Medical Examiner by Daniel Pearson

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SEPTEMBER 7, 2012

MEDICINE:

Pass Fail? The home game O

nce upon a time, the list of medical events that could land someone in the hospital for an extended stay was about as long as, well, most hospital stays back then. Having a baby or just about any surgical procedure, including an appendectomy or tonsillectomy could easily mean a week in the hospital, often more. For more serious situations patients could routinely expect a month in the hospital followed by extended at-home care. That, as they say, was then. Now, the same procedures that put patients flat on their backs with aroundthe-clock medical care in olden times (meaning as little as ten or twenty years ago) might very well be an outpatient procedure today. That means you’re going home immediately afterward. Another aspect of this issue: the hospital stays of yore also began earlier. While a patient today might be told to report to the hospital at some godforsaken pre-dawn hour on the day of surgery, back in the day that patient might have checked in the day before (or earlier). Is that a bad thing? In some ways yes, in other ways it’s one giant leap for mankind, as the late great Neil Armstrong would have said.

he article about laws relating to passing stopped school buses in

our last issue prompted several readers to ask about funeral processions. Is it legal to pass a funeral or not? We turned to law enforcement for the official answers, and they’re inside.

When you... We...

What’s good about it? On the simplest, most humanistic level, most of us would rather be at home in our own comfortable surroundings than in a hospital room. That presumes, of course, that we can have our cake and eat it, too, that being at home will not compromise our return to normal activities. Read on for more about that.

When we’re at home, it’s a safe bet a total stranger will not clatter into our bedroom at 3:00 a.m. to check vitals. Gotta love that. On a more practical, nuts-and-bolts level, outpatient procedures and early discharges save money. Some people might view that as a negative: “My care has been short-changed because they sent me home to save money. Save money? For who? They sent me a bill for fifty thousand dollars!” Hold on. Calm down. You’re going to bust your stitches wide open. First of all, you should have asked, “For whom?” Who is a nominative pronoun and... well, never mind... Pronouns aside, when insurance companies spend money, insurance rates go up for everybody. Nobody wants that. When they save money, it ultimately saves money for all of us. Everybody wants that. Secondly, when a hospital saves money it can do all kinds of good things: protect jobs, enable upgrades to and purchases of expensive medical equipment, and yes, also keep our money in our collective pockets. Shortened hospital stays (and the dollars they save) are not dollar-driven decisions. That’s just one contributing factor. A hospital could save tons of money by sending a patient home the same day they get a lung transplant, but you’ll never see that happen. Shortened stays are first and foremost decided from the standpoint of patient outcomes. No hospital is going to leave itself wide open to malpractice litigation due to a reckless discharge policy. Despite the benefits, for patients there are some definite and serious drawbacks

THE SKINNY ON HEALING THYSELF • Why is there a growing outpatient trend? Among the reasons: • advancements in surgery, including laparoscopies and other less invasive procedures that reduce time in surgery, minimize blood loss and decrease operative and post-op complications • improvements in anesthesia allowing faster recovery • better pain medicines • cost-saving efforts by hospitals and insurance companies

• Underscoring the rise of outpatient medicine, the Wall Street Journal reports that there were just 240 freestanding outpatient surgery centers nationwide in 1983; there were more than 5,000 in 2010 (including several in Augusta). • A federal study says the mean cost of all inpatient surgeries is about $40,000 versus a mean $6,000 pricetag for all outpatient surgeries. • 65% of all surgeries required an overnight hospital stay in 1980; only 16% did in 2010. In the same timeframe the average hospital stay has dropped from about two weeks to about three Please see HOME GAME page 16 days. +

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

SEPTEMBER IS PROSTATE CANCER AWARENESS MONTH

Prostate cancer and PSA test controversy: What should men do? by Dr. Samir N. Khleif Director, Georgia Health Sciences University Cancer Center In May, the U.S. Preventive Services Task Force, an independent group of national experts that provides evidencebased recommendations to improve Americans’ health, made an announcement that was widely debated by cancer communities and men everywhere. The announcement was this: The U.S. Preventive Services Task Force recommends against prostate-specific antigen (PSA)based screening for prostate cancer. The potential benefit does not outweigh the expected harms. A simple blood test, the PSA screening, combined with a digital rectal exam, has been relied on for the past two decades as an easy method to evaluate men’s risk for prostate

cancer, although its accuracy and efficacy for decreasing the risk of prostate cancer death has long been a matter of debate. This announcement understandably caused confusion, doubt, even anger among men in general and prostate cancer survivors in particular. But, it’s an announcement that perhaps has been a long time coming. What the task force really found is that too many of us have been relying too much on the PSA test. As a screening tool, it has always been somewhat controversial. The PSA test frequently leads to the detection of slowgrowing, non-life-threatening prostate cancers (referred to as “overdiagnosis”), putting men at risk for more invasive tests and unnecessary therapies that can cause pain and health problems. In addition, many other factors besides cancer

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Study authors said “Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.” can raise PSA levels, including infection, certain medications and a benign enlargement of the prostate that often occurs with age. As a result, about 100 to 120 out of every 1,000 men screened will receive a false-positive test—in other words, the test may suggest they have cancer when in fact they don’t. This can cause anxiety and worry. It can also lead to other tests, including invasive biopsies that surgically remove tissue samples and may cause complications like infection (which may sometimes be life-threatening), bleeding, urinary problems and pain. The PSA test can also lead to overly aggressive treatment. The fact is, most prostate cancers— nearly 63 percent—occur in

men 65 and older. Because most prostate cancers are slowgrowing, these men will more likely die from old age or other health problems than from this type of cancer. But since there’s also no sure way to tell which cancers are aggressive, many men choose to receive invasive treatments that often lead to permanent urinary and sexual dysfunction. So what should men do? Certainly, the PSA test has been overused. But it can be helpful for men in certain risk categories. These categories include men 50 or older who: • Have one or more first-degree relatives (a father or brother, for example) who were diagnosed with prostate cancer before age 60; • Have one or more first-degree relatives who died of prostate cancer before age 75. Still, even in these men, it is important to note that it remains unproven whether any benefits of screening outweigh the harms. However, a more

personalized approach to screening will help target men who should be more concerned about their risk of prostate cancer. And based on the test results, physicians can also talk to men about their options. Not all men with prostate cancer may need cancer treatment right away. Careful periodic monitoring for signs of cancer progression might be the best first step. Finally, the task force’s recommendation underlines how important it is for all of us to be informed about the benefits and risks of any screening test. Some men may still opt for the screening after their physician has carefully explained the potential risks and benefits. + Dr. Samir N. Khleif has more than 22 years’ experience in cancer research and treatment, including in the Cancer Vaccine Section at the National Cancer Institute. The GHSU Cancer Center is working toward becoming Georgia’s second National Cancer Institutedesignated cancer center.

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

What’s your story? “Say Goodnight to Cancers Below the Waist!” Saturday September 22nd, 2012 Lake Olmstead Stadium

Run begins at 9am Registration begins at 7:30am with a Pre-Run Program 8:30am Benefiting Georgia Health Sciences University Cancer Center

Nearly all of us — even doctors and nurses — are sometimes patients. Perhaps you were recently injured playing your favorite sport, or years ago you somehow got hurt without even leaving your favorite recliner. Maybe you were diagnosed with a dreaded disease, mugged in a dark and lonely parking lot, or you stubbed your toe in the safety of your own bedroom. On the other hand, perhaps you needed medical attention 5,000 miles from home. Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale. We’ll publish your encounters with the medical profession as often as we receive them. + Send your submissions for Medicine in the First Person to the Augusta Medical Examiner via e-mail: info@AugustaRx.com or to PO Box 397, Augusta, GA 30903-0397. (The Medical Examiner reserves the right to accept, reject, or edit any submission at its sole discretion.)

