Feb16 18 by Daniel Pearson

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FEBRUARY 16, 2018

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AUGUSTAMEDICALEXAMiNER BODY PARTS, THE OCCASIONAL SERIES

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Mention “body parts” and we think of vital major organs: lungs, kidneys, the heart and brain. Often overlooked are the little guys, the body parts that operate unseen, perhaps even on a molecular level. Human tears might not make many lists of Top 10 or even Top 100 elements of the human body, but people with chronic dry eyes or other tearrelated disorders know how important tears are. As is true of virtually everything in nature, a closer look reveals incredible complexity and sophistication, and that is true of tears too. Simply put, tears are produced continuously, not just when we cry or slice onions. Tear (or lacrimial) glands are located above and to the outside of each eye, the perfect place to produce tears that are spread evenly over the eye each time we blink, cleaning and lubricating our eyes in the process. Across the eye and down toward the nose, each eye has tear ducts to drain tears away. Think of the system as having tear glands in the Seattle area and tear ducts in Florida (but on a much smaller scale), allowing tears to wash uniformly over the whole eye. Tears themselves are astonishingly complex. If you think they’re just a simple homogenous fluid, think again. The tear film coating our eyes actually has three layers. The outer layer, called the lipid layer, is composed of oil called meibum, and fittingly comes from meibomian glands (not tear glands). As Wikipedia puts it, “the biochemical composition of meibum is

extremely complex.” Meibum essentially encases or covers over tears and prevents them from evaporating or running down our face. Actual tears, then, are deftly deposited betwen the lipid barrier provided by the meibomian glands and the eye itself. Did we mention that the outer lipid layer is “extremely complex”? Well, the box below offers an incomplete, generalized ingredients list of tears themselves. Mix them all together in a blender and you have an extremely effective lubricant that incorporates antioxidants and a sophisticated barrier against infection provided by antibacterial enzymes. Finally, the tear layer closest to the eye is sort of like a CHEMICAL COMPOSITION OF TEARS’ MIDDLE LAYER Electrolytes, 60 metabolites: Amino Acids (1-Methylhistidine/3Methylhistidine, Arginine, Asymmetric, Asymmetric dimethylarginine/Symmetric dimethylarginine, Citrulline, Creatine, Glutamine, Homoarginine, Hydroxyproline, Phenylalamine, Proline, Pyroglutamic acid, Serine, Taurine, Theonine, Tryptophan, Tyrosine, Urocanic acid, Valme), Amino Alcohols (Panthenoll), Amino Ketones (Allantoin, Creatine), Aromatic Acids (Cinnamic acid, o-Coumaric acid/mCoumaric acid/p-Coumaric acid), Carbohydrates (N-Acetylneuraminic acid), Carnitines (Acetylcarnitine, Carnitine, hexanoylcarnitine, Palmitoylcarnitine); Cyclic Amines (Niacinamide); Dicarboxylic Acids (Fumaric acid/ Maleic acid), Nucleosides (1-Methyladenosine, Adenoisine, Cytidine, Guanosine, Inosine, S-Adenosyl-homocysteine, S-Adenosylmethionine, Uridine, and Xamthosine), Nucleotides (ADP, AMO, CMP, Cytidine diphosphate choline, GMP, IMP, UDP, UMP, UDP-N-acetylgalactosamine/UDPN-acetylglucosamine), Peptides (Oxidized glutathione), Phospholipids (1-Palmitoyllysophosphatidylcholime), Purines and derivatives (Hypoxanthine, Theobromine, Uric acid, Xanthine), Purines and derivatives (4 Pyridoxic acid), Quaternary Amines (Acetylcholine, Glycerolphosphocholine, Phosphocholine), and Tricarboxylic Acids (Citric acid), plus other substances such as proteins (e.g., antibodies, lipocalin, lactoferrin, lysozyme,and lacritin). +

primer, coating the cornea with mucins, which are gellike proteins that help promote even distribution of tears over the entire surface of the eye. As if all of that isn’t complicated enough, there are three basic types of tears, and they are chemically (and functionally) different from each other. “Ordinary” everyday basal tears are what we’ve been describing to this point. Their basic job is to lubricate and nourish the cornea, and keep the eyes clear of minor dust particles. When the foreign particles get serious — invading the eye with solids like sand and dirt or vapors like tear gas, pepper spray or onions — reflex tears are dispatched in buckets (tiny buckets) by a complex set of sensors called TRP channels (for Transient Receptor Potential). TRP channels are signaling complexes located throught the body, not just the eyes. When they are activated by, in the case of the eyes, pepper spray, foreign bodies like dust and dirt, the superhot wasabi you just bit into or a thousand other triggers, they will immediately flush your eyes with reflex tears to neutralize the problem. Finally, psychic or emotional tears, the ones that are produced when we cry from sadness, stress, joy or other emotions, have their own distinct chemical makeup different than basal tears. One of the unique compounds in emotional tears is leu-enkephalin, “an endogenous opioid peptide neurotransmitter.” Did you catch the word opioid in there? Leu-enkephalin also bears Please see TEARFUL page 6

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PROFILES IN MEDICINE presented by Queensborough National Bank & Trust Co.

A 60-YEAR CAREER This graduate of the Medical College of Georgia Class of ’45 immediately fi lled a tremendous need in medicine. “During the war there was a doctor shortage,” says Alva Faulkner (right), “so our courses were accelerated. We went 12 months a year for 3 years.” That was followed by a 1year internship and 3 years of residency. As an Ob/Gyn, Dr. Faulkner served on a 5-star volunteer clinical faculty for the Department of Ob/Gyn at the Medical College of Georgia alongside wellknown names like Clyde Burgamy, William Boyd, W. G. “Curly” Watson, and others. “We were never paid a penny for being on the faculty,” recalls Dr. Faulkner, who was in private practice at the time. In those days, being an obstetrician meant being on call 24 hours a day, 365 days a year. Many births occurred at home so house

calls were a regular event. “When there was a call two medical students would head out with the equipment they needed — hopefully — and perform the delivery.” But as Dr. Faulkner recalls — then and now — babies tended to arrive on their schedule, not the world of adults. As a result, not only might a house call take place at 2 a.m., “but sometimes the house had no electricity or running water.” That all changed in 1946 when Dr. Richard Torpin, professor and department

chair, founded the Stork Club. Housed in the basement of the Newton Building (see photo, p. 16), the Stork Club offered a safe, clean place where low-income patients could deliver their babies —and it had both electricity and running water. Originally built as the Augusta Orphan Asylum, the Newton Building stood on 45 acres of land. The 4story building itself housed clinical faculty offices on its top floors and the maternity shelter below. It was a busy place. Not long after it was established, a one-year tally of its activities was reported in MCG’s History of the Department of Obstetrics and Gynecology: Aug. 1 1947-Aug. 1, 1948 Total admissions: 458 Deliveries: 413 Transferred to hospital: 23 False labor: 14 Born on call and attended by students in the home: 8 And the cost? $10 for Please see PROFILES page 16

Editor’s note: this is a monthly series presented by Queensborough National Bank & Trust and the Medical Examiner profiling exceptional physicians and others of note in Augusta’s long and rich medical history.

