Apr13 18 by Daniel Pearson

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APRIL 13, 2018

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The invisible clock Every previous edition of Body Parts, our occasional series featuring components of the human machine, has featured something fairly major: the heart, DNA, hair and others, including the most recent installment in February, tears.

This time the body part is essentially intangible: the internal circadian clock that regulates huge segments of our lives, sometimes in ways that we’re very much aware of, others that subtly occur on a molecular level. Like most clocks, our on-

BODY PARTS, THE OCCASIONAL SERIES

board timekeeper operates on a 24-hour cycle, creating patterns called circadian rhythms. That word circadian comes from two Latin root words: circa, meaning “about” or “approximately,” and diem, meaning “day.” By definition, then, anything circadian occurs about once a day, or on a daily rotation. The phrase was coined by University of Minnesota professor Franz Halberg in the 1950s, but the phenomenon had been noted as early as the 4th century B.C. Circadian rhythms are not limited to humans. They have been observed in insects, plants, animals, and even fungi and singlecelled bacteria. In one early experiment (1729), a French scientist noticed a pattern of daily leaf movements in a plant of the Mimosa family. The movements continued even when he kept the plant in complete darkness, establishing the difference between reacting to external stimuli versus marching to the beat of an internal clock. Where is our internal clock located? It’s ticking in a pair of cell groups called the suprachiasmatic nucleus (SCN) located in the brain’s hypothalamus which, if you

put a dot on your nose right between your eyes, would be straight back, more or less in the middle of the head. Specialized photosensitive ganglion cells in the retina communicate directly with the SCN, helping to calibrate the circadian clock, synchronizing it with Earth’s rotation. Indeed, it’s no accident that our circadian clock is directly connected to the daily turning of our planet on its axis. In fact, one of the definitions of a circadian rhythm (you’ll recall the fi rst is that it must occur on a daily basis) is that it can be reset when necessary based on information fed from the retina to the SCN. For example, at 3 o’clock on a Friday afternoon in Augusta, it’s 4 o’clock on Saturday morning in Tokyo. If someone flew from Augusta to Tokyo, he would initially experience that circadian disorientation often called jet lag. This happens on a smaller scale twice every year when we go on and off daylight savings time. Whether the change involves a single hour or the 13-hour difference between here and Japan, the SCN will immediately begin the recalibration process. One of the resets would be

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adjusting the daily delivery time for melatonin, a hormone that promotes sleep. Around sunset, the SCN activates the brain’s pineal gland to start producing melatonin, a standing order for most of the night; melatonin is barely detectable in the body during daytime. The body will further adjust its production of melatonin depending upon the season, starting earlier in the evening during winter, later during the long days of summer. Despite mankind’s many advancements in taming the natural world, it seems that in the end, nature often wins. In the context of this discussion, we usually can’t fight against circadian rhythms and win. Airline pilots, for example, can cross several time zones in a day’s work, prolonging their hours spent in daylight or darkness and disrupting normal sleep patterns. Pilot fatigue as a direct result of this constant clock resetting has been blamed as the primary cause or major contributing factor in countless plane crashes. Shift workers at least have the advantage of a steady schedule (usually), but even so, they Please see CIRCADIAN page 3

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APRIL 13, 2018

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Healing healthcare’s violence epidemic

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The murder of Jaz-na Outlaw (Timmons) in the parking lot of Georgia War Veteran’s Nursing Home in February may have seemed like an unusual event. The facts suggest otherwise. According to the Bureau of Labor Statistics, 186 murders occurred between 2006 and 2015 in the healthcare industry. A 2009 study found that 80 percent of nurses do not feel safe in their workplace, and INCIDENCE RATES FOR NONFATAL ASSAULTS with good reason: AND VIOLENT ACTS BY INDUSTRY, 2015 • a 2002 study of nurses at rates per 10,000 full-time workers a regional medical center 20 revealed 82 percent of Emergency Department nurses had been physically assaulted 15 within the previous year. • one-fourth of psychiatric 10 nurses experience disabling injuries from patient assaults. • depending on the study, 5 anywhere from 35 to 80 percent of hospital staff have been physically assaulted at 0 least once during their careers. • in 2015, health care and social assistance workers Why the problem exists overall had an incidence rate Many factors are at work, of 8.0 (out of 10,000 full-time but experts in the field workers) for injuries resulting highlight the top reasons as from assaults and violent acts the following: by other persons. The rate for • the perception that it just nursing and personal care goes with the territory in facility workers was 21.4. healthcare • data obtained from nurses • the belief that patients are (RNs/LPNs) in a major not accountable for their population-based study actions in many circumstances showed a rate of physical involving healthcare assaults at 13.2 per 100 nurses • poor institutional support for per year and at a rate of 38.8 nursing staff per 100 nurses per year for • overly complex reporting non-physical violent events procedures (threat, sexual harassment, • fear that reporting will verbal abuse). reflect poorly on the victim Regardless of who did (the nurse) the research or where, most • resignation that nothing will studies show that healthcare change as a result of reporting workers, particularly nurses, an incident are at a far higher risk of None of this should probably workplace violence than most come as any surprise in a other professions. field of endeavor where the

practitioners routinely deal with people on the worst day of their lives, especially in the ED setting. Unlike law enforcement where there is almost an expectation of at least the possibility of mayhem, in healthcare the situation can unexpectedly erupt from complete calm to screaming, flying fists and even gunfi re in mere seconds. The perpetrator could be an elderly patient who moments before seemed frail and compliant and now is demonstrating surprising strength and ferocity. What can you do? That depends on who you are. If you’re a hospital administrator or physician group practice manager, you no doubt have policies in place to prevent violent encounters and minimize or contain them when they do occur. Hiring an outside expert in workplace safety and security to look over your shoulder, so so speak, to review your existing policies, is a prudent course of action. If you’re a nurse or other worker in the front line trenches of healthcare, make sure you know the emergency policies your institution has in place. In addition, anyone can take a free online healthcare workplace safety course offered by NIOSH, the National Institute for Occupational Safety and Health. It’s replete with lots of prevention and intervention strategies for dealing with violence from patients, coworkers, and friends and relatives of both. Here is a link to the free course: https://www.cdc. gov/niosh/topics/violence/ training_nurses.html +

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CIRCADIAN… from page 1 are continuously working against the body’s internal clock night after night. You might be thinking, “I’m retired, I never travel, and I go to bed every night like clockwork.” Despite that you could accidentally be wreaking havoc with your internal clock. How?

