Medical Examiner 8/9/19 by Daniel Pearson

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AUGUST 9, 2019

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PARENTHOOD by David W. Proefrock, PhD

Your 3 year-old son has a terrible temper. He has serious tantrums almost every time he is told no, when he doesn’t get his way, or is in the least bit frustrated. He hits, kicks, and bites when he is mad. You are afraid he is going to be asked to leave his current day care. They try with him, but say he is becoming too much to handle. He is no better at home. What do you do? A. You are going to have to be very firm with him. Spank him every time he has a tantrum or hits others. B. The day care workers are probably doing something wrong. Find a different day care setting for him. C. Children sometimes go through phases like this and some boys are just a little too rough. Don’t worry, he will probably get better on his own. D. Take him to a mental health professional for an evaluation and treatment. If you answered: A. While you probably do need to be firm with him, spanking is rarely the solution to tantrums and aggressive behavior. This is a serious problem. If he can’t be handled in day care, it is time to consult a professional. B. It is extremely unlikely that this kind of behavior, both in day care and at home, is the fault of the day care workers. C. This is a serious behavior problem and you should be concerned. In fact, it is past time to consult a professional. D. These tantrums and aggressive behaviors appear to have reached the point that you need help. Consulting a mental health professional is the right thing to do. An occasional temper tantrum is to be expected, but daily tantrums accompanied by serious aggressive behavior should not be ignored. This is the kind of behaviors that mental health professionals are trained to help you with. +

Dr. Proefrock is a local clinical and forensic psychologist

Snap, crackle, pop! “Stop cracking your knuckles. You’re going to get arthritis.” I’ve never been much of a knuckle cracker, but I’ve heard this adage often. People crack their knuckles out of habit, to loosen up their joints, and to simply hear the sound. So what causes the popping sound so alluring to those who enjoy cracking their knuckles? And is it harmful? Knuckles are synovial joints. Synovial joints form where two cartilaginous ends of bones meet and move against each other. They are encapsulated joints and characterized by a cushioning cavity filled with synovial fluid. The synovial fluid is important to the joint because it lubricates it as well as provides nutrients important to the bone surfaces that meet in the joint.1 It is believed that bubbles in the synovial fluid pop when the bones are stretched due to negative pressure created in the joint.2 What are the repercussions of knuckle popping? There is

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1. Pappas, D. Johns Hopkins Arthritis Center. Knuckle Cracking Q&A. https://www.hopkinsarthritis. org/arthritis-news/knuckle-cracking-qa-from/. Published 2007. Accessed July 15, 2019. 2. Harvard Health Publishing. Does cracking knuckles cause arthritis? https://www.health.harvard.edu/pain/ does-knuckle-cracking-cause-arthritis. Accessed July 15, 2019. 3. Deweber K, Olszewski M, Ortolano R. Knuckle cracking and hand osteoarthritis. J AM Board Fam Med. 2011;24(2):169-74. doi: 10.3122/jabfm.2011.02.100156 4. Castellanos J, Axelrod D. Effect of habitual knuckle cracking on hand function. Ann Rheum Dis. 1990;49(5):308–309. doi:10.1136/ ard.49.5.308 5. Olsen, J. Mayo Clinic Minute: A hand surgeon’s advice about knuckle cracking. https://newsnetwork. mayoclinic.org/discussion/mayo-clinicminute-a-hand-surgeons-advice-aboutknuckle-cracking/. Published June 2017. Accessed July 15, 2019. 6. Unger DL. Does knuckle cracking lead to arthritis of the fingers? Arthritis Rheum. 1998; 41(5): 949-50. doi: 10.1002/1529-0131(199805) 41:5<949:: AID-ART36>3.0. CO;2-3 https://onlinelibrary. wiley.com/doi/epdf/10.1002/15290131%28199805%2941% 3A5%3C949%3A%3AAID-ART36%3E3.0.CO%3B2-3

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no conclusive evidence that popping knuckles causes arthritis.3 However, there are a few discrepancies in research if you’re wondering about joint health and popping knuckles. Researchers have focused on two areas of joint health in relation to knuckle cracking. The first is whether or not there is an increased risk of osteoarthritis in those who crack their knuckles. The second is other aspects of joint health, such as range of motion, injury, and swelling. Most recent research claims that there is no increased risk of osteoarthritis. But there is debate on other joint health such as swelling, reduced range of motion, increase risk of injury, and lower grip strength.1-4 How do you know if you have a knuckle cracking problem? If you crack them more than five times a day, you are a habitual knuckle cracker.5 One habitual knuckle cracker, a doctor, even performed a one-man experiment in which he cracked the knuckles on his left hand for

fifty years! After all of this knuckle cracking, he found no differences between the knuckle joints of his hands.6 As with any body of research, it is important to look at the entirety and quality of the research before making judgments. There is no conclusive evidence that popping your joints will increase your risk of osteoarthritis. However, there is some evidence of a correlation with decreased joint health as previously described. As always, if you have concerns, talk to your healthcare professional. +

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AUGUST 9, 2019

ROAD TO RECOVERY? CELLULITIS VS CELLULITE

ord knows, we need a new road. Desperately. Consider this: since January 2000, more Americans have died on our highways than in World Wars I and II combined. Read that sentence again. And the numbers aren’t even close. Some 535,000 American soldiers were killed during the two World Wars. Our highway death toll so far this century exceeds 624,000. Read that sentence again. Consider for a moment the implications of those figures. The 2ist century death toll covers only the years 2000 through 2017, the most recent year for which statistics are available. During the roughly 8-year combined duration of both World Wars, millions of combatants were actively, deliberately trying to kill one another using machine guns, tanks, bombs, flamethrowers,

hand grenades, torpedoes, and any other lethal weapons they could get their hands on. Despite the global scope of those two wars and their intense focus on killing, their death toll falls far short of the highway fatalities in just this country. By another yardstick, there has been outrage aplenty about the opioid epidemic, which

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killed almost 100,000 people between 2006 and 2012. But during those same years, road wrecks where speeding and drunk and distracted driving were the cause (one or all) killed 190,455 people. Sure, go ahead and reread that sentence too. Let the numbers sink in. Obviously we’re heading the wrong way down the road to disaster at breakneck speed. According to the National Highway Traffic Safety Administration, 94 percent of car crashes are due to human error. That means as many as 94 percent of all car crashes could be avoided. Does that sound like an unreachable goal? It isn’t. Consider that the last crash of a commercial passenger plane in the United States was more than ten years ago. The 94 percent figure also means that our collective priorities may be seriously skewed. There is absolutely no point in improving our diet, getting exercise, quitting smoking and generally being the poster child for salubrious living, and then texting while we drive. Or speeding. Or driving under the influence. Those actions make all of our other health pursuits pointless. It’s not like unsafe driving is rare either. It’s as common as fatal accidents, and there are roadside crosses all over the CSRA marking deadly wrecks. Seeing people running red lights, speeding, and illegally using their phones while driving (which means even so much as touching your phone) is an everyday event. No wonder the Medical Examiner is launching a new feature in this issue called “Crash Course.” Read it! Then live it! It’s on page 10. +