W E A LT H M A N A G E M E N T Our experienced, financial team focuses on you, our client, to ensure that all aspects of your financial affairs are being monitored and managed appropriately in accordance with your life goals. We welcome the opportunity to serve. Call today for an appointment.

Why don’t EMTs run up to emergency scenes? Emergency personnel in general — not just EMTs — are rarely if ever seen running around (or to) the scenes of fires, accidents and crimes. But isn’t it true that seconds count? That is, indeed, true. But what if an EMT runs up to an accident victim, thereby saving a second or two, and in the process fails to notice a downed power line or a growing puddle of spilled gasoline? What if running startles the injured person’s dog, which then attacks the EMT? Any of those plausible scenarios could end up costing minutes of precious time. The second or two saved would turn out to be a very poor investment. Emergency responders have very stressful jobs. Lives are frequently on the line, and usually a crowd gathers, so they’re working in front of an audience. All of that is stressful enough, but emergency responders need to keep their cool, think clearly, and swiftly make important decisions correctly and calmly. If someone is out of breath and their heart is pounding (which it probably already is anyway even though they walked from their vehicle to the scene), it makes it that much more difficult to focus on the patient. Safety is also a factor. Traffic accidents can happen in rainy or icy weather that makes surfaces slippery anyway, but fluids leaking from vehicles (and people) can add to the mix. Not every injury or emergency takes place on a smooth road; some are in ditches, fields, and yards, or inside messy or cluttered homes and workplaces where every step needs to be taken with care, and sometimes it’s too dark to see much of anything. Slipping and falling could definitely interfere with patient care or add additional patients, especially when emergency personnel are carrying heavy equipment. Finally, the demeanor of anyone helping us in an emergency situation, whether doctor, firefighter, police officer, EMT or nurse, sends implicit messages that can be either calming and reassuring or stressful and panicinducing. Calming and reassuring is definitely the better option. +

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#61 IN A SERIES

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

his physician of yore holds a curious position in medical history. On the one hand, he was the personal physician of perhaps the most influential and powerful man on earth; on the other hand, his treatment of that patient has been second-guessed and harshly critiqued for 200 years. His name is James Craik, and he was not only the personal physician of George Washington but a close friend too. He was called to Washington’s plantation at Mount Vernon to treat Washington, who had been out on his horse in heavy snow all day on December 12, 1799. When he awoke the next morning, Washington complained of a sore throat, but spent another snowy day on his estate marking trees to be cut down. During the middle of that night Washington awoke, struggling to breathe. When his estate overseer discovered the situation at dawn, he prepared a concoction of molasses, vinegar and butter for Washington to drink. Washington choked trying to drink it, not surprisingly perhaps, and ordered the man to perform venesection (bloodletting) on his arm, a practice Washington strongly endorsed. At this point, riders were dispatched to bring Craik and two other doctors (Gustavus Brown and Elisha Dick) to assist. Craik, the closest doctor, arrived first. Alarmed by the seriousness of Washington’s condition, he applied a “blister” of dried beetles (comparable to a salve or poultice made of hot peppers) to the general’s throat and performed two more bloodlettings of 20 ounces each. When a gargle prepared with vinegar and hot water was unsuccessful, another venesection was repeated, this one 40 ounces of blood. At this point (3:00 pm), Dr. Dick arrived and promptly bled another 32 ounces from Washington’s forearm. Brown arrived shortly thereafter, and together the three doctors determined the diagnosis was “an inflammatory affection of the upper windpipe, called in the technical language, cynanche trachealis,” as they wrote five days later in an account published in The Times of Alexandria (VA). So they decided the best thing to do next was to rectally administer a preparation of calomel and tartar. Despite all this state-of-the-art medical attention, Washington’s breathing continued to be labored, and he made several statements as the day wore on that indicated he knew the end was near. Around 5:00 pm, Washington told Craik, “I believed from my fi rst attack that I should not survive... My breath cannot last long.” Refusing to let the revered general slip away without a fight, at about 8:00 pm the doctors applied blisters and poultices of wheat bran to Washington’s legs. To no one’s surprise in 2018, this too was ineffective and their patient still struggled to breathe. Realizing that drastic measures were in order if Washington was to be saved, Dr. Dick proposed a then-radical new procedure: a tracheotomy. Craik and Brown vigorously opposed the idea despite Dick’s assurance that he would take full responsibility if the procedure failed. The vote was 2 to 1, so the trachea remained untouched, and Washington took his final breath at 10:10 pm on the night of December 14, 1799. It didn’t take long for the Monday morning quarterbacks of the medical community to register their objections to the way the three doctors treated Gen. Washington. Six weeks Please see WHO IS THIS? page 6

It has been a cold winter in the South. Snow was supposed to fall one night just a few weeks ago, but “supposed to” doesn’t necessarily mean it will happen. That reality underlies a great deal of life, not just the weather. For example, there are certain beliefs held by many of today’s physicians that may be statistically accurate across populations, but not true at all of specific patients. Statistics can never be relied upon to assert that any of its findings are applicable to all members of any group or individuals. Its general findings may be relevant, but are never going to apply uniformly and with absolute certainty. A number of years ago (2005) I experienced this fi rst-hand. I was being prepped for a knee replacement, seeing a family doctor not at all familiar with me. “We have to do a stress test with you because you have heart disease,” he said. “I do not have heart disease,” I told him. “Oh, yes you do!” he exclaimed. “You have diabetes, and all diabetics over sixty have heart disease.” So I had the stress test and, lo and behold, my heart was functioning very normally and I did not have heart disease. Now it is 2018 and I still do not have heart disease. We are watching me for heart failure because my dad had it, but so far no heart failure, no heart attacks, no anything negative about my heart. Another one I’ve experienced is that with surgery ALL patients must have a postop series of blood thinners so they don’t

get blood clots. Now while this may be a generalized practice, it is not beneficial for all patients. Here, too, I am an exception. I have Idiopathic Thrombocitic Purpura (ITP). This means my body already has far fewer than the normal supply of platelets that aid in clotting. In fact, I have to be tested before surgery to ensure that I have enough platelets so I won’t bleed out during surgery. Normal patients without ITP have somewhere between 150,000 to 300,000 platelets. I usually have about 60,000 of them, sometimes as many as 80,000, and sometimes as few as 40,000. It varies from month to month. I pray regularly that I never need emergency surgery when I am unconscious and can’t tell them “do not give me a blood thinner.” That thought is a bit scary when I know how many physicians base their decisions on averages which do not apply to me, not to mention thousands of other patients. Recently, doctors changed the recommendations about treating high blood pressure. I had one reading where mine was 131 diastolic. So my doctor prescribed a blood pressure medication. A few days later at physical therapy, I was on the elliptical machine and felt “weird” when I got off. The PT helping me took my blood pressure and it was 64/40. They kept me until my blood pressure was closer to normal. I called my pharmacist when I got home. He called my doctors, my primary stopped the medication, and this week my blood pressure was a lovely 113/64 without any medication. So much for one recommendation applying to all patients! +

MYTH OF THE MONTH Your toothbrush can make you sick In all likelihood, that is not a true statement. It’s possible, but the odds are against it. However. That doesn’t mean that the toothbrushes we use are usually sterile, either. In fact, clinical tests of typical toothbrushes scooped up from family bathrooms have discovered they can be awash in germs like flu virus, staph bacteria and E. coli. Thankfully, our bodies come equipped with a pretty effective immune system to ward off attackers.

