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AUGUST 21, 2015

S I E M F O

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AN AMAZING TRUE TALE by Ryan Heckendorn Medicine in the First Person Page 3

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AUGUSTA MEDiCAL EXAMINER

AUGUST 21, 2015

Kid’s Stuff

NOTES FROM A PEDIATRIC INTERN by Caroline Colden, M.D.

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daily activities of living, or only master these much later than other children, and they can even have lower lifetime intelligence if the brain growth is harmed extensively enough. Babies exposed to tobacco during pregnancy are at much greater risk for being born prematurely and with very small birth weight. Premature babies often spend time in the neonatal intensive care unit because of underdeveloped lungs or other life-threatening issues from being born too early, and they have increased risk of having medical issues later in life, too. Smoking during pregnancy also increases the risk of placental abruption — the separation of the placenta — too early. This causes severe bleeding in the mom that can be life threatening, and also severely reduces the amount of lifesustaining blood going to the baby as well. Unborn and newborn babies are completely dependent on their mothers and families to keep them safe. They have no way of controlling their environment or safety, and rely on the people who love and care for them to protect them. So if you smoke, please quit today, for the sake of all the children around you who rely on you to keep them healthy. +

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Let’s talk about smoking. Cigarettes are bad for us, and we all know this. They are even worse for kids. Kids can be exposed to the harms of cigarettes in many ways – second-hand smoke (by inhaling the smoke around them), third-hand smoke (from the chemicals and toxins leftover on a smoker’s clothing, carpet, skin), and possibly even firsthand smoke from using cigarettes themselves. Studies have shown again and again that kids who are exposed to smoke, whether it’s first-, second- or third-hand, are more likely to get upper respiratory or ear infections, bronchitis, pneumonia, asthma, and suffer from other health problems. Young babies exposed to smoke are at even greater risk because their bodies are more delicate and they cannot remove themselves from dangerous situations. Infants are also at risk for the horrible condition known as SIDS, or Sudden Infant Death Syndrome, which is characterized by a seemingly healthy baby passing away during sleep, without a direct cause ever being identified. Another population of babies that can be seriously harmed by cigarettes includes those who are still in their mom’s bellies. In fact, the effects of smoking by a pregnant mom can sometimes be even worse for a child before they are born. Mothers who smoke during pregnancy vastly reduce the amount of oxygen their babies get while they are growing. This can cause significant brain and organ damage, especially if the mother is smoking several cigarettes daily. Even though the babies are not directly breathing in the cigarette smoke, the harmful chemicals, including carbon monoxide, lead, arsenic and tar, are passing from the mother’s blood stream to the baby’s, poisoning their bodies. Smoking increases the risk for birth defects to occur, especially cleft lip and palate, or for the babies to die before they are even born. Babies might experience developmental delay, difficulties with learning to walk, talk or perform

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1/3 of me is gone! “I kept it simple.” responsibility to those two, so fix it.” First let me say yes, it is hard at first, but it’s so worth it. I didn’t go on any specific diet that tells you to eliminate or avoid any food group, like carbs or glutens. I just kept it simple: I do my best to no longer drink soda, to eat breakfast, eat more fruits and vegetables, to eat lean meats and no fried foods, and I cook most of what I eat. I downloaded an app called Lose It. This tracked my caloric intake and output. After two weeks of changing my diet in those ways, I started walking. I took it slow, walking during lunch and after work. I worked up to a mile here and a mile there, tracking my food and my limited exercise with the Lose it and MapMyWalk apps. With less weight I was able to be more active. The more I walked, the less my knees hurt and the more weight came off, and a cycle was started. Now I run 4 miles a few afternoons a week and up to 10 miles on Saturday

mornings. I have no joint pain, a resting heart rate of about 50 beats per minute, and my blood pressure is great! Here is how I intend to keep the weight off: do something every day. Walk, run, swim, hike, shadow box, play tag, something. It doesn’t matter if it’s only for 10 minutes, just do something active. Don’t get yourself into a restrictive diet. No carbs, no glutens, no ice cream — does that sound like something anyone can sustain for more than a few weeks? Eat right and be aware of what you’re putting in your body, but don’t be fanatical. Have a treat every now and then, like a little ice cream after dinner or some dark chocolate. Workout time is for working out. Don’t make it anything else or let anything interfere with it. Set reasonable goals and exceed them. (My big longterm goal is to run a marathon by the time I turn 40.) Lastly, I know this may sound conceited but it has worked for me: look in the mirror. A lot. I’m doing it so I don’t have to have a picture taken by a total stranger kick me back into reality. + — by Ryan Heckendorn Columbia, SC

Everyone with a story to tell is invited to send it in for Medicine in the First Person. There are few rules: it has to have something to do with health, medicine or general wellness. It can be short or long, tragic or funny, and we’ll publish your name or say it’s anonymous if you prefer. See above right for contact information.

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

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A year ago I weighed 257 pounds. Today I weigh 172. How did you lose so much weight? Why did you start it? What diet are you on? Was it hard to do? How do you continue? Aren’t you always hungry? Don’t you miss carbs? These are a few of the questions friends and coworkers have asked me. I started about a year ago after coming back from a family vacation at Hilton Head. While in Hilton Head, we asked a passerby to take a picture of me, my wife Holly, and our daughter. When I saw the picture I couldn’t believe what I looked like. The whole rest of the vacation I didn’t want to take my shirt off. I knew I was bigger than I should be, but something about that picture really hit me. It was as if all the problems from my weight came into focus from that one picture: sore joints, sleep apnea, constantly being out of breath, blood pressure too high, clothes always getting tighter... I thought, “Boy, you better start doing something or you may not make it long enough to see your daughter fall in love and get married, or retire, or go on all the wonderful vacations you and Holly are always talking about doing. You have a

AUGUSTA MEDiCAL EXAMINER

MEDICAL EXAMINER

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 news within every part of the Augusta medical community. Submit editorial content to graphicadv@knology.net Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com Augusta Medical Examiner photography: H + D Photography www.handdphoto.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net Opinions expressed by the writers herein are their own and their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., or its agents or employees take any responsibility for the accuracy of submitted information, which is presented for informational purposes only. For specific medical advice, diagnosis and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2015 PEARSON GRAPHIC 365 INC.

