Medical Examiner 8/23/19 by Daniel Pearson

MEDICALEXAMINER

HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

AUGUST 23, 2019

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

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161,3 74

598, 038

635, 260

1.6

AUGUSTARX.COM

PER DAY

442

PER DAY

1,638

PER DAY

1,740

WHAT’S BEHIND THE NUMBERS? SEE PAGE 2

PER DAY

AUGUSTAMEDICALEXAMiNER

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD by David W. Proefrock, PhD

Your 15 year-old daughter has become extremely concerned about her weight. She is not at all overweight. She eats all the time and doesn’t seem to gain any weight, but constantly complains about being fat. You haven’t seen any evidence, but you suspect that she is making herself vomit after she eats. What do you do? A. Before you take any action, have a serious talk with her about eating disorders. Listen carefully to her responses in order to judge what to do next. B. Monitor her closely after she eats and don’t let her go into the bathroom for at least an hour after a meal. C. Give her a reasonable diet to follow and monitor her progress. D. Take her to her physician and have her evaluated for a possible eating disorder. If you answered: A. This is the best thing to do first. One of the hallmarks of an eating disorder is a distorted body image. If she denies making herself vomit and seems to have a realistic idea about her weight when you talk to her, you may not need to be so worried. If she insists that she is fat and you are still worried that she may be purging, an assessment by her physician is in order. B. It is better to establish the problem before taking a specific action. Have a serious talk with her before deciding what to do next. C. Again, this is taking action before you have really assessed the problem. If she does have an eating disorder, she needs treatment, not a diet. D. Unless you are truly reassured that there is no purging going on and that her body image is realistic, this is the thing to do. Just talk with her first so you have a better idea about what is going on. An eating disorder is a serous problem and must be taken seriously. However, taking action before you assess what is actually going on is a mistake. A discussion won’t deter an effective response and will help you plan what that response should be. +

AUGUST 23, 2019

FOCUS ON THE NUMBERS Those page one numbers are quite interesting. Here they are again (right) for your viewing convenience. They reflect annual numbers of several of the leading causes of death in the U.S. Which one doesn’t belong? The smallest number at the top of the pyramid is the only one that reflects yearto-date data for 2019. The other three reflect the latest figures available, which can be 2017 or 2018 depending on the data category a person is researching. You might be surprised to know the cause of death at the top of our pyramid, responsible for an average of

373 161,3 74

598, 038

635, 260 just 1.6 deaths per day so far this year, gets by far the most media coverage. The ones that kill well over 1,600 and 1,700 people a day don’t get nearly as much attention. Odd, isn’t it?

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Dr. Proefrock is a retired child clinical and forensic psychologist.

1.6*

PER

DAY

442

PER DAY

1,638

PER DAY

1,740

PER DAY

* As of Monday, Aug. 19, day 231

The base of our pyramid reflects the #1 killer in the U.S., which is heart disease, according to the CDC. You can see the terrible toll it takes. The #2 cause of death is cancer, responsible for the numbers shown next, on the green level. Above that, responsible for more than 161,000 annual deaths, are accidents, the #3 killer. This figure includes work-related accidents, hunting mishaps, and traffic accidents - in short, all accidental deaths by all causes. Have you guessed the reason behind the top number? 373 reflects the death toll from mass shootings as of Monday, August 19, as calculated by the website massshootingtracker.org. There are various ways that multiple-victim shootings are defined by various private and governmental organizations, but Mass Shooting Tracker (MST) defines the events included in their count as those where four or more people are shot. While no sane person would or should minimize the plague of senseless mass murders we continue to see (320 so far this year as of Please see FOCUS page 3

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AUGUST 23, 2019

FOCUS… from page 2

day 231, by MST’s count), don’t you think we need to sharpen our focus in the direction of the plagues that are killing hundreds of thousands of people? While people endlessly argue about gun control, a worthy debate hopelessly mired in political wrangling, the top three just keep mowing people down, some 3,800 every day versus less than two by mass shooters. It’s not that we’re helpless to do anything to protect ourselves today and every day from mass shootings. We can (see below). But these events are completely random in nature. A person might live 80 years and never encounter an active shooter situation. Or they might be ensnared in one tomorrow. By comparison, heart disease, cancers and accidents are largely considered to be directly linked to the long-term behaviors of their victims (or short-term, in the case of many accidents). When death strikes someone we know and love, it hits home that statistics are cold, impersonal, and meaningless. If someone near and dear to us is killed by a bowling ball that fell from an airplane, it’s of no comfort that it’s a statistically insignificant cause of death. A single death is one death too many when it strikes someone we care about. But the 1.6 deaths per day resulting from mass shootings is exactly 1.6 too many for all of us because even if we know none of the many victims, there is something about the completely random nature of these attacks upon innocent and unsuspecting victims in “safe” places that strikes a chord with all of us. We can say “I don’t smoke” or some other risky behavior, but no one can say “I don’t go places where mass shootings are likely.” That would be impossible. We all know we’re all vulnerable.

We just have to live life, even in this era of random killings. Naturally, we want to live life as long as possible. So here are a few simple and basic general tips to help us survive the threat we may fear most — an active shooter situation — plus ways to prevent far more likely threats like heart disease, cancer, and accidents. Mass shootings Experts recommend being alert to your surroundings. If something doesn’t look right or normal, react in ways that will protect you. Make it a habit to take note of exit locations in any building or venue you’re in. Identify places where you could hide or take cover if you had to. Heart disease Lifestyle changes can prevent many cases of heart disease. The top ways to stay heart-healthy are to avoid (or quit) smoking, exercise regularly (five days a week for 30 minutes is great; if five isn’t possible, exercising more days than not), maintain healthy weight, and eat a healthy diet. Cancer As is the case with cancer, the prevention list starts with not smoking, maintaining healthy weight and diet, and exercising regularly. In addition, avoid prolonged sun exposure (and tanning beds), and have regular cancer screenings. Accidents Avoid careless and reckless actions at work and when enjoying recreation. Drive safely, avoiding dangerous actions like tailgating, speeding, and distracted driving. +

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WHY DOES MY LEG FALL ASLEEP?