CRASH

COURSE

These two words are about as close in meaning as brews and bruise. In other words, not a lot. They may be mistakenly used interchangeably by people sometimes, perhaps the same people who refer to vanilla folders and vowel movements. When it comes to cellulitis and cellulite, one is a potentially serious medical condition — that would be cellulitis — and the other (cellulite) is a cosmetic issue rather than a medical one. That doesn’t mean cellulite is an unimportant thing. Ask any woman, since it affects females far more than males. Among women it’s practically universal. One medical journal estimated that 80 to 90 percent of post-adolescent females have cellulite; another journal put the estimated range between 85 and 98 percent. What is cellulite? It is dimpled or lumpy skin that is most common on thighs, buttocks and abdomen. At its worst it is described as looking like cottage cheese. Its cause is fibrous cords that attach skin to underlying muscle tissue, like the cords that pull the fabric down on a tufted couch or ottoman. In the case of skin, as more fat cells accumulate under the skin, it is pushed up, but wherever a cord is attached the skin doesn’t move. Hence the uneven, dimpled effect. Although there are plenty of products that claim to banish cellulite, most are scams designed to relieve you of your money. Ask your doctor or dermatologist for their advice. Cellulitis, on the other hand, is not a cosmetic issue. Its -itis ending advertises that it involves inflammation, in this case of the skin or subcutaneous tissue. As a bacterial infection, cellulitis will result in pain, redness and swelling. Sometimes the affected site can feel hot to the touch. Cellulitis can worsen and spread, so it’s important to seek medical treatment promptly, especially if you develop a fever. Other risk factors for people with cellulitis include having a weakened immune system due to diabetes, HIV/AIDS, leukemia, chemotherapy, and some medications. A past history of cellulitis makes people more susceptible to repeat occurrences too. Prevention includes cleaning, treating and covering ports of entry like cuts and scrapes. Treatment of cellulitis is usually with antibiotics. +

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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

(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net www.Facebook.com/AugustaRX Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., nor its agents or employees take any responsibility for the accuracy of submitted information, which is presented for general informational purposes only. For specific medical advice, diagnosis, and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2019 PEARSON GRAPHIC 365 INC.

AUGUST 9, 2019

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#96 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE

ery few among us would be insightful and imaginative enough to encounter the weeds shown below and think, “I could make millions from those.” But that’s exactly what our subject for this installment, one George de Mestral, thought. You probably don’t recognize his name or face, but you’ve heard the story of the man who noticed burrs sticking to his clothing and his dog’s fur after taking a hike in the woods and fields of his native Switzwerland. He removed some of them and took a peek at their design and structure under a microscope, and voilà! Velcro was born. Except that’s not how it happened at all. De Mestral was an electrical engineer by trade, born in 1907 near Lausanne, Switzerland. He was awarded his first patent at age 12 for a toy airplane he invented. But back to that famous dog walk... One takeaway from the toy airplane story is that when it came to patents, de Mestral didn’t mess around. So it’s significant to note that he looked at the burrs under a microscope in 1941 but didn’t get a Velcro patent until 1955. In other words, everything about that initial eureka moment in Velcro’s development is accurate except the voilà! part. It was an incredibly slow process that almost never happened. Fortunately for a lot of products that take advantage of Velcro’s convenience, the idea stuck. Kind of like Velcro itself. The challenge wasn’t figuring out how the burrs worked. That took all of five minutes. The mountain that had to be climbed was how to duplicate that with man-made materials. After that, the next huge obstacle was how to mass produce the stuff. That seems like the real story of the Velcro story: how does someone continue their pursuit of an idea when it is met with one failure after another? When a new and seemingly impassable obstacle appears around every corner? A crystal ball would be handy. If a person knows that success lies at the end of the long and difficult road, perseverance is easy. But all de Mestral knew was that a dozen experts in the fabric and weaving center of Lyon, France, said his idea was impossible to reproduce and impractical in application. When he finally found someone who said they would try to help him, one idea after another failed. Some didn’t grab; others did, but wore out after a few rips. The eventual success of the manufacturing side of the coin was then met with sluggish sales. It wasn’t until NASA saw its value in spacesuits in the early 1960s, two decades after the voilà! moment, that Velcro took off. Puma was the first company to use Velcro in sneakers, in 1968. These days it’s everywhere. Or is it? Since the Velcro patent expired in 1978, anyone can make a hook and loop fastener. And like saying Kleenex and Clorox used to describe any old no-name tissues or bleach, velcro has become so generic that it’s both a noun and a verb. But only one company actually makes “Velcro.” +

Search “Velcro legal” on YouTube for two highly entertaining videos produced by Velcro’s legal department attempting to protect their trademarked name and product.

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 When it comes to being alone, praying is good, but it doesn’t take the place of action on your own behalf. After some time spent on the internet researching possible ways to summon help if I need it, I settled on a plan that provides several essential services. It has one button to I wear in the house connected wirelessly with a base station when I’m home. It can even be worn — and in fact, should be worn — in the shower, so help can be sought there. But it also functions via a cellular component when I leave the house, so it works at the grocery store, the mall, church, the theater, the beach, or wherever I am traveling, and stores its charge for as long as 24 hours. No matter where I might go it serves to keep me connected to nearly instant help whenever I might need it. Not only does it know who I am, it also knows where I am through its GPS function. So it can direct help to wherever I might need it, including locations where people often do not have direct access to others. Like if I go for a walk on the beach or in the woods. This kind of connection could be invaluable for people who may be in the beginning stages of Alzheimer’s disease or other forms of dementia where wandering away from home can lead to tragic consequences. In addition, it knows

what medical conditions I have, so a diabetic episode won’t be misdiagnosed as drunkenness. With the cellular component, all I need to do if I get lost is push the button and people will be able to find and help me. Another issue for me is falling without being able to get myself up. For this I wear another button that can actually detect a fall as it occurs, regardless of why I might have fallen. It has a button I can push if I’m able to, but it also alerts the operator that I need help even if I am unable to push the button. After I set up this unit and we were testing it, I was amazed to drop the pendant and hear the operator saying that she had received an indication that I had fallen. There is also a coded lock box on the front door that holds a key so first responders don’t have to break down the door to get to me if I am inside my locked home and can’t get to the door to let them in. Before I began researching, I had no idea this kind of equipment even existed. Ordering it was simple and the equipment arrived within a week and was easy for me to install myself. I recommend it to those living alone. It’s amazing how much peace of mind can come from a simple button. + Editor’s note: This installment of On the Road to Better Health is a vintage favorite from our archives.