Even so, oral hygiene should be accompanied by brush hygiene. Here are a few ideas: • wash hands before and after brushing • alternate between two toothbrushes to allow the brushes to dry completely between uses • change to a new brush at most every three months, and whenever you have had a cold or the flu • if you do have the flu or a cold, use a separate tube of toothpaste from others in the family • sterilize your brush with an alcohol-based mouthwash. +

FEBRUARY 16, 2018

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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AUGUSTAMEDICALEXAMiNER

was disappointed and disgusted upon graduating from medical school when I realized I was never told why some people have “innie” bellybuttons and some have “outies.” It is another example of how far America has slipped in its educational process. Fortunately, I have since discovered the reason (and feel incredibly fulfi lled because of it). When the umbilical cord dries up and comes off, it leaves a scar. Some people get bigger scars than others – some babies develop umbilical granulomas which are red, weeping scars at the site where the cord once was. Outie bellybuttons are largely due to this scar tissue. Umbilical hernias also play a role, although they are not responsible for the classic “alien coming out” appearance of the outies I remember as a child. They scared me a little. I am a proud innie. Probably the biggest downside of being an outie (other than complete ostracizing as a child) is that outie bellybuttons don’t collect lint. Navel lint was the subject of research by Dr. Karl Kruszelnicki of

Where is Bad Billy Laveau? Even the best storytellers have only so many stories to tell, and Bad Billy let us know a few weeks ago that he was tapped out and heading off into retirement. Bad Billy Laveau was the kind of writer you either loved or hated, but over the many years he wrote for the Medical Examiner (since 2009) the people who liked his column vastly outnumbered those who didn’t. It would not be an exaggeration to say his column was the most popular feature in this newspaper by a wide margin, and a huge thank you to him is in order. If you’re new the Examiner and never got acquainted, or you’re a long-time reader who still wants an occasional dose of “What Everybody Ought to Know,” just click your way over to issuu.com/medicalexaminer where more than 150 back issues await your perusal. What’s next for this spot? A nationally acclaimed medical writer and blogger from right here in Augusta, Dr. Rob Lamberts, is taking over, as you can plainly see. His sense of humor is, as we often say here in the South, par excellence, but he tackles serious subjects too (although he may sometimes do so with a spoonful of humor). We think you’ll quickly agree this is going to be an upgrade. +

PAPER OR PLASTIC?

the University of Sydney, Australia. Wikipedia gives a good summary: • Navel lint consists primarily of stray fibers from one’s clothing, mixed with some dead skin cells and strands of body hair. • Contrary to expectations, navel lint appears to migrate upwards from underwear rather than downwards from shirts or tops. The migration process is the result of the frictional drag of body hair on underwear, which drags stray fibers up into the navel. • Women experience less navel lint because of their finer and shorter body hairs. Conversely, older men experience it more because of their coarser and more numerous hairs. • Navel lint’s characteristic blue-gray tint is likely the averaging of the colors of fibers present in clothing; the same color as clothes dryer lint. • The existence of navel lint is entirely harmless, and requires no corrective action. For his contribution to mankind, Dr. Kruszelnicki was awarded the Ig Nobel Prize for Interdisciplinary Research in 2002. Wikipedia goes on to describe another Australian

who became famous over navel lint: Graham Barker of Perth, Western Australia, is in the Guinness Book of Records as the record holder for collecting navel lint. He has been collecting navel lint almost every day since January 1984. He collects about 3.03 mg per day. Contrary to the research of Dr. Kruszelnicki, Barker’s lint is in a particular shade of red, even though he rarely wears red clothes. This raises several questions about the Australian people: 1. Is there a higher innie/ outie ratio in Australia? 2. Do Australians have too much time on their hands? 3. What kind of underwear do Australians wear that would cause such an infestation of lint? 4. Would you buy a red sweater made in Australia? I am personally glad the article points out the harmlessness of lint. I had once told someone they had only two months to live because of their navel lint, but I will stop that practice from this point on. All of this reminds me of something important: I have some serious lint harvesting to do. +

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FEBRUARY 16, 2018

DEAR DOC: I’M AN ADDICT by Ken Wilson Executive Director, Steppingstones to Recovery

And as an addict, please do not believe anything I say if it has even the slightest connection to me getting a fi x. My brain isn’t working too well, especially the frontal lobe where my reasoning and conscience is located. I know that if I’m clean and sober for a long time my old self will return, because I really did have a good old self...but right now, because of my brain’s drug-hunger, all I can think of is getting my next fi x and I’ll do or say just about anything to get it. And I do think about it 24/7 – even when I wake up in the middle of the night if, in fact, I’m able to sleep at all. I am possessed and saturated with the obsession to use again. You see, I used to use to feel euphoria – but now I use just to feel good. In fact, if I used enough to get “high,” I’d probably be taking a lethal dose. That thought really doesn’t sound so bad right

now either...I am SO tired of trying to find my drug of choice that often I’ll use anything I can get. I am actually in hell now...the thought of having rest from this devil which has grasped my soul is one of relief. It might be today. I hope not, but at this point I hardly care anymore. And if I told you this truth, don’t call 911 on me. I know the game. The hospital can’t hold me if I convince them that I don’t have a suicide plan. If you call for help for me, make it good...make it a long term program with detoxification, treatment, counseling, good food, trusting friends, and humane conditions. But after losing my job, my family, my legal status, and not being able to afford insurance anymore, I know that the help I really need is hardly available anymore. I guess the likes of us have discouraged lawmakers and budget bean-counters due to our incidence of relapse and we know we are not pleasant to deal with – but

nobody really understands us except those who have been where we are. You see doc, I have called “treatment” centers all week long and have been turned down for admission about 73 times. It seems that there are work programs, religious programs (and I am not religious), and short term crisis stabilization programs, but no long-term places for me to go with not a cent to my name. Sofasurfing is getting old, not only to me but to my friends as well. Doc, don’t you know of any places I can go? I don’t mind working or going to church but I need more help than that. I mean, you are my Primary Care Provider! I look to you for life! And by the way, thanks for the prescription you’re offering me...it’ll get me through a few days if I can con some money from somebody to pay for it. But if I can get it I might not even take it. I’ll try to trade it for my own drug of choice. That’s something I