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appears exclusively in the Medical Examiner’s 3rd Friday issue of even months, written by Augusta’s own Bill

Why would anyone pay for a subscription to a free newspaper? That’s certainly a legitimate question. The answer: as a major regional medical center, patients come to Augusta hospitals and physicians from all over the Southeast. The MCGHealth Medical Center alone sees patients from every single county in Georgia, not to mention South Carolina, Florida, and beyond. Add to that the regional reach of Eisenhower Army Medical Center and both Veterans Administration hospitals, the Joseph M. Still Burn Center at Doctors Hospital, MCGHealth Children’s Medical Center, Walton Rehab and University Hospital, and it’s clear that many people seeking treatment in Augusta are not local residents. Furthermore, some of our most loyal readers are in town only occasionally. Or their treatments and visits to Augusta are only temporary. Even local residents may find it more convenient to walk to their mailbox than visit one of our many newsstands. Subscriber copies are mailed the day prior to the issue date so they will be received by most readers no later than the publication date printed on the paper. Copies are sent by First Class mail in a sealed envelope so they’ll arrive promptly and in crisp condition. Rates are $16 for a 6-month subscription (12 issues), $32 for a full year (24 issues). Complete the form below and drop it in the mail with your payment. Thank you! +

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www.AugustaRx.com • E-mail: graphicadv@knology.net Opinions expressed by the writers herein are their own and their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., or its agents or employees take any responsibility for the accuracy of submitted information, which is presented for informational purposes only. For specific medical advice, diagnosis, and treatment consult your doctor. © 2012 PEARSON GRAPHIC 365 INC.

SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

Hope IS Possible

The weight is on our shoulders

Helen Blocker-Adams fter reading an article recently I was appalled to learn that not only do we have an obesity epidemic in this country, we have one right here at home in Georgia. We rank second nationally in childhood obesity and overweight. I realize that young people have become too sedentary due to computers, Internet, hand game toys, Wii games, cell phones and texting, television and so much more. Some schools have practically eliminated physical activities, politicians are cutting back on important public health related concerns due to budget cuts, and I could go on and

on. A UK study not long ago revealed that only 25% of kids play outside. That’s pretty unbelievable to me because I remember when growing up, we always played outside, and we had fun too. The childhood obesity problem has doctors trying to figure out ways to encourage kids to spend time outdoors, exercise more and change their lifestyles. Through a fascinating Healthy Living Home article entitled “Dirt on Dirt,” I learned of an unexpected side effect experienced by kids who don’t play outside. This article reveals that kids are not getting enough exposure to germs. Yes, that’s right, germs. They aren’t being exposed to enough germs, “impairing their immune systems, fostering allergies, and causing asthma and other autoimmune diseases such as multiple sclerosis and type-one diabetes during adulthood,” said the author. It went on to say that kids need to go outside more so they can get dirty and come in contact with all the healthy microbes and germs that will ultimately prevent illness. Parents may cringe and fuss when their children run in

the house with mud all over themselves, but experts say that playing in the mud and dirt also increases happiness. Studies show that there are bacterium found in soil that triggers the release of serotonin that uplifts moods and decreases anxiety. Playing in the dirt can also alleviate ADHD in children. So go figure: there is value in playing in the mud and getting dirty. Governor Nathan Deal has taken this chronic childhood obesity problem seriously and has begun statewide efforts to combat it. That’s commendable. The campaign website is www.georgiashape. org.

The month of September is National Childhood Obesity Awareness month and the national website is www. coam-month.org. Both of these websites have so much valuable information that I highly recommend you visit. There are more than 23 million children and teenagers in the United States who are obese or overweight. The experts call that an epidemic level. That also means that nearly one third of America’s children are at risk for Type 2 diabetes, sleep apnea, high blood pressure, heart disease and stroke – conditions usually associated with adulthood. Do these statistics disturb you at all? They got my attention and that’s why we added health and fitness sessions with Weight Loss Specialist TJ Simmons of Champion Fitness & Nutrition to our Unlikely Allies Emerging Leaders Conference series. Our unique approach in building healthy leaders impacts middle and high school students in the CSRA. If you’re interested in supporting this endeavor, please email me for more information. I have to admit that I am a late bloomer when it comes to really taking a more concerted interest in my health. Thank God I have always been a relatively healthy person, have only been hospitalized one time when I had surgery, and have only had one broken bone. My exercise routines in past years have been sporadic and not consistent at all. My weight

has fluctuated over the years. It wasn’t until about five months ago, that I decided to take charge of my health. I’ve made a healthy lifestyle change that has me pretty amazed at times. In four months, I’ve lost 20 pounds and more than 28 inches with changed eating habits and 3days-per-week early morning workouts with Champion Fitness & Nutrition along with two days of cardio exercise. As an advocate for young people and the growth of our youth leadership development program and now the addition of the health and fitness element, it is important for me to lead by example. I think more adults should take charge and lead in the effort to be a role model for healthy lifestyles. Our children are depending on us. So with that in mind, “the weight is on us” to use this month of September to educate, bring awareness to childhood obesity and at the same time take a physical assessment of our own health that will result in action now and on into the months and years ahead. + Helen Blocker Adams is President/ CEO of The HBA Group, Intl and Executive Director of the Southeast Enterprise Institute, Inc. Visit her website at www.helenblockeradams. com. If you like politics, visit her blog at www.projectlogicga.com. You can reach her via email at hba@hbagroup-intl.com Helen’s new book, Unlikely Allies: 8 Steps to Bridging Divides that Impact Leadership can be purchased by visiting www.hbagroup-intl.com or www.authorhouse.com

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW ABOUT A CENTURY OF PROGRESS by Bad Billy Laveau Most people celebrate their personal birthday about once a year. I say about once a year because some people of the XY chromosome persuasion tend to be less that accurate about their exact number of birthdays. But I have the solution to their problems. After a woman turns 39, from then on she can celebrate the anniversary of her 39th birthday. I have been celebrating the anniversary of my 49th birthday for some years now. I canâ&#x20AC;&#x2122;t rightly remember exactly how many. And for the record, I donâ&#x20AC;&#x2122;t care how many. Actually, I am not completely sure of my birth date. I was young at the time and have to take the word of others regarding that. There might have been two deliveries in that South Georgia farmhouse that night. The other might have been Obama for all I know. If so, my mother forgot to mention it. To celebrate my latest birth date anniversary, I cooked on my Green Egg, ate too much, took a nap in my favorite chair, and finished off the rollicking date by taking a continuing education medical course online. It was a wild evening for me. I could have gone out to the Redneck Olympics and entered the belly flop contest. But I didnâ&#x20AC;&#x2122;t. Iâ&#x20AC;&#x2122;m too old and ugly for that. After my nap, I thought back about things that have changed in my lifetime, or more accurately, in the last hundred

years. As usual, I made a list for you think about: 100 Years Ago: The average life expectancy for men was 47 years. The average US wage in 1910 was 22 cents per hour. The US had 8,000 cars and 144 miles of paved roads. The speed limit in most cities was 10 mph. Fuel for cars was sold in drug stores only. 14% of homes had a bathtub. 8% of homes had a telephone. It was believed that telephones would never be a commercial success because women and children would be too frightened to use them. 18% of households had at least one full-time servant or domestic help. The tallest man-made structure in the world was the Eiffel Tower (1,050 feet tall). The average US worker made $200 to $400 per year. Competent accountants made $2000 per year. Dentists made $2,500 per year. Veterinarians made $1,500 to $4,000 per year, mechanical engineers about $5,000 per year. 95% of all births were HOME deliveries. 90% of Doctors had NO COLLEGE EDUCATION! Instead, they attended socalled medical schools, many of which were condemned in the press AND the government as â&#x20AC;&#x153;substandard.â&#x20AC;? Sugar was 4 cents a pound.