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AUGUST 9, 2019

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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I’m back…again. You Medical Examiner readers may not realize that most of the columns you’ve been reading are ones I wrote some time ago. One of the reasons I slowed down (big euphemism there) in my writing is that I feel like my posts were predominantly about how wonderful my new practice is. That does two things: it makes it seem like I’m just bragging all the time about how smart I am and how great my practice is, and it makes it seem like I’m saying the rest of medicine is lousy in comparison. That is not polite. That is not in my comfort zone. But that is basically the truth. OK, so I guess I’m just a conceited SOB. Sorry. I was struck by the difference between my care and that of the rest of the system as I cared for a patient recently. She was complaining of a strange pulsating noise in her ear that had started a few weeks before. We chatted for a while as I asked about any sinus symptoms, if she’d ever had anything else going on like this, what other significant symptoms she was having (headache, other sensory changes), and just general medical questions. The diagnosis remained a mystery as I went to examine her. The exam was not really helpful. She had no foreign bodies in her ear canal (something I was guessing I’d find), no fluid behind her eardrum, and basically a negative exam. The diagnosis was “pulsatile tinnitus,” which is basically a description of her symptoms: a loud whooshing symptom in her ear. One of the best tricks a doctor can do to b.s. patients is to use fancy words to describe exactly what the patient tells you. So when a person has a rash, you call it “dermatitis.” When they have a loose cough, you call it “bronchitis.” And when they hear their heartbeat as a “whooshing” in an ear, you call it “pulsatile tinnitus.” It offers absolutely no help, but it may impress them with your grasp of medical jargon and distract them from the fact that you don’t know what is going on with them. Not satisfied, I chatted with her some more, talking about tinnitus, something that I’ve had for the past 15+ years. I talked to her about the frustration of this condition and how certain things make it worse. One thing that makes tinnitus worse, I happened to

mentioned, is aspirin therapy. She interrupted my rambling. “Wait. Aspirin makes it worse? I just started aspirin therapy for my knee a couple of weeks ago.” And that is pretty much exactly when her pulsatile tinnitus

THIS CAME UP 20 MINUTES INTO THE EXAM. 20! began. This was about 20 minutes into my time in the room with her. Let me clarify: she had spent 25 minutes in my office, 20 of which was spent discussing her situation with me. We just talked, and this fact came out at minute 20 of that discussion. That’s a minute that doesn’t happen very often. This is one of the reasons I believe this practice model is clearly superior to the “care as usual” with the assembly line/hamster wheel care that is done by most primary care doctors. I have time. I can listen. I can chat with people until important information emerges. In many, if not most, primary care practices, this patient would’ve been referred to ENT for a workup that may have possibly resulted in lab testing and likely CT scans or other testing. Having the time to listen was better than an ENT consult, labs, or a CT scan. Time is something I have for patients. I give them 30 minutes of my time for normal

visits, and 60 for complex care or new patient visits. Often the time I spend is shorter, but that time is available. This is exactly the opposite of what happens in most primary care settings. I used to have only 15 minutes set aside for people, much of which was devoted to documentation, and had to stretch that out to 30 or more minutes to get in the basics of care for complex problems. With so much attention to physician burnout and the high cost of care, the national discussion spends far too little time talking about the lack of time most primary care docs have for their patients. Before I left my old practice (nearly 7 years ago!), I was increasingly burdened by the fact that I was being robbed of the time necessary to give good care. I was spending too much time dealing with red tape from insurance companies and government rules aimed at “improving” care. Since quitting, I’ve yet to see more than 15 patients in any given day, and am often reminded how much my patients appreciate the time I can spend with them. It doesn’t matter to me how we accomplish it — whether by the direct care model or another — but we must fix this problem. Primary care just had its worst year in matching residents from medical school, and this at a time when we need more primary care doctors and less specialists. My decision to practice this way has saved my career, has healed my heart, has saved money for my patients, and has given me the time to listen, the time to care for them. +

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AUGUST 9, 2019

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here have been a lot of news stories lately about people getting necrotizing fasciitis (NF) from swimming in the ocean. What everyone might not know is that bacteria that like to live in warm, moist places are not the only kind that cause flesh eating bacteria. I should know because I almost lost my life from NF but am a survivor of this deadly bacteria. I got NF from Strep A. It was never determined how it entered my body (I had no visible wounds). Two years ago my encounter with necrotizing fasciitis began. I contracted it at home after swimming on June 4, 2017. We had been swimming in the pool and I had laid in the kiddie pool with my grand-

And I had it. son. I started to have pain in my left arm that would come and go. On June 5 the pain was worse, so I went to prompt care that morning thinking I had pulled a muscle in my arm. I was given a pain killer and ointment. I went to work. By that night the pain was worse and I could not sleep due to my arm aching. So on June 6 I went to the same prompt care, telling them the pain medicine was not working. I was prescribed a stronger pain med and given a Toradol injection.

I went to work but left early because my arm was hurting worse. By the morning of June 6 I decided to go to a different prompt care but this time my husband, Mark, took me because I was not feeling well. The pain in my arm was excruciating and my back was hurting. That prompt care gave me no medicine and I do not remember anything they said about my arm. I told Mark to take me to the ER because I was tired of hurting. When we arrived at Doctors Hospital they first thought I had cellulitis in my arm. They put me in a room and Mark left to feed our dogs. NF can spread an inch an hour and quickly cause sepsis, multi-organ failure

AUGUST 9, 2019 and even death in as many as one in three of those infected. Within 30 minutes of my arrival everything started going downhill quickly. My vital organs (kidneys, liver, lungs, etc) were shutting down due to toxic shock. Not long after Mark got home they called him and said Gloria is very sick and has to undergo emergency dialysis. All sorts of tests were run and the doctors determined I had NF in my arm. Dr. Mullins told my family if we had waited a few more hours I probably would have died. If it wasn’t for the quick responses and aggressive treatments at the burn and wound center I received at Doctors Hospital, I probably would not have survived. It was a race against time to stop the aggressive infection. The possibility of losing my arm was still in question, but so was my very survival. I had surgery almost every day for the next 6 weeks, undergoing about 23 surgeries in all as an inpatient to save my arm. I also spent hours

every day in a hyperbaric chamber to aid in the healing of the open wound. After almost two months in the hospital I was discharged, but then I had to continue with outpatient surgery for approximately two more months. Physical therapists came to my house twice a week at first, and when I was able I went to physical therapy, until January 2018. Dr. Mullins and Dr. Homsombath saved my arm and my life. It is critical to be aware of signs and symptoms. Do not wait. I did not have any open wounds, not even a scratch, and the doctors said they did not know why or how I became infected. One doctor did comment to my family when asked how I got it. He said, “The stars must have aligned,” meaning it was an unexpected event that was impossible to have prevented. + — Submitted by Gloria Sloan Augusta, Georgia

