Apr5 19

MEDICALEXAMINER

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APRIL 5, 2019

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

Y

According to recently released nationwide data, if Augusta was a car this is what it would look like.

FAT

IS NOT PHAT

es, it’s true: we’re fat.

We’re masters at it, so much so that Augusta is getting national attention for it.

According to WalletHub, the financial research and credit score website, Augusta is the fattest city in Georgia and the 10th fattest city in America. That, as the kids would say, is not phat.

Why is a financial site sticking its nose in our business? WalletHub has figured out, among other things, that it’s difficult to have the financial freedom to travel to Fiji or retire at age 45 if you’re dead — or worse, burdened with a couple hundred thousand dollars in medical bills.

Health is truly the ultimate wealth.

Here are a few of the areas in which only 9 other cities in the entire nation beat us.

#10 The cumulative score of each metropolitan area was based on an evaluation of 19 relevant metrics broadly grouped under three main headings: a Food & Fitness ranking, Health Consequenc-

MASA Make Augusta Salubrious Again

es, and an Overweight and Obesity ranking compared to other cities. Augusta’s strengths (or lack thereof) and weaknesses (more about those in a moment) averaged out to place us at #10.

Just slightly worse than us (by 0.01 points) was Baton Rouge, then Toledo, Knoxville, Tulsa, Mobile, Jackson (Mississippi), Memphis and Shreveport. Alone at #1, the fattest city in all the land, is McAllen, Texas.

Memphis actually has the most overweight and obese adults, teenagers and children (six separate categories in the matrix) of any city in the nation; by comparison, Augusta ranks 31st in that cate#31 gory. But where we do a little better, another city does a little worse.

In fact, in the important category of Health Consequences, Memphis stands at #25 out of 100 cities ranked — still nothing to brag about — but Augusta is #4 (#1 being the worst).

UPGRADE

AUGUSTARX.COM

Health Consequences is a measure of the actual damage being obese and overweight (aka “fat”) does to a population. The category measures factors like the share of adults who have high blood pressure, #4 high cholesterol, diabetes, and heart disease, as well as the obesity-related death rate. In case you missed it, we’re #4. Only three cities in the entire U.S. — New Orleans, Memphis, and overall champion McAllen, Texas — are worse than we are in paying the price for our condition.

How did this happen? Part of the blame can be laid at the feet of our Top Ten ranking in the #7 Food & Fitness category. There we measure a collective #7 nationally.

Food and Fitness is a compilation of lots of data, some of it factors beyond our control, everything from if a city is designed for fitness (with amenities like bike lanes, walking trails, parks, and recreation programs) to how many people live in low income areas a mile or more from a grocery store, health educators per capita, and whether the average citizen surveyed says their fresh fruit and vegetable consumption is high or low.

For a few ideas on how we can help Augusta plummet in these rankings, see page 3. +

Read the complete report at https://wallethub.com/edu/fattest-cities-in-america/10532/

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

APRIL 5, 2019

Dr.busbee’s CELEBRATED

c C ELIXER of TRUE Health DECIPHERING HEALTH MYTHS, SNAKE OIL CURES AND OLD WIVES TALES NEW MONTHLY FEATURE BY TRACEY BUSBEE, MLIS, AUGUSTA UNIVERSITY

PARENTHOOD

by David W. Proefrock, PhD

Your 20 year-old daughter is in college. She is passing, but not doing nearly as well as she did in high school. She recently announced that she is going to change majors from business to art. You are worried that she won’t be able to make a living with an art major. What do you do?

A. Talk with her about your concerns, but support her decision.

B. You can’t really do anything about it so you may as well not say anything. She’s going to do what she’s going to do anyway.

C. Tell her that you don’t approve of her changing her major to art and that you will no longer pay for any of her education if she goes through with it.

D. Tell her that she’s making a big mistake and that she will regret it later, but there’s not much else you can do.

If you answered: A. This is the best response. You should share your concerns, but listen to her reasons for making the change.

Encourage her to pursue her own plans for her future.

B. It is very likely that she will do what she wants, but this is a chance to talk with her about her plans for the future. She may actually want your advice. It never hurts to talk.

C. This is just too much interference in the life plans of an adult child. This is a time to communicate. Share you concerns, but listen to her reasons.

D. You could communicate your concerns in a much more constructive manner. You should listen to her and try to be supportive, not just tell her what a terrible mistake she’s making.

The key in this situation is communication. Your daughter is struggling with life plans. So are most other college students. It would be different if she announced that she was going to drop out of school to join a cult, or a commune, or the circus. She’s just changing majors. Be supportive and open to talking with her about her future. + Dr. Proefrock is a local clinical and forensic psychologist

BLACK SALVE A quick search for “black salve” yields dozens of products that tout healing and reliance on classic recipes for the balms just like what grandma or the Amish used.

And they are “natural.”

There are a myriad of ointments that are labeled “black salve,” but some are nothing more than black and an ointment. Many products are marketed as black salve and may be derived from any one of many plants, including (but not limited to) bloodroot and oleander, galangal, ginger, red clover, sheep sorrel, turmeric, chaparral, and graviola. Other modernly manufactured components may be added as well, such as zinc chloride, and dimethyl sulfoxide (DMSO).1 DMSO is supposed to enhance the penetration of the salve into the skin. Zinc chloride can be used as a nutritional supplement or in industrial practices.2 In some concentrations, zinc chloride can burn skin, eyes, mucous membranes, and corrode metal.3 See where this is going?

Black salve is commonly known as a “cure” for skin cancer. People reach for it to reduce cost or because they prefer a “natural” cure.

However, black salve is not regulated by the FDA so you never know what you are

getting. Researchers in Utah found that 74% of users of black salve were not aware that infection, scarring, and disfigurement can occur with its use.4 Google image search “black salve” to view people who have been disfigured in attempts to self-treat their skin ailments.

Another bit of misinformation about black salve is that it targets skin cancer cells and does not harm healthy tissue.

This is false. In one study published in 2017, a review of 131 papers cited two possible explanations: black salve causes death of good and bad cells, and the cases studied (where damage was extensive) may have been worse than originally thought. In addition to zinc chloride’s corrosive nature, some of the plant ingredients also possess qualities of toxicity to cells. Ingredients can interact with each other to create a dangerous concoction.1 The assertions that black salve will cure cancer are simply not substantiated. In one case study a patient who attempted to treat melanoma with black salve describes that 5 years later the cancer returned to her calf and spread to her lymph nodes, lungs, liver, and other tissues.5 While it is not wise to cite just one study as a truth for all circumstances, it is wise to be aware of the counter-arguments to far-reaching claims.

As always, check with your doctor about any remedies you may want to try. Do not attempt to treat serious conditions yourself. Use the power of the Internet to find reliable health information. One tip is to visit sites that are backed by documented research and reliable sources. When I conduct a Google search for medical information, I filter out a lot of questionable material by entering my search terms followed by site:.gov.

For example, type into Google “black salve site:.gov” to find free, researched articles and content. You can use this method with any search term(s). + References 1. Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Liu L. A Review of Black Salve: Cancer Specificity, Cure, and Cosmesis. Evid Based Complement Alternat Med. 2017;2017:9184034.

2. National Center for Biotechnology Information.

PubChem Compound Database; CID=5727, https:// pubchem.ncbi.nlm.nih.gov/ compound/5727 (accessed Mar. 10, 2019).

