Apr27 18 by Daniel Pearson

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APRIL 27, 2018

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MONEY CAN BUY HAPPINESS Money can spawn untold misery too, but it can definitely buy happiness. The key is how it’s spent. Studies have revealed a secret about money: using it to buy stuff is not satisfying. That is not widely known because people who are loaded with cash — and all the material things they buy with it — are not eager to admit that all their expensive toys can leave them feeling shallow, empty and lonely. On the other hand, people in desperate poverty are often no strangers to emptiness and loneliness either. But researchers at Purdue University and the University of Virginia analyzed data from 164 countries, crossreferencing the earnings and life satisfaction of 1.7 million people to see if there was a correlation. As it turns out,

fabulous wealth and profound happiness are not exactly nextdoor neighbors. In fact, the study found the ideal income for personal satisfaction is less than $100,000 a year, and the optimal income for what the study called “emotional wellbeing” is even lower: $60,000 to $75,000. If we dismiss visions of bliss from winning the lottery from our dreams, what can our modest incomes do for us? A segment on last week’s CBS Sunday Morning offered one clue, reporting on an experiment by a Harvard Business School professor. She handed out money to two groups of people. One group was told to use the money to buy themselves something, the other group told to use it to pay someone to do a chore they despise, like cutting the grass or doing laundry.

The second group, those who in effect bought themselves time, reported more happiness than those who bought things. The Harvard experiment underscores a basic principle of happiness: doing is better than having. In other words, spending money on something that creates an experience or builds memories tops buying stuff. Taking art lessons, for example, beats buying a painting. The ancient adage that there is more happiness in giving than receiving can be put into practice by anyone. One author wrote of an acquaintance who abandoned the standard 20% tip at restaurants in favor of a 50% tip. It makes him feel good. Maybe your choice would be different: setting up even a $5 monthly donation to a charity or cause can, in the words of one study, “predict greater happiness.” +

You’ve got pareidolia by guest columnist Justin White Don’t worry. Everyone else has it too. How old were you when you fi rst looked up at the sky and noticed clouds forming familiar shapes: a cat or dog, a rabbit or sailboat? How could that be? Those things didn’t belong way up there. We’ve all heard the stories, maybe even seen them ourselves. A chicken nugget shaped like George Washington. The face of Jesus burned on a piece of toast. Some would say these things are the product of mere chance Please see PAREIDOLIA page 2

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APRIL 27, 2018

PAREIDOLIA… from page 1 or an overactive imagination. Others say it’s the hand of God. Whatever the cause, if you’ve seen the man in the moon, you’ve experienced this phenomenon. It’s called pareidolia (pair-eye-DOHlee-uh) and it’s quite common. Pareidolia often has religious overtones. In Finland a study found that religious people or people who strongly believe in the supernatural are more likely to see faces in objects and landscapes, and what they see may be connected to their faith. For example, in December 1996 a large stain was noticed on the windows of an office in Clearwater, Florida, which bore an uncanny resemblance to the Virgin Mary. Soon after the event was reported by news media, nearly 500,000 people showed up to witness the “miracle.” Eventually the Clearwater pilgrims reach into the millions. Was the source of this alleged miracle God, or something more mundane? To understand pareidolia we need to understand where it comes from. Pareidolia is a type of apophenia, “the tendency to perceive connections and meanings between unrelated things” The word pareidolia derives from the Greek words para which means “beside, alongside, instead [of],” and the word eidlon which means “image, form, shape.” At one time pareidolia was considered to be caused by psychosis, but is now recognized as normal and common. In one Japanese study, however, 166 undergraduates completed questionnaires assessing their mood and personality. Then the students were asked to look at patterns of random dots and describe what they saw. The students who scored highest in negative moods and neuroticism were most likely to see patterns suggesting faces in the ink dots, with women more likely to see faces than men were. Even so, nearly everyone has experienced pareidolia. The neurological foundation for pareidolia rests in an area of the brain called the fusiform gyrus, which appears to be solely dedicated to facial recognition. In fact, psychologists and psychiatrists use Rorschach inkblot tests without any specific image in a manner known as “directed pareidolia” to gain insight into a person’s mental state. Pareidolia is nothing new. Leonardo da Vinci, who lived from 1452 to 1519, wrote about it as an artistic device: “If you look at any walls spotted with various stains or with a mixture of different kinds of stones, if you are about to invent some scene you will be able to see in it a resemblance to various different landscapes adorned with mountains, rivers, rocks, trees, plains, wide valleys, and various groups of hills...and strange expressions of faces.” Pareidolia can be the explanation for many things: sightings of UFOs, Elvis, or even the Loch Ness Monster, not to mention many things commonly thought to originate in the realm of the supernatural. Pareidolia is what Dr. Kang Lee, a neuroscientist at the University of Toronto, calls “a normal neuroperceptual phenomenon.” At some point in our lives we will all experience this phenomenon, just like Leonardo da Vinci. +

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APRIL 27, 2018

PROFILES IN MEDICINE presented by Queensborough National Bank & Trust Co.

RECAPTURING YOUTH The man pictured here hold a unique place in Augusta’s rich medical history. His story is one of heartbreak, disappointment, determination, and innovation, but some might disagree. Some might say it’s simply a love story. The focus of our story, Geddings Osbon, achieved his accomplishments without benefit of a medical degree — or a high school diploma, for that matter — yet despite that he helped improve the quality of life for untold thousands of patients around the nation and the world. If you have lived in Augusta for at least a few decades, his name might be familiar to you: his family owned and operated Osbon Tire on Broad Street in downtown Augusta for many years. And you might also remember the family focus changing in the late 1970s and early 1980s from Osbon Tire to Osbon Medical. The chasm isn’t as large as it might seem at first glance. In 1960, Osbon (who was born in 1901) sought the advice of his doctor for help with erectile dysfuntion, a common side effect of many medical conditions, including diabetes, heart disease, atherosclerosis, prostate cancer,

and medication side effects. There really weren’t a lot of treatment options at that time, decades before the emergence of drugs like Viagra and Cialis, and it was a taboo topic in society to begin with. Osbon’s doctor told him to give up on marital intimacy. Those days were past. “Appreciate the good years,” he said. Savor the memories. Undeterred, Osbon borrowed processes used in the tire business to develop a vacuum erection device (VED), and in 1974 he founded the Youth Equivalent Company to market his “Youth Equivalent Device.” To appreciate the groundbreaking nature of his development, a 2013 article in Reviews in Urology made the point that, although the fi rst vacuum device for ED was developed in 1874, the last clinical application of it or minor improvement upon it before Geddings Osbon came along happened in 1917. That doesn’t mean 1974 marked the beginning of smooth sailing for Osbon. As the Reviews article notes, the invention was greeted with everything from criticism and scorn to charges of disseminating Please see PROFILES page 16

Editor’s note: this is a monthly series presented by Queensborough National Bank & Trust and the Medical Examiner profiling exceptional physicians and others of note in Augusta’s long and rich medical history.

