Medical Examiner 8.7.20 by Daniel Pearson

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PREACHINGTOTHECHOIR? AUGUST 7, 2020

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Here at our sprawling Medical Examiner world headquarters campus in Augusta, we would like to think that we have sufficiently and correctly educated our readers about various realities of the historic pandemic we’re all trying to survive. For instance, we have written many words about the wisdom of wearing masks, and in other ways cooperating with the recommendations of public health experts. On these pages we have also tried to offer sound reasoning against some of the wild conspiracy theories that have sprung up and spread with a contagion all their own. Hopefully we are indeed preaching to the choir; we hope you’re as convinced as we are about the value of hand washing, physical distancing, mask wearing, and avoiding large gatherings, as well as rejecting most of the outlandish theories about this pandemic and its origins and eventual demise (example: “Just wait and see! This will all disappear right after the election! Mark my words!” People, please. Get a grip.). A logical question, then, if we suspect we’re preaching to the choir, is: why do we keep doing it? There are a couple of main reasons. First, we realize that not everyone does agree. Opposing viewpoints are regularly posted on the Medical Examiner’s Facebook page (Facebook.com/ AugustaRX). There are still people out

there — and some of them read this newspaper — who think wearing masks is for idiots, who think Democrats and liberals engineered this whole crisis (or are at least happy to take advantage of it), who believe the numbers of cases and deaths are wild exaggerations designed to promote panic, increase ratings and sell ads, and who believe the best thing all of us could do around the world is ignore this virus and all the mandates and get back to normal living — and do it yesterday. We still want to talk to those people. A second reason is that none of us, not even members of the choir, are exactly living in a vacuum, even though it would probably be beneficial if we were. We all hear things every day — this doctor says masks are unnecessary; that doctor says he has found the cure but no one will listen; kids can go by the thousands to school, but a dozen people can’t sit here and there in a spacious bar? — and those news flashes raise questions in our minds. We’d like answers, and we want to be able to intelligently agree or disagree with the latest developments. We might even occasionally try to point out the error of someone else’s thinking, although in most cases that’s a pointless endeavor. But it’s so hard to resist! We have fallen into the trap ourselves. Within the past week on the NextDoor app, we noticed a lively exchange of ideas — sure, let’s call it that; it sounds better than argument — about the pros and cons of wearing a mask. One lady, the self-appointed advocate that masks are not just useless but also dangerous and unhealthy, was single-handedly taking on all comers. She offered no evidence or credentials, but it’s much more likely that she’s a nail tech than a physician or epidemiologist. She did offer plenty of dogmatic statements that were completely at odds with the world’s medical community, and they were delivered with total assurance.

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Not a shred of doubt or uncertainty. Rather than wade into the public fray on the app, we sent her a private message with one simple question: why are you doing this? Everyone has the right to ignore medical advice, even life-saving medical advice, we wrote her. Cancer patients refuse chemotherapy treatments all the time. That is their right. But can you imagine someone doing so and then loudly and publicly campaigning for all other cancer patients to refuse chemo too? Why would anyone do such a thing? In the context of the Great Pandemic of 2020, if you feel mask wearing (etc.) is foolish, feel free to embrace that belief and put yourself and others at risk. But as if that isn’t self-centered enough, why are you then going another step and trying to convince everyone else? Why have you appointed yourself as the spokesperson who opposes public health experts all over the world? If you want to act AMA (Against Medical Advice), so be it. But please, stop trying to infect others, literally and figuratively. It’s unhealthy. +

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critically low oxygen levels in their blood. This decline typically happens in a couple of days, but sometimes it is only hours. Often after being on the ventilator for several days under heavy sedation and paralytic agents their oxygen levels

“This round of COVID feels worse than the first.”

{

If you answered: A. Was this your choice? If so you chose the best response. Take every opportunity to teach her to think about treating other kids the way she would want to be treated. B. At her age, numerous short conversations are better than one long one. You want to help her understand the way the other children are feeling. C. Actually, she probably won’t figure out on her own why the other kids are mad at her. That’s a connection that you should help her understand. D. This plan teaches the wrong lesson. You want her to stop tattling because it is wrong, not because she might get punished. When you have a child with problem behaviors, it is important to consider what it is you are trying to teach. Punishment is rarely the best way to teach. It is much better to help them understand what they are doing wrong and why they should change. +

I love my career and I am passionate about respiratory therapy. Lately, the mental toll my job has taken on me, my colleagues, nurses, doctors, etc. is tremendous. The recent surge of COVID-19 was unexpected, at least by me. It is a very defeated feeling that is difficult to put into words, but I will try my best. I am often assigned to care for patients who are sick with coronavirus, some of them deathly ill. I go into each room dressed from head to toe with a hair net, goggles, N-95 mask and another mask over that, a gown, 2 pairs of gloves and shoe covers. I enter the room with enthusiasm and words of encouragement to keep their spirits up while I am administering their treatment. These patients are incredibly grateful and kind, which makes the next part of this story even harder. As I care for these patients I have witnessed the decline of many of them, as they progress downward from breathing room air to a nasal cannula to a heated high flow nasal cannula to a ventilator, all due to

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Your 8 year-old daughter has developed a problem with tattling and telling things she shouldn’t. No secret is safe with her, and her friends always seem to be mad at her because of things she has said about them. Your other children are angry that she constantly tattles on them. Even her teacher has commented about the things she has said about her family and about the other kids in her class. What do you do? A. Keep reminding her of the Golden Rule and that she wouldn’t want other kids tattling on her or talking about her. Ask her often about how she would feel if her friends and family treated her that way she treats them. B. Have a long talk with her about how hurtful she is being by tattling and telling secrets. C. Her friends and your other children seem to be handling the situation already. She will figure out on her own what she is doing wrong. You don’t need to do anything else. D. Start punishing her when you hear that she has tattled or told a secret. Make sure she knows exactly why she is being punished.