3. National Center for Biotechnology Information. PubChem Compound Database; CID=5727, datasheet=lcss, https://pubchem.ncbi.nlm. nih.gov/compound/5727#datasheet=lcss (accessed Mar. 13, 2019).

4. American Academy of Dermatology. Beware of black salve, https://www.aad.org/ media/news-releases/bewareof-black-salve (accessed Mar. 10, 2019).

5. Sivyer GW, Rosendahl C. Application of black salve to a thin melanoma that subsequently progressed to metastatic melanoma: a case study. Dermatol Pract Concept. 2014;4(3):7780. Published 2014 Jul 31. doi:10.5826/dpc.0403a16

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APRIL 5, 2019

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AUGUSTAMEDICALEXAMiNER

LET’S CUT THE FAT According to Wikipedia, the population of the Augusta metropolitan area is over 583,000 people (as of 2014). How can more than half a million people collectively lose weight and shed the shame of being one of the Top Ten fattest cities in the U.S.?

The experts say the big mistake we all make when we try to live healthier is a simple one to fix. We focus on what we need to stop doing, like eating an entire bag of Cheetos right out of the bag in one sitting.

Doctors and nutritionists and dietitians say we should instead focus on the things we need to start doing: taking a brisk walk after supper for instance.

The funny thing is, the very same people who don’t have time for a daily 30-minute walk do have time to watch TV for 3 hours every evening. Weird how that works, isn’t it?

But if we somehow manage to carve out the time to begin doing good things, there is another secret to success endorsed by the very researchers who put us near the top of this unenviable list.

If we want to succeed at living life more salubriously, we have to throw away the clock.

More than that, we need to throw away the calendar. When we decide to change we expect results quickly, and we get discouraged and give up when they don’t materialize.

We set a goal to lose x pounds by x date and it doesn’t go according to plan. What we often fail to remember is that the poundage we want to lose was gradually added a few ounces at a time over a period of years, maybe even decades. And now suddenly we want them gone in a matter of weeks, or a few months. It isn’t

realistic, and it dooms most diets to failure.

That’s why people who want to lose weight are often encouraged to ban the word diet from their vocabulary. A diet is something we “go on” for a limited period of time. Almost by definition, it’s also something we’re going to go off. Many if not most diets are simply not sustainable over the long run.

So what word should replace “diet” in our vocabulary? Don’t roll your eyes, but it’s “lifestyle.” It might be challenging to alter our whole way of living, but remember, we threw away clocks and calendars. And maybe we put the bathroom scale in storage too. We’re not focusing on short-term goals and results. This is a marathon, not a sprint. But even a marathon consists of individual steps taken one at a time.

As mentioned on page 1, community-wide obesity is partly a function of urban design. City leaders can accelerate creation of public amenities like biking and walking trails. Such expenditures pay dividends many times over.

Employers also can have a tremendous impact on community health. They can make sure vending machines are stocked with salubrious items; if special meetings, events or seminars are catered, healthful options can be provided; the break room should have a refrigerator and microwave to encourage brown-bag lunches; smoking should be banned on company property; walking paths can be provided or mapped in the neighborhood and their use encouraged.

In the final analysis, while the stats paint an unflattering portrait of half a million people, addressing the problem will benefit individuals.

Maybe even you and me. +

Proudly announcing our affiliation with Dr. John Cook of Southern Dermatology, Aiken

WHAT ARE STEM CELLS?

We’ve all heard of stem cells. They’re mentioned on the news all the time. They seem to be the subject of both excited optimism and controversy. But if our lives depended on it, could most of us offer a reasonably accurate definition of stem cells and what all the hoopla is about?

Maybe. Let’s make sure.

Once upon a time we were all zygotes, the single cell that results when an egg is fertilized by a sperm cell. From that single cell eventually come all of the more than 200 types of different cells found in the human body. Once the various original cells find their true calling in life — this one becomes a nerve cell and that one becomes a skin cell, for instance — they then reproduce according to their kind.

Stem cells, on the other hand, like the earliest cells arising from the zygote, are cells that can develop into many different kinds of cells.

Adult stem cells (those taken from adults) are specialized or tissue-specific. They can generate cell types that are unique to the specific organ or tissue from which they were harvested.

For example, blood-forming stem cells can grow into mature blood cells.

Embryonic stem cells, on the other hand, can develop into every cell type in the body. And unlike adult stem cells, under the right conditions they can propagate themselves indefinitely.

Both types of stem cells hold great promise for research and potential applications in restorative and regenerative medicine.

But the word embryonic raises red flags for some. Where do they come from? Embryos? Aborted fetuses?

Couples with fertility issues often turn to in vitro fertilization (IVF) for assistance. The woman’s eggs are fertilized with the man’s sperm in a petri dish. After about 5 days the fertilized eggs have divided and grown enough for some to be implanted into the woman. The rest remain in the IVF clinic’s freezer where the couple can continue to pay for their storage pending a successful pregnancy, decline and have them defrosted (which destroys the cells), or donate the frozen embryos (each about the size of the dot on this i) for research. Those donated embryos are the source of human embryonic stem cells. +

MEDICALEXAMINER

M.D. John Cook,

TM

AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER

www.AugustaRx.com 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 salubrious news within every part of the Augusta medical community.

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

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

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The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2019 PEARSON GRAPHIC 365 INC.

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APRIL 5, 2019

AUGUSTAMEDICALEXAMiNER

#88 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

T

by Marcia Ribble

his dashing gentleman has apparently been wronged, and even the Medical Examiner has been an unwitting contributor to the unfortunate injustice.

His name is Arthur Eichengrün. He was a German chemist and inventor who lived from 1867 to 1949.

Along the way he developed an I anti-gonorrhea drug that was the gold N MA OF THE YEAR THE SKINNY standard of treatment for more than 50 years, and pioneered processes that led to the use of plastics in an all-new M way: injection molding.

But perhaps his greatest scientific accomplishment is one clouded by controversy to this day.

Make a big splash this sum mer!

A man named Felix Hoffman has long gotten the credit for the process of synthesizing aspirin, and for that feat we even named him the Medical Examiner’s Man of the Year for 2012, a huge honor. But for years Eichengrün claimed that he was responsible for the breakthrough.

Both men were employed by Bayer at the time of aspirin’s development, and according to Eichengrün’s version of events, he was Hoffman’s superior. Seeking a way to employ the longknown beneficial effects of salicylic acid without its usual side effects (such as gastric irritation), Eichengrün in 1897 directed Hoffman to synthesize acetylsalicylic acid. Hoffman complied with no idea of the purpose or significance of the work. He was just performing a procedure as instructed, according to Eichengrün. The procedure was a success, and Bayer was heavily marketing its patented aspirin formulation by 1899.

The first time Hoffman was ever given a key role in aspirin’s development was in a 1934 history of chemical engineering in a German encyclopedia. Given the rise of the Nazis in Germany at that time, Eichengrün, a Jew, was in no position to dispute those claims. In fact, he had left Bayer by that time to form his own company, and was forced by Nazis to sell the firm to “Aryan” Germans. Ten years later he was imprisoned and sent to Theresienstadt concentration camp, where some 33,000 Jews died. Eichengrün was freed in May of 1945.