W E A LT H M A N A G E M E N T Our experienced, financial team focuses on you, our client, to ensure that all aspects of your financial affairs are being monitored and managed appropriately in accordance with your life goals. We welcome the opportunity to serve. Call today for an appointment.

What is the noise when someone cracks their knuckles? Is it harmful? The standard wisdom — folklore, actually – is that this practice damages joints and leads to arthritis, a belief that is not backed up by clinical evidence or medical studies. A previous Medical Examiner article on this topic referenced one noteworthy study, a 60-year examination of the topic by physician Donald Unger. Discovering a dearth of studies on the topic, Dr. Unger proceeded to crack his own knuckles every day for more than sixty years and document the results. The right hand was never cracked as the control hand; the left hand was the test hand which he cracked the fingers of every day. While he evaluated his hands throughout the duration of the study, after more than six decades he was confident in his conclusion that no adverse effects such as swelling or arthritis ever manifested themselves in either hand. Of course, one-person study, even one lasting more than half a century, is statistically insignificant, but more traditional medical studies, such as one reported in the Journal of the American Board of Family Medicine in 2011, have reached the same conclusion. That one, a 5-year study of 215 people aged 50 to 89, measured their knuckle cracking during the study and in their lifelong past prior to the study and found no connection between cracking and osteoarthritis, and no statistical difference between crackers and non-crackers. It isn’t just finger joints that can be cracked. Some people crack their neck, back, jaw, hips, wrist, and other joints. Some people pay to have others (chiropractors) do the cracking for them. Therein lies a clue to the sound, actually. The process of cracking a joint (in over-simplified terms), enlarges the space occupied by synovial fluid between joints, reducing the pressure in the space. That, in turn, allows gases in the synovial fluid to escape into the joint space, resulting in the popping sound. That same process also slightly enlarges the joint, temporarily resulting in increased range of motion. That feels good. +

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APRIL 27, 2018

AUGUSTAMEDICALEXAMiNER

#65 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

hances are very good that you’ve heard of the gentleman pictured above despite the fact that he died more than a century ago. Let’s introduce him. He is Sydney Ringer and his claim to fame is the IV solution known as Ringer’s Lactate (or Lactated Ringers). A noted physician and outstanding bedside teacher at University College Hospital, London, Ringer authored the go-to medical reference of his day, Ringer’s Handbook of Therapeutics, a thoroughly practical and concise guide that replaced a massive and weighty tome written by a predecessor. Handbook went through thirteen reprints between 1869 and 1897. Ringer was a devoted investigator who was known to spent every spare moment possible in the laboratory when he wasn’t making rounds or lectures. His research is the basis for his enduring fame. In the 1860s, another medical researcher, Carl Ludwig of Germany, had been studying “isolated” organs, that is, organs that had been removed from the body. These “extravital” or in vitro investigations were typically performed using frog hearts. Learning of Ludwig’s experiments through medical journals, Ringer attempted to duplicate them in London, suspending frog hearts in various solutions and observing how they were affected. His first experiments, in 1885, used a solution of 0.75% sodium chloride (common salt). By experimenting with a series of various additives in varying concentrations, Ringer discovered that trace amounts of calcium in the perfusing solution are optimal (a discovery made possible when Ringer discovered that instead of using distilled water, his lab assistant was using calcium-containing London tap water). Ringer also discovered that small amounts of added potassium further enhance the viability of organs in suspension. Decades before, intravenous fluids had come into wide use during cholera outbreaks to treat the dehydrating effects of the disease. A simple solution of water and salt — “normal saline” — was the de facto IV fluid of the day. Its name comes from an erroneous 1883 study which concluded that the concentration of salt in human blood was 0.9 percent. Any equal concentration would therefore be of “normal” composition. Normal saline drips into human veins to the tune of more than 200 million liters per year in the U.S. alone. As pointed out about a month ago in the New England Journal of Medicine, there isn’t much that’s normal about normal saline, and for all its popularity there is very little clinical evidence in support of its use — until recently. A study published in 2012 compared patients receiving normal saline versus lactated Ringer’s and found that mortality was 2.7 percent higher in the normal saline group, and complications were also more common. A 2013 study found increased mortality and longer hospital stays among post-op patients receiving normal saline compared to Ringer’s. Given the tens of millions of patients involved every year, researchers say shifting the default fluid from normal saline to a balanced fluid like Ringer’s holds the potential to be a huge (and very inexpensive) game-changer. +

This past week I tried to figure out if it would be cheaper for me to continue to purchase my medications from a local pharmacy or get them from Humana’s mail order pharmacy. I never reached a reasonable conclusion because I was so shocked by the costs: I’m already in the donut hole so early in the year. Why? Because I’m a diabetic and my diabetic medicines are incredibly expensive. The rest of my meds are generic and not very expensive at all. Who or what is responsible for this issue? The big pharmaceutical companies which are increasing drug prices, especially for lifesaving medications, ones patients must take to survive. Not so many years ago my insulin cost $15 for a month’s supply. Today the same quantity of insulin cost nearly $900. Based on the costs of my diabetic medicines in 2010 when I retired, I expected my Social Security and my retirement account to last until I was at least 80 years old. My costs now for those meds are over $5,000 a year, and that does not account for the amounts for doctor’s visits. In 2016 my deductible medical expenses were over $12,000, more than half of my Social Security, forcing me to take out more in my retirement account. This has happened every year since I retired, with the costs increasing every year. I read an article about the cost of a new drug to cure Hepatitis C. In the United States it is now around $84,000 for a twelve week treatment procedure, an increase from the $76,000 it was only a year ago. However

shocking those figures are, they stand out even more when we realize that people in India pay $900 for the same medical cure. With prescription costs so exorbitant in the United States, at some point my retirement account will run dry, and I have grave concerns about my ability to survive after that. Also culpable is AARP, which agreed to the donut hole which ate up most of my retirement account. When I retired in 2010, it never occurred to me that my medical expenses would increase so rapidly, or that food costs would soar at the same time. I thought that I could easily live on my social security and my retirement for as many as 16 to 20 years, which is what the social security work sheet suggested would work. I am now disabused of that notion. This tale is not designed to elicit sympathy, but to serve as a warning for folks who have not yet retired. The last five years before retirement, my income had dramatically increased, so I maintained the same standard of living and saved the rest with some great advice from my workplace financial analyst. He explained that I could save a significant amount each year and place it in my TIAA account without penalty. I did that. I also paid off my car which was fairly new, so I wouldn’t have to make a car payment. I bought enough clothes to last for a long time. All-in-all those are some of the tactics to make retirement easier. The last piece of advice I’d have is to join a group working to lower essential medical costs to what a moderate income can handle. +