GOT A STORY?

t s e B Eggs were 14 cents a dozen. Coffee was 15 cents a pound. Women washed their hair once a month, and used Borax or egg yolks for shampoo. Canada passed a law that prohibited poor people from entering their country for any reason. The five leading causes of death were: 1. Pneumonia and influenza 2. Tuberculosis 3. Diarrhea 4. Heart disease 5. Stroke Penicillin and other antibiotics had not been invented. Pneumonia had a 90% death rate if the victim was overweight. Only 50% of the skinny died. The American flag had 45 stars. The population of Las Vegas, Nevada, was 30. No one had ever heard of silicone breast implants. Some football players played without using helmets. Crossword puzzles, canned beer, and iced tea hadnâ&#x20AC;&#x2122;t been invented yet. There was no Motherâ&#x20AC;&#x2122;s Day or Fatherâ&#x20AC;&#x2122;s Day. 20% of adults couldnâ&#x20AC;&#x2122;t read or write. 6% all Americans were high school graduates.

e n i c i d ME

Marijuana, heroin, and morphine were all available over the counter at the local corner drugstores. Back then pharmacists said, â&#x20AC;&#x153;Heroin clears the complexion, gives buoyancy to the mind, regulates the stomach and bowels, and is a perfect guardian of health.â&#x20AC;? Coca Cola contained cocaine and was commonly called, â&#x20AC;&#x153;Dopes.â&#x20AC;? Womenâ&#x20AC;&#x2122;s panties were frequently homemade from flour sacks. Bras had not been invented. There were about 230 reported murders per year in the ENTIRE U.S.A. A mouse was a four-legged rodent that made women scream and act crazy. If a kid got a spanking in school, he got a worse one when he got home. 5th graders could actually do math and long division without a calculator and make change at the store. Every man and boy carried a pocketknife at all times, including when at school and church. By age 12, every self-respecting boy had a dog, a gun, and a knife. By age 12, girls could sew, crochet, iron, and as well as kill, dress, cut-up, fry and serve a

chicken for Sunday dinner. Girls were expected to remain a virgin until married. Pregnancy before marriage was a family disgrace and the girl was sent far way to have the baby, which was put up for adoption. Single-parent homes usually meant the husband had died in a war or in some other tragedy. Men smoked in public. Women did not. It was disgrace for a man to beat his wife any more than she needed. Soldiers were admired and respected. Only veterans of war and criminals had tattoos. Being on welfare or getting a government check was a disgrace. Not paying oneâ&#x20AC;&#x2122;s bills and filing for bankruptcy was unheard of. Every decent person went to church regularly. Presidents and presidential candidates always appeared in public wearing a coat and tie. Yes, much has changed in the past century. We have made much progress, medically and mechanically. But are we better off socially or morally? I think not. + Bad Billy Laveau is a retired MD with a pointed sense of humor. Bad Billy speaks and entertains at public and private events for audiences not subject to cardiac seizure secondary to overwhelming laughter and glee BadBilly@knology.net or 706306-9397

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

Health 101 by Sandy Turner, RN, EdD, Family Nurse Practitioner, and Assistant Dean for Administration in the GHSU College of Nursing OH, THOSE ACHES AND PAINS! ain is the number reason people seek out health care. But never forget that pain isn’t the problem. Pain is only a symptom. It is the body telling us something and it is up to us to listen and try to figure out what to do about it. The source of the pain is the important thing to determine. There are all kinds of pain: sharp, dull, radiating, acute and chronic, to name a few. I am going to start with some general pain and then we can look at some specific areas. Most often we have pain related to use. That is, we have overdone some activity. We may spend most days with little or no physical activity and then go out and clean the yard or move furniture around. Another example is repetitive motion pain. That is when we do the same thing over and over whether at work or play. Tennis elbow, golfer’s elbow, wrist or pain in the tendon at the base of the thumb are all examples of pains we get when our body is telling us to slow down and use another body part for awhile. Unfortunately, most of us either don’t want to stop or can’t because it involves our work. So, what do we do then? If it

is pain from joint inflammation, the old acronym “RICE” may help. Rest, Ice, Compress and Elevate may help, with the possible addition of an antiinflammatory medicine. We may try the old “ignore it and it will go away” or just “grit your teeth and work through it” if we just can’t stop, but our bodies do have a way of getting our attention sooner or later. If we don’t listen sooner, we will end up paying more attention later. Muscle pain or strain can be almost anywhere, but the most common sites are in the muscles we use (and overuse)

most often: in our arms or legs or even in our backs. What can you do to minimize that pain? If you have an exercise program, these muscles can be strengthened if you spend some time with focused exercises. Stretching before and after you exercise may help to minimize pain or injury, and drinking water when you are active helps to keep those muscles healthy. Sometimes people begin an exercise program, build up our muscles in a particular area, like arms and shoulders or legs, and then stop exercising. What happens then is the muscle de-conditions. The muscle loses tone. Changing that muscle back into healthy function can be hard work. A program of moderate steady regular exercise that doesn’t overtax but helps the body keep its tone will help those muscles keep their tone and maintain function. Many feel that it is easier to maintain without losing interest in the program. Walking is always good and climbing stairs is great for the legs. Backs are injured when we don’t bend those leg muscles when we lift, or when we bend and twist while picking up something. Exercises that strengthen abdominal muscles will help those back muscles too. As with being successful most things, staying healthy isn’t something done in occasional intense spurts, ignoring the issue the rest of the time. Success involves regular activity, moderation and paying attention to ourselves and our pains. + HEALTH 101 – Information to help you make positive changes in your life to improve your health by Sandy Turner, RN, EdD, Family Nurse Practitioner, Director of the Good Samaritan House, A Free Community Health Center Open Mondays 15 pm. 213 N Main St., Dearing, GA 706-556-9080.

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Editor’s note: Exceptional Living appears exclusively in the Medical Examiner each month, addressing issues that all of us can benefit from involving people with special — let’s call them exceptional — needs.

Exceptional Living

Are you ready? by Naomi D. Williams, MPH, CHES, CIC® Labor Day has come and gone. Kids are back in school. Summer 2012 has officially come to a close and hurricane season is in full swing. September is National Preparedness Month so it’s fitting to talk about preparation. Have you heard of Hurricanes Hugo, Rita or Irene? What about the Chernobyl disaster? Do you remember the unimaginable 2004 tsunami that hit Thailand, or the catastrophic 2010 earthquake that demolished Haiti? You say it can’t happen here? Let me bring it a little closer by reminding you of the 2005 Norfolk Southern train derailment which turned Graniteville just shy of a ghost town. And of course we all remember and many are still healing and rebuilding from the turmoil caused by the terrorist attacks of 9/11, the movie theatre massacre in Denver, CO and Hurricane Katrina. Although Augusta is far enough inland to be somewhat shielded from hurricanes, we aren’t completely immune to them or to other forces of nature or man-made disasters. So my question for you is, are you prepared in the event of an emergency? Still thinking none of these things can happen to you? Well, are you prepared in the event of a house fire? I will leave my cooking skills out of this, but just know that once upon a time as a teenager, had my dad not come home when he did, the kitchen fire that required a new ceiling and all new cabinetry would have burned our entire house down. As I’ve gotten older and have become a parent I know what I need and the importance of having things together, yet I’m still not prepared to survive without electricity for an extended period of time if required. As I watched the news the last several weeks, my mind started racing. Do I have things in place for Noah and his caregivers if we were separated or if I were to die suddenly? Do I have food that he can eat that doesn’t have to be refrigerated? Do I have enough medical supplies and medicine to last me two weeks or longer in the event I can’t get to the pharmacy? In all honesty I can only answer yes to one of those questions. This is in part due to thinking that I’ll have plenty of time to get things together. But in actuality I’m not even promised to see tomorrow. So as I work to prepare myself for life’s unforeseen yet common events I will share some basic tips that you and I can do to be better prepared for a disaster or emergency. There are several areas of emergency preparedness. So to help ease the process I will break it down into categories: food, medical, insurance, will/trust. First and foremost create and share a family emergency/ evacuation plan. Electronic devices are known to lose charge and networks get overloaded, so make sure to have important phone numbers memorized or written down in a safe and easily accessible place. Your budget may not allow you to stockpile supplies, however there are some staples that one should have in cupboard just in case. Nonperishable items such as peanut butter, raisins, canned tuna fish, etc., are great to have in the cabinet, as well as bottled drinking water. Please make sure you have a manual can opener too; an electric one will be of no use if you lose power. For medicines, keep a current list of medications (name, dose, and frequency) that are taken and include the pharmacy name and phone number (it also wouldn’t hurt to include the doctor who prescribed the medicine and their phone number). It’s good to do the same thing for the medical supplies that you use. I remember after Noah came home and when we were finally able to travel I had to make sure I had enough of everything before

