guess how happy I was! I told her nobody was going to weigh me in that torturous machine and to get a scale, since by that point in my recovery I could stand up. She did get a scale and weighed me, but by then I was so upset I didn’t sleep the rest of the night. That morning when they came to get me for Physical Therapy

and Occupational Therapy, I was downright hostile! “Get out of here, I’m sleeping!” I growled. They pretty much left me alone to sleep the rest of the day, coming in only to bring me food, hook me up to the IV, or whatever really had to be done. I knew I was starting to heal when I had enough energy to create boundaries and enforce them. The rest of my stay everyone was aware that I would throw anyone out of the room who disturbed me while I was sleeping. I told them, “You can wake me up at 8 am and not one minute before that!” I didn’t care if they liked me, but by golly, they were going to respect me. Many patients are too vulnerable, too much in need, too alone, and too frightened to stand up for themselves. If they don’t have a patient advocate who comes often and stays long enough to see what is going on, they are easy to abuse, even when the abuse is not a matter of an evil caregiver intentionally harming them. With the boundaries established, they might weigh me after 11 pm, but only if I was awake already, and only with my permission. They told me when they wake up old people to take vitals or whatever they go right back to sleep. I’m sure that was the case for me when I was very sick and slept most of the time. But it was no longer the case. I was better. They also learned that even if I was very angry about something, I didn’t carry resentment afterwards and I really appreciated the care they gave me. Thanks to them all, within 20 days I went from totally helpless to being able to take care of myself at home. So yes, there are problems that they are working to fix, but they are still doing a lot to improve the quality and quantity of life for their patients. +

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SEPTEMBER 20, 2019

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

MEDICALEXAMINER

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SEPTEMBER 20, 2019

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elcome to hell. “What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?” Sigh. Welcome to priorauthorization hell. We are here discussing generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10 milliliter bottle (I checked before prescribing them). “No,” I responded to Jenn, “it would be ICD-B36.9 for otomycosis” (translation: ear fungus). Jenn tried submitting this new diagnosis without success. She then noted that this medication was supposed to be authorized without need for authorization, so she called the pharmacist, who ran the 30 milliliter bottle through the computer system, and the medication was authorized. That size bottle goes for $27 cash. Dr. Rob bangs head on wall. But Jenn didn’t yell. She didn’t say any profanity (that I could hear). Jenn’s a saint. She lost 30 minutes of her life to this nonsense, as did the pharmacist. As for me, I just got a little extra blood pressure points, a little acid corrosion of my stomach, and a stronger desire for a beer when I get home this evening. While my practice doesn’t accept money from insurance companies, we do serve our patients. This means that we advocate on their behalf in a system that seems hell-bent on making care less accessible. Prior-auth hell is one example of the wall that has been built between people and reasonable care. Electronic medical record hell, pharmacy trickery hell, specialist noncommunication hell, bloated hospital gouging hell, media non-story hype hell, and opportunist alternative medicine hell are all contributors to the hell-fire heat we are all feeling. By “we” I don’t just mean the people working in my office. I also don’t just mean primary care office workers. The pharmacist, the patient, and even the insurance company minions

were drawn into negotions over a $15 medication authorization. Would you want the job of explaining the reasoning behind denying a 10 ml bottle and accepting a 30 ml bottle? Countless hours are sucked from people’s lives across the country each day, sucked away with the end product being: nothing. No, not nothing. The end product is worse than nothing; the end product is poorer care for people who need it and increasingly embittered healthcare workers.

Would you want the job of explaining the reasoning behind denying a 10 ml bottle and accepting a 30 ml bottle? Nobody benefits from this. Nobody is making more money because of this prior authorization for a 10 ml bottle of ear drops. It’s not that the insurance company increases its profits by denying cheap generics. Their benefit comes from having a “cost control” plan in place to prevent unnecessary or inappropriate medication cost. As is often the case, the inefficiency of the process and resultant increase in cost is passed through the insurance company and sent to the person writing the checks (whether individual, business, or government institution). The idea of “cost control” makes some sense (nobody wants expensive unnecessary drugs to be paid for without question), but the total chaos of the system results in everyone gaming the system to pass the buck up to the person paying the bill. What can be done? The biggest thing is to stop using insurance to pay for cheap things! Automobile insurance does not cover routine maintenance, or even expensive repairs. The car owner is expected to pay for these out of pocket, with no consideration of whether they can afford it or not. While this results in hardship, I’ve heard no one clamoring for “MediCar for all.” So why are we paying insurance for primary care? As hard as some try, primary care docs will never give