For years scientists have known that light is the most powerful messenger from the body to the circadian clock. Maybe because the sky is blue during daytime, the body reacts to blue light by suppressing production of melatonin, the body’s natural sleep aid.

That other clock

In addition to the 24-hour circadian clock affecting us all, women have a another timer ticking away, the so-called “biological clock.” While clocks usually measure the forward passage of time, this clock counts down, measuring the slow closing of the window of opportunity to have children. Unlike past decades, more women in recent years have delayed childbearing for career and educational pursuits. Having a first child near age 30 or beyond was once a rarity. It is fairly common now. The entire issue is a complex one, combining medical, social and economic issues. While women are enjoying greater opportunities and choices than ever in the workplace, those advantages can present dilemmas too. While having children may have been a couple’s original plan, is it still the goal for both? If so, how long can they wait? Both biological and practical considerations enter into the picture. Can a family accustomed to two incomes temporarily (or permanently) survive on one? As for biological and medical questions, tests are available to measure hormone levels as one indication of fertility. Discuss the questions you have with your doctor. From a practical standpoint, it makes sense to investigate your employer’s maternity leave policies and your insurance coverage. Not to be overlooked is talking to your partner to make sure you’re both on the same page. Family counselors say the key is striking the proper balance between rushing into pregnancy just because the clock is ticking versus waiting too long and elevating the risk of complications. Your decisions will have an impact on your life for decades to come, so they should be made prudently. +

What does blue light have to do with any of us? Quite a bit, actually. The light from televisions, smartphones, tablets and computers is from the “cold” end of the spectrum where white or blue light predominates. By contrast, most light bulbs and lamps shine from the other end of the light spectrum, where the warm glow of yellow light is found. Clinical studies have established that warm yellow light has little effect on our circadian rhythms, while exposure to blue light — in other words, reading an e-book, surfing the internet, posting on Facebook and Instagram, etc., even watching TV — can result in difficulty falling asleep, less healthful REM sleep, more difficulty waking up the next morning, and feeling less alert throughout the day. Sleep scientists say children and teenagers are even more affected than adults. Their recommendation for people in all age groups: avoid screens, especially non-TV screens, in the hour or two before bedtime. Wakefulness is just a tiny aspect of all the body mechanisms and processes controlled by the circadian clock, but it’s a very important one. Circadian disruptions have been implicated in obesity and a greater risk of diabetes, since a number of metabolic systems can be collateral damage, including the body’s ability to process insulin. Some bipolar disorders are thought to be connected to circadian rhythms. We’re still learning about the relatively new and growing field known as chronobiology: the 2017 Nobel Prize in Medicine was awarded to three researchers “for their discoveries of molecular mechanisms controlling the circadian rhythm.” +

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Are tetanus shots really important? I read that tetanus is extremely rare. True, tetanus is very rare. On average, only about 30 people are diagnosed with tetanus or “lockjaw” each year in the United States. But whether they recover or go to an early grave, those 30 undoubtedly fervently wish they had gotten a tetanus shot. There are not many ways to die that are more horrible than tetanus, and it’s not exactly rare in other parts of the world. The medical journal Lancet reports that some 59,000 people died from it in 2015, which is actually wonderful news: as recently as 1990 the death toll was well over 350,000. Tetanus is often called lockjaw for good reason. One of the earliest signs is contractions and rigidity in the jaw, creating a characteristic grimace, followed by spasms and stiffness that gradually spreads across the face, neck, chest, back and abdomen. A person may have difficulty swallowing and/or breathing. As the disease rapidly progresses (from onset to death can take as little as four days), spasms can be so violent that they tear muscles and break bones. Fever, excessive perspiration, drooling, uncontrollable urination and defecation and irregular heartbeat are not uncommon symptoms. Death can result from suffocation or heart attack. Fortunately, tetanus is rare in persons who have had a tetanus shot; the disease occurs almost exclusively in those who have not. An unvaccinated person who experiences a puncture wound — the classic stepping on a rusty nail, for instance — a dog bite, or any wound contaminated with dirt, saliva or feces is advised to thoroughly clean and disinfect the wound and get a tetanus shot pronto. Tetanus is more common in hot, damp climates where soil is rich in organic matter, so keep that in mind on your next exotic vacation or mission trip to a third world paradise. No matter where you are in the world, including your own backyard, always practice good wound care, even for little cuts and scrapes. And make sure you are up-to-date on your tetanus shot. Even adults should get a booster every 10 years. +

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#64 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 by Marcia Ribble

his photograph shows a woman whose intellectual brilliance was exceeded only by her dedication and determination. All three were key elements of a remarkable career in medical research. At first glance, a student of Gerty Cori (above) might see only her academic accomplishments. She was the first woman to win the Nobel Prize in Medicine and only the third woman to win a Nobel in the science categories (the preceding two being Marie Curie and her daughter Irène in Physics and Chemistry). She shared the 1947 prize with her husband, Carl, for their discovery of how the body breaks As a research worker, the down glycogen and resynthesizes and unforgotten moments of stores the energy, a process known as my life are those rare ones the Cori cycle. which come after years of Born in Prague in 1896, Gerty plodding work, when the Radnitz decided at age 16 that she veil over nature’s secrets wanted to be a doctor, only to discover seems suddenly to lift and that she lacked the required premedical when what was dark and training. Undeterred, in a single year chaotic appears in a clear she covered the equivalent of eight and beautiful light and years of Latin, five years of physics pattern. and chemistry, and five years of math. — Gerty Cori She passed the university entrance examination and began medical school in Prague in 1914, a rarity for women at that time. In medical school she met her future husband, Carl Cori, and they married in 1920, the same year they graduated, and the same year they published their first joint research paper. Two years later, Carl obtained an assistant pathologist position at what is now the Roswell Park Cancer Institute in Buffalo, New York, and the couple immigrated to America. Gerty, who had already established herself as a researcher in the pediatrics ward of Prague’s children’s hospital, worked with Carl in the lab as a lowly assistant, but not without opposition. The director of the Institute threatened to fire her for collaborating with her husband. They ignored the threats and kept working, publishing some fifty papers in their time at Roswell, bucking the custom of the day by publishing as lead author the one who had done the most research on the subject, not by gender (which back then would always have listed her as a secondary author). Their persistence led to the 1929 discovery of the cycle named in their honor and (eventually) the Nobel Prize. Their glycogen discovery led to job offers for Carl from a number of universities around the country, but none for Gerty. Washington University School of Medicine in St. Louis was the exception, although Gerty was paid a dime for every dollar they paid her husband. It was thirteen years before she attained the same professional standing as her husband. As her Washington University biography puts it, “for more than half her career she was marginalized in non-tenured track research positions at token salaries.” Yet today, she is the more remembered and celebrated half of the Cori team. It is a measure of her humility that several years after winning the Nobel Prize she called herself “a research worker” (see box). Gerty Cori died of myelosclerosis in Glendale, Missouri, on October 26, 1957 at age 61. +

