Apr15 16 by Daniel Pearson

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APRIL 15, 2016

Walkability and Wellness

Your walk of life

THIS IS YOUR BRAIN

Opiates: Pleasure or Pain? by Ken Wilson, Executive Director, Steppingstones to Recovery “Opiates.” Everybody’s talking about them, but nobody knows much about them other than that they are a double-edged sword. Take a pill when you’re in pain – presto – the pain goes away. There’s no euphoria, just no pain. Take a pill when you’re NOT in pain – PRESTO! – you’re in heaven! You feel magic, not a care in the world. And the problem with that is??? It can kill you. “But everybody’s doing it, and they aren’t dying!” Ah, but some are. And those who die never knew what happened. You see, just a couple miligrams too much and the part of the brain that regulates breathing slows down the respiratory process and sometimes stops it altogether and alas...who ever knew? “Opiate.” The word sounds so pharmaceutical, so clinical and so benign. But it’s misleading. Why not call it what it is? We might as well call the contents of the cotton-packed-child-safeamber-colored-bottle-from-the-drug-store heroin — or Percocet, hydrocodone, oxycontin, morphine, methadone, buprenorphine, lortabs, lorcet... They’re all about the same shape and do about the same thing in the brain. All of them. If you don’t have one, get one of the others and they’ll do for awhile. It’s not poison. Just particles of a similar shape. They’re like a dozen eggs in a carton from the grocery store, all the same basic shape but in reality some are shorter, some taller, some slimmer, some fatter, some white, some brown. Please see OPIATES page 3

How much of your morning routine requires you to walk further than just a few steps to your kitchen, car or office? It’s suggested that the average adult needs to take about 10,000 steps every day — the equivalent of walking about 5 miles — to maintain optimal weight and cardiovascular health. However, for those of us who work at a desk or live a sedentary lifestyle for other reasons, we may manage a mere 1,000-3,000 steps a day. Fitness trackers, apps, and a slew of online articles outline creative,

new and unique ways to get those extra steps in. But have you ever considered where you live to be a factor? One “new” trend in real estate may actually hold at least part of the key to a healthier, happier lifestyle: walkability. You may have noticed the quotation marks around the word “new” in the previous paragraph. That’s because in reality, there’s nothing new about walkability. Prior to the advent of the automobile and the suburb, walking to work and doing errands on foot

was the most effective mode of transportation for a large majority of the population. But now, a few generations removed from the urban heyday, the idea of being able to walk to work, to the store or to dinner at a nice restaurant is, in most places, novel at best. New developments and redevelopments, however, are Please see WALK page 2

It’s not rocket science But that doesn’t mean it’s easy. What? See page 2

AUGUSTA MEDiCAL EXAMINER

APRIL 15, 2016

It’s not rocket science As Confucius said... well, if we told you it would give away the answer to the Quotation Puzzle on page 12. But what he said applies to something we’re all interested in: good health. A study released last month by researchers with Oregon State University and the University of Mississippi found just four key components in the creation of a healthy lifestyle. That’s it. Four simple habits. What are they? 1. Being sufficiently active 2. Eating a healthy diet 3. Having the recommended body fat percentage or BMI

4. Being a nonsmoker Doesn’t sound all that difficult, does it? Those four measurements are pretty basic. Sometimes things that seem almost effortless as we watch others do them look effortless because the person we’re watching has spent years, maybe even decades, perfecting their golf swing or mastery of the guitar or whatever the activity might be. Were we to try it, we would discover how challenging the “simple” activity might be. That seems to be the case with living a healthful life. In fact, the Oregon and

Mississippi researchers say more than 10 percent of Americans fail all four categories: they smoke, eat poorly, don’t get adequate exercise and are overweight. In fact, almost half of all Americans (45 percent) meet either one or none of the four yardsticks. But there is good news. More than one third of us are practicing at least one characteristic of a healthy lifestyle. 37 percent make the grade in two categories. 16 percent are doing three out of four. The study’s lead author

offered one more result of the study that she described as “mind-boggling.” A mere 2.7 percent of Americans meet all four characteristics. Yikes. However, not all is lost. Articles like this one offer anyone who reads it the encouragement to put forth an effort to do better, not just this week, but on a systematic basis. Researchers also noted that it isn’t necessary to meet all four criteria in order to enjoy health benefits. Wherever we are today, being able to add

another category in the “Yes” column is a plus. Meeting two of the four is better than meeting one. Meeting three is better than two, and so forth. Any improvement is a good thing. The study was conducted with 4,745 participants, and its conclusions were extrapolated to the population at large from there. For additional information about how the characteristics were defined — what is “sufficiently” active? what is a “healthy” diet? — and what you can do to put yourself in better compliance with the simple yardsticks for better health, visit http://oregonstate.edu/ ua/ncs/archives/2016/mar/usadults-get-failing-grade-healthylifestyle-behavior, or simply Google “oregon mississippi health study.” +

WALK… from page 1

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building off of that novelty and creating not only new places to live, but new lifestyles altogether. Multifamily projects located in the heart of cities, or mixed-use projects combining residential buildings with retail and office options are on the rise, and people are already beginning to see the benefit that comes with living at the heart of it all. And it’s not just a social- or entertainment-related benefit. Being at the heart of it all actually may help your heart (and your whole person) to be healthier. Whether it’s the ability to walk or bike to work most days, or simply the option to spend your weekends running errands on foot rather than in the car, the option to work more exercise into your routine without logging more hours at a gym is a great antidote to the busy but sedentary modern lifestyle. The very nature of a walkable neighborhood encourages people to get outside and enjoy the outdoors more, which can help lower blood pressure and increase Vitamin D levels. Also, cutting down on time spent struck in traffic will work wonders for better circulation and lower stress. What walkability options are available in Augusta? Our advertiser, The JB Whites Building on Broad Street, immediately comes to mind. So does Enterprise Mill and The Cobb House on Greene Street. There are countless others. Seeking out those options may help to simplify your lifestyle and improve your health. While the convenience of living in a walkable area is not going to translate into 10,000 steps a day and perfect health for everyone, it is definitely a proven way to encourage healthier choices that can lead to happier, longer lives. +

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Kid’s Stuff

The

Advice Doctor

NOTES FROM A PEDIATRIC INTERN

RUNNING ON FUMES I have been eating terribly lately, and it’s catching up with me. I’m not just talking about putting on a few extra pounds of “fluff,” but about fueling my body improperly. Humans really are what we eat. What I have been eating lately is mostly carbs. It’s awful. Its true: cereal, bagels, frozen pizza, potato soups, bread, etc., taste delicious, but you sure do feel awful after a few weeks. The body becomes chronically exhausted with a diet consisting primarily of carbohydrates, feeling fatigued even after a full night’s sleep. Workouts are non-existent or sub-par due to lack of energy. The mind feels foggy; just thinking is hard. I may be over-exaggerating ever so slightly, but I also like to go big or go home when it comes to driving home a message. I can easily recall the days when I ate eggs regularly for breakfast and was not starving by 9:30 in the morning waiting for lunch. I also recall the times when I was incorporating chicken and vegetables into my dinners rather than eating chips and salsa out of the jar and calling it a night (like I’m doing these days). My work schedule has been crazy lately, and getting to the store with my work hours is hard. But I feel like a car that has been one tic-mark above empty on gas for weeks now. I have hit rock bottom when it comes to realizing now how horrible it is to have a protein & vegetable-deficient, carb-heavy