ECMO is a by-pass machine used for the heart and lungs or just the lungs when there is an injury to them. So much energy is poured into these patients, rooting for them to improve. Unfortunately, very often these patients who we have poured our hearts into do not improve, even after days of proning, ECMO, and ventilator assisted breathing. All these things are going on simultaneously, meanwhile the Chaplain is Face-timing the patient’s family so they can see their loved one. Often conversations regarding the goals of care are conducted over the phone. Can you imagine talking about what lengths you do or do not want taken to care for your loved one in that environment? I cannot remember giving this much emotional energy to something or someone as I find myself and my colleagues giving to these patients now. This round of COVID is different than the first. It never went away but it is far worse now. I have to say what you already know: wear a mask, stay home if you do not feel well, social distance and all of the things to keep us all safe. If not for yourself for others; and if you see or know a healthcare worker keep them in your thoughts and prayers. We are pouring into our patients like they are our own family and fighting this fight to honor those who do not make it back from the decline. This sounds grim and dark, but for many of us at this time in history it is our reality. We will continue to do this every day because it is just what you do when you are called to the service of healthcare. +

do not improve or continue to decline the decision is made to prone the patient (turn them on their stomach), in an effort to improve their oxygenation. It is a daunting task to prone an intubated patient that is on a ventilator while being mindful of IV tubing that is used to deliver medicine or to get blood for labs. There have been cases where ECMO (extracorporeal membrane oxygenation, a technique of providing respiratory support) has been attempted to “rest” the lungs so that they might heal.

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— Kimberly Savage is a respiratory therapist who works at two Augusta-area hospitals

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Let’s spend a few calm, quiet and rational minutes talking about everyone’s favorite subject, the coronavirus. (Part 9 of a feature of unknown duration.)

Here is a news flash: humans are imperfect. Governments and organizations large and small are imperfect, since they’re usually made up of people who are all imperfect. The bigger the organization, the more imperfect hands are in there stirring the pot. We all know this and have known it, but for some reason right now people have an extremely low tolerance for mistakes (or merely perceived mistakes) in others. It is no doubt related to the levels of stress and anxiety everyone is facing to some degree or another during this pandemic. As one example, perhaps you have heard comments (or you’ve seen it firsthand for yourself) that people seem to be driving more aggressively and impatiently than they usually do (see also page 10). That feeling of intolerance and impatience with others might be what’s behind the ongoing debates raging over coronavirus response measures. Mistakes have been made, there is no doubt, and mixed messages are being sent

out each and every day. The federal government is leading the program we call Groping for a Cure: one top official issues a statement in favor of masks while another downplays their importance; one department urges use of a certain drug while another department of the same government says it does not work; let’s get back to work and get back to school, urge some, while others say slow down, it’s too much too soon. Admittedly, it is all a bit chaotic, but how could it not be? If the top two items on the government’s agenda are 1. vanquish the virus, and 2. energize the economy, they are faced with two opposing objectives. Progress in one goal must come at the expense of progress in the other. There is no simple way to accomplish both simultaneously. It’s like some kind of Chinese puzzle — forgive the analogy — where the harder you work for a solution the farther you get from it. Also, many in the anti-PPE crowd like to quote people like Anthony Fauci (see also page

4), who said months ago that wearing a mask was not necessary and offered no protection. That was then. This is now. He retracted that statement months ago as more information about this virus became known, and as shortages of masks and other items of protective gear were solved. For many months he and others — the medical community is virtually unanimous on this — have repeatedly urged the importance of wearing masks and following the other simple, basic preventive steps. If you’re still stuck on statements from February and March, check your calendar: it will be September in a few weeks! Catch up! One of the most popular genres of TV programming right now are true crime shows. The first suspect police search for might be an unknown subject who is tall, slender, and seen on security videos wearing a blue hat, a white t-shirt and green shorts. When he is located, it turns out he has an iron-clad alibi that completely removes him from suspicion. The investigation moves on as more information is gathered, always improving and further narrowing its focus until the real perpetrator is identified and brought to justice. When many in the loud and vocal anti-mask movement cite old information in defense of their position, they’re like a homicide detective who is still stalking that innocent guy in the blue hat. Folks, the rest of the department has moved on. Let’s catch the real killer. +

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Where are all the disinfecting wipes? We need these items to do our part in helping slow the spread of this pandemic, especially for households where one or more persons have tested positive. Washing hands and disintecting surfaces, physical distancing, and wearing masks are three simple steps recommended for everyone. But here we are, months into the crisis, and these items are still very difficult to find. Logic would suggest that manufacturers and suppliers have had ample time to ramp up production and address the shortages. So what gives? The CEO of Clorox told Reuters earlier this week that its bleach and other cleaning products will catch up with demand within the next 4 to 6 months, but shortages of disinfecting wipes are going to continue into 2021. The challenge for them and other similar manufacturers is two-fold. First, demand is up more than six times what it was before the pandemic erupted, at least for the Clorox company. And it isn’t just grocery store shelves. Hospitals are buying barrels instead of gallons; ditto for school systems; airlines are sanitizing and disinfecting between flights as never before; virtually every potential customer wants to buy, and is buying a lot more than ever before. Clorox says every one of its plants is running at full speed 24 hours a day, 7 days a week, 365 days a year to keep up with demand, plus they’ve started outsourcing manufacturing to third-party suppliers. The situation with disinfecting wipes is a little different. Many wipes are made from a material called polyester spunlace, which is in super-high demand since it is also used to make personal protective equipment like masks, medical gowns and medical wipes. Every end user of products containing polyester spunlace is ordering far more than their highest-ever past orders, stressing the supply chain for every application. And naturally, spunlace destined for so-called “front line” healthcare use typically gets priority over consumer products. So the shortages aren’t likely to end anytime soon. If you see some in the store, grab a package. A package. Not twelve. Remember that others want some too. +

