Dec1 17 by Daniel Pearson

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MEDICAL EXAMINER recipe feature PAGE 7

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DECEMBER 1, 2017

Has your BP ever been measured correctly?

120/80 MM HG

THE NEW BP GUIDELINES

bout the time our last issue went to press, news of a major change in the definition of high blood pressure, or hypertension, made lots of headlines. Previously, the treatment threshold was triggered at 140/90. Anything below that was, for most patients, good. The new definition of hypertension is 130/80 and up. Normal and healthy blood pressure is now defined as lower than 120/80. Blood pressure readings of 120 to 129 with a diastolic less than 80 is now considered “elevated.” With this change, millions of people are now considered hypertensive who weren’t just a few weeks ago, including many in their 30s and 40s. (Note: the new recommendations may not apply in every case to people aged 60 and above. Check with your doctor.) In fact, the official definition of hypertension has been steadily dropping for years as new research is done. Why the changes? Elevated blood pressure means that your heart is working extra hard for each and every one of its 100,000-plus daily beats. Enlarged hearts and heart attacks can be the result. High blood pressure can be caused by arterial blockage from plaque buildup, which is a dual threat: the heart is working harder than ever, yet the circulatory system’s efficiency is dropping. Hypertension causes strokes when blood vessels in the brain rupture or are blocked by clots. Additional problems caused by high blood pressure include kidney disease, vision loss, chest pain, sexual dysfunction and peripheral artery disease. There are undoubtedly many people who suspect the stricter guidelines are part of a sinister conspiracy by doctors and pharmaceutical companies working in collusion to drum up business. Please see 120/80 page 2

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Probably not. What’s the normal scenario at doctor appointments? Your name is called and a nurse ushers you to a scale where your weight is recorded, then seconds later your blood pressure reading is taken as you and the nurse engage in idle conversation. Perhaps your temperature is taken too, and then it’s back to the waiting room or on to an exam room. The American College of Cardiology (ACC), the folks behind last month’s revised blood pressure guidelines (see story, left), would point to numerous reasons why that typical scenario results in inaccurate measurements. Because the new guidelines have lowered the definition of hypertension, accurate readings are more important than ever. A correct reading begins long before the BP cuff is pumped up. The ACC says patients should be instructed to avoid caffeine, tobacco, alcohol and exercise for at least 30 minutes prior to their appointment. BP should be measured with an empty bladder, and patients should sit quietly (not speaking) for at least 5 minutes before measurements are taken and remain still with both feet on the floor while BP readings are taken. The arm should be supported while testing so it is about the same level as the heart. Which arm? Both. Whichever one is higher should be the one entered into your records. A BP cuff should be inflated over bare skin, not shirt sleeves. The ACC says an accurate picture of your blood pressure should be based on the average from at least 2 readings properly taken on at least 2 separate occasions. Instruments in doctors offices THIS IS OUR should be regularly calibrated to ensure their accuracy. Home testing is recommended between appointments (at about the same th time every day), but the ACC says drug store BP monitors are often ISSUE! found to be inaccurate. +

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DECEMBER 1, 2017

120/80… from page 1 The problem with that theory is that the recommended treatment guidelines focus on lifestyle changes, not drugs, as the first and preferred line of defense. In fact, the list of recommended non-drug treatments is lengthy, and they are proven to be effective among patients who conscientiously apply them. What are they? One of the fi rst is for hypertensive people to adopt the DASH diet. Fear not: it’s not one of those diets that requires eating weird stuff like broccoli and rice cakes — together. (Not that there’s anything wrong with either.) The DASH diet was created expressly for people with hypertension. DASH is an acronym for Dietary Approaches to Stop Hypertension. It includes meat, fish, poultry, nuts, beans, fruits, vegetables, grains and low-fat dairy foods. It is so non-weird that it is recommended as an ideal healthy diet for everybody, whether they have hypertension or not. Among those who recommend it: The National Heart, Lung and Blood Institute (aka NHLBI, part of the National Institutes of Health); the United States Department of Agriculture (USDA); and U.S. News & World Report, which issues an annual ranking of diets. Its DASH rankings: #3 “For Heart Health,” in a 2nd-place tie as best “For Diabetes, and ranked #1 in the categories “For Healthy Eating” and “Best Diets Overall.” Look it up, buy a book about DASH or get one from the library, or consult one of the area’s many registered dietitians and get started phasing in a diet that’s delicious, nutritious and healthful. A Harvard researcher says the DASH diet alone can lower systolic blood pressure (the higher first reading) by 10 points or more Next on the list for lowering blood pressure: be more physically active. Everyone can do this. Everyone. The NHLBI’s short list of common chores that qualify as moderate-level physical activity includes “wheeling self in wheelchair for 30-40 minutes.” If people confined to wheelchairs can exercise, all of us can. That’s not to say we have to do it all at once, with or without a wheelchair. The overall recommendation is 30 minutes of moderate-level physical activity on most days of the week. Breaking it up into 10- or 15-minute segments works too, and it can be almost effortless: for example, parking at the farthest corner of the parking lot at work or the grocery store; taking the stairs instead of the elevator or escalator; raking leaves instead of using a blower. Once you start looking, there are a million ways every day to be more active. Need ideas? Visit the website of the American Council on Exercise (ACE) for its library of exercises sorted by body parts you want to target, your fitness level, and what equipment you may have. They also list local ACE trainers who can help (acefitness. org/exerciselibrary). Most people don’t need to check with their doctor before moderately increasing their level of activity. If you aren’t sure, or if you have a history of heart trouble or heart attack, by all means check with your doctor fi rst. Regular exercise also lowers the risk of heart disease, diabetes and colon cancer, among many other benefits. And it just makes people feel better. Another strategy for lowering blood pressure: more spice, less salt. There are a lot more flavor enhancers out there than just salt, most with no adverse health effects. Tossing the salt shaker from your table and kitchen may have only limited effect, since many foods are high in sodium straight from the grocery store. Become a label reader looking for salt-free, no-salt, reduced sodium and “no salt added” products. The target for most people: a maximum of 2,400 milligrams of sodium per day (for some the recommendation is 1,500 mg). An interesting project to help judge intake is to keep a food diary for a few days, reading labels and adding up the per-serving sodium content of your diet. It might surprise you. Yet another way to lower blood pressure is losing weight. Doing so rapidly usually means gaining it back just as rapidly, often with a few extra pounds thrown in for good measure. A slow and steady plan to lose weight, perhaps 2 pounds a week or less, is a good strategy. A specific goal, rather than just “losing weight,” helps define the project. Many people aim for 10 percent of their current weight. Once they reach that, they can decide if they’re all set or want to embark on a new goal. It’s all quite important when you consider that a systolic blood pressure that’s 20 points higher than it should be, along with a diastolic reading that is 10 points higher, translates into double the risk of death from a heart attack, stroke, or other cardiovascular complications, like aortic aneurysms. Worse still, those who experience those events and survive often find their quality of life seriously compromised. Do your research on the new guidelines and you’ll note that even though millions of Americans are newly hypertensive, very few will be advised to start a drug regimen. For most of them, the best medicine will be diet and lifestyle changes. Most of the rest of us would also benefit greatly from the same medicine. +

How to get your blood pressure down without medications

THE

Money Doctor Coming up in our next issue.