Kids are even less in control of their diets than adults. diet. Last night I ate a steak and it was glorious. Even if the protein does not come from meat, I need to make a change, and the carbs have got to be no more than supporting actors only in this stage-play of my life. Let’s apply this whole scenario now to kids. Kids are even less in control of their diets than adults. They eat what they are given, and if given a choice, they will mostly choose something that tastes good (donuts, French fries, or pizza) before they choose something good for them. The sugar in carbs is immediately released, giving that burst of energy that everyone will experience right after eating a piece of cake, but as quickly as the high comes, so does the crash. The body consumes the sugar and then is empty again, and this can wreak havoc on a child’s body if their carbs aren’t accompanied by more nutritive foods. It can make it hard for them to pay attention in school, too hyper to sit still, too tired to stay awake, and at a much much greater risk for becoming obese. They might come home exhausted, too tired to exercise or go out to play, but then sleep poorly due to an overall sedentary lifestyle. Then the cycle viciously continues. Carbs do have value, though,

because the body needs sugar that is easily broken down, accessible, and short-acting. They also complement other foods well, and can contribute to a well-balanced diet if consumed in moderation. But too many carbs without enough other foods rich in protein, fiber, vitamins and minerals can make a body feel close to dying. Muscles will break down and the body will feel fatigued and sore even without having exercised. Fat gets stored at the expense of muscle being regenerated, and weight loss or maintenance can be difficult. So before I state what I propose as a solution, let me state what I am not endorsing – and that is cutting carbs out of the diet altogether. As I said earlier, moderation in everything is good. Cereal in the morning, mashed potatoes with meatloaf or turkey, bread on a sandwich, tortillas with fajita veggies & meat – are all great ways to make a meal balanced and appealing while also covering all bases. I do not support any elimination diet really, unless it is focusing on eliminating a regular diet of processed or junk fast food. What I do recommend is that for every carb one consumes (and feeds to their children), one should add vegetables, meats, fruits, or salads. For vegetarians, there are plenty of vegetarian options as well; just be sure to focus on foods that satisfy recommended daily amounts of protein, fiber, and nutrition requirements. It will pay off in the end. The body is a machine, and so must be fueled well to function fully. +

Dear Advice Doctor, My best friend and I have been planning a once-in-a-lifetime trip to Europe in June after graduation, but she’s got itchy feet all of the sudden because last week she found an unbelievable super-cheap airfare — two-thirds off! — but it’s only good if used in the next 30 days. If we go now it will mean that we lose credits and would have to go back and catch a few classes in the fall. Do you think we should stick with the original plan, or save the money? — Fare is Fair Dear Fare, Itchy feet can be simply annoying and uncomfortable, or they can be a symptom of something serious. For example, for some people itchy hands and feet are their first clue that they have diabetes. More often, however, itchy feet are a fungal infection commonly known as athlete’s foot. It’s usually caused by perspiration and sweaty socks, but athlete’s foot is highly contagious, so a person can easily pick it up in community showers and locker rooms in fitness clubs and school gyms and locker rooms. Beginning now as the weather gets warmer and people are outside more, going barefoot or wearing sandals, skin reactions from poison ivy and poison oak can also cause itchy feet. Spring Break often results in people getting the soles of their feet sunburned after spending hours in the sun, exposing feet that don’t often see the sun. For that matter, walking on hot sand can cause burns that are bad enough to begin with, but become very itchy as they heal. Itchy feet are often just a temporary annoyance, but if the problem persists, ask your pharmacist or visit your doctor. + Do you have a question for The Advice Doctor about love, life, personal relationships, career, raising children, or any other important life topic? Send it to News@AugustaRx.com. Replies will be provided only in Examiner issues.

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AUGUSTA’S MOST SALUBRIOUS NEWSPAPER

OPIATES… from page 1 Remember Chinese checkers, the game where a marble settles down into a hole about the size of the marble? Opiates work similarly, lodging in the same way in “receptor” holes in the brain. The main difference is that Chinese checkers won’t kill you. Accidentally even. And then there’s this thing called “tolerance.” Clinical research shows that when these receptors are frequently matched with opiates, the brain grows more receptors. More receptors means the same dose matches with a smaller percentage of receptors. Alas, two pills used to do the trick, but months later it takes four to do the trick, then eight, then sixteen... See where this is going? The process never stops — until one day our friend takes just enough to fill up all the receptor sites – maybe just 16 — and poof... One too many shuts down the respiratory system...slowly...slowly... slowly... and our friend

AUGUSTA

by Caroline Colden, M.D.

www.AugustaRx.com dies while sleeping and never knows what happened. Sad. We see them in the obituary column regularly. They didn’t mean to hurt themselves or their friends and family. According to federal Substance Abuse and Mental Health Services Administration (SAMHSA) statistics, there are 400 opiate addicts today where there was just one ten years ago. Yeah, read that sentence again please. No wonder insurance companies refuse to pay for drug detox like they did 15-20 years ago. “It’s not life-threatening,” they say. No, you just feel like it is when you stop taking the pills: headaches, flu-like symptoms, sleeplessness, joint aches and pain, and a greater than 90 percent chance of recidivism, going back to the drug after detox. So what can you do about your friends who need help on this? Check back next month and I’ll tell you what to do, or Step 1 at least. +

The Medical Examiner’s mission: to provide information on topics of health and wellness of interest to general readers, to offer information to assist readers in wisely choosing their healthcare providers, and to serve as a central source of news within every part of the Augusta medical community. Submit editorial content to graphicadv@knology.net Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

(706) 860-5455 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. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2016 PEARSON GRAPHIC 365 INC.

APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

The Aging & Disability Resource Connection The CSRA Aging & Disability Resource Connection (ADRC) is managed by the CSRA Regional Commission Area Agency on Aging. The ADRC is the entry point for information on long term services and supports to those in need. If you are a caregiver, or if you are aging yourself, you may not know where to turn. The ADRC is the first step to explain what is available, what individuals are eligible for and to help older adults, people with disabilities and caregivers make an informed decision on services. What is the difference between the ADRC and the Area Agency on Aging? The ADRC is the region’s designated entry point for people over 60, people with disabilities and caregivers managed by the region’s Area Agency on Aging. The Area Agency on Aging is a coordinated system of services and support. The ADRC is a part of this comprehensive approach to person center options and services. The Area Agency on Aging also does planning and program development for people with disabilities. When a person calls the ADRC, a certified counselor will speak with the caller. The people answering the phone are certified counselors ready to answer questions, identify needs and get to the core of the issues a caller may have. They will help in a way that is non-judgmental, unbiased and person centered. After listening to the caller, the counselors will ask certain questions to determine what programs the person in need is eligible for or what are their preferences. The most common calls received at the ADRC include caregiver requests, children who are reducing their employment in order to take care of their parents, housing options, in-home services and transportation questions. ADRC provides: • Direct information referral specialists • Option counseling, which follows the person for a few months to address needs they may have • Contract with county agencies and over 30 specialized provider agencies that provide in-home support, meals on wheels, personal support, medication management, wellness classes, chronic disease self-management classes, and help with bathing, etc. Medicaid Waiver Programs • Medicaid/Medicare • Options Counseling • Prescription Drug Assistance • Private Pay Services • Transportation • Medicaid Waiver Programs • Medicaid/Medicare • Options Counseling • Prescription Drug Assistance • Private Pay Services • Transportation • Assistive Technology • Benefits Counseling • Eligibility Screening • Employment Options • Family Caregiver Assistance • Futures Planning • Hospital Transition Services • Housing • How to apply for Services/Benefits • Meals on Wheels The Area Agency on Aging A Division of the CSRA Regional Commission 3626 Walton Way Extension, Suite 300 Augusta, GA 30909 www.csrarc.ga.gov 706-210-2018 Toll free (866) 552-4464

OLD NEWS +

POINTS OF INTEREST TO FORMER KIDS by Trisha Whisenhunt, Senior Citizens Council

WELFARE FOR THE ABLE-BODIED

he federal government spent one trillion dollars on welfare aid last year. In 2000, there were 17.2 million people receiving food stamps and that number rose to 45.8 million in 2015. The food stamp program is the second largest of the entitlements. The cost of this program increased from $20.7 billion in 2000 to $83.1 billion in 2014. The most rapid growth in the food stamp program was seen among able-bodied adults without dependents (ABAWDs); work-capable adults between the ages of 1849, who don’t have children or others depending upon them for support. Among this demographic, the caseload has more than doubled since 2008 from 2 million to almost 5 million today. Paul LePage, the governor of the great state of Maine, has established a work requirement program for all ABAWDs. They must either get a job, be enrolled in a training program or do community service to avail themselves of food stamps. This is sound public policy by any standard and