In 1949 Eichengrün published a paper in the German journal Pharmazie in which he offered proofs that he was the inventor of aspirin. His version of events was largely ignored by medical historians until 1999, when Scottish professor of pharmaceutical sciences Walter Sneader evaluated the evidence, reviewing letters, patents, and records of lab work. His review, published in the BMJ (formerly The British Medical Journal) as “The Discovery of Aspirin: A Reappraisal” endorsed and supported Eichengrün’s key role, and found no evidence that Hoffman had ever been credited with any significant part in aspirin’s development until the Nazi Party came to power. Then it became important to credit the product to a non-Jew. Hoffman, who lived until 1946, never published his own account of the discovery of aspirin. For its part, Bayer responded to professor Sneader’s paper with a press release which denied Eichengrün’s role and reaffirmed its support of Hoffman as aspirin’s inventor. +

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2012

ON BAYER’S WAR HEADACHES

Two Thousand Twelv e

Aspirin bottle, 1900

Aspirin emerged from the labs of Bayer, a German company, in 1899. Business was good and growing until Germany went to war in 1914.

German assets in Britain were frozen, and Allied nations like the US were not inclined to buy products from enemy nations.

This had a negative effect on the aspirin supply at a time when it was desperately needed.

Beginning in 1915, Bayer set up a number of shell corporations and subsidiaries in the US to guard against the possibility that, if America entered the war, Bayer’s ore than twenty years sales ago, then-editor of and assets in the US Augusta Magazine, from stubbing your would Beth Siciliano, gave toe. The answer for be lost. A US war office me an assignment all these situations and more to write an article is aspirin, a modern-day about once-a-day called the Alien Property drug if ever there aspirin miracle was one. thought taking aspirin therapy. At the time, I continue to be discovered. New benefits from aspirin Custodian was established was supposed to be a reactive event, something

by Woodrow Wilson, But an aspirin a day you did when you chaired had a headache, isn’t for everyone. a toothache, fever. take pains to avoid Who should by A. Mitchell Palmer, whose The concept of taking aspirin? How did an aspirin on general principles job was to seize, this administer, drug amazing come to be, and how was new to me back it seemed like a fitting does it work? then, and in some cases sell commentary on modern but something is bound “enemy property” in life: A drug with an ancient the US. to hurt before this day history so you might as well Palmer soon uncovered is over, Most histories of accept that fact and the aspirin begin with just take the the aspirin as soon as Hippocrates in Bayer subsidiaries that were you get up. It’s going fifth century B.C. writing about a bitter to happen soon enough, so get nominally American-owned made from willow it over with. bark that helped ease powder but actually controlled I remember jokingly aches and pains and reduce by asking Beth, “Is this fevers. aspirin in addition Bayer’s German headquarters. daily Actually, aspirin’s to the ten or more origins date much most already taking in He seized Bayer’s US farther back, into earliest Biblical the course of a typical of us are assets times: remember day?” and by the authority Well, as we all know God telling Moses, “take these of the by now, an aspirin two tablets”? has replaced an apple Trading with the Enemy a day Fast forward many Act, a day as the cornerstone centuries to the late preventive medicine. sold all of Bayer’s US of and we meet Felix 1890s patents, Aspirin is at the same Hoffman, the German most mundane of factories and trademarks, time the pictured above (and chemist drugs and the most that’s aspirin’s molecular amazing. including the Bayer cross Quick: name a drug structure logo, you take if you have on the left), an employee headache — or a stroke. bought by patent medicine a of a company you may have heard of: Name an inexpensive, Bayer. For several the-counter drug company Sterling Products. overdecades prior to his appearance that can help prevent The in the story, salicin heart attacks, blood clots, strokes, rights to “Aspirin” and or salicylic acid had been given the US cancer — and pain in high doses to treat and swelling rights to the Bayer name pain, and trademarks were bought Please see ASPIRIN back page 2

by Bayer in 1994 for $1 billion. +

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My home is great. I love its size. I love its rooms. I no longer love all the stuff that I have over the years stuffed into it. And all the time I was stuffing it full, I was becoming less able to move things around, lift and bend, and keeping my balance started to become a serious issue. Altogether, I’m getting old in a house that requires someone younger to deal with my stuff.

When I moved in ten years ago, I was able to walk unaided. Now I have to use a walker.

And all my stuff that I moved in, including nine bookcases stuffed with the books I cherish, no longer give me the pleasure they once did. All the academic papers, so necessary to my life then, hold less value now.

Somehow, I need to seriously organize and downsize all my stuff.

And I cannot even begin to imagine how I will accomplish that goal, so the word I am looking at is “overwhelmed” with too darned much stuff. Hmmm. Yard sale. How will I set it up? How will I decide what to sell and for how much? And when? What should I give away? What value does anything have? I wish organizing guru Marie Kondo was here to help me decide what gives me joy.

Perhaps I am looking at it from the wrong perspective. Maybe I need to ignore most of the stuff for now and work on deciding what does give me joy that I need or want to keep first, and then work on what’s left over after

I’ve removed my heart’s treasures.

I recall my folks at this stage of life, downsizing from a big three bedroom, two bath house to a much smaller two bedroom, one bath house. It was hard for them, too, letting go of their old possessions and becoming comfortable with their much smaller lifestyle. At that time they had enough money that they were able to give away what they did not want. I’ve already given away a lot, and need to make at least a little on things I sell.

Starting a to-keep list should help my to visualize the process better. A mock-up of the space left to fill when I have weeded things out might work well. Where will I put my chair? I know the beds have to go. Of course I’ll keep my chests of drawers, at least the ones for my clothes. Do I still need my file cabinets? Probably not, and ditto the ton of papers in them. I have at least five of those plastic cubbies. Maybe keep a couple of them for storage, and get rid of the rest? I’ll still need my desk, which would function much better with ancient papers I no longer need removed! My computer? Of course! I still use it every day.

I think creating zones and categories might be useful. Kitchen stuff. Books.

Furniture. Pictures and other décor.

Desk and computer and essential papers.

Oh, yeah, clothes. Medical supplies and medicine. OK. I have done a little thinking, but it’s time for a snack and bed.

Goodnight. +

Essential oils are exactly that: essential WHICH WILL IT BE? Actually, they can be the very definition of nonessential. But that depends on who’s writing the definition.

If you hear the word essential and think “absolutely necessary; extremely important,” you

probably wouldn’t make a list like this: • oxygen • water • food • lavender-scented candles Then again, perhaps you would. We aren’t going to spring a pop quiz on you, but for the purposes of our discussion here, three of the four items above are essential, the fourth is not.

You have to identify which one doesn’t belong.

Essential oils get their

name from being infused with the “essence” of something, like strawberries, lemons or eucalyptus. The essential ingredient gives many products we buy their characteristic flavor or aroma.

They are definitely essential to the financial welfare of their makers and sellers — perfumists, candle makers, and so forth — but not so essential when it comes to a salubrious state of health. +

Tell a friend about the Medical Examiner!

APRIL 5, 2019

I

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker.

Reach him via Twitter: @doc_rob or via his website: moredistractible.org

MEDICALEXAMINER

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APRIL 5, 2019

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OUR NEXT ISSUE: APRIL 19, 2019

’ve been getting winded lately.”