IT’SYOURTURN! #oneinthreediefromit #Flesheatingbacteria

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 9, 2019

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GARDENVARIETY

Every great hibachi meal must start with a simple salad topped with ginger dressing. I must say, I might judge a hibachi restaurant by its ginger dressing. You know some can be watery, bland or not enough ginger punch. It’s also pretty obvious if they make it fresh or buy it in a bottle from their supplier. When I created this miso carrot ginger dressing, I was looking for the perfect balance of flavors that I could easily make at home. I also wanted it to be healthy, full of fresh ginger flavor, and less than 10 minutes to make. There is a lot of debate out there about the original ginger dressing recipe. Many recipes do not include carrots and add things like celery, soy sauce, and onion. However, I found that this recipe yields a healthy fresh dressing that I am used to being served at my local hibachi restaurants. There are many great health benefits to eating ginger. It has antiinflammatory properties, and it helps treat indigestion, lower blood sugar, and reduce menstrual pain. My favorite reason was to help curb morning sickness. When I was pregnant, I would send my husband out to buy it by the pint at our local hibachi restaurant. Easy Ginger Dressing Ingredients • 1 cup of peeled and shredded carrots • 3 tablespoons white vinegar • 2 tablespoons honey • 1/2 cup canola oil • 2 teaspoons white miso paste • 1-1/2 teaspoons fresh finly grated ginger root (more if you like it spicy) Be sure to use small roots to eliminate stringiness. • 1/4 teaspoon pink Himalayan salt Instructions Place all ingredients into a blender such as a VitaMix, blend on high until smooth for about 30 seconds. To store this ginger dressing, keep it in the fridge in a tightly sealed jar. It should keep for up to a week and

tastes delicious as a salad dressing or tossed with stir fry veggies. It’s a good idea to set the dressing on your countertop 10-15 minutes before you plan on using it. This gives the oil a chance to warm up. Just shake well before serving. + 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 9, 2019

How to communicate with a loved one who has Alzheimer’s disease by guest columnist Dr. Nancy V. Karp, Ed.D., M.Ed., P.T. It is important to continue to communicate with your loved one diagnosed with Alzheimer’s disease, even as the disease progresses and you think they cannot hear or understand your words or feel your emotional message. Communication can be challenging. A one-size-fits-all approach does not work. Success will depend upon the Alzheimer’s stage, the way your loved one communicated before Alzheimer’s, and your own personal abilities and methods of communication. Alzheimer’s disease is characterized by much more than a decline in memory. People also show declines in learning, attention, decision-making, word-finding and visual and auditory perception. All these affect communication. The extent of decline in each of these varies from person to person, so it is important to come up with unique communication approaches specific for each individual. In general, however, there are some communication techniques that might be helpful to review. As your loved one progresses through the different stages of Alzheimer’s Disease, you must continually evolve your communication style to meet both your loved one’s and your own needs. Let’s start by looking at communication needs during early stages of Alzheimer’s. At this point, your loved one may be noticing difficulty remembering

a word or where something was placed. They may forget a scheduled appointment. It becomes more difficult to plan and organize or to concentrate. Trying to fulfill job or social obligations may be increasingly stressful. At this stage your loved one may try to deny or hide cognitive problems from friends and family. This is where the importance of open communication comes in. When a loved one expresses concern about memory loss, this is the time for you to be open, honest, understanding and supportive. If you, too, have noticed your loved one forgetting things, communicate this and encourage the person to see a physician. Do not be passive. The earlier the diagnosis is confirmed, the more you can prepare for the progression. Expect a diagnosis of Alzheimer’s to cause your loved one to feel overwhelmed, apprehensive and overcome with grief and sadness. This is a normal reaction. Help them to re-focus on what they still can do rather than on all the frustrations. This is also the time to communicate about medical, financial and spiritual plans that need to kick in as the disease progresses. Identify and communicate the resources available to you, your loved one, the family and close friends. There are some steps you can take to improve communication at this stage. Ask the person which method of communication is preferred: face-to-face conversation,

the family, friends and days and other details. This other people surrounding so-called reality therapy should your loved one. They will be used only when safety is at all play a role in communi- stake. Ask only “yes” or “no” cating with a person with questions. For example, “Are Alzheimer’s, and need you thirsty?” If your loved one support and education so thinks today is Tuesday, is it they know what to exworth the frustration to insist pect. it’s actually Thursday? If a per When they picture a person son is asking for a spouse who with Alzheimer’s disease, the died 5 years ago, is it really moderate or middle stages of helpful to remind them that the disease is what most people the spouse is dead? The person think of. The middle stage of will then start grieving for their Alzheimer’s disease presents mate as though it is the first with its own unique commutime they’ve heard the news. nication issues. Persons in the If you need a person to do a middle stage remember major complex task, like putting on events in their lives and close a coat, communicate what you family members. However, want done in smaller steps and they may no longer remember by giving visual and touching phone numbers, addresses or cues. Choices should be limitdistant family members. They ed. For example, you may hold no longer can function in the up both a jacket and a sweater community without assistance. and ask which one she would They can no longer do their like to wear. Choices should finances or drive a car. Combe limited to two alternatives. munication during this stage Very simple written instrucis more effective if you have tions may be helpful communione-on-one conversations in a cation tools. It may be a simple quiet place. Speak slowly and sign that tells the person to ring clearly. Don’t increase your a bell when he or she wants to volume; nothing has changed walk to the bathroom. with your loved one’s ability to Communication in late Alzhear. Maintain eye contact, as heimer’s Disease will change as this will help the person focus the person’s physical abilities on what you are saying. It is change. In this stage, the pervery important to give plenty of son loses the ability to move time for the person to respond. or walk, to communicate with The silence as you wait for a words, has difficulty eating response may be awkward for and swallowing and becomes you but not for your loved one. incontinent. Your loved one Offer reassurance and enbecomes totally dependent on courage the person to explain assistance for all activities of thoughts. daily living. Communication Don’t get stuck on details. becomes more physical and Don’t stress correct times, Please see ALZHEIMER’S page 15

What works can change as the disease progresses from its early stage to moderate and advanced phases

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email, text messages or phone calls. Make sure you acknowledge and include the person with Alzheimer’s in all conversations, whether in a public setting or at home. Take time to listen to the person so that he is able to express himself. Give the person time to respond. Don’t interrupt or try to finish the person’s thought unless asked. If you are in a social situation and your loved one seems uncomfortable, ask what he or she would like to do. Don’t make decisions on your own. Involve your loved one as much as possible. Use laughter to lighten moods. Most of all, don’t back away because of communication problems. It is OK just to sit quietly, not talking, but still showing your love and support. Identify “triggers,” which are situations which cause increased stress, agitation or difficulty thinking. Understanding these will help you respond to them and decrease their impact on the person. This will be invaluable, especially in later stages. The primary communication goal in the early stages of Alzheimer’s disease is to establish open lines of communication and planning, not only with your loved one, but also with

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Ask a Dietitian LECTINS: AVOID OR NOT?