Are you really hypertensive? See also the page 1 article about how to get the most accurate blood pressure reading possible.

DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

Defining the terms of today’s healthcare discussion

The

In other words...

Advice Doctor

Twelve years ago, when Medicare Part D was a brand new government entitlement, I was in a little kiosk in the Evans Walmart helping to introduce the prescription drug insurance plan that resulted from The Medicare Modernization Act. I’ll never forget the very distinguished 75-year-old man who sat with me and asked if what he had recently read as an explanation of the mathematics of the “coverage gap” (nicknamed “the donut hole”) was accurate. I quickly answered no, but also expressed my amazement to have met someone astute enough to spot such confusing discrepancies. Naturally I had to ask, “What did you do before retirement?” “I’m an economist,” he said. He went on to say that this kind of ambiguity – and even inaccuracy – is common in complex documents and government programs. That was an eye-opener to the difficulties the average person encounters in understanding the many words, phrases, abbreviations and acronyms that are part of the non-medical side — call it the bureaucratic side — of medicine. This brief series will hopefully enlighten readers with a few clarifyng definitions and explanations. Let’s start with Medicare and Medicaid – two words that were invented, I’m guessing, by some government employee who was given a bonus for inventing new words that combine medical with care and aid. My dictionary says both are “U.S. government programs of hospitalization and medical insurance…” But how do we keep them straight? How are they different? Simply put, MediCARE is “for persons aged 65 and over and for certain persons disabled who are under 65,” whereas MedicAID is “for persons of all ages within certain income limits.” State and local funding comes into play with MedicAID, but MediCARE’s funding is all federal. My wife, who according to a bona fide test on Facebook is a genius, came up with a simple way to keep them straight in my head: When we focus on the word, “aid,” we often think of aid of the financial variety. So MedicAID would be for those who have particular financial limitations. Sooner or later, everybody is going to need some kind of CARE. But not everyone will need financial AID. People of all income levels can still get MediCARE; the need for CARE is universal. Still, some may ask, “Why did the government decide to give these two programs titles that are so similar and therefore so hard to not confuse one with the other? Were these named by the same person who decided that Augusta should not only have a University Hospital but also an Augusta University Hospital?” Here is my answer: I do not know. An acronym that comes up frequently in this arena is CMS, which stands for Center for Medicare and Medicaid Services. Why is it not CMMS? I have no answer for that either. Now let’s get into defining some terms I’ve already thrown your way. How about this one: Medicare Advantage Plan. This phrase sounds like something contrived by the insurance industry, doesn’t it? Similar to how it’s not your insurance cost – it’s your “premium.” Or, it’s not the money you’ve got to pay before they start helping you – it’s your “deductible.” At any rate, a Medicare Advantage Plan is an arrangement where a Medicare member who has Part A and Part B chooses to have their Medicare administered by a health insurance company rather than what we call Original Medicare. It must cover everything that Original Medicare covers and the typical “advantages” would include having coverage with no deductibles (Original Medicare Parts A and B both have them), as well as limiting your out-of-pocket costs to no more than $6,700 (Original Medicare has limit to its 20% coinsurance). Another common term is Medicare Supplement or Medigap plan (they are interchangeable terms). This is an insurance policy designed to cover some or all of Medicare’s gaps, also known as deductibles. 2018 gaps include the Part A (Hospital) deductible of $1,340, the Part B (Medical) deductible of $183, and the Part B coinsurance of 20% of which there is no maximum limit. What is the difference between a Medicare Advantage Plan and a Medicare Supplement (Medigap)? Medicare Supplements do exactly what the name describes: They supplement, or fill in gaps of Medicare – kind of like how a good multi-vitamin can supplement that burger and fries platter. Medicare Advantage Plans cover everything that Medicare covers for little or no monthly premium (because the insurers are paid well from Medicare funds) and although they usually have no deductible (if you use providers in the plan’s network), you will still have copays or coinsurance up to a certain maximum limit. No one has Original Medicare and a Medicare Advantage plan. Therefore, no one has a Medicare Supplement and a Medicare Advantage plan. So when you get on Medicare parts A and B, you have a choice of either staying on Original Medicare and perhaps purchasing a Supplement and/or a stand-alone Part D prescription drug plan, or opting for a Medicare Advantage Plan, which becomes your route of access to Medicare. Unfortunately these few terms and phrases barely scratch the surface of today’s healthcare vocabulary, but if you keep tuning in to future issues of the Medical Examiner I’ll try to clarify more of them. +

What does it all mean?

by Jeff and Micki Price of Augusta Medicare Solutions. For more information, questions, or suggestions for future articles, reach them by email at mickiandjeff@yahoo.com, call 706-829-8017, or visit their website: augustamedicaresolutions.com

Dear Advice Doctor, I was offered a promotion at work involving more responsibilities, more hours and a very impressive-sounding title — but not more pay. My manager told me that I would get an “unpaid raise” (his words) effective immediately. He said if I succeed in the new position I’ll get all the money owed to me retroactive to the date of the promotion. I think I must have a hole in my head, because I’m actually thinking of accepting this offer. What is your take on this situation? — Getting An Invisible Raise Dear Invisible, I’d like to address the legality of this proposal in labor law but alas, I am not a doctor of law. Instead, I’d like to address to long-standing human condition you refer to of having a hole in one’s head. Admittedly, you don’t see this much anymore, but it was standard medical practice for centuries and still takes place today. Known as trepanation, it’s the process of deliberately boring a hole in the skull for various alleged benefits, and it is one of the oldest surgical procedures in the annals of medicine. Hippocrates is even said to have endorsed it. Modern medicine acknowledges the need to relieve intracranial pressure in cases of brain injury and swelling inside the unforgiving confines of the skull. Such procedures are designed to be temporary. In ancient practice, trepanation was performed ritually to release evil spirits and heighten consciousness, and medically to cure cancer, epilepsy and mental disorders, and relieve headaches among other reasons. There are ultra-alt practitioners of “medicine” today who even advocate self-trepanation as a means to duplicate the curiosity and openness of very young children, whose skulls, goes the logic, are unfused and flexible. + 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.

MEDICAL EXAMINER

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

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Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., or its agents or employees take any responsibility for the accuracy of submitted information, which is presented for 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. © 2017 PEARSON GRAPHIC 365 INC.

DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

#56 IN A SERIES

OLD NEWS

Who is this?