He’s a middle-aged man with diabetes. This kind of thing is a “red flag” on certain patients. He’s one of those patients.

“When does it happen?” I ask.

“Just when I do things. If I rest for a few minutes, I feel better.”

Now the red flag is waving vigorously. It sounds like it could be exertional angina.

In a diabetic, the symptoms of ischemia (the heart not getting enough blood) are atypical. It’s the pattern of symptoms that is the most important, and to have exertional shortness of breath which goes away with rest is a pattern I don’t like to hear.

What he needs is a stress test, more specifically in his case, a nuclear stress test (because his baseline EKG is abnormal). But there’s a problem: he has no insurance. A nuclear stress test will cost thousands of dollars.

I can refer him to the hospital, but I know the financial situation he and his wife face. They have no money because of a chronic pain problem he has. He hasn’t worked in several years, but hasn’t ever been able to get disability either (“I tried, but was denied three times”). Without insurance he’s not able to get his problem fixed, so he’s disabled. But he can’t get disability, so he can’t get insurance to get his problem

fixed and no longer be disabled.

The problem at hand is this: he needs a test he can’t afford.

There are many folks out there in this same situation.

It may not just be the people with no insurance, and it may not even be people who don’t have money. In fact, my own family is facing

He can’t afford to get the test. Or to not get the test. this same problem. Multiple family members (myself included) need dental work done. Some need it done badly, yet we don’t yet have the money to pay for it. So we wait for the money to show up while the problems get worse.

Many problems are being put off because of high deductibles or underinsurance. Sure, the ACA has helped people get insurance, but many people got the “bronze plan” and so pay out of pocket for much of their care. What ends up happening is that folks don’t get their blood pressure managed, their diabetes controlled, or their shortness of breath assessed because it simply costs too much to do so.

And so my patient, who has a lot more than cavities to worry about, puts me in a difficult situation. He can’t

afford to get the test done, and he can’t afford to wait to get this test done. We will do what we can to find ways to find the cheapest way to assess this problem and potentially fix it, but I am not sure exactly how we will accomplish that.

Until our healthcare system can figure out a way to handle this kind of thing, we will pay a big price. Waiting for problems to become emergencies is a terribly expensive approach to medicine. I’m not sure I know exactly what needs to be done for this, but it’s becoming an increasingly common problem. Some say that a single-payer system will be the remedy, but they ignore the fact that a thirdparty payer system is what got us in this mess in the first place. Things are far too expensive because patients don’t have to pay for them.

That’s why stress tests, which don’t actually cost thousands of dollars to do, are so expensive. That’s why there is $100 hemorrhoid cream. That’s why medications are unreasonably expensive: someone else pays the bill.

I hope the answers are out there somewhere. I’m trying to work on ways to negotiate cheaper prices for my patients for such services, but this kind of thing will take a lot of work and will have to overcome a lot of inertia. It’s going to take time.

Unfortunately, my patient with shortness of breath may not have so much time. +

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

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.”

“We had triplets.” “He was just two when he died.”

“The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.”

“I sure learned my lesson.”

“The cause was a mystery for a long time.”

“The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.”

“I thought, ‘Well, this is it’.” seven years ago.”

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“Turned out it was only indigestion.”

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“And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

Everybody has a story. Tell us yours.

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

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Sometimes I am just hungry for something slightly sweet, but I intentionally want to choose nutritious food, not empty calories. That’s why I created the recipe for these sweet & spicy roasted cashews. They are a delightful appetizer, snack or gift to give that is quick and easy to make. Best of all, these cashew nuts are healthful, gluten-free and vegan.

Cashews offer several health benefits, although many avoid eating them because of their fat content. The fact is that cashews contain less fat than many other nuts, and what they do provide is primarily unsaturated fat. Unsaturated fats can help lower cholesterol levels and improve heart health. Along with delivering healthy fats, cashews have a positive impact on health.

According to Weill Cornell Medicine, new research suggest that cashews and other tree nuts might be as effective as some of oncology’s most effective treatments at keeping colon cancer from recurring after surgery and chemotherapy—and even at keeping patients from dying. Of 826 patients in one study, those who reported having two or more servings of tree nuts per week (as 19 percent did) had a 46 percent lower risk of their cancer returning, and a 53 percent lower risk of dying than those who said they did not Sweet & Spicy Roasted Cashews eat tree nuts.

Roast nuts on a parchment paper lined sheet So eat cashews, and feel good about pan for about 10 minutes, stirring and turning your choice for a snack! pan 1/2 way through roasting. Then roast for another 7 minutes or until golden brown. I set my Sweet & Spicy Roasted Cashews timer and checked them every minute until they Ingredients were brown and caramelized. Be careful: they • 2 cups raw cashews can go from golden to dark fast!

• 4 teaspoons butter-flavored coconut Immediately after removing the cashew nuts oil, melted and warmed from oven, sprinkle with remaining salt and fresh • 3 tablespoons maple syrup rosemary. Allow to cool one minute, then give • 2 teaspoons brown sugar them a stir. Allow to cool another minute or so • 1 teaspoon pink Himalayan salt and then lift the parchment paper with the nuts divided on it and break apart any nuts sticking together.

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ASK DR. KARP

NO NONSENSE

NUTRITION

Rob from Augusta, asks: “Are all proteins the same quality or are some foods better to eat as a source of protein than others?

Great question, Rob. When I buy protein-rich foods, I am usually thinking about cost rather than the “plant vs animal” debate. Most of the time I end up buying the less expensive plant proteins rather than the more expensive animal proteins.

For example, think about the price of a steak compared to the price of beans, eggs or low-fat dairy. Quite a difference. In addition, when I

choose plant proteins, I stay away from the “millennial” protein fads, like quinoa, chia seeds, etc. and stick to the just-as-healthy and less expensive black beans, chick peas, potatoes (yes, a medium potato has about 4 grams of protein) and other plant sources.

It is ironic that most dietary recommendations for Americans de-emphasize the quantity of protein that should be in your diet and emphasize that your focus should be on the quality of protein instead. That’s because protein deficiency in the general U.S. population is rare. Yes, there are specific individuals who should be aware of their protein intake, people like vegetarians, growing kids, pregnant and breastfeeding women, people recuperating from surgery or an illness, people on very restrictive diets and the oldest-old. However, if you don’t have a specific medical reason to worry about the protein in your diet, you shouldn’t. Look around. In the U.S., chronic diseases such as heart disease, stroke, cancer and diabetes, are associated with diets too high in salt, saturated fat, sugar and calories, not diets too low in protein. Focus on those components in your food, not your protein intake.

Americans are following the present protein recommendations in reverse, doing the exact opposite of what is recommended by nutrition scientists such as myself.

Americans go around trying to gobble up as much protein as possible, paying little attention to the sources and quality of protein. If the food package says “protein” on it, Americans grab it up.

It’s a very expensive way of meeting your food needs. For example, although it is true that some Greek yogurts contain more protein than plain yogurt (for an extra cost), the extra protein is most likely meaningless for your health.

Another example are those high protein bars. Although high protein bars are all the rage, the fact is that they are basically glorified candy bars. I know the marketing and advertising tell you otherwise. Follow the science, not the advertisements.