“With surprising selfpossession he prepared to die. Composing his form at length, and folding his arms on his bosom, without a sigh, without a groan, the Father of his Country died. No pang or struggle told when the noble spirit took its noiseless flight; while so tranquil appeared the manly features in the repose of death, that some moments had passed ere those around could believe that the patriarch was no more.” +

Rawlins (the estate overseer) 2. 20 ounces, Dr James Craik 3. 20 ounces, Dr James Craik 4. 40 ounces, Dr James Craik

A monthly series by an Augusta drug treatment professional

should tell you...never give narcotics to an addict! If it’s for ambulatory/walking detox – thanks! But give them to a trusted friend, employer, or 12-step sponsor who will give them to me like it says on the bottle... or I’ll come to your office daily...twice a day...to get them. But for heaven’s sake, don’t give them to me! Oh, I’ll whine, stomp my feet, raise my voice, and act like an adolescent (which I guess I really am about now) but don’t ever give ‘em to me! My last friend got some

“prescription drugs” (after all, they’re “safe,” right?) and overdosed and died. They just went to sleep and never knew what happened. As I said before, that doesn’t sound so bad. If I don’t find a safe haven pretty soon, I think I’ll give it a try. Hopefully nobody will find me after I take an overdose and shock me back to life. Because this ain’t no life. I actually have lots more to say, doc. But I’ll wait and see how you take this before saying more. +

TEARFUL… from page 2

WHO IS THIS?… from page 4 after Washington’s death, one Dr. James Brickell wrote an article expressing his outrage at the treatment (but the article was not made public until 1903). Among Brickell’s main points was his disbelief at the quantity of blood drained from a man nearly 70 years old. He had no problem with the bloodletting itself. He was a fan of the practice. But Brickell wrote, “I think it my duty to point out what appears to me a most fatal error in their plan ... Old people cannot bear bleeding as well as the young. They drew from a man in the 69th year of his age the enormous quantity of 82 ounces, or above two quarts and a half of blood in about 13 hours.” That may sound like a lot, but the facts suggest the blood loss was even greater, some 124-126 ounces or 5-7 pints (3.75 liters), drawn over a period of nine to ten hours. At 6 foot 3 inches and weighing 230 pounds, Washington’s total blood volume has been estimated at about 7 liters, so he lost well over half. Here is the complete tally of the five venesections: 1. 12-14 ounces, Mr Albin

THIS IS YOUR BRAIN

5. 32 ounces, Dr Elisha Dick Brickell also took issue with the site of the venesections, believing the taps should have been made closer to Washington’s throat, the location of his chief complaint. Brickell suggested the doctors should have “attacked the disease as near its seat as possible; the vein under the tongue might have been opened; the tonsils might have been sacrificed; the scarificator and cup might have been applied on or near the thyroid cartilage.” Many contemporaneous stories of Washington’s final moments recounted his brave and stoic surrender as he calmly awaited death (see box). Doctors doing the postmortem in the decades since 1799 have surmised he stopped struggling to breathe not from bravery but due to hypotension, hypovolemic shock and “preterminal anemia.” Cause of death has likewise been debated, ranging from diphtheria, inflammatory edema of the larynx, sore throat of streptococcal origin and acute bacterial epiglottis. +

some structural similarities to morphine. It’s a natural pain killer and helps explain why people feel better after a good cry. But it has to be the right kind of cry. You can’t mace yourself and get psychic tears with all of their feel good chemicals. You can’t fool those TRP channels. Socially (not just chemically), tears are also complicated. Shedding tears can be viewed by some as a sign of compassion and sensitivity, and by others in the same situation as a sign of weakness or loss of control. In many cultures men are not supposed to cry, a fact that researchers say robs men of the stress-reducing chemicals of emotional tears. In one study, 94 percent of the women surveyed reported shedding emotional tears in the previous month but only 55 percent of men. The Michael Jordan of tear research, Dr. William Frey, believes statistics like that help explain why men develop more stressrelated diseases than women do. Maybe “Big boys don’t cry” should be banished from the lexicon along with “now, now, don’t cry.” Maybe our bodies — male and female — are crying out for a good cry. +

TEARS IN GEORGIA The Peach State could well rename itself The Tears State. The world’s #1 drug for dry eyes, Restasis, was developed in Athens at the University of Georgia College of Veterinary Medicine. It is one of only a handful of drugs ever developed for veterinary use and then approved for humans. The drug, which racks up sales of more than a billion dollars a year in more than 35 countries, has caused more than a few tears to be shed: it sparked a legal battle between the College and UGA researcher Renee Kaswan, the inventor of Restasis. She was supposed to receive royalties from the sale of the drug, but while UGA was in the process of assigning the patents to her, they sold the rights to the drug to the pharmaceutical firm Allergan. In Athens-Clarke County Superior Court, Kaswan was determined to be entitled to a 35 percent share of the sale proceeds as inventor. The school refused to pay until it lost a second legal battle, settling with Kaswan for $20.2 million in 2010. +

FEBRUARY 16, 2018

Southern Girls Eat Clean Navy Bean Soup with Veggies

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Alisa Rhinehart writes the blog www.southerngirlseatclean. com She is a working wife and mother living in Evans. Visit her blog for more recipes and information on clean eating.

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immersion blender, puree the soup leaving about 1/3 to half the beans whole. (If you do not have an immersion blender you may place about 2 cups of the soup in an upright high speed blender, blend until smooth and place back into the pot on the stove top.) Add the spinach leaves to the soup and stir until wilted. Adjust the seasoning as needed. Ladle into soup bowls and serve immediately. +

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Instructions: Rinse and drain 1 can of the navy beans and place into a high speed blender

Navy Bean Soup with Veggies with 1 cup of filtered water. Blend until smooth. Add 1 Tbsp. of olive oil to a large pot and heat over medium to high heat. Add onion, carrots, celery and garlic to the pot and saute until soft, 5-8 minutes. Add crushed red pepper, tomato paste, white wine vinegar, chicken broth, bay leaves and rosemary to the pot. Stir well to combine. Add the pureed navy beans, the remaining two 15 oz. cans of navy beans, rinsed and drained, sea salt and cracked black pepper to taste. Bring to a boil, reduce heat to medium/low and simmer for approximately 25-30 minutes or until the vegetables are soft. Using a hand held

FLOYD & LEOPARD ATTORNEYS AT LAW

January and February are always great months to try new soup and stew recipes. During the cold winter months, having a warm bowl of something hearty and delicious soothes the soul. My husband has asked me several times to try and find a recipe for a homemade navy bean soup. When he was a bachelor and ate all sorts of unhealthy foods, Campbell’s Bean and Bacon soup was one of his favorites. This recipe is much healthier with the added veggies and so tasty and filling. Although navy beans may seem bland and ordinary, they have tons of nutritional benefits. Here are a few: • The high fiber in navy beans can help you manage the symptoms of diabetes. • Improves digestion and intestinal health due to the high fiber in these legumes. • Magnesium and folate in navy beans keep the heart strong and protected. • A great source of protein with more than 15 grams in a single cup. I hope you’ll stay warm and survive the cold of February by giving this delicious soup a try. Enjoy!