anyone a huge bill for their care. Primary care, generic medications, and even simple emergency care don’t need to be expensive. They are only expensive because of insurance hiding the cost and putting a layer of administrative people between the patient and the care they are getting. If pharmacies competed for your business by publishing prices of drugs, what would happen to those prices? The same is true for simple emergency care and primary care. I know the answer because I lived in that kind of system for nearly 7 years. My patients know the price I charge for everything I do, and we don’t do something before getting their agreement on the price. Often, that’s not a difficult thing to get from them. “That medication is 75 cents per month,” or “The thyroid test costs $4” is not often met with anything but surprise over the low price. My goal with these prices is to make it so my patients can’t afford to stop paying my monthly fee. Because they are paying me directly, I am aggressive in trying to keep them as my patient by cutting cost and improving service. This is good business for me. But why not push that to the rest of medicine? Insurance is why we have $100 hemorrhoid cream. It’s why a 100 year-old medicine for gout still costs $70 per month. It’s why generic ear drops for swimmer’s ear still cost over $100. It’s because someone is still willing to pay those ridiculous prices: the insurers. Direct pay pricing can even extend to more expensive things. There is a surgery center in Oklahoma City that accepts only cash and posts the cost of procedures online. Doing this significantly reduces the overall cost of procedures (and patients can go back and recoup money from insurance if needed). While this doesn’t work all the time, the reality is that our healthcare crisis (and yes, folks, it is a crisis) doesn’t necessarily require more or better insurance to fix. Perhaps we need to stop insuring things. Maybe that’s the road out of hell. +

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SEPTEMBER 20, 2019

The

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...and your excuse is...what?

Will he ever get one right?

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MEDICALEXAMINER

Questions. And answers. On page 13.

IT’SYOURTURN! www.facebook.com/AugustaRX

Your turn for what? To tell the tale of your medical experiences for Medicine in the First Person. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. See our “No Rules Rules” below. Thanks!

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.” “We had triplets.” “He was just two when he died.” “The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.” “I sure learned my lesson.” “The cause was a mystery for a long time.” “The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.” “I thought, ‘Well, this is it’.” seven years ago.”

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

Everybody has a story. Tell us yours.

Here’s our “No Rules Rules.” We’ll publish your name and city, or keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.

SEPTEMBER 20, 2019

GARDENVARIETY

Fall is in the air — or will be eventually — which means it’s time for warm spiced drinks. Yes, I succumb to the pumpkin spice craze at the drive-through coffee shop. However, this fall, I wanted to create something I could serve at home when we have guests. A drink that makes them feel special and puts them in a festive fall mood. We entertain young and old, so mocktails are a fun choice for all. Mocktails are named so because they mock cocktails i.e., they look like cocktails but are non-alcoholic. It was also important to me that my drink was low in sugar for my diabetic husband, and all the ingredients were healthy. To make my Autumn Spiced Mocktail I start by filling a tea bag with whole cloves, cinnamon stick, and fresh sliced ginger. That goes into a pan with lowcalorie cranberry juice, some freshly squeezed orange juice and Granny Smith apple slices. I allow this to simmer for about an hour before serving. You can serve the Autumn Spiced Mocktail in a pretty glass garnished with orange slices and a sprig of rosemary. If the evening air is crisp, this recipe is also great to serve warm in a big mug garnished with a cinnamon stick. For a big party, this recipe would be easy to prepare and serve from a large crockpot with a ladle. Autumn Spiced Mocktail Ingredients • 4 cups diet cranberry juice drink (I use Ocean Spray) • 1 orange, juiced • 1/2 Granny Smith apple, cored and cut into slices • 1 teaspoon whole cloves • 1 cinnamon stick • 1 piece fresh ginger cut the size of a penny that is 1/4 inch thick • 1 empty tea bag or cheese cloth • orange slices, rosemarry springs and cinnamon stick for garnish (optional)

Nathan H. Brandon, M.D. Board Certified in Pain Management & Anesthesiology

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Autumn Spiced Mocktail (served cold) Instructions Place ginger, cinnamon stick, and cloves into the tea bag and pull drawstring tight. You can also tie the spices in cheesecloth instead of a tea bag. Pour 4 cups cranberry juice into a saucepan. Place teabag of spices, orange juice and apple slices in pan. Simmer over low heat for one hour. Remove teabag of spices. Chill to serve cold over ice or serve immediatly if you would like it warm. Garnish cold drink with orange slice and a sprig of rosemarry. Garnish warm drink with a cinnamon stick. + by Gina Dickson, a mom to six and Gigi to 10 from Augusta. Her web site, Intentional Hospitality, celebrates gathering with friends, cooking great healthy meals and sharing life together around the table. www.intentionalhospitality.com and IG: @intentionalhospitality