Protein from plants is just

APRIL 5, 2019

as healthy as protein from animals, in fact, sometimes healthier. When you get your protein from plants, then fiber, unsaturated fat, vitamins and minerals also accompany the proteins. Animal proteins like beef, on the other hand, come along with higher levels of saturated fat, and in the case of beef, zero fiber.

Animal proteins are associated with more calcium, iron, and vitamin B12. However, if you drink low-fat or skim milk, eat low-fat dairy and eat eggs, you can get adequate calcium, iron and B12.

If you are a strict vegetarian (a vegan), then you need to take supplements to insure you take in enough calcium, iron and vitamin B12.

Since plants can’t make cholesterol, there is no cholesterol associated with plant proteins. In addition, most plants (with a few exceptions) contain mostly the healthier unsaturated, rather than saturated fat.

The health data is pretty clear; the higher saturated fat and cholesterol level in your diet, the higher your blood cholesterol level and the higher the risk of cardiovascular disease. In addition to the fat and cholesterol content of animal meat, the way the meat is cooked and prepared, such as grilling or preserving, can increase health risks.

What plants are the highest in protein? Plants like beans (soybeans, black beans, red beans, pinto beans, white beans, lentils, and chick peas), legumes and nuts.

So, what is the “No-Nonsense” nutrition advice for today? Simply this: when it comes to protein, get your protein mostly (if not exclusively) from plants, and choose the less-expensive varieties of plant proteins, not the fads. It is not a crime or a mortal sin to eat meat.

It’s simply an expensive and less-healthy way of eating compared to meeting your daily protein needs using plants. So stop obsessing about protein. If you need to obsess about what you eat, obsess about the fat, salt, sugar and calories in what you are eating instead. +

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

Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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Ask a Dietitian THE FRUIT VS VEGETABLE DEBATE

by Lo Bannerman, MS, RDN, LD Entrepreneurial Dietitian, Teal Avocado

Many people explain the difference between fruits and vegetables by seed location, taste, or educated guesses, but botanically speaking, there is a method to the madness of fruit and vegetable classifications. Without getting too scientific, let’s discover their culinary, legal, and botanical differences.

In culinary terms, most chefs and laypeople agree fruits are sweet and vegetables are savory, and the law tends to follow this theory. In 1893, Nix v. Hedden, a legal case involving a tomato importer and the New York port authority made its way to the Supreme Court. Ten years earlier, the Tariff Act of 1883 was signed into law, taxing imported vegetables but not fruits. The Nix family’s lawsuit claimed tomatoes are in fact fruits and should be excluded from this tax.

Unfortunately for them, the Supreme Court ruled that the Tariff Act of 1883 used the “common language of the people,” in which tomatoes are considered vegetables. The law got involved once again in 1947 when the US Customs Court in Buffalo, New York, ruled that rhubarb (coming from the stem-like part of a leaf) is to be taxed as a fruit because it is typically used as a fruit.

Botanically, both cases came to incorrect conclusions. Fruits are seed-bearing structures that develop from the ovaries of plants.

That means fruits include our sweet and juicy favorites such as apples, peaches, and berries, but they also include tomatoes, avocados, cucumbers, green beans, bell peppers, and eggplant. Legumes and nuts also fall under the botanical fruit category. Taking this one step further, berries are defined as fruits with multiple seeds all coming from one ovary. Botanically speaking, peppers, bananas, tomatoes, and grapes are all berries whereas raspberries and blackberries are considered aggregate fruits (a bunch of small fruits grouped together). Other categories such as Please see FRUITS v VEGGIES page 10

Lemon Dijon Asparagus This recipe is a surprisingly delicious way to eat asparagus and more (think green beans, and blanched broccoli too).

1½ pounds fresh asparagus ends trimmed 2 tablespoons extra-virgin olive oil 2 tablespoons lemon juice 1 tablespoon Dijon mustard 2 teaspoons minced lemon zest ¼ teaspoon ground pepper 1 teaspoon sugar 1 tablespoon minced fresh parsley 1 tablespoon minced fresh chives or dill Blanch the asparagus in boiling water for 3 minutes. Plunge it into a bowl of ice water to stop the cooking and preserve the bright green color.

Drain well. Whisk together the remaining ingredients in a small bowl. Pour over the asparagus and serve at room temperature. + Yield: 4-8 servings Nutrition Breakdown: Calories 110, Fat 8g (1g saturated fat), Cholesterol 0mg, Sodium 95mg, Carbohydrates 9g, Dietary fiber 2g, Protein 6g.

Reprinted with permission from the American Dietetic Association’s Cooking Healthy Across America (Wiley, 2004).

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H H H H H 3/27/2019 This kid at my school is always telling brainteasers. I told him it isn’t nice to tease, but he keeps doing it. So then I told the teacher because she always says don’t fight, tell me if there’s a problem.

But when I did she told me not to be a tattletale. So tomorrow I’m just going to beat the kid up. +

APRIL 5, 2019

FRUITS v VEGGIES… from page 9

accessory fruits (strawberries, for example), drupes (coconuts and peaches), pome fruits (apples and pears), and hesperidium fruits (citrus) also exist.

Vegetables, on the other hand, are any other part of a plant including leaves (spinach, romaine, kale), stems (celery, asparagus, bamboo), bulbs (garlic, onion, shallot), and roots (carrots, radish, sweet potato). Although both are flowers, broccoli and cauliflower are considered vegetables because they consist of compact heads/crowns of undeveloped flower buds. Lastly, roots can be subdivided as true roots including tuberous roots (yam, sweet potato, yuca) and taproots (jicama, radish, turnip, carrots), or modified plant stems including corms (taro), rhizomes (turmeric, ginger, ginseng), and tubers (potatoes). Is your head spinning yet?

Regardless of how you classify them, aiming for five to thirteen servings of fruits and vegetables each day is a wonderful way to get a large dose of vitamins, minerals, and antioxidants and help your body thrive! +

H H H H H 3/27/2019 This kid at my school told me he’s going to beat my brains out tomorrow. What did I ever do to him?

I told him either you figure out what word is spelled “incorrectly” in the dictionary or I’ll be the one beating you. That should keep him busy for awhile. +

Edwina Y. Augusta, GA

H H H H H 3/28/2019 When someone says, “it’s not rocket surgery,” does that mean they have brain damage? +

Jack H. Waynesboro, GA

H H H H H 3/28/2019 Ok, so the brain is supposedly the most complex matter in the entire universe. You hear all these amazing things about the brain all the time. But what is the source of all this pro-brain propaganda? The. Brain. Hello! Wake up people. The brain is so full of itself I can’t stand it. The next time you hear the term “brain trust,” don’t. Just don’t. +

Elena S. Evans, GA

Leon M. Aiken, SC

H H H H H 3/29/2019 I was reading about the blackpoll warbler. It’s this tiny bird that migrates thousands of miles every year over open ocean waters. How it navigates over this distance, flying non-stop for more than 72 hours, is a complete mystery to scientists. Obviously it has some sort of incredible innate intelligence. So the next time my husband calls me a birdbrain I’m going to say “Thank you!” +

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H H H H H 3/30/2019 You’re going to think I’m joking, but I actually know a girl named Sarah Bellum. Unfortunately for her though, I think all her brains are in her name. +

Tanya G. Grovetown, GA

H H H H H 4/1/2019 We’re building a new house in Columbia County with everything! I’m getting a dream kitchen that my husband said can include anything I want, like marble and granite countertops, stainless steel appliances, a Jenn-Air range, an island, a pantry, maybe even a brain drain. I don’t even know what that is, but I heard the term and I want one! +

Samantha K. Beech Island, SC

H H H H H 4/2/2019 Whenever I even think about exercise I get brain cramps. Just sayin.’ +

Kimber E. Harlem, GA

H H H H H 4/2/2019 I read a really interesting article about this new thing called brain mapping, but I can’t find it on Waze. Can anybody help me? +

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The blog spot — posted by Marcia Glass, M.D., on April 1, 2019 (edited for space)

A TRAGIC FENTANYL STORY Matt was 40. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler when you have a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on.