by Jennifer Peters, RDN Charlie Norwood VA Medical Center “I heard that I shouldn’t be eating tomatoes and other vegetables anymore, and now I’m confused about what I should eat.” This question has been shared by many of my patients as the popularity surrounding the lectin-free diet has grown. The lectin-free diet first gained popularity after the publication of “The Plant Paradox: The Hidden Dangers in ‘Healthy’ Foods That Cause Disease and Weight Gain” by Dr. Steven Gundry. Lectins are carbohydrate-binding proteins found in many healthful plant-based foods. These proteins are designed to protect plantbased foods from predators. Lectins are “associated with toxic reactions because they bind to carbohydrates, particularly sugars, in the body, and can block messaging between cells” (Castaneda, 2019). Gundry proposes that these toxic reactions are contributing to increased inflammation in the body which can contribute to a wide variety of other diseases such as digestive issues, cancer, food allergies, obesity, and autoimmune disorders. What food contain lectins? Lectins are found in a variety of plant-based foods, and Gundry proposes eliminating or limiting the following from the diet: • Beans, peas, and lentils • Grains: pasta, rice, breads, grain-based flour products, oats, rye, bulgur, and quinoa • Vegetables: tomatoes, cucumber, peas, sugar snap peas, bell peppers, legumes, green beans, chickpeas, zucchini, soy, tofu, and edamame • Oils: soy, grapeseed, corn, peanut, safflower, and sunflower • Nuts and seeds: pumpkin, sunflower, chia, peanuts, and cashews Controversy about the diet Due to the restrictiveness of the diet, this diet should be widely understood before it is promoted. This diet eliminates essential nutrients from the diet and would be impossible for any vegan or vegetarian to adhere to. There is currently very little research or evidence suggesting that lectins are the cause of inflammatory processes in the diet. There is some evidence that lectins can affect gut health because lectins survive digestion in the gastrointestinal tract. However, most lectins are destroyed in the cooking process long before they enter intestinal tract. Additionally, there are different types of lectins – some toxic and some non- toxic. Furthermore, the known health benefits of a varied diet filled with whole grains, fruits and vegetables, and nuts and seeds far outweigh the concerns for lectins in the diet.

CAPRESE ZUCCHINI SALAD WITH BALSAMIC VINAIGRETTE Serving size: 1/5 of recipe

Ingredients: • 2 medium zucchini, sliced into half-moons or spiralized (I used the ribbon setting) • 1 cup cherry tomatoes, halved • 3/4 cup fresh mozzarella pearls • 1/2 small red onion, thinly sliced (~1/2 cup) • 1/2 cup fresh basil, thinly sliced • 1/2 cup Tessemae’s Balsamic Vinaigrette (add more to taste) • Black pepper Directions: • Gather all of the ingredients and prepare veggies. • For the spiralized or sliced zucchini, pat dry with paper towels to absorb as much liquid as possible. • Next, combine all of the ingredients in a large bowl. Toss with the dressing. • Allow to marinate for 30 minutes in the fridge before serving. • Toss and add salt & pepper to taste. • Top with additional fresh basil and a pinch or two of black pepper. + Nutrition Calories: 237 Fat: 20 g Total Carbs: 6 g Sugars: 4 g Fiber: 2 g Protein: 7 g Sodium: 300 mg

Please see LECTINS page 15

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CRASH P

COURSE

lease don’t be offended by the sight of a dummy in this column’s header. Unfortunately, though, it is a fact that many crashes are caused by driving behaviors that aren’t simply illegal. They’re also incredibly stupid. Among the many ways aggressive driving can manifest itself, one of the most unsafe (and idiotic) is tailgating. Let’s paint a realistic scenario that includes a tailgater driving a huge, ladder-worthy pickup truck, one that shines its 1000-watt headlights into the rear view mirror of every car he tailgates. Having met the tailgater, we should also introduce the tailgatee. Let’s assume the lead car is being driven by a complete stranger to the tailgater. Despite that fact, the tailgater trusts this unknown person to the extent that he is following so closely that he can’t even see the car’s back bumper or most of its trunk. The car is kind of a clunker. It doesn’t go too fast. It’s in the left lane, the fast lane,

not because it’s going fast, but because the driver will be turning left just ahead. In fact, the driver of the clunker is currently unemployed, and is returning from the 78th place he has applied to for work in the past month. This one, like the others, did not seem promising. Driving back home he is very discouraged. His situation has been desperate. Now it’s beginning to look hopeless. Ah, but wait! There is an answer! Help has arrived! His financial problems are soon to be over! All our unemployed friend needs to do is slam on his brakes to avoid hitting that dog in the road. He definitely saw a dog in the road. Absolutely. No question he saw a dog in the road. Soon after the ensuing rearend collision, which is 100% the tailgater’s fault, the ambulance arrives to transport the innocent driver to the nearest emergency room. On the way, a phrase suddenly pops into his head. “One call, that’s all.”

  '''NEW´FEATURES''' He heeds the call as soon as he can, which is a good thing, because he suffered debilitating whiplash that simply will not go away despite months of physical therapy. He also suffers much pain and anguish and mental distress. He’s almost afraid to leave the house anymore, his attorney tells the court. Not that he is physically able to do so. But if he was able. He can’t even look for work anymore in his condition, but with the size of the settlement, he really doesn’t need to. If he plays his cards right, he’s financially set for life. And he feels sure that his neck and back pain will get better any day now. It mainly hurts only in court anyway. As for the pickup truck driver, he paid a huge fine for speeding and tailgating, lost his truck because he couldn’t afford the astronomical new insurance premiums (it cost his insurance company over $300,000 to close the case, so our hero is relegated to insurers of last resort), and he now drives a car that’s a lot like the one he rear-ended. Yes, every time someone tailgates, it’s like giving a total stranger a blank check good for all the money you currently have and a sizeable chunk of your future earnings too. How trusting and generous of you! +