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SEPTEMBER 20, 2019

DRUG SCREENS, PART 2 by Ken Wilson Steppingstones to Recovery

ALL DRUG SCREENS ARE NOT CREATED EQUAL, PT. 2 “I passed my drug test!” Do I get a trophy?” Not necessarily. Maybe you passed it and maybe you didn’t. Many who think they passed a drug “test” have only passed a drug “screen,” a device that basically says “yes” or “no.” Kinda like an EPT stick. It tells whether there is or isn’t a pregnancy, but doesn’t tell the gender, how far along the pregnancy is, etc. Urine drug screens what most employers use to monitor employee compliance with company policies, but they are not “tests.” They have a place for two marks/ indicators to show up… if there is only one line, it’s positive (dirty) and if 2 lines show up it is negative (clean). They are made of 2 acetate (plastic) strips and a piece of tissue in between that absorbs the urine and detects various drugs that the tissue has been primed to indicate. The strips are marked and there are 5-panel through 15-panel options available. A “panel” is a single drug, so the 10-panel, for example, screens for 10 drugs. “Screen” is the operative word here…if the “screen” comes up positive (dirty), the same sample of urine should ideally be sent off to

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a registered laboratory for a dures are actual “tests,” and urine “test.” Just because a give metabolic counts. screen-strip comes up posi What’s the big deal with tive doesn’t mean the person metabolic counts? Hey, if is actually positive! It could you’re positive, you’re posibe a “false positive” which tive, right? only a lab test can indicate. Maybe so, maybe not. Like The screens don’t give a if you blow a .02 on a road“metabolic count,” in other side sobriety device, no DUI! words tell you how high of a But if you blow .08 (somelevel the drug is in the body. times even lower depending For the most part they just on why the officer pulled say Yes or No. you over) – prepare for the The lab tests are more exGray Bar Motel, the poorest pensive (not $5-$40 like the accommodations and the strips) and are often $100highest priced motel you’ll $200 each depending on the ever stay in! number of drugs being tested That’s the way metabolic for, and sometimes which counts work. Most screens drug is being tested for. test marijuana for 50 metab There are GCMS or LCMS olites and above…so if you (don’t ask! Just Google and have 48 metabolites (partilearn) tests that are about cles) of THC in your urine 99.999% accurate. I know it you won’t test positive for sounds crazy but they really the drug! Woohoo! Maybe are. Study the process and it’s been awhile since you you’ll see why. These proce- Please see DRUG SCREENS page 15

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SEPTEMBER 20, 2019

Useful food facts from dietetic interns with the Augusta University MS-Dietetic Internship Program

How (Food) Sensitive Are You? by McKinsey Fiveash, MS-Dietetic Intern ly. When certain areas swell in and around the throat, it blocks an individual’s ability to breath. This is called anaphylaxis and this can cause death without help from a medical professional. On the contrary food sensitivities, also called non-allergic hypersensitivities or food intolerances, can be far less dangerous in the short term. While allergies usually cause immediate reactions, food sensitivities can take between hours and days to cause any symptoms. Along with delayed reaction times, food sensitivities also have some similar symptoms to food allergies, making it even more difficult to diagnose. Some of these include headache, cough and stomach ache. Unlike food allergies, food sensitivities do not cause a release of the chemical histamine. Currently there are no blood tests that can detect if someone has a food sensitivity. The most reliable way to test for a food sensitivity is by eliminating the food from

the diet that may be causing the problems. Some common sensitivities include lactose, wheat, gluten, caffeine, foods naturally high in histamines, and food additives such as artificial sweeteners, dyes and added flavors. An example of a common food intolerance is lactose intolerance. Lactose is the type of sugar found in milk and lactose intolerance is a digestion issue and not an allergy. Lactose intolerance is when the body lacks enough compounds called enzymes in the stomach to digest lactose. Lacking enzymes is just one of the many ways food sensitivities are activated, which is why they can often be difficult to diagnose. Recent science shows that many common health conditions could be caused by a sensitivity to gluten. One of the most common conditions is irritable bowel syndrome (IBS). This condition is not fully understood but new research shows a close association to food sensitivities. Another common condition is a skin condition called eczema. This itchy rash on the skin could be due to a food sensitivity. As researchers continue to study these associations, the more closely related they become to food. For now, eliminating foods from your diet for a period of time and then checking for symptoms is the gold standard. More information about nutrition and health is available at www.eatright.org. +

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CRASH J

COURSE

ust as the September 6 issue of the Medical Examiner was being built came the news that we all knew already: running red lights is an epidemic. Alas, we had already promised an article in this space about the Cheetos Diet for that issue, so we had to put that breaking news on temporary hold. Here is the now-stale news: death caused by running red lights has reached a 10year high, according to data compiled by the American Automobile Association (AAA) Foundation. In 2017, the latest year for which figures are available, 939 people were killed in the U.S. by drivers blowing through red lights. That figure is 28% higher than it was as recently as 2012. Curiously, 28 is also the percentage of drivers killed in crashes at intersections caused by someone running the light. Since 2012, overall traffic deaths have risen by “only” 10%, while red light fatalities are pushing 30%. It would be poetic justice if