WORK HARD Millions on welfare depend on you is supported by 9 out of every 10 Americans, that welfare recipients should work, receive training or do community service for the benefits they receive. Once this program was implemented, most refused and their benefits ended. In the first three months of Maine’s work policy going into effect, the caseload plummeted by 80%, falling from 13,332 in December of 2014, to 2,678 in March of 2015. There is historical precedent. Requiring welfare recipients to work was the foundation of President Ronald Reagan’s plan put into place for Aid to Families with Dependent Children (AFDC) in the 1990’s. The nationwide caseload dropped

by almost as much, albeit over a few years as opposed to the few months in Maine. Giving welfare to those who won’t help themselves is a tremendous burden on the American taxpayers and enables those receiving it to develop a dependence on programs which were designed to help the neediest portion of our population. According to Robert Rector, a leading national authority on the U.S. welfare system, government data shows that able-bodied welfare recipients use their own funds counterproductively. Example: more than one half regularly use tobacco, consuming an average of 19 packs of cigarettes per month at an estimated cost of $111. The current national caseload of able-bodied welfare recipients is 4.7 million. If the government were to implement a work program as the state of Maine has, the taxpayer savings would amount to $8.4 billion per year. Additional reforms could raise that number to $9.7 billion or a savings of about $100 per year for everyone currently paying federal income tax. Welfare has been the refuge for many who want taxpayers to pay for what they need so their own money is available to spend on what they want. The ethic of working for what one has is fading. It’s high time to return to the principles for which the welfare program was originally designed. +

MYTH OF THE MONTH “My diet isn’t great, so I take a multi-vitamin.” The capsule you see to the right — and its contents — should be your first clue as to whether or not taking a multi-vitamin is the best option for you. It is commendable that you recognize the true quality (or lack thereof) of your diet, and it’s also admirable that you want to do something about it by taking a vitamin supplement. What you are doing, however, is a little bit like reading Cliff’s Notes instead of a great classic novel. One is A-B-C, the other is A-to-Z. One is the real thing; the other is a poor substitute for the real thing. Food should always be the primary source

of our nutrition. Foods naturally contain all kinds of vitamins and minerals, and some suspect even yet-to-be-discovered nutrients. That is not to say that vitamins are unnecessary. They are beneficial to some people. Just remember to believe one thing on the label of a vitamin supplement: it is intended to supplement a healthful diet, not provide it. + — by F. E. Gilliard, MD, Family Medicine 4244 Washington Road, Evans, GA 30809 706-760-7607 Editor’s note: See also the article on page 9

APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW res? k good eno r skin can ugh cer? son.” o

Niccolo Paganini lived from 1782 to 1840. In his day he was the greatest violinist in the world. He could do things no other violinist could do. His looks? A different story. He was far too pale. Had dark oily hair. Looked like a skinny Herman Munster. He had Marfan syndrome, so he had hyper-flexibility of his long fingers (colloquially known as double-jointed), giving him exceptional unnatural flexibility and inordinately long reach. His alcoholic father abused him as a child and forced him to practice from daylight to dark every day. He was beaten if he stopped. He was never allowed to be a “normal” child. His musical notes conveyed monumental sadness, power, and feeling, deeply touching his listener’s emotions. His music was real and seeped fire and sorrow and anger. His talents were so great that he frightened the Church. People whispered that he had made a deal with the Devil in exchange for his skills. (In this century, the same was said of Robert Johnson, the first great bluesman. Check out the movie, Crossroads.) Paganini performed for high fees throughout Europe before elites and royalties. He was arrogant. Sometimes when the concert hall filled up, he insisted everyone leave, go outside, and pay again to hear him play. He became a womanizer and would pick a lady out of the audience, never mind that she was with her husband, and claimed her for the night. k

ABOUT THE LIMITATIONS OF A NORMAL CHILDHOOD His ability and fearsome appearance forced compliance. He was focused. He cared not what the average person thought. He did whatever he felt like doing. He was his own man. This lifestyle lead to multiple diseases, including syphilis and TB. When he died, the Church bought into the deal-with-thedevil mania and denied him burial in hallowed grounds. It took years before this conflict was resolved, and he was properly buried. Stradivarius violins are considered to be the finest violins ever produced. They are renowned for their quality, tone, and longevity. Those that still exist are valued in the millions of dollars. Modern technology has not been able to copy or reproduce these awesome instruments. Certainly the original craftsmen who created them had internal knowledge and drive not common among their peers. Had Paganini had the privilege of playing a Stradivarius, certainly the finest music, enjoyment, appreciation, and performance in the world would have occurred. Closer to home, a lady we shall call “MM” was reared as a single child to a single mother. However, her extended family protected her from the cruelties of the world. MM was on horseback by age 4. She rode almost every day. Trainers nurtured her, pushed her, and drove her to excel. Second-best was the first loser. MM grew tall and lean. An

t s e B athletic body. A focused mind. MM listened to her mother and ignored the usual “everybody is doing it, so I’m doing it, too” peer pressures that trap so many. Some whispered that MM was pushed too hard, that she should have been allowed to be a “normal” child. She excelled in high school. Homecoming queen with brains and body. Horses were not popular in her school, but she cared not. She followed her feelings. She bred and reared her own saddlebred horses. They became near perfect instruments in her hands. She delivered them as foals, reared them, and trained them to excel as she does. If it stormed, she slept in the barn with her horses. (Frightened horses want to see their people.) She can stop a charging 1500 lb horse by whispering, “Whoa.” She does not need reins. Her horses are extensions of her personality. Horses are her instruments. MM has won dozens of shows all over the Southeast, including Kentucky, the horse capital of the world. Her horses sell for high dollars when she finishes their training

The Augusta Medical Examiner’s publisher, Daniel Pearson, has continuously published a newspaper in Augusta since 1990, longer than any other publisher in Augusta except the gentleman to the right, publisher of The Augusta Chronicle, “The South’s Oldest Newspaper,” founded in 1785.

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and development. She is the reigning champion for Georgia, Florida, and Alabama. She beats men with ease. They call her GoldiLocks. Riders withdraw from events rather than face her. MM is Paganini. Her horses are her Stradivarius. Why do I tell you this? She is my patient. She travels a great distance to see me occasionally. I know not why. She takes only vitamins. Her BMI is 19 (normal is 18.5 – 25). She has had three C-section births. She has no outstanding medical diagnosis. She is 40. She looks 21. She is ready for a New York runway fashion show with a one-day notice (In fact, she did that for a while until she became bored with it.) A recent award winning country music hit song was written about her. (No, I will not tell you which one.) She turned down an invitation to be on the recent Country Music Awards show.

Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology. net or 706-306-9397. FREE T AKE-H OME C OPY!