It isn’t just legs, sweetheart. Sometimes our feet, hands and legs seem like they’re getting more sleep than we are. Sometimes an arm will be asleep at the same time as the rest of us: we wake up in the morning to an arm that feels so completely numb it’s like it isn’t even attached anymore. The technical term for this condition is paresthesia. The word comes from two Greek words, para- denoting a disordered function or faculty; and aisthesis, sensation. It has roots in the same family as anesthesia: an- without; and aisthesis, sensation. Why does it happen? And should it be a matter of concern? In most cases, paresthesia is caused by prolonged pressure on a nerve. (It has nothing to do with circulation of blood, or the lack thereof.) Like a pinched garden hose, pressure on the nerve temporarily interferes with its ability to communicate sensations to the brain. Typical scenarios that trigger paresthesia include sitting with your legs crossed or sleeping on your arm or hand. Pretty soon all sensation is cut off. Especially a so-called dead arm in the morning can be very disconcerting. Whose is this? Fortunately, the solution in most cases is simple: change positions to eliminate pressure on the nerve. That’s when an entirely new unpleasant symptom begins, the famous tingling known as pins and needles. Like paresthesia, pins and needles is harmless and temporary. It’s the sensation of nerves waking up again. Both paresthesia and pins and needles are generally nothing to worry about. Simply move and you’re on your way to a full and fairly swift recovery. If the recovery isn’t swift, or your paresthesia is chronic, it’s a good idea to have your doctor check into its cause. Diabetes, peripheral neuropathy, carpal tunnel syndrome, multiple sclerosis, stroke, and tumors are some of the common reasons for chronic paresthesia. The earlier the cause is correctly diagnosed, the sooner it can be treated, and the better the chances are that any potentially permanent nerve damage can be prevented. +

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AUGUST 23, 2019

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#97 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com by Marcia Ribble

his man is a textbook example of mankind’s progress in knowledge of health and wellness. As you can tell from his likeness above, his history goes back quite a ways. He was born in 1530 in the South of France in the town of Nimes - pronounced “neem” - and christened with the name Jean at birth. Incidentally, Nimes has an amazing place in popular culture thanks to a man named Levi Strauss, born in Bavaria in 1829. Strauss developed a line of work clothing made from a sturdy twill fabric manufactured in Nimes. The serge fabric, usually blue, was known by its French name serge de Nimes, which was often shortened to de Nimes. Today we call it by an anglicized version of de Nimes: denim. That may have seemed like a completely unrelated side trip in an article about Jean — obviously Jean and Levi never met, having lived centuries apart — but it’s included here to make the surprising point that as ubiquitous as denim is, Jean’s name is actually more well known. He is by far the most famous person with a connection to Nimes. The history books we peeked into didn’t say exactly how, but somehow Jean, the son of a humble notary in Nimes, managed to become part of French King Henry II’s inner circle. At age 29 he was appointed ambassador to Portugal and sent to Lisbon to negotiate the arranged marriage of six-year-old French Princess Margaret of Valois to five-year-old King Sebastian of Portugal. Surprisingly enough, the marriage deal fell through, but while in Lisbon, Jean was introduced to the plant that would make him famous. Or was it the other way around: did he make the plant famous? The plant certainly seemed worthy of fame. Based on some tests he conducted on patients in Lisbon and what locals told him about it, Jean was convinced that he had stumbled upon a medical miracle, a panacea capable of curing everything from gout to cancer. Excited by the prospects, he sent samples and seeds to his queen, Catherine de Médicis, in Paris. Returning from Lisbon in 1561, Jean presented the queen with dried leaves of this plant with instructions on how to crush the leaves into a powder that could be inhaled through the nose as a quick and effective headache cure. The remedy soon became popular with the French court, making Jean something of a celebrity. Eventually the general populace jumped on board to such an extent that the plant was cultivated across France and northern Europe to keep up with demand. The sound made administering the powdered version gave rise to its popular onomatopoeic name: snuff. If you had not guessed it already, that tells you the plant we’ve been talking about: tobacco. And the full name of the gentleman above was Jean Nicot (pronounced Niko). Although he died in 1604, Nicot was immortalized in 1735 when Swedish naturalist Carl Linnaeus named the genus Nicotiana tabacum in recognition of Nicot’s role in popularizing the plant. Then in 1828 when the plant’s active ingredient was isolated, it was named nicotine. Nicot would probably be surprised to learn that over the years tobacco’s reputation has gone from innocuous cure-all to deadly carcinogen. +

Home Again, Finnegan! That’s a phrase often used to denote being home again after a considerable absence, so it applies to me. I returned home last Wednesday after a monthlong stint, first in the hospital, then in rehab after suddenly experiencing excruciating pain in my lower back so severe I couldn’t stand up. I called 911 and an ambulance soon arrived to take me to the hospital, but while they were taking me out of the house on the gurney my dog, KC, escaped. The EMTs worked for almost an hour to catch her without any success. We finally left for the hospital leaving the gate open and the back door also open. Fortunately, after a few hours the neighbors spotted her in the backyard and closed the gate, trapping her in the backyard with the door still open so she could get food and water. My granddaughter soon arrived to pick KC up and take her to their home. While that was going on the doctors began to investigate what was causing such intense pain. Each step of the investigation required being transferred from a bed to a gurney, to a treatment table, and back to the gurney and the bed. Each transfer was very painful, despite the administration of strong painkillers. Fortunately, I don’t remember a whole lot of those first few days in the hospital, but the antibiotics they administered via IV began to be effective and the pain began to subside in my back. I didn’t remain pain-free; however, because other parts of my body were attacked and my knees, upper back, neck, and right arm were affected to the

point that my arm was paralyzed. It was also excruciatingly painful. I couldn’t even wiggle my fingers. I had a CT scan, an MRI, and a biopsy of my spine where they found a serious lesion which they assumed was causing the pain. They haven’t been able to identify what caused the lesion yet, but the antibiotics are working to make the pain subside and the healing begin. After two weeks, that allowed them to transfer me to a rehab facility to help me regain my strength. After almost twenty days in rehab, I was allowed to come home with continuing IVs I give to myself and another antibiotic pill, both of which are to be continued for at least a month, and possibly another month after that, depending on how fast I heal. The idea of giving myself an IV using a PICC line freaked me out at first, but it only took me a couple of days to master. Rehab got me walking again well enough that I can handle most of my self-care needs. It feels good to be able to walk around the house. It feels even better to be able to cook a little bit and reject anything faintly resembling hospital food--more on that later! For now, I am just celebrating being in my own chair, eating food I get to choose, and not being awakened in the middle of the night to get weighed. Even better, today I received a visit from my daughter, granddaughter, and great-granddaughter who, at four, changes so much every time I see her. Today she was wearing the cutest braids and had me grinning with delight to watch her playing in my living room. She, her mom and grandma are the best of all medicines! +

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For external use only. May be habit-forming. Take regularly; do not discontinue reading unless advised by a physician. Product not child resistant. Do not chew or crush. Not to be taken by mouth. May be taken (read) on an empty stomach, or with food. May be taken one hour before or after meals. And at any other time. Product may not be gargled. Do not drive a motor vehicle or operate heavy machinery while reading. Tell your doctor if you are pregnant or expect to be. Use in conditions of adequate light. Store in a cool dry place. Not to be used as a personal flotation device. Dispose of properly. Overeating, poor diet, cigarette smoking and excessive drinking may alter the effectiveness of this product. Do not use near spark or flame. Not dishwasher safe. If you become too salubrious, please read fewer articles.