I saw an interesting program on WJBF about stroke treatment, information folks need to be aware of, and that is especially important to people like me. Seems as though clot-busting drugs work pretty well for lots of folks, but there is a new, advanced treatment, that is a significant improvement for many. On the program with Jennie Montgomery, two doctors from MCG discussed a procedure in which neurosurgeons go into the brain’s blood vessels to remove clots. This procedure rapidly restores blood flow to the part of the brain affected by the stroke, preventing most stroke effects from becoming permanent. With them on the show was a neurologist who has received the new treatment. He had come to MCG paralyzed on one side and unable to speak. They showed pictures of the blocked blood vessel and the area affected by his stroke before the procedure. Then they showed another picture after the procedure in which the blood is seen returning to the area of his brain affected by his stroke. The patient talked about how fast his recovery was, with his paralysis ending within a couple hours. Within a few more days he was also speaking again. Fully. Completely. Recovered. According to the doctors, Augusta is the only place in Georgia other than Atlanta where the procedure is available. I am hoping that because MCG is a teaching hospital those two surgeons will soon be teaching

the procedure to younger doctors studying to become neurosurgeons, or more seasoned doctors attending educational opportunities to learn the procedure, called a thrombectomy. To view the program, click or copy this link: http://abc6.wjbf.com/2FTGp1v - or this one: http://www.wjbf.com/news/breakthroughstroke-treatment-astonishes-doctors-andpatients_20180305061834423/1009309208. This is the kind of issue that requires patients and their families to know about this procedure. It is especially important for patients who have contraindications for using clot-busting drugs to know that this is an option available to them. I am one of those people. I have ITP (idiopathic thrombocitic purpura). Mostly it’s not much of a problem, but it means I already do not have the number of platelets most people have, so clotting is something my body doesn’t do very well. Because of that I need to avoid anything that would reduce my already low number of platelets, so blood thinners, aspirin, and NSAIDS are on my “DO NOT USE” list. Along with clot busters! I may never have a heart attack or stroke because in me, clots form less easily, but even with ITP there is always a risk of clots forming and blocking blood vessels essential to the functioning of my heart and brain. Be sure to remind people you know, because an informed patient and his or her family are able to make better decisions when time for deciding is limited to the golden hour. +

MYTH OF THE MONTH Essential oils are exactly that Actually, they can be the very definition of non-essential. But that depends on who’s writing the definition. If you hear the word essential and think “absolutely necessary; extremely important,” you probably wouldn’t make a list like this: • oxygen • water • food • lavender-scented candles Then again, perhaps you would. We aren’t going to spring a pop quiz on you, but for the purposes of our discussion here, three

of the four items above are essential, the fourth is not. You have to identify which one doesn’t belong. Essential oils get their name from being infused with the “essence” of something, like strawberries, lemons or eucalyptus. The essential ingredient gives many products we buy their characteristic flavor or aroma. They are definitely essential to the financial welfare of their makers and sellers — perfumists, candle makers, and so forth — but not so essential when it comes to a salubrious state of health. +

APRIL 13, 2018

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

MEDICAL

INER

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APRIL 13, 2018

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’ve been getting winded lately.” He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients. “When does it happen?” I ask. “Just when I do things. If I rest for a few minutes, I feel better.” Now the red flag is waving vigorously. It sounds like it could be exertional angina. In a diabetic, the symptoms of ischemia (the heart not getting enough blood) are atypical. It’s the pattern of symptoms that is the most important, and to have exertional shortness of breath which goes away with rest is a pattern I don’t like to hear. What he needs is a stress test, more specifically in his case, a nuclear stress test (because his baseline EKG is abnormal). But there’s a problem: he has no insurance. A nuclear stress test will cost thousands of dollars. I can refer him to the hospital, but I know the financial situation he and his wife face. They have no money because of a chronic pain problem he has. He hasn’t worked in several years, but hasn’t ever been able to get disability either (“I tried, but was denied three times”). Without insurance he’s not able to get his problem fi xed, so he’s disabled. But he can’t get disability, so he can’t get insurance to get his problem

fi xed and no longer be disabled. The problem at hand is this: he needs a test he can’t afford. There are many folks out there in this same situation. It may not just be the people with no insurance, and it may not even be people who don’t have money. In fact, my own family is facing

He can’t afford to get the test. Or to not get the test. this same problem. Multiple family members (myself included) need dental work done. Some need it done badly, yet we don’t yet have the money to pay for it. So we wait for the money to show up while the problems get worse. Many problems are being put off because of high deductibles or underinsurance. Sure, the ACA has helped people get insurance, but many people got the “bronze plan” and so pay out of pocket for much of their care. What ends up happening is that folks don’t get their blood pressure managed, their diabetes controlled, or their shortness of breath assessed because it simply costs too much to do so. And so my patient, who has a lot more than cavities to worry about, puts me in a difficult situation. He can’t

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afford to get the test done, and he can’t afford to wait to get this test done. We will do what we can to find ways to find the cheapest way to assess this problem and potentially fi x it, but I am not sure exactly how we will accomplish that. Until our healthcare system can figure out a way to handle this kind of thing, we will pay a big price. Waiting for problems to become emergencies is a terribly expensive approach to medicine. I’m not sure I know exactly what needs to be done for this, but it’s becoming an increasingly common problem. Some say that a single-payer system will be the remedy, but they ignore the fact that a third-party payer system is what got us in this mess in the fi rst place. Things are far too expensive because patients don’t have to pay for them. That’s why stress tests, which don’t actually cost thousands of dollars to do, are so expensive. That’s why there is $100 hemorrhoid cream. That’s why medications are unreasonably expensive: someone else pays the bill. I hope the answers are out there somewhere. I’m trying to work on ways to negotiate cheaper prices for my patients for such services, but this kind of thing will take a lot of work and will have to overcome a lot of inertia. It’s going to take time. Unfortunately, my patient with shortness of breath may not have so much time. +