MEDICALEXAMINER

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

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AUGUST 7, 2020

#120 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

veryone knows the answer to this installment of “Who is this?” Why, that’s the most well-known doctor in America, Anthony Fauci! Until recently — you know, before the death threats started coming in — Fauci was enjoying a sterling and highly respected career as a disease fighter. Born on Christmas Eve 1940 in Brooklyn, New York, Fauci worked at the family pharmacy during his younger years making neighborhood deliveries. His father was a Columbia University-educated pharmacist. With that exposure, Fauci’s interest in healthcare was kindled. Pursuing a degree in medicine, he graduated first in his class from Cornell University Medical College in 1966. In the years since 1966 he has accumulated honorary doctorates from no fewer than 30 universities around the world. Why? Although Fauci may not have been a household name until this year, he has been a medical pioneer for decades, especially in attacking infectious diseases and those driven by skewed immune responses. For example, he was one of the leading researchers at the forefront of the AIDS epidemic in the early 1980s, successfully lobbying for sharp increases in AIDS research funding. A 1985 survey of rheumatologists by Stanford University named discoveries by Fauci as the most important advances in patient management for rheumatology over the previous 20 years. He has developed treatment therapies for a number of formerly fatal diseases, has been a key medical adviser for every U.S. president since Ronald Reagan, and since 1984 has been Director of the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health (NIH), where his wife of 35 years is chief of the Department of Bioethics at the NIH Clinical Center. He has been at the forefront of the U.S. (and often global) response to viral outbreaks over the years like Ebola, SARS, MERS, the 2009 swine flu pandemic, and this year’s coronavirus pandemic. According to the Institute for Scientific Information, Fauci in 2003 was the 13th most-cited scientist in articles published in scientific journals between 1983 and 2002. Considering that as many as 3 million authors were published in the scientific literature during those years, his ranking shows the high esteem in which he is held in the scientific and medical community. If all that is true, why does he have a security detail these days trying to protect him from death threats? Public health officials right now are fighting a battle that is often at odds with another very important concern: restarting the economy. An all-out focus on pandemic suppression efforts is an economy killer, but being too economy-centric is like like feeding vitamins to the virus. Each side believes its agenda is the most important. Striking a perfect balance is proving to be almost impossible, but that hasn’t stopped millions of armchair quarterbacks from loudly making their opinions heard. Anthony Fauci is often the target, but he seems to be immune to the criticism. +

The other day I saw Lindsey Graham do an interview on TV. The interviewer asked him if there would be any more stimulus checks coming as we face more weeks of a disrupted economy. He responded that one group to get paid would be seniors, and I know that many of us are struggling with exploding grocery and delivery costs, so that is very much needed, but he did not mention parents and others caring for children with few or no resources. Back in Reagan’s days, with huge cuts in taxes for the wealthy and excruciating times for families with children, I was one of the moms affected by those cuts. A bit after the show ended, I began to weep and it seems his words had taken me back to those days of terrible poverty for my children and me in the early 80s. They took me to a time in the grocery store when my four year old daughter asked me for a candy bar and I slapped her because I could not afford to buy her a candy bar. In part to pay for those tax cuts for the ultra-wealthy, they cut food stamps to the point that as a newly single mother I had only $35 a week to feed myself and five kids, three of whom were teenagers. At that time, I contacted the head of our county’s DSS. She told me that those tax cuts so desperately needed by the wealthy had reduced food stamp funding to the degree that they could, at most, provide food sufficient for two months. Beyond that, the ill effects of malnutrition could set in. I also recall Reagan belittling poor moms as lazy frauds taking advantage by having big families to get more welfare. I hadn’t had my children to take advantage of the system. I had them because that was what good Catholic wives did in the 60s and 70s, and because I loved and wanted every last one of them. I didn’t have any of them after Reagan became president. I did have every one of them as a married woman, married to just one person. But none of that mattered

to other grocery store patrons who would see my food stamps and denigrate me for buying healthy vegetables and fruit for my kids. One of them asked me how dare I buy asparagus for my children. Another attacked me for buying one steak to give a little treat to six people. Those people are why I slapped my child for asking for a candy bar. Forty years later the pain over what I did is just as acute as it was that day. Only today I am not concerned for myself, nor for my daughter. I am concerned for all the moms and dads out there who have been treated badly by a society which values the wealthy more than they value families struggling to survive in a broken economy and pandemic. Get a job, they might say to those families struggling to survive. In the 80s, like today, most jobs had disappeared. In Michigan I contacted the state DSS head, Dr. Manseur. I have a BA in English I told her. I want to work, I said. I still have the letter she sent telling me that she was sorry, but there were no jobs. Today the same situation exists for many families who are about to have their water and power turned off and the roofs over their heads taken away from them. Please, do not be one of those responsible for pulling the plugs and throwing families out on the street. Please do not make any mother or father or aunt, uncle, or grandparents feel guilty enough if a child asks for a candy bar that they slap that child like I did. Our millionaires and billionaires and those who give them tax cuts and stimulus packages they don’t need must think of the innocent little children they are hurting with their greed. Today I wept, not for myself, nor for my daughter, but for today’s parents and children living in poverty so the wealthy can be rich. The pot, my friends, is only so big; but it is enough, more than enough, for all to live decently, if the mindset of social responsibility begins to inform our federal, state, and local decision-making. In those to whom much has been given lies great responsibility. +

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age BY J.B. COLLUM

moment. I asked Uncle Larry if perhaps we should call his son or daughter to find out where his wife was. He didn’t like that solution. He wasn’t on good terms with them at the moment and didn’t want to ask for help. So instead, I called the main phone number for the nursing home and simply asked where we we could find Uncle Larry’s wife. Unfortunately, due to patient

though with two people in our party having dementia, it got a little repetitious at times and even a little confusing, especially for them, but also for me trying hard to follow along. However, with the right attitude, born of experiences so far on this trying day, it also brought me some chuckles. Sometimes, all you can do is laugh. We persevered through the repetition and confusion and in about an hour, my father told me we needed to go. He was tired and wanted to get home. So we said our goodbyes, loaded up and headed back to Uncle Larry’s. We dropped Mary off on the way, and I must admit that I started to feel the first wave of relief as the end was in sight, and one source of stress, the unpredictable Mary, was no longer my responsibility. After getting Uncle Larry back into his house and making sure he was comfortable, Dad and I started beating the path back home. This was my second wave of relief. However, with my father, the late afternoon and evenings are when his cognitive issues seem to be worse. This was new ground for us as I had not had him out alone past sundown in a while. I had some concerns about how it would go, and as you will see in the next issue those concerns were justified. Until then, stay safe and stay in touch at the email address listed below if you have any thoughts you’d like to share about your own adventures in middle age. +