MYTH OF THE MONTH Bacteria is bad news If we could live in a completely bacteriafree world and eliminate all bacteria from our bodies, we wouldn’t recognize the altered state of the world — and then we would very quickly die. Bacteria is essential for life. The best guess molecular biologists can give us is that there are 10 times more bacterial cells in the our bodies than human cells. (Bacterial cells are significantly smaller than human cells.) It’s not easy to count human cells — they’re very tiny and one interruption can make you forget and have to start over — but the estimates range from 15 trillion cells up to

70 trillion. Smithsonian magazine says 37 trillion or so is a good compromise. By that estimate, then, the number of bacterial cells in the body would add up to 370 trillion. And we think washing our hands with antibacterial soap is important. The digestive and immune systems could not function without bacteria. Not that people haven’t tried to find out: taking antibiotics kills good and bad microbes indiscriminately, which can disrupt the balance of our intestinal flora, causing diarrhea and upset stomach. Bacteria can be bad news. But not always. +

APRIL 27, 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

MEDICALEXAMINER

TM T

APRIL 27, 2018

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had a great day yesterday. I saw three patients who had recent diagnoses of cancer. Yeah, those two statements seem to contradict. They don’t. Each person I saw gave me a clear view of how my practice is making a difference. The first patient was a guy who is pretty far along in the treatment of his cancer. I sent him to a specialist about a year ago and he was diagnosed with a serious but treatable form of cancer. While he’s happy with the overall outcome of his disease, he has a complication called lymphedema which is making him very uncomfortable. When he asked his specialists about this, they told him that nothing could be done. He expressed his frustration at the fact, so I did what every red-blooded person does these days: I Googled his problem. I immediately found a number of useful websites which talked about exactly the problem he was facing, one written by a physician who had this form of cancer. I discovered that the pessimism of his specialists was unfounded. In fact, I found out that there were important steps to take to prevent this problem from becoming permanent. “Why didn’t my other doctors tell me this?” he asked. I shrugged my shoulders. “I guess they didn’t have the time to do it.” He nodded in agreement, acknowledging the reality the big advantage he

has in my office: access to me. The second patient, coincidentally, had the same kind of cancer. In fact, it was my experience with the first patient just a few months before this second patient’s presentation that allowed me to quickly diagnose and treat his problem. He had a peaceful expression as he sat across

It’s one of the hardest things about being a doctor. me in my office. “I just keep thinking about how many things worked out to get me diagnosed and treated. I noticed the lump and thought to myself: ‘I should make an appointment with Dr. Rob,’ and then you saw me the next day. Within a week I was diagnosed with cancer and things took off from there.” I reminded him that before he got treatment we had a discussion about “alternative” treatments that were suggested by a family member. “You remember when I told you about how Steve Jobs’ death was probably due to the time he spent going after alternative treatments before getting standard medical care?” He nodded. “Yeah, and I’m real glad I listened to you. I just wonder what would’ve happened if you weren’t in this office. I usually hate going to the doctor and put

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stuff off. I wonder if things would’ve turned out like they did.” The third patient was a younger woman who was recently diagnosed with a very serious cancer. I saw her and her husband for the fi rst time since the diagnosis. After tearful hugs and warm greetings, I asked how they were doing. She had presented with symptoms not generally suggestive of cancer which persisted and grew worse. After going after the most likely causes, her husband asked me to do more to diagnose and treat her. We immediately ordered the test that made the diagnosis. “She got mad at me for doing that,” he said with a smile, “but I’m sure glad I did.” She grudgingly agreed that he was right. “I would have waited much longer before doing that test. I’d probably have been nearly dead before making the diagnosis.” One of the worst parts of being a doctor is to diagnose people with cancer. At the same time, however, there is a sense of this being the highest honor paid to me as a person: I am the person who is there to help when the stakes are highest and the future looks darkest. I have the opportunity to be the right person at the right place at the right time. Bad stuff happens, and I will likely face many more sad yet meaningful days in the future where I am called on to stand beside people on the hardest days of their lives. +

AUGUSTAMEDICALEXAMiNER

APRIL 27, 2018

PART TWO 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 Coinsurance is the portion of covered medical services you are responsible for after meeting deductibles, usually paid as a percentage of the total cost. Coordination of benefits: A way to determine which health plan pays a medical claim fi rst when you’re covered by more than one insurance policy. Copayment is a set dollar amount you’re required to pay for medical services or supplies, such as $10 for a prescription or doctor’s visit.

Coverage gap: Most Medicare Prescription Drug plans have a gap in coverage, which is also called the “donut hole.” It’s a temporary limit on what your drug plan will cover that begins after you and your plan have spent a certain amount on covered drugs. Once you reach the coverage gap, you qualify for savings on both brand-name and generic drugs.

health care services before your Medicare plan begins to pay and help cover your costs.

Creditable prescription drug coverage: A health plan with prescription drug coverage that is likely to pay at least as much as Medicare’s standard prescription drug coverage is considered creditable. To avoid paying a penalty for signing up late for a Part D drug plan, you must have alternate insurance that is considered creditable when you become eligible for Medicare.

Extra Help is a Medicare program to help people with limited income and resources pay for the premiums, deductibles and coinsurance associated with their Medicare prescription drug plan.

Deductible refers to the amount you must pay for

Donut Hole is an unofficial term for the difference in Medicare prescription drug coverage between what a beneficiary has to pay for after reaching the initial coverage limit and the amount the government will pay for “catastrophic” drug coverage.

Formulary means the list of prescription medications covered by your Part D prescription drug plan or another insurance policy with drug benefits, like Medicare Advantage Prescription Drug plan.

General Enrollment Period: People who don’t sign up for Medicare Part A and/or Part B when they are fi rst eligible can do so during the General Enrollment Period. GEP runs each year between Jan. 1 and March 31. Medicare Savings Program helps people with limited income and assets pay some or all of their Medicare premiums, deductibles and coinsurance. Medicare Summary Notice: MSNs are notices you receive after your doctor or medical supply vendor submits a claim to Medicare for services you received. The Medicare Summary Notice explains what your health care provider or supplier billed Medicare, the Medicareapproved amount, how much Medicare paid and what you must pay.