Ingredients: • 3 15 oz. cans of organic navy beans, rinsed and drained • 1 Tbsp. of extra virgin olive oil • 1 medium sweet yellow onion, chopped • 2 carrots, peeled and diced • 2 stalks of celery, diced • 3 cloves of garlic, crushed • 1/2 tsp. of crushed red pepper (less if you prefer) • 1 Tbsp. of white wine vinegar • 2 Tbsp. of tomato paste • 4 cups of organic reduced sodium chicken broth (use vegetable broth for a vegetarian soup) • 2 bay leaves • 1 sprig of rosemary • 3-4 cups of organic spinach • Sea salt and cracked black pepper to taste

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FEBRUARY 16, 2018

THE MONEY DOCTOR DATA SECURITY — A PROACTIVE APPROACH

t seems that the latest data breach is an almost daily fi xture of news reports. None of us want to be a victim of the next one, so here are some ideas on how to improve your data security. One item all consumers can do for free is get a copy of their credit report from all five nationwide credit reporting companies (Equifax, Experian, Transunion, Innovis, and CheckSystems). Most people know about the big three, but Innovis and CheckSystems are less known and worth accounting for when reviewing your credit reports. You can request all reports at once or get one report at a time. A good technique is to download one report every three to four months (rotate companies), which allows you to monitor your credit more frequently throughout the year. You can do this by going to annualcreditreport.com or call 877322-8228. For Innovis and CheckSystems you will need to go directly to their websites. The best proactive step you can take is to place a credit or security freeze with all five nationwide credit reporting companies. This is a measure that restricts access to your credit reports. It makes it difficult for identity thieves to open new accounts in your name. It is important to remember that existing accounts are still vulnerable to fraudulent transactions, so monitoring all active accounts on an ongoing basis is important too. Beyond monitoring credit, accounts, and placing a security freeze, you may want to review the protection of your passwords. Lastpass is an online password storage vault. They offer many features, but the free basic package allows you to store all your usernames and passwords in one secure location. All your sensitive data is encrypted and is accessible only by you. They offer multifactor authentication which can add another layer of security. Finally, they offer a random password generator that anyone can use to

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create sophisticated passwords. There are other online password storage vaults companies as well with similar services. With technology changing quickly it can be hard to keep up with everything. Here are a few key areas to review on a regular basis to make sure you are taking the necessary steps to stay protected: • Manage your devices - access sensitive data only through a secure device; install the latest antivirus and antispyware programs on your devices; create a regularly scheduled scan. • Protect all passwords - consider using a password manager like Lastpass; reset your passwords on a regular basis; don’t use common passwords across all accounts; use a password generator. • Surf the web safely - do not connect to the internet via an unsecured or unknown wireless network; do not access confidential personal data in a public location or public network. • Protect information on social networks - Limit the amount of information you post on a social network site; consider keeping your birthday, address, and phone numbers confidential. • Protect your e-mail accounts - review unsolicited emails carefully for spam or phishing attempts and don’t click on the links inside suspicious emails. • Safeguard your financial accounts - Review your credit reports and financial statements for any suspicious activity; put a security freeze in place with all five reporting agencies. With tax season approaching, this is a great time to think through the items mentioned above. No strategy is ever 100% safe, but implementing some of these items will help to minimize your exposure. + by: Clayton Quamme, a Certified Financial Planner (CFP®) with Calvary Wealth, LLC (www.calvarywealth. com). Calvary Wealth is a fee-only financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

FEBRUARY 16, 2018

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AUGUSTAMEDICALEXAMiNER

Ask a Dietitian PUTTING YOUR HEART FIRST

by Deanna Shade, MS, RD, LD CNSC Nutritional Informatics Dietitian, Eisenhower Army Medical Center Still looking for that perfect Valentine’s Day gift? Give yourself the gift of heart health. Even if Valentine’s Day has already come and gone as you’re reading this, February also marks American Heart Month. What a perfect time to pledge to live a healthy lifestyle that can lead to a lifetime of heart health. Heart disease is the leading cause of death for men and women. It affects people of all backgrounds, but African American men are at the highest risk of heart disease. When it comes to taking great care of your heart, you can never start too soon and small lifestyle changes can make a big difference over time. Here are some easy steps to take to get started during the month of February to give your heart the ultimate Valentine’s gift: • Increase the fiber in your diet! Increasing the fiber in your foods will help keep your cholesterol in balance which decreases your risk for heart disease. High fiber foods include whole grains like brown rice, whole wheat pasta, and oatmeal, as well as fresh fruits, vegetables, and legumes.

• Start cooking at home! Cook a hearthealthy meal at home at least 3 nights of the week. Focus on recipes with lean meats, cook with vegetable oils instead of butter and lard, and swap salt for dried herbs and spices. • Get a heart check up! Schedule a visit with your doctor to see where your heart health currently stands, ask questions, and help focus your goals. • Give your heart some exercise! Your heart is a muscle and needs to be challenged to keep it strong. Try adding daily walks after lunch or dinner to get your heart pumping. • Take steps to quit smoking! If you currently smoke, quitting can cut your chances of heart disease and stroke significantly. In addition to putting your heart first this month, talk to your loved ones about their heart health as well. Talking with your family and friends about heart disease can be awkward, but it is important and could help save their life. Have a “heart-to-heart” this Valentine’s season at the dinner table, in the car, or even over the phone by sharing these tips alongside that gift of a teddy bear, fresh flowers, or a box of chocolates. +

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Kid’s Stuff

NOTES FROM A PEDIATRIC RESIDENT by Caroline Colden, M.D., Children’s Hospital of Georgia

For crying out loud! Let’s talk about crying in babies, and just how much parents should, or should not, ignore their crying babies. Several years ago, psychologists aggressively argued against allowing babies to cry too much, stating that ignoring a baby’s crying will cause long term psychological damage and anxiety disorders as the infants grow older. However, studies have now demonstrated time and time again that this is not the case, and that in many instances

allowing a baby to “cry it out” does not cause any long term consequences or emotional disorders later in life. These same studies acknowledge parenting methods such as “graduated extinction” when it comes to teach an infant to selfsoothe and go to sleep independently are also okay and not considered dangerous to a child’s development. Sometimes babies just cry,

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despite having plenty of attention and all of their needs met. So let’s discuss crying and what varied approaches and concerns come to mind. First, it is important to keep in mind age of the baby and current caregiver status. Newborns are especially prone to crying as they adjust to life outside the womb, and caregivers are often exhausted as they adjust as well to having a new, tiny human in their homes. Shaken Baby Syndrome has the highest incidence of occurrence in the newborn period and believe it or not, most cases of it are not perpetrated by caregivers who willingly hurt or intended to damage a baby’s brain. They are simply exhausted, frustrated, and desperate for the baby to stop crying. So for this reason, I tell every single parent going home with a new baby that if the baby is crying and won’t stop, but is fed, clean with a new diaper, warm in a blanket, etc (i.e. all needs are met) then it is OKAY to put the baby in the bassinet or crib (where they will be safe) and WALK AWAY. Sometimes parents need breathers too, and that is okay. I think it is important to distinguish the situations of a devoted, nurturing parent who needs a “breather” from legitimate neglect. True neglect, when an infant or child is habitually and repeatedly left alone without attention to their needs, deprived of ready access to food or water, and lack of regular bathing or clean clothing can have significant and lifelong consequences. Besides the obvious consequences of neglect on a child’s physical health, their psychological health can be profoundly damaged as well.