GEORGIA DISASTER QUIZ PAGE 13

Please see READY? page 13

SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

Adventures in Administration

s a leader in health care organizations for many, many years, I recently looked back through the past and some pretty dicey events came to mind. With little effort I listed about 20 such events and decided to write a short piece about each. I like to think of them as “True Tattles.” You can anticipate one tale per issue until I run out or give out. Most of the stories happened in Augusta, so you may recognize some names. I promise not to be too scandalous. This first adventure — with a slightly different outcome — could have ended my career. If you have had contact with St. Joseph Hospital (now Trinity) in the past 40 years you may recognize the name Jim Moorehead. Jim was one of the first people I hired in 1971. He and I squabbled about everything. I loved him because everything that Jim represented compensated for my failings One day early on as I saw him coming down the corridor, I could see bad news written all over his face. Whatever it was, it was news that I knew I did not want to hear. He was neither excited with good news nor perplexed with bad news. Just stoic, pensive, and clearly troubled. I said nothing. “We had an incident in the OR.” I waited. “One of our operating room lights came loose from the ceiling and fell.” An operating room light must weigh over 100 pounds. I paused. “Where did it land? “On the OR table.” “Where was the patient?” “On the gurney.” “Where was the gurney?” “Next to the OR table.” “And the patient?” “The patient is fine. Did not know that it happened.” There was a moment of silence and Jim turned and walked away knowing exactly what had to be done. Within a few days he had a report on my desk saying that every piece of equipment in the building was now considered safe and would be inspected henceforth based upon a rigid preventive maintenance program. Jim and I worked together for the next 17 years, often differing, but always learning from each other. I would never have survived without him. The moral of the story: leadership is, in part, knowing when to be quiet, when to get out of the way and when to rely on the strength of others. Jim died a few years ago. I think of him often. +

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Editor’s note: This article is by Bill Atkinson, former CEO of Trinity Hospital (then St. Joseph Hospital), and the author of the comprehensive 2009 Medical Examiner series on the founding of the Augusta area’s major healthcare providers. This is the first installment in a new series.

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Around town: • Barney’s Pharmacy, 2604 Peach Orchard Rd. • Birth Control Source, 1944 Walton Way • ASU Student Bookstore • Blue Sky Kitchen, 990 Broad Street • Columbia County Library, main branch lobby, Ronald Reagan Drive, Evans • Enterprise Mill (North Tower), 1450 Greene Street, Augusta • Daniel Village Barber Shop, Wrightsboro Road at Ohio Ave. • Hartley’s Uniforms, 1010 Druid Park Ave, Augusta • International Uniforms, 1216 Broad Street, Augusta • Marshall Family Y, Belair Rd, Evans • Mellow Mushroom, 12th and Broad Streets, Augusta • Southside Family Y, Tobacco Road, Augusta • Surrey Center, Surrey Center Pharmacy, Highland Avenue, Augusta • Top-Notch Car Wash, 512 N. Belair Road, Evans • Wild Wing Cafe, 3035 Washington Road, Augusta

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

EDITOR’S NOTE: Very little if anything about healthcare is inexpensive, and that includes medicine. Tiny pills can command large prices. Over-the-counter medications may be less expensive, but are they also less effective? Find the answers to lots of your drug store questions in this column written by Augusta pharmacists Chris and Lee Davidson exclusively for the Medical Examiner.

HOW DOES MY MEDICINE DO ITS JOB? People take prescription and over-the-counter medications for a variety of reasons. How does an antibiotic know how to kill a germ and not beneficial cells? How can a pill improve my mood? There are so many medicines — and sometimes we’re taking more than one at a time — that it seems impossible for each one to know where to go and what to do within our body. Let’s talk a little about how medicines work. There are several basic actions a medication can take. A medicine can be the replacement for a needed substance in which we may be low at the present time. An example would be a vitamin or mineral supplement. Or, as in the case of antidepressants, it can change the way a body cell acts. Some medicines attack foreign cells such as bacteria or cancer, killing off the invader while leaving the body’s own cells intact and functioning. So how do drugs know when to kill an invader vs. improving our mood? Let’s look at invaders first. Germs and cancerous cells are two main types of invaders that we deal with in our bodies. Germs can be bacteria or viruses. Bacterial infections require drug intervention to kill the infection, while viral infections are usually self-limiting and require only symptomatic relief. Antibiotics for bacterial infections can work by destroying or changing the bacterial cell wall, resulting in the death of the bacterial cell and, in time, the infection. Antibiotics can interfere with the reproduction of the invading cell by interfering with the replication of nucleic acids, the building blocks of the cell. In the case of cancer drugs, the tumor may be cut off from nutrients or oxygen by preventing the creation of blood vessels to the tumor. Some drugs can interfere with the ability of the cell to reproduce, thereby giving the body’s immune system a leg up on fighting the tumor. Anti-cancer drugs can work like antibiotics do, fighting bacterial infections just specifically targeted to cancer cells. But how do anti-bacterial, antibiotic, and anti-cancer drugs

attack only their specific targets? Each of our body’s billions of cells has a wall that guards the cell and its contents, keeping them intact and protected inside. Each wall is different depending on the type of cell involved and its purpose in the body. Cell walls also have unique receptors that vary from one cell type to another. Receptors allow a cell to interact with outside substances, much like your unique telephone number allows other phones to interact with yours. Drugs can be programmed with the “phone number” of certain cell types to defeat the cell’s defenses and access its receptors. By the same trick, almost like a teenager’s fake I.D., a drug can get through channels in the cell’s wall that allow normal transfer of materials into and out of the cell. This allows the drug to alter the cell in a way that results in the death of the cell. We could fill an article or two (or six) about how drugs work. Cells are like tiny chemical factories, and some drugs produce a health benefit by affecting the factory’s output. Antidepressants, for example, increase serotonin levels and therefore improve mood. Serotonin is normally released by nerve endings into the synapses — the spaces between nerve endings — and is then reabsorbed so that there is not too much in the synapses. If the nerve cells are taking up too much serotonin (called reuptake), the synapses may be low on serotonin resulting in depression. When serotonin is increased in the brain, it results in improved mood and other positive physical effects. Some antidepressant drugs slow the cell’s rate of reuptake while leaving the rate of release constant. The net result is higher serotonin levels and better moods. There are other classes of antidepressants but that too is a story for another day. The simplest mechanism of action is replacing deficient substances in our body. Like a non-dairy creamer in place of cream, chemical reproductions can make up for shortages of substances made by our body but in short supply. This may be done by taking a pill, by inhalation or by injection. Insulin is one example. Regardless of how the substance reaches our body it is distributed throughout the body and increases the level of the deficient substance to normal and therapeutic level. As with the drugs discussed earlier, the drug produces a result only where it is needed. How drugs work is the subject of years of study in pharmacy school and can’t easily be digested into one article. For more information about your medications please email us or check with your pharmacist or physician. +

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Questions, article suggestions or comments on this article email us at cjdlpdrph@bellsouth.net Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson (cjdlpdrph@bellsouth.net )