THE

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In the previous two issues, I shared with you the first two parts of the trip with my father to visit his uncle in Charlotte. We now resume the story with us headed to visit Uncle Larry’s wife at the nursing home along with his vexatious hitchhiking neighbor, Mary. As Uncle Larry directed me to the nursing home where his wife was housed we got lost. I asked for the address so I could just put it in the GPS, but he didn’t know the address and insisted that he would get us there. We did make it, eventually, but this nursing home was enormous, and we drove around it for a while as he tried to recognize the correct building. After driving around the grounds for a while in the hopes that he would see an entrance that looked like the correct one, I pulled into a shady parking spot in front of what looked like the main entrance. From there we could tackle this on foot. Uncle Larry was a bit flustered, as one might imagine, and Mary didn’t help as she kept offering suggestions about where to go even though she admitted to never having been there before. I wasn’t in the mood to go into the wrong building several times, each time going through the laborious process of getting my dad and uncle out of the car and then back in. Mary didn’t have a good track record at getting the right door (or the right jacket for that matter, as we chronicled in part two or our story). At least my dad was his usual quiet self as he patiently waited for us to solve this latest crisis. He was in a comfortable, air-conditioned car, nobody was looking to him to solve any problems, and he wasn’t in any hurry. How I envied him at that

{

“They refused to tell him where his own wife was.”

privacy regulations, they couldn’t tell me anything. And I mean, anything. I handed the phone to Uncle Larry and for some reason, they wouldn’t tell him where his own wife was either. My frustration level was beginning to mount. I took a breath and decided to call his son, despite Larry’s previous objections, since I had that number handy in my phone and there was no end for our predicament in sight. I knew Larry wouldn’t like it, but our options had dwindled to where this was the best choice. We got a quick answer as to her room number and even some directions to the front of the correct building, which was quite a ways away. I drove us over there and went through the long, drawn-out process of helping my father and his uncle out of the car and into the building and then I went to find another shady parking spot as the day had gotten quite warm. After parking the car again, I joined them inside and we had a pleasant visit,

J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.com

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Don’t be fooled. Many zucchini bread recipes are actually not a healthy snack. The recipes might have a vegetable in them, but they are also loaded with sugar and processed white flour. Good news though! I created a Healthy Chocolate Zucchini Bread that is good for you. I have substituted many of the unhealthy ingredients for healthier things. For example, instead of oil I used unsweetened applesauce, and I replaced white processed flour with quinoa flour. The sweetness comes from my new favorite sweetener called Lakanto Monkfruit Sweetener. It measures zero for calories, glycemic and carbs. It gets its sweetness from erythritol and monk fruit. If you are interested in purchasing some, stop by my website, www.intentionalhospitality. com, for a link to where I purchase mine. I have also discovered Lilly’s Dark Chocolate Chips that I sprinkled on the top of this zucchini bread before baking. They are also zero calories and are sweetened with stevia. I purchase mine online, but most local stores are starting to cary this brand of chips. Healthy Chocolate Zucchini Bread

Ingredients • 1-1/2 cups shredded zucchini • 1/4 cup unsweetened applesauce • 1/3 cup plant-based milk • 1/3 cup all-natural almond butter • 1 tsp vanilla • 1/4 cup Hershey’s Special Dark Cocoa • 1/3 cup Lakanto Monkfruit

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NUTRITION Thomas, from Beaufort, SC, writes: “My 15-year-old son loves whole milk. He easily drinks 2 gallons a week. Is this healthy? By the way, he’s underweight.”

Yes, your family needs to choose skim or low-fat milk as the only milk in the house. It should be the family’s milk. The decision to make this switch needs to be a family decision, especially since your son is 15 and should participate in family nutrition decisions.

The data show that when nutrition decisions are shared by the entire family, the outcomes are much better, especially with teens. Going “cold turkey” from whole milk to skim milk will mean a big change in the taste of the milk. That oftem presents a barrier to change. My suggestion is that, instead of going cold turkey, try the “weaning” approach. For a few months, buy 2% milk, then a few months later, buy 1%, then skim milk. And if you stopped at the 1% milk stage, that wouldn’t be a big issue. Anything above 1% is simply too high in saturated fat. A natural question that people ask me concerns whether there really is a big difference in the fat content between whole milk, which is 4% fat, and, let’s say, low fat milk, which is 1% milk. After all, that’s only a 3% difference in the fat content, so what’s the big deal? The big deal is the big difference in fat content. The fat percentage expressed on milk containers is by weight, not by calories. Since most of the weight of milk (87%) is water, expressing fat content as a percentage of its weight leads to the false impression that whole milk has very little fat. If whole milk is 4% fat then who might think it’s 96% non-fat, right? But whole milk is actually about 50% fat, based on calories, most of which is saturated fat. If your son is drinking two gallons of whole milk a week, he is getting a whopping and unnecessary load of saturated fat. We know that cardiovascular disease begins as a teen or before, so we do not want teens taking in all this satu-

AUGUST 7, 2020

Milk: is it good? Or bad?