Network Pharmacies: Medicare drug plans contract with pharmacies that agree to provide members with services and supplies at a discounted price. Some Medicare plans will not cover your medicines unless you get them fi lled at a participating network pharmacy. Preferred pharmacy: These are part of a Medicare drug plan’s network. Your out-ofpocket costs for prescription drugs may be lower if you get them fi lled at a preferred pharmacy. Mail-order programs: Some prescription drug plans and Medicare Advantage Prescription Drug plans offer mail-order programs that allow you to fi ll a 90day supply of your covered medications and have them delivered to your home. +

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 27, 2018

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AUGUSTAMEDICALEXAMiNER

Southern Girls Eat Clean Banana-Blueberry Ice Cream Pie

then press into the bottom and sides of a 9” pie dish to form a crust. Let crust sit uncovered for 3-4 hours or place in a food dehydrator for about 3/4 hour. Place frozen bananas and frozen blueberries together in food processor and pulse just until ice cream consistency. Put ice cream into the crust and freeze. When ready to serve, thaw

for 20-30 minutes and top with fresh fruit and slice. + 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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Instructions: Drain water off of almonds. Pulse almonds, cashews, sesame seeds, pecans, dates and raisins together in food processor. (If you have a Greenstar or Champion juicer, you can grind these ingredients using the proper attachments for your machine). Mix in the vanilla and honey; knead to form dough,

Banana-Blueberry Ice Cream Pie

Ingredients: • 1 cup soaked raw almonds • 1/2 cup sesame seeds • 1 cup raw cashews • 1/2 cup raisins • 1/2 cup PITTED dates • 1/2 cup raw pecans • 1 teaspoon vanilla • 2 tablespoons raw honey • 7 frozen bananas (peeled, cut in thirds or halves and placed in freezer bags) • 1-1/2 cups frozen blueberries When serving, top with your choice of fresh fruit. In this photo, I used: • 1 fresh kiwi, sliced • Fresh raspberries • Fresh blueberries • Fresh mango, diced

to call home

Did you know that even dessert can be a whole-food, nutritious part of your meal? This amazing treat not only gets rave reviews for its beautiful rainbow of color but also for the flavor burst you find in every bite! Made with a nutbutter crust and fresh fruits (even the ice cream!), you can let your creativity soar when adding the final layer of yumminess. If you have a Greenstar or Champion juicer, the nut-butter crust can be made with that amazing machine. If not, just use a good food processor. This can be made ahead and will keep in the freezer for at least a couple of weeks. Yes you CAN enjoy guilt-free dessert.

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AUGUSTAMEDICALEXAMiNER

APRIL 27, 2018

YOUR SICKNESS IS MY SICKNESS by Ken Wilson Executive Director, Steppingstones to Recovery

When our customers find exactly what they’re looking for, that’s known as an

INSIDE THE PARKS HOME RUN

It has been said that the biggest lies are the ones we tell ourselves! Have you told yourself: “This one doughnut won’t hurt me!” (300 calories! Really?!!! 8 or 9 of these would be an entire day’s worth of calories.). One of the biggest lies addicts and alcoholics tell themselves is: “It’s my body and I can do what I want with it...I’m not hurting anybody but myself.” When you have time, Google the term “Butterfly Effect.” Interesting. How it is possible for the tiny wings of a butterfly – in time and with the right conditions – to cause a windstorm! Somebody else put it this way: “No man is an island.” We are all intertwined; we all bounce off each other in some way, even if minutely. For instance, have you ever met someone you just felt warm ’n fuzzy with from the outset? Amazing isn’t it? I don’t know how to explain it. I wish I could. On the other hand, have you ever encountered someone and you just wanted to flee before you got to feeling any worse? Maybe even before a word came from their mouth! Explain that, Sherlock! My elementary country explanation is that we just all “bounce off” each other. It has been estimated that about 30% of all patients in the hospital at a given time are there for an alcohol- or drug-related health problem – if not the cause of the hospitalization, then perhaps the victim of an alcohol or drug-related problem, like being in a motor vehicle accident. The greatest exhibit that

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional the alcoholic/addict does not practice in isolation is in the family unit. Behind closed doors is where the drama of addiction is played out and causes lifetime damage to character and personality formation. Let’s take one family’s story. This story only changes by address. With very little variation the actors remain the same. Let’s say the alcoholic is Dad. In a family unit of two parents and four children, for some reason the roles play out like this over and over: Mom becomes the Enabler. She desperately tries to keep the family unit together, keeping secrets from the children, relatives, and neighbors, calling in to work for Dad on Monday mornings when he’s hung over, driving him around when he can’t drive, getting him to bed when he passes out on the sofa, and cleaning him up when he throws up. To “enable” means “to help.” In this case she’s helping him be a successful alcoholic, because if she quit her helping behaviors he’d quickly suffer the consequences of his drinking

and might learn quicker. For now, Dad can drink more because good ol’ mom will get him fi xed up. The children often take on these roles: fi rst, one becomes The Family Hero. He/she makes good grades and gets awards and subconsciously tries to take the focus off Dad (who really needs to feel the heat). When Dad starts yelling, The Hero brings out his report card and shifts the attention to get it off Dad! Second, another child often becomes The Family Clown. When the climate at home gets too tense, he/she starts acting the fool – jokes, songs, somersaults – to take the heat off dad! Third, another child becomes The Hell Raiser. He/she doesn’t care that the attention is negative – but only that it shifts off Dad. Funny how the mind works. Sadly, the fourth child is often The Lost Child. This is often the youngest sibling. He - call him Bob - just goes into hiding...reading quietly in his bedroom with the door shut, creating a peaceful oasis. At the end of the day Please see FAMILY page 16

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CAN DIET IMPROVE MY FERTILITY? by Sarah G. Schmidt, MS, RDN, LD

According to the CDC, approximately 12% of women ages 15 to 44 in the United States have difficulty getting pregnant or carrying a pregnancy to term. This is about one in eight couples. Despite its prevalence, many people do not understand the myriad of physical, emotional, and financial factors associated with infertility. One attempt to alleviate this lack of knowledge is National Infertility Awareness Week® (April 22-28, 2018), a federally recognized observance founded by RESOLVE: The National Infertility Association. A better understanding of infertility will show how diet changes might improve fertility. In general, infertility is defined as not being able to get pregnant after one year of trying. While infertility has typically been considered a women’s health condition, both male- and female-related factors have been shown to contribute to infertility. Causes of infertility vary widely and are sometimes unexplained. Some common causes of female infertility include problems with ovulation, blocked fallopian tubes, and uterine fibroids. In males, infertility is often associated with altered sperm number, shape, and/or motility. Fortunately, a combination of medical interventions and lifestyle changes has enabled many to achieve and maintain pregnancy. Two lifestyle factors

that many people can modify include weight and nutrition. Of course, these two areas alone may not improve fertility for all couples, but at the least they can benefit overall health. Weight Women: Achieving a healthy weight is important. A body mass index (BMI) between 18.5-24.9 is ideal for most people. This number is found using your height and weight in the calculation: [weight (lb) / height (in) / height (in)] x 703. Women classified as overweight/ obese (BMI greater than 25) could improve their fertility by losing just 5% of their body weight. On the other hand, a BMI less than 18.5 can possibly disrupt ovulation, especially if combined with intense exercise. A moderate amount of exercise, however, is recommended. Men: A healthy BMI is also important for the male partner since obesity can impact hormone levels and sperm quality. Moderate exercise is encouraged as well. Diet Women: The specific diet changes highlighted below may provide the greatest improvements for women who suffer from Please see FERTILITY page 15