AUGUSTAMEDICALEXAMiNER

APRIL 13, 2018

PART ONE OF A BRIEF SERIES

The vocabulary of healthcare Editor’s note: with this issue we begin a brief series to help decipher the sometimes confusing terminology of healthcare. We’ll do it more or less alphabetically, but if we happen to miss a word or term — there are zillions of them — we’ll go back. We start unalphabetically with the big healthcare program elements Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people regardless of their age. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments. Its specific coverage and elegibility requirements can vary from state to state Medicare is the federal health insurance program for people aged 65 and older regardless of their income. It also covers people younger than 65 who have disabilities, plus those

with end-stage renal disease, requiring dialysis or a kidney transplant, or amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease). NOTE: It is possible to qualify for both Medicare and Medicaid benefits, so-called “dualeligible” beneficiaries. Original Medicare is the insurance program managed by the federal government. This type of coverage generally includes Medicare Part A and Part B. Under Original Medicare, the government pays hospitals and doctors directly. Medicare Part A is essentially hospital insurance. It covers different types of inpatient care, including inpatient hospital stays, care received in skilled nursing facilities, hospice care and some home health care. Medicare Part B covers services that are delivered on an outpatient basis, including

doctors’ visits, laboratory and imaging tests, medical supplies and preventive services.

and health care when traveling outside the U.S. that Original Medicare does not.

to Medicare Advantage or from Medicare Advantage back to Original Medicare.

Medicare Advantage Plans, also called Medicare Part C include coverage for both Medicare Parts A and B through a private health insurer that’s been approved by Medicare. These plans cover hospitalization, outpatient care and often prescription-drug coverage under one policy.

Medigap Open Enrollment Period is a six-month window that starts the first month you become age 65 (or are older) and are covered by Medicare Part B. Coverage is guaranteed during this period. In addition, you cannot be charged more for coverage because of current or past health problems.

Annual Notice of Change A notice your Medicare plan sends each fall to alert you to any changes in coverage, costs or service area your plan is making that will take effect in January.

Medicare Prescription Drug Plan (Part D) plans are private insurance policies that add prescription drug coverage to Original Medicare, some Medicare Cost Plans, Medicare Private-Fee-for-Service Plans and Medicare Medical Savings Account Plans. Medigap policies are supplemental insurance sold by private insurance companies to fill “gaps” in Original Medicare coverage. These policies help pay for copayments, deductibles

Other terms Advance Coverage Decision A notice you get from a Medicare Advantage Plan letting you know in advance whether or not it will cover a particular service. Annual Enrollment Period Each year between Oct. 15 and Dec. 7, you can change your Medicare Advantage or Part D prescription drug plans for the following year. You can also switch from Original Medicare

Benefit period A benefit period is the way Original Medicare measures your use of hospital and skilled nursing facility (SNF), services. A benefit period starts the day you’re admitted as an inpatient in a hospital or SNF. It ends after 60 consecutive days without receiving care. Medicare’s inpatient hospital deductible is paid at the start of each benefit period. A new benefit period begins when you are admitted to a hospital or SNF after one benefit period has ended. There is no limit to the number of benefit periods. +

WE’RE BEGGING YOU We’re never too proud to beg. What we’re begging for is Medicine in the First Person stories. 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. Thanks!

“The cause was a mystery for a long time.” “And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.” “I was a battlefield medic.” “He was just two when he died.”

“OUCH!”

“It was a terrible tragedy.” “She saved “I sure learned my lesson.” “I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.” “It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.” “They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

ambulance crashed.” “Now THAT hurt!” “The “My leg was broken “I’m not supposed to be alive.”

“This was on my third day in Afghanistan.” in three places.” “I lost 23 pounds.” “Turned out it was just indigestion.” “At first I thought it was something I ate.” “The smoke detector woke me up.”

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.

APRIL 13, 2018

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doesn’t always have to be

Caribbean Chicken and Mango Salsa - with a vegetarian option

Who doesn’t love an island vacation, the energizing beat of steel drums and the robust taste of Caribbean fare? (Yes, please!). Even without the vacation part of the equation, you can enjoy the wonderful tastes and aromas in this fabulous island dish any time of the year. Although I eat a plantstrong diet, this meat dish with free-range, organic chicken is also chock full of phytonutrients from spices, herbs, fruits and veggies. It can be served over mixed greens or as lettuce wraps to get even more of those 9-13 daily servings of fruits and vegetables recommended by the FDA. (Did you know we’re supposed to eat that many servings to maintain good health?) To make this a quick vegetarian dish, omit the tomatoes and chicken broth from the recipe and substitute the chicken with 3 cans of organic black beans. In a large pot, saute the bell pepper, onion, garlic and jalapeno until tender-crisp. Add the black beans to the sauteed veggies (retain just a small amount of the liquid) and all of the spices in the recipe down to the coconut sugar. Bring to low-simmer on the stove-top for about 30 minutes to infuse flavors. You can serve either mixture on top of mixed greens, on top of your favorite rice, or in lettuce wraps...and whichever way you serve it, load it up with Mango Salsa/toppings. And, believe me...whether you make the chicken or vegetarian version of this Caribbean fare, you’ll do a • 1 tablespoon paprika shred with two forks while salsa dance right there in the • 1/2 teaspoon coconut sugar still in the slow cooker. Give kitchen when you taste it! the mixture a stir to combine. I think I could sit down and MANGO SALSA Cover and let sit about 10 eat the whole bowl of salsa by • 3 ripe mangos, diced minutes before serving. itself! • 1/3 cup red onion, diced Assemble onto plates over

Caribbean Chicken and Mango Salsa

Ingredients: CARIBBEAN CHICKEN • 1 1/2 lbs. boneless, skinless (organic) chicken • 1/2 cup diced canned tomatoes • 1 cup chicken broth • 1 bell pepper, diced • 1 onion, diced • 2 garlic cloves, minced • 1 jalapeno, minced (optional) • Juice of 1 lime • 1/2 cup fresh cilantro, chopped • 1/2 teaspoon ground ginger • 1 tablespoon cumin • 1 teaspoon sea salt • 1/2 teaspoon pepper • 1/4 teaspoon allspice