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APRIL 15, 2016

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She is a church soloist. She eats healthy. Neither smokes nor drinks. Her manners are perfect. MM and Paganini are mirror opposites. But they are alike: focused, disciplined, determined, and impervious to wagging tongues. But for different reasons. They have different moralities. What can we learn from MM and Paganini? Regardless of your upbringing, your health, or family situation, you can excel — if you are disciplined, determined, keep your goals clearly in mind, and listen to yourself while ignoring peer pressure. Both illustrate that you should see exactly what everyone else is doing ... and then don’t do that. Following the crowd will make you average. +

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#20 IN A SERIES

The Short White Coat

Who is this?

hances are pretty good that you’ve never heard of this woman. Born Elizabeth Jane Cochran, after marriage she went by Elizabeth Cochran Seaman. Ring any bells? Probably not, but despite that, she brought about major societal changes that helped improve the lives of a few billion people around the world. And although she is the first non-medical person profiled in this series, she also single-handedly changed the face of care and treatment for countless people under medical care, changes that benefit thousands of patients in the Augusta area and across the planet to this day. It wasn’t easy. In fact, it all started in an insane asylum. Yes, this was long before “mental health facility” or other similarly sanitized terms. This perfectly sane-looking young lady, all of 23 at the time, managed to get herself committed to Blackwell’s Island Madhouse in 1887. See what we mean about the names back then? She wasn’t crazy. Not at all. She was just an intrepid newspaper reporter who wanted to get the real story behind the walls of an asylum. In print she went by the pen name Nellie Bly — a name you surely have heard — but for this escapade she checked into a New York boarding house for women using the name Nellie Moreno, and promptly proceeded to terrorize everyone in it, spewing hostile, irrational threats (in both English and Spanish) alternated with vacant, faraway stares. The police were called in short order, and she was hauled off to the psychiatric ward of Bellevue Hospital, where she continued the act. She was promptly diagnosed as insane and delusional and was shipped off aboard the “filthy ferry” to Blackwell’s Island (known today as Roosevelt Island) where the madhouse awaited. Things were going exactly as planned. Bly spent ten days inside the walls. That may not sound like a long time, but as she wrote, “People in the world can never imagine the length of days to those in asylums. They seemed never ending.” She describes a typical day as sitting “from 6 a.m. to 8 p.m. on straight-back benches,” forbidden to speak or even move during these hours. She described the doctors as “oblivious,” but the orderlies were even worse: some were convicts from a nearby penitentiary who “choked, beat and harassed” patients. The food was scarce and rancid. An early version of water boarding was regularly employed. Bly dropped her act as soon as she arrived at Blackwell’s, but later wrote, “the more sanely I talked and acted, the crazier I was thought to be.” As previously arranged, lawyers from her employer, The World newspaper, arrived on Day 10 to extricate Bly. Two days later the first installment of her exposé appeared in print. Within weeks a grand jury accompanied by Bly inspected the asylum, adopting every change recommended by Bly. The city of New York added an additional $1 million to its budget “for the benefit of the insane.” Aside from breaking new ground for women in the workplace, Nellie Bly’s efforts radically and permanently improved healthcare for people with mental illnesses. +

APRIL 15, 2016

“9-1-1. IS THIS AN EMERGENCY?” by Jasmine Rivas Those are words I’ve never had to answer yes to. But today was different. My grandmother was sitting on the couch because she felt fatigued and within minutes she was asking for an alcohol swab. My sister sat by her side and by the time I got back with the swab and a glass of water, she was unresponsive, her eyes veered to the right, her left arm began to twitch and the left side of her face drooped. I grabbed the phone. “Yes, we need an ambulance.” Remaining calm during times of critical stress is a trait I am grateful to have. Nevertheless, thoughts of my grandmother’s medication list, past medical history, recent events, and other details were racing through my mind. The list of differentials was present and I knew what tests would be ordered at the hospital. Within 3 to 4 minutes — with EMS yet to arrive — she was responsive and the symptoms resolved. To gain a sense of control, I performed a neurological exam. She was at baseline and that offered momentary peace of mind. EMS arrived and the portable EKG read Normal Sinus. Her vital signs were all within normal limits and the next step was calling her primary care doctor. She was scheduled for

an emergency MRI. With another medical rotation in the bag, I decided to visit my family in Miami, FL during a small break between school-related obligations. My sister and niece picked me up from the hustle and bustle of Miami International Airport and the year-round summer’s heat let me know I was home. Just ten days ago, I completed three months in an academic hospital among attending physicians and resident physicians who deal with this scenario multiple times a day. I expected an uneventful vacation with family and friends, not to come faceto-face with a medical emergency. But that is life. It catches you by surprise and you are either ready or not. I’m not a doctor yet. However, this incident solidified one reason why I have committed so much time to this profession. The intense training we undergo to become physicians is what enables us to eventually be prepared to handle these kinds of situations. In every patient I have encountered at a clinic or hospital I saw someone’s family. When it is your family, it really does hit home and the phrase, “knowledge is power” comes to life in a brand new way.

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A med student’s notebook As a medical student, my knowledge, experience and ability to apply medicine are currently limited. With every rotation, I add more tools to my belt. Nevertheless, one of the many beauties of medicine is that it is always changing, always growing and evolving. There is never room for boredom, and arrogance and overconfidence is the surest way to limit yourself and the difference you can make. To think any of us knows it all is not only shortsighted, but dangerous. One of the many lessons I learned on my recent rotation was that in medicine and in life, we all have more to learn. Whether you’re a medical student or the Director of Medicine, the learning never stops. + by Jasmine Rivas, a third year medical student at University of Medicine and Health Sciences. Feel free to contact her with questions or feedback: jrivas@umhs-sk.net

APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

Southern Girls Eat Clean Low Country Shrimp and Grits — healthy & clean version

Shrimp and grits has been a favorite of mine for a good many years now. However, the version I used to make was full of artery-clogging unhealthy fats like butter, Half & Half, bacon, and of course, cheesy white grits. Sound familiar? But since I love shrimp and grits, I was determined to find a way to clean up this dish. It took me a while, but I think I nailed it. I added more veggies, left off unhealthy fats and white flour, and used polenta instead of white grits. This dish is gluten-free, my friends, and full of flavor. It met my husband’s seal of approval. Give this recipe a try and see how delicious “healthy and clean” meals can be. • 2 to 3 Tbsp. of organic cold pressed extra virgin olive oil • 5 shallots, 3 sliced and 2 finely chopped • 5 cloves of garlic, crushed • ½ to ¾ of each: a red, green and yellow pepper, julienned • 1 cup of chopped fresh tomato, seeds removed • 1 to 2 Tbsp. of Blackened Seasoning (See recipe below) • 1 quart and 2 cups of organic chicken broth (or vegetable broth) • 2 Tbsp. of gluten free Worcestershire sauce • 2 Tbsp. of garbanzo bean flour • 2 Tbsp. of organic tomato paste (I used Muir Glen Brand) • 1 pound of wild caught shrimp, peeled, deveined and tails removed (SC local shrimp are my favorite) • Organic corn polenta • Scallions to garnish Heat 1 Tbsp. of olive oil over medium to high heat. Add 2 chopped shallots and 2 cloves of crushed garlic to oil and sauté until softened. Add 1 quart of chicken or vegetable broth to pan and bring to a boil. Once broth is boiling, slightly reduce heat and slowly whisk in 1-1/3 cups of polenta. When polenta is completely thickened to desired consistency, pour into a parchment lined 9 X 13 pan and let cool, then place in refrigerator to harden for approximately 30 min. Remove the polenta from the refrigerator and cut into 3 X 3 inch squares.

Clean Low Country Shrimp & Grits Place the squares onto a slightly oiled cookie sheet and broil in the oven until brown, turning squares once to brown both sides. (Alternately you may brown both sides of the polenta squares in a skillet with olive oil if you choose.) While polenta is browning in the oven, heat 2 to 3 Tbsp. of olive oil over medium to high heat. Add 3 sliced shallots and 3 cloves of crushed garlic to pan and sauté until softened, 3-5 minutes. Add red, green, and yellow peppers to pan and cook until tender-crisp, stirring often. Pour in 1½ cups of chicken or vegetable broth. Add blackened seasoning, Worcestershire sauce and tomato sauce, mix well and simmer for 3-5 min. In a small bowl whisk together garbanzo flour and ½ Cup of chicken or vegetable broth, pour into sauté pan with the vegetables, stir to mix well and let simmer until sauce is thickened. Once the sauce has thickened, add the shrimp and chopped

tomatoes. Simmer until shrimp are cooked through, approximately 5-7 minutes, stirring often. Place 2 or 3 polenta squares onto 4 dinner plates and spoon shrimp/vegetable mixture over the polenta. Garnish with scallions. Serve immediately. Recipe for Blackened Seasoning 1 Tbsp. each of garlic powder, onion powder and ground dried thyme, plus 1½ Tbsp. of paprika, 1 tsp. each of cracked black pepper, dried basil and dried oregano. Then add 1¼ to 1½ teaspoons of cayenne, according to your taste. Mix well and store in an airtight container. +

WHEN CARS DREAM

Alisa Rhinehart is half of the blog southerngirlseatclean. com She is a working wife and mother living in Evans, Georgia. Visit her blog for more recipes and information on clean eating.