POINTS OF INTEREST TO FORMER KIDS by Trisha Whisenhunt

FINANCIAL EXPLOITATION OF THE ELDERLY

here are more than a few survivors of colon cancer among us, as well as others who have suffered vascular injuries caused by car crashes, industrial accidents and gunshots. Believe it or not, they may owe their survival to the 1894 assassination of the president of France. President Marie Francois Sadi Carnot had just given a speech in Lyon on June 24, 1894, when he was stabbed by an Italian anarchist. He died within hours, bleeding to death from a severed portal vein. The assassination of the respected leader caused widespread shock and grief throughout France, including the gentleman above, Alexis Carrel, a native of Lyon and at the time a young French surgeon. The death, one he thought could have been prevented, left a deep impression on him. “Assassinat du President Carnot” With the help of sewing lessons from an embroideress, by 1902 Carrel developed a technique for suturing severed blood vessels back together end-to-end in a way that minimized damage to inner vascular walls, thereby preserving their ability to convey blood. The procedure, called anastomosis, earned Carrel the Nobel Prize in 1912. The very same procedure, also called a resect (or resection), is used when sections of the colon are removed due to cancer. Years later, Carrel collaborated with famed airman Charles A. Lindbergh to create a perfusion pump which enabled organs to survive outside the body (for more than 30 years in one noteworthy instance of Carrel research), a major step in making organ transplants and open heart surgery possible. The two appeared on the cover of Time magazine’s issue of June 13, 1938, and co-authored a book together about their work, The Culture of Organs. The partnership was born when Lindbergh sought out Carrel to see if the heart of his sister-in-law, Elisabeth Morrow, could be repaired after being damaged by rheumatic fever. In 2002, MUSC (the Medical University of South Carolina at Charleston) established the Lindbergh-Carrel Prize, awarded for major contributions in the “development of perfusion [...] technologies for organ preservation and growth.” The bronze statuette awarded to recipients (who include Michael DeBakey) is named “Elisabeth” in memory of Elisabeth Morrow. Carrel was also a pioneer in antiseptic procedures in battlefield medicine. Although Carrel was born and died in France, he spent much of his medical career in Chicago and New York. +

read an article about a Florida man who had placed each of his parents in a different nursing home and confiscated their cell phones. He then sold all their physical assets, pocketed the cash and drained their bank accounts. Each state continues to do all it can to protect our elders from abuse, but often those being taken advantage of won’t speak up because they don’t want their child(ren) to face the consequences. According to Allianz Life Insurance stats, 1 in 10 seniors age 60 an older experience this type of abuse. That’s five million nationwide. Some useful advice below comes from financial experts who write for USA TODAY. The two greatest risk factors for being a victim of financial abuse are social isolation and cognitive impairment. Stay active and engaged. If someone tries to isolate you from family and friends, seek help. Don’t allow anyone to pressure you into signing anything. Don’t sign any document, or make a purchase or give away a portion of your money or property. Any

time you are considering making a financial change, take your time and consult with a reliable and trusted, independent party. Avoid setting up joint accounts. If you feel you need help paying your bills, speak to your banker about the options for getting assistance with your finances. Don’t give your home away in exchange for a promise of care. It is shocking how many of these promises are broken even by the best intended individuals. Keep your home in your own name or you could find yourself without

a roof over your head or the help you need. Make sure you have a financial team in place. A group of professionals who can address your financial affairs will keep you secure by having this extra layer of protection. Be cautious about family members, friends or even professional caregivers. Sadly, most financial abuse is committed by those closest to you. Setting up a revocable trust with a corporate trustee can be your best protection. These trusts are the most regulated financial entities in the industry. They are regulated by the FCC, FDIC and the state banking commission. Execute a durable power of attorney with the assistance of an attorney. This can be your most useful and important estate planning tool but can be misused. It is a legal document that gives someone the power to act in your place should you become mentally incapacitated. This person will also have unlimited access to your finances. To further protect yourself, make certain the person you have chosen is sending copies of all transactions, banking, investment, and credit card statements to your financial team each month. Planning ahead is important for you and your family. It will mean peace of mind for you to know they will be able to carry out your wishes without second guessing if they are doing the right thing. +

MYTH OF THE MONTH Pregnant women should avoid all contact with cats This could be true in extremely rare and unlikely circumstances, like if the cats we are referring to are pumas, cougars, tigers, etc. The kernel of truth that got this semi-myth started in the first place is that little word toxoplasmosis. It is an infection caused by an organism found primarily in cats in the wild who are eating the dead meat of other animals infected with toxoplasmosis (so it could in rare instances also apply to ordinary cats that are strays living out there on their own). It would be highly unlikely that a house cat, or any cat that never eats the meat or feces from wild animals, or which is under the regular care of a veterinarian, would present a

problem. To be on the safe side, an expecting mother can give someone else the job of changing the kitty litter. Thorough hand washing is another way to cut the odds from 1% down to zero. Another way to assure yourself of your cat’s safety in the home is having it checked for this infection by your family veterinarian. In all likelihood you’ll get a clean bill of health and be able to put this worry to rest. + — by F. E. Gilliard, MD, Family Medicine, 4244 Washington Road, Evans, GA 30809 706-760-7607

DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW

t is been a most exasperating week. I was tooling along with nothing more than the normal difficulties expected with 76 years of advanced maturity. My wife’s doctor changed her medications and suddenly she had no use for a partial bottle of Lipitor. Being of the “waste not, want not” generation, I decided the only reasonable thing to do was take the Lipitor myself. My blood cholesterol for the last half-century has been about 240. Nowadays we subdivide cholesterol into high-density and low-density cholesterol. For our purposes here let’s just go with cholesterol. Anyways, I took one of Lipitor tablets. Within four hours every bone and joint ached, my skin felt like you were it peeling off, body hair was sore, and chills began. Doing what no doctor is supposed to do, I diagnosed myself as coming down with the flu. I treated myself with Naprosyn, literally crawled into my bed, and stacked the covers up high. For a while, I was afraid I might live and keep feeling this terrible. Through the fog I remembered my brother describing similar events a few months ago. Eventually I called him. He confirmed that he took Lipitor for 3 days a few months ago for