rated fat. Your question actually has several other interesting aspects to it. For example, I want to ask if you are sure your son is underweight. What the data show is that so many Americans, including teens, are overweight these days, that parents are incorrectly thinking their normal weight child is underweight. When researchers show parents pictures or silhouettes of teens and ask them to pick out the normal weight and overweight images, parents consistently choose the overweight image as normal weight. So the first thing I would ask you to do is calculate what his Body Mass Index or BMI is. This is calculated from his height and weight, using BMI tables appropriate for his age and gender, not the common adult tables you see. You can find these teen-specific BMI calculators on the web. He should be in the range of what is considered a normal BMI. Another interesting aspect to your question centers on the common misconception that if a boy is underweight, it is important to bulk him up by having him drink a lot of whole milk. This suggestion is very com-

monly given to underweight boys by coaches wanting them to participate in sports. Now we know better. If your son needs more calories, they should come from healthy foods higher in fat and calories, but low in saturated fat, sodium and sugar. For example, always have healthy cooking oils at home, like olive oil or canola oil. Cook with these oils to add extra calories or, better yet (so the whole family doesn’t gain weight), you can add these oils to cooked vegetables or pastas prior to serving them to your son. It takes very little oil to add significant calories. Other ways of adding extra calories to the nutrition of an underweight boy (if in fact he is) is for him to munch on nuts, hummus or to add peanut butter, oily fish, avocados or olives to his diet. For example, you might slice in an avocado into a salad and throw on some toasted almonds. What is the “no-nonsense” nutrition advice for today? You are right to be concerned about your son’s whole milk intake. It is excessive. The family needs to come up with a strategy to make the “real milk” in your house low fat or skim milk. Make sure that your son is, indeed, underweight, by having his BMI measured using the appropriate teenage comparison data. If your son is underweight, then extra calories can be added to his diet by adding healthy calories, not by adding foods high in saturated fat, salt or sugar. One way that your teenage boy differs from you is that he is growing. That means that, unlike you, your son needs sufficient calories for growth and development. +

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

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Ask a Dietitian MINDFUL EATING

by Lo Bannerman, MS, RDN, LD Nourishing Families LLC • www.nourishingfamilies.org We thrive when we consciously do one thing at a time, but for many of us, busy lives have caused us to cut corners and overlap daily tasks. This busyness has caused many to work or scroll social media during meals, to lose the art of cooking, or even forget to chew or taste their food. We’ve become so disconnected from food, and it’s time to find our way back. Efficient eating is eating as quickly as one comfortably can so one can get back to a busy life. In this approach, eating is seen as a task to cross off, not an experience to enjoy. It is often combined with other tasks and typically leads to overeating and under-enjoying food. Mindful eating is allowing a meal or snack to be the focus; pausing one’s busy life to enjoy the sustenance that keeps one going. Mindful eating honors hunger and fullness cues and is a judgment-free, pleasurable experience. Mindful eating is not a new diet plan or gimmick. It is a return to your innate ability to regulate your food intake and help your body thrive!

Pathways to Mindful Eating Step One Choose one meal to eat without distractions. Value and enjoy this eating experience and be realistic with yourself; this eating style may not be available at every meal. Step Two Let go of rules. Food is meant to be enjoyed and mindful eating allows you to honor your hunger and fullness, finding the sweet spot of satisfaction. The only forbidden foods should be those that cause an allergic reaction. Step Three Choose food that sounds satisfying and eat when you are hungry. Fiber and protein can help you feel full, but unsatisfying meals can lead to overeating. Finding a balance of carbohydrates, fat, protein, and satisfaction is key.

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Step Four Fill your own plate with how much you think you want to eat. Many people feel obligated to eat what’s in front of them and many portions are supersized. Consider transferring some to a small plate or storing some in a container. Step Five Engage your senses. What do you see? What do you smell? What does each food feel and sound like as you chew? What flavors do you taste? Repeatedly return to your senses throughout the meal. Step Six Pause in the middle of your meal to check in. Is the food still tasting good? Are you feeling hungry or full? Honor your cues and continue eating as long as you’re enjoying your food. (If you’ve eaten mindlessly for years, it may take some time to relearn your cues. Be patient and gentle with yourself!) Step Seven Decide when you are finished and physically reinforce that decision. Push your plate forward and

inch, pack any leftovers, or place your napkin over your plate. These actions help avoid nibbling on remaining unwanted food just because it’s there.

support through a dietitian and/or therapist. Local dietitians can be found at www.eatrightaugusta.org.

Step Eight Get the support you need. If you have any health concerns or food has been used as a coping mechanism or comes with strings attached, seek professional

Mindful eating is meant to highlight the pleasurable experience of food. Savor your meal. Explore new cuisines. Listen to your body. And remember to be gentle and kind throughout the process. Enjoy! +

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined

lease take a moment to read the sentence just above. There is no number shown, but more deaths than two world wars — and just since 2000 to boot — is an appalling death toll. Here is a fact that is even more appalling: according to the American Automobile Association (AAA), more than half of all fatal accidents (as studied between 2003 and 2007) involved at least one driver who performed a potentially aggressive action. That represents a tremendous toll of lives lost. What is aggressive driving? As defined by AAA and other highway safety organizations, examples of aggressive driving behaviors include things that many of us may be guilty of: • Speeding • Tailgating • Cutting in front of another driver and then “brake-checking” them • Running red lights • Weaving in and out of traffic • Changing lanes without signaling • Blocking cars attempting to pass or change lanes • Using headlights or brakes to “punish” other drivers Who does it? Hundreds of millions of American drivers are guilty of one or more infractions that are defined as aggressive driving. Here are a few triple-A stats: • Purposefully tailgating: 51% (104 million drivers) • Yelling at another driver: 47% (95 million drivers) • Honking to show annoyance or anger: 45% (91 million drivers) • Making angry gestures: 33% (67 million drivers)