AUGUST 23, 2019

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

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AUGUST 23, 2019

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ello, this is Dr. Rob, and you have reached my column. If you are here to read what follows, please continue to do so. If this is an emergency, please stop reading and call 9-1-1. That is one of my pet peeves. Every doctor’s office I call I get the same thing: “if this is a true emergency, please hang up and dial 9-11.” I even got that message when I called the ER. Clearly, the message is put on every office phone system to cover their collective tushies (is the plural of “tush” tushuses or tushi?) They are protecting these sacred parts from a patient having a stroke who sits and listens to the 21 options followed by 20 minutes of 60’s classics lovingly interpreted by Kenny G. Scientific evidence shows that after listening to muzak for long enough, even people without an emergency will eventually hang up and dial 9-1-1. But I don’t put that warning on my phone system (and have opted for folk music instead of Kenny G). It’s not because my patients are smarter (although they clearly are), nor is it because I don’t value my tush. I wouldn’t mind getting rid of a little of it, but overall I value that part of my body. The reason I don’t put the “moron repellant” message on my service is because a lot of patients aren’t really sure they have a true emergency and are calling to get advice about whether or not they should call 9-11, make an appointment, or if they should just take some Tylenol. To make this decision, the patient has to run the gauntlet of

the typical medical office’s “doctor protection plan:” 1. The patient calls and listens to all 21 options (as the menu items have changed). 2. Listens to Kenny G (in the South, it’s sometimes Travis Tritt) for an indeterminate amount of time. 3. Speaks to a front desk person who is assigned to phones (usually a newer staff person who is not a clinically trained). 4. Is offered a.) an appointment for some time in the next few weeks; b.) transfer to the nurse (or her voicemail); or c.) be told to go to the ER (if it’s a true emergency). 5. If lucky enough to talk to a nurse, the nurse will give the same three options. 6. Eventually see the doctor when the next appointment is open (after 2 hours in the waiting room). But what if it’s a “true emergency” and the patient takes option 6? Then the “moron repellant” message about 9-1-1 protects the doctor from the patient’s bad decision - a decision based on not knowing when something is worth worrying about and what is not. The keys to good care are: 1. Care that is accessible 2. Care that is based on accurate information. Our health care system puts a huge wall between doctor and patients - a wall made of inane messages, voicemail, Kenny G, front desk staff and clinical staff. Doctors are reluctant to speak to patients about their problems because they are too busy seeing people in the office, and because they are not interested in giving away care for free. We physicians force people to come to the office because it

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is the only business model that works. While the PCP (primary care physician) has the most information about the patient, they are not accessible. So people then go to the ER (or prompt care) because the incredible frustration they feel dealing with most doctors’ offices. Although the ER is more accessible, it is not based by good information about the patient. The doctor there has to get to know the person’s medical history quickly, assess whether or not this constitutes a “true emergency,” take care of those with “true emergencies,” and give a temporary solution to those who don’t qualify, with instructions to follow up with their PCP. This obviously poisons people’s view of the medical system, since care that is both accessible and informed is hard to come by. Nobody can answer the patient who wants to know if they have a “true emergency,” yet isn’t that one of the most critical questions to answer? Avoiding unnecessary treatment and promptly getting necessary treatment are two keys to reducing the cost of care. The system forces patients to assess themselves as to whether their conditions constitutes a “true emergency” before they get a chance to talk to anyone. Patients use the ER unnecessarily because the it’s a pain in the tush to deal with their PCP, and when they do sit in front of their actual doctor, that doctor is tired, getting their tuchus whipped by CPT codes, ICD codes, and meaningful use criteria. There has to be a better way. And actually, there is. +

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AUGUST 23, 2019

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...and your excuse is...what?

Will he ever get one right?

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Questions. And answers. On page 13.

IT’SYOURTURN! www.facebook.com/AugustaRX

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.”

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “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.

AUGUST 23, 2019

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GARDENVARIETY

Wouldn’t you love to have cookies for breakfast? Me too, so that is why I created this recipe for healthy breakfast cookies. They are packed with yummy ingredients like oats, chia, pecans, banana, and a hint of cinnamon. They are gluten-free, dairy-free, refined sugar-free, vegan, and perfect for a quick, nutritious breakfast on the go your whole family will love. After my battle with cancer, I decided to do my best to eat healthy by eliminating white sugar from my diet. I confess one of the things I miss the most is a delicious cookie snack at the end of a long day. Cookies are such comfort food. So you can understand why I was so excited to discover I could start my day with a plate full of healthy cookies! This breakfast cookie recipe is very versatile. It’s easy to change up your ingredients to your family’s liking. Some ideas would be to add pumpkin seeds, cashews, walnuts or pistachios. Dried fruits could be raisins, apricots, cherries, or even one of my favorites, blueberries. The best part is, they are quick to make without a lot of mess. They will store in an airtight container for several days. Breakfast Cookies Ingredients • 1 cup old fashioned rolled oats • 1/2 cup almond flour • 1/2 dried cranberries • 1/2 chopped pecans • 1/2 cup ground flaxseed • 1 tablespoons chia seeds • 1 teaspoon cinnamon • 1/2 teaspoon baking powder • 1/2 teaspoon pink Himalayan salt • 1 large mashed banana (about a cup worth) • 3 tablespoons melted butter flavor coconut oil • 3 tablespoons maple syrup or honey • 2 tablespoons unsweetened almond milk (more if needed) Instructions Preheat oven to 325 degrees. Combine oats, almond flour, dried cranberries, pecans, chia seeds, ground flax, cinnamon, baking powder and salt. Mix well.