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HUMAN BEHAVIOR

How neuroscience works in everyday life

You work together in the same office day after day with this person who is just a nightmare, a bully, a gossip, and who gets under your skin every day. You look down the road and envision years of daily torture. Assuming you don’t want to or can’t leave this job, how do you handle this? First, take a deep breath, wipe down those sweaty palms, and calm down your heartbeat. Then ask: What’s the bigger goal here? It’s to have the best workplace you possibly can. Here’s exactly how you can make that happen. • Identify the problem. Start by tackling this like any other assignment at work. Figure out what’s really bothering you. Is this person abusive and bullying? Is this person the worst kind of malicious gossip? Or is this person just annoying? • Don’t be surprised. Once you’ve identified what’s going on, don’t be surprised when the person acts that way. In other words, you know it’s going to happen—it’s inevitable. So don’t let yourself react emotionally (“I can’t believe he just did that!”) when, really, you kind of expect it. • Come up with a plan. Keeping in mind your goal of having a great workplace, figure out what will get you there. Maybe it’s watching your coworkers and how they interact with that person: Can you mimic their style or get insight on conversation starters? Maybe it’s making sure your interactions are always limited by time, and aren’t open-ended. Or maybe, right now, it’s just simple avoidance, until you can get to a place where you can revisit how to make this relationship better. Just be careful of ignoring the situation altogether because that’s how emotions can start to fester, making it worse. • Figure out what you want to say. If you decide that a heart-to-heart is the answer, think about exactly what you want to say so you can offer up solutions, in a tactful way. Your coworker might not react the way you want, so think about that too, and what you might say in response. Just stay professional, calm and tactful and remember that your goal is to make the workplace better. If it helps, write down what you want to say and practice beforehand. And don’t feel like you have to do this alone: You don’t have to make a formal complaint, but HR can give you tips on how to interact with this person. • Don’t contribute to the problem. People always say this and you might hate hearing it, but you can control only your own actions. So make sure that you’re not making the situation worse. For example, don’t think that you have to win, like you have to make that snarky remark and hear your coworkers laugh in support. Because it’s really hard to change other people, but if you change how you react to them, guess what? Their behavior will likely also change. • Stay calm. If you start feeling overwhelmed, give yourself a break: Take a sip of water, use positive self talk, and breathe. There’s actually huge value in a good yawn to draw in oxygen to your brain. Try it. • Give positive criticism. As you communicate with the other person, remember that sometimes the person may not even realize they’re being rude or bullying. So instead of being defensive, you could try saying something like, “That was hurtful; I wish you had said that differently.” It’s easy to assume that you know why someone is acting a certain way (“Because they’re just a horrible person!”), but maybe it’s because they are dealing with a loved one who’s sick or they’re really insecure. When you react, maybe they think you are the one who’s coming across as nasty or aggressive. • Get help. If none of this works, then it might be time to bring in HR in an official capacity. Sometimes, there’s only so much you can do on your own before you need help to make sure your workplace is a fulfilling and happy place to be. +

THE CO-WORKER YOU ABSOLUTELY CANNOT STAND

Jeremy Hertza, PsyD, is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC in Augusta

AUGUST 9, 2019

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Elizabeth Binsfield, RN, on August 4, 2019 (excerpt)

HAVE A ROUGH SHIFT? These six strategies may help

Most people in the medical profession agree that a nursing career can often be stressful; it comes with the territory of caring for those who are ill and injured. And on an average day, well-trained nurses are more than capable of managing the day to day stressors that their profession brings. But there are also those occasional shifts that bring nurses to their knees, putting them in need of restorative tactics. Here are some solutions for com back from the brink after a rough shift. Let’s Be Brief After a rough shift, it helps to debrief with colleagues who have also had a tough day. Reviewing what didn’t go well and determining how events could have been better managed can be educational or reinforce that the decisions made were the best possible options. And the opportunity to share the days’ struggles can be a great bonding experience for the team. Break Up the Monotony Break up the routine. Take a different or longer route home. Taking the long way home can provide valuable time to clear the mind and break up the “autopilot” to which we tend to default on our commutes. Take Time to Be Quiet Play soothing or instrumental music on the radio, or leave it off altogether. Patient care can be extremely noisy, especially in acute and long-term care facilities. After a long shift of constant noise, a little oasis of quiet can be very soothing. After you get home, continue to limit external stimuli for a while. Keep that Zen mode going as long as you’re able. Happiness is a Warm Puppy, or Kitten, or... Are you a pet owner or lover? It’s a wonderful thing after a long day to be greeted at the door by a faithful companion, but take it a bit further. A long walk with your dog or some snuggle time with your cat, ferret, or another small animal can help you detach from the day. Your focus is shifted from your own worries to the needs and appreciation of your furry friend. If you don’t have a pet yourself, perhaps you can visit a friend or neighbors’ dog. Petting an animal lowers blood pressure and facilitates the release of relaxation hormones. Sleep it Off Taking a nap or reading something simple and calming can help bring you back to balance by focusing your mind on something other than the friction of the day you’ve had. Fresh Start Even if your work isn’t necessarily as grimy as some careers, most nurses make it a point to bathe after a shift. A shower or a soak in the tub cleanses off the residue of the day and leaves you fresh and ready for bed. However you choose to spend your time after a rough shift, it’s important to make sure that you know how to take care of yourself. Elizabeth Binsfield, BA, RN, has been a Virginia registered nurse for more than twenty years. This story was originally published by Daily Nurse. +

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Unfortunately, many of us need this book. The person who always knows just what to say and when to say it — not to mention how to say it — is the exception. For the rest of us, all kinds of situations can present a bit of a communications dilemma. Throw in something like bad news from some medical tests, losing a baby, finding out a friend has cancer, or any one of dozens of other health-related bombs that one of our friends may have dropped on them (including death), and it can be very difficult to know what to say. Sue Halpern to the rescue. Her book, The Etiquette of Illness, was born of personal experiences and those of her friends. And let’s face it: we’ve all been to these places. In one case, she had lunch with a friend who had been diagnosed with cancer and was undergoing treatment. One of this woman’s close friends, someone she regularly spoke with, hadn’t called or returned any of her calls in months, roughly since the time of her diagnosis. She didn’t know what to say, so she didn’t say anything. All of us can identify with that to some degree. It’s not always

easy to comfort someone who has experienced a death in the family or who has received some sobering and serious bad news from a doctor. Then again, neither do we want to rush in like a bull in a china shop in some imaginary race to be the first to reach out to someone. As the title reminds us, there is etiquette involved. No points are awarded for being the first to extend words of comfort, any more than they are for waiting months and being the last. It can be beneficial to get one’s thoughts together, perhaps do some research on the subject of the person’s diagnosis, and give careful thought to what you’ll say. That’s where this

book comes in handy. Halpern, a psychotherapist, social worker, and human being, offers lots of sound advice on great ways to avoid that nagging guilty feeling we get when we retreat from a friend in their time of need instead of reaching out to help. Granted, we could tweet our friend or send them a text, but that has to rank near the top of bland and impersonal ways to communicate. Nor is there any law against getting help from Hallmark — quite the opposite in fact — but simply buying a card and signing it, or adding a few words (“thinking of you at this difficult time”) is a poor substitute for a few warm words spoken directly to our friend. Better to call or visit and send a card. Ah, but what to say when you call? There is the rub. Fortunately for us all, here’s a book that offers “what to say when you can’t find the words.” And we’ve all been there — and will be again in the future. Unless, that is, we learn The Etiquette of Illness. + The Etiquette of Illness, What to Say When You Can’t Find the Words, by Susan P. Halpern, 208 pages, published in 2004 by Bloomsbury USA