FEBRUARY 16, 2018 Babies require stimulation and interaction with their environment to grow and develop properly. Seeing smiling faces triggers happiness in babies and helps them learn socialization. Absence of interaction hinders language development, and if this persists long enough a child may never learn to speak properly. Is it like keeping a baby in total darkness at all times - their eyes will never learn to see. But let’s reiterate again

that sometimes letting your otherwise-healthy-and-caredfor-but-crying-baby just cry for a bit is not the same thing as neglect. Another point I want to bring up is that the age of a child is also important to take into account. Older children (who are starting to walk, talk, develop their own personalities, and learn especially the word “No”) will challenge their parents every day as the parental wishes clash with their wishes at times. Example 1: bedtime. Parents will want to enforce a bedtime but the child has decided that no, playing is more fun. Crying at bedtime is a great way for children to test boundaries, and they will learn very quickly that if they cry enough when placed in their beds that many times parents will come back and get them and attention-giving/play time will resume until the next attempt at bedtime is made or

until the child falls asleep in the parents arms. Some babies and families really struggle with colic. Unfortunately, there is still a lot we don’t know about colic. But some families deal with a crying baby for a greater portion of their day, for reasons that are unclear. The baby has been fed, changed, given a pacifier, wrapped in comfy warm blankets, etc, but still continues to fuss and be colicky. Colic is typically diagnosed before 3-4 months of age, and occurs for more than 3 hours a day, for 3 or more days a week. This can be especially exhausting for the baby’s caregivers and also can create a sense of guilt because they wonder “is there still something I could be doing to help my baby?” This is where discussions with the pediatrician can help to try to identify other things going on. But also the take-home message is that some babies are just especially prone to being fussy. In summary, the biggest message is that not all crying in babies can be prevented, nor should it be. Crying is the primary method of communication in young children and especially infants, and can mean literally anything. Age is important, since newborn crying means something different than a 3 year old crying as part of a tantrum. Any baby who is regularly fed well, given clean diapers and clothes to wear and a safe bed to sleep on, etc will not be at risk for neglect. Crying at times is just part of life. Parents who spend time talking to their baby, smiling at their baby, reading to their baby, holding their baby, feeding their baby, etc will have happy, well-nourished, well-adjusted children. And these same children may cry from time to time, and sometimes, it really is ok. +

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Nada Awad on February 9, 2018

A MEDICAL STUDENT IS DISCRIMINATED AGAINST BY A PATIENT On my outpatient family medicine rotation, I met a patient I will never forget. She was a middle-aged white woman — a new patient to the clinic — there to establish care. When I walked in and introduced myself, she looked me up and down with a glazed expression. Within two minutes, while I was trying to gather a history from her, the patient interrupted to say, “Dr. Smith (name changed), isn’t he the best? It’s so refreshing to finally find an all-American doctor.” I knew from that statement that this conversation was about to take a turn for the worst. “All the immigrant doctors are taking over,” she said, “and all the specialists I’ve had to see have been brown men with thick accents, and I’m so relieved to have found Dr. Smith!” She was sitting comfortably in her chair, her legs crossed, looking me straight in the eyes, while I was standing awkwardly by the sink, fidgeting, trying to avoid eye contact with this woman. I wish I could tell you I said something smart, enlightening or witty back to this patient, but I did not. I am an immigrant from the Middle East and a student doctor. But to her, I was yet another brown immigrant doctor — a nuisance to patients like her who prefer their doctors with whiter skin. I was speechless and confused. How could she feel so comfortable saying these views to me? I bit my tongue, gathered her history and examined her. “No offense, honey,” she added, “But last time I checked we’re still in America and is it too much to ask for an American doctor for once?” In her TED talk Dr. Suzanne Barakat describes her own struggles with patients who harbor racist views against her. When these actions happened in front of a big group of people, the discomfort of confronting the aggressors kept others from standing up for her, a deeply hurtful, disappointing and for me, a familiar, experience. Before we went back into the room, I briefly told “Dr. Smith,” my attending, about the patient’s comments. He raised one eyebrow, shook his head in disapproval, but did not utter a single word. I walked back in the room right behind him, and the patient grinned and eagerly shook my attending’s hand. I was in the back, feeling invisible and a little numb. I didn’t expect Dr. Smith to scold the patient or to give her a lecture on basic human decency. Truthfully, I’m not sure what I expected, but I remember feeling so small and so insignificant, in disbelief that this patient encounter was treated as routine by my attending. When I had time to digest what happened, I thought about what would have been an appropriate reaction to this incident, which might happen to me again in the future. As physicians-to-be, we still adhere to the Hippocratic oath. We must care for all patients without discrimination. But what do we say to patients who blatantly disrespect us and share their racist views about us? Do we stay silent like I did because they’re our patients and a clinic is not the place for such discussions? Or do we stand up for ourselves and our colleagues who face similar prejudice and risk the fact that the patient may never come back to see us again? So maybe when a patient says something that qualifies as racist to me or a colleague in the future, silence cannot be an option. Maybe we can care for our patients and treat them with most utmost respect and dignity, but still maintain our dignity. And maybe, just maybe, we can change a couple of minds in the process. +

I wondered what I should have said

Nada Awad is a medical student

Reading this book calls to mind the famous quote by Stuart Chase: “For those who believe, no proof is necessary. For those who don’t believe, no proof is possible.” We are currently rehashing issues that were hotly debated in the 1700s and even earlier: the first military defeat in American history happened when George Washington vacillated on whether or not to have his troops vaccinated against smallpox. After a forced retreat he made inoculation mandatory. That he was unsure of the safety of vaccines was not the thinking of the day. As Eula Biss shows in this slim but well-researched volume, many centuries before George Washington vaccines were the subject of broad acceptance and pockets of entrenched skepticism. The more things change, it seems, the more they stay the same. The debate has little to do with fact, although this book is densely packed with them. Consider a little of the related history Biss reviews: the theory that AIDS is a government plot to kill

segments of the population the government supposedly views as undesirable. As one African man near AIDS’ ground zero remarked, however, wouldn’t it have been simpler to poison their Coca-Cola than to concoct a virulent disease? Another: Cotton Mather, became a proponent of variolation in the early 1700s (coincidentally, not long after losing his wife and three children to measles), and was rewarded by a firebomb thrown through his window. Consider the so-called antivaxxers who ignore mountains of evidence provided by the World Health Organization, the

CDC and countless independent studies by organizations with impeccable credentials, and instead hitch their wagons to a disgraced doctor and a former Playmate of the Year. Indeed, this debate is really not about facts. It’s about trust: of government, of the medical profession, and of the pharmaceutical industry. As Biss acknowledges, there are plenty of reasons to distrust all three. That does not mean, however, that everything they endorse or recommend is some diabolical plot. If it is, one has to wonder what’s behind government speed limits, healthful suggestions from the medical field (like encouragement to quit smoking), and aspirin tablets made by the pharmaceutical industry. The best idea may be found in the words of Biss herself, who suggests that we should “trust, but in an intelligent, skeptical way.” Her book will help you do just that. +

On Immunity: An Inoculation by Eula Biss, 205 pages, published in January 2014 by Graywolf Press

Research News Possible migraine breakthrough Since the 1980s, researchers have known that people in the throes of a migraine have high levels of a protein called calcitonin gene-related peptide, or CGRP. Part of the research has uncovered that this neurochemical is a direct migraine trigger: if it is injected into a person’s bloodstream (assuming that person is prone to migraines) it will trigger a migraine. For people who don’t experience migraines, an injection of CGRP causes, at worst, mild pain. With CGRP thus unmasked as a direct cause, scientists went to work looking for a way to block transmission of CGRP’s calling card. The initial clinical trials in 2011 were stopped due to fears of liver damage in study participants. After changing their approach, a

total of four pharmaceutical companies are poised to start new clinical trials this year, pending receipt of an FDA green light. The new treatments, if they ever make it to market, are likely to be expensive, but migraine researchers are optimistic: in early testing the drug seems to work and is free of the normal migraine drug side effects. Alzheimer’s blood test developed A new blood test that was accurate in 90 percent of patients tested claims it can accurately predict Alzheimer’s as much as 30 years before the appearance of symptoms. Until recently, the only definitive test to confi rm a diagnosis of Alzheimer’s was during an autopsy. While there is no known cure for Alzheimer’s, knowing it’s on the way decades ahead of time could

well suggest changes in diet, exercise and lifestyle that could delay onset or lessen its impact. The test could also be invaluable in finding potential patients for new drug trials to treat Alzheimer’s. Bullying’s lifelong effects New University of Warwick research says that people involved in sibling bullying — as either victim or perpetrator — are three times more likely to develop psychotic disorders such as schizophrenia in early adulthood. And the more often they are involved, the greater the likelihood. Children bullied by both siblings and schoolmates are 4 times more likely to develop psychotic problems, and tops among all at-risk groups studied were children who were bullied and, in turn, did bullying of their own. The study involved 3,600 children tracked from age 12 through age 18. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

FEBRUARY 16, 2018

THE MYSTERY WORD

Are you all set for your surgery tomorrow?

I think so.

by Dan Pearson

There’s always a ton of paperwork ahead of time.

Right. Like they want a contact number in case of emergency.

What number did you give them?

The Mystery Word for this issue: RIBAN

9-1-1.

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Swift 5. Wood sorrel plant 8. Palmetto util. 13. Earthen pot 14. Visit Mistletoe? 16. Former Alaska governor 17. Coconut husk fiber 18. Lyft rival 19. Representative 20. Emphasize 22. Greek goddess of night 23. Perceive with the eyes 24. Son of Jacob 25. Wreath of flowers 27. Chronological measure 30. Scull power 31. Brass wind instrument 32. And not, in brief 33. Dream Home network 36. Scent 37. Very bad ER diagnosis 38. Solve, as a mystery 42. Eternal 44. Fur scarf 45. Bedouin 47. Endure (archaic, poetic) 48. Weight/height meas. 49. Trigonometric function 50. Popular ISP 52. Nevertheless 53. Vietnamese offensive 54. Help 55. “Don’t ____ on it” 58. Operate 60. Inclusive 63. View 65. Quantity of paper 66. Its capital is Tehran 67. Unstressed syllable 68. Apollo agency 69. HIV/AIDS and others 70. Does light housework

53 58

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

QUOTATION PUZZLE

22 25

47 50

P H G O A S R S R E E P P T F O A

54 60

7 15

71. Cozy room 72. Word from America DOWN 1. Center of interest or activity 2. Isolated 3. It’s put under a microscope 4. Weight deduction equal to the weight of the container 5. Of the eyes 6. Mamie had one 7. Final word? 8. Ballesteros or Olazabal 9. Secretive; wary 10. Washington Road to Riverwatch connector 11. Reznor group, for short 12. Insect 15. Honda sold from 1978 until 2001 21. Nutrition label abbrev. 26. Ebony 28. Augusta’s “Blue_____” 29. Delete; remove 30. Eggs (Latin)

M E E E

D S H N N W Z O ’ R H R S T W E S A A I C A O I E L H R M

— Unknown

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

31. With 46-D, the start of a famous question 33. Wifey’s mate 34. Dwarf of legends 35. Woman who is a traitor 39. Immensity 40. Great Lake 41. Portable light 43. “Bad” cholesterol (in brief) 46. See 31-D 50. Lindbergh, for instance 51. Room within a harem 54. Humiliate 55. Genesis; onset 56. Elude 57. Taut, as muscles 59. Single entity 61. Alcoholic drink of fermented honey 62. Ancient tomb 63. Disconsolate 64. French vineyard

X A M I N E R

4 2 2 8 1 6 9 3 4 2 8 6

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

U D O K U

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

Solution p. 14

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

1 2

1 2 K 1 2 3 4

NUMBER SAMPLE: BY

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

B 1 2 3 4 5 6 A 1 2 3 4

1 2

1 2 3 4

1 2 3 1 2 3

S 1 2 3 4 5 6 7 H 1 2 3 4

V 1 2 3 4

1 2 3

U 1 2 3

1.WAASYYLIBIOFTT 2.VOOOOSTEWERHAL 3.AALLUUMOTTE 4.TEMKNRY 5.OE 6.RN 7.E

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

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

FEBRUARY 16, 2018

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AUGUSTAMEDICALEXAMiNER

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camouflage jacket: you can hide but you cannot run.

ha... ha...

Moe: How are your driver’s ed classes going? Joe: Ok, but I had a setback today. Moe: Uh oh. What happened? Joe: I was going down a ramp about to merge onto the expressway and the instructor reminded me, “Always let people know where you’re going.” Moe: So you put on your blinker? Joe: No, I updated my Facebook status.

enetic scientists have discovered the gene that is responsible for shyness. It was hiding behind two other genes.

Moe: Why the long face? Joe: My wife and the kids left me because, according to her, I’m obsessed with horse racing. Moe: That’s terrible! Couldn’t you stop them? What did you say when they left? Joe: “And they’re off!”

Moe: What has 8 wheels and flies? Joe: Um... a garbage truck? Moe: What do you call a dead fly? Joe: A flew! Moe: Wow, I heard about an actor who fell through the floorboards during a play. Joe: Was he hurt badly? Moe: No, I think he was just going through a stage.

After examining the woman, her doctor said, “Well, it looks like you’re pregnant.” “What??? I’m pregnant?” she responded in disbelief. “No, no,” said the doctor. “It just looks like you are.”

Moe: But seriously, do you know why we tell actors to break a leg? Joe: No, why? Moe: Because every play has a cast.

Moe: I think it’s weird how all the seasons are named after coils of metal. Joe: They are? Moe: Sure. Well, except for Summer and Winter. Oh, and Autumn.

Moe: Do you know how to make a cheese puff? Joe: Sure. Just chase it around the block a few times.

Moe: What did one plate say to the other? Joe: I give. What? Moe: Lunch is on me. +

To the guy in the wheelchair who stole my

Why subscribe to the MEDICAL EXAMINER? What do you mean? Staring at my phone all day has had no affect on ME!

Because try as they might, no one can stare at their phone all day.

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Dear Advice Doctor, When I was hired about a year ago, I was told I would have to work no more than two Saturdays a month. That was great because on my previous job I probably worked 50 Saturdays a year. But despite their promises I hardly ever get a Saturday off. Sometimes I feel like telling the boss, “You know what? Nuts to you!” and just walk out and never come back, but I know that’s a dumb idea. I’m just afraid they can find plenty of people more than willing to work Saturdays and then I’ll lose my job or they’ll cut my hours. I can’t afford that. What should I do? — Seeking Saturday Siestas Dear Seeking, Actually, I kind of like your idea. I don’t think it’s dumb at all. Nuts offer excellent nutrition and are a great source of energy. Giving some to your boss would definitely be a nice gesture. Which nuts would be best? Most nuts are healthful, although not all nuts are created equal. Pecans and macadamia nuts are among the lowest in protein and the highest in calories and fat. On that note it’s important to remember that there are good fats and bad fats, and nuts generally deliver the good kind. We tend to think of all fat as bad, but fats are essential nutrients, ranking right up there in The Macronutrient Top Three alongside protein and carbohydrates. There are so many different kinds of nuts that it would be impossible to cover them all in an answer this brief, but in general all nuts deliver heart-healthy unsaturated and monounsaturated fats, and many (especially walnuts) also offer equally heart-healthy plant-based Omega-3s. Nuts are good sources of fiber, vitamin E and antioxidants, and all kinds of essential trace minerals. In fact, one National Institutes of Health study concluded that some 4.4 million premature deaths around the world could be prevented with higher nut consumption. But the picture isn’t 100 percent positive (although it isn’t the nuts’ fault). Nuts are often processed with lots of salt, or glazed with sweet coatings that add lots of calories and no nutrition. Sometimes a perfectly healthful nut is packaged in a large canister that makes it hard to avoid overindulging. It’s very easy to pop the lid, sit back in the recliner and toss two or three (or more) servings down the hatch while watching TV. In the same way that if 2 aspirin are good, 8 will be even better — not! — it’s important to exercise portion control when eating nuts directly from the package (as opposed to including them in recipes, another good way to eat more nuts). So your idea is nutty, but it also isn’t. Know what I mean? + 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 only be provided in the Examiner.

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

...cleverly hidden on the logo in the p. 7 ad for FLOYD & LEOPARD ATTORNEYS AT LAW THE WINNER: STEVE SWENSON 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!

AUGUSTAMEDICALEXAMiNER

FEBRUARY 16, 2018

THE PUZZLE SOLVED F O C U S

A L O N E

H U B B Y

G N O M E

S L I D E

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

T A R E R D O A V A V A S T U N N E I S T S

O C U L A R

C A B I N

E R I E

L A N T E R N

A M P E R N E L T U O D E B E A M B E A A S D E

S P A N I A R D

C A G Y

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

N A I N N T G O O S E

E R A S E

E V A D E

T E N S E

SEE PAGE 12

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

It is better to let someone walk away from you than all over you.

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

7 8 9 2 6 3 5 4 1

6 5 3 4 8 1 2 9 7

9 1 5 8 3 7 4 2 6

8 7 4 6 9 2 3 1 5

3 6 2 1 4 5 7 8 9

2 4 6 9 5 8 1 7 3

5 3 8 7 1 4 9 6 2

1 9 7 3 2 6 8 5 4

QUOTATION QUOTATION PUZZLE SOLUTION: “The person who proofed Hitler’s speeches was a grammar Nazi.”

— Author unknown

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— Author unknown

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AUGUSTAMEDICALEXAMiNER

SIXTH IN A SERIES

The vitamin alphabet Do you like a nice crunchy bowl of cereal in the morning? How about cereal with a sliced banana on top? If you answered yes, you’re in no danger of a diet deficient in vitamin B6. Of course, you may call it pyridoxine, pyridoxal, or pyridoxamine. That’s okay. It’s all one and the same thing (or nearly so). Vitamin B6 is described as a coenzyme in more than 100 enzyme reactions. Let’s define those terms. Everyone has heard the word enzyme, but exactly what is one? An enzyme is a catalyst for various biochemical reactions in the body. They’re busy little beavers: the human body carries on more than 5,000 biochemical reactions to function properly, and enzymes accelerate these reactions. Without them many

of the reactions would not occur at all, or would occur too slowly to sustain life. Most enzymes are proteins, but coenzymes are non-protein compounds that are could be described as “enzyme helpers.” They react with the enzyme, sort of like the two components of epoxy paint or adhesives that are incomplete without each other, but when combined they become the intended substance that gets the job done. Vitamin B6 focuses its attention on reactions related to amino acid, glucose and lipid metabolism. That makes it an extremely important vitamin: amino acids form the largest component of many human tissues (other than water); glucose is the

scientist, Paul Gyorgy, discovered vitamin B6 in 1934. His name should be familiar to Examiner readers because in 1927 he also discovered and isolated riboflavin, a.k.a vitamin B2. Alas, our article on B2 focused more on the vitamin than on its discoverer. President Gerald R. Ford, however, did not overlook Dr. Gyorgy. In 1976 Ford awarded him the National Medal of Science for his vitamin discoveries and for greatly improving human nutrition. Unfortunately, Gyorgy died before the award could be presented; his wife, Margaret, accepted the award on his behalf. The U.S. honors were made because Gyorgy had emigrated to the United

body’s fuel, and lipids have vital functions in storing energy, molecular signaling, and in the structural components of many cells. A Hungarian-born

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States. Gyorgy actually discovered vitamin B6 at the University of Cambridge, where he had gone to escape growing unrest in Germany. In 1935, he accepted a position as visiting assistant professor of pediatrics at Case Western Reserve University in Cleveland, and two years later received a permanent position there. Then in 1944 he moved to the University of Pennsylvania and stayed in Pennsylvania in various positions through his retirement. Much of his later research focused on the benefits and protective factors in breast milk. Gyorgy and his wife had three sons: Hans, an organic chemist; Michael, a physicist; and Tilbert, a surgeon. He died of pneumonia on March 1, 1976 at age 82. +

+ 16

AUGUSTAMEDICALEXAMiNER

FEBRUARY 16, 2018

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