• Trying to block another vehicle from changing lanes: 24% (49 million drivers) • Cutting off another vehicle on purpose: 12% (24 million drivers) • Getting out of the vehicle to confront another driver: 4% (8 million drivers) • Bumping or ramming another vehicle on purpose: 3% (6 million drivers) Did you read one or more of those numbers and think, that figure is definitely too low? There is no doubt that these numbers, even if they’re accurate or on the low side, represent a huge problem and a great risk to safety. It is no great stretch to imagine that aggressive driving leads to traffic accidents. Anyone who has experienced even a minor traffic accident knows how inconvenient and expensive they can be. But they can be life-changing too. Even life-ending. Aggressive driving also can easily lead to road rage, situations where a trivial, forgettable and forgivable infraction (like having someone honk at you) escalates to deadly reactions like trying to ram another car or its driver, forcing the other car off the road, or one or both drivers resorting to gunfire to solve their petty little skirmish. Keep in mind that even the most aggressive driving infractions are usually completely inconsequential. Granted, that isn’t true if they cause a collision. But someone who fails to use their blinker or gives you an angry yell or an obscene gesture in the grand scheme of things means absolutely nothing. Forget it. AAA makes these three suggestions: • Don’t Offend: Never cause another driver to be forced to change their speed or direction in response to something you have done. • Be Tolerant and Forgiving: The other driver may just be having a really bad day. Assume that it’s not personal. • Do Not Respond: Avoid eye contact, don’t make gestures, maintain space around your vehicle, and contact 9-1-1 if needed. +

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HUMAN BEHAVIOR You’re talking to someone when you see it start to happen: Their eyes glaze over, they look past you, they’re shifting their feet. When you pause, they start talking about something completely unby Jeremy Hertza, Psy.D. related to what you were saying, or start making their way to talk to someone else. It’s the kind of communication breakdown we all experience— and it makes us feel absolutely terrible. It can also cause a lot of relationship problems at home, at work and in our social lives. Communication breakdown is a big issue that’s even bigger because of technology. Texts, emails and Facebook all are different opportunities for miscommunication. Think about it: One short email could lead to the entire office talking about how rude or aggressive you are. And that email was completely and totally misunderstood. Most of us want to communicate better. But before we can, we need to understand what communication really means.

WHAT IS SAID VS HOW IT’S SAID;

Breaking Down Communication Communication really is all about what you say and how you say it: In other words, it’s verbal and nonverbal. It has to include active listening and knowing when to talk and when to shut up. For example, if your spouse is already stressed, it’s probably not a good time to tell him or her that you really didn’t like what they made for dinner. How you talk also really does matter—is your voice high or raised, or are you just talking about yourself and not pausing to let the other person talk? The first can seem aggressive or like yelling, and the second can just seem rude. If you’re facing the person, if you’re making eye contact and if you have a relaxed arm position, those are all signals to the other person that you’re connected. A Lot To Talk About Fixing all of those parts of communication can seem a little overwhelming. So if you know you’re having problems communicating, start with just one or two things. And know this: Being self aware is a great start all on its own. One easy thing you can try is reflexive listening, which means that you repeat back, in your own words, what someone just said to you. That shows that you really are listening, which is an important part of communication that people sometimes forget since we can be so focused on making our own point. Also work on your eye contact. Don’t glance at your phone, don’t look around the room at every interruption, but focus—but not in a creepy way!—on the person you’re talking to. On the other hand, if you’re the one who feels that you’re not being heard by a family member or friend, think about what it would take for you to feel heard. Then, in a kind way, let the other person know, because no one can read minds. The hope and expectation is that they’re not trying to ignore you, but be prepared in case of pushback. Talk about the fact that you really want to make how you communicate better—which in itself is communication. Also think about this: Could it be partly your fault that you’re not being heard? For example, are you bringing up a work problem with your spouse when she or he is really focused on taking care of your child, or is doing other work where it’s hard to split attention? Waiting until the other person can pay attention can make all the difference. Finally, if you’re having trouble communicating, don’t let yourself fall in the trap of hiding behind technology. Sure, it’s easier to send that text, but it’s much better for you to practice communicating well, especially if communication issues are something that’s really bothering you. After all, trust and communication are the two things that you must have for a great relationship. +

Jeremy Hertza, Psy.D., is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC, in Augusta, on the web at http://nbageorgia. com. Contact him at 706-823-5250 or info@nbageorgia.com

AUGUST 7, 2020

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The blog spot From the Bookshelf — posted by Ryan D. Murphy, MD, on August 3, 2020

4 WAYS TO ENSURE COVID COMPASSION A few days after my dad flew to Salt Lake City from California, he developed a small cough and fatigue, and then started getting fevers. He subsequently tested positive for COVID-19, and was admitted to the hospital on a Friday. Everything happened quickly after that. By Saturday, he was in the ICU for increasing oxygen needs. By Sunday, he was on even more oxygen. By Monday, he was intubated. Fortunately, my dad recovered after being on a ventilator for five days. The first days were touch and go, but after that, he stabilized and started to get better. He recovered, discharged, and is now staying with me. The experience has helped me break down what some have called the compassion wall—the barrier created by the extra precautions COVID-19 requires, and how to overcome it.

Don’t ask, “Do you have any questions?”

1. Help patients stay connected. I empathize with patients who don’t have their families with them. I make sure that patients can communicate with their families and that they have a phone or an iPad and a charger. I recently had a patient who was recovering from COVID-19 after being very ill at another hospital. He hadn’t been able to FaceTime with his wife and two kids until recently. We made sure he had an iPad available. 2. Answer their questions. Instead of saying, “Do you have other questions?” I ask, “What other questions do you have?” I ask this multiple times before I leave the room. I also make sure they have a pen and paper, or their cell phone, to write down additional questions after I leave. 3. Validate emotions to close the physical distance. When I see COVID patients, I’m in full protective gear, including a face shield or a PAPR. When I see non-COVID patients, I’m wearing an ear loop mask. No matter what kind of room it is, I have to do a lot of communicating. In light of the pandemic, I rely on my eyes and my body language, but even that is limited. I don’t sit down like I usually do, I touch things minimally, and I don’t shake hands. I stand six feet away—and it’s really awkward. I recently had a patient who became very emotional. Normally, I would sit down and be close, but I had to stand six feet away and just hand him a box of tissues. Given these precautions, I try to validate patients’ emotions by telling them that I recognize how scared they must feel. I spend time focusing on their emotions first, instead of diving straight into the medical details. I believe it is easier for patients to listen to the medical analysis if you address their emotions first. Then, I ask, “What is your understanding of what is going on?” Learning what a patient already understands about their care helps me tailor the conversation to their needs. 4. Share the decision-making One of the hard things about COVID is the unknown. We developed protocols and processes in the several weeks between my dad being hospitalized and my return to clinical service. But there are still unknowns. I’ve adopted a mindset similar to other clinical decisions that don’t have clear answers. I embrace shared decision-making. I tell them, “Here are your options; here are the pros and cons of each.” I say, “I would recommend this, or I would prefer that.” Ultimately, you have to be transparent and honest with what we know and what we don’t know. + Ryan D. Murphy is an internal medicine physician.