Research News Fan research Your air conditioning is on the fritz, the repairman is backed up for three days ahead, and it’s jungle-hot and humid outside. Will a fan help? Of course, you say. But new research says the correct answer is, “It depends.” New clinical research by the University of Sydney (Australia) examined whether an electric fan would have beneficial effects in lowering an individual’s core temperature, reducing cardiovascular strain, their risk of dehydration, and improving general comfort levels. They discovered the determining factor to be humidity. In hot, dry climate conditions, fans were actually detrimental by all measures. On the other hand, good news for our climate: in hot, humid conditions (the heat

index created for the study was 133°), fans lowered core temperatures, reduced cardiovascular strain, and improved thermal comfort. The results contradicted recommendations by the US Environmental Protection Agency and other public health organizations, which discourage fan use when heat indexes rise above 99°. Australian researchers called those recommendations “unnecessarily conservative,” particularly in light of increasingly frequent and torrid heatwaves around the world. The study was published August 5 in the Annals of Internal Medicine. Now hear this Johns Hopkins scientists have found a pair of proteins that control activation of sound-detecting cells in the middle ear. Although the discovery was found in mice,

the proteins may hold a key to future human therapies, even in people with deafness that is currently irreversible. 3D printing of the heart Researchers at Carnegie Mellon University have developed a new technique that makes it possible to print tissue scaffolds out of collagen, the major structural protein in the human body. The buzz is that the technique is a huge advance in the direction of being able to 3D print a full-sized adult human heart. The news is significant because collagen is a component of every type of tissue in the entire body. Developing a technique for printing it could have a major impact on the millions of people worldwide who need organ transplants and/or are on transplant waiting lists, all vying for a very limited supply of available organs. 3D printing could change that dramatically. +

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AUGUSTAMEDICALEXAMiNER

The Examiners +

What was that you were drinking before?

Water.

by Dan Pearson

Just water? Not sports water, vitamin water, electrolyte water?

Nope. Just plain old undiluted water.

Watered down water.

Undiluted? So what would diluted water be?

PUZZLE

19 23

20 24

26 31

38 42

43 47

48 52

54 59

60 66

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, AUGUST 5, 2019

We’ll announce the winner in our next issue!

E X A9 M4 I N E R 7

1 4

S U D O K U

5 6

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

followers 32. Glass under a microscope 33. _____-wheeler 34. Roof overhangs 37. ____ date 40. Fossil product 42. Sustained pull, as on a leg 45. Frenetically busy 47. Sofa 50. Stroke gently 52. Apply lightly, as paint 55. Children, informally 56. Notion 57. Lofty 58. Lead-in to rival or enemy 59. Identical 60. Scratch 61. Michigan or Ontario 62. New Age singer 65. Definite article 68. Type of girl Clara Bow was 70. These are dotted Solution p. 14

8 2 6 9 S 4 T 3 T 1 5 7

3 4 5 2 7 1 9 8 6

— someecards

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. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving words with letter clues and entering unique and minimal choice letters. A sample is shown. Solution on page 14.

’ 1 2 3 4 1 2 3 4

E 1 2 3 4 M 1 2 3 4

O 1 2 3 4 5 6 1 2 3 4

1 2 3 4 S 2 3 4 5 6

P . 1 2 3 4 5 7

1.TSTDRYYPP 2.OLEEOOHHE 3.AUSLEONOU 4.WULNRRTMP 5.SLL 6.TE 7.S

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

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D 5

21 22 ACROSS 1. Augusta mill 25 5. Augusta’s “The _______” 27 28 29 30 10. 2nd son of Adam and Eve 14. Potpourri 35 36 37 15. Hilo greetings 39 40 41 16. Uber competitor 17. A version of Baal 44 45 46 18. Occur before something 49 50 else 53 20. Part of a combo with feathers 55 56 57 58 21. Carry out 63 64 65 23. Bible coin 25. Speed abbreviation 67 68 69 26. Make a mistake 71 72 27. Business matters 31. Fancy word for doing by Daniel R. Pearson © 2019 All rights reserved. nothing 35. And not DOWN 36. Guides 1. Honshu port 38. Ukraine seaport 2. Holly genus 39. Got bigger 3. West ____ Virus 41. Rejoice 4. Depart 43. Capital of Ukraine 5. Big event Masters Week 44. Iron feature 6. On sheltered side 46. A goat might have one 7. Former weight for wool 48. Dr. of rap 8. Central African republic 49. State of having a will 9. Intense dislike 51. Young girls 10. @ 53. Nurse asst. 11. Nearby South Carolina 54. Stroke abbrev. town 55. Greek island 12. Test 59. Like a mobile, but 13. Old Italian money stationary 18. It’s in the center of an iris 63. McKinley’s First Lady 19. Type of bird? 64. Sure 22. Nashville awards prog. 66. Joy Luck Club author 24. Floorboard sound 67. Reuben seller 27. Anguish 69. Average Joe’s last name 28. Specialty 70. Distasteful; yucky 29. Liberates 71. Shaker contents 30. Sen. Chambliss 72. Luster 31. Religion with a billion 73. Mets’ former home

WORDS NUMBER

THE MYSTERY WORD The Mystery Word for this issue: GUNRINS

EXAMINER CROSSWORD

AUGUST 9, 2019

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Advice Doctor

anesthesiologist said he could either put me to sleep with gas, or he could do it with a big wooden boat paddle. Moe: That sounds like an ether/oar situation.

Moe: I wonder if there is a patron saint of security cameras. Joe: Sure. St. Francis of a CCTV.

y wife told me I spend too much time on my computer. She told me that she’s going to slam my face into the keyboard the next time she catches me online. “I’m the King of the Castle,” I told her. “I’m the boss! You’re not goikmdj}sinxNsks . xnxnEn . Kfizkn^# xnxk’cj’O&:9m &:&ndjchnapn!:!2kskn !&/9nMsosk/ raeqbsn Moe: What’s the difference between a kleptomaniac and a literalist? Joe: A literalist takes things literally. A kleptomaniac takes things, literally. Moe: How do you like my new sweater? Joe: Hey wait, it’s blue. I thought you just bought a new red sweater. Moe: It was picking up so much static electricity I had to take it back. Joe: Is this one ok? Moe: Well, the store said it’s free of charge. Moe: How did your operation go? Joe: Ok, but it was a little weird. Moe: How so? Joe: Before surgery, I was offered a couple of different options to knock me out. The

Moe: What’s wrong with your girlfriend? Joe: She was crying because she went to the salon to get blonde highlights, but it turned her hair bright green. Moe: Were you able to comfort her at all? Joe: I think so. Moe: What did you say? Joe: I said, “What are you upset about? I’m the one who has to find a new girlfriend.” Moe: After I broke my arm, my buddy wrote down all of my homework assignments on my elbow cast. Joe: I bet that really classed up the joint. Moe: I heard your boys are being bullied at school. Joe: Yeah, it’s real bad for both of them right now. Non-stop. Moe: Kids can be so brutal. What are you going to do? Joe: Well, last night at bedtime I sat both boys down and told them they’re just going to have to be tough. Moe: Do you think they’ll be ok? Joe: I think Marylou will be, but I’m worried about Daisy. +