Breakfast Cookies Stir in finely mashed banana, coconut oil, maple syrup, and almond milk. Mix well to make a thick dough, adding 1 to 2 more tablespoons of almond milk if needed. Divide dough into 10 even balls. Place on a parchment lined cookie sheet. Press balls so they are slightly flat. Bake for 15-18 minutes, or until cookies are lightly golden around the edges. Store in airtight container for up to 3 days. + by Gina Dickson. “As a mother of six who beat cancer, I want to share with you what I’ve learned. Healing from cancer can take everything a mom has, yet you still want to love and care for your family through the treatments. My blog is a community full of encouragement for moms going through cancer treatments who would like to use a plant-based vegan diet to complement their healing journey. www.thelifegivingkitchen.com

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AUGUST 23, 2019

ALL DRUG SCREENS ARE NOT CREATED EQUAL The words a drug user fears most at work: “Your name just came up for a random drug test!” “Oh no!” thinks the user. “Should I walk out now and quit my job? Or drink a lot of water to dilute it? Or just do it and hope I pass?” Many users are ready for such a surprise announcement. They have a plan! They have done what I just did out of curiosity, and entered in their internet search engine the words, “how to pass a drug test.” And guess what? 172,000,000 sites came up to answer the question! They only hope that the boss will, even for just for a short moment, take their eyes off them…or will give them 2 hours to get to a lab…or won’t witness the screen…or won’t make them empty their pockets before going into the testing room… or, or, or… Some even know what

common chemicals to grab on the way to the test to sprinkle in their urine to sabotage the test. You see, the first two rules of drug screening are as follows: Rule #1. A pre-announced screen is no good. When a drug screen is announced it must be given immediately without taking eyes off the client. Otherwise, if they are a user they will have figured out a way to pass it by the time they donate their sample! Promise. I have waited over two hours in the past and watched clients drink two quarts of water and still not be able to give a urine sample! Or so they say. I don’t know about you, but my bladder just won’t hold that much liquid! After two hours, my rules are a., go see a medical doctor and see if you have a medical problem voiding and if so what is the solution, or b., it is a failed drug screen. This

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policy is what most major companies and government agencies follow. “Shy bladder” does exist, but rarely. Rule #2. A drug screen that is not witnessed is no good. This fact doesn’t need explaining, does it? Even with personally witnessed drug screens I have seen baby shampoo bottles with someone else’s urine used in a slight-of-hand way, and the ever popular bag of urine with a tube routed to the point of exiting the body (points for creativity). If you are an employer, I encourage you to become a Drug Free Workplace through the local Chamber of Commerce. The program involves a once yearly hourlong educational session for your employees and a once-yearly two-hour-length educational session for supervisors, including how to detect illicit drug use in the workplace and how to handle such situations. Drug users, you see, flock to employers who do not conduct drug tests. Often, such businesses are the construction and F&B (food & beverage) industries. Not all of them have a no-test policy, of course, but many of them do. Which may explain why your new house has

THIS IS YOUR BRAIN

A monthly series by an Augusta drug treatment professional major defects, and why your restaurant food rarely comes out the way you ordered! If you are a parent out there who tests your children, the first urine of the day is the best sample ever. Yep, just stand by their bed and when they get up have that drug screen bottle ready for action. You won’t have to wait two hours either! And please, screen your kids with a positive attitude! You won’t get anywhere with an, “I’m gonna get ya” attitude. Instead, make sure your teenager knows that you’re trying to get a number of clean drug screens, a clean pattern, to boost your confidence in their actions.

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So, where do you get these test kits? Online, at drug stores and department stores. Are they reliable? For the most part, yes. Most of the urine drug screens are about 95-97% accurate if kept at room temperatures and are given before their expiration dates. But be aware, they are just a “screen!” Wait. What? I thought they were for drug testing! Next month we’ll address the difference between screens and tests, and talk about the upside and downside of urine tests, blood tests, saliva tests, and hair follicle tests. You see, they are not all equal. +

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AUGUST 23, 2019

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AUGUSTAMEDICALEXAMiNER

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

Food allergies or intolerance? by Hannah Bieze, MS-Dietetic Intern Food allergies are a rapidly growing health concern due to their increasing prevalence and life-threatening potential. An allergic reaction to food involves the immune system, which controls how the body defends itself. These kinds issues with a particular food of allergies occur when the may be intolerant to it, not body’s immune system misallergic. Food intolerance takenly identifies a safe prooccurs when the body’s tein as being harmful to the digestive system is unable body. The system overreacts by producing antibodies, trig- to properly break down the food. This could be due to digering the release of agents gestive enzyme deficiencies, causing allergic symptoms. sensitivity to food additives, Although nearly any food or reactions to naturally can cause an allergic reacoccurring chemicals in foods. tion, the eight that cause Individuals can often eat most reactions are milk, small amounts of specific eggs, peanuts, soy, wheat, foods without causing comtree nuts, shellfish, and fish. plications. While bothersome, Food-related reactions are associated with a broad array food intolerance is a less severe condition that generof signs and symptoms that ally makes someone feel sick usually develop within a few with an upset stomach. The minutes to a few hours after eating the food. Allergic signs most common intolerance is to lactose, a natural sugar and symptoms can occur on found in milk. the skin, in the gastrointesti The correct diagnosis of nal or respiratory tract, and a food allergy requires a dewithin the cardiovascular tailed health history, physical system. In severe cases, a examination, and diagnostic food allergy can lead to the tests. Most clinicians rely on potentially life-threatening condition called anaphylaxis. skin prick testing (SPT) and/ All Big Eight common food or a blood test to establish the diagnosis of food allerallergens have specific labelgy. The primary diagnostic ing requirements under the test used by most allergists Food Allergen Labeling and is SPT. It is not painful, is Consumer Protection Act of relatively inexpensive, and 2004. This law requires manis done in a medical office. ufacturers of packaged food Results are provided immeproducts sold in the United diately. Most foods can be States to clearly label the tested with SPT. Typically, an presence of these ingredients extract or fresh food is placed in their products. on the underside of the fore Many people who have

arm and the skin is pricked with the instrument. Fresh food testing can also be accomplished using the prickto-prick method, where the testing device first pricks the food to be tested and is then used to prick the patient. A positive test will result in swelling and erythema, indicating sensitization to the allergen tested. The measurement of a specific antigen in the blood can be done to diagnose food allergies. Like SPT, it assesses sensitization rather than clinical food allergy. While management strategies are currently limited to allergen avoidance and emergency treatment of accidental exposures with allergy medications, immunotherapy trials offer great promise for developing desensitization. Immunotherapy’s goal is to induce tolerance in the subject. Patients are considered tolerant when they can safely consume the food without following a daily oral food routine. In most oral immunotherapy protocols, small quantities of allergen are administered to patients in steadily increasing amounts, with the direct goal to induce desensitization. With desensitization, the treated patient displays a decreased response to the ingested food allergens but must continue to take daily food doses. Enhanced diagnostic capabilities and management techniques will transform food allergy diagnosis and management for physicians and patients alike in years to come. For additional information on food tolerance and allergies, contact a Registered Dietitian Nutritionist (RDN) for evidence-based information or visit www.eatright.org. Registered Dietitian Nutritionists are trained and credentialed health professionals in the science of food and nutrition. +