• 1/3 cup fresh cilantro, chopped • Juice of 1/2 lime Other ingredients: • Lettuce leaves of choice (for wraps) • Sliced avocado (topping) • Chopped green onions, or other desired toppings (optional)

lettuce, your favorite rice, or into lettuce wraps and top with mango salsa, avocado and any other desired toppings. If making the black bean version (see comments in the intro), plate or serve in lettuce wraps and top the same way you would with the chicken mixture. +

Instructions: If making the chicken version, put all chicken ingredients into slow cooker. Mix and cook on high for 3 hours. Meanwhile, prepare salsa ingredients and toss together in a bowl. Refrigerate until ready to use. When the chicken is cooked,

Cinde White is a certified health/recovery coach (myhdiet.com) and a certified introductory wellness chef (cindewhite. towergarden.com or cindewhite.juiceplus.com and southerngirlseatclean.com)

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ASK DR. KARP

NO NONSENSE

NUTRITION Anna from Savannah Tech asks, “What’s the effect of sodas on the body and health?”

Soda, either regular or diet, can be a part of a normal diet — occasionally. It is the over-consumption of soda that is associated with many health issues. And the word “over-consumption,” means routinely drinking soda every day, even one. “Moderation,” when it comes to soda, means drinking a soda every now and then. There really is no debate about this; the issues are pretty well-documented, although social media has thrown a lot of overexaggeration, emotion and hype into the discussion. The fact is that an occasional soda is not bad or evil, and is ok. It used to be that sodas were an occasionally treat at parties, at a baseball park with a hotdog, on July 4th, etc. Now, people drink either diet or regular sodas as their main liquid throughout the day. This is how so many health issues arise. Sodas, whether they are diet or regular, are acidic. Those bubbles you see are produced by the breakdown of the carbonic acid in the soda to carbon dioxide and water. This occurs in both diet and regular sodas (and in those carbonated bottled waters, too). When you routinely expose your teeth to acids, their enamel dissolves. This is called “enamel erosion.” Sodas also contain phosphoric acid, which gives the drink a “tangy” taste and retards

APRIL 13, 2018

microbial growth, especially in high sugar drinks. Regular sodas also contain sugars, so there is a double-whammy effect. The sugar, whether sucrose, fructose or glucose, is food for dental plaque bacteria. Oral bacteria metabolize sugar to produce organic acids, such as lactic acid. Sucrose (table sugar), is particularly well-suited for bacterial metabolism. These acids cause decay. So, whether the acids are inorganic (like carbonic and phosphoric acid) or organic (from bacterial metabolism), the effect on your oral health is the same: enamel erosion and/or dental caries. In addition, there is a clear relationship between excessive calorie consumption (whether as soft drinks, high fat foods, over-eating, etc.) and obesity. Obesity comes with all the associated metabolic consequences such as heart disease, stroke, diabetes,

high blood pressure and cancer. The parallel between the dramatic rise in soft drink consumption in the U.S. and obesity is not coincidental. A large soft drink at a fast food restaurant has about 400 calories in addition to all the calories in the food itself. It’s easy to drink in excessive calories in a very short period of time. Does the over-consumption of soda also cause decreased bone density? Yes. Most studies conclude that decreased bone density is caused mainly by the substitution of sodas for milk and other calcium-containing foods and drinks. It is not possible to rule out a direct effect of sodas, either from the sugar, the acids or the caffeine, on bone density itself. This is still being studied. What’s the “No-Nonsense” nutrition advice about for today? The overconsumption of sodas, either diet or regular, leads to dental problems, such as enamel erosion and dental decay. The over-consumption of sugar also leads to metabolic problems, such as obesity and osteoporosis. Remember, however, if you want to drink a soda, whether diet or regular, once in a blue moon, this is not a health issue. When you open your refrigerator, what beverages should you see? A big pitcher of cold tap water and some skim milk. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook - www.Facebook.com/AskDrKarp - or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D. is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at The Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can fi nd out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles or books and has no fi nancial or other interests in any food, book, nutrition product or company. His interest is only in providing freely-available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not intended to be used to diagnose, manage or treat any patient or client. The views and opinions expressed here are Dr. Karp’s alone and do not reflect the views and opinions of Augusta University or anyone else.

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APRIL 13, 2018

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AUGUSTAMEDICALEXAMiNER

DON’T LICK THE BEATERS Useful food facts from dietetic interns with the Augusta Area Dietetic Internship Program, Augusta University

THE CORNED BEEF 411 by Ashley Jones, MS-Dietetic Intern

Please see 411 page 10

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How “nutritionally lucky” is corned beef and cabbage? Corned beef is rich in is protein, zinc, selenium, and vitamin B12. It is high in sodium and like all other red meats, high in saturated fat too. During the corning/ curing process of the meat nitrites may have been added. Cabbage is a nutrient dense low calorie vegetable. It is an excellent source of fiber, magnesium, phosphorous,

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Ohio Ave.

Spring is finally here. During this time of the year, gardens will soon begin to produce a wide variety of fresh fruits and vegetables. With the recent celebration of St. Patrick’s Day in mind, did you know corned beef and cabbage was not started in Ireland? It began when Irish immigrants came to the US. To continue the celebration of their lucky day, they wanted to eat what reminded them of home, and that was boiled bacon. Unfortunately, this meat was expensive, but beef brisket was an affordable substitute with cabbage completing the perfect pair. Ever since, corned beef and cabbage has remained the popular option in the American culture for luck.

calcium, potassium, manganese, vitamins B1, B6, C, K, and folate. These essential nutrients serve many roles in the body. Some B vitamins (B1, B6, and B12) are important for red cell and energy, muscle contraction, and normal nerve function. Due to the high sodium and saturated fat of corned beef, leaner cuts of unsalted beef are the recommended substitute. Also, select meats that are nitrites free. Sodium is an essential nutrient that is required to send nerve impulses and maintain muscle function. However, excessive intake of sodium often pulls extra water into the blood vessels. This increased fluid volume in the blood vessels may cause an increase in blood pressure. This is commonly referred to as hypertension. Hypertension is the leading cause of cardiovascular diseases and kidney failure. There are different types of fats. Some that are healthy, however, saturated fats are unhealthy. Saturated fats may increase bad cholesterol (LDL). This type of cholesterol is a major risk factor for developing cardiovascular diseases. Nitrites are often added to the brine