ABOUT SAVING MONEY WITH A $10,000 PILL

elevated cholesterol. (Our whole family has elevated cholesterol. It is a genetic thing.) His joints became so sore and painful he could not raise his arm to shave. He discontinued Lipitor and a few days later his symptoms cleared. He discussed the events with his cardiologist who said that while his cholesterol was significantly high, the Lipitor side effects in his case far outweighed the benefits. My brother reminded me that our father had similar events taking the drug years ago. I made a silent vow that if I lived through this episode I was done with Lipitor. For the next couple days, surviving seemed somewhat in doubt. I could barely move and spent two days in bed. Resolution was slow, which is a bad thing because everything about me is much slower than it used to be to begin with. They say that is the function of advanced maturity, which I have a lot of. I only moved when absolutely necessary. I am still not back to normal. Even when the Georgia Bulldogs beat Kentucky, I did not physically move to celebrate ... unless you count blinking more often and smiling slightly. I lost 4 pounds, even after going to Perfect Health Urgent Care where Dr. Sharon Palmer

t s e B kindly ordered her nursing assistants to punch holes in my veins and pour in 2000 mL of IV fluids pronto. Their smiles were infectious and kind words were soothing. IV fluids helped a lot, but they could not turn back the clock and erase my medical misadventure. This is all a long way of saying I took a medication to lower my cholesterol, but it lowered me into the Pit of Misery. It is not a good thing when you look and feel like a zombie from the Walking Dead cast. Will I ever return to normal? No way of knowing at this point. It ain’t over until the fat lady sings and I can’t even see the fat lady yet. On the other hand, my wife takes Lipitor every day, as do thousands of others, with no negative side effects. What is good for the goose ain’t necessarily good for the gander. This illustrates why the practice

e n i c i d ME

of medicine is an art as well as science because what is true for one patient may or may not be true for the next patient. Medical treatment must be individualized. As I frequently tell patients, I have a lot of education, training, and experience. But with all that, I am right only 90% of the time, wrong the other 10%. This holds true for physicians in general. Clearly the decision I made to take Lipitor was a wrong decision. If you look in the social media or mainstream news, you will hear a lot more about the 10% wrongs than you do about the 90% rights. If it bleeds, it leads. No media source ever got rich spreading good news. It seems there is a genetic component related to who does or does not react negatively to Lipitor. Oneperson testimonials are not a valid foundation for sweeping

conclusions. Is Lipitor a good medication for hypercholesterolemia treatment? Without a doubt, Yes! For certain individuals, including my close blood related family, No!. If we could figure out a way to implant my Lipitor-hatinggenes into terrorists, they could close down Gitmo and quit waterboarding. Just give them Lipitor for three days. They would tell us anything we wanted to know. Once the word got out to other terrorists, the mere threat to give them Lipitor would convert them into a volcano of information. The makers Lipitor could make a ton of money selling Instant Confession Pills for $10,000 each to the government. And it still would be a great cost saver for the taxpayers. Long live Lipitor ... as long as I don’t have to take it. +

Bad Billy Laveau is a formerly-retired MD who wields a pointed sense of humor - and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology.net or 706-306-9397. F REE T AKE-HO ME CO PY!

Calling all Bad Billy fans! More than two dozen of Bad Billy’s personally handpicked stories are collected together in his first book. Get yours today at amazon.com or barnesandnoble.com For personalized autographed print copies, call 706-306-9397

MEDICAL EXAMINER

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E R U FEAT

The vitamin alphabet NEW

Let’s take a serial look at the very short alphabet of vitamins (kids, there’s only A, B, C, D, E, and K!) and see what they do, why we need them, where we can get them and what happens when we don’t. Vitamin A seems like a logical place to start. All vitamins are either fat soluble or water soluble. Vitamin A is fat soluble, meaning that it goes through the digestion process and is absorbed into the body through the intestines and is stored in fat cells throughout the body. By contrast, water soluble vitamins dissolve in water and enter the bloodstream. Excess amounts are easily excreted through the kidneys. That basic fact is a key to understanding why it’s important to get the right

amount of vitamin A (or any other fat soluble vitamin). Since fat soluble vitamins are stored in fat, it’s not as easy for the body to rid itself of excess amounts, or as fast. Fat soluble vitamins can accumulate, sometimes to toxic levels, if they are consumed in quantities larger than the body requires. Vitamin A isn’t hard to find. It’s found in many foods, and that’s a good thing, since it is important for good vision, reproduction, a healthy immune system, and healthy skin, bones and teeth. There are actually two types of vitamin A. Socalled “preformed” vitamin A is found in meat, fish, poultry and dairy products. “Provitamin” A is found in fruits, vegetables and other

plant-based foods. Provitamin A is rich in carotenoids, of which the most well known might be beta-carotene. Betacarotene is an antioxidant, a

substance that protects cells from damage by substances called free radicals, thought to a accelerate aging and contribute to certain chronic diseases, including cancer. Unfortunately, however, beta-carotene supplements don’t seem to have any effect on cancer risk. For that we have to actually eat the foods containing vitamin A and beta-carotene, not pop a pill. But that’s a good thing, really. Food is better medicine than pills every day of the week. Good sources of vitamin A are broken down into the two types of A. For preformed vitamin A, the kind found in animal products, the best sources are fish oils and liver. They have lots and lots of vitamin A. Salmon is another good source.

In the plant world, anything that’s richly colored is likely to offer an abundant supply of provitamin A. The prime sources include foods like spinach, kale, carrots, peppers, cantaloupe, mangos, pumpkin, blackeyed peas, broccoli, apricots, sweet potatoes, collards and squash. Vitamin A deficiencies are pretty uncommon in developed countries, although alcoholics can be affected and should therefore consume a diet rich in vitamin A. The Recommended dietary allowance (RDA) for vitamin A is 900 micrograms daily (3,000 International Units) for men and 700 mcg (2,300 IU) for women. Anything over 10,000 IU per day is considered toxic if it comes from animal sources.

WE’RE BEGGING YOU We’re never too proud to beg. What we’re begging for is Medicine in the First Person stories. 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. Thanks!

“The cause was a mystery for a long time.” “And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.” “I was a battlefield medic.” “He was just two when he died.”

“OUCH!”

“It was a terrible tragedy.” “She saved “I sure learned my lesson.” “I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.” “It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.” “They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

ambulance crashed.” “Now THAT hurt!” “The “My leg was broken “I’m not supposed to be alive.”

“This was on my third day in Afghanistan.” in three places.” “I lost 23 pounds.” “Turned out it was just indigestion.” “At first I thought it was something I ate.” “The smoke detector woke me up.”

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.

DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

Southern Girls Eat Clean Roasted Brussels Sprouts and Red Grapes Most people have strong opinions about Brussels sprouts. They either love them or hate them. If you are one of those individuals who hate Brussels sprouts, this recipe is sure to win you over. This dish was on the blog a few years ago. A friend of mine, Jason Becker, did a guest post for me and this was his recipe. We enjoy this dish in our home during the holidays each year. It has become one of our favorites. Jason and his lovely wife Stasha currently live in Colorado with their son Julian and the two family dogs, Max and Bruce. Jason is a Lieutenant Commander in the US Navy. Stasha is a great photographer and the writer of the blog “Northwest Mommy.” While Stasha is busy taking care of the family, blogging and capturing the most amazing photos of Julian, Bruce and Max; Jason serves our country and is the chef in the Becker household. He is the creator of delicious, healthy and nutritious meals. Besides the numerous health benefits of Brussels Roasted Brussels Sprouts and Red Grapes sprouts, when prepared properly, they have a thyme, salt and pepper. Ingredients: slight nutty flavor and are Pour the olive oil mixture • 1-1/2 lbs. of Brussels sprouts, absolutely delicious. Do not over the Brussels sprouts and rinsed, trimmed and cut in overcook them or they will grapes and toss well to coat. half become mushy and have a Place onto a rimmed baking • 1 1b. of red seedless grapes very unappealing smell and sheet in a single layer. (You • 3-1/2 Tbsp. of extra virgin a harsh taste. When you pair may actually need two baking olive oil the Brussels sprouts with red sheets.) • 2 Tbsp. of white balsamic grapes, the sweetness of the Roast in oven for 20-25 vinegar grapes helps to compliment minutes until lightly browned • 3 cloves of garlic, crushed them and takes this dish to a and tender. Stir around • 1 Tbsp. of fresh thyme leaves very different level. I added halfway through cooking time. • 1/2 tsp. of sea salt + another ingredient to Jason’s Serve immediately. • 1/4 tsp. of cracked black recipe; white balsamic pepper vinegar. I think the balsamic Alisa Rhinehart adds a bit of caramelization Instructions: is half of the blog to the sprouts as they roast, Preheat oven to 400 F. southerngirlseatclean. which really enhances the Place the halved Brussels com. She is a working taste of this dish. sprouts and red grapes into a wife and mother living This recipe will quickly large bowl. in Evans, Georgia. become a holiday favorite for In a smaller bowl, whisk Visit her blog for more recipes and your family, as it has ours. together olive oil, white information on clean eating. Merry Christmas! balsamic vinegar, garlic,

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DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

ASK DR. KARP

NO NONSENSE

NUTRITION Virginia from Augusta asks, “Do you have any nononsense nutrition advice for Santa?”

I sure do, Virginia. First Santa, ditch the smoking. Those rings circling your head are leading you to emphysema and COPD. You already have a barrel chest. All that smoking and ring-circling-your head stuff may have been “cutsie” in the 1600’s, but it just doesn’t cut the mustard today. Besides, aren’t you supposed to be a role model for kids? Chew sugarless gum instead, and get your teeth whitened. A couple of thousand years of smoking have wreaked havoc on your teeth. Like, gross, man! Big guy, you need to move, move, move. Working like crazy just one day a year simply isn’t good enough. What about the other 364 days, huh? You’re worse than a weekend warrior. You’re a one-day-a-year Christmas warrior! I realize your activity options are somewhat limited at the North Pole. Have you considered an indoor pool, a treadmill, or an exercise bike? Take those snow shoes out of the closet and go for a walk with Rudolph every day. Santa, you need to lose weight.

Remember when you lost a few pounds in the 1980’s? You told me that you felt better having a lighter life? Your clothes fit better and you didn’t get out of breath going up and down those chimneys. You even stopped having sleep apnea, which used to scare Ms. Claus to no end. Santa, Santa, Santa...the amount of fruits and veggies in your diet, quite frankly, sucks. I know it’s hard to get fruits and veggies to the North Pole, and fuitcake doesn’t count as a food group. Have you ever thought about ordering fruits and veggies off the internet and having them delivered? Where’s your nearest store, Nome or Fairbanks, Alaska? If you have to travel 2000 miles to go shopping every week, the internet becomes a very attractive alternative. You can also subscribe to one of those Fruit-Of-The-Month Clubs. Yes, you will be totally inundated with grapefruit and oranges, but you have a couple of thousand elves to help you eat all that stuff, right? Santa, maybe next year you should

think about hydroponic or salmon farming. Buy one of those prefab steel buildings. If they can build indoor ski resorts in Dubai, you can certainly do some indoor hydroponic farming at “The Pole.” Besides, farming is a good stress-buster and getting you out of that cottage a few hours a day will do a world of good for Ms. Claus. Another important thing to do....you need to take your cholesterol and blood pressure medication every day, not just when you remember. Get one of those reminder apps for your smartphone or those automatic pill boxes. Cholesterol and blood pressure are two things that go right back up, the minute you stop taking your meds. And have you gotten your blood sugar measured lately? You look pre-diabetic to me. Talk about an abdominal fat distribution pattern! Well, Virginia, let’s hope Santa heeds some of this advice. How can you tell if he did? Just stick your head out the window Christmas night and listen to see if he exclaims, “Happy Christmas to all, and remember, EAT LIGHT!” +

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 fi nd 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 fi nancial 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. Tthe views and opinions expressed here are Dr. Karp’s alone and do not reflect the views and opinions of Augusta University or anyone else.

Dr. Karp

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AUGUSTA MEDiCAL EXAMINER

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

FALL INTO A HEALTHY LIFESTYLE by Stephanie Page, MS-DI As winter approaches, it’s easy to pick up unhealthy habits as we spend less time outside and consume high calorie comfort foods. Poor eating choices and inadequate physical activity may have a negative impact on our nutritional status. Seasonal depression may affect us psychologically and increase our risk for fatigue, depression, and withdrawal. Maintaining a well rounded diet with lean proteins, fruits, vegetables, and whole grain choices will help maintain good nutritional status and may support mental health. Fruits and vegetables are important components of a healthy diet. Eating locally grown or in-season food is

less expensive and provides a wider variety of foods. In the fall, apples and pumpkins are delicious in-season favorites. Whether adding an apple to the lunch box or making a creamy pumpkin soup on a cool fall evening, both can be added to the diet as fresh food options during their peak seaso. Broccoli, carrots, peppers, mushrooms, onions, and leafy greens are also a season option right now that are perfect for stews, soups, and stir-fry. Most of these vegetables can be used in practically any dish, especially for those being prepared in a slow cooker or by adding to casseroles. Cabbage, carrots, kale, onions, and potatoes all carry into the harvest season for winter. Leafy green vegetables contain high

WE CAN PREVENT THIS

amounts of folic acid, which some studies have shown to improve mood by increasing serotonin and dopamine production. Sweet potatoes and winter squash peak in fall and winter months. These make tasty and nutritious entrees, side dishes and desserts. Nuts, such as almonds, pistachios, and walnuts, are in season during the cooler months. Nuts are a great source for healthy fats. Select unsalted and unprocessed nuts to reap the most nutritionally benefit. They can be crushed and used to top breakfast items such as yogurt, pancakes, or waffles, or as a pick-me up snack during the day. Maintaining exercise habits may be challenging due to cold weather, but getting into the gym or making an extra trip up the steps instead of the elevator are other ways to add exercise into a daily routine. Exercise and a healthy diet also help improve moods and reduce risk of seasonal depression. Exercise increases endorphin production to improve mood and anxiety, and eating protein rich food will provide the energy needed to maintain daily activities. Eggs, nuts, lean meats, and assorted beans are excellent high protein choices. Making a pot of chili is an easy and popular seasonal dish that can provide high protein. Cooked chili can be easily frozen and safely thawed to make a quick lunch or dinner. Exercise combined with a well-rounded diet may help to maintain good nutritional status and optimal mental health throughout the changing seasons. + For a complete list of in-season fruits and vegetables, go to the USDA website for more information: https://snaped. fns.usda.gov/seasonal-produceguide.