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THE MONEY DOCTOR UNPACKING: THE STEP-UP (OR DOWN) IN BASIS RULE

fter the recent tax reform changed many things starting in 2018 for both income taxes and estate taxes, one of the questions we have heard a lot the last 90 days is “What has changed?” To fully answer that question we add a second question to the conversation: “What has not changed?” You really have to understand the answers to both questions before you start making any changes. One of the items that did not change was the step-up in basis rule. For all families this is a very important rule to understand and plan around. The information below will provide a basic overview of the rule and general planning strategies. As always, we recommend you work with an estate attorney, tax advisor or CPA, and financial planner or CFP® when applying this information to your situation. What does the rule say? Step-up in basis says the person inheriting the asset after death receives a basis in the inherited property equal to its date of death value. What is an example? Uncle Bob bought a stock in 1980 for $1,000 and today the stock is worth $50,000. If Uncle Bob passes away today, the basis is stepped up to today’s value of $50,000 and the $49,000 gain escapes income taxation forever. Once Uncle Bob’s beneficiaries receive the stock as part of the inheritance, they will have the ability to sell the stock and report a much smaller gain than Uncle Bob would have if he sold while living.

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Can you receive a step-down in basis? Yes, let’s reverse the Uncle Bob example before. Uncle Bob bought a stock in 1980 for $50,000 and today the stock is worth $1,000. If Uncle Bob passes away today, the basis is stepped down to today’s value of $1,000. This means the $49,000 income tax loss is lost forever. Once Uncle Bob’s beneficiaries receive the stock as part of the inheritance, they will have the ability to sell the stock, but they will not be able to take the loss Uncle Bob could have if he sold while living.

What steps can you take today to plan? The initial step is to get organized which is part of our process when we start working with clients. It is very common for new clients to bring us multiple accounts or stock certificates. Consolidating and organizing those small holdings into one larger account simplifies account management. From there, we help clients track down the basis for each holding. This can be tricky because the IRS expects account holders (not financial intermediaries) to calculate and report basis for anything acquired before 2011. We help clients with those calculations as they can get complicated with stock splits, mergers, spin offs, and other major events that can impact the basis. Helping clients get appraisals for inherited land or properties is also part of this process. The next step is to evaluate each holding and asset given the basis and decide how it fits into your overall goals. This is really an ongoing process each year. You have lots of options to consider such as holding, selling, gifting, or buying more along the way. It is a balancing act as you weigh all the different factors before taking or not taking action. A few key questions to continue asking as part of this process are: • How will this impact my overall financial statement, net worth, cash flow, and goals? • How will this impact the diversification and overall risk I am taking? • How will this impact my taxes now vs. later? Do we expect to be in a more or less advantageous tax situation for paying taxes on long-term gains in the future? • How will this impact my legacy and the tax plan for any inheritance I leave behind? What is the tax situation of my beneficiaries? Basis is one piece to a very large puzzle that we help clients solve as it impacts almost all the different areas of your financial plan including estate planning, taxes, investments, cash flow, retirement withdrawal strategies, and many more. So before you make your next financial decision be sure you can answer the question “What is your basis?” + by Clayton Quamme, a Certified Financial Planner (CFP®) with Calvary Wealth, LLC (www. calvarywealth.com). Calvary Wealth is a fee-only financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

APRIL 27, 2018

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by The Skeptical Scalpel, M.D. on April 16, 2018

THE DEMISE OF THE DIGITAL RECTAL EXAM For almost 20 years, the value of the digital rectal exam (DRE), a long-time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications. As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable for patients already traumatized and its yield is so minimal, he advocates doing it only in patients with spinal cord injury, pelvic fracture, and penetrating abdominal trauma. For a more extensive discussion of the topic, see “Life in the Fastlane,” an emergency medicine blog. A systematic review and meta-analysis of the role of DRE in prostate cancer screening done by primary care physicians was just published in Annals of Family Medicine. Seven studies including 9,241 patients who had both DRE and biopsy comprised the study. The authors found the sensitivity of DRE was only 0.51 and the specificity was 0.59. The positive predictive value was 0.41, and the negative predictive value was 0.64. In plain English, it was similar to flipping a coin. The quality of the included papers was low, and the heterogeneity between the studies was high. In reviewing other relevant literature, the authors found that about half of graduating students from Canadian medical schools had never performed a digital rectal examination. A previous survey of Canadian primary care physicians revealed that only half of them felt confident in their ability to feel prostatic nodules on DRE. Another study found when two urologists examined the same patient, “the interexaminer agreement among urologists was only fair.” The paper’s conclusion was “Given the findings of our analysis and appraisal of available studies, we do not recommend routine screening for prostate cancer using DRE in primary care.” In a 2011 BMJ (British Medical Journal) editorial, Des Spence, a general practitioner in Glasgow, wrote “Rectal examination is unpleasant, invasive, and as an investigation has unknown sensitivity and specificity.” In young patients with rectal symptoms, cancer is unlikely, and in symptomatic older patients, a negative DRE would not preclude further workup. Spence raised similar concerns about the role of DRE in screening for prostate cancer or in patients with lower urinary tract symptoms. UpToDate does not recommend DRE for prostate or colorectal cancer screening because there are no studies showing the performance of DRE reduces mortality rates for either tumor. +

This is certainly good news

“Skeptical Scalpel” is a surgeon who blogs at his self-titled site, Skeptical Scalpel.