Since we learned about these two books in a combined review in The Wall Street Journal, it’s only fitting that we keep them combined in our review here. We predict these two books will land on many a local bookshelf. After all, we live in an M&M city: medicine and the military are both huge players in Augusta, and that second M is often M-squared, as in military medicine. Having made our prediction that many Augustans will want to read these books (as do we), word is that these are grim and unflinching accounts of trauma care in a time and place where there was more trauma going on than at any other place on earth: Iraq during the US troop surge of 2007. For Dr. Hnida, an experienced 48-year-old doctor from Colorado and no stranger to battlefield wounds (his office in Colorado was a stone’s throw away from Columbine High School, where nine of the thirteen fatalities were his patients, some since birth), the level of carnage was such that Hnida felt on

his arrival in Iraq’s ”Paradise General” field hospital near Tikrit “like a first-day intern suddenly told to perform brain surgery.” The workload was like the busiest urban ER on a rainy Friday night with a full moon — times ten. The gore the unit experienced is described in these books, and it’s strangely illuminating. For instance, surgery on one soldier badly wounded by a suicide bomber revealed an extra rib. It turned out to belong to the bomber. As wrenching as the physical and emotional aspects of the job could be expected to be in a frenetic trauma unit, it presented challenges and ethical dilemmas to both authors that were completely

unexpected: how many people realize that wounded Iraqi insurgents wind up in the same ORs as American soldiers and are transfused with blood donated by Americans? That doctors work to save the lives of people who, before being wounded moments ago, would have gladly killed them? Who thinks that insurgents were brought to the trauma unit by coalition soldiers who were exposed to — and sometimes killed by — ambushes and roadside bombs? Both authors include quite a bit about their personal lives before Iraq in their books, and those chapters too are filled with tragedy and violence. These books are not for the faint of heart, but they are utterly compelling reads. + The Nightingale of Mosul by Susan Luz, 243 pages, published in 2010 by Kaplan; Paradise General by Dr. Dave Hnida, 288 pages, published in 2010 by Simon & Schuster. Editor’s note: This review originally appeared in a previous issue of the Medical Examiner.

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The Examiners +

This is sad.

What?

by Dan Pearson

It says Columbia County is canceling Halloween this year to support President Trump.

It’s a Republican county.

Huh? What’s the connection?

Oh, now I get it. Nobody will wear masks.

AUGUST 7, 2020

THE MYSTERY WORD O The Mystery Word for this issue: ELLBIRA

N ACAthen begin exploring Simply unscramble theVletters, TIONspelled word our ads. When you find the correctly hidden in one of our ads — enter at AugustaRx.com

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Benign tumor of muscle tissue 6. Like some jokes 10. Increases 14. Examine account books 15. Sewing case 16. Chapter of the Koran 17. Very noticeable; conspicuous 19. The ____ (former Augusta restaurant) 20. Sheriff before Roundtree 21. One of these can be held onto for years 23. Stir up 24. Hold responsible 25. Bequest 28. Adage 30. Tiger’s dad 31. Pale purple 32. It comes before bub sometimes 34. Ft. Gordon 35. Become sturdier 37. Before in poetry 38. Williams of Cooperstown 39. World’s skinniest nation? 40. Counterfeit 41. Latin term for “in secret” 43. __________ Bash 45. Wide awake 46. Game played in Aiken 47. Canadian capital 49. New town (in SC) 53. Like some vacations 54. Growing by successive additions 56. Lotion or soap ingredient 57. Ancient Greek goddess 58. The official national animal of Bhutan

21 23

39 41

37 40

45 47

25. Pre Easter season 26. Relaxes 27. Degree ceremony 28. Poundstone name 29. Local county named for a British member of parliament 31. Damp 33. Alcoholic beverage 35. Metal fastener 36. Of the chest 40. ____ lobe 42. Shoulder bones, familiarly 43. Cotton seed pod 44. Salt of oleic acid 46. Luxuriant 47. Gemstone 48. Story 49. Give off 50. Polynesian carved image 51. Roman poet 52. Hawaiian goose 55. Olympic chant?

DOWN 1. Two-dimensional land diagrams 2. Mongol tent 3. Scent 4. Type of oil or water 5. Not accented 6. Monetary unit of Lesotho 7. Scratch cause 8. Type of stick 9. Idiom for careful, delicate treatment 10. Suppose 11. Dunce 12. Medicine 13. ______ Valley (in SC) 18. Repulsive 22. Lustrous black 24. Squad in Princess Bride

E X A M I N E R

8 9 2 1 1 4

8 3

S U 5 D 7 O K 8 1 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.

59. Optical device 60. _____ lab 61. Leave out when speaking, as a syllable

We’ll announce the winner in our next issue!

Solution p. 14

QUOTATIONPUZZLE W C N G T P E S A T V C O H S I H I T O A H T E E S V A H D C E E T

E I E O R N I C S T S

8 9 2 6 3 1 7 2 G 1 8 U 4 5 5 4 6 3 9 7

— Author unknown

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.