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OUR NEWSSTANDS Medical locations: • Children’s Hospital of Georgia, Harper Street, Main Lobby • Department of Veterans Affairs Medical Ctr, 15th St., Main Entrance • Dept. of Veterans Affairs Medical Center, Uptown Div., Wrightsboro Rd., main lobby • Doctors Hospital, 3651 Wheeler Rd, ER Lobby Entrance • Eisenhower Hospital, Main Lobby, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • Augusta U. Hospital, 1120 15th Street, South & West Entrances • Augusta U. Medical Office Building, Harper Street, Main Entrance • Augusta U. Medical Office Building, Harper Street, Parking Deck entrance • Augusta U. Hospital, Emergency Room, Harper Street, Main Entrance • Augusta U., Laney-Walker Boulevard transit stop, Augusta • Select Specialty Hospital, Walton Way, Main entrance lobby • Trinity Hospital, Wrightsboro Road, main lobby by elevators • Trinity Hospital Home Health, Daniel Village, main lobby • University Health Federal Credit Union/ University Hospital Human Resources, 1402 Walton Way, Main Lobby • University Hospital, 1350 Walton Way, Emergency Room lobby area • University Hospital, 1350 Walton Way, Outside Brown & Radiology/Day Surgery • University Hospital - Columbia County, 465 N. Belair Road, Main Lobby • University Hospital Prompt Care, 3121 Peach Orchard Road, Augusta

Around town: • Barney’s Pharmacy, 2604 Peach Orchard Rd. • Birth Control Source, 1944 Walton Way • GRU Summerville 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 • Parks Pharmacy, Georgia Avenue, North 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

Plus... 800+ doctors offices throughout the area for staff and waiting rooms, as well as many nurses stations and waiting rooms of area hospitals.

APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

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.

SPRING IS HERE — AND 3 GUESSES WHAT ELSE It’s springtime in the southeast and residents know drug has been introduced and is available at a reasonable that means pollen and allergies. Thick yellow pollen coats price, so if it helps you this may be a good choice to add to everything in the Deep South. Fortunately its peak is gone your current allergy treatments. for another year, but the other good news is that the thick Another option available through your allergy doctor is yellow clouds of pollen so prevalent allergy shots. These follow a workhere in April actually does not cause up to determine exactly what your the vast majority of allergy attacks. primary allergens are. They are Unfortunately, the rest of the trees, then formulated into an injection grasses and weeds also produce pollen. that contains small amounts of We cannot see these pollens that are the allergens so that as the dose is the smaller and more intense allergens gradually increased over time a that are responsible for the majority of tolerance is developed. This slow severe attacks. progression of allergens allows a Let’s look at what you can do to treat tolerance to be built up without your allergy symptoms. provoking an allergic reaction. This The mainstay of allergy treatment provides relief for the patient from are antihistamines. This can range the chronic allergy symptoms. The from the old classic diphenhydramine, downside to this approach is that it which goes by the trade name involves a number of injections both Benadryl, to the newer once-daily before treatment can be started and antihistamines. These can be loratadine during the often multi-year course of (Claritin) and fexofenadine (Allegra), therapy. It also involves numerous which are non-drowsy, or cetirizine trips to the doctor’s office for the (Zyrtec) which may cause a little injections or learning to do the drowsiness. injections at home, sticking to a rigid The pollen map for the Southeast earlier this week If your allergies are more severe than showed most of Georgia as “High” in pollen, with oak, schedule. you can treat with an antihistamine Whatever plan you use to treat poplar and maple being the main culprits. alone then you may need to explore your allergies, you can get relief from Source: www.pollen.com additional options. Steroid nasal the allergies that have plagued you sprays are now available without a prescription, such as for so long. Talk to your doctor about what may be right for Flonase, Nasacort and Rhinocort brand products with you to help keep you from suffering with allergies year after original prescription strength. A steroid nasal spray has been year. The last couple of years people that have never had a cornerstone of allergy treatment for years as an add-on to allergies in the past has been presenting to the pharmacy with antihistamine treatment. These products are not extensively allergy symptoms. One thing is sure it is more common to absorbed, so they treat nasal congestion and allergy develop new allergies than to have these allergies magically symptoms without the side effects of oral steroids. The newer go away without help so get help. + treatment option is montelukast (Singulair) tablets, originally Written for the Medical Examiner by Augusta pharmacists Chris and used to treat asthma. Lately it has also been found useful in treating chronic allergies, although some insurance companies Lee Davidson will only cover it if used for asthma. The generic form of this Questions, comments and article suggestions can be sent by email to cjdlpdrph@bellsouth.net

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

WHAT’S WITH YOUR SUPPLEMENT? by Megan Patterson, Augusta University Dietetic Intern

Nutrition supplements seem to be all the rage now. The labels of these supplements are filled with promises such as “Lose weight fast!” or “Helps improve your mood!” to get everyone to buy them. Let’s be honest, who wouldn’t want to buy supplements that make us these promises? People are always looking for quick and easy ways to lose weight or want to drastically improve their health by popping a nutrition supplement into their mouth. Supplement companies embellish their promises with just enough scientific language to make us think the ingredients are legit. The label will describe the benefits of different amino acids or talk about the benefits of “bacopa monniera,” which is clearly something most of us haven’t heard of before, but it looks scientific enough, right? These are all common tactics that supplement companies use to get us to buy their products. After all, they are running a $21 billion business. Nutrition supplements come in many forms: pills, drinks, and powders, and can be bought at your local grocery, health food or drug stores. But there is one minor detail about nutrition supplements that most people do not understand: they are NOT regulated by the Food and Drug Administration (FDA). Here is a description of what the FDA actually does: “FDA is responsible for protecting the

public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.” In a nutshell, the FDA ensures that food, drugs, and a few other things are safe for us to use. The catch? Nutrition supplements are not included in that description. Supplements are classified as neither food nor drug, but as a nutrition supplement. You may wonder, how do supplements make it to store shelves if they are not regulated? In October of 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law by President Clinton. Before this act, dietary supplements were required to undergo the same regulatory requirements as other food and drugs. DSHEA amended the Federal Food, Drug, and Cosmetic Act and created a new way of labeling and regulating dietary supplements. Under the terms of this law, a company does not have to provide FDA with the evidence of safety or effectiveness ofa supplement. There are no rules that limit the amount of an ingredient in the product or the serving size. This decision is made by the manufacturer and does not require FDA review or approval. Who has the responsibility for ensuring a dietary supplement is safe? DSHEA says the manufacturer is responsible for the safety of a dietary supplement. The FDA does not review the safety or effectiveness of a nutrition supplement before it hits the market. However, if the FDA proves a product is unsafe, they can have the product removed from the

shelves. Do manufacturers or distributors of dietary supplements have to tell FDA or consumers what evidence they have about their product’s safety or what evidence they have to back up the claims they are making for them? No. Manufacturers and distributors do not have to tell the FDA or consumers what evidence they have about their product’s safety. Manufacturers can make the information they have on safety or benefits of the supplement available to consumers if they wish. Basically, these manufacturers have to do some sort of testing on their supplements, but they do not have to relay the results to the public no matter the results of the testing. Does FDA routinely analyze the content of dietary supplements? Not necessarily. The FDA has limited resources and has to prioritize how they use those resources. Usually the FDA will use those resources first on public health emergencies or products that may have caused harm or illness to the public. The next priority for resources is usually dedicated to products thought to be unsafe or in violation of the law in some way. Their remaining resources can be used for routine monitoring of products pulled from store shelves or collected during inspections. So when it comes to monitoring dietary supplements, routine checking of the product is at the bottom of the priority list and may not have enough funding for the monitoring to be effective. Clearly then, it is important to be cautious when buying dietary supplements. They are not regulated very well and do not have to be proven safe to be put on the shelves in your local drugstore. There also may be different amounts of ingredients in the supplement

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THE DOCTOR IS IN Ten Things to Know About Testicular Cancer

pril is Testicular Cancer Awareness Month. Here are ten things to keep in mind about the most common cancer affecting men aged 18-34. 1. Testicular cancer is actually NOT common, and is usually NOT life-threatening Testicular cancer affects about one in 263 men and the lifetime risk of dying from testicular cancer is about 1 in 5,000.