READ EVERY ISSUE ONLINE! WWW.ISSUU.COM/ MEDICALEXAMINER

We live in a very very noisy world. And it isn’t all audible. There is a constant din of background “noise” from texting, email, Facebook, Twitter, Instagram and dozens of other sources. In olden times, newspaper columnists had a voice; Paul Harvey had a voice; Austin Rhodes has a voice. Today, everyone does. And then there’s literal noise. Television. Muzak. Ipods and ear buds. Radio. Author Susan Cain is not content with the noisy status quo. Her bestseller Quiet is the manifesto for a world drowning in its own cacophony of voices. She explores the historic era a hundred years ago when the loud and brash person became the model for the ideal shaker and mover. There’s just one problem. Quiet is an absolute necessity. For everybody. Including people like musicians who make their living from sound. Beethoven didn’t write his masterpieces with a radio or TV blaring in the background, right? (Forgive the flawed analogy, but you get the point.) We need quiet to innovate.

cards. • If you’re an introvert, staying true to your temperament is the key to finding work you love and work that matters. • Everyone shines, given the right lighting. For some, it’s a Broadway spotlight, for others, a lamplit desk. • “Quiet leadership” is not an oxymoron.

We need to celebrate the quiet colleague, the quiet boss, the silent partner. There’s a word for people who are “in their heads” too much: thinkers. That’s just one of many wise maxims this book brings to light: • Our culture rightly admires risk-takers, but we need our “heed-takers” more than ever. • Solitude is a catalyst for innovation. • Texting is popular because in an overly extroverted society, everyone craves asynchronyous, non-face-toface communication. • Rule of thumb for networking events: one genuine new relationship is worth a fistful of business

Many of us have probably worked for someone whose management style was yelling. People who cannot make a major point without cursing or yelling are, unfortunately, not an endangered species. That doesn’t mean that quiet and introverted people cannot be good leaders — or simply good and valued employees. Cain extols the virtues of the introvert, and it’s a message many of us need to hear. As Gandhi expressed it, ”In a gentle way, you can shake the world.” + Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain, 368 pages, published in January 2013 by Broadway Books

Research News Good news/bad news For anyone unfortunate enough to suffer from severe and recurrent migraine headaches, no amount of money would be too much to pay for relief. And that’s a good thing because a new drug may be available as early as next month that has been described as a true game changer in the fight against migraines. But it won’t be cheap. The drug is erenumab, a long-lasting injection that works by blocking the molecule which transmits pain signals during a migraine. In effect, it aborts any migraine in progress and prevents recurrence. Researchers are not only encouraged by the effectiveness of the drug, but also by its absence of side effects. The number of migraine sufferers participating in clinical trials of the drug who stopped

taking it due to side effects tallied exactly zero. While some people get relief from over-the-counter drugs like ibuprofen and others need stronger prescription medications like sumatriptan (Imitrex), erenumab was tested solely on patients who had failed to get relief from at least two other prescription treatments. Monthly injections (here comes the bad news) could cost an estimated $10,000 per year, but will be covered by some insurance plans. Strictly bad news A Clemson University study published April 19 in Springer’s Journal of Child and Family Studies examined the history of mass shootings at schools in the U.S. Their findings are disturbing, to say the least. Defining a mass shooting as one with four or more deaths (not counting the shooter),

the practice is not a strictly modern phenomenon: in 1940 a junior high school principal killed six adults. There were no mass school shootings during the 1950s or 1960s, with a steady increase from the 1970s to now. The death toll at schools in the 18 years of this century, in fact, has already exceeded the total for the entire 20th century. Calling the shootings “a deadly epidemic,” the study’s authors made recommendations to help prevent deadly school shootings in the future. Get moving It isn’t news that a sedentary lifestyle is as bad for cardiovascular health as smoking, but a new UCLA study adds that inactivity is also linked to negative changes in brain areas crucial to memory and cognition. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

APRIL 27, 2018

THE MYSTERY WORD

Do you still run all the time?

Sure! It’s great exercise.

by Dan Pearson

Not at all. In fact, I just set my new personal best in the 100-yard dash.

I thought you would be bored with it by now.

That’s great. What was it?

The Mystery Word for this issue: HAYSLEE

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. It can lead to ground 5. French infantry soldier (esp. of World War I) 10. Noted architect 13. ________ from heaven 14. Ink can do this 15. Gehrig’s disease (abbrev.) 16. Amused 18. Sick 19. Whimper 20. Banks, a.k.a. “Mr. Cub” 22. Lot fled from this city 23. Racing type (in Aiken) 25. Capital of Yemen 27. They accompany hunger 28. Area judge and former DA 30. Nocturnal mammal 31. DDS org. 34. Rubio of note 35. “Good” cholesterol (abbrev.) 36. “The cruelest month” 38. First responders, in brief 39. Type of cow 41. wives’ club 42. “Like a house _____” 43. Reject 44. Toward the sun 47. Rescued 50. Leaning 51. Latin for “the same” in bibliographies 52. Manipulate 53. Final phase of an endeavor 60. Malt beverage 61. Columbia County town 62. Travelocity mascot 63. 2013 Joaquin Phoenix film 64. One of the Quaids 65. Sicilian volcano

17 20 23

VISIT WWW.AUGUSTARX.COM

Click on “READER CONTESTS”

QUOTATION PUZZLE

42 45

10 15

L E D H Y N S P O E T O N F S R Y Y R S U R A M O W E E T I U L O

DOWN 1. Tin container 2. Fiery insect 3. Memory-assisting device 4. Trimmed; reduced 5. Sacred hymn 6. River flowing from Burkina Faso to Ghana 7. Novelist Fleming 8. Commit perjury 9. Informal term for a college student who has yet to earn a degree 10. Augusta College 11. New York island 12. British follower 13. It comes before myself and I 17. Scorecard entry for a birdie on 16 21. Certain nurses (in brief) 22. Augusta Mall anchor store 23. Perhaps (archaic or literary) 24. Blackbird 25. Peak

N I E E A G H

B T S A

— Lord Chesterfield

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.

26. Small drink of liquor 27. Southern California athlete 29. Mario Puzo bestseller (with “The”) 30. 90 feet from home 31. Packing heat 32. Eating regimen 33. Too 37. Ashphalt 40. “Free ____” (gas station sign) 42. Shoemaker’s tool 44. Ms. Palin 45. Useful 46. Republic in NW Africa 47. She portrayed Loretta 48. Large area employer 49. Margin 54. Eggs (Latin) 55. Adult male 56. Conclusion 57. Unit of weight 58. Nashville awards show 59. Masculine pronoun

X A M I N E R

3 3 8

6 1

5 3 3 1

8 4 4 9

8 7 9 3

3 7

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.