Matt’s best friend Ben organized his groomsmen to fly to Las Vegas for a bachelor party. They planned a crazy night out together, a break from their busy home lives juggling long work hours and small children. This was a weekend to suspend responsibility. Las Vegas is a good place for that.

They found an Airbnb near the Strip and set out for a night of drinking. At some point, one of Matt’s friends asked him if he wanted to try cocaine. He hadn’t planned on it, but the Vegas attitude was contagious. Matt decided to try some.

A friend of one of the groomsmen handed the cocaine out, and Matt snorted it soon after. He fell on the ground immediately, his heart stopped. Ben’s friends desperately tried to resuscitate him with CPR. It took at least 20 minutes for them to call 911. The cocaine Matt snorted was mixed with Fentanyl, a drug readily available on the streets and hundreds of times as strong as morphine.

When EMS arrived, Matt still had no pulse, so they tried to stabilize him in the field before bringing him to the hospital. They quickly gave him Narcan, the opioid reversal agent that almost certainly would have saved his life if they had made it to him sooner. They put a breathing tube in him since he was no longer breathing on his own.

They gave him drugs to start his heart beating again and shocked him several times with a defibrillator. Eventually, his heart started to beat spontaneously, and they drove him to our trauma hospital.

When I met him, he looked like a burly athlete who was sleeping connected to a breathing machine. His wife was sitting next to him after getting a call in the middle of the night to fly to Las Vegas immediately. She’d brought her baby and her toddler. She was petite, naturally pretty, completely in shock. She asked me if he was going to wake up. I wondered the same thing.

Our ICU team tried everything and talking to everyone – the ER doctors on call the night Matt came in, the neurocritical care specialist, the medical director of Las Vegas EMS. We went through every detail of his cardiac arrest, of the attempts to bring him back, of each medication given to him in the hospital. We checked his neurologic function over and over; we got second opinions, we sat in the room and listened to everyone cry. And still, he didn’t wake up. Every day Matt’s wife came to the hospital after she breastfed her baby and sat by his bed holding his hand and waiting for his eyes to open.

After a week, Matt’s wife was ready to disconnect him from the ventilator. This machine was keeping his breathing going while his brain had left a week ago. She knew he would never want to be kept alive by machines, and she couldn’t watch him in this state anymore. She gathered her family and explained as much as she could to her toddler, who’d been asking every day if his dad would help him fall asleep that night. Her raw personal suffering and her grief by proxy for her children were a hideous burden to witness. The resolution I felt knowing Matt would be spared an institutional existence tortured by devices was tempered by the nagging thought of his innocent children. They hadn’t signed up for this.

This is what’s happening in our country. Narcan would have saved Matt’s life, but no one at the bachelor party had it, and no one called 911 in time for EMS to bring it.

Fentanyl is a lethal substance concealed in drugs in your city. No one knows who will be next. + Marcia Glass is an internal medicine physician.

11 +

AUGUSTAMEDICALEXAMiNER

From the Bookshelf Editor’s note: The following is an encore review from an issue of the Medical Examiner in 2012.

For far too many of us, our identity and sense of personal worth is inextricably intertwined with what we do, our jobs, our careers.

That is a slippery slope, indeed. Jobs are temporary things. I know a young doctor here in Augusta, a decade or two younger than me, who suffered a stroke and was forced to leave his practice.

I frequently think about the plight of professional athletes, full-grown kids who can be considered old in their early thirties.

What do you do at age 30 when “old age” forces you into retirement from the job you’ve had since 3rd grade, the only vocation you’ve ever known?

Yes, what happens when the job that is your very identity is taken away from you?

That describes just part of the message of Still Alice, a book suggested for this review by a Medical Examiner reader.

It’s the story of a 50-year old woman, one Alice Howland, who is a celebrated and esteemed Harvard psychology professor, a woman known

for her intelligence even in the rarefied air of Harvard.

When she begins forgetting things a bit too often, she at first blames menopause, but eventually seeks medical help.

She gets a stunning diagnosis: early-stage Alzheimer’s.

Still Alice tells the story of the descent into Alzheimer’s from the viewpoint of just one person: Alice Howland. That’s unusual.

“The lion’s share of everything written about Alzheimer’s is written by clinicians or caregivers,” says author Lisa Genova, who happens to hold a Ph.D. in neuroscience from Harvard herself. “So we rarely get to sit in the seat of someone with Alzheimer’s.”

That perspective, however,

is one that many of us want to and need to understand.

Countless people who read this paper provide care every day for patients with Alzheimer’s. For others, their family’s matriarch or patriarch has the disease. That can sometimes mean spending the proverbial 36-hour day caring for someone you’ve known as long as you can remember, but who doesn’t remember you or know who you are.

That isn’t easy. But as is the case with almost every subject, the more informed we are, the more capably we can deal with difficult situations.

Alzheimer’s is like death in that none of us know anyone who has fully experienced it and then come back to tell us what it’s like.

Despite that handicap, Lisa Genova has given us a rare understanding from inside the mind of an Alzheimer’s victim.

In the Examiner’s nearly six years of publication, non-fiction books have monopolized this space. Still Alice seems like a great reason to make an exception. + Still Alice by Lisa Genova, 292 pages, published in 2009 by Pocket Books, Simon & Schuster

Research News The care and feeding of cancer Baylor College of Medicine and Weill Cornell Medicine researchers published a study last week in Science suggesting that consuming a modest amount of high-fructose corn syrup (HFCS) — an amount that would be the equivalent of drinking a 12 oz. sugar sweetened beverage each day — accelerates the growth of intestinal tumors in mice.

One of the mechanisms of this unhealthy development was the discovery of high levels of fructose and glucose in the intestines of mice compared with those drinking water only. Intestinal tumors use these sugars as fuel, accelerating their growth.

The study suggested a possible new avenue for cancer treatment: since fructose (unlike glucose) is not essential for survival, it’s possible that therapies targeting fructose metabolism by the body could help slow

the growth of cancers.

The best recommendation for one and all, however, is to reduce or eliminate the consumption of sugary beverages and HFCS. Mood enhancing chemical This isn’t one you have to get a prescription for, or buy secretly in a shady part of town. This chemical doesn’t work like that.

Some people have their own individualized strategy for improving a bad mood.

It might be eating chocolate or engaging in some retail therapy.

But researchers at Iowa State University found a better way.

Instead of focusing on ways to make ourselves feel better, their study found the best way is to wish others well.

Relax; this isn’t about walking up to complete strangers and saying, “Have a blessed day.”