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AUGUSTAMEDICALEXAMiNER

CRASH

COURSE

ot every reader understood our last issue’s “wild, wild west” headline above a picture of a horrific wreck. Our fault entirely. May we have a do-over? It was said in the Wild West that there was no law west of the Pecos. That is, until Judge Roy Bean (right) came along and appointed himself as the decider and enforcer of the law west of the Pecos River. Before (and after) assuming that title, Bean was a thief, a serial miscreant, barroom brawler, and killer. He regularly ignored, broke and invented laws as it suited his purposes. In other words, he was a lot like many of today’s drivers. In the August 9 Medical Examiner, it was mentioned that 94 percent of all traffic accidents in the U.S. can be attributed to driver error. All of us see this demonstrated every single day. Following are a few driving behaviors that a.) are proven to sharply elevate the risk of accidents, b.) are out of control on

area roads, and c) are illegal: Talking on a cell phone or texting while driving. Does anyone within the sound of this newspaper not know it’s against the law to use a device while driving? Answer: nope. But anyone who is even marginally observant while driving can see this law being regularly and blatantly violated by motorists. Perhaps people are being ticketed, but by and large the enforcement effort is not effective. Speeding. It is said that speeding is the most commonly broken of all laws. Just about

  '''NEW´FEATURES''' everyone does it. Sometimes it’s about unrealistic speed limits (where it’s safer to go with the flow than constantly risk being rear-ended), but in many cases it’s reckless and aggressive driving, plain and simple. Running red lights. How many times have you been sitting at a red light and after it turned green watched not one, not two, but three or more cars sail across the intersection? How many times have you gone through an already-red light yourself, and then made that automatic look in the rear view mirror only to see yet another car follow your lead through the intersection? You honestly thought your offense was pretty flagrant, but that car 100 feet behind you ran the light too. The list of driving laws people obey only when it’s convenient for them is long. That’s part of the reason why more than 624,000 people have died on U.S. roads just since 2000. Not all of those people were law breakers, though. Some of them were doing everything right when they were creamed by someone who ran a red light, was speeding, or texting, or all three. So which person are you: a law & order driver? Or a wild, wild west driver? + Next issue: the Cheetos Diet and traffic safety.

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AUGUST 23, 2019

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AUGUST 23, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

It all started with notecards. In high school and college, I used to make these ridiculous notecards for school. I figured, “Well, if I’m writing it down, it’s getting into my brain.” It took me almost eight years to figure out that, at least for me, stacks of notecards did nothing for me. While it could work for someone else, I just don’t learn that way. It would have been nice if someone said to me, “Cut that out. Try this instead.” Now, I get to be that someone.

HOW TO TURN Ds INTO As AT SCHOOL

Paying Attention Yet? Say the words “neurobehavioral testing,” and prepare for eyes to glaze over. But for a family whose kid has a learning disability or a behavioral or cognitive disorder, testing is really, really important to help figure out what their child needs to do better at school. But testing’s not just for kids with learning, behavior or cognitive problems. It’s also valuable for any kid who is just like I was. The kid who’s struggling with figuring out the best way to learn. The kid who works so hard but is still getting Ds in school. The kid who really, really wants to do better (even if they don’t know it yet) just but doesn’t know how. It’s also for children in categories you might not think about: Those with diabetes whose brains might be just a little slower at processing (a possible side effect of the disease). It’s for children with asthma or another chronic illness who’ve missed a lot of school and can’t seem to catch back up. And it’s definitely for that star athlete who chokes in big competitions because nerves take over, or who’s had a concussion. This is where (cue the big words) neurobehavioral testing and training can really make a big difference. Let’s Start Training A lot of us think that to help kids focus, medicine has to be a part of that. Sure, it can help in some instances, but you don’t necessarily have to start there. In other words, medicine shouldn’t be a substitute for learning how to use your brain. Think about it: We work out because we want stronger bodies and stronger hearts. Mental training is just as important to help improve our memories, our focus and attention, and our ability to learn effectively. And just like with working out, it’s important to have a personal trainer to help your child get there. The only difference is that mental training uses pencil and paper or a computer program instead of weights or exercise machines. Here’s one example: To help train kids to focus their attention, we use a computer program where the child focuses in on a specific image while regular stimuli (visual distractions) change around that image. As kids keep working on maintaining that focus, their ability to pay attention improves. One final, important piece is figuring out ways to help children compensate for areas where they may not be as strong. For example, maybe a child has a really hard time staying organized with how they study. While notecards didn’t work for me, they might be a great solution for your child. The Whole Point All of us want our kids to succeed in school. But not all kids learn the same way. So for any child, whether or not they have a diagnosis, the point of this kind of neurobehavioral testing and training is to help them figure out the way that works best for them, help train them to think faster and remember best, and use their brain effectively so that school is less about work—and notecards—and more about learning. + Jeremy Hertza, PsyD, is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC in Augusta

AUGUST 23, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Heather Hansen, JD, on March 27, 2019

3 TIPS FROM AN ATTORNEY TO AVOID A MEDICAL MALPRACTICE LAWSUIT Twenty years of defending doctors and hospitals in medical malpractice cases has made me into a nervous patient. When you see the worst, you look for it. At least I do. That’s why when I was scheduled for a minor elective procedure, I was nervous. I set aside the day, canceling all of my depositions and planning to spend the day on emails and phone calls. My specialist’s office texted me to confirm the procedure date, which was a week away. Then I received an email from her office with the same date, but a different location. This made my med-mal antenna go up, but I told myself to chill. In the days leading up to the procedure I was traveling from NYC to San Francisco to teach, so when I hadn’t received any instructions I planned to call the specialist’s office the day before the procedure. When I did, the assistant informed me that my procedure was scheduled for that day, in an hour. Since I was in the green room at Dr. Oz at the time, this wouldn’t do. I told her they had confirmed, by text and email, that the procedure was tomorrow. She didn’t apologize, but did reschedule me for one week later, on a Wednesday. I asked her to send instructions for the prep. When I didn’t receive them by Friday morning, I emailed the office and asked for them. In response, I got an email with a messily scanned page of instructions. They said I couldn’t take Advil for a week before the procedure — I had taken Advil that morning. They said I needed an escort to and from the procedure — I hadn’t planned for that. I called the office, and the assistant said that I didn’t really need to avoid Advil and I didn’t really need the escort. I canceled the procedure. It was all too disorganized, impersonal and messy. Minutes later, the doctor called me. She was very upset that I’d canceled my procedure because it messed with her schedule. I tried my best to remain professional in response to her unprofessional behavior. I wanted her to understand something. “Doctor, if I had any sort of complication as a result of this procedure, you’ve provided any good attorney with a way to pursue a case.” I once heard a medical malpractice attorney who represents patients give a talk. He said “I look for damages. If there’s damages, I will take the case. I’m a good lawyer. I can create liability.” Doctors make it easy for lawyers to create liability when they lack perspective, when they don’t have systems in place, and when they are just plain messy. Studies show that there is very little correlation between true negligence and lawsuits. I believe that the best way to avoid lawsuits is with better perspective and better systems. After 20 years of defending doctors, I know how to avoid lawsuits. If I were this doctor’s attorney, this is what I’d tell her.