1 B 1

M P 1 2 3 4 5 6 7 8 9 1 2 3 4 P U 1 2 3 2 3 1 2 3 4 5 6 7 8

NUMBER SAMPLE: BY

T H 1 2 3 4 5 6 7 4

— Author Rex Stout

1.BGNPPAS 2.LOUUEE 3.TTTRES 4.SPASH 5.SIRI 6.NAIM 7.SING 8.SET 9.ST

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 27, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

Moe: Did you enjoy your fi rst game at SRP Park? Joe: Yeah, except it was so hot that day. Moe: That’s hard to believe. Joe: Why do you say that? Moe: The whole stadium was full of fans.

ha... ha...

Moe: How was your vacation? Joe: It was pretty good. Moe: Weren’t you planning to visit the house where toothpaste was invented? Was that interesting? Joe: We never could find it. There was no plaque on it.

fi rst grade teacher gave her class a show and tell assignment. Each student was instructed to bring in an object to share with the class that represented their religion. The fi rst student got up in front of the class and said, “My name is Benjamin. I am Jewish and this is a Star of David.” The second student walked up to the front of the class and said, “My name is Mary. I’m a Catholic and this is a Rosary.” The third student got in up front of the class and said, “My name is Tommy. I am Baptist and this is a casserole.”

Moe: Hey, would you like to come with me to the soup kitchen and help out this weekend? Joe: Man, you could not pay me to do volunteer work. A farm boy accidentally overturned his wagon load of corn on a country road. The farmer who lived nearby heard the noise and went to see what happened. “Tell you what, son,” he said, “Come have dinner with us, then I’ll help you get your wagon up.” “That’s mighty nice of you,“ the boy said, “but I don’t think Pa would want me to.” “I’m sure it’ll be okay,” the farmer insisted. “A boy’s gotta eat, don’t he?” “All right,” the boy finally agreed, “but I know Pa won’t like it.” After dinner, the boy thanked his host. “I feel better now, but Pa is going to be mad.” “Don’t be silly,” the neighbor said. “Where is your Pa anway?” “Under the wagon,” said the boy. +

Boy: *calls 911* Hello? I need your help! 911 operator: What’s wrong? Boy: Two girls are fighting over me! 911 operator: So what’s your emergency? Boy: The ugly one is winning!

Moe: How is your diet going? Didn’t you have a goal to lose 10 pounds? Joe: Pretty good. I only have 20 pounds to go! Moe: What’s red and invisible? Joe: No tomatoes.

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 thought I did a great job raising my children, but as adults they often seem helpless. My daughter called the other night practically incoherent she was sobbing so badly. At her insistence I caught a red eye, travelled all night and was at her door before sunrise, only to discover her “crisis” was a flooded bathroom. Where did I go wrong? — Parent of grown children

Dear Parent, Barring an in-person examination it’s difficult to determine exactly, but I have a few ideas. This time of year, allergies definitely cause many a red eye. Most people either suffer through the season, well aware of what’s ahead, or they reach for the allergy medications that have helped them in the past. Any allergy that is severe requires a doctor visit or a trip to the Emergency Room. Sometimes a foreign object in the eye — sand, dust, dirt, or even contact lenses — can scratch the cornea, the clear protective coating over the eye. First aid starts with blinking, which might eliminate small particles. Immediately remove your contacts if you wear them. Another step to promptly take: rinse your eyes with clean water or a saline solution. Avoid rubbing your eyes, even though it is the natural reaction: if a foreign object is the cause of your discomfort, you might make the corneal abrasion much worse. Dry eyes can also result in redness, but the bigger question for you and your doctor is what is causing the dry eyes? Is it one of the medications you’re taking? Is it a medical condition like diabetes or rheumatoid arthritis? Tears are incredibly complex (see our cover story about tears in the Feb. 16 Medical Examiner), and the culprit could be insufficient tears, or tears that are chemically flawed in a way that accelerates their evaporation. Other medical causes for red eye include conjunctivitis, commonly known as pink eye. Inflammation of the many tiny blood vessels in the white of the eye make it appear pink, leading to the name. The cause of pink eye can be viral or bacterial and can piggyback on a cold or sore throat. The bacterial variety can be triggered by contact lenses that haven’t been properly cleaned. Some people act like anyone with pink eye should be quarantined. Conjunctivitis is contagious, but no more so than the common cold, according to the Mayo Clinic. It’s safe to return to work or school with ordinary good hygiene. + 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.

SUBSCRIBE TO THE MEDICALEXAMINER +

Why read the Medical Examiner: Reason #63

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

STATE

ZIP

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

BEFORE READING

AFTER READING

+ 14

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

...cleverly hidden in the upper left corner of the p. 2 ad for OVERHEAD DOOR COMPANY THE WINNER: MICHELLE TYNER Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED C A M P M A N N A E N T E R M E S O D A D E N C R A I G M A R C O E M S D A F S U N W A A T I L T R I G H A L E E H E R R

P O I L U S T A I N T A I N E D W L E R O M H A R N P A N G S T A P I R H D L A P A I R Y D A I R E V R D S A V E I D E M O M E S T R E V A N S G N A N D Y E T

P A I N E

E L L I S

I S L E S

A R M E D

D I E T

A L S O

T C H O M E N A

SEE PAGE 12

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.

“A pessimist gets nothing but pleasant surprises.” — Author Rex Stout

The Sudoku Solution 9 8 7 2 5 3 4 6 1

1 6 5 7 9 4 3 8 2

2 4 3 6 8 1 9 5 7

5 3 8 1 4 9 2 7 6

6 9 4 8 2 7 1 3 5

7 1 2 5 3 6 8 9 4

8 2 6 9 1 5 7 4 3

4 5 1 3 7 8 6 2 9

3 7 9 4 6 2 5 1 8

QUOTATION QUOTATION PUZZLE SOLUTION: “Modesty is the only sure bait when you angle for praise.” — Lord Chesterfield

The new scrambled Mystery Word is found on page 12

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

APRIL 27, 2018

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

APRIL 27, 2018

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AUGUSTAMEDICALEXAMiNER

TENTH IN A SERIES

The vitamin alphabet We’ve spent a long time visiting the extended clan of B vitamins, all eight of them. Now we’ve reached the Final Four: C, D, E and K. Vitamin C is an essential nutrient that is needed for tissue repair, production of some neurotransmitters, and the proper function of the immune system and certain enzymes. It also may be the most controversial vitamin thanks to one of its biggest proponents and various claims about what vitamin C can do. Linus Pauling, a respected and honored biochemist (he won the Nobel Prize twice, one of only four people to have that honor; he is the only person to be awarded two unshared Nobels, and one of only two people to win his awards in different fields), made a huge splash