This was all internal. Study participants were instructed

to walk around campus for 12 minutes while practicing one of three strategies: • Loving-kindness - Look at everyone they encounter and think, “I wish happiness for that person.” They were encouraged to really mean it in their thoughts.

• Connectedness - View others as people they’re connected with, imagining that they share many of the same hopes and dreams.

• Downward comparison To feel better, view yourself as better off in many ways compared to those you see.

Participants self-reported on their moods relative to stress, empathy, happiness and anxiety before and after the exercise.

Not surprisingly, the lovingkindness group felt happiest and both more caring and less anxious. The connectedness group felt the greatest empathy. The downward comparison strategy provided no benefit. +

+ 12

AUGUSTAMEDICALEXAMiNER

The Examiners +

Your friend is in the hospital?

by Dan Pearson

Yes. I’m going to visit her this afternoon.

Do you mean University Augusta?

Which hospital?

University Augusta AND Augusta University?

Well, you know there’s Augusta University too

No, Milwaukee.

Duh! Of course Augusta!

ACROSS 1. 1951 Masters champion 6. Last name, with 55-A 10. Medicine 14. Throat dangler 15. By mouth 16. Clinton Attorney General 17. Drug runners 18. Exhort 19. Untie 20. Entirely 21. Capital of Western Samoa 23. Emptied (as a bladder) 25. Unnecessary 27. Snake 28. Famed dancer and actor 29. Itinerary shorthand 30. Gamma follower 32. Israeli submachine gun 33. Wrestling acronym 34. Little old Chevy 35. Cleveland nine, casually 38. Java 39. Cowboy show 40. Welt 41. Pledge 42. UGA conf.

43. To be under the weather 44. Doggie doc 45. Famous area road 49. Noted downtown building 51. Unusual 52. Ed Rice or Philip Morsberger 53. NBA team not ending in S 54. Georgia-based news pioneer 55. First name, with 6-A. 56. Ahmadinejad’s country 58. Land grant holder (in Old England) 60. Computer command 61. AU Health’s ____ Lane Parking Deck

WORDS

NUMBER BY

The Mystery Word for this issue: MATRUEA

1

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3

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5

6

7

Yes. When she gets home.

8

9

10

14

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17

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26

11

32

30

33

37

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44 49

31

34

38

43

13

24

29

36

12

27

28

35

I have no idea.

© 2019 Daniel Pearson All rights reserved.

Well are you still going to visit her?

PUZZLE

THE MYSTERY WORD

University.

Nope. So which one is it?

EXAMINER CROSSWORD

You’re kidding, right?

Yeah, both.

APRIL 5, 2019

45

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47

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51

52

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DOWN 1. Doctors (once upon a time) 2. Undeveloped seeds 3. Esophagus 4. Malt beverage 5. Pronounce as a nasal sound 6. Augusta author Shivers 7. Rich tapestry 8. Aiken has-been 9. Raise 10. Augusta Park?

11. Portrayed 12. Not legal 13. Well-behaved 22. Prefix for “around” 24. Room within a harem 26. Meat stew braised in red wine 29. Female sheep

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, APRIL 15, 2019

We’ll announce the winner in our next issue!

E X 3 A M I 5 N E 2 R

1 2 9 8 6 9

3 8

7 4

7

1

S U D O K U

9 5

8 7 6 5 1 4 9 8 7

3 4

by Daniel R. Pearson © 2019 All rights reserved.

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

by Daniel R. Pearson © 2019 All rights reserved.

62. Duck with soft down 63. River in central Europe 64. Comply 65. Prepared

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

31. NBA’s Ming 33. Exclamation of surprise 34. Pertaining to the voice 35. Major airline of yore 36. Georgia and Bank separator (once upon a time) 37. Inferential; by inference 38. Write down quickly 39. In law, a defendant’s reply 41. Only movie ever named for an inner ear problem?

42. Caribbean calypso music 44. -ectomy beginning 45. Really, really small 46. Noisy insect not heard for years at a time 47. Preserved produce 48. Mean, stubborn 50. Skinflint 51. Facet 52. Too 57. Steal from 59. Hasten Solution p. 14

QUOTATIONPUZZLE W U A M N Y N U T S R I O G O E O E E ’ I E B D A R U P N S L T R O O N E O D N N T I D H V D E

8 4 6 1 3 2 4 8 7E 3 5C 9 9 7 T 1 6 2 5

— Amelia Earhart

by Daniel R. Pearson © 2019 All rights reserved

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.

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.

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

1

8 9 10 11

2

3

U 1 2 3 4 5 6 7 8 9

1 2 3

1 2 3

— Dr. Seuss

1 2 3

A 1 2 3 4 5 6 7

1

2

3

1

2

3

4

5

6

1.AAAASSTTCQ 2.HHOONNRRUI 3.DEEEEEMMMS 4.SEWPP 5.LLTTE 6.EIIIR 7.MSOC 8.NEA 9.TSS 10.E 11.D

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

7 5 9 6 2 1 3 4 8

3 8 1 7 9 6 2 5 4

5 9 7 2 8 4 6 3 1

2 4 6 1 5 3 8 9 7

APRIL 5, 2019

13 +

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

A

circus couple wanted to start a family, but after trying for some time and failing, and then exhausting all medical options, they decided to try to adopt a child.

Naturally, their traveling circus lifestyle was an obstacle, but the couple showed the social worker photos of their beautiful and spacious motor home, already equipped with a nursery.

While the social worker was impressed, she raised concerns about the inability of a child who lives on the road to receive a good education.

“We have arranged for a full-time tutor,” said the husband, “who is skilled in all subjects, has degrees in elementary education, computer science., and she speaks English, French and Spanish.”

“That’s reassuring,” said the social worker, “but I still think living the circus lifestyle is not an stable environment for raising a child.”

“I think you’ll be glad to know the nanny we have hired,” added the wife, “is a registered dietitian, a certified chef, and she has ten year’s experience in childcare.”

The social worker was finally convinced.

“What age child are you hoping to adopt?”

“Any age, really,” said the husband. “As long as he fits in the cannon.”

The

Advice Doctor ©

Moe: Man, I would love to be a lawyer.

Joe: Why? Moe: Well, I should clarify. Specifically, I would love to be a lawyer defending a penguin.

Joe: Ok, I’ll bite Why? Moe: Because it would be so cool to say, “Your honor, clearly my client is not a flight risk.”

Moe: What did you tell the cops? They must have been grilling you for what, the last two hours?

Joe: The whole time I just kept saying “No comment.”

Moe: Well how did it all end?

Joe: They said I could leave. Oh, plus they said I didn’t get the job.

Moe: Yesterday for old time’s sake I drove by the house I grew up in. It sure brought back a lot of memories. I actually went up and knocked on the door and asked if I could go in and look around for a few minutes.

Joe: Did they let you?

Moe: No, my parents are total jerks.

Moe: What has eight legs and eight eyes?

Joe: Eight pirates?

Moe: What do you call a witch that eats nothing but sand?

Joe: Haha, that’s easy. A sandwich!

Moe: Oh. I was going for malnourished. +

Why subscribe to theMEDICALEXAMINER? What do you mean?

Staring at my phone all day has had no Effect on ME!