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AUGUSTA MEDiCAL EXAMINER

Ask a Dietitian Keeping school lunches safe

It’s not quite fall but it’s back to school anyway and school safety is the topic of the day. It’s pretty typical to get an overdose of information about the dangers at the bus stop, practicing sports in extreme heat, and heavyweight back packs, but not much is said about another school day risk; that of lunch box safety. Yes, that little box with the cute cartoon characters has the potential to land a child in sick bay after just a couple of bites of tainted food. More commonly known as “food poisoning,” foodborne illnesses can result from storing food at improper temperatures. Proper food storage is no problem at home with that large refrigerator looming in the kitchen, but do we know what to do when it comes to taking food out of the home? A couple of recent studies on lunch box safety concluded that the majority of parents are aware of the potential food safety risks and some actually try to minimize exposure through the use of ice packs. However, 88% of all lunches checked (with or without ice packs) contained food that was at room temperature. Room temperature is significant because harmful bacterial multiply rapidly at temperatures between 40º and 140º, a range called the “Danger Zone.” There is a good school day lesson to be learned here, which is that one ice pack may not be enough. So how do you know whether or not the ice pack is “chillin”? One simple idea would be to run a test lunch on the weekend. Place an ice pack and test food in your child’s lunch box at the usual time in the morning and leave it out at room temperature until your child’s usual lunch hour to check the state of affairs. (Want

to sleep in on the weekend? You can do this any time of day. If it’s normally five hours between packing lunches and your child’s lunchtime, do it at noon and check the lunch at 5:00.) If your timed experiment reveals that cold items aren’t staying cold, try these tips: • Ice packs come in all shapes and sizes; select one or several ice packs appropriate for the task. You may also freeze some of the lunch box items prior to packing such as the juice/milk box, Gogurt tubes, fruit cups, sandwich bread, etc. • Place the ice pack where it is most needed, directly beside the perishable food. • Invest in an insulated lunch box, which better maintains the desired temperature than the standard brown paper sack. However, the high school crowd generally shuns a lunch box of any type regardless of how fashionable (especially the guys). In this case, doublebagging the lunch will offer slightly more insulation than a single bag. Freezing certain lunch components is also helpful since teens likely won’t agree to an ice pack. • Minimize the risk by using mostly non-perishable foods such as whole fruits and

vegetables, shelf stable fruit cups, whole grain breads/ crackers, peanut butter and jelly, trail mix, etc. Another concern identified in the study was the method and frequency of cleaning lunch boxes. The first rule of food safety is cleanliness and this begins at home on the kitchen counter where the lunch is made and with the hands that prepare it, then to the lunch box and ice pack(s), which should undergo a daily wash with warm soapy water. Sanitizing afterwards would be great as well, and can be easily accomplished with a commercial spray or a homemade bleach and water solution. Finally, the little hands that unpack the meal should be cleaned by washing with warm soapy water for 20 seconds (the time it takes to sing the Happy Birthday song twice) before eating. Hopefully that’s part of the school’s routine, but one way to make sure is to pack an antibacterial towelette and/or hand sanitizing gels in the lunch box and instruct your child on proper use. Finally, children sometimes leave uneaten food in their lunch box or bag to eat later as an after school snack. Educate your child on which leftovers are safe and which should be thrown away at lunchtime. If necessary, pack a separate nonperishable after school snack in their back pack. While everyone enjoys a day off now and again, nobody enjoys spending it suffering from foodborne illness. Be sure you only pack a lunch and nothing more by taking the time to follow food safety guidelines. If you have any food safety questions, contact the USDA Hotline at 1-888-674-6854 tollfree or online at AskKaren.gov. + Pediatrics. 2011 Sept; 128(3): 519-23. Epub 2011 Aug 8. Temperature of foods sent by parents of preschool-aged children. Perspect Public Health. 2009 Mar; 129(2):77-84. Food Safety issues and children’s lunchboxes Author Cindy Elia, M.S., R.D., C.D.E. is the Nutrition Specialist for the CSRA Area Agency on Aging, your gateway to aging resources. Got a question? Drop us a line: info@AugustaRx.com.

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

WANTED EXCEPTIONAL MEDICAL STUDENT Even if it is legal, do you really want to pass a funeral?

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The Medical Examiner is looking for you! Are you interested in writing a once-monthly column — The Short White Coat — about your experiences as a medical student? Drop the Medical Examiner a line today! Info@AugustaRx.com

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Funeral traffic laws Capt. Steve Morris of the Columbia County Sheriff’s Office was kind enough to answer our question: “Is it legal to pass a funeral procession? Does any law require pulling over, or even slowing down? His answer: There are no laws requiring motorists to stop or pull over. This is what the law states about operators of a vehicle NOT in a funeral procession. (d) The operator of a vehicle not in a funeral procession shall not interrupt a funeral procession except when authorized to do so by a traffic officer or when such vehicle is an authorized emergency vehicle or law enforcement vehicle giving an audible and visual signal. (e) Operators of vehicles not a part of a funeral procession shall not join a funeral procession by operating their headlights for the purpose of securing the right of way granted by this Code section to funeral processions. (f) The operator of a vehicle not in a funeral procession shall not attempt to pass vehicles in a funeral procession on a two-lane highway. (g) Any person violating subsection (d), (e), or (f) of this Code section shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine not to exceed $100.00. A brief survey we conducted on facebook revealed some drivers stop only if traffic in front of them does; others only if they’re going in the same direction as the funeral, while still others always stop and others just slow down. It turns out they’re all legal. +

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The blog spot — Posted August 2012 at whendoctorsdontlisten.blogspot.com. Excerpted and edited.

5 THINGS YOUR DOCTOR WANTS YOU TO KNOW 1) Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which is a whole different type of organism. Some patients will swear that taking antibiotics will help, but we know scientifically that this is not true; the cold was going to go away on its own anyway. Much better than taking a pill that doesn’t work is to strengthen your immune system and prevent the cold from happening in the first place. Get adequate sleep. Eat a healthy diet. If you do have a cold, drinking lots of fluids and taking tylenol and ibuprofen is key to your recovery--not antibiotics. 2) A CT scan will not help a headache. Having a headache, just like catching a cold, is unpleasant. Your head throbs. You might feel that you can’t concentrate and go about your daily activities. While there are potentially serious causes of headache, the vast majority of them are due to tension headache or migraine. They will go away with time. Over-thecounter medications like tylenol and ibuprofen can help, as can rest in a quiet, dark room and lots of fluids. A CT scan will only show what you DON’T have, and in the vast majority of cases won’t make you feel better. 3) Tests are not the ultimate diagnostic tool. Patients often ask their doctors for tests to figure out what’s wrong; doctors often rely on tests to save time making a diagnosis. Studies have shown that actually sitting down with the patient and talking will much more likely yield the diagnosis than any test. And every test has potential side effects. CT scans involve radiation, and each individual scan increases your lifetime risk of getting cancer. Some CTs and MRIs involve administering contrast dye that could cause kidney damage. Even the simple blood draw can lead to complications like infection and bruising. This is not to say that you should never get tests done; it’s just a reminder that tests are not always the answer. 4) Lifestyle changes make a huge difference. Study after study show that the single most important contributor to decreasing your risk of heart disease, for example, is your lifestyle. You can take pills to decrease your blood pressure, lower your cholesterol, and control your diabetes--but even better is to eat a healthy diet with low saturated fat and exercising. Similarly, the single biggest risk to health that is preventable is smoking. Within even a few months of stopping smoking, the risk of cancers and heart disease begins to decrease. Don’t get me wrong: it’s not easy. Working on your lifestyle requires far more investment in your time and energy than popping a pill. But it’s the most effective way to really make a difference in your health. 5) Aspirin is one of few medications that’s been definitively shown to help you. Big pharma would like us to believe that the newest and greatest drug is the best thing out there to prevent heart attack and stroke, but actually aspirin is one + of very few medications that’s proven its weight. It reduces the risk of hear attack and stroke, and some studies are demonstrating that it may even be preventative against cancer. People who experience chest pain get aspirin first, before they get anything else, because it is the one thing that helps them if they are already having a heart attack. Not everyone needs to take aspirin, and there are some for whom it may be harmful (all medications, just like all tests, have side effects), but this is one more reminder that the newest and greatest isn’t always the best; sometimes it’s the tried and true that you need. + Editor’s note: is there a favorite web log you enjoy reading that is in any way related to health and wellness? Send us the link and we may feature it here in a future issue. Send your suggestion to to info@AugustaRx.com.