in the early 1970s with the publication of his book Vitamin C and the Common Cold, later revised to Vitamin C, the Common Cold and the Flu. Pauling’s advocacy continued with another popular book, Cancer and Vitamin C. While the books were popular with the public, studies to confirm Pauling’s claims came up short: research did not show vitamin C could prevent colds (although it can slightly shorten their length); the high-C-dose cancer treatment he championed could not be duplicated. In fact, vitamin C was no better than placebo at preventing or treating cancer. The medical establishment concluded Pauling’s trials and claims were quack medicine, while Pauling denounced the criticisms

of his findings as fraud. While differences between Pauling’s studies and peer review have been noted (oral versus IV administration of vitamin C during studies, for

example) neither the medical establishment nor the Pauling camp (Pauling died in 1994) has ever fundamentally changed its opinion of the other side and its views. One thing is certain, however: vitamin C is a vital nutrient, and its deficiency results in scurvy, a disease that results in malaise, gum disease, hair loss, easy bruising, bleeding from the skin, poor wound healing and eventually personality changes and death. At the height of the great age of sailing, it was generally assumed that 50 percent of the sailors on any given voyage would die of scurvy. Its cause was unknown until James Lind, a Scottish surgeon in the Royal Navy, established that citrus fruit given to sailors would treat and or prevent

scurvy. As Lind’s profile in one of our previous “Who is this?” entries noted (see p. 4), however, his findings were ignored for more than 40 years before changes were finally implemented. Millions of lives were unnecessarily impacted by the delay from 1753 to 1795. The nutrition label Daily Value for vitamin C was changed (in May 2016) from 60 mg per day to 90 mg, but food and supplement companies have until Jan. 1, 2020 to reflect the change in their labeling. Smokers and those exposed to secondhand smoke experience oxidative damage, depleting antioxidants like vitamin C. The Institute of Medicine recommends an additional 35 mg of daily C for smokers. Fruits and vegetables are rich sources of vitamin C. +

plain popcorn and sprinkle with cumin, curry, and redpepper flakes for some extra pizazz. • Combine rolled oats, whole milk yogurt, a splash of milk, and a handful of frozen berries in a mason jar; cover and refrigerate overnight for a

quick and healthy breakfast. • Swap out chicken for some pinto beans or tofu when building your burrito; add a few slices of avocado for some healthy fats. • Sprinkle walnuts onto some bran flakes and pour in 1 cup whole milk. +

FERTILITY… from page 9 ovulatory disorders. • Grains Select more whole grains instead of highly refined grains. Whole grains can help regulate blood sugar, lower inflammation, and might even promote weight loss. Examples of healthy options include oatmeal, quinoa, and whole-grain pastas and breads. Check for the term “whole grain” on the ingredient list, and choose grains with little to no added sugar • Dairy products This recommendation may be surprising. Some studies show women whose diets favored high-fat dairy instead of low-fat dairy experienced improved fertility. So consider adding a glass of whole milk or a serving of whole .milk yogurt to your diet (though be sure to watch for those added sugars!). If you have cardiovascular disease risk factors, such as high cholesterol, you should first consult your healthcare provider or a registered dietitian nutritionist • Protein Lean sources of protein are part of a healthy diet. However, some research suggests that higher intake of animal protein could increase risk for ovulatory dysfunction. Instead, consider eating more vegetable protein. Examples

of vegetable proteins include legumes (beans, peanuts, peas), soy foods (tofu, tempeh, soybeans) and nuts. When selecting vegetable protein, try to include sources that contain iron, such as legumes, since adequate iron status is an important factor in fertility • Fat Eat less transfat! This type of fat can be found in processed foods such as biscuits, scones, baking mixes, and fried foods. Select more polyunsaturated and monounsaturated fats, found in foods like avocados, canola oil, flaxseed, walnuts and salmon • Multivitamins Take them daily! Choose one containing folic acid and iron. Some studies suggest that women with regular multivitamin use had a lower relative risk for infertility. Plus, folic acid is important for a developing baby if you do get pregnant Men: General healthful nutrition is recommended, with a focus on consuming foods high in antioxidants. A diet rich in antioxidants can have a protective effect on sperm quality. • Grains Make half your daily grains whole grains. Think whole-wheat bread, barley, popcorn, and brown or

wild rice • Protein Moderation is recommended Avoid excessive consumption of protein, especially animal proteins, and replace some of these foods with fruits and vegetables. The goal is to increase antioxidants in the diet • Fruits and vegetables Aim for 2 cups of fruit and 3 cups of vegetables daily. And go for color to maximize antioxidants. Toss some raspberries or blueberries on your cereal, munch on an apple for a snack, and load up on veggies when making stir-fry • Multivitamin or supplements The research seems to be more mixed for men than for women. While a multivitamin may be a good addition, a pill cannot replace a healthy diet. Talk to your health provider or a registered dietitian nutritionist for .more personalized recommendations What are some easy ways to start incorporating these diet recommendations? Nutrition tips: • Try whole-grain bread when making sandwiches; fill with hummus and roasted veggies. • Drizzle canola oil over

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AUGUSTAMEDICALEXAMiNER

APRIL 27, 2018

PROFILES… from page 3 pornography leveled against Osbon. The existence of VEDs as an ED treatment option today, one supported by medical and educational literature, “in [in] thanks to the efforts of Osbon,” says Reviews. Henry Hudson, M.D., a past president of the Americal Urological Association, gave much support and legitimacy to vacuum therapy and Osbon’s device in 1979, noting, “it was not a doctor who created this product, but it really works.” That helped open the door, leading to FDA approval for clinical testing in January 1982. By October, a mere 22 years after his doctor told him medical science had nothing to offer for the treatment of impotence, Geddings Osbon

got permission for the firstever non-invasive impotence treatment. Although some might think The Age of Viagra put an end to any other ED treatment, in 1995 the American Urological Association endorsed vacuum therapy as the fi rst-line treatment of choice for ED. By then, notes Reviews in Urology, “the device” (they were referring to Osbon’s) was prescribed more than any other treatment for ED.” In fact, in its 2013 article “The Use of Vacuum Erection Devices in Erectile Dysfunction After Radical Prostatectomy,” Reviews in Urology“ says therapy with vacuum pumps is good not only for sexual health (80 percent of participants in one study reported

successful intercourse with VED following radical prostatectomy), but promotes overall nerve and vascular recovery following prostate surgery, among other benefits. The article also notes the pump can be effective in well under a minute, something no other option can offer, Other unique features: VED is the only non-invasive option and boasts the fewest side effects and contraindications,

and “is by far the cheapest long-term option among all ED treatments on the market today.” It’s an amazing success story that began right here in Augusta. Broad Street is still the home of Augusta Medical Systems, managed by the third generation of the Osbon family. Geddings Osbon lived 85 years, long enough to see the FDA’s historic approval of his device. +

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