the 939 who died in 2017 were the red light violators themselves. Unfortunately, only about a third of the fatalities are the perpetrators. Nearly half were innocent occupants of other vehicles or passengers in the offending car. More than 5% of the dead were pedestrians or bicycle riders. What is perhaps the strangest result of the AAA research is that the vast majority of all

drivers, some 85%, say that running red lights is dangerous (even stranger: why wasn’t it 100%?), yet nearly a third admitted they had run a light within the past month when they could have stopped. These are the kinds of things that have killed more drivers on U.S. roads since 2000 alone — 624,000 and counting — than died in World Wars I and II combined. Why do people do it? More than 40% basically said because they could get away with it. That is a rather frightening admission considering that decisions like this kill an average of two Americans each and every day, and that accident or not, it is illegal. It makes you wonder what else ordinary people would do that’s both lethal and illegal just because they think they can pull it off without being arrested. Ironically enough, the AAA recommendation is to do the opposite of the current trend: that is, slow down slightly when approaching an intersection, especially if the light has already been green for a while. On the negative side, you might arrive at your destination a full 60 seconds later if you do hit the red. But on the plus side, you won’t risk killing yourself or others. That is never a bad trade. + Next issue: Fast-forward

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SEPTEMBER 20, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

Your once-sweet child has become a rude, moody teenager who is disturbing everyone in the family — including the dog. Do you just have to wait it out until the terrible teen leaves for college or grows out of his hormonal rage?

THE MOODY TEEN WHO RUINS IT FOR THE WHOLE FAM

Here’s What’s Happening Your child’s brain is reacting—hard—to hormonal changes during puberty, which can begin as young as 10 years old. What hormones do is take what we normally might feel and amplify it. So if your child typically struggles when handling change or has trouble handling emotion, hormones make it even harder. Kids who have been diagnosed with ADHD, bipolar disorder, oppositional defiant disorder or conduct disorder also have a harder time since a hallmark of these disorders is difficulty regulating attention or controlling behavior. A New Normal Just because hormonal changes are normal doesn’t mean they don’t come with a lot of emotional challenges. What can help is to start teaching kids—well before puberty— how to recognize when their emotions are heightened and giving them tools to deal with bigger-than-life emotions and to release tension. • Internal methods: Remember time-out for your 2-year-old? It’s the same principle. Teach kids to think through what they’re feeling to help them process and overcome negative emotions. Or, they can write or draw what they’re feeling, or talk it over with someone who will listen. • External methods: These include ways to distract from negative emotions and reduce stress. It could mean exercise, like running or yoga; a game, whether that’s on the computer solo or a board game with a friend; or an activity with a friend, like going to a movie, bike-riding or swimming. Kids may end up doing both methods at the same time or at different times. Parents can do the exact same things to deal with their own stress and frustration. It’s very important that parents monitor their own emotional reactions and not turn a minor problem into a bigger one. Remember, even though a child is always responsible for their own behavior, it’s important to take things in context, too. Try This At Home The situation: My teen is freaking out about having to finish homework. The fix: Acknowledge your child’s frustration, but ask, “What would you like to do to solve this problem?”, making it clear they understand the consequences at school and at home. Maybe your child wants to set a time when they will work on homework, or needs something before they can start. The situation: My teen is really mean to a younger sibling. The fix: One idea is to get them to work together on a project to foster a little teamwork. Or, if that makes things worse, try figuring out what exactly is happening (is the older child wanting to control the younger one? Is the younger one unsure of how to deal with the older child?). Work with each child to provide guidance/tools on how to fix the situation. The situation: My teen is pushing back against all authority figures. The fix: Get your teen to stop and think about what they want out of the situation and how they plan on getting it. Say they want parents/teachers to stay out of their business; are they achieving that by starting fights and causing trouble? It can really help when you put it into perspective and work on setting goals. The Small Details Pay attention to small details and trust your intuition. If something seems off with your child, don’t brush it off. In this day and age, also make sure that any weapons are locked up. Please see HUMAN BEHAVIOR page 11

SEPTEMBER 20, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Amit Phull ,MD, on September 13, 2019