Don’t make their attorney’s job fun

1. Get a system My specialist clearly did not have a system in place. Systems save lives, as anyone who has read Atul Gawande’s “The Checklist Manifesto” can tell you. But systems also save doctors from lawsuits. If, after all of the issues I described above, I’d had a complication during my procedure with my specialist, the jury wouldn’t like to see the lack of a system to ensure the patient didn’t take Advil and did get home safe. More importantly, the fact that I didn’t get the instructions until five days before the procedure could have caused a complication. If I bled as a result of the NSAID, or fell on my way home, the doctor would arguably be responsible. The assistant’s instruction that I didn’t need to follow those instructions also could have caused a complication. I kept notes on our phone calls. I bet she didn’t. When you don’t have a system and you don’t have documentation, you do have a problem when it comes time for trial. Please see BLOG: 3 TIPS page 16

We medical examiners like to stick together. And so we herewith remind you of a book that isn’t a new release, but it’s still highly readable and full of valuable information. And it’s written by a doctor who... well, let’s just say when she talks, we really should listen. She knows what she’s talking about. Here is an excerpt from the review of her book at Amazon. com: Thousands of people make an early exit each year and arrive on medical examiner Jan Garavaglia’s table. What is particularly sad about this is that many of these deaths could easily have been prevented. Although Dr. Garavaglia, or Dr. G, as she’s known to many, could not tell these individuals how to avoid their fates, we can benefit from her experience and profound insight into the choices we make each day. In How Not to Die, Dr. G acts as a medical detective to identify the oftenunintentional ways we harm our bodies, then shows us how to use that information

to live better and smarter. She provides startling tips on how to make wise choices so that we don’t have to see her, or someone like her, for a good, long time. • In “Highway to the Morgue,” we learn the one commonsense safety tip that can prevent deadly accidents—and the reason you should never drive with the windows half open • “Code Blue” teaches us how to increase our chances of leaving the hospital alive—and how to insist that everyone caring for you practice the easiest hygiene method around • “Everyday Dangers” informs us why neat freaks

live longer—and the best ways to stay safe in a car during a lightning storm Using anecdotes from her cases and a liberal dose of humor, Dr. G gives us her prescription for living a healthier, better, longer life— and unlike many doctors’ orders, this one is surprisingly easy to follow. This book is valuable in the way the author presents each case. she describes in detail the damage done to the body by human indifference, forgetfulness and recklessness. You think you don’t you need to take that blood pressure medication because you “feel fine”? Well, you might not feel it but your heart is enlarging to double its size and your arteries are hardening, which will lead to a stroke in a few months. The book is full of examples like this. You already know most of this, but you might need a reminder of just how bad things can get if you don’t start taking care of yourself. + How Not to Die by Dr. Jan Garavaglia, 288 pages, published Sept. 2009 by Harmony

Research News New weapon for antibiotic resistance A serious and growing concern in the field of healthcare is antibiotic resistance, where bacterial infections persist despite antibiotic treatment. Last week, scientists at the University of North Carolina School of Medicine published results of new research in Cell Chemical Biology which describes ways to make pesky bacteria like Staphylococcus aureus more susceptible to common antibiotics. In brief, the UNC researchers found that by adding molecules called rhamnolipids to certain antibiotics (like tobramycin) makes them hundreds of times more potent against S. aureus and other strains that are notoriously hard to kill. The technique essentially makes the bacterial membranes more permeable to induce antibiotic uptake.

Fresh vaping concerns The CDC is working with health departments in more than a dozen states from California to Wisconsin after nearly 100 cases of serious pulmonary illnesses erupted in recent weeks linked to e-cigarette use, mostly among adolescents and young adults. Investigators have seen symptoms like coughing, shortness of breath, and fever that seem manageable, yet the patients have continued to deteriorate despite treatment. Some have suffered respiratory failure and had to be put on ventilators. Doctors are baffled because the symptoms seem routine, yet are leading to severe complications and extended hospitalizations. Long-term consequences are still unknown. Vaping as a whole is similarly unknown. Unlike tobacco smoking, vaping is

a new phenomenon without a long history of clinical and real-world experience in its health consequences and appropriate treatments. Health officials continue to warn people about the dangers — known and unknown — connected to e-cigarette use. New concussion protocols Just in time for football season, researchers at the University of Washington School of Medicine have refined guidelines for treating pediatric brain injuries. Published Aug. 16 in JAMA, the scientists say monitoring and regulating a child’s level of carbon dioxide is crucial to ensuring adequate blood oxygen in the brain and to preventing secondary brain injury. The study confirmed the “gold standard” approach for measuring carbon dioxide: using an arterial line rather than end-tidal capnography. +

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AUGUSTAMEDICALEXAMiNER

The Examiners +

by Dan Pearson

Are you kidding? Well, I’m trying to see if my That’ s about as cutting edge lettuce stays fresh longer on I heard you’re doing CRISPR research. Wow! Oh, it’s really not as you can get right now. the shelf or in the crisper. Tell me all about it! such a big deal. That’s impressive!

You don’t have to be speechless. It’s not that impressive.

Oh.

EXAMINER CROSSWORD

PUZZLE

22 24 30

36 39 42 45 47 52

THE MYSTERY WORD The Mystery Word for this issue: LAMSEES

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

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, SEPT. 2, 2019

We’ll announce the winner in our next issue!

E 7 X A6 M I 5 N3 E 2 R

2 5 3 1

5 9

3 2

4 7

1 4 7 8 4 1 9 2 7 5

S 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.

QUOTATIONPUZZLE

32. Got up 33. Legendary king of Crete 35. Islamic chieftain 36. Play the main character 38. Musical study piece 39. Bone-chilling 44. Wheel add-on 45. “The Governator” 46. Unrefined 47. Grinding tooth 48. Cover with wax 49. Portent 50. Display 51. Chute starter 52. Chief Justice Warren 53. Tide that attains the least height 54. Invent, as a new word or phrase 55. Finishes 56. Animal hair

O A B M N N U E I

D O U V

E O U T

T ’ W H O E P A L N T E I R T S

Solution p. 14

I T P N

7 4 1 L E A G6 9 E E N Y5 K I 3 K 2 8 — Dwight Eisenhower

8 2 5 7 3 4 1 9 6

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.