11 +

AUGUSTA MEDiCAL EXAMINER

From THE Bookshelf Here is a book with an admittedly limited audience: only people who will eventually die, or those who know someone who has an end-of-life health issue. That cuts down the market considerably. Still several people have reviewed this book. Here are a few of their comments (from Amazon):

“Ira Byock presents an agenda for end-of-life care that should serve as an ideal template on which to build our best hopes for the final days of those we love— and ourselves.” –Sherwin B. Nuland, MD, Yale Interdisciplinary Center for Bioethics and author of How We Die “[Dr.] Byock shows us how to get the best end of life care. He is a great storyteller and a brilliant analyst of health care in America. This is the book to read or give if you are facing this hard situation.” -Jane Isay, author of Walking on Eggshells “At a time when a long life can become a curse as readily as a blessing, this lucid and compassionate book points the way to more humane treatment of a life’s last days.” –Rabbi Harold

Kushner, author of When Bad Things Happen to Good People “This book is a must-read for anyone who thinks there’s even a possibility that they someday might die.” –Dave Isay, founder of StoryCorps, author-editor of Listening Is an Act of Love “Dr. Byock outlines the challenges for the patient, the caregivers, and the medical community, and ably advocates a revolution of care for the end of life. This is a revolution sorely needed and worth fighting for.” –Pastor Robert Fleischmann, National Director, Christian Life Resources

“In The Best Care Possible, Ira Byock tells us why we need to move beyond medicine’s fixation on conquering death to a vision of end-of-life care focused on the quality of the patient’s experience. This is a beautifully written, highly personal account that makes real the struggle of patients and families to escape the “hightech”, more is better imperative that dominates the American way of death. It provides compelling examples of how the physician, committed to reform, can help patients achieve the care they want and need. But Byock goes further: he makes the case that professional reform is only part of the solution; overcoming the medicalization of death will require the mobilization of the wider community in the support of the dying (and those with chronic illness).”--Jack Wennberg, MD author of Tracking Medicine: a Researcher’s Quest to Understand Health Care “This is a profoundly truthful book. Who should read it? All of us who are mortal.” -- Bill Novelli, Professor, Georgetown University and co-chair, the Coalition to Transform Advanced Care (and former CEO, AARP) +

the

Clipping File Bursting the organic bubble The blockbuster health news this week may well have been the study released by Stanford University which concluded that organic food offers no significant health benefits over conventionally grown foods. The findings came as something of a surprise to researchers, who expected to find differences in nutrition, chemicals and pesticides, and even in taste. Instead, they concluded “there isn’t much difference” between the organic and conventional foods. One notable exception was in meats and other foods which happened to be contaminated with bacteria. If that happened to some non-organic foods, the germs were found to be much more resistant to antibiotics. That is an issue caused by nonmedical use of antibiotics in farming, a topic that is facing governmental regulations aimed at limiting the practice.

Lean diets don’t prolong life At least not in monkeys. That’s the conclusion of a quarter century of research on rhesus monkeys who were kept lean and hungry, the equivalent, said The New York Times, of a 6-foot-tall man weighing around 125 pounds. That’s not just lean, that’s downright skinny. One study does not a definitive and final conclusion make, but the extensive study, begun in 1987, did not support the long-standing health claims of calorie restriction enthusiasts. Instead, lifespans were equal in skinny and normal monkeys, as were death rates from cancer and heart disease. Even cholesterol levels were the same in females of both groups, although the skinny males did enjoy lower cholesterol. Monkeys are not humans, admittedly, but researchers say it does cast doubt on health benefits specifically thought to accrue from a very restricted

diet. They are also quick to caution that the results of this study do not establish a corollary, namely that obesity or overeating does prolong life. That would qualify for a resounding Not! But the corollary of that corollary, according to this study, is that an extremely lean diet does not offer significant health benefits. About that emergency water Why does bottled water have an expiration date, usually two years from the bottling date? That question was recently tackled on mentalfloss.com. The answer, in short, is that water will not go stale. Then again, neither will it age to perfection like some fine wine. Chances are that over time the plastic bottles will transfer some of their taste to the water, resulting in slightlyplastictasting water (but nothing lethal or even harmful). The solution is to regularly rotate the bottled water in your family’s emergency kit. +

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SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

Have you been following the economic problems in Europe? Not really.

by Dan Pearson

The euro crisis in Greece is threatening the whole What if the world economy.. worst happens?

Oh no. I love those. I The euro could always used to order collapse. them at Dino’s.

The Mystery Word for this issue: MATCHOS

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. The first man (in a Bible encyclopedia) 6. Area abbrev. 10. Stir up 14. Ms. Witherspoon 15. Mosque leader 16. Republic in SW Asia 17. Lock of hair 18. Las Vegas lead-in 19. Ancient burial chamber 20. Computer game for the idle 22. Deputized group 23. Off (or on) the _____ 24. Egyptian goddess of love 25. ______ Psalms (Jewish liturgical prayer) 28. Appropriate, fair 29. Canal name 30. Pointed, as an insect’s defense 35. Geographic picture 36. Dried or salte codfish 38. Center prefix? 39. Extrmely offensive word or phrase 41. Greek goddess of the earth 42. Tear apart 43. Type of horse seen at least annually in Augusta 45. Llama relative 48. 2002 biopic starring Salma Hayek 50. One of the five senses 51. Female horse used for breeding 55. Wait in concealment 56. Lower digits 57. Inspire or permeate 58. Church recess 59. Scottish Gaelic 60. Mamie’s _______ 61. Propagative part of a plant

t. 21! p e S s n r u t e ord r W y r e t s y M The

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

All Mystery Word finders will be eligible to win by random drawing. We’ll announce the winner in our next issue!

VISIT WWW.AUGUSTARX.COM TO ENTER! 1

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QUOTATION PUZZLE

28 30

42 46

23 25

T I

G U F C M D Y A L W S T T T T I R L D H O A A T N E O N Y E E R I Q I K I F Y

I I

— John Wesley (1703-1791) on his view of money

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above. Once any letter is used, cross it out

Solution p. 14

62. Words of contentment 63. Mr. Lott, Mississippi senator (1989-2007) DOWN 1. First name of Sept. 14-16 event 2. Air (prefix) 3. Spool 4. Small bone 5. Snuggle 6. ______ Center 7. Smug smile 8. Talk irrationally 9. Doc’s org. 10. Soft cheese 11. Inhabitants of Ireland 12. Rope with running noose 13. Go into 21. Popular ISP 22. Leisurely stroll 24. Hawaiian native dance 25. Blood prefix 26. Bedouin

27. Cyanotic body part? 28. 7th month 30. Rain adjective 31. Common pet 32. Lachrymal drop 33. Fencing sword 34. Clock face 36. Nearby Island 37. Ms. Karenina’s given name 40. Opned a book 41. Science of language 43. Life starter 44. A cigarette smoker is one 45. Famous Charles 46. Jeweler’s magnifier 47. Masters total money pool 48. Market introduction 49. Store once located inside Gerald Jones Honda 51. Half of a Polynesian island 52. French clergyman 53. Undoing 54. Sinus M.D. 56. National Drink of the South

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.

X A M I N E R

6 8

7 6 8 3 2 1

7 9 8 2 5 4 7 1 2 7 9

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.

Use the letters provided at bottom to create words to solve the puzzle. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving words with letter clues and entering unique and minimal choice numbers (such as 5 thru 8 in this puzzle). A sample is shown. Solution on page 14.