5 TIPS FOR SURVIVING MED SCHOOL I still remember the feeling of my first few days of medical school. Walking the halls felt like a giant, very real step towards a career that I had dreamt of pursuing for years. While I knew that academic excellence was vital, what I did not think about at the time was how important the other the parts of my life would be to my success. From my current vantage point (I am an attending in emergency medicine) — with medical school now far in my rearview mirror — I wanted provide a few tips for those of you who are just starting out as medical students this fall: 1. Get out and be social. This may seem like a counterintuitive first tip, especially with the workload that you already have piling up, but trust me, it’s important. Every new student is trying to orient themselves with the campus, classes, and meeting new people. Get out there and attend school events, social gatherings, and make friends. Building your network will give you a diverse crowd to lean on and share frustrations, failures, and wins. Having an active social life will help you keep your priorities in perspective by doing something other than just studying. 2. Exercise. You may think I’m saying this because I’m a doctor, which is partially true, but I’m also saying it because I really believe that exercise is a great reliever of stress. A study from the National Center for Biotechnology Information showed that 53% of U.S. medical students met the criteria for burnout. Exercise is an effective way to help combat stress and burnout. Even if it is only for 20 minutes a day, exercise can make all the difference in your health, stress levels, and ability to focus and study. 3. Be humble and accept your failures. One of the essential qualities for a doctor is humility. Fostering this quality will help you better connect with patients and their families and provide the right answers. But for now, you’re not going to have the answers; you’re just going to have questions. So, ask them. All of them. Admit when you need help and ask for it. No doubt, you will stumble along the way. If you fail a test or miss a diagnosis, take a breath, this happens to all of us and it’s better to learn from our mistakes in a classroom or on a test than with a patient. 4. Stay organized. Trying to balance classes, meetings, and school events can be next to impossible. Start by finding the right tools to keep organized. Whether it’s a task scheduler on your phone or using a simple paper calendar and to-do list, find a system that works for you and stick to it. Set a list of priorities and work through it. 5. Find a mentor. Finding a mentor can seem like a difficult task when you’re still struggling to remember the names of all the faculty, but as you get to know your professors, take note of teaching style, tone, and approach. Look for a mentor who you think will not only support you, but will also challenge you as you progress in your studies and eventually grow in your career. The mentor/mentee relationship doesn’t have to be formal, and likely you’ll need to do the heavy lifting when it comes to building the relationship, but keep in mind that the benefits of having strong mentors will be enormous in the years to come. +

That all-important first year

Amit Phull is an emergency physician and vice-president of strategy and insights at Doximity.

HUMAN BEHAVIOR … from page 10

Stay in control as the parent, and don’t allow your hormonal child to be in control. Finally, remember that it’s OK for your child to talk to a counselor (sometimes your child might be more willing to talk to a counselor). And your pediatrician is a great resource for therapies to help regulate hormones if things are really out of control. +

Jeremy Hertza, PsyD, is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC in Augusta

Every year thousands of freshly minted doctors, diplomas in hand, head off to their first residencies and the wide world beyond. Each and every one of them knows first-hand how difficult it is to make it through all the hurdles med school represents. This book tells the story of one doctor who might well tell today’s med students, “You have no idea how easy you’ve got it.” Yes, this doctor could really write the book on how hard medical school is. But he was too busy for that. Someone else had to tell his story, and this book is the result. You already know how this particular plot thickened: it’s right there in the title. Dr. Jacob Bolotin was blind from the moment he took his very first breath in January of 1888. How could someone who has never seen a human being become a master of the healing arts? He never saw an anatomy chart, never looked through a microscope, never saw the dial on a blood pressure cuff or took a reading from a thermometer. He didn’t even know what skin looks like. He couldn’t take notes during

professor’s lectures — and even if he could, how would be read them? Yet being blind was, if you can believe it, at times the very least of Bolotin’s obstacles. From the title of the book alone, you know how the story ends: the blind medical student does indeed become a doctor. Even so, the mine-strewn journey from his earliest determination to pursue medicine to the day he earned his diploma would scarcely be believable if it were a tale of fiction. At that point (graduation), the reader expects the many pages remaining in the book will be devoted to his illustrious career and amazing accomplishments.

Not quite. As it happened, graduating from the Chicago College of Medicine and Surgery (today part of Loyola University) was just the beginning of the hurdles he had to clear. Doors were slammed in his face; other doors never opened: in its first six months his practice cleared a grand total of two dollars. Yet by the time his life ended, he was Chair of Diagnosis at the Chicago School of Medicine, Lecturer on Diagnosis and Diseases of the Chest at Jenner Medical College (among other positions), and had treated more than 3,500 patients, only 50 of whom were said to know Dr. Bolotin was blind. News accounts of the day frequently compared him to Helen Keller, but today, 95 years after his death at age 36, Jabob Bolotin is nearly forgotten. He should not be. His accomplishments in the face of obstacles and adversities most of us can barely imagine is one truly inspiring tale. + The Blind Doctor; The Jacob Bolotin Story by Rosalind Perlman, 236 pages, published in 2007 by Blue Point Books

Research News This could be handy You may recall that the first double hand transplant in American history took place ten years ago in Pittsburgh. The recipient was Augusta resident Jeff Kepner. Now comes news of a promising development in Switzerland for people who have lost their hand(s). Engineers there have successfully tested a new neuroprosthetic hand that combines robotic control with users’ voluntary control. The technology is able to detect intended finger movements from muscular signals in the amputee’s stump and respond within 400 milliseconds. That is combined in the hand under development with pre-programmed robotic control. As is often the case, there is a lot of work still to be done before this development is readily available to help amputees. To see a video of the project,

search “smart artificial hand” on YouTube for a 2:48-long video. Care for a spot of tea? Researchers at the National University of Singapore published a study this summer in the journal Aging which reports that people who regularly drink tea have more well organized brain regions — a faculty associated with healthy cognitive function — when compared with nontea drinkers. Study authors previously (2017) published research which showed daily consumption of tea reduced the risk of cognitive decline in older adults by 50 percent. The small group of study participants, who consumer either green tea, oolong tea or black tea at least four times a week for 25 years, had brain regions that were “interconnected in a more efficient way” as identified by MRI examination and neuropsychological tests.