1. 27623 (area road) _____

6. 227866 (area road) ______

2. 35547 (area road) _____

7. 473363 (area road) ______

3. 235247 (area road) ______

8. 3369425 (area road) _______

4. 8353247 (area road) _______

9. 73966537 (area road) ________

5. 427737 (area road) ______

________

INSTRUCTIONS: Use keypad letters to convert numbers into the words suggested by the definitions provided. There is often a theme linking all answers. Sample: 742 (body part) = RIB. Answers on page 14.

The first issue of each month contains a “Words by Number” puzzle in this space; the second issue contains 10. 26586242 (area road) a “Text Me” puzzle.

20 21 ACROSS 1. Ike’s ________ 23 5. Atlanta’s ____ House 25 26 27 28 29 9. Prefix meaning tissue 14. Capital of W. Samoa 34 35 15. First-class 37 38 16. Speak extemporaneously 17. Depend 40 41 18. Cowboy item 43 44 19. Detroit team 20. Science of sedation 46 23. Dispose of 48 49 50 51 24. Portable bed 25. Mount of note 56 57 29. Film first seen in Atl. 59 60 31. Male sheep 62 63 34. Equivalent to 35. Great Lake by Daniel R. Pearson © 2019 All rights reserved. 36. Garment worn by women in India DOWN 37. Addition to 1. Medic beginning 40. Fastens a knot 2. Bad type of fracture 41. Bound 3. West _____ Virus 42. Rope with running noose 4. _______ Inn 43. Monkey 5. Late local historian Ed 44. Still concern 6. Wished 45. Concurs 7. Responsibility; duty 46. Vulgar, ill-bred fellow 8. Around prefix 47. Med. image 9. Sanctify 48. Letters 10. Utterly stupid person 56. The body’s largest bone 11. Trudge 57. Nimbus 58. Very long time (British var.) 12. Very small 13. Baby doctors 59. Skin irritation; hives 21. Cave-dwelling dwarf 60. By mouth 22. Eight singers 61. Cockroach killer 25. Roman goddess of hearth 62. Get more magazines and household (and/or newspapers) 26. Stock; furnish 63. Division of a hospital 27. Indian money 64. Certain nurses 28. Sleeps briefly 29. Jackets’ color 30. Word in 29-A 31. Rear

TEXT

AUGUST 23, 2019

3 9 6 1 8 2 7 5 4

4 3 8 2 5 6 9 1 7

1 7 9 3 4 8 5 6 2

5 6 2 9 7 1 4 8 3

AUGUST 23, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

The

Advice Doctor

Joe: How’s that working out? Moe: Right now it’s about half empty.

Moe: We just discovered that our church is full of termites. Joe: Yikes. What are y’all going to do about that? Moe: Well, on Sunday the preacher started his sermon with “Let us spray.”

n Take Your Child to Work Day a man took his 7-year-old daughter to the office. She was very excited as he gave her a complete tour of the place, but the longer the tour went on, the sadder and more disappointed the little girl got. Finally when she had seen the whole office she burst into tears. Her father and half the office staff gathered around to find out what was wrong and console her. “What’s wrong, sweetheart?” her father asked. “Daddy, where are are all the clowns you said you work with?” Moe: I’m so sorry about your father. Joe: Thank you. He’ll definitely be missed. But at least he died doing what he loved. Moe: What was that? Joe: Googling his symptoms instead of going to the doctor. Moe: You know how a lot of people have a swear jar? Joe: Yeah. Moe: Well I have a negativity jar. Joe: How does that work? Moe: Whenever I have a negative thought or say something negative I put a dollar in it.

Moe: What do you call a monkey walking through a mine field? Joe: A baboom. Moe: You got a rescue dog? That is great! Joe: Nobody wanted him because he has no legs. Moe: No legs? Oh my. Well what did you name him? Joe: Cigarette, because when I have to take him for a walk it’s a drag. Moe: You know what really makes me smile? Joe: Facial muscles? Moe: Exactly. Moe: The service at Popeyes is amazing. Joe: Why do you say that? Moe: I went in there today and ordered lunch. I said I wanted dark meat, drumsticks if possible. Joe: So? Moe: So then the lady asked me what side I wanted. No one has ever asked me that in a restaurant before! After thinking about it for a second I decided to go with the right side. +

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.

Dear Advice Doctor, My elderly mother is still in her home even though my father died several years ago. The house is far too big for one person, but that’s just the tip of our iceberg of problems. My mother has about a thousand habits (conservatively speaking) that absolutely drive me crazy. Meanwhile, she says I’m driving her up the wall with things I do. Something’s gotta give. You’re The Advice Doctor, so please give me some. — Mother’s Little Helper Dear Little Helper, First, I’d like to commend you for helping your mother stay in her home. For many older adults who have retired, lost many of their lifelong friends and even their marriage mate to death, the family home is sometimes their lone remaining anchor to the past. It can be a challenge to stay, but sometimes downsizing to an apartment or moving to a senior living community can feel like they have been cast adrift into a strange and impersonal new world. You mention driving your mother up the wall. I assume you’re referring to a stairlift. This is a very practical way to ensure that a home is still accessible for someone with mobility issues. Believe it or not, home elevators are another fairly reasonable option. Not much more space than a closet is required, and the price can be far less than the financial and emotional cost of moving. There are other simple and inexpensive options that can help older adults maintain their independent living arrangements. Here are a few: encourage them to stay active the regular exercise and walking to keep muscle strength and balance at optimal levels; rearrange furniture for maximum ease of travel through main rooms; remove clutter and potential tripping hazards like throw rugs; don’t allow vanity to keep them from using a walker or a cane; install railings inside and outside the home to prevent falls; improve outdoor lighting; in medical matters, be alert to changes caused by their medications and carefully manage their side effects. Best wishes! I hope my advice has been helpful. + 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 Examiner issues.

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THE MYSTERY SOLVED The Mystery Word in our last issue was: NURSING ...cleverly hidden on the shaver in the p. 2 ad for DANIEL VILLAGE BARBER SHOP

THE WINNER: DENNIS HOECHST ! 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!

AUGUST 23, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED P A R A

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SEE PAGE 12

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

...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.