Will it hurt?

2. Self-exams are crucial to finding testicular cancers early Although there are no generalized screening guidelines, self-exams allow men to find tumors earlier. The best way to perform self exams is in the shower when the testicles are readily palpable. 3. Having an undescended testicle increases risk Men with a history of an undescended testicle should perform examinations regularly for this reason.

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4. A normal physical examination of the testicle does not exclude the possibility of cancer Anytime there is an abnormality of the testes like pain or swelling, physical exam sometimes does not reveal the cause. Commonly, ultrasound is used to examine the interior portion of the testicle that cannot be palpated. 5. After a testicle is removed, the other testicle is not harmed in any way In fact, the contralateral testicle might enlarge somewhat to compensate for the increased need after an orchiectomy.

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8. A family history sometimes plays a role For genetic reasons not fully understood, a minority of testicular cancers have a genetic link. 9. Any man can get testicular cancer at any age Some more notable testicular cancer patients include, John Kruk, Tom Green, Richard Belzer, and the infamous cyclist, Lance Armstrong. 10. With early detection, testicular cancer has an extremely high cure rate of 95 to 99 percent Men diagnosed with testicular cancer should expect to be cured, with either surgery, or a combination of surgery with chemotherapy or radiation. Sometimes, very aggressive surgeries must be performed to eradicate the cancer in the lymph nodes outside of the testicular tissue. Testicular cancer is a disease that when treated early enough has a near 100% cure rate. For this reason alone, if there is any concern, patients should seek out their primary care physician or a urologist for an evaluation. Dedicated to those living with and affected by testicular cancer. + Dr. Darren Mack is a graduate of the Medical College of Georgia and is a urologist with offices in Evans and Aiken. He may be reached at (803) 716-8712; via Twitter: @doctordmack and Instagram: @aikenurology

6. There is only a 2 to 3 percent chance that the other testicle might develop a tumor These cases, though rare, usually mandate removal of the contralateral testicle. 7. Sperm banking is a cost-effective means of

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preserving fertility. For men that must have surgery, chemotherapy, or radiation for testicular cancer, sometimes, fertility is impaired for years, despite a highly effective cancer treatment.

David Russell Photography The information provided in this article

is not a substitute for an evaluation by a licensed health care provider.

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AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — posted by Alan G. Berg, D.O. on April 10 (edited for space)

I STOPPED PRESCRIBING NARCOTICS — and never looked back I was never a big prescriber of narcotics. I grew up “country,” in a tougher world where your parents taught you to accept pain as a part of life. Pain is how you know you’re still alive. They’d tell me, “if you’re hurtin’ you ain’t dead yet.” You fell down; it was going to hurt. You learned not to fall. Twisted your ankle doing something stupid (and it was always while doing something stupid, like jumping off the roof), well, we’ll wait a day or two and see how it goes. Put ice on it, and next time think harder before you jump off the roof. Just because everyone else was doing it, yada yada yada. So most of the time it never occurred to me to prescribe narcotics, except for crippling, incapacitating pain. Cancer, broken bones, post-surgical pain, or severe arthritis. After thirty years in practice, I knew I was an expert at figuring out who really needed the medication, and who was just scamming me. When a new patient wanted narcotics, you know how it goes. You get the history of some terrible trauma/ongoing problem/ lost medications/etc. Then you ask, what were you taking? The patient can’t remember. It was “a round white pill” for pain. I’d respond, “Ibuprofen!” “No doc, that wasn’t it. It was depo or hypo something.” “Ahh,” I’d reply knowingly, “It was Depo-Medrol.” “I wish I could remember. It was hydro-something.” Again, I would reply with a knowing smile: “Hydrochlorothiazide!” Frustrated, the patient would decide to end the game and suddenly recall that it was hydrocodone. Or Dilaudid, or Percocet, or any number of high-powered narcotics. The game now over, I would deny any prescription. I knew the “druggies.” I could pick them out of a crowd. They were so obvious. And then Ms. Bessie came to see me. She was 71 years old. Sweet, conversational, always on time, and followed all my instructions. She was the perfect patient. She had bad arthritis and significant problems with her lumbar spine. Studies had confirmed this. Normal arthritis meds just didn’t allow her to be up and active, so I had been treating her with hydrocodone. One or two per day if she really needed it. Every 90 days she would be back for a refill. We had been taught to take care of chronic pain. I went to all of the lectures. I knew how to take care of this type of patient. We assessed her for depression, and she always filled out a pain scale. And then new recommendations came out recommending a drug screen. And so we did that too. She told me she was taking the medication as prescribed, but her drug screen was negative for codeine. It was, however, positive for marijuana. This sweet, 71-year-old grandma was selling her codeine and buying marijuana. I was shocked. Ms. Bessie was not a druggie, but she admitted to the marijuana use, and told me that sometimes she would also mix a little crack or heroin with the marijuana cigarette. And that was the day my office stopped prescribing narcotics. Just like that, we stopped contributing to the narcotics problem in this country. We didn’t suffer a loss of patients. No loss of revenue. If anything we got busier. All of the problems that used to occur with patients and their narcotics magically disappeared. My staff was thrilled with the change. In short, life actually became easier. I still treat pain, but with NSAIDs, exercise, and physical therapy. I let the oncologist, the orthopedist or the surgeon treat those I can’t help. After 30 years, I learned that I can’t recognize who has a drug problem. Ms. Bessie never came back to the office. And I never looked back. +

And then Ms Bessie came in.

From the 2006 back cover of this book, originally published in 1863:

Before her wider fame as the author of Little Women, Louisa May Alcott achieved recognition for her accounts of her work as a volunteer nurse in an army hospital. Written during the winter of 1862–63, her lively dispatches appeared in the newspaper Commonwealth, where they were eagerly read by soldiers’ friends and families. Then, as now, these chronicles revealed the desperate realities of battlefield medicine as well as the tentative first steps of women in military service. Writing under a pseudonym, Alcott recounted the vicissitudes of her two-day journey from her home in Concord, Massachusetts, to Washington, D.C. A fiery baptism in the practice of nursing awaited her at Washington Hospital, were she arrived immediately after the slaughter of the Army of the Potomac at the battle of Fredericksburg. Alcott’s rapidly paced prose graphically depicts the facts of

hospital life, deftly balancing pathos with gentle humor. A vivid and truthful portrait of an often overlooked aspect of the Civil War, this book remains among the most illuminating reports of the era’s medical practices as well as a moving testimonial to the war’s human cost. AMAZON READER REVIEWS The Civil War has many sides. From Lousia’s viewpoint it was a personal tragedy for her and the men she cared for. A must read for anyone.