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, Last week at work I got a major promotion and a huge raise. This came totally out of the blue. I was so shocked you could have knocked me down with a feather. I was on cloud nine — for about 5 minutes. Then I was told that my immediate supervisor, who is an absolute witch, was being demoted to take my old position and I will now supervise her. I guarantee she’s going to make this extremely unpleasant. Any advice on how to deal with this matter would be greatly appreciated. — A Big Raise - and a Big Headache Dear Big Raise, Before we get too excited about your raise, let’s make sure about something a lot more important: making sure you’re around to enjoy it. You see, whenever a person’s balance becomes unsteady it raises some medical red flags. In your case, your balance was so precarious you state that someone could have knocked you over with a feather. I assume they did not or you would have specifically mentioned it. But you state they could have. Perhaps no one in the office had a feather that day. You are fortunate, indeed. Problems with balance, dizziness, vertigo, etc., can be caused by a number of factors, some of them potentially serious, others very minor. Among the possible causes: side effects from a medication could do the trick. An inner ear infection could be the cause. A concussion or a blow to the head can cause dizziness. Migraines cause some people to experience vertigo, and low blood pressure can be another culprit that may result in insufficient blood flow to the brain, especially right after standing from a seated or prone position. In your situation, perhaps the one-time reason was the momentary excitement of the big news. It may never happen again. But if you have another episode be sure to check with your doctor right away. The cause can be identified and treated. I hope my advice has been helpful to you. And congratulations on your promotion! + 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: SUTURE

...cleverly hidden on the leaf of the apple in the p. 2 ad for MEDICAL ASSOCIATES PLUS

THE WINNER: STAN GREENBURG! 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 9, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED K O B E

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A B E T A X T A C H M R E S S A L T K I E D R D E N A B I L T A I C K S H E

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

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The #1 word we hear from readers when they talk about the Medical Examiner is love. “We love your paper!” That is a very cool thing. Our response: “We love you back!” But don’t stop with loving just the Medical Examiner. Save some love for our awesome advertisers. Their support makes this free newspaper possible. In turn, our support of them makes everyone happy.

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ALZHEIMER’S… from page 8

sense-based. Make sure you always approach your loved one from the front and state who you are. Don’t assume that just because you are their child, your parent knows who you are. If your loved one is non-verbal, encourage him or her to point, gesture or shake a head to let you know what is wanted. Use touch, sounds, smell or taste to communicate. Look at the facial expression, body language and the emotion behind any sounds that are made. Never lose sight of the fact that your loved one is an adult, not a child… an adult who deserves respect, regardless of condition. When you communicate with a person with advanced Alzheimer’s Disease, don’t use baby talk or cutesy or diminutive language. Most of all, keep visiting and communicating with your loved one. Even if you are still not sure how to communicate, that’s OK. Your being there, your touch, your presence…all those are communicated, felt and gives comfort to your loved one. Don’t stop visiting, thinking people with advanced Alzheimer’s don’t perceive the presence of loved ones. They do. + Dr. Nancy V. Karp, Ed.D., M.Ed., P.T. is a member of The Section of Geriatrics of The American Physical Therapy Association. She has practiced in the area of Geriatrics Physical Therapy for over 46 years and teaches in the Alzheimer’s component of the Doctoral Physical Therapy Program at Augusta University.

LECTINS… from page 9 So should I avoid lectins? There is little research indicating that a lectin-free diet is effective, helpful, necessary, or sustainable. All foods can fit in a healthful diet, and foods should be eliminated only because of food allergies or sensitivities. The most sustainable and healthful diet is one that includes a balance and variety of whole grains, fruits, vegetables, lean protein, and healthful fats. There are definitely more effective and sustainable methods for improving gut health, losing weight, and managing autoimmune disorders. The lectin-free diet is an extreme one, and extreme diets should be reserved for extreme purposes. I hope you + enjoy the fun, colorful (and lectin-filled) summer salad recipe! References: • Castaneda, Ruben. Is a Lectin-Free Diet Healthy for Vegetarians and Vegans. US News Health. 15 July 2019. • Amidor, Toby. Today’s Dietitian. Clearing Up Lectin Misconceptions. Great Valley Publishing Co. October 2017. Vol. 19. No. 10, P. 10. • Riddle, Judith. Today’s Dietitian. Another Dose of Food Fear. Great Valley Publishing Co. October 2017. Vol. 19. No. 10. P.4 • Recipe: https://therealfoodrds.com/caprese-zucchini-salad/

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IT’S A QUESTION OF CARE Case Management vs Care Management: what’s the difference? Case Manager • A Case Manager is usually affiliated with a certain institution, facility or entity (hospital, rehab facility or insurance company). While they allow for patient choice and attempt to provide unbiased support to

the patient or client, they must function within the boundaries and restrictions set by the group or institution for which they work. A Case Manager’s institutional alliance can sometimes affect to whom and where they refer their clients for additional resources. • A Case Manager usually follows a medical model. Whether they are connecting patients to outside resources to prepare them for discharge from the hospital, or they are managing the care a patient is receiving while on a certain service, the majority of the time these services are related to one’s medical needs only. • Case Managers usually provide referrals to needed resources, but are unable to provide ongoing oversight and follow up with these resources. Once the situation or environment that created the Case Manager and patient or client relationship ends, their role as someone’s Case

Manager ends. Care Manager • Aging Life Care Managers have an allegiance to the client and their family only. Their work is based on the needs and wants of the client and family rather than with a certain agency, provider, or institution. This allows a Care manager to freely connect clients to the resources that best fit their needs. • Care Managers take a holistic approach in the care management they provide. This means assessing and manage all aspects of life, not just the medical portion. They oversee and manage the medical needs of their clients and often work closely with Case Managers who may be assigned to clients through a specific institution or agency, and make it a point not to duplicate the service/s they are able to provide. They also ensure that each client’s

AUGUST 9, 2019 social, emotional, financial, legal, and housing needs are met. They look at the big picture and connect clients to the needed resources and support to ensure they have and live an abundant life. • Care Managers oversee and manage the day-to-day happenings of their clients’ lives as time passes and provide oversight of the different resources with which we have connected them. If the client has hired them for ongoing Care Management they

interface with entities such as CPAs, Caregiving agencies, Trust Officers, Home Health or Hospice Agencies, Doctors and Pastors, etc. on a regular basis to ensure their clients continue to receive exceptional care and all pieces of their lives fit together appropriately. + Lori Beth Charlton, MSW, LMSW, C-ASWCM is an Aging Life Care Manager who assists her clients and their families in choosing the best care options for their needs.

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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!

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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!

Medical Examiner 8/9/19

Articles inside

Two New Columns

The Road to Recovery?