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APRIL 13, 2018

A note to readers

As you are no doubt aware, our normal publication schedule is twice each month, usually on 1st and 3rd Fridays. There is the occasional adjustment required by extenuating circumstances, however. The Masters Tournament, for example. With many offices closed during tournament week, the April schedule will be 2nd and 4th Fridays. That change will create a domino effect

that will last awhile. It takes a 5-Friday month before we self-adjust back to 1st and 3rds, but this year the next 5 Friday month is June. That will put us smack dab in the middle of deliveries July 4 week, which could present a number of office closings, so we’ll stay with 2nd and 4th Fridays through the end of August. The schedule for the next several months is shown below (Examiner issue dates circled). +

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411… from page 9 solution used to cure meats. The upside of nitrites is that they extend the shelf life of meats since it is a preservative and prevents bacterial growth. It also gives meat that attractive red color and a distinct flavorful taste. However, when meats are cooked, especially at very high temperatures, nitrites are broken down to a very dangerous cancer-causing product (carcinogen). This may damage cells and increase the risk of developing cancer. Curious to know whether your diet is balanced and full of variety? Would you like to know how to make healthy choices? The USDA

has published MyPlate (www.choosemyplate. gov) that shows the food groups and provides tools to help build a healthy diet. This is an excellent source to help guide you on food decisions. You can contact a Registered Dietitian Nutritionist (RDN) to help you improve your nutritional status and health. Registered Dietitian Nutritionists are expertly trained to help you better enjoy the foods you want to eat, provide guidance in food choices and a healthy you. To learn more about the role of an RDN or if you want to find an RDN in the CSRA, ask your doctor or visit www. eatright.org. +

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We’ve just added this shirt to the haul winners of the Mystery Word contest receive — in addition to gift cards from Wild Wing Cafe and Scrubs of Evans.

FIND THE WORD AND ENTER TODAY! Remember: the Mystery Word is always hidden. It is never in plain sight and it’s never in an article. See all the deets on page 14.

YOUR SUPPORT OF OUR ADVERTISERS MAKES THIS NEWSPAPER POSSIBLE

APRIL 13, 2018

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Neil Baum, M.D. on March 11, 2016

2 POWERFUL WORDS MORE DOCS SHOULD USE Sticks and stones may break my bones but two words — thank you — will not hurt you but will certainly help you. We are often so busy (I include myself) and always in a hurry rushing from one task to another that we can forget common courtesies. I believe that we can accomplish so much more with our patients, our staff, and even in our personal lives by not forgetting to make good use of those magic words: thank you. Relationships with our patients and our staff are the cornerstone of a successful practice. Common wisdom dictates sending referring physicians a note regarding the patient they sent you as a way of communicating your opinion. It is also common to send a gift at holiday time to colleagues and friends who have been helpful to you and your practice throughout the year. I believe it is important to express your appreciation not just in the month of December but all year round. Here are a few suggestions that allow you to say thank you to your patients, your staff, colleagues, family and friends all the time so that your appreciation is noted and you don’t take for granted how nice others have been to you and your practice. Thank yous are most appreciated when they are least expected. We have a policy in our office that when a pharmaceutical company or a vendor brings the doctors and the staff a lunch, everyone in the office who had lunch sends a thank you note to the sponsor of the luncheon. I have heard on multiple occasions that our office is the only office that acknowledges the lunch, and that the representatives from pharma are very impressed that our staff is so thankful for the meal. Thank patients who take the time to complain. It is not easy for a patient to register a complaint with a doctor. If the practice receives a complaint, it is imperative to follow up and let the patient know that action has been taken to resolve the problem. This also applies to your online reputation and physician grading sites on the Internet. If a negative comment appears on a grading site, acknowledge the complaint and without using the commenter’s name or anything that could identify the patient, let them know that you appreciate their comment and that you are taking action so that it doesn’t happen again. Remember that patients who complain and feel that you recognize their problem and try to correct it often become your most loyal patients and greatest promoters. I think that a thank you that is handwritten is more meaningful than one sent via email. Recipients of your thank you note recognize that it takes a little extra effort to write a note and mail it than to send it via email. I use a “thanks a million” check to write my thanks to a patient, an employee, or friend. I have gone to their desks or their offices and note the recipient will often tape my thank you note prominently as a lasting reminder of my graciousness. It takes only a minute or two to say thank you. Don’t miss out on this opportunity to acknowledge those who have been helpful and nice to you. It will make their day. And yours. +

It’s most effective when it’s least expected.

Neil Baum is a urologist and author

If you noticed the subtitle of this book (“A Funny Book About Horrible Things”) you already understand the contrasts painted by this author. Jenny Lawson, you see, is writing about depression and mental illness. If you would like to read a depressing book about depression, this is not the book for you. In fact, if you’d like to read a Grated book about depression, keep moving right along. Jenny has what some people might call a potty mouth. She has words, and she’s not afraid to use them. But no one can accuse her of not getting her point across. And it’s a rather important point, since millions of Americans have to deal with chronic depression, severe anxiety, and various mental disorders that range from merely annoying to crippling and life-altering. It probably tells you all you need to know about Jenny Lawson and this book that her readings are a lot like stand-up comedy. But that doesn’t mean she trivializes this important subject; it just

means she isn’t wallowing in despair or living her life curled up in the fetal position in her closet. Depression is giving her a battle, and she’s fighting right back. And making a lot of fair points for all of us, even people who aren’t battling depression. Example: have you ever told someone in the throes of depression to “just cheer up” (or words to that effect)? As defi ned by this book, you have said the equivalent of telling someone who just had their legs amputated to “just walk it off.”