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AUGUSTA MEDiCAL EXAMINER

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Carl is a recent winner of our celebrated Mystery Word contest and sent us this selfie sporting his sweet Medical Examiner jersey — plus he won gift cards from Wild Wing Cafe and Scrubs of Evans. Life is good when you’re Carl.

FIND THE WORD AND ENTER TODAY! Remember: the Mystery Word is always hidden. It is never in plain sight and it’s never in an article. See all the deets on page 14.

DECEMBER 1, 2017

11 +

AUGUSTA MEDiCAL EXAMINER

The blog spot From the Bookshelf — posted by Peggy A. Rothbaum, MD, on Nov. 22, 2017

THE DOCTOR-PATIENT RELATIONSHIP IS EVERYTHING While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the director that he visit her, he did so. He pulled up a chair by her bed and assured her that he did care about her and requested her cooperation with the residents, as a favor to him. She was totally cooperative from that point forward. After I completed my doctorate in psychology, I did a two-year fellowship in mental health research. I learned that research has shown that the doctor-patient relationship is a key part, quite possibly the most important part, of health care. The strongest predictor of compliance with medication is patients’ perceptions of the relationship with their doctors. Research also shows that overall, patients with a better relationship with their doctors have better health outcomes. In the intervening years, a terrible health care crisis had developed. It seemed unlikely, however, that the importance of the doctor-patient relationship would have diminished. When interviewing doctors for a book I’m writing, I asked about real-life experiences. One interviewee said, “So much of primary care is not just the science. If you have a good relationship, it helps you do your job better. You can uncover things that you need to make the diagnosis.” Another interviewee said, “It’s important to the diagnosis, as the patient feels free to discuss with the doctor.” Agreement from another doctor, “It’s key. If it’s not there, the patient won’t trust you and take your advice. It’s the key to being a successful physician.” One doctor interviewee got to the heart of the matter. “The doctor-patient relationship takes what we do out of the dimension of strictly delivering a service. Sometimes I can do an exam relatively quickly and spend the rest of the time talking about children, bereavement, interests. I let patients sit and cry in my office and cry for as long as they need to about things that have nothing to do with their exam because that particular day they needed to come to someone’s office and cry. The exam was sort of a bonus.” Another doctor said about caring, “I can’t tell someone no. Throw me in jail, if you must, for taking care of a child whose parent cannot afford to pay. What jail do they have for doctors who care too much?” As we struggle with the health care crisis in this country, we can forget the heart of the matter: the doctorpatient relationship. This is damaging for patient health outcomes. It’s expensive financially too. “When you don’t have a doctor-patient relationship, you don’t have compliance, and then costs go up. They go up because patients who are not compliant have worse outcomes,” said one doctor. We are so concerned about the cost of health care and here is a crucial factor that is being ignored. Is that supposed to make sense? We all need to stop pretending that that this relationship doesn’t matter, because it does matter. As one doctor interviewee said, “It is everything. And we are losing it.” We all need to work together to get it back. Lives depend on it. +

Better relationships = better outcomes

Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum.

At first glance, this seems like it would be a nice book for families with inquisitive little children. Upon further review, it’s just as appropriate for families with no kids. The reason: this book is full of the kinds of questions kids ask all the time — and that even very well-educated parents don’t have a clue as to how to answer. Could you, for example, give a factual answer to why blood is red? Or if any other animals have blood that isn’t red? Are there still any undiscovered animals? Where does wind come from? Why can’t I tickle myself? Why did dinosaurs go extinct, but not other animals? Why is the sky blue? Why are planets round? How come none of them are pyramidshaped or square? How do they know that no two snowflakes are alike? Why can’t we live forever? Where do hiccups come from? Why do people have differentcolored skin? Can a bee sting a bee? How do lost cats and dogs always find their way home? Do numbers go on forever? Why do penguins live at the South Pole but not at the North?

Will we ever be able to travel back in time? Why is urine yellow? Why do we sleep? Who invented chocolate? What causes lightning? How far away is space? Why is the ocean salty? How have fresh and salt water kept separate for thousands of years? How come snails have shells and slugs don’t? As any fool can plainly see, these are tough questions. As one of our celebrated page 12 word puzzles once noted, some anonymous sage once observed that “A child can ask questions that a wise man cannot answer.” True, indeed.

Except that this book does provide the answers. Some of them are a little on the fanciful side, but for the most part they are simple but accurate and thorough explanations, proffered by experts. That doesn’t necessarily mean you can look at the table of contents and recognize each expert who has been expertly paired with a specific question. For example, the answer “How long would it take to walk around the world?” begins like this: “I don’t know how long it would take to walk around the world but it took me 1,789 days to run. I wore out fifty-three pairs of shoes.” That was written by Rosie Swale-Pope, who did indeed run completely around the world, a feat you and I were unaware of until this moment. So in summary, here’s a fascinating book for inquiring minds, whether little people are part of the equation or not. + Big Questions from Little People - And Simple Answers from Great Minds, compiled by Gemma Elwin Harris, 336 pages, published October 30, 2012 by HarperCollins

Research News Drink up! There are certain health topics that seem to appear in the news in sort of a roller coaster fashion: Up, then down, then back up and down once again. The ups are, “This [fill in the blank] is safe and healthful.” The downs are, “New research shows [it] is dangerous and unhealthy.” Coffee is one of those up & down subjects. In one study it causes everything from ingrown toenails to cracked ribs, and then in the next it’s the magical elixir that cures everything. Well, the pendulum is currently on the upswing for coffee. A meta-analysis (that’s one where multiple studies and their results are analyzed) of more than 200 unrelated independent studies around the world has concluded that drinking three to four cups of coffee per day is associated with a lower risk of heart

disease, diabetes, liver disease, some cancers, and dementia, as well as an overall lower risk of dying in general when compared with drinking no coffee. The sole main cautions from the analysis are connected with women, who are advised to drink no (or less) coffee during pregnancy, and who have a higher risk of bone fractures as coffee drinkers than women who don’t drink coffee. No such risk was observed in men. In short, drinking coffee “is more likely to benefit health than to harm it.” The study was published November 22 in The BMJ (formerly the British Medical Journal). A vexing trade-off A study published by Elsevier on November 27 has found that tooth decay is higher among children who do not drink ordinary tap water.

The CDC says tap water treated with fluoride has dramatically reduced the prevalence of tooth decay over the past 70 years. But fewer children drinking tap water has resulted in tooth decay in about 23% of U.S. preschoolers (2011-2012 numbers). So we should get the kids to start drinking more water, right? Not quite. There’s a tradeoff. A small number (3%) of children who routinely drink tap water were found in a national survey to have elevated levels of lead in their bloodstream. However, 49.8% of children and adolescents in the same survey had tooth decay. The message is clear: check local water quality test reports (they are available online) and if they pass with flying colors on lead content, the water is safe to drink and will help prevent tooth decay. +

+ 12

DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS

THE MYSTERY WORD

How’s the job search going for that It’s over. He found teenager of yours? a great job.

by Dan Pearson

Wow! Where does he work?