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AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

OLD NEWS

WORLD OF MEDICINE

POINTS OF INTEREST TO FORMER KIDS

“Obamacare” in other places on the planet R National Health Insurance in Taiwan

by guest columnist Fox Si-Long Chen Augusta, Georgia

ational healthcare in the U.S. has been a constant source of debate. Despite countless reforms, healthcare in the United States is still perceived as expensive and inaccessible to a lot of people. Even those who are insured under national plans face great limitations in their healthcare options. Before Obamacare was officially implemented, I was a junior in college who constantly heard objections to any form of national healthcare from my peers. To me the question wasn’t, “Why should we have national healthcare?” It was, “Why has it taken so long for us to have a national healthcare?” To my friends in the U.S, it was hard to convince them that a national healthcare program was feasible; in fact, it has been feasible for many countries for decades. Where I originally come from — Taiwan — there is a national health insurance (NHI) program that covers everyone in the nation. It offers great choices of doctors and a variety of service options with short wait times. Best of all, it is affordable. Before the national healthcare movement there, only a little over half of the Taiwanese population was insured by different public insurance schemes. In the 1980s, Taiwan’s economic growth also resulted in a growing demand for affordable health insurance. President Lee Teng-Hui initiated the planning of NHI in 1986; it took about five years of drafting and two years of legislative work. The launch of the NHI program took place on March 1st, 1995. Keep in mind, Germany, England, Canada, France and many other nations already had an NHI system in place long before Taiwan. Taiwan took those countries’ success as models and crafted a national healthcare system as a government-run program. It was modeled after provincial health plans and a payroll-based premium system. Three years after its inception, 92 percent of the Taiwanese population was enrolled under NHI. As of this year, enrollment has risen to 99.9 percent. Some 92.6 percent of hospitals, clinics and healthcare facilities are affiliated with NHI. By law, NHI cannot operate as a for-profit enterprise. Funding for NHI comes from several sources: taxes, employers, premiums from the insured, co-pay charges, supplemental premiums, contributions from the public welfare lottery, and cigarette taxes. The premium is the primary source of funding among all the sources. Insured individuals, providers, and the government all have a monthly share in premium. The premium for an individual is based on his primary payroll income (at 4.91 percent), in addition to the number of dependents (up to three). Patients are responsible for their copayments, but the payments are designed to be inexpensive. The primary purpose of co-pay is to discourage unnecessary overuse of healthcare. To put it into local context (in other words, as US dollars), a patient pays the equivalent of $7 with a referral, and $12 without, for a visit. Co-pay for dental care and traditional Chinese medicine visits are always the same: $1.67. Hospital stay and prescription co-payments are based on 10 to 20 percent of the overall cost (depending on the situation), but Taiwanese NHI has a cap on the total amount for a co-pay, so patients will never face bankruptcy. Earier this year the referral system was integrated into the co-pay system, which helps individuals with referrals pay lower co-pays compared to those without referrals. Furthermore, co-pays are exempted for aboriginal groups, women in labor, veterans with low income families, children under three, or any patients suffering from cancer, tuberculosis, chronic renal failure, and immunodeficiency disorders. Please see TAIWAN page 6

by Trisha Whisenhunt, Senior Citizens Council

THE SECOND TIME AROUND: GRANDPARENTS AS PARENTS

ehabilitation can mean learning a new skill — or it can represent every parent’s worst nightmare of a child with an addiction who needs to be in a residential rehab facility. Sometimes this nightmare is visited upon the grandparents. In the State of Georgia, there are 164,432 children living with their grandparents. That is 7.6% of all children in the state. Another 53,785 live with other relatives. Of the households headed by grandparents and other relatives, 98,773 of these children are living without either parent present. Nationwide the numbers are 4.5 million living with grandparents, another 1.5 million living with other relatives. This is a 30% increase since 1990 and a 15% increase since 1997, according to AARP’s website. I recently had an opportunity to visit a residential rehabilitation facility in Atlanta. While attending a lecture, I noticed an older woman who was accompanied by a young

woman and an infant. This grandmother told me a story of years of drug abuse by her son. Her failed efforts to help finally brought him to the choice of rehab or jail. She had burned through her savings to pay for his treatment, used up vacation and sick time in order to be available for therapy sessions, both group and private, lectures and family visits. Her insurance was maxed out for the year and she felt stressed over the possibility of becoming ill and having no coverage for herself. Her employer was empathic, but any further time off would have to be without pay. She worried about providing for her grandson with reduced income while his father’s recovery time remained openended. As a last resort she was now turning her eyes to her 401(k) as a source of immediate income. The baby’s mother

holds a part-time job and said if it were not for her child’s grandmother, she didn’t know what would become of her and the baby. This is a family in crisis, stretched to the breaking point by the overwhelming and tenuous odds of recovery, knowing that statistics are against this being her son’s one and only attempt at getting clean. Many grandparents find themselves in a similar situation; they have worked all their lives and raised their families, and finally are at a place in life where they can focus on themselves — only to find that for whatever reason they are forced to step into their children’s shoes and become hands-on parents again for grandchildren. For most of us, raising a child under the most ideal conditions is a challenge. For grandparents that may have health problems and other concerns, being a fulltime parent again can get complicated. There is help; start with your computer. Type in “Grandparents raising grandchildren.” You may be surprised by how many websites pop up. I recommend www.aarp.org/grandparents/. This website offers a large variety of subjects especially for the grandparent raising children for the second time. The reasons why grandparents take on the role of parenting vary widely. Some stories I’ve heard are sad, many have been inspiring. All are heroic. +

MYTH OF THE MONTH I can make up for lost sleep by sleeping in on the weekend This is semi-true, but that doesn’t make it a good idea. The body has a built-in recovery system for people who ignore the guideline that everyone knows: that we each need seven to eight hours of quality sleep per night. Think of it like this: if you had been crawling through the desert for days without a drop of water and then you found a gallon of cool, clear, pure water, you wouldn’t politely sip a little; you would guzzle a quart or two and pour another quart over your head. The sleep-deprived body is like that: it will immediately dive down into the deepest sleep and REM stages that it has been missing, foregoing other stages of sleep.

This recovery system only works within limits: you can’t subsist on five hours of sleep a night all week and then think a few hours extra over the weekend will compensate. You’ve dug yourself a hole that’s too deep to get out of. Your deficit will remain. But to go back to the desert analogy for a moment, what physical damage is done by someone who deprives their system of water - or sleep? It is far better to avoid deprivation than to try to later repair it or recover from it. + — by F. E. Gilliard, MD, Family Medicine 639 13th St Augusta, GA 30901 706-823-5250

AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW res? ABOUT MEDICAL DIALECTS

k good eno r skin can ugh cer? son.”

ack in the last century when I attended medical school, things were different. I went to the Medical College of Georgia. For more than 100 years, it was a name Georgians were proud of. The hospital had 8 floors and was named for Governor Eugene Talmadge: Eugene Talmadge Memorial Hospital or ETMH. The Governor’s son became our US Senator representing Georgia. I roomed with the Senator’s son at UGA. After UGA, ETMH and MCG had special meaning to me. They took me from the tobacco fields of South Georgia and put MD after my name. ETMH was known throughout Georgia as the hospital you went to when you were very sick. You either “got well” or “got dead.” Such was the case with my childhood neighbor’s daughter, Vernell. The local physician heard strange sounds in her heart, so be referred her to ETMH. Her father brought Vernell up here in a pickup truck, set through hours in the admission clinic with her — and then went home, leaving a frail, frightened teenage girl alone in Mr. Talmadge’s hospital. The tallest building k

she had ever seen before coming here was a two story court house. A month later, the Bacon County Sheriff showed up at her father’s house, telling him that there was a telephone call for him regarding his daughter at the Sheriff’s office. (That’s right, back then we didn’t have telephones at home because we lived out in the country. Only city folks had telephones.) The voice on the phone said he could come to get Vernell. When he picked her up at ETMH, he was told that she had a new heart valve, but probably wouldn’t live very long. The doctors in ETMH lied. She lived another 50 years. Such were the wonders of ETMH and MCG. When I was a junior at MCG, we got a new head for the Department of Medicine. She was a Yankee. She did not speak Southern dialect. Some of our students and residents were from out-of-state or Atlanta and did not speak the dialect either. The Department Head was fascinated by my accent and knowledge of South Georgia dialect ... or so she said. She arranged for me to dictate a list of commonly used terms which her secretary typed up and ran off copies FREE T AKE-H OME C OPY!

MEDICAL EXAMINER

t s e B to be handed out to anyone who was afflicted with the inability to adjust to the local patient population. It COUNTRY TERM Brown Crowders Kernel Heart dropsy Flutters Squirts Green apple trots Back door trots Gouch Flowers Fell off the roof Flying the flag Pigged 9-month virus Got popped Pukified Knee-monia Laid up Hen-pecked Shakes and Horrors Snakes in the Head Claps Quincey Ants in pants Slack Jawed Mouth breather

e n i c i d ME

turns out that most patients do not speak Latin or Greek, nor have they read Harrison’s Internal Medicine

TRANSLATION Bronchitis Swollen Lymph Node Congestive Heart Failure or CHF Atrial Fibrillation or A-fib Diarrhea Diarrhea Diarrhea Gout Monthly period Monthly period Monthly period Pregnant Pregnant Pregnant Nausea & Vomiting; N&V Pneumonia Sick or injured; unable to work Husband ruled by wife D.T.s; Delirium Tremens Mental Problems Gonorrhea Tonsillar abscess Anxious or hasty Unintelligent Unintelligent

nor Guyton’s Physiology. (Together these books weigh about 10 pounds.) I no longer have a copy of my piece and momentous document. (It did not make the New York Times best seller list.) But I do remember some of the 300 or so words, and a few of them are in the shaded box so that you can entertain yourself. If you become ill while stranded on the edge of the Okefenokee Swamp and run into a swamper, with these terms in your vocabulary you can describe your illnesses to him with some degree of certainty that he will comprehend. Now, if you instantly recognized 6 or more of these terms, you are more country that you care to admit in distinguished company. On the other hand, you are the salt of the earth and an asset to our declining society. You are my kind of people. + Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology. net or 706-306-9397.

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AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

TAIWAN… from page 4 supplemental premium should help NHI to be financially sustainable through at least 2017. From the launch of the NHI until today, the improvement in the health of the nation overall has been remarkable. In addition, foreign nationals are eligible to enroll after living in Taiwan for 6 months. Inmates are now covered under the establishment of second generation NHI. As for native citizens having emergency procedures while abroad, out-of-pocket expenses can be reimbursed by NHI. The U.S. has been a leader in the international arena for many reasons. Yet, when it comes to its health insurance system, it seems the U.S. has fallen behind. While NHI is only available from one provider, it provides individuals with equal access to a variety of services from different physicians and facilities. By comparison, our plan here offers many providers and many complicated plans to choose from. My hope is that the U.S. will eventually develop a system that borrows the best elements from the best programs around the world. National insurance should be available to everyone. It should include a comprehensive benefits package that allows everyone to have equal access to excellent care options at an affordable price. That is what a good health insurance program is all about. +

Over the years, Taiwanese NHI has faced its own share of obstacles. Because of such a high NHI utilization rate and increased traffic to hospitals, there has been a shortage of doctors, nurses and hospital staff. However, since 2001 the majority of patients are managed via NHI Identification Card (IC). This smart card not only reduces hospital administration work, but also keeps records uniformly and accessible to hospitals and physicians alike. According to the IC database, a Taiwanese citizen has an average of 14 hospital or clinical visits per year. It’s quite normal for an average Taiwanese doctor to see up to 50 patients in a day, which results in a short consultation duration. Each session typically last between 10 to 15 minutes, and it’s rare that a session would take over 30 minutes. Overcoming the financial challenges the program presents has always been a top priority. The Taiwanese government has to constantly borrow from banks to cover expenditures. The premium rate was 4.25 percent for the first seven years after the NHI’s inception. It was raised to 4.55 percent in 2002 and then to 5.17 percent in April 2010. After the launch of the secondgeneration NHI in 2013, the premium was reduced to its current 4.91 percent. The secondgeneration NHI collects a supplemental premium of an insured individual’s annual bonus if it is greater than a quarter of his annual pay, stock dividends, and interest at a rate of 2 percent. The purpose of this progressive design is to increase the premium on people of wealth rather than those of disadvantage. It is estimated that the

Editor’s note: If you have a viewpoint or experience on medicine, health, or wellness that involves somewhere other than the US, we’d love to hear from you too. Medical Examiner addresses are shown on p. 3.

TAKE ONE TABLET

Seniors Caring for Seniors by Kathy Crist Paul is 92 years old and is slowed significantly by Alzheimer’s disease, but when his 74-year-old home caregiver arrives to get Paul out of bed, bathed and groomed, the day takes a turn for the better. As the demand for senior care services increases across the country, more and more families are finding a supportive lifeline in older caregivers – who are sometimes nearly the same age as their clients. The Paraprofessional Healthcare Institute, a Crist nonprofit advocate for America’s workers caring for the elderly and disabled, projects that by 2018, 29 percent of direct senior care providers will be age 55 and older. In some U.S. population segments, seniors already make up the majority of older home healthcare professionals. Home health jobs are fast-growing in today’s world of everincreasing elderly baby boomers. With the challenging job market and people living longer on fixed incomes, many American seniors are drawn to work in elderly care to supplement their retirement incomes. And despite the physical demands, thousands of older individuals are finding success and fulfillment in helping other aging adults. Right at Home has lots of direct experience in hiring senior adults to provide home healthcare for other seniors and disabled adults. In both 2014 and 2015, our company honored a senior professional caregiver as the Right at Home National Caregiver of the Year. Both of these extraordinary senior caregivers demonstrated exceptional skills and compassion in caring for their elderly clients. Active older caregivers often stand out with years Please see SENIORS page 13

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re you a New Year’s resolution fan? Or a resolution hater? Both sides in this annual discussion have their valid points. On the negative side, by the time you read this many carefully made resolutions may have already slipped a little. Statistically, by this date (January 9) 25 percent of all resolutions have already gone down in flames; that many usually fail within the first week. By the six-month mark the failure rate is about half. And by this time next year, the wreckage of 88 percent of all those shiny new intentions of last week’s New Year’s Day 2015 will lie strewn across the landscape. On the plus side, that means a fairly decent 12 percent of all resolutions are achieved after a full year. Building on that positive note, making New Year’s resolutions is evidence of one of the finest aspects of human nature — that we continuously evaluate ourselves and constantly strive to improve, to be better husbands or wives, better moms and dads, better employees, better bosses, and just better human beings. The typical resolutions reflect those basic desires: the #1 resolution every year is always some form of better health. Lose weight. Get more exercise. Eat less junk food or fast food. Eat less, period. Quit smoking. Drink less, or quit altogether.

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You really can’t fault anyone for such noble goals. After all, health is the ultimate wealth. It’s the currency that makes every other endeavor in life possible. Speaking of currency, improving finances is, broadly speaking, the second most popular resolution category. Common examples include establishing and/or sticking to a budget; saving more; cutting impulse buys; getting a better job, a raise, or a promotion. The third-most common resolutions might be categorized as self-improvement: read more; temper control/ anger management; reduce or manage stress; watch less TV; get more education: learn a new language, skill, or hobby; improve your marriage and other personal relationships, and so forth. All of these are worthy goals. They are well worth pursuing, even if that means getting past occasional setbacks. Since failure is always an option, it’s good to expect it and be ready to keep making progress. There is nothing magical about January 1. If you haven’t made some kind of self-improvement goal, it’s never too late. If you’ve started and failed already, restarts are always allowed. Whatever you set your sights on, keep the letters shown below in mind, as well as what they stand for. Please see RESOLVED page 2

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MEDICINE IN THE FIRST PERSON Everybody has a story. Tell us yours! 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. Tell us if you want it “by you” or if it needs to be anonymous. Thanks!

AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

Southern Girl Eats Clean

Mediterranean Shrimp & Vegetables

Voted “BEST BARBER SHOP” in Augusta Magazine many times!

Daniel Village Barber Shop 2522 Wrightsboro Road

I am all about putting a delicious meal together that looks as if I’ve spent all day in the kitchen but in reality....it takes me no time at all to have on the table. This recipe fits the bill for quick, that is for sure. It also has great flavor and is clean and nutritional. Shrimp and veggies roasted in the oven with a bit of a Mediterranean flare will make for a perfect weeknight dinner or to serve your guest at a casual summer dinner party. Throw in some toasted sprouted grain bread for the perfect one-dish meal. I hope you’ll give this recipe a try! Enjoy!!!

Directions: 1. Preheat oven to 450 degrees. 2. For the vegetables, in a large bowl, whisk together the white wine, olive oil and garlic.

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Mediterranean Shrimp & Vegetables 3. Add the artichokes, haricot vert, tomatoes, olives, capers and onions. Toss to coat all the vegetables. 4. Season with about 1⁄2 tsp. of salt and 1⁄4 tsp. pepper. 5. Place the vegetables onto a large baking sheet and spread out evenly. 6. Roast until the tomatoes begin to release their juices. Approximately 10-12 minutes. 7. For the shrimp, while the vegetables are roasting use the same bowl and whisk together olive oil, dried oregano, red pepper, garlic, lemon zest and juice. 8. Add the shrimp to the bowl and toss to coat. Season with a pinch of salt and pepper. 9. Remove the vegetables from the oven after approximately 10-12 minutes and add the shrimp to the

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FOR THE SHRIMP • 1 1b. of shrimp, deveined and tails removed (Purchase wild-caught whenever possible) • 1 Tbsp. of extra virgin olive oil • 1⁄2 tsp. of dried oregano • 1⁄2 tsp. of crushed red pepper • 2 cloves of fresh garlic, crushed • Grated zest and juice of 1 lemon • 1 pinch of salt and cracked black pepper • To add when combined: 4 oz. of crumbled feta cheese

JUST WASH, DRY, COMB, AND GO.

Ohio Ave.

Ingredients: FOR THE VEGETABLES • 3 Tbsp. of dry white wine (I used Pinot Grigio) • 2 Tbsp. of extra virgin olive oil • 4 cloves of fresh garlic, crushed • 12-15 oz. of artichoke hearts, drained • 8 oz. of haricot vert, trimmed • 1 pint of grape tomatoes • 1⁄3 cup kalamata olives • 2 Tbsp. capers, drained • 1 red onion cut into 1-2 inch chunks • Salt and cracked black pepper (I used Real Salt brand)

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baking sheet. Stir around and evenly spread out the shrimp and vegetables. 10. Place the baking sheet back in the oven and roast until the shrimp is pink and opaque. Approximately 8-10 minutes. 11. Remove from oven and place into a large serving bowl, sprinkle with crumbled feta cheese and serve immediately with toasted sprouted grain or gluten free bread. + Alisa Rhinehart writes the blog www.southerngirleatsclean.com She is a working wife and mother living in Evans, Georgia. Visit her blog for more recipes and information on clean eating.

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

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

Plus... 600+ doctors offices throughout the area for staff and waiting rooms, as well as many nurses stations and waiting rooms of area hospitals.

AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

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

MY INSURANCE SAID WHAT???

n the world of healthcare in general and pharmacy in particular there is a never-ending quest to understand your insurance policy and its benefits. You may call your insurance company to ask about benefits and get no clear cut answer. If you make more than one call you may get more than one answer. Sometimes the only way to figure out the truth is to get multiple answers and see where the overwhelming majority of answers lie. But what happens when you and your doctor get different answers? This happens more frequently than you may think. We had a couple of examples of multiple answers this week in the pharmacy. Here are our stories. One patient had a cream with very specific application directions that caused the 42-gram tube to be a 98-day supply. The tube was the only size available, so it could not be split into smaller amounts. The patient’s insurance plan paid for this medication with copays of $50 for a one-month supply and $125 for a three-month supply. Since the plan had a 90-day option, the tube could legally be billed as a ninety-day supply. According to the pharmacy help desk, by that same logic that tube could not be billed as anything less than a ninety day supply. This meant that the patient was going to have a high copay for this tube of cream. She called the customer service help desk (a different group of people than the pharmacy help desk) and was told to have the pharmacy bill it as a thirty-day supply so that she would only have to make a one-month copay. They also gave the patient the number of the pharmacy help desk and told the patient to have the pharmacy (that’s us) call if we had any questions about how to bill it. When I called the pharmacy help desk they repeated that billing for one month was not legal and that it would be subject to audit. The audit process is when the insurance company doublechecks claims and decides if the pharmacy can keep the money paid for that claim or not. These always take place several months after it is too late to rebill a claim. If the payment is denied by the audit, the pharmacy must refund the money it was paid by the insurance company. The pharmacy will lose money on that sale. In this case, because of the stalemate we ended up transferring

Many transactions at Parks Pharmacy are

ILL-TIMED.

the prescription to another pharmacy. The patient was going to try to get them to bill it as a thirty-day supply and get the lower copay. That pharmacy may or may not get to keep the money they collect and will probably end up losing a couple of hundred dollars. It is sort of like gambling, but in this case you don’t find out if you win or lose your hand until a year later. You thought the lottery was our only form of gambling in Georgia, right? The other example of multiple answers involved a patient we were transferring from another pharmacy. They had filled a prescription at the other pharmacy but had not picked it up. The other pharmacy filed to reverse the claim (knowing the customer wasn’t coming back), but for some reason the computer system of the insurance company did not reverse it. So now we fill the prescription and try to bill the claim and get a refilltoo-soon rejection. The multiple answers then start as ten days later the other pharmacy is told by the pharmacy help desk that the claim has already been paid and cannot be reversed. The patient will need to pick up the prescription and then have us bill it next month. We all know I think that insurance claims are seldom paid in less than ten days, but so be it. I then call the insurance company and was told that the claim was eligible for reversal and to have the other pharmacy call the pharmacy help desk. You see where this going don’t you? We contact the other pharmacy and they make a second call. only to be told that you can’t reverse a claim online and it will take 7-10 days for a manual reversal. No mention of the claim having been paid already like last time. The only issue is that the patient will be out of blood pressure medicine in three days. Never fear, we have a plan to handle this situation also. The moral of this article is to never assume that your healthcare provider is trying to pull a fast one if the story you are getting told is different from what you hear from your insurance company. It may very well be a case of multiple people giving multiple answers. Ask your pharmacy what they can legally do to help you and they will happy to do everything they can. Just know that there are certain yes answers we cannot give. + Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson. Questions, comments and article ideas can be sent by email to cjdlpdrph@bellsouth.net

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AUGUST 21, 2015

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

APPLE CIDER VINEGAR

AUGUSTA MEDiCAL EXAMINER

by Elodie Bouchard, RDN,LDN, Dietetic Intern Graduate Augusta Area Dietetic Internship, University Hospital

n apple a day keeps the doctor away, but what about apple cider vinegar? This tart condiment has been used for ages as a cure-all for various medical conditions, as an antiseptic and for cosmetic reasons. Recently, the media has brought this old wives tale back into the spotlight as a benefit to weight loss, glucose-control, skin and hair care, decreased heartburn and constipation, an aid in healing sore throats and more, but are these claims proven by science? Raw, unfiltered, organic apple cider vinegar (ACV) is often used as a dietary supplement. Some take it by the teaspoon, and others mix the condiment in juice or water as an everyday health boost. Apple cider vinegar is made from crushed whole apples that are fermented over time to make a brown liquid with a sediment that often settles at the bottom of the jar. Most ACV is filtered, but many of the most dramatic health claims refer to the organic, raw, unfiltered vinegar that includes the solid, web-like substance called the “mother” that is claimed to have the most health benefit. ACV is mostly composed of acetic acid, which makes the condiment low in pH, making it a bad environment for bacterial growth. This low pH is also

what gives it the potential antiseptic benefit. Claims that ACV aids in digestion are also due to this low pH, potentially causing an increase in stomach acidity that would help with digestion and absorption of nutrients. Additionally, ACV is promoted as high in antioxidants, providing the body protection from damage by toxins and helping to prevent cancer. Vitamins and minerals are also claimed to be plentiful in ACV. Lastly, ACV is claimed to have both soluble and insoluble fiber, providing potential health benefits like lowered cholesterol, better glucose control, and regulated digestion. Studies in support of the claims that apple cider vinegar can provide these many health benefits are limited. One of the most popular uses for apple cider vinegar is the potential to boost weight loss. Consumers typically take ACV before meals to promote weight loss. Some

studies have suggested that ACV can increase short-term satiety, in other words, it may help people feel full faster, and so they may be inclined to eat less and take in fewer calories. This feeling of fullness could be due to people mixing ACV with a large glass of water, which may be physically filling the stomach. People may also be drinking this ACV/water elixir instead of sugar-sweetened beverages, which also can cause decreased calorie intake. Other studies questioning effects of ACV on weight loss are limited. There are more studies available questioning glucose-control and ACV. Some research suggests better glucose-control for people with diabetes when taking ACV as a supplement before meals. ACV taken before meals seemed to cause diabetics to have less of an increase in blood glucose levels after meals. Apple cider vinegar has many components that are potentially beneficial to people’s health, but clinical studies providing proof are limited. It is unknown if using ACV as a supplement actually provides the many health benefits that are claimed through the media and ACV companies. However, if take in modest amounts, there is no health danger associated with taking ACV as a supplement. If a person decides to drink ACV daily for its potential health benefits, it should be a supplement to an overall balanced and healthy diet rich in fruits and vegetables.

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If you aren’t a fan, some of the potential benefits of ACV are available from other foods; for instance: fiber, vitamins, minerals and antioxidants are all present in a variety of fruits and vegetables, so it is not necessary to take a supplement if someone’s diet is already full of delicious whole foods.

Resources: • http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1785201/ • http://bragg.com/books/acv_ excerpt.html • http://www.apple-cider-vinegarbenefits.com/apple-cider-vinegarhealth-benefits.html • http://care.diabetesjournals. org/content/27/1/281.full +

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The Money Doctor Flexible Charitable Giving Through Donor-Advised Funds

For individuals and families that have a charitable intent, donor-advised funds (DAF) have become increasingly popular over the last twenty years. Many smaller foundations are collapsing into donor-advised funds because of the increased flexibility and low administrative burden. An easy way to think about donor-advised funds is as a charitable savings account that allows a donor to separate the timing of the tax deductible contribution and the grant or gift to charity. How does this work? It starts with the donor making an irrevocable contribution of personal assets, such as appreciated stock or cash, to the donor-advised fund. The donor receives a tax deduction for the year the contribution was made just like when you give money to your church or another qualified charity. The contribution is placed into a donor-advised fund account where it can be invested and will grow tax free. In the future, you can recommend grants from the account to your church or qualified charities. This unique design allows individuals and families to plan and accomplish goals across multiple financial planning

AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

areas especially when doing tax, charitable, and estate planning. For tax planning, the most common strategy is using the donor-advised fund to frontload charitable contributions in a high income year. The donor can maximize the value of the tax deduction in a high income year, but retain the flexibility to decide which charities the funds will go to and when. This is common strategy for individuals about to enter retirement as they transition from peak earning years to lower retirement income years. Donors can supercharge the tax savings when giving appreciated stock. When gifting appreciated stock they can avoid capital gains tax and get an income tax deduction for the year of the gift. Sometimes the church or charity that donors want to gift the appreciated stock to will not have an investment account established, so the charity cannot accept the appreciated stock in-kind. The donor-advised fund is a great solution and can act as a conduit for that gift. Estate planning strategies are significant especially for large estates with a desire to include charitable gifts as part

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of the family legacy. The use of donor-advised funds can also help reduce estate taxes. Donors can contribute to the donor-advised fund at death by naming it as a beneficiary on a qualified account or by listing customized instructions in estate planning documents to match goals. They can also fund it along the way while living, which will help take advantage of the income tax deductions and capital gain

tax savings mentioned above. The naming of beneficiaries for the donor-advised fund is also flexible. You can list specific gifts to organizations, individuals to manage the account grants in the future, or list custom instructions for gifts such as a specific percentage to an organization for many years in the future. A combination of those options can be used to accomplish many different goals when working through legacy planning with families. The flexibility of donoradvised funds has helped many of our clients meet specific charitable, tax, and estate goals. The most exciting part of working with families and donor-advised funds has been helping parents teach their kids about responsible charitable giving as part

PET VET I

HEARTWORMS

f you own a dog and don’t know anything about heartworms, you don’t have to use a lot of imagination to figure out where the name comes from. This is one condition that’s pretty literal in its description. There are worms — long ones at that — living in the heart (and lungs) of afflicted dogs. Yikes, right? Yes. Yikes. You can well imagine how devastating such a condition would be to the effective operation of the heart and lungs. And if they aren’t working well, lots of other things aren’t either. A dog that is tired out or panting after even slight, mild or moderate activity may not have heartworms, but is at least exhibiting a symptom of heartworms. Trouble breathing and coughing are also symptoms of possibly having heartworms. On the other hand, dogs with heartworms can be completely asymptomatic

in the early stages of this condition Fortunately, there is relatively effective treatment for heartworms, but you really don’t want to go there. Heartworm treatment is no fun for your dog or your wallet, and comes with the possibility of potentially serious complications. The route every responsible dog owner should take is prevention. Note that word every. Heartworm comes from parasitic worms that are spread by mosquito bites. The microscopic worms live in the mosquito briefly, awaiting permanent housing in some unfortunate dog. Once they’ve moved in, they don’t stay microscopic for long; in fact, they can grow so much and so long that when they’re removed it looks like the ingredients for a spaghetti dinner. Yikes, right? Yes. Yikes. Some dog people think that

of the family legacy. Once funds are in the donoradvised fund, they have been earmarked for a gift to a qualified charity which helps facilitate a constructive conversation about targeted family charitable giving. Many families have also enjoyed the additional benefits of gifting anonymously when desired. With school back in session this month, be sure the take some time to plan for your families charitable gifts before the year is over. by Clayton Quamme. Clayton is a financial planner with Preston & Cleveland Wealth Management, LLC (www.preston-cleveland.com). Preston & Cleveland is a fee-only financial planning and investment advisory firm with offices in Atlanta and Augusta, GA and Columbia, SC. + since their dogs are indoor dogs, they are not at risk for getting heartworms. Unless your house is hermetically sealed and its doors and windows are never opened, there is always the realistic possibility that mosquitoes can get into your home and from there transmit heartworms to a dog that never goes outside, This would be a good time to mention that people don’t get heartworms from mosquito bites, and while cats are not completely immune, they are considered to be a resistant host and therefore their risk of becoming infected is much lower than dogs. Also heartworm disease is not contagious: one dog can’t get it from another dog. It’s spread only through mosquito bites. Back to dogs: if you own one, it should be taking medicine that prevents heartworms. The options, which are all prescriptiononly, range from once-amonth to once every six months, and can be pills or topically applied. We live in a part of the world where a mosquito bite could happen at any time of the year. In the frozen north, people might feel safe in discontinuing preventive treatment in the winter. Here, prevention should be a yearround program. Talk to your veterinarian! +

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AUGUST 21, 2015

11 +

AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — Posted by Kathryn Hughes, MD on May 15, 2015 at behindthemaskmd.com. Edited slightly for space.

LITTLE MIRACLES It is amazing when things in medicine work just the way they are supposed to — it’s like a miracle. When I take an antihistamine, I can breathe, and all the itching and sneezing stops. When I get an injection of local anesthetic, I can touch and poke and pinch to test that it is working — and it is. As a surgeon I get a kick out of operating on acute appendicitis, where often even in the recovery room immediately after surgery, the patient already feels better. I used to worry that as I entered the world of science, and then medicine, I would lose the ability to see beauty, to appreciate and be amazed and awed by the world around me. I worried that the more I knew about the details of how things worked, that I would not be able to see the glorious whole, the big picture, whatever that big picture might be. As I got deeper into this world of science and medicine, and then surgery, I was concerned that the experiences around me might overwhelm or blunt my humanity and become mundane. Would I become callous, detached, dispassionate? Would I still feel? Would I lose my faith, whether in people and humanity, or even more? Thankfully, blessedly, those fears have not been borne out (although admittedly at times feelings and faith have been strained, tested). On the contrary, my sense of awe and amazement has been heightened by what I have learned in science and medicine, and humbled by the appreciation of what we as scientists and physicians do not know. My appreciation of the beauty around me is not diminished by my understanding of component parts. I am perhaps more amazed now than before that it all actually works, both form and function. More often that not, my faith is boosted, not destroyed. I did not have to worry about not feeling. It is true that it would be hard to be professional and function as a ball of raw nerve and emotion. But it has been important to me to preserve a piece of myself in a space open to the humanity and feeling in my interaction with patients. I see them in critically important times, if not while critically ill, and that humanity is part of the bond and the relationship. They want a doctor, but they also want a real person who not only cares for them but cares about them. They can spot the fake; they need the authentic. There is incredible trust and intimacy in the physician-patient relationship and in that bond, and it works both ways—the only way to get it is to give it. I honor and respect that trust, and the best way I can do that is to give me, a piece of myself. I appreciate how the patients must feel as they proceed through consultation and evaluation, treatment, procedure and operation, and healing and recovery. Each step of the way brings little bursts of amazement as signs and symptoms yield a diagnosis, as diagnosis leads to treatment, and as healing and recovery progress, function restored as they return to their lives. This is the ideal, and sometimes it doesn’t quite work out this way, despite our skills, despite what we had hoped or planned. The disease or injury may be too much to overcome, or a complication may intervene, function may be diminished from what it was before. But most of the time it does work out, and that is a little miracle. The little miracles surround us every day. The trick is to keep our eyes open, to notice, and take a moment to let the amazement sink in and shine out. +

Trust and intimacy: the only way to get it is to give it.

Kathryn A. Hughes is a general surgeon who blogs at behindthemaskmd.com.

Medicine is full of antidotes. Afflicted with this? Take that. Accidentally swallowed that? Then swallow this. This book is 300+ pages of antidote. For what, you ask? This book is the antidote to the doctor you barely know; the doctor who rarely spends more than five minutes with you; the doctor who doesn’t really know your name; the doctor whose fees can run into the thousands of dollars. This book is about the only surgeon on a small island. Timothy Lepore (which rhymes “peppery”) is that doctor, and the island is Nantucket. Ah, you say. Nantucket. No wonder he has time for every patient. He’s probably rich. No wonder he doesn’t bill some patients, and accepts payment in oatmeal raisin cookies from some others. After all, what does he treat? Sunburn? The occasional fish hook caught in some angler’s finger? It won’t take you many pages to discover that a lot happens on Nantucket Island that requires every skill the most capable doctor could bring to the task: “[Over time] hundreds of people would

have died if he wasn’t there, if not thousands,” asserts another doctor who knows Lepore. Aside from his serious medical skills —you’ll get to know those both on the island and in his pre-Nantucket days — Lepore has what author Pam Belluck calls “his patientcentered approach, once much more the norm, [which] now strains to survive in towns and cities across the country as health care costs skyrocket, medicine becomes more corporatized and monetized, and extended face time with doctors is an increasingly vanishing commodity.” So yes, there is a little bit of

sermonizing in this book, but it’s much more a fast-reading peek into the everyday life of a busy, if somewhat eccentric doctor. Along the way you’ll get to know a number of his more noteworthy patients, from Jimmy Buffet to the titular Underground Tom, and the downright weird Billy Dexter. Part of Lepore’s duties involve expert testimony in court cases, and being crossexamined by lawyers who know he might have to save their life one day. There are first-hand accounts of mass casualty fires, open heart surgery, colon obstruction operations, cancer, stabbings, shootings, and ticks, one of the banes of island living. Yes, Nantucket is just a nice quiet island where nothing ever happens — until it does. All those times are what this book is about. + Island Practice: Cobblestone Rash, Underground Tom, and Other Adventures of a Nantucket Doctor, by Pam Belluck, M.D., 304 pages, published in July 2013 by Public Affairs

Research News Building a better mouse University of Leeds researchers have created “unusually intelligent” mice by altering a single gene. In addition to their ability to learn faster and remember longer and solve complex exercises better than “ordinary” mice, the genetically altered mice were also less likely to feel anxiety or recall fear. The researchers produced these results by genetically inhibited the activity of an enzyme called phosphodiesterase-4B (PDE4B). The next step for the study is developing a drug that will specifically inhibit PDE4B and test it in animals. If those results are promising, the next step down a very long road would be clinical trials in humans. The ultimate hope would be that the drug would improve cognition and memory in Alzheimer’s patients and victims of other cognitive disorders.

Cut fat or cut carbs - which? A study from the National Institutes of Health has yielded some of the “most precise human data yet” on whether cutting carbs or fat has the most benefits for losing body fat. In a paper published August 13 in Cell Metabolism, the verdict is in: restricting dietary fat can lead to greater body fat loss than carb restriction. One of the problems with past dietary studies is failed compliance, misjudged amounts eaten and being less than truthful in follow-up surveys. For this study, however, 19 consenting obese adults lived in a lab for a pair of two-week periods, during which every single crumb of food they ate was carefully controlled and monitored. The same subjects were given a carb-restricted diet in one twoweek module and a fat-restricted diet in another. Body fat lost through dietary fat restriction was greater than the loss through carbohydrate restriction.

Related to the previous... Another study released earlier this month found that the kind of fats in our diet can play a significant role in our overall health. A McMaster University study found that trans fats may increase the risk of coronary heart disease. No big surprise there. But an analysis of data from 50 published clinical studies found “no excess cardiovascular risk” associated with saturated fat. Researchers stated further that saturated fats are not associated with an increased risk of death, heart disease, stroke, or Type 2 diabetes. With that said, study authors pointedly stated they are not advocating an increase in allowances for saturated fats in dietary guidelines, or for people to increase consumption of any kind of fat: there is no associated health benefit. For the record, saturated fats come from animal products like butter meat, milk, egg yolks and chocolate; trans fats are produced industrially from plant oils. +

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AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

I want you to launch our new initiative.

This is going to be quite an undertaking.

by Dan Pearson

I expect the program That seems like can be fully operational a very optimistic timeline. within six months.

You don’t see full-fledged within six months?

I see partially-fledged. Maybe half-fledged.

The Mystery Word for this issue: INCADAT

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. He is the current 51-A 6. It can be dull 10. Literature, music. etc. 14. Experiencing fatigue 15. Ethereal 16. Emperor of Rome 54-68 17. Greek epic poem 18. Often confused with a gator 19. Lean 20. Alliance, especially a temporary one 22. Woody tropical vine 23. Quantity of bricks? 24. _____ Girl cornstarch brand 26. Definition 30. Positions; places (technical) 31. Like yogurt cultures 32. It comes after sales 33. Car brand from 1897 to 2004 (as used informally) 37. Common cell addition 38. Color with Sea or Square 39. Type of pigeon? 40. Unspecified in number 41. Par 3 day (abbrev.) 42. Tapering mass of ice 43. Of the ear 45. Duped 46. Having a notched edge, as a leaf 49. Basketball net holder 50. Person who prefers to be alone 51. Currently, it is 1-A 57. Med. prefix meaning within 58. Pierce with a knife 59. Reduce or narrow gradually 60. Port city of Yemen 61. Seep or leak slowly 62. Mountain ridge

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VISIT WWW.AUGUSTARX.COM

23 26

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

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

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.

63. Traveled by horse 64. Star ____ 65. Ms. Witherspoon

29. Emergency numbers 32. Mr. Turner 34. Key receptacle 35. Deal out sparingly 36. Winter toy 38. Organ or cell capable of responding to external stimuli 39. Sword with a curved blade 41. Mental sharpness and humor 42. What surrounds a pupil 44. Tobacco component 45. Jeopardy! host 46. Distinct 47. Musical composition 48. Terminated 52. Tear down 53. Challenge 54. Fencing sword 55. Takes home 56. House type 58. Drunkard

DOWN 1. Auricular 2. Grocery chain with 10 CSRA stores 3. Melody for Jessye Norman 4. Repast 5. STP, or FD&C Yellow No. 6 6. Walking back and forth 7. Air prefix 8. Strong, as a guarantee 9. MSG loc. 10. Penicillin, for example 11. Walton _______ 12. One-third, as of a circle 13. Echolocation 21. ____-deaf 22. Fond du ___, Wisconsin 25. Smoked salmon 26. Geographic diagrams 27. Reflected sound 28. Type of bomb

- Arthur Koestler 1905 — 1983

X A M I N E R

6 1

7 7

2 9

2 3

1 2

4 1

1 3

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.

O 1 2 1

3 3

4 4

5 5

6 6

7 7

2 9 10

C 1

2 1

A 1 2 3 4 5 6

3 2

1 S 7

B 1 2 3

1 2 3 4 U U 1 2 3 1 2 3 4 5 6

1 . C C N DW C T W D F T B E P 2 . A O E H O H U H AV E O H U 3 . E E T S T E TA N A 4 . N N H R U T 5 . R I G GY 6 . E E N T E 7 . S G H 8 . I 9 . N 1 0 . G

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

THE MYSTERY WORD

AUGUST 21, 2015

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

f I told you that I threw a stick 10 miles away and my dog managed to found it and brought it back, what would you say? I’d say that sounds a bit far-fetched. A mother visits her son for dinner, and finds out that he lives with a girl he introduces as his roommate. During dinner, the mother couldn’t help but notice how pretty her son’s roommate was. She had long been suspicious of a relationship between the two, and this only made her more curious. Over the course of the evening while watching the two interact, she started to wonder if there was more between him and his roommate than met the eye. Reading his mom’s thoughts, the son volunteered, “I know what you must be thinking, but I assure you, we are just roommates.” Nothing more was said about it that evening, but the mother continued to wonder. About a week later, his roommate came to him saying, “Ever since your mother came to dinner I haven’t been able to find our silver plate. You don’t suppose she took it, do you?”

”I doubt it,” he said, “but I’ll email her and ask just to be sure.” He sat down and wrote, Dear Mother: I’m not saying that you ‘did’ take the silver plate from my house; I’m not saying that you ‘did not’ take the silver plate. But the fact remains that it has been missing ever since you were here for dinner. Love, Your Son Several days later, he received an email from his mother which read: Dear Son: I’m not saying that you ‘do’ sleep with your roommate, and I’m not saying that you ‘do not’ sleep with her. But the fact remains that if she was sleeping in her own bed she would have found the silver plate by now, which I placed under her pillow. Love, Mom. Why was Pavlov’s hair so soft? He conditioned it. Bill: Do you know why when geese fly in a V formation, one side is longer than the other? Will: I’ve always wondered that. Why is it longer? Bill: Because that side has more geese.

SENIORS… from page 6 of work competency and a depth of generational awareness that strengthen their first-rate senior care. Listed below are a number of advantages to hiring older adults as professional at-home caregivers: • Personal knowledge of the aging process. Because of their own adjustments to aging, senior caregivers can relate to the health changes and emotions their elderly clients are experiencing. • Years of work and life experience. Many older at-home care providers have weathered decades of financial, family, career and health challenges, which equips them with invaluable flexibility and resolve. • Dependability and commitment. Older adults model trustworthiness in consistently showing up for work on time and completing assigned tasks. Reliability is a trait of senior caregivers that increases their “I’m-here-for-you” relationship with elderly clients and their families. • Common-age relational skills. Do you remember the day JFK was shot? Who were your favorite music groups of the 40s, 50s or 60s? When did you first see color television? Older loved ones often enjoy reminiscing about their lives and milestone world events. Seasoned in conversing and listening, senior at-home care providers build a natural rapport and genuine friendships with their elderly clients. + Right at Home is dedicated to helping caregivers and those needing care by providing professional private-duty care giving services. Right at Home has served the CSRA since 2005. For more information, please call 803278-0250 or visit us on the web at www.rightathome.net/csra.

Joe: Did you hear that Caitlyn Jenner was kidnapped and is missing? Moe: Not only have I not heard that, I don’t believe it. Joe: It’s true! I saw her picture on the side of a carton of Half & Half. +

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

Don’t feel like kissing your money goodbye? The Medical Examiner offers advertisers a focused, + +

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

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www.AugustaRx.com/news

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AUGUST 21, 2015

AUGUSTA MEDiCAL EXAMINER

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

...cleverly hidden (on the delicious wrap) in the p. 8 ad for ROLY POLY Congratulations to GAIL PITTMAN, who scores a coveted Scrubs of Evans gift card, 2 movie passes courtesy of Health Center Credit Union, and a $20 Wild Wing Cafe gift certificate. Want to find your name here next issue? The new Mystery Word is on page 12. Start looking!

The Celebrated MYSTERY WORD CONTEST ...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher.

EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC. HOUSE FOR RENT IN N AUGUSTA For Rent: House: two bedroom, one bath, kitchen with stove and refrigerator, bonus room, laundry closet with washer/dryer hook ups, basement, screened porch, handicap ramp. New carpet in bedrooms and living room. Nearly new vinyl floor in kitchen, double pane windows. Near North Augusta Public Safety and NA Community Center. Within walking distance of Greeneway. Ideal for students, a couple or single person. Handicapped ramp entrance. $650.00 per month, a security deposit of $650.00 is required with first month’s rent. No pets! Rental Application required. Prefer 1 year lease. Call 803 599 0781 for appointment to see. ONE BDRM COTTAGE FOR RENT with off-street parking/carport in Hill area 2 blocks from college. Washer/dryer. We furnish water, you pay electric. $675/$500 dep. No pets. (706) 736-7168; email: ronst79@gmail.com Pictures avail. AUGUSTAGAHOMESEARCH.COM Foreclosures • MLS • Rentals • Builders 706-564-5885 FOR SALE: GORGEOUS, immaculate, never occupied townhome located mins from Medical District. 2 bed, 2 bath,

master en suite, walk-in closets, office. 1450 sq ft. hardwood floors throughout, fabulous upgrades, custom kitchen and baths. Floor to ceiling windows, fenced yard. Partially furnished! 120k OBO. 803-507-6621.

HELP WANTED PART TIME HELP NEEDED MATH AND SCIENCE TUTORS NEEDED: Local tutoring company seeking qualified math and science tutors. Please reply to: info@maeseducationcenter.com

SERVICES

MISCELLANEOUS WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer. BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net CEMETERY SPACES (2) Sunset Memorial Gardens, Graniteville SC adjacent to lighted military flagstaff, includes granite bench with urn space, installation and inscription. All $4700 ($8600 value). Spaces only: $2700. Call (803) 295-3033

HOUSE CLEANING Your house, apartment, rental move-outs. Thorough, dependable. Weekly, or whatever schedule you prefer. References. 706.267.9947

FISHING CLUB wants more grey-haired members. Meet 2nd Thurs of month at Harbor Inn Restaurant, 12 noon. “Adventure Before Dementia” Info: (706) 736-8753 or (706) 829-1729

BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673)

PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-829-1729

F. E. GILLIARD, MD FAMILY MEDICINE Acute & Chronic Illnesses Occupational Medicine PROMPT APPOINTMENTS 706-823-5250

CEMETERY PLOTS Side-by-side cemetery plots for sale located at the Heart Section of Hillcrest Cemetery. $3600 for BOTH. (706) 798-8495

Thanks for reading the Medical Examiner!

The new scrambled Mystery Word is found on page 12

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

THE PUZZLE SOLVED

WHAT’S YOUR DRUG OF CHOICE? (OURS IS COFFEE)

Augusta Medical Examiner Classifieds

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

.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

5.25

5.50

5.75

6.00

6.25

6.50

6.75

7.00

7.25

7.50

7.75

8.00

8.25

8.50

8.75

9.00

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

M E A L

A D D I T E A N I C T I V H O N E O M E O T R E N A O N E R N D O D E N O D E

P A C T I O N N G E R W E I C T E P S T O O T R

A E R O

I R O N C L T A E D D T R R E A B Z E E K

N Y C L L A O C X S I C R I I M S I T A R

A N T I B I O T I C

R E H A B

T R I N E

S O N A R

L O C K

D O L E

S L E D

D A R E

E P E E

N E T S

T R E E

QUOTATION PUZZLE SOLUTION: Page 12: “The more original a discovery the more obvious it seems afterwards.” — Arthur Koestler

The Sudoku Solution

COFFEE IS GOOD MEDICINE

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

Send this form with payment to:

C L E A R

A R I A

QUOTATION

AD COPY (one word per line; phone numbers MUST include the area code): .50

M A P S

B I L O

SEE PAGE 12

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

.25

O T I C

4 9 7 8 3 6 5 1 2

2 6 1 5 9 4 3 8 7

5 3 8 7 1 2 9 6 4

9 7 6 4 5 1 8 2 3

8 4 5 3 2 7 6 9 1

1 2 3 9 6 8 4 7 5

6 8 4 1 7 3 2 5 9

7 5 2 6 4 9 1 3 8

3 1 9 2 8 5 7 4 6

WORDS BY NUMBER

VISIT DRUGOFCHOICECOFFEE.COM

“Nothing we do can change the past but everything we do changes the future.”

Thanks for reading!

www.AugustaRx.com

— Ashleigh Brilliant

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

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 7 days prior to our publication date.

AUGUST 21, 2015

15 +

AUGUSTA MEDiCAL EXAMINER

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PROFESSIONAL DIRECTORY DERMATOLOGY

ALLERGY

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

CHIROPRACTIC

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

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

Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

EMPLOYEE BENEFITS

FAMILY MEDICINE F. E. Gilliard, MD Family Medicine 639 13th Street Augusta 30901 706-823-5250 Industrial Medicine • Prompt appts. Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

CALLING ALL M.D.S!

MEDICAL MASSAGE Medical Massage Stuart Farnell L.M.T. 803-646-1846 jsfarnell@att.net www.FarnellClinic.com

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

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

Group & Benefits Consultants Inc. 3515 Wheeler Rd, Bldg. C Augusta 30909 706-733-3459 Floss ‘em or lose ‘em! www.groupandbenefits.com

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048

Ideal Image 339 Furys Ferry Rd Martinez 30907 1-800-BE-IDEAL • www.idealimage.com Schedule a FREE Consultation

OPHTHALMOLOGY

DRUG REHAB

COUNSELING

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

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

DEVELOPMENTAL PEDIATRICS

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

DENTISTRY

LASER SERVICES

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

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

...SENIOR LIVING

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

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

THERAPEUTIC MASSAGE Centered in Georgia Diane Young L.M.T. 4488 Columbia Rd Martinez 30907 706-251-2244

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

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

SUPPORT YOUR PRACTICE - AND THE MEDICAL EXAMINER A simple listing in the Professional Directory is less than $100 for six months or less than $200 for an entire year, and puts your contact information in front of 30,000 readers a month. CALL 706.860.5455 TODAY AND BE IN THE NEXT ISSUE

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AUGUSTA MEDiCAL EXAMINER

AUGUST 21, 2015

Lost in the maze? Why enter in the first place?

We know the way. EMPLOYEE BENEFITS • COMPLIANCE • WELLNESS • CONSULTING • EXCHANGES • PARTNERSHIPS • TECHNOLOGY

RUSSELL T. HEAD, CBC, CSA-PARTNER • 706-733-3459 • E: RTHEAD@GANDBC.COM • WWW.GROUPANDBENEFITS.COM