July26 19 by Daniel Pearson

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JULY 26, 2019

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BODY PARTS: THE OCCASIONAL SERIES

THE LIVER

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s there a body part that isn’t amazing? None come to mind. They are all astonishingly complex and sophisticated in their design and function, marvels of compact efficiency. The liver certainly deserves its place in the HBHOF (Human Body Hall of Fame). This 3-pound organ doesn’t get the publicity that some of its co-workers like the brain and heart do, but it doesn’t seem to mind. It just quietly does its job, which is a good thing. If it went on strike we would quickly die. (Is that why it’s called the liver?) Unlike the pancreas or the heart that are available in artificial, mechanical versions, the liver is irreplaceable. Unless, that is, it replaces itself: surgeons can cut away diseased portions of