Fresh and compelling, this novelette was drawn from Louisa May Alcott’s short stint as a hospital nurse during the Civil War. It’s delivered with a strong dose of Victorian morality and Victorian prose style, but Alcott’s experiences are vividly recorded. So is her sympathy for the wounded and with the African Americans she meets. This is the Civil War as seen+through a distinctly New England view, strongly abolitionist and strongly moralistic, but also practical, self-reliant, and positive. I only wish there was more about the hospital. One thing that jumped out at me was the central character’s familiarity with death; she is only thirty, but she says she has already been called to several deathbeds. The Victorians may have been repressed, but they knew a lot more about the facts of life than we do. + Civil War Hospital Sketches by Louisa May Alcott; 80 pages, published in February 2006 by Dover Books. Originally published in August, 1863

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AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS

THE MYSTERY WORD

Are you a hip doctor?

by Dan Pearson

But I thought you said you’re a hip doctor.

Yes I am. How I’d like to be evaluated I can give you can I help you? for a joint replacement a referral. I’m a procedure. podiatrist.

Perhaps I should have said I’m fly.

The Mystery Word for this issue: LIECROA

EXAMINER CROSSWORD

PUZZLE

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QUOTATION PUZZLE

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

— Confucius

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.

X A M I N E R

9 3

5 1 4

9 6

8 1

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

1 R 1

U 1 2 3 4 5

1 2 3 4 5 6 7 8 ’

9 10 11

L 1 2 3 4

1 2 3 4

M 1 2 3 4

1 2 3 1 2

P 1 2

1.CUTTTTRINGIL 2.NEETHHUIPIOO 3.SKEMAARTTS 4.TEEELOH 5.MISI 6.ZNN 7.GIA 8.AT 9.I 10.O 11.N

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

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 1

ACROSS 1. South American Indian 5. Sounds of contentment 9. Word with stone or football 13. Friday intro sometimes 15. Curtain material? 16. Sexual assault crime 17. Finely ground grain 18. Laker of note 19. Harbinger 20. Toxic evergreen 21. “I hear they are an ____” 23. A matter of fact lead-in 25. Last word in a Sendak title 26. _____-Bifida 27. Clinton’s successor at State 29. George of Augusta’s WJBF by Daniel R. Pearson © 2016 All rights reserved. Built in part with software from www.crauswords.com 32. Group of two 33. Loud unpleasant sound daughter 34. _____ lab 34. Dove call 73. Desire 35. Exclamation of surprise 36. Dwight’s wife 37. Groan 40. A failure DOWN 38. Doing nothing 41. School at AU (abbrev) 1. Uncertain 39. Not difficult 42. Room within a harem 2. West ____ Virus 44. Ernie of the PGA 43. Name of famous twins 3. Type of bar? 45. The Secret of _____ 46. Lower digit 4. Acronym before AU (animated film of 1982) 47. Jennifer of “Flashdance” 5. County next to Richmond 47. Grand hotel of yore in 49. In fantasy fiction, a corpse 6. Fragrance Augusta 51. Mitt of note 7. ____-nob 48. Ambulance worker 52. Gadget 8. Furtive 50. Looped 54. Swoon 9. To follower? 51. Tease 56. As needed, medically 10. ______ Building (downtown) 52. Jacket color? 57. Hello there 11. Mimicry 53. Bay 58. Title of respect for God 12. Mr. Sarazen 54. Legendary NFL quarterback 59. It’s bad (abbrev.) 14. Off the wall hit? 55. White poplar 62. Long fish 22. Stroke abbreviation 56. Medical prefix 64. Davis III 24. Jean joint 59. Nancy Lopez org. 66. Louvre pyramid architect 26. Distress signal 60. College department head 68. Walter, Army surgeon 28. Dietary abbreviation 61. Cheerful tune 69. Tiger’s dad 29. Medical prefix 63. “Star Wars” letters 70. Cinemas 30. Name of a downtown Bar 65. Scull power 71. Former Peru monetary 31. Patients at CHOG 67. Gull or cat cry Solution p. 14 72. Mariel (Hemingway) 32. Medicinal quantity

WORDS NUMBER

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

APRIL 15, 2016

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

he substitute teacher was filling in on the day of a big test. He passed out the test to everyone in the science class and gave all the usual warnings: no talking, eyes on your own paper, etc. A few minutes into the test he noticed a student flipping a coin, making a mark on the test paper, flipping it again then marking another answer. He walked to the student’s desk and asked what he’s doing. “I didn’t really study, so this seemed like a good way to choose the answers,” said the student. The sub didn’t think it was cheating or against the rules, so he let him continue. As the end of the test period approached,mopi the teacher noticed the student flipping his coin frantically over and over. The teacher again walked to the student’s desk. “Now what are you doing?” “I’m checking my answers, man.” What do you get when you combine a joke with a rhetorical question? Q. Why did the chicken move her nest across the street? A. She had Restless Egg Syndrome.

There once was a guy from Japan Whose poetry no one could stand. When friends told him so, He said, “Yes, I know... It’s because I try to fit as many words into the last line as I possibly can.” Q: Who is bigger? Mrs. Bigger or Mrs. Bigger’s new baby boy? A: Mrs. Bigger’s baby: he is just a little Bigger. A guy walked into a lawyers office and said, “I need some legal advice. How much do you charge?” “$50 for 3 questions,“ the lawyer replied. “That’s kind of high isnt it?” “Not really,” said the lawyer. “What’s your third question?” What’s the difference between a home remodeling contractor and a common criminal? Criminals are more likely to return to the scene of the crime.

SUPPLEMENTS… from page 9 than what is stated on the label. Most of the general population does not need to take a dietary supplements. There are a few groups of people that should consider taking a supplement under specific circumstances: • Infants and children Vitamin D might be a concern among infants, children, and young adults. Some infants may not get enough vitamin D from breast milk or from formula and will need additional vitamin D. • Women of childbearing age: Women who are at the age where they could become pregnant need to obtain enough folic acid. Folic acid helps reduce the risk of some major birth defects and can be found in fortified foods, such as breads and cereals, leafy green vegetables, or as a supplement. Other populations that might need a supplement include pregnant or breastfeeding women, elderly, menstruating women, those with food restrictions, or those with diseases that may lead to deficiencies. It is important to always consult a doctor or a dietitian before taking a nutrition supplement. They can provide valuable information on supplements and which ones are reliable supplements to take to meet your needs. +

I DON’T ALWAYS READ THE MEDICAL EXAMINER BLOG

“Knock knock.” Who’s there? “Cows go.” Cows go who? “No they don’t. Cows go moo.” Did you hear the hillbilly from Arkansas who was recruited by ISIS? He ended up in the hospital after trying to blow up a school bus. He burned his lips on the tailpipe. +

Why subscribe to the Medical Examiner? Because no one should have to make a trip to the doctor or the hospital just to read Augusta’s Most Salubrious Newspaper.

+ +

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

STATE

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Choose ____ six months for $20; or ____ one year for $36. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BUT WHEN I... WAIT A SECOND. YES I DO! www.AugustaRx.com/news

STAY HEALTHY MY FRIENDS. We

your

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APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

Looking for Likes in all the right places.

ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble wrote a long-time column in this paper entitled The Patient’s Perspective reincarnated in this new format. Feel free to contact her at marciaribble@hotmail.com by Marcia Ribble

Please Like us at facebook.com/AugustaRx

One road to better health is to recognize missing pieces in one’s life. These missing pieces take many forms, from the most abstract to the most touchable and real. Some fall under both headings at the same time. One of those material/immaterial realities is the night sky—a thing of immense and incalculable beauty. The other night at about

THE MYSTERY SOLVED The Mystery Word in our last issue was: PHYSICAL

...very cleverly hidden (in the wrap) in the p. 9 ad for ROLY POLY Congratulations to TONYA HIERS, who scores the current contents of the Medical Examiner goody bag. Sweet! Want to find your name here next issue? The new Mystery Word is on page 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 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. 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

t ha n Less

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far too numerous to count, and directly connected to the magic of the night sky. The realization that they are missing even on a clear, cloudless night, made me realize that the material/immateriality of stars had disappeared from my life without me noticing they were missing, like the haunting echo of a dream almost forgotten. All of a sudden I realized why online pictures and

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4 a.m, when I was going out to bring in the newspaper before it started to rain, I noticed a very buttery moon, like a big sugar cookie with a bite out of it. Then I noticed several very bright stars scattered hither and yon and totally disconnected from one another. Suddenly, I asked myself where all the other stars were, the ones I remember from childhood, the Big Dipper, the Milky Way, stars

F. E. GILLIARD, MD FAMILY MEDICINE Acute & Chronic Illnesses Occupational Medicine PROMPT APPOINTMENTS 706-760-7607

videos of galaxies far away touch me so deeply now. Those millions of missing stars are an absent part of who I am, of who I was as a curious child. That knowledge helps me to understand how to create a fuller life for myself, a more vibrant, healthier life. I know that to find more stars, more constellations, I simply need to take myself out of the city and away from the light pollution making those stars invisible. I know places where it is still possible to see the night sky more completely. Up in Michigan, in the Upper Peninsula, the night sky is vast and bright over Lake Superior. From the lakeshore the stars are easily seen shimmering overhead. I’m not too likely I’ll drive all the way up there by myself, but who knows when a travel offer might be extended to me, and it’s also likely that I’d be happy to go and see the stars against that deep black infinity. A nice way to reach toward better health on a most pleasant road. +

THE PUZZLE SOLVED

MISCELLANEOUS ELIPITICAL IN EXCELLENT CONDITION Asking $75.00. Please call 706-3064666 SUNSET MEMORIAL GARDENS Opening and closing at Sunset Mem. Gardens in Graniteville. Sale: $760 (Value: $1520+) Call 706-736-0596 KING-SIZED bed frame with rails, dark wood, some surface scratches but overall very good condition. $90 Call 706-3730193 ANTIQUE maple dinette set with buffet corner cabinet table with pull-out leaves. Four chairs with two captain’s chairs. Excellent condition. $300. Double bed early 1930s with mattress spring coverlet shams $150. Call (706) 860-2170 WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer. BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net

SEE PAGE 12

QUOTATION QUOTATION PUZZLE SOLUTION: “Life is really simple but we insist on making it complicated.” — Confucius

The Sudoku Solution

CEMETERY SPACES (2) Sunset Memorial Gardens, Graniteville SC adjacent to lighted military flagstaff, includes granite bench with urn space, installation and inscription. All $4700 ($8600 value). Spaces only: $2700. Call (803) 2953033 FISHING CLUB wants more grey-haired members. Meet 2nd Thurs of month at Harbor Inn Restaurant, 12 noon. “Adventure Before Dementia” Info: (706) 736-8753 or (706) 829-1729 PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-8291729

WORDS BY NUMBER “Nothing cures insomnia like the realization that it’s time to get up.” — Author unknown

APRIL 15, 2016

15 +

AUGUSTA MEDiCAL EXAMINER

THE

Money Doctor HEALTH SAVINGS ACCOUNTS Health Savings Accounts (HSAs) are becoming a common term in many American households today. An annual census conducted by America’s Health Insurance Plans (AHIP) found a 22% increase in the number of consumers with HSAs from 2014 to 2015. In 2015, 19.7 million people were enrolled in an HSA. This means almost 17% of all American households now have an HSA. To better understand why more and more people are choosing to use these accounts,

it is helpful to understand how they work and the rules they must follow. To qualify for an HSA account you must have a high deductible health plan (HDHP). You also cannot be enrolled in Medicare, be claimed as a dependent on someone else’s tax return, or have other health coverage unless permitted by IRS rules. Given the complexity of the rules, we recommended you confirm with your CPA that you are eligible to use an HSA. If you qualify to use an HSA account, it is important to

understand the tax benefits of using the account. This account is the only account available today that offers a “triple” tax advantage which is one of the main reasons these accounts have become so popular. You get an income tax deduction when you contribute funds, the earnings grow tax free, and the withdrawals are tax free if you withdraw funds for “qualified” medical expenses. What are “qualified” medical expenses? These are medical expenses that generally qualify for the medical and dental expense deduction based on IRS rules for Schedule A (itemized deductions) on your personal tax return. The list is extensive and worth looking up. A few of the larger items are long-term care insurance premiums (subject to limits based on age) and Medicare premiums. A few smaller

the account will be treated as items that surprise people are your spouse’s HSA after you first aid kits, hot/cold packs, pass away which will preserve sunscreen (SPF-15 or higher), the tax benefits. If your thermometers, and prenatal beneficiary is a non-spouse, vitamins The most common the account becomes taxable to are copayments, coinsurance, the beneficiary in the year you and deductibles for health, pass away. If you do not name dental, or vision. Make sure a beneficiary, the account value you save your receipts to will be included in your gross document these expenses. income for the year you pass What happens if you away. withdraw funds for “nonOnce you understand the tax qualified” expenses? It depends on how old you are. If benefits and rules for taking funds out of the account, you are under age 65, you will you will be in a much better be subject to income tax and a 20% tax penalty. If you are over position to decide how much to put in the account. The age 65, you will no longer be IRS does have contribution subject to the 20% penalty but limits. For 2016 families can will still need to pay income contribute up to $6,750, and taxes. What happens to the funds if individuals can contribute up to $3,350. There are catch-up you pass away? You can name a beneficiary just like you can contributions for age 55 an for life insurance or retirement older and specific calculations accounts. If you Please see MONEY DOCTOR page 16 name your spouse,

PROFESSIONAL DIRECTORY DERMATOLOGY

ALLERGY

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

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

COUNSELING

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

DIABETES WOUND CARE

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

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

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 706-733-3373 www.GaDerm.com

Aiyan Diabetes Center “A Comprehensive Diabetes Clinic” Dr. Janaki Nadarajah, DPM 706-868-0319 462 Furys Ferry Road

DRUG REHAB Floss ‘em or lose ‘em!

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

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

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

FAMILY MEDICINE

SENIOR LIVING

F. E. Gilliard MD, Family Medicine 4244 Washington Road Evans, GA 30809 706-760-7607 Industrial Medicine • Prompt appts.

Augusta Gardens Senior Living Community 3725 Wheeler Road Augusta 30909 SENIOR LIVING COMMUNITY 706-868-6500 www.augustagardenscommunity.com

Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

Cornerstone Compassion Center 420 Warren Road Augusta 30907 706-228-5359 or 706-394-6518 Assisted Living • Personal Care

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

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

PSYCHIATRY Psych Consultants 2820 Hillcreek Dr Augusta 30909 (706) 410-1202 www.psych-consultants.com

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

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

WEIGHT LOSS Medical Weight & Wellness Specialists of Augusta Maycie Elchoufi, MD 108 SRP Drive, Suite B Evans 30809 • 706-829-9906 YourWeightLossDoctor.com

+ 16

MONEY DOCTOR… from page 15

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This could be y you. The Medical Examiner can be delivered right to your door! Use the handy form on page 13

APRIL 15, 2016

AUGUSTA MEDiCAL EXAMINER

for people that start or end a HDHP in the middle of a year. It is best to confirm with a CPA the amount you can contribute each year. There are many other planning items to consider as certain employers offer employees the ability to make contributions through payroll deductions which can provide additional tax benefits if part of a cafeteria plan. Most HSAs now offer investment options as well. There is a lot of value to having a good fee-only advisor

working with you as you decide if you should contribute, how to contribute, how to invest, and what withdrawal strategy to use given your current and future tax situation. + by Clayton Quamme, a Certified Financial Planner (CFP®) with Preston & Cleveland Wealth Management, LLC (www. preston-cleveland.com). Preston & Cleveland is a fee-only financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

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