Have you ever told someone who is depressed that they just have “a case of the Mondays”? If so, you’ll get a reminder that mental illnesses are borne of issues a lot more complex than what day of the week it is. Even so, no one should expect to read this book for scientifically-based clinical insights. It might even be slightly comparable to this newspaper: hopefully informative and insightful, but perhaps leaning more in the direction of general knowledge than doctorate level data. And in the case of this book, throw in an almost prescription-level humor and entertainment factor. Add it all up, and without discounting the importance of therapy and medication, it offers a light-hearted cheering section for anyone determined to be, despite their depression, furiously happy. +

Furiously Happy: A Funny Book About Horrible Things by Jenny Lawson; 352 pages, published by Flatiron Books in 2017

Research News Praising autism Since April is National Autism Awareness Month, let’s begin with new research from the University of North Carolina, where a very simple strategy offers benefits to young people with autism. Previous research has shown that regular exercise that is moderate to vigorous helps increase and lengthen mental focus in the classroom for those with autism. But research has also demonstrated that individuals with autism exercise less and less the older they get, putting them at extra risk for outcomes like obesity and diabetes. The UNC research explored the impact of praise in promoting exercise, and found it to be a powerful motivator. Both in person and delivered through earbuds, specific messages (addressing both the activity and the participant: “Good job skipping rope,

Derek!” or “You’re getting better and better at jumping, Austin!”) resulted in extended exercise periods and longer and more focused attention to classroom activities with fewer “challenging behaviors.” Study authors noted that delivering the messages via iPods or cellphones was easier, yet equally effective. A sports drink alternative A study by researchers at Appalachian State University released April 5 compared the effects of carbohydrates provided by sports drinks with bananas. Athletes of every stripe from weekend warriors to the pros look to the carbs delivered by energy drinks to extend workouts at peak intensity and help promote faster recovery. However, the study found that bananas actually provide comparable or greater anti-inflammatory (and other) benefits

compared to sports drinks. The research, partially funded by Dole Foods, did not specify the quantity of bananas needed to equal the benefits provided by sports drinks. The study, reported on WebMD, was published in the journal PLOS One. Reducing food allergies Northwestern University researchers have found an unusual combination of environmental and genetic factors that are contributing to the nearly 20 percent increase in food allergies among children between 1997 and 2007. One of the contributing factors is the use of baby wipes that leave soap residue on the skin, and skin contact from those providing infant care. The study says washing hands before handling a baby and rinsing soap residue off the baby’s skin after using wipes will help reduce food allergies. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

APRIL 13, 2018

THE MYSTERY WORD

Did you get that teaching job you applied for?

I think so! The interview went really well.

by Dan Pearson

As soon as my drug test When will you comes back and they finish know for sure? checking my references.

Just that and my marksmanship test.

That’s it then?

The Mystery Word for this issue: LESNAI

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

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Easy stride 5. Short note 9. Breath sounds 14. Part of the eye 15. Parched 16. Late film critic 17. Almost tailless rodent 18. Home of a noted medical school 19. Robust (Scottish) 20. 1969 bestseller (ending with “-Five”) 23. Natal start 24. Bottom-row key 25. His donkey spoke 29. A woman, in old movies 31. A little taste of a drink 34. Unwraps 35. Alpha follower 36. Main ingredient in some salads and casseroles 37. Eye specialist 40. Swing around 41. Threaten, as a crisis 42. Locations 43. Lead-in for 56-D 44. Macon county 45. 2-point football play 46. Tavern 47. There’s a big one in Columbia County 48. Mathematical operation 56. Augusta ________ 57. A month of the Jewish calendar 58. Sports award 59. Bladder liquid 60. Sea eagle 61. On the sheltered side 62. Noted apostle 63. No longer living 64. Monthly expense

VISIT WWW.AUGUSTARX.COM

Click on “READER CONTESTS”

QUOTATION PUZZLE 32

E N T I E E E N T Y S E S V R N S B H R R N S I S O E N T C S Y M O U B I O A A E O U V U Y A D

46 48

DOWN 1. They can be cyanotic 2. Spoken; verbal 3. Size of type 4. Jacob’s twin 5. Chaos 6. Muse of lyric poetry 7. 1,760 yards 8. River in central Europe 9. A job for a cobbler 10. Approximately 11. Optical device 12. Scottish Gaelic 13. Pigpen 21. Grind teeth together 22. Brightest star in the Aries constellation 25. Uplift 26. Singer Fiona 27. Tiny island west of Kauai 28. Poker stake 29. Send troops home at war’s end (in brief) 30. It comes from a Greek word meaning indivisible

— Antisthenes

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.

31. Connected series of rooms 32. A small map within a map 33. Nashville’s Cline 35. Glob or spot 36. Week-ending abbreviation 38. Person used as one’s excuse 39. He founded al-Qaeda 44. Local high school 45. _______ Heart 46. Flying vehicle 47. Princess of Wales, 1981-1996 48. Female horse 49. Single entity 50. Piper adjective 51. Small harplike stringed instrument 52. It can precede gas 53. Small piece of land surrounded by water 54. Nasty type of fracture 55. No to Boris 56. It often follows 43-A

4 9 7 6 3

X A M I N E R

2 5

5 9 4 6 6 3

3 9

9 2

1 7 9 6 3

1 5

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.

Solution p. 14

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

C 1

NUMBER SAMPLE: BY

1 2

S 1 2

U 1 2 3 4 5 6

F 1 2 3 4

I 5

— George S. Patton

1 2 3 4 5 6

1.C H O A F L I M 2.SOOONIE 3.LANUN 4.RRUDG 5.EATI 6.NERG 7.GE

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

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

APRIL 13, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

Moe: Define anxiety. Joe: Underestimating your ability to deal with something in the future that probably will never happen.

ha... ha...

Moe: Define marriage. Joe: The process of discovering what kind of man your wife would have preferred to marry. Moe: My wife doesn’t like to talk while she’s doing her beauty regimen. Joe: So? Moe: So I was trying to talk to her while she was applying a mudpack. Joe: So? Moe: So you should have seen the dirty look she gave me!

mathematician finally gets back home after a night on the town at 3:00 am. His wife is furious. “You told me you’d be home by 11:45!” she yells. “No,” said the mathematician patiently. “I said I’d be home by a quarter of 12.”

Moe: Are you going to that party for the newlyweds? Joe: No, I don’t have a gift. Moe: I thought you bought them an air conditioner. Joe: I did. But then I heard it was a house warming party.

Moe: Did you hear about the kidnapping at school? Joe: Yeah, but it’s okay. I heard he woke up.

Moe: What do you call a fireman who lost his job? Joe: A fi redman.

Moe: I’ve got very sensitive teeth. Joe: How sensitive are they? Moe: They’re probably going to be upset that I told you.

Moe: What do you call bears with no ears? Joe: Bs. Moe: Don’t you hate it when people answer their own question? I know I do.

Moe: I wonder how much it would cost my event to buy a huge singing ensemble? Joe: You mean a choir? Moe: Fine, Mister Grammar Nazi. How much would it cost to acquire a singing ensemble? +

Moe: Kids in Dubai don’t like The Flintstones. Joe: Really? Moe: Really. But kids in Abu Dhabi do. Midwives help people out.