News for fatheads Actually, it’s for all of us. Earlier this month, Yale University researchers made a departure from the typical studies linking high-fat diets with obesity — that has been pretty well established, after all — and instead explored how diet can affect the brain. Their research revealed that high-fat diets contribute to irregularities in the brain’s hypothalamus, the region of the brain responsible for regulating metabolism and, significantly, body weight homeostasis, the body’s system for regulating and maintaining its weight at a more or less constant level. The Yale team noted changes in the mitochondria — organelles in the brain that help us derive energy from the foods we consume — among subjects on a high fat diet. The study adds to the body of evidence about how unhealthy diets affect us physically and how an unhealthy diet alters our food intake neurologically. +

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AUGUSTAMEDICALEXAMiNER

The Examiners +

Aren’t you taking first aid classes?

by Dan Pearson

No, I finished that course.

I’ve just started a new course in ALS: Advanced Life Support.

What’s next?

EXAMINER CROSSWORD

PUZZLE ACROSS 1. _____ Gordon 6. Around prefix 10. Within prefix 14. Slow (in music) 15. Ready for business 16. Incline 17. ____ Flu 18. Infant mort. cause 19. It can be posted or jumped 20. _______-Lambuth chapel 22. Post-mortem 24. ____ up, as with bread 25. Brag 26. Of black & white ancestry (obs.) 30. Little ball stand 31. Cage material? 34. One and all 36. Just an ordinary Joe 38. Sci-fi classic by 54-A 39. Cinemas owner 42. Kelly on TV 43. Greek epic poem 45. Short joke 47. Metal container 48. Doctrine suffix 51. Single-celled adjective 52. Rectangular pier 53. Fur scarf 54. Author of 38-A 57. Continuing 62. Parched 63. By mouth 65. Stomach woe 66. Stead 67. Flightless bird 68. Fragrant resin 69. Took a tumble 70. Upper management person (in short) 71. Radioactive gas, element no. 86

24 26

35 39 44

36 40

45 49

37 42

46 51

52 54

57 64

The Mystery Word for this issue: TOFO

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

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, SEPT. 30, 2019

We’ll announce the winner in our next issue!

E X A M I N E R

7 9 4 4 3 9 6 9 5 8 2 4 1 9

3 4 1 2 8 5 8 5 3 2 4 7 3 5

S U D O K U

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

DOWN 1. Common type of stone 2. Son of Jacob and Leah 3. Indigo dye 4. Thrust with a knife 5. Integrity 6. Defer; delay 7. Upon or above prefix 8. Edit or censor, as a legal document 9. Call The General 10. Type of grease? 11. Low tide 12. Raised platform 13. Solely 21. Rotating part 23. Lower digits 26. Corpsman 27. The throat’s “little grape” (Latin) 28. Russian Premier 1917-1924 29. Extent of space 31. Nose prefix 32. Louvre Pyramid architect

THE MYSTERY WORD

33. Get on 35. Self-esteem 37. Child’s bed 40. Steroids starter 41. Yellow citrus 44. Take dinner 46. Word often following little and big 49. TIA as it’s more commonly known 50. Reeves movie 52. Arabic word meaning slave or servant 54. One of two equal parts 55. Great lake 56. Monetary unit of Cambodia 58. Earthen pot 59. Like most tea 60. Captain of Twenty Thousand Leagues Under the Sea 61. Smile 64. Reverence; admiration Solution p. 14

8 6 5 1 7 9 4O 3 1 2 6T 8 9L 5 3 4 2 7

— Kahlil Gibran

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.

1. 276 (body part) ___

6. 62835 (body part) _____

2. 327 (body part) ___

7. 35269 (body part) _____

3. 447 (body part) ___

8. 26553 (body part) _____

4. 2663 (body part) ____

9. 6678745 (body part) _______

5. 24378 (body part) _____

10. 7283552 (body part) _______

INSTRUCTIONS: Use keypad letters to convert numbers into the words suggested by the definitions provided. There is often a theme linking all answers. Sample: 742 (body part) = RIB. Answers on page 14. The first issue of each month contains a “Words by Number” puzzle in this space; the second issue contains a “Text Me” puzzle.