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

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1 2 3 I 1

1 2 3 4 5 6 7 8 9

1 2 3 4

R 1 2

1 2 3

L 1 2 3 4 5 6 7

1 2 3

A 1 2

1 2 3

8 9 10

M 1 2 3 4

— Charles Schulz

1.AAAPODDDITION 2.NARTHIVEEN 3.VILWEEEMY 4.ALEEY 5.LDO 6.OS 7.OP 8.EP

SAMPLE:

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

L 1

O 2

V 3

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WORDS NUMBER

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, June 1, 2020

7 4 5 3 6 9 2 1 8

3 1 6 9 5 7 8 2 4

5 7 4 8 2 3 1 9 6

2 9 8 6 4 1 3 7 5

AUGUST 7, 2020

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THEBESTMEDICINE ha... ha...

penguin walks into a bar... Wait. Strike that. A penguin walks in to an airport terminal and a TSA officer stops him and says, “Sorry, pal. Penguins can’t fly.” Moe: Did you hear about the polygamist cat? Joe: I sure didn’t. Moe: It had nine wives. A woman is walking along the shore when she sees something shiny half buried in the sand. She picks it up and discovers it’s an old brass lamp. As she brushes the sand off, a genie pops out. “Thank you for freeing me,” says the genie. “To show my appreciation I will grant you anything you desire.” “I wish for a million dollars!” the woman screams excitedly. “As you wi...” “No wait!” interrupts the woman. “That’s completely shallow,” she says thoughtfully. She pulls a map out of her purse and as she starts to unfold it she says, “What I want is for all wars to end.” She unfolds the world map and points to countries scattered across the globe. “See all these countries? Every one of them is scarred by

violence, killing and hatred. I want them to finally know peace, for some of them the first time in centuries. That is my wish.” “Madam, that is a very noble wish,” said the genie, “but it is next to impossible. I would have to change the hearts and minds of millions of people. That is far beyond my ability. Is there something else I could do?” The woman sighed. “Well,” she said, “I’ve been looking for a husband so long I’ve given up. Please bring me a man who is gentle and kind, who loves to cook and will help me clean the house, who is handsome and muscular, and who will bring me flowers every day and who will understand me.” The genie sighs and says, “Ok, you win. Give me the damn map.” A dad was doing errands one Saturday with his 10-year-old daughter, who was telling him all about everything she was learning about snakes at school. Amazingly enough, as they came out of a store and walked up to their car, the dad noticed a snake sunning itself on the car’s front glass. “Look honey!” he pointed. “Do you know what kind it is?” “I think it’s a windshield viper!” she said. Moe: I can always tell when people are lying just by looking at them. Joe: Oh really? Moe: Yup. And I can also tell when they’re standing. Moe: Why did the detective cross the road? Joe: I give. Why? Moe: To get to the homicide. +

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.

The

Dear Advice Doctor, I’m up for a possible promotion at work against two other people. In all honesty, each of us have our definite strengths and weaknesses, reasons we could be the one, or be passed over. My personal Achilles heel is a reputation for being late - never for deadlines or important work, but rather when it comes to showing up on time in the morning. I will gladly work ’til midnight, just don’t ask me to show up at 7 am. I’m not a morning person and never have been. Any advice on how to change this? Slow Starter, Strong Finisher Dear Slow Starter, Thank you for bringing up a topic that affects many people of all ages and all levels of physical activity. It’s easy to hear the words “Achilles heel” and automatically think about athletes. Earlier this week, for example, Atlanta Braves pitcher Mike Soroka suffered a season-ending injury when he tore his Achilles tendon. The typical timetable for an injury like his is six months, sometimes longer, so it’s obviously a serious situation. In truth, however, as I alluded to above, problems with the Achilles tendon can affect anyone. Heel-related aches and pains caused by Achilles problems are not exactly rare, even when a full tear isn’t involved. Sometimes a sudden move or stretch can strain the Achilles tendon, and it can be quite some time before pain-free movement returns. For one thing, this tendon is the largest one in the body. Another reason for slow recovery is the difficulty in resting this tendon. Every thing we do involves a step here and a step there, always flexing the foot and ankle. Also, if the Achilles tendon has an Achilles heel, it is its low level of vascular supply. That is a definite factor in its slow healing. Even so, a minor strain can feel better within a few weeks with ice, rest, ibuprofen, and perhaps an elastic wrap to help minimize movement. Two keys to recovering from any injury to the Achilles tendon: don’t try to self-diagnose. Have an evaluation by a doctor and then be an obedient, compliant patient. Secondly, don’t try to rush it. Let recovery take its course to make it as speedy as possible. I hope this answers your question. Thanks for writing! + Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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AUGUST 7, 2020

IT’S A QUESTION OF CARE How do I choose the ideal assisted living setting for my loved one?

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The choices among assisted living these days can be daunting. There is “traditional” assisted living and “memory care,” and now some assisted living communities offering a “premier” level of care which falls between traditional and memory care levels. In addition to the level of care you need to choose for your loved one, it’s important to understand which details about an assisted living environment can make it more ideal. • There is continuity and longevity of staff. The staff gets to know your loved one, which helps in the type and detailed level of care they provide to your loved one. The staff includes everything from the administrator to the activities coordinator to the personal care assistants to the nurse. The staff even includes maintenance personnel, who understand the comings and goings of your loved one. (The maintenance

person is in the building all day long with your loved one just like the other staff.) Everybody within the assisted living facility will end up knowing your loved one, so if there’s high turnover, this could impact the quality of care your loved one receives since there are new faces and therefore a new learning curve over time. • The assisted living community has a nurse on staff. Often, assisted living facilities will use a licensed practical nurse (LPN) and will have a registered nurse (RN) on call. Some assisted living facilities have the LPN in the building from approximately 8 a.m. until 5 p.m. five days per week. However, the trend seems to be having the LPN available through second shift until about 11 p.m. This is in part because the needs of the typical assisted living resident are becoming more medically complex. • The community offers convenient

in-house services. Examples of beneficial in-house offerings include a physician, a podiatrist, or a beauty salon. It would be wonderful to begin to find assisted livings that have dentists who come into the building, as that is a much-needed service. • Consider the location. Your loved one will want to see you and you will want to visit him or her. If the location of the Assisted Living community is convenient for you or the other people who will visit regularly, you will be able to visit more often and this in turn will increase the chances that your loved one’s care is even better as you will be able to catch nuances in their needs and determine if these are being consistently met. + by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and a Certified Advanced Social Work Case Manager.

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