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

SUBSCRIBE TO THE MEDICALEXAMINER +

+

Dear Advice Doctor, My supervisor asked me to do a job that was his responsibility on the basis of an excuse that turned out to be completely bogus. Not to brag, but I killed it and he got all kinds of praise for the project, but he never told anyone that I actually did it. Not only did he fail to thank me (even privately), he offered a left-handed compliment about the job that was really more insult than commendation. Do you think I should go upstairs and tell his supervisor the whole truth?

— Wants to Return the “Compliment” (if you know what I mean) Dear Wants to Return, Once upon a time this would have been a simpler topic to discuss, but as more research is conducted and analyzed, some former “facts” are relegated to myth status by new and unexpected discoveries. Even so, very little about left-handed anything (except compliments) is carved in stone.

For instance, in the days of old wishing left-handedness upon someone was like putting a curse on them: left-handers were believed to be more susceptible to sickness and have shorter life spans. Scientists now generally accept that being a leftie or a rightie has no effect on longevity.

There are differences, however. Some studies (but not all) suggest that being left-handed affects early learning and school performance in areas like vocabulary, reading, writing, social development, plus gross and fine motor skills (not to mention scissor use). Oddly enough, ambidextrous or mixedhanded kids perform at a still lower level than southpaws.

Some studies also suggest a link between left-handedness and a greater incidence of mental health issues like dyslexia, attention deficit hyperactivity disorder, and some mood disorders. Being left-handed may also be connected to a higher risk of breast cancer, sleep problems and a greater susceptibility to PTSD. On the plus side, being left-handed can help protect against arthritis and ulcers.

But keep in mind that despite the findings of any ten studies, there are millions of left-handers who don’t exhibit learning disabilities, mental health issues, or any other negatives for which lefties are supposedly at higher risk.

Ultimately, what researchers don’t know about this topic — including why some of us are rightie and others are leftie in the first place — is far greater than what they do know.

I hope that answers your question. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

Why read the Medical Examiner: Reason #53

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

2

+ 14

4

9 7

8

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

...cleverly hidden on the leg of the far left musician in the p. 16 ad for SILKROAD ENSEMBLE CONCERT THE WINNER: DIANNA WILSON! 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!

APRIL 5, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED H U M A N A

O V U L E S

G U L L E T

T R I W A L A I L L A A R T L O I S A V O D E

A N L A E S A D L A I U Z B E E V M A I S S E R

L O U P I E S R E I J V O E T R T I R G O O B

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

R E N D E R E D

U N D E R A G E

G O O D

C I C A D A

C A N N E D

O R N E R Y

Y A O

SEE PAGE 12

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

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package!

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

6 3 4 7 5 9 1 2

1 2 8 3 9 7 6 5

5 9 6 2 1 3 4 8

Love to stare at your phone?

Visit issuu.com/ medicalexaminer and stare away.

8 1 7 9 6 2 5 4

9 7 2 8 4 6 3 1

4 6 1 5 3 8 9 7

7 4 3 1 8 5 2 6

2 5 9 4 7 1 8 3

3 8 5 6 2 4 7 9

QuotatioN QUOTATION PUZZLE SOLUTION “Never interrupt someone doing what you said couldn’t be done.”

— Amelia Earhart

WORDS

BY NUMBER “

Sometimes the questions are complicated and the answers are simple.”

— Dr. Seuss

+

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

APRIL 5, 2019

15 +

AUGUSTAMEDICALEXAMiNER

Spread the love The #1 word we hear from readers when they talk about the Medical Examiner is love.

“We love your paper!” That is a very cool thing. Our response: “We love you back!”

But don’t stop with loving just the Medical Examiner. Please save some love for our awesome advertisers. Their support makes this free newspaper possible.

In turn, our support of them makes everyone happy.

“I saw your ad in the Medical Examiner.

Do you carry...?”

“Thanks for advertising in the Medical Examiner.”

ThE

On

+ 16

AUGUSTAMEDICALEXAMiNER

IT’S A QUESTION OF CARE Advance Directives

If you have ever accompanied an elderly parent or friend to the hospital or a doctor’s appointment, you’ve probably heard the question, “Are you the power of attorney?”

Healthcare Power of Attorney is a type of advance directive in which a trusted person is designated to execute end of life wishes and/ or to make medical decisions in the event an individual is unable to speak for himself.

The “powers” of a Healthcare Power of Attorney (also known as agent or proxy) are meant to be broad, so it is important to discuss desired medical treatment, or lack of treatment, with your agent at length. If specifics are known, a Living Will should be considered. A Living Will is a document that can be

utilized to express specifics of treatment that are desired, and can include details about CPR, tube-feeding, artificial respiration, comfort measures, and even burial/cremation plans.

Advance Directives are important because without them families are left struggling to determine what their loved one would have wanted for themselves. These matters are literally life and death, because without direction family members will have to make decisions about life-sustaining medical procedures. I have worked with many patients who are suspicious about completing advanced directives because they feel they will be giving up the power to make their own medical decisions. My argument is that, on the con-

APRIL 5, 2019 trary, completing advanced directives and designating a trusted power of attorney ensures that you are able to make your own decisions, even in the event that you are unable to speak for yourself.

The person best suited for the role as your Healthcare Power of Attorney may not always be the most obvious choice. Be sure to choose someone who will be able to follow through on your expressed wishes. A spouse or child may have difficulty with your choices, so discuss this with them prior to designation.

Most states have come to recognize the importance and benefits of advance directives and have made fillable documents available on their state government websites. Always be sure to read the fine print,

as witnesses and a notary public are likely required to make the document legally binding. If you have the financial ability, an elder care attorney will also assist with completion of documentation. Once forms are completed, original copies should be stored at home and a copy should be given to your physicians, Power of Attorney, friends and family.

Leah Klein, LMSW, MPH, has been working with the geriatric population since graduating from The University of Georgia with a dual master’s in social work and public health in 2014. Currently, she is an Aging Life Care Manager and Medical Social Worker, and has worked in the fields of skilled nursing, hospice, and home health.

PROFESSIONAL DIRECTORY +

ALLERGY

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

AMBULANCE SERVICE AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

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

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

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

IN-HOME CARE

DENTISTRY

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

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

Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE WOODY MERRY www.woodymerry.com Long-Term Care Planning I CAN HELP! (706) 733-3190 • 733-5525 (fax)

Medical Center West Pharmacy 465 North Belair Road Evans 30809 Georgia Dermatology & 706-854-2424 Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) www.medicalcenterwestpharmacy.com Augusta 30904 Parks Pharmacy 706-733-3373 SKIN CANCER CENTER 437 Georgia Ave. ARKS www.GaDerm.com HARMACY N. Augusta 29841 803-279-7450 www.parkspharmacy.com Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com

DRUG REHAB Steppingstones to Recovery 2610 Commons Blvd.

Augusta 30909 706-733-1935

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

TRANSPORTATION Caring Man in a Van Wheelchair-Stretcher Transports • Serving Augusta Metro 855-342-1566 www.CaringManinaVan.com

VEIN CARE

PHARMACY

DERMATOLOGY

DEVELOPMENTAL PEDIATRICS

SLEEP MEDICINE

P

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

YOUR LISTING HERE Augusta Area Healthcare Provider Prices from less than $100 for six months CALL 706.860.5455 TODAY!

If you would like your medical practice listed in the Professional Directory, call the Medical Examiner at 706.860.5455