Why subscribe to the MEDICAL EXAMINER? What do you mean? Staring at my phone all day has had no affect on ME!

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

Dear Advice Doctor, I hate to air dirty laundry in public, so the anonymous format you’ve provided here is perfect. My question is about my husband. He’s a quiet man, which I don’t mind at all. But when I want him to talk, it’s like pulling teeth. The man is the poster child for poor communication. How can I get him to open up? — Sounds like the sounds of silence Dear Sounds, You used an apt analogy: it’s not easy to pull teeth. It can be when teeth, gums or bones are abnormal in some way. But pulling a healthy tooth, such as an orthodontist does to make way for realigning teeth, is a bit of a job. Fortunately, anesthesia makes it easy for the patient. In fact, if you do feel pain during a dental procedure like an extraction, don’t be afraid to speak up (if your mouth isn’t full of gauze and cotton balls, that is). There’s no need to try to be a hero. In various medical settings patients are sometimes told, “You’re going to feel a little pressure.” In many cases they should probably just go ahead and say pain instead of pressure. But in a dental setting pressure is the perfect word. As we have established, the goal is for dental patients to feel little to no pain. But removing a tooth is a rather physical act. The phrase often used, pulling a tooth, as though pulling a knife from its sheath, paints a very inaccurate picture. After all, teeth are solidly embedded in bone, held in place by ligaments. That’s how we can bite into apples and steak and corn on the cob without our teeth coming out. They are very firmly entrenched. Extracting a tooth requires a little wiggle room, and a dentist or oral surgeon will try to provide that as step two (step one being anesthesia). The composition of bone in the jaws is spongy, comparatively speaking, so wiggling a tooth around with special dental tools enlarges the space around the tooth and makes extraction easier. It might be compared to trying to pull a deeply driven tent stake straight out of the ground versus trying to wiggle it around sideways in all directions to loosen the ground’s grip on the stake before pulling it out. That is basically what a dentist is doing prior to extracting a tooth: moving the tent stake — I mean tooth — around to make it easier to remove. It’s pretty physical. It’s the perfect time to say, “You’re going to feel some pressure.” Best wishes! + 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 only be provided in the Examiner.

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The Celebrated WORDS BY NUMBER 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 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 of 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.

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1 8 4 5 3 9 2 7 6

6 5 2 8 7 4 1 9 3

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NINTH IN A SERIES

The vitamin alphabet This is as close to royalty as it gets in the world of vitamins. You don’t see any other vitamins being hawked on roadside signs, but that’s not true of vitamin B12. Getting a B12 shot is often advocated by weight loss clinics. More about that in a moment. First, let’s get acquainted with this vitamin, also known as cobalamin. It plays a vital role in the proper functioning of the brain and nervous system and the formation of red blood cells. Those jobs clearly mark B12 as exceptionally important. Something else that sets it apart: it is the most chemically complex of all the vitamins. Here (above), for example, is the structure of niacin, aka vitamin B3. By comparison,

take a look at a B12 molecule. Not only is its structure complex, but it contains a metallic element, cobalt, essential in the formation of red blood cells. Ironically (which is sort of a pun), people who may believe their diet is super healthy may be the most likely to experience a deficiency in this essential vitamin. That would be vegans and vegetarians, since B12 is present only

name for a B12 deficiency, since red blood cells will automatically be in short supply whenever B12 is in short supply. It’s a serious matter: a deficiency in B12 can cause serious and irreversible damage to the brain and nervous system. Even at levels only slightly lower than the recommended daily allowance (which for most adults is 2.4 mcg per day, slightly more for pregnant and breastfeeding women), people can experience memory lapses, fatigue poor reflexes, depression, weakness, headaches and shortness of breath. Fortunately, a vitamin B12 deficiency is rare, in part because the body stores it. As mentioned, strictly following a vegan or vegetarian diet can do the

in animal products like poultry, fish, meat, eggs, milk and dairy products, and is unavailable from plant sources. Anemia is the common

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trick unless supplements are taken. Another problem can be a medical issue resulting in malabsorption. Deficiencies and their cause and treatment should be discussed with your doctor. Vitamin B12 can interfere with medicines and vice versa (metformin is one example), so your doctor should always be included in discussions about B12 supplements. Taking B12 is often touted as a weight loss aid, energy stimulant and athletic booster. However, according to respected and unbiased sources like the National Institutes of Health and Mayo Clinic, there is no solid evidence that B12 injections or supplements accelerate weight loss, increase energy or improve athletic performance. +

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IT’S A QUESTION OF CARE What are some effective ways to improve the diet of an aging person?

As people age or are battling illness, their appetite can be affected – usually negatively. Age itself, a slower metabolism, and illness can also cause someone to lose their appetite. Medications used to treat illnesses, or treatments like chemotherapy or radiation, can also make people feel sick, nauseated, or almost too tired to eat. One way we show love in our society is by feeding those we love and participating in sharing time with them while we eat. As someone struggles with not having enough

appetite due to sickness or the effects of aging, they need to be supplemented in some form or fashion. • You can buy basic supplements, like Ensure or Boost. There are many varieties and flavors, and ones that are particularly better for people with diabetes that do not raise their blood sugar. The idea is to supplement their diet with more protein, calories and vitamins, while being careful not to substitute these supplemental shakes for food. Perhaps you can offer a half of a shake with a small meal. • Another way to

APRIL 13, 2018

increase calories for our loved ones is to blend ice cream, which is calorie dense, but also provides some additional calcium from milk, with something like Boost or Ensure to make a nutritious milkshake. Creating an even denser milkshake can be done by putting peanut butter or almond butter in to provide more protein and calories. • You can also sprinkle some slivered almonds, raisins, dried cherries or anything that might be considered an “extra” on top of yogurt, cottage cheese, soups or ice

cream. Creamy foods are often easier to get down when someone is just taking little nibbles, since they do not require a lot of chewing. Adding calorie-dense items as a topping can be very helpful. Yes, we do want our loved one to eat what is served to them, but sometimes we need to offer a little assistance to make it more appealing. + by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

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

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

Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Floss ‘em or lose ‘em! Thomson: 706-595-7825 Primary Care Rates

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

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OPHTHALMOLOGY Roger M. Smith, M.D. 820 St. Sebastian Way Suite 5-A Augusta 30901 706-724-3339 PRACTICE CLOSED

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