TEXT

SEPTEMBER 20, 2019

3 2 4 5 9 7 8 1 6

5 7 6 1 3 4 2 8 9

2 9 3 6 8 5 1 7 4

4 8 1 2 7 9 6 5 3

SEPTEMBER 20, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

eople with bad eyesight are so excited that this year is going to be over soon. Next year is the first time they’ll be able to see 2020. Moe: It’s amazing that Jesus could walk on water. Joe: That’s nothing. Stephen Hawking could run on batteries. Moe: People always told me I would fail at poetry because I’m dyslexic and can’t read well. Joe: And? Moe: And I always said what does that have to do with anything? Today I made two vases and a bowl, so who’s laughing now? Moe: How is your job search coming along? Joe: Not that great. I couldn’t concentrate in the orange juice factory; wasn’t suited to be a tailor; the muffler factory was just exhausting; I couldn’t cut it as barber; didn’t have the patience to be a doctor; didn’t fit in the shoe factory; pool maintenance was too draining, dental work was like pulling teeth, I couldn’t really see myself working in a mirror factory, and there was no future as a historian.

Moe: Well, I hear garbage collection is really picking up. Joe: That job stinks. Moe: What about working in the film industry? It’s really growing around here. Joe: No, that’s not my scene. Moe: Think you might like accounting? Joe: That would be a really taxing job. Moe: Isn’t the death penalty back? You could be a hangman. Joe: But who would show me the ropes? Moe: What about working in a cemetery? Joe: I hate working graveyard shift. Moe: Think you might like to be a detective? Joe: No, I would have no clue. Moe: What about being a philosopher? Joe: I thought about that... Moe: How about a career in baseball? Joe: I already gave that a swing. Moe: Cyber security would be a good field. Joe: Nah. I couldn’t hack that. Moe: Think you might like to be a gynecologist? Joe: There aren’t enough openings. Moe: You could be a human cannonball. Joe: Tried that. Got fired. Moe: You could get a pilot’s license. Joe: Tried that too. Never got off the ground. Moe: You could learn pest control. Joe: That job would kill, but no. Moe: What about watch repair? Joe: The hours are too long sometimes. Moe: Why not train to be an astronaut? Joe: That job would be out of this world! Moe: Well, you always say you need your space... +

Why subscribe to theMEDICALEXAMINER? What do you mean? Staring at my phone all day has had no Effect on ME!

Because try as they might, no one can stare at their phone all day.

The

Dear Advice Doctor, My sister and I have always been close, but last winter we had a bit of an argument that has festered ever since. It progressed to big noisy fights, and now has disintegrated into a cold war. When I think about how often we used to talk, the silence these days is deafening. The thing is, over the months I have come to the realization that I was in the wrong from the start. I don’t know how to fix this, but I hope my sister can find it in her heart to forgive me. Any ideas? — Seeking the war’s end Dear Seeking, I’m sure this is distressing to you, but I want you take an optimistic view of your situation. You are most fortunate to be alive now. I don’t know from your question what “it” is that your sister thinks she might find in her heart. But consider for a moment what she would have faced in generations past. The only two choices back in the day were not enough and too much. On the one hand, all doctors could do was listen with a stethoscope. The only other diagnostic option was open heart surgery. A hundred years ago it would have been considered unthinkable science fiction to examine blood vessels and even the heart from the inside. But that is done every day of the week at hospitals around the country and across the globe. Sometimes the procedure is very simple and non-invasive: a contrasting agent is injected into the bloodstream, and an x-ray will identify anything needing attention, such as an arterial blockage. Even more amazing to someone from a century ago might be the common procedure today known as cardiac catheterization. As common as it is, it’s still somewhat astounding to think that a camera and a wire with tools a skilled surgeon can employ can be threaded into the heart itself from a vein in the leg. By these means, problems can be identified and corrected. Stents can be deployed, for example, to alleviate arterial blockages. Whatever your sister hopes to find in her heart, I wish her well. Thanks for your question. I hope my advice has been helpful. + 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 Examiner issues.

SUBSCRIBE TO THE MEDICALEXAMINER +

Why read the Medical Examiner: Reason #371

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY STATE ZIP Choose six months for $20____ or one year for $36 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

4 1 + 14

THE MYSTERY SOLVED The Mystery Word in our last issue was: CLAVICLE ...cleverly hidden in the chicken in the p. 7 ad for WILD WING CAFE

THE WINNER: ANNIE LEACHMAN! Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

SEPTEMBER 20, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED F L A G

L E V I

M E D I C

U V U L A

H A L F

E R I E

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The Celebrated TheSUDOKUsolution MYSTERY WORD CONTEST 8 6 3 5 2 4 9 1 7

...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.

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Love to stare at your phone? Visit issuu.com/ medicalexaminer and stare away.