He’s over more than 500 people!

Good for him.

He cuts the grass at Westover Cemetery.

The Mystery Word for this issue: GEDSAO

EXAMINER CROSSWORD

PUZZLE

VISIT WWW.AUGUSTARX.COM Click on “READER CONTESTS”

QUOTATION PUZZLE

20 21 22 ACROSS 1. Melts 23 24 25 6. Dawgs conf. 26 27 28 29 30 31 32 33 9. Customary 34 35 36 37 38 14. Warble 15. She often performs in 39 40 41 42 43 44 films for Quentin 45 46 47 48 16. Marco or Coco 17. Like a man on death row 49 50 51 52 53 54 55 56 19. Units 57 58 59 60 20. Latin for eggs 61 62 63 64 65 66 21. Indian grain sorghum 22. Breastfeed 67 68 69 23. Gamble 70 71 72 24. Joke teller 73 74 75 26. Word before up or down 29. Abominable snowman by Daniel R. Pearson © 2017 All rights reserved. Built in part with software from www.crauswords.com 30. TV award 34. Women’s follower DOWN 39. Lou Gehrig’s letters 36. Jim _____, PGA golfer and 1. Local legend 40. Fabled bird from Arabian Augusta native 2. 31st president of the U.S Nights 38. Food label abbrev. 3. Congenitally attached (in 41. Campus org. 39. AU’s former ______ Oak botany) 42. Person involved in a lawsuit 43. Accurate art genre 4. Get hitched 44. Grant opponent 45. Cabin builder 5. Toy rarely played with in 47. Swamp that is part of the 46. Fluent but insincere Augusta Okefenokee 48. Bandage type 6. Beam from our star 50. Part of Athens daily 49. Fresh wound reminder 7. Appeared; came into view newspaper’s name 51. Sewing case 8. Official real estate register 52. Demented 53. Entice 9. Bladder contents 54. Measuring instruments 57. Appoints to 10. Stitch 55. Quickly 60. Period of history 11. Lyft competitor 56. Plaid 61. Alma mater for 36-A 12. Points 58. Prophets 64. Vaporous fuels 13. Misplace 59. Become firm 66. Rocky pinnacle 18. Coffee cup 61. Chemicals banned in the US 67. Identical cell 25. Fungal skin infection since 1979 68. Letup; reduction 27. Part of IPA 62. Drug-yielding plant 70. Pleasant shady spot 28. Pendleton follower 63. State north of Missouri 71. How a conformist can start? 31. Med pic 65. Thin stratum 72. The body’s main artery 32. Docs 69. Extinct flightless bird 73. Augusta Mall anchor 33. Sweet potato 74. Nail prefix 35. Bundles 75. Stone worker 37. Diplomacy Solution p. 14

S S T O L R O S R O U L A T S I I N T Y U A T F E T P H E W I S D U P R T R S S R O I M Y T U L Y A O — Drake

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.

X A M I N E R

1 9

4 2 1 7

6 2

6 9

3 6

2 6

1 8 7

4 9

U D O K U

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

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

O 1 2 1

3 3

4 4

I 5 5

6 6

7 7

2 9 10

C 1

2 1

A 1 2 3 4 5 6

3 2

1 S 7

B 1 2 3

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

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

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

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

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

DECEMBER 1, 2017

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

Moe: How’s your new job? Joe: I had to quit over religious differences between my boss and me. Moe: Religious differences? What? Joe: My boss thought he was God and I didn’t. Moe: Name your three favorite things. Joe: Three? Let’s see... eating my children and not using commas.

wo carrots were walking down the street when one of them stepped a little too close to the road and was run over by a car. The other carrot called 911 and got him to the hospital as quickly as possible. After hours of pacing and waiting, a doctor finally came out to give him an update. “I have good news and bad news,” the doctor said. “The good news is your friend is going to make it. The bad news is that he’s going to be a vegetable for the rest of his life.” Moe: I feel like I’m addicted to Thanksgiving leftovers. Joe: Been there done that. I had to quit cold turkey. Moe: I made my wife breakfast in bed this morning. Joe: I bet she appreciated that. Moe: Actually, she was pretty irritated. I think next time I’ll use the kitchen.

Moe: You know how a group of geese is called a gaggle? Joe: Yeah. Moe: What is a group of 3-year-olds called? Joe: A migraine. Moe: People say “icy” is the easiest word in the English language to spell. Joe: I see why. A man went to an appointment where the doctor gave him a thorough prostate exam. Right after the doctor left the room a nurse came in and said the worst possible thing the man could imagine: “Who was that guy who just left?” Moe: My career counselor said I couldn’t be an exhibitionist. Joe: What did you say? Moe: I said, “Oh yeah? Just watch me.”

Moe: I explained to my 4-year-old that it’s Moe: Astronauts always seem so cool, calm and perfectly normal to accidentally poop in your pants. collected. Joe: That was nice. Joe: That’s because there’s no pressure in Moe: But he’s still making fun of me. + space.

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ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble wrote a long-time column in this paper entitled The Patient’s Perspective reincarnated in this new format. Feel free to contact her at marciaribble@hotmail.com Tonight I figured out how to stream live TV on my computer. My big TV was out of sorts and I wanted to watch the news to see the weather report on CBS. Given that I mostly kind of squeak and cower in response to any electronics issues, the fact that I actually succeeded is somewhat amazing. When specialists talk with us about maintaining a healthy mind, one thing they often mention is putting ourselves in positions where we learn new things. I learn a lot from watching the local and national news reports. I also read the Augusta Chronicle daily. I do indulge in reading Facebook posts, but try to be as discriminatory as possible to weed out the fake, the improbable, and the like. I rather enjoy the merely silly, funny, and even the ridiculous. Laughing is excellent exercise. I delight in scientific advances, often a long time before they are able to be pragmatic instead of speculative. I sigh in pleasure over sunrises and sunsets, gorgeous flowers, cute animals, and marvelous, magical scenery. At 74, new ideas, new adventures, are so easy to come by electronically, and even those of us who are less than adventurous when it comes to new technologies may, nonetheless, push ourselves further when a strong personal desire to learn a new skill presents itself. I suppose at some point I may even join the worlds available through Netflix. Not today, and perhaps not tomorrow or even next week, but some day when there is a movie I really want to see, but it’s too hot outside or too cold, I may decide to get onto Netflix and do some exploring. My children and grandchildren will be surprised that I have entered a formerly inaccessible realm, and they will tease me because I will still be a troglodyte with my nose just barely sticking above the primordial ooze. That’s OK. They will rescue me when I am hopelessly lost in Modernity. The funny thing is they also enjoy the story-telling that carries them back into the past with me, especially stories they inhabit as children, not adults. Together we form a sense of continuity, of linkages to the past and the present and the future. All of these linkages are essential to knowing who we are in the broader context of family life. Recapturing bits and pieces of memories as adults helps us all to solidify and ground ourselves in places, times, and people which are part and parcel of our being whole. The process is much like putting together a stained glass window or a pieced quilt. At fi rst they each begin as fragmented bits and pieces that may not fit very well together, like the start of a crazy quilt made from bits and pieces of clothes worn by family members. Over time quilters organize those patches of cloth, trying to find in their exquisite variety some way to compose a meaningful whole, to see how the colors merge into one another, how the textures create interesting patterns, how the quilting stitches overlay and intermix until the whole makes sense. Then beauty connects a unified reality between the quilt and the minds of its creators. What a lovely tool for a healthy mind—body connection. +