1 1

1 2 3 4 5 1

R 1 2 3 4 5 6 7

O 1 2 3

A 1

R 1 2 3 4 5

1 2 3 4

— Robert A. Heinlein

1.AAMMWWFLIN 2.EEEGRIHA 3.TRAVOON 4.MHEER 5.ERN 6.DE 7.D

SAMPLE:

1. ILB 2. SLO 3. VI 4. NE 5. D =

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

THE MYSTERY WORD

SEPTEMBER 7, 2012

13 +

AUGUSTA MEDiCAL EXAMINER

The Patient’s Perspective by Marcia Ribble

Today might be the day before something big. Who knows what tomorrow might bring? Why is July 1 shown for the state of Georgia? July 1 was the day before something that, on July 2, made people wish they had been better prepared. Do you know what happened? See below. (Image from Ready.gov)

READY?… from page 6 we left (at least one backup canister of oxygen, plenty of feeding bags, syringes, antiseizure medicine, etc) in the event we broke down, got stuck or couldn’t get home in a timely manner, and that was just for a day trip. The last two items I want to talk about are potentially the most important, yet the most overlooked or neglected things on any emergency planning list. It is imperative to have life insurance. Life insurance doesn’t benefit you. It benefits your family in the event you die. It’s not about you. It’s about them! You say you can’t afford it? Let me tell

you, you can’t afford not to have it, especially if you have a family. When I was laid off from my job I was tempted several times to cancel my life insurance even though it was only $25 a month. When Noah was born at 26 weeks I knew I had to increase the value of my policy. Even though I had basically a non-existent income I knew I had to get more coverage so that if I unexpectedly died, money would not be the most pressing issue of his care. Lastly, creating a will or trust and having it in place before you die is vital. I understand it isn’t pleasant

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to think about death, yet this is the one thing that we know, without any shadow of a doubt, will happen. We just don’t know when. Having your final wishes legally documented can ease your mind while still living, and reduce any nonsense or confusion after you are gone regarding your children and material possessions. This information provided is applicable to everyone, not just those in the exceptional or differently-abled community. For more detailed preparedness kits and plans visit www.ready.gov or www. cdc.gov/features/BeReady. + Naomi Williams is a health educator by training, an entrepreneur by nature, mom, and advocate of the best kid ever, Noah Samuel. EDITOR’S NOTE: The July 1 in question was July 1, 1994, a Friday leading into a long holiday weekend promising barbecue, burgers, beer and fireworks. Unfortunately, no one told Hurricane Alberto, which made landfall with 65 mph winds and then settled over Macon and Americus that weekend, dropping 30 inches of rain and displacing 500,000 people in seven counties in and around Macon. No potable drinking water was available for almost a week, and 23 counties surrounding Macon declared states of emergency. And it was all supposed to be a fun-filled and relaxing holiday weekend. Note also that every state has its own “The Day Before” date.

ome health questions remain just that, questions, even with quite a lot of medical attention. My platelets and their appearing/ disappearing act fall into that category. So far in the past year I’ve had three IV treatments (chemotherapy) to increase the number of platelets before I had my three eye surgeries, and they increased the platelet count from around 50,000 to 130,000. But shortly thereafter the platelet count dropped back down again, so for each of the V-NUS Closures, I had a treatment with 40 mg of a steroid, dexamethezone, per day for four days. Those treatments brought the platelet count up to 80,000, but it promptly dropped again after the surgeries. The numbers settled in at around 30,000 which is pretty low, but not quite life threatening—yet. This week they were all the way up to 73,000, and I’m not sure if they are going up or coming down. They seem to act independently of whatever I’m doing or not doing, going up and down at will. Affected by the drugs, they are nonetheless independent of them except within a short time frame. All of my doctors are aware now of the meandering platelet counts. The doctors and I are far more interactive now than they were when this all started a year and a half ago. The platelet counts affect all of my other health issues, so it’s not just the hematological oncologist who needed to be aware of them. The erratic nature of the platelets lately can cause problems in so many different areas of the body. Eyes, ears, nose and throat; mouth, esophagus, and the rest of the digestive system; bones; brain; skin and other tissues— every system in the body is dependent on blood flow and the ability of the platelets to stop bleeding. So what have we learned? We’ve learned that at this time, after almost twenty years of fairly consistent platelet counts varying from 80,000 to 100,000

Talk is cheap. Not talking can be deadly.

which were below normal, but not worrisome, somewhere in my system is a platelet gobbler which is eating up my platelets. What that is, we don’t know. We know what it’s called when platelets are being destroyed— ideopathic thrombocytopenia— which translates to a platelet gobbler of unknown origin. Now we are at a point where the costs, both physical and monetary, are beginning to call into question the wisdom of just continuing treatments before surgeries or dental work or after accidents, or whether trying to find a reason for why this is occurring in the first place would allow us to find a long term solution less damaging to my body. Is this caused by an out of whack immune system? So far this is the assumption behind the treatment with steroids. But there could be other causes. Is there internal bleeding somewhere that we’re unaware of which is using up my platelets faster than they can be produced in my bone marrow? Is my spleen the naughty culprit busy gobbling up platelets because they’ve been marked as intruders? Is the bone marrow itself defective in some way? So we have questions. What we don’t have is conclusive answers. At least not yet. + Marcia Ribble received her PhD in English at Michigan State and recently retired from the University of Cincinnati where she taught composition. She taught writing at the college level and loves giving voice to people who have been silenced. She can be reached with comments, suggestions, etc., at marciaribble@hotmail.com.

GRAPHIC ADVERTISING Publisher of the Medical Examiner Proudly celebrating our 24th year in Augusta publishing

1988 — 2012

+ 14

SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

THE MYSTERY SOLVED The Mystery Word in our last issue was: STOMACH s Sept. 21!

urn t e r d r o W y The Myster

...carefully hidden (on the skeeter) in the page 7 ad for JURY PEST CONTROL

Congratulations to Jeffrey Burns, who scores a $20 Wild Wing Cafe gift certificate, two free movie passes courtesy of Health Center Credit Union, a free Top Notch Car Wash gift card, and anything else we may be able to scrape together on short notice. Win this stuff! The new Mystery Word is on p. 12. Start looking!

The Celebrated MYSTERY WORD CONTEST ...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then be the first to 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: gift certificates from Wild Wing Cafe, Top Notch Car Wash, Cheddar’s, and movie passes from Health Center Credit Union! 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. 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.

The new scrambled Mystery Word is found on page 12

EXAMINER CLASSIFIEDS and Internet service. Please contact 706589-0238 ask for May.

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HOUSE FOR SALE 3 bedroom, 2 full bath, 2-car garage. Off Dyess Pkwy near Ft. Gordon. $99,900. Call 706-3395548 or 706-210-4334 TOWNHOME large furnished room (dresser, bed, night stand, linens) for rent with private bathroom in convenient and very nice neighborhood near Doctors Hosp. $445 a month includes utilities

TOWNHOME Great location, everything new, 2 master suites, sunroom, all appliances. $98,000 (706) 504-4023 HOMESBYOWNER.COM Sell • Buy • Rentals • 706.564.5885 WEST AUGUSTA Luxury 3 BR / 2 BA Townhouse, 1-car attached garage located off Pleasant Home Road $725 /mo 706-228-4655 TOWNHOME 3 bedroom, 3 full bath townhome. 2 master suites, like new, end unit with extra parking, single garage, covered patio, $125,000. 706-799-0394

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NOTICE! ATTENTION! If any current or past employer has failed to pay you min. wage or time and a half overtime pay, you may be entitled to an order from US Federal Court awarding you twice the amount of your unpaid wages plus atty. fees. For info, call Arthur H. Shealy, Attorney at Law, 803-278-5149, 1010 Plantation Rd, North Augusta SC 29841. You may be entitled to a similar award for unpaid wages if your employer required you to perform duties during your lunch hour, before clocking in, or after clocking out. LAWN SERVICE Commercial, residential. Call Vince: (704) 490-1005 OVERWEIGHT PEOPLE WANTED! Try our bold new formula for weight loss, mood enhancement and energy. 100% natural, pharmacist-tested and recommended. Visit www.weightlossbyfrank.com to request FREE 2-day trial. Serious inquiries only. (706) 373-8867 after 5 pm. or e-mail f.wadford@comcast.net 9212

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THE PUZZLE SOLVED

USE THE FORM BELOW AND MAIL IT IN, OR GO TO WWW.AUGUSTARX.COM AND PLACE & PAY CONVENIENTLY AND SAFELY ONLINE. THANKS!