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QuotatioN QUOTATION PUZZLE SOLUTION “Life without love is like a tree without blossoms or fruit.” — Kahlil Gibran

TEXT ME 1. ARM 2. EAR 3. HIP 4. BONE 5. CHEST

6. NAVEL 7. ELBOW 8. ANKLE 9. NOSTRIL 10. PATELLA

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

SEPTEMBER 20, 2019

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AUGUSTAMEDICALEXAMiNER

DRUG SCREENS… from page 8

indulged; maybe you just had a big cup of coffee and the urine is slightly diluted with more water than usual. It’s possible, in such a case, to test clean for THC in the morning but test dirty for it in the afternoon after you’ve urinated and not re-hydrated yourself! All drugs on screens have the built-in cutoff levels. Strict drug tests have lower cutoff levels…for instance, 15 metabolites (nanograms) of THC vs. 50 in the less exact screens. More up-to-date drug screens also have a strip for alcohol! They do! And it doesn’t

Voted “BEST BARBER SHOP” in Augusta Magazine many times!

test for alcohol present in the body now but screens for alcohol that has been in the body for up to the past 72 – 80 hours! It screens for ethyl-triglyceride. Google and learn! Oh my…I’m out of room and haven’t addressed the upsides/downsides of other drug tests as promised! There’s always next month. Now that you’re more educated on this subject, maybe you’ll test clean then if you’re not clean now! And you can retain even more knowledge with a brain that’s working better. That’s the way it was with me anyway. +

Daniel Village Barber Shop 2522 Wrightsboro Road • 736-7230

Proudly affiliated with Dr. John Cook of Southern Dermatology in Aiken

YOU DRESS FOR SUCCESS

WE TRIM FOR SUCCESS

M.D. John Cook,

5 BARBERS! • FLAT SCREEN TV! • PAY BY CREDIT/DEBIT CARD! • FREE POPCORN!

Head to toe service: Jerry will shine your shoes while we cut your hair. Visit us at danielvillagebarbershop.com 76 Circle K

Highland Ave.

DANIEL VILLAGE BARBER SHOP

Ohio Ave.

Pictured above (from left to right), John Cook, MD; Lauren Ploch, MD; Jason Arnold, MD; Caroline Wells, PA-C; Chris Thompson, PA-C

Daniel Field

Complex WRIGHTSBORO ROAD Augusta Mall e E Medical Tue - Fri: 8:00 - 6:00; Saturday: 8:00 - 2:00 2110 Woodside Executive Court Aiken, South Carolina • 803-644-8900

SKIN CANCER CENTER

2283 Wrightsboro Road Augusta, Georgia • 706-733-3373

Skin Cancer Removal • Mohs Surgery • Routine Skin Exams • Mole Removal • Botox • Dermal Fillers

An archive of past Medical Examiner issues is available online at

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GENERAL, SURGICAL & COSMETIC DERMATOLOGY

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SEPTEMBER 20, 2019

PROFESSIONAL DIRECTORY +

ACUPUNCTURE

DENTISTRY

DRUG REHAB

Dr. Eric Sherrell, DACM, LAC Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707 www.AcuClinicGA.com

Dr. Judson S. Hickey 2315-B Central Ave Augusta 30904 PRACTICE CLOSED 706-739-0071

Steppingstones to Recovery 2610 Commons Blvd. Augusta 30909 706-733-1935

ALLERGY Tesneem K. Chaudhary, MD Allergy & Asthma Center 3685 Wheeler Road, Suite 101 Augusta 30909 706-868-8555

AMBULANCE SERVICE

Floss ‘em or lose ‘em!

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048 Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

DERMATOLOGY AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

CHIROPRACTIC Evans Chiropractic Health Center Dr. William M. Rice 108 SRP Drive, Suite A 706-860-4001 www.evanschiro.net

COUNSELING Resolution Counseling Professionals 3633 Wheeler Rd, Suite 365 Augusta 30909 706-432-6866 www.visitrcp.com

IN-HOME CARE Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) WOODY MERRY www.woodymerry.com Augusta 30904 Long-Term Care Planning 706-733-3373 SKIN CANCER CENTER I CAN HELP! www.GaDerm.com (706) 733-3190 • 733-5525 (fax)

DEVELOPMENTAL PEDIATRICS Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com

YOUR LISTING Augusta Area Healthcare Provider 4321 CSRA Boulevard Augusta 30901 706-555-1234 CALL 706.860.5455 TODAY!

PHARMACY

Medical Center West Pharmacy 465 North Belair Road Evans 30809 706-854-2424 www.medicalcenterwestpharmacy.com Parks Pharmacy 437 Georgia Ave. ARKS HARMACY N. Augusta 29841 803-279-7450 www.parkspharmacy.com

SLEEP MEDICINE Sleep Institute of Augusta Bashir Chaudhary, MD 3685 Wheeler Rd, Suite 101 Augusta 30909 706-868-8555

VEIN CARE Vein Specialists of Augusta G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 706-854-8340 www.VeinsAugusta.com

YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by thousands of patients every month. Call (706) 860-5455 for all the details!

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