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DECEMBER 1, 2017

AUGUSTA MEDiCAL EXAMINER

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

...cleverly hidden on a necktie in the p. 3 ad for QUEENSBOROUGH NATIONAL BANK & TRUST THE WINNER: LAUREN RAMOS 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!

THE PUZZLE SOLVED T Y C O B B

H O O V E R

A D N A T E

A R S L O G S C A P C B S

A L O E

I O W A

W S E L D E M D U G A K L I B E N A G L B E A S S N E N E E R R S

S U N R A Y L I T I G A N T

E M E R G E D B U G A B O O

C A D A S T E R I N S A N E

U R I N T E I N T E A A C T S E S T E A M

S U T U R E

U B E R

A I M S

L O S E

M M Y R D A L I S M E E M P T E R A T O R M E N T O R T A A S O N

SEE PAGE 12

The Celebrated WORDS BY NUMBER Nothing we do can change the past but MYSTERY WORD CONTEST “everything we do changes the future.”

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available of 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.

WRITER WANTED

— Ashleigh Brilliant

The Sudoku Solution 1 4 3 6 9 8 7 5 2

9 2 8 3 7 5 4 6 1

5 7 6 4 1 2 3 9 8

3 6 2 9 5 4 8 1 7

7 8 5 1 2 3 9 4 6

4 1 9 8 6 7 2 3 5

2 9 7 5 4 1 6 8 3

6 3 1 2 8 9 5 7 4

8 5 4 7 3 6 1 2 9

QUOTATION QUOTATION PUZZLE SOLUTION: “No matter how dirty your past is your future is still spotless.”

READ EVERY ISSUE ONLINE

— Drake

The new scrambled Mystery Word is found on page 12

WWW.ISSUU.COM/ MEDICALEXAMINER

The Medical Examiner has for years published a monthly column by an Augusta medical student as a chronicle of his or her thoughts and experiences during medical school. Are you interested in becoming the next author of The Short White Coat?

Please call (706) 860-5455 or write to Dan@AugustaRX.com

Want to reach Augusta’s multi-billion-dollar medical community? +

MEDICAL EXAMINER

Our target audience is • 25,000 CSRA healthcare professionals • 500,000 area residents who are interested in better health and better living If these are people you’d like to reach, call 706

.860.5455 or visit www.AugustaRx.com

DECEMBER 1, 2017

IT’S A QUESTION OF CARE How do I deal with a loved one who wanders? by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

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AUGUSTA MEDiCAL EXAMINER

Sometimes as people age and dementia creeps in, wandering off becomes a problem. The person often does not feel as if they are at home, and in their mind they’re searching for surroundings that feel more familiar. To keep them safe and secure, there are simple steps and technology options that will help. • Purchase a personal emergency response button with GPS. This can be worn around the neck or as a wristwatch. The hurdle can often be that the person does not want to wear the apparatus on their body. However, if you can convince them to do so, it can be very effective if the person happens to wander, because you will know where they are. • Insoles with built-in GPS to put in their shoes is another option that many people are not aware of. This can work well if the person tends to wear the

same shoes every day or they are being assisted with dressing, so they don’t necessarily choose their own shoes. • There are many fairly inexpensive options using cameras, sensors, and alarms that will alert caregivers and family members to a wandering person. (Just make sure that securing the home doesn’t make it feel like a prison.) • Add safety features to your home. Certain safety features can be placed on doors, such as handles that make them difficult to open. They are similar to an apparatus used when young, curious children are in the home. They aren’t challenging or inconvenient for the rest of the family, but these simple devices will usually stop someone with dementia. • Hire a caregiver. If a person is living in their own home, sometimes a caregiver needs to be hired to monitor them constantly when none of the above

options are feasible. This is an expensive option, but often necessary. For families who can afford it, the peace of mind it affords is well worth the expense.. • Consider Assisted Living. If the above options have been tried and don’t work, or they’re not applicable for whatever reason, assisted living is another option. The community chosen must be one that is locked so that their loved one cannot escape outside or into other parts of the building. Yes, wandering within the building is yet another aspect of this problem, and it can present issues with other residents. It takes commitment and attention on the part of the staff to know the whereabouts of the person who wanders and be ready and willing to redirect them at all hours – day and night. (Unfortunately, people with dementia often wander at night as that is when they can be the most confused.) +

PROFESSIONAL DIRECTORY ALLERGY

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

AMBULANCE SERVICE

AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

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

FAMILY MEDICINE

DENTISTRY

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

F. E. Gilliard MD, Family Medicine 4244 Washington Road Evans, GA 30809 Floss ‘em or lose ‘em! 706-760-7607 Industrial Medicine • Prompt appts.

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048 Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

DERMATOLOGY

Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

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

SENIOR LIVING

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

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

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

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 Medical Center West Pharmacy 706-733-3373 465 North Belair Road www.GaDerm.com Evans 30809 Vein Specialists of Augusta Resolution Counseling Professionals 706-854-2424 G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 3633 Wheeler Rd, Suite 365 www.medicalcenterwestpharmacy.com 501 Blackburn Dr, Martinez 30907 Augusta 30909 706-854-8340 706-432-6866 Parks Pharmacy Karen L. Carter, MD www.VeinsAugusta.com www.visitrcp.com 437 Georgia Ave. 1303 D’Antignac St, Suite 2100 N. Augusta 29841 Augusta 30901 803-279-7450 706-396-0600 If you would like your www.augustadevelopmentalspecialists.com www.parkspharmacy.com medical practice listed Your Practice in the Professional And up to four additional lines of your choosing and, if desired, your logo. Directory, Keep your contact information in Steppingstones to Recovery Psych Consultants call the Medical this convenient place seen by tens of 2610 Commons Blvd. 2820 Hillcreek Dr Augusta 30909 thousands of patients every month. Augusta 30909 Examiner at Literally! Call (706) 860-5455 for all 706-733-1935 (706) 410-1202 706.860.5455 the details www.psych-consultants.com

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AUGUSTA MEDiCAL EXAMINER

DECEMBER 1, 2017