(OURS IS COFFEE)

M A

N T

M A

SEE PAGE 12

CLASSIFIED ADVERTISING FORM Name Address Work number (if applicable) ( ) Home phone ( ) Category of ad (leave blank if unsure):

SPARKLING CLEAN Looking for offices to clean. No contract req. Husband & wife team have years experience and give FREE on-request estimates. Call 706.831.8552 or 706.831.8553

8113

SENDING US A CLASSIFIED? WHAT’S YOUR DRUG OF CHOICE? Augusta Medical Examiner Classifieds

Growth. Call 706-855-WORD (9673)

QUOTATION

In case we need to contact you. These numbers will not appear in the ad.

QUOTATION PUZZLE SOLUTION: Page 12: “I get rid of it quickly lest it find a way into my heart.” — John Wesley

AD COPY (one word per line; phone numbers MUST include the area code): .25

.50

.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

5.25

5.50

5.75

6.00

6.25

6.50

6.75

7.00

7.25

7.50

7.75

8.00

8.25

8.50

8.75

9.00

(Copy this form or continue on additional sheet if more space needed.)

Send this form with payment to:

AUGUSTA MEDICAL EXAMINER, PO BOX 397, AUGUSTA, GA 30903-0397 Total ad cost by number of words as shown above: $

The Sudoku Solution

COFFEE IS GOOD MEDICINE VISIT DRUGOFCHOICECOFFEE.COM FOR YOUR REFILLS TODAY

WORDS BY NUMBER “I never learned from a man who agreed with me.” — Robert Heinlein

Multiply by number of times ad to run: x Total submitted: $

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 5 days prior to our publication date.

Thanks for reading!

www.AugustaRx.com

SEPTEMBER 7, 2012

15 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

A couple was on vacation camping up in the woods. One morning, the husband got up well before dawn, went fishing and returned just as his wife was rising. While her tired husband slept, the wife decided to take his boat out onto the quiet lake and read. She picked a spot down the shore in the shade of a large tree, anchored the boat, and started reading. Before long the game warden pulled his boat up alongside hers. “What are you doing, ma’am?” he asked.

“Reading my book,” she said. “I’m sorry, ma’am, but you’re in a nofishing area. I’m going to have to issue a citation for violation of a no-fishing area.” “What? Why? I’m not fishing!” He replied, “Perhaps, but your boat is filled with fishing gear. You say you’ve been reading but you have the equipment. I’m afraid I’m just going to have to write you up.” Angrily, she snapped, “If you do, I’ll charge you with rape.” The warden was shocked. “But I haven’t touched you!” To which she replied, “Yes, but you have the equipment.” Doctor: We need to get these people to a hospital - stat! Medical student: What is it, doctor? Doctor: It’s a big building where they cure people! +

TO SUPPORT MEDICAL EXAMINER ADVERTISERS

Got a What percentage of our readers are healthcare consumers*?

SKINNY

ad budget? SKINNY works for us too. CALL US FOR SOME “PHAT” DEALS! 706.860.5455

PERCENT * In other words, potential new patients.

If these are people you want to reach, call or write today! (706) 860-5455 or info@AugustaRx.com +

WE PUBLISH ON 1ST & 3RD FRIDAYS

+ 16

SEPTEMBER 7, 2012

AUGUSTA MEDiCAL EXAMINER

HOME GAME… from page 1 to early hospital discharges and outpatient procedures. What are they?

Hey, even if you don’t like the Medical Examiner, you could still “Like” the Medical Examiner.

The long term issues Not being a good patient — being an impatient patient — can have ramifications far beyond the immediate recovery

period from any procedure. It doesn’t matter if it’s one of those things like a colonoscopy where after the fact (definitely after) you say, “that wasn’t so bad,” or if it’s something life-threatening and life-changing, or something in between. It’s all really important. If you aren’t a good knee replacement patient for instance, will you be more or less likely to have the second knee done if that becomes an issue? Probably less. That might mean a lower quality of life. That might mean having to permanently say goodbye to your upstairs bedroom, or you could be forced to retire, to sell your house, to give up activities you’ve

enjoyed all your life. Meanwhile a friend, neighbor or co-worker who had the same procedure and was a more compliant patient is sailing on with his life and doing better than ever. Granted, no two people are the same and outcomes can vary from one patient to the next. That’s all the more reason to take the advice, “patient, heal thyself.” Like it or not, we live in an era when patients shoulder more and more of their own care, and that’s not likely to change anytime soon. Being an obedient, compliant patient is more important than ever before. +

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The days after the day after So far we’re only on the day of or the day after. Outpatients may be in for many weeks and sometimes months of post-care instructions. Joint replacement operations are good examples of procedures that come with a lengthy list of follow-up instructions. Some of them may be things to avoid, others things you absolutely need to do if you want to recover completely, and as quickly as possible. Some of the instructions may be sort of complicated. Others might be so simple that if you don’t obey, you may deserve whatever happens to you. Examples of simple things: you know that breathing thing they give you in the hospital? You’re supposed to blow or suck or whatever you do — I forget which — to raise a little ball inside a tube to a certain level. Do it and you can avoid lung infections and you reduce your risk of pneumonia. Don’t do it and you’re only hurting yourself and risking needless complications. Another simple example: when you shower, don’t get sutures or staples wet. Careless adherence to that caution is risking an infection and more unnecessary complications. It might take a little more effort to faithfully do exercises and report to physical therapy appointments, but in the outpatient era, the onus is on us. In ancient times, a nurse would come to our room and wheel us down the hallway for these sessions. Today it’s our responsibility. Your surgeon or a staff nurse is not going to call you every day and remind

you to do your exercises; when you don’t show up for physical therapy, well, it’s a free country. The biggest bugaboo for some patients is the instruction to lose weight or keep weight off. It’s usually good advice for any time of life, but it’s especially good in the wake of a major medical procedure like hip or knee replacement. Tackling the assignment to lose weight is hard enough for all of us during the best of circumstances. It’s doubly difficult when we’re unable to be physically active, and possibly taking medications that can cause weight gain.

Ohio Ave.

What’s not good about it? Think about the aforementioned olden days of medicine, when getting a splinter extracted from your pinkie would result in an overnight stay. Trained professionals were all over the case and every aspect of it. By contrast, when we’re sent home a day or two after something five thousand times more serious than a splinterectomy, we had better have our ducks in a row. If you’ve been there and done that, you know the drill. In fact, you could have merely been the driver, but you still know it. As your personal Medical Examiner, I had the experience not long ago of accompanying my wife to some anesthetizing procedure or another. As she gradually woke up, she was eventually able to form coherent sentences and obey simple commands, like “if you can stand up, honey, you can get dressed.” Shortly thereafter, a nurse was going over a lengthy list of dos and don’ts —not with me, but with my wife. I’m not sure, but I think this episode may have been post-colonoscopy. If so, when I had one I cannot tell you how I got dressed afterward or got home, even though my wife will tell me I dressed myself and talked coherently all the way home (while she drove, of course). This time I remember thinking, “does this nurse really expect my wife to remember any of this? Is this all actually for my benefit? If so, why isn’t she talking to me? And why is my wife signing the form acknowledging that she has been informed of all these important matters?” Even someone obviously as brilliant as me (yeah, right) can’t remember half of what I’m told on a good day, let alone on a

day when I get up at 5:00 a.m. to deliver a patient to a doctor’s office. The moral of this part of our tale: make certain you get written copies of all follow-up instructions. This is usually a matter of course, but it never hurts to ask to make sure.

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