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

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QuotatioN QUOTATION PUZZLE SOLUTION “Never waste a minute thinking about people you don’t like.” — Dwight Eisenhower

TEXT ME 1. BROAD 2. ELLIS 3. BELAIR 4. TELFAIR 5. HARPER

6. BASTON 7. GREENE 8. FENWICK 9. REYNOLDS 10. COLUMBIA

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

AUGUST 23, 2019

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AUGUSTAMEDICALEXAMiNER

PROFESSIONAL DIRECTORY +

ACUPUNCTURE

DENTISTRY

DRUG REHAB

Dr. Eric Sherrell, DACM, LAC Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707 www.AcuClinicGA.com

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

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

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

AMBULANCE SERVICE

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

DERMATOLOGY 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

IN-HOME CARE Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) WOODY MERRY www.woodymerry.com Augusta 30904 Long-Term Care Planning 706-733-3373 SKIN CANCER CENTER I CAN HELP! www.GaDerm.com (706) 733-3190 • 733-5525 (fax)

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

YOUR LISTING Augusta Area Healthcare Provider 4321 CSRA Boulevard Augusta 30901 706-555-1234 CALL 706.860.5455 TODAY!

PHARMACY

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

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

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

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 thousands of patients every month. Call (706) 860-5455 for all the details!

READ ONLINE THE

MEDICALEXAMINER VISIT AUGUSTARX.COM FOR EVERY NEW ISSUE, AND ISSUU.COM/MEDICALEXAMINER, WHERE MORE THAN 185 PAST ISSUES OF THE EXAMINER AWAIT YOUR READING PLEASURE.

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AUGUSTAMEDICALEXAMiNER

AUGUST 23, 2019

THE MONEY DOCTOR

THE FED AND INFLATION – WHAT’S THE BIG DEAL? The big financial news last month, on July 31, 2019, was from a meeting of the Federal Reserve, often called

simply the Fed. The news was that the Fed lowered the federal funds rate by 0.25% for the first time since the end of the 2008 financial crisis. At these meetings the Fed can make adjustments to the federal funds rate to influence the U.S. economy. When the economy is heating up, the Fed can increase the rate to try and keep the economy from overheating. A good example of this was between 1981 and 1982 when inflation was running 14%, the Fed increased the federal funds rate to 20%. When the economy is slowing down, the Fed can lower the rate to entice people to borrow and spend money. A good example of this was between 2000 and 2003 when the Fed decreased the federal funds rate to 1.25%. In 2008 they decreased the federal funds rate all the way down to 0%. After the cut in July, the current federal funds rate is now 2.25%. The Fed cited lower inflation as the main reason for the cut this July. The current inflation rate is around 1.5% compared to 2.95% in July last year. Inflation is a key metric that the Fed uses to make rate decisions and it is important to understand. What is inflation, why is it a big deal, and how does it impact financial plans? What is inflation? Inflation is the general increase in

prices that happens overtime as our economy grows. As prices of goods and services rise, our purchasing power (the amount our money can buy) decreases over time. A common example is the price of gas. In 1959, a gallon of gas was around $0.27. Inflation has caused the price of gas to increase a lot over the years. Today the national average for a gallon of gas is over $2.75.

Why is inflation a big deal? Over time inflation can significantly reduce the purchasing power of money that you have worked hard to save. As an example, if you have $100,000 saved today at the age of 60 and you put it under a mattress earning 0% for 25 years. At age 85, based on 3% inflation you will only have around $48,000 of purchasing power left. Said another way, your $100,000 will only buy things that cost $48,000 today. The only way to stop that from happening is to invest your money and earn an investment return equal to or above the inflation rate. How to plan for inflation in retirement As part of the cash flow planning we do for clients, we must make assumptions about future returns and inflation. We explain to clients that the most important number is actually the difference between the two numbers, known as your real return (real return = return

Proudly affiliated with Dr. John Cook of Southern Dermatology in Aiken

by Clayton Quamme, a Certified Financial Planner (CFP®) with AP Wealth Management, LLC (www.apwealth.com). AP Wealth is a financial planning and investment advisory firm with offices in Augusta, GA.

BLOG: 3 TIPS… from page 11 2. Get perspective Had my doctor seen things from my perspective, she never would have called me to berate me for canceling. I was frustrated, nervous and confused. Now I was mad. And mad patients sue doctors. Wendy Levinson has been on the forefront of the work that shows us that patients sue doctors who don’t communicate well. Frustrated, nervous, confused patients are just looking for some empathy. If a doctor can’t put herself into a patient’s shoes, she is going to have trouble at trial when she has to put herself in a juror’s shoes. And she is far more likely to find herself having to do exactly that.

M.D. John Cook,

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

2110 Woodside Executive Court Aiken, South Carolina • 803-644-8900

on investment minus inflation). For example, if your return is 6% and inflation is 2.5% then the real return 3.5%. If your retirement cash flow projections look good with a real return of 3.5%, you can feel confident that you will be successful in retirement if you earn a real return each year of 3.5% or higher. As an example, if inflation jumps to 10% and your investment return is 13.5% that same year, your real return is still 3.5% and your retirement cash flow projections will still work. Understanding the assumptions used in your retirement plan will help you evaluate each year whether you are staying on track or if you need to make adjustments. A good financial planner will go over all of these assumptions with you as part of your financial plan. They can also explain why they used the numbers they did and what the impact will be if the real return is different than expected. With the Fed making changes, now is a great time to review your financial plan to make sure the assumptions you have used are still reasonable given the economy today. +

SKIN CANCER CENTER

2283 Wrightsboro Road Augusta, Georgia • 706-733-3373

Skin Cancer Removal • Mohs Surgery • Routine Skin Exams • Mole Removal • Botox • Dermal Fillers

GENERAL, SURGICAL & COSMETIC DERMATOLOGY

3. Get clean I don’t mean wash your hands, though this goes without saying. I mean don’t be messy. When I have to defend a doctor with missing notes, inconsistent practices, and undocumented phone calls, I know I’m facing an uphill battle. Messiness gives the patient reason to be upset, and it gives the patient’s attorney so much to play with in establishing a case. When you’re messy, you are making the patient’s attorney’s job fun. Defensive medicine adds $45 billion to the cost of health care. Doctors are ordering more tests, and doing more procedures in an effort to avoid lawsuits. I’ve defended doctors for over 20 years. I love and respect health care providers, but I know better than almost anyone how human they can be. And I know that small fixes can make a huge difference. Get a system, put it in place, and stick to it. Get perspective, be empathetic and communicate with your patients. Get clean, and don’t allow your practice to be messy and disorganized no matter how busy you may be. This is the best type of defensive medicine, and it is free. + Heather Hansen is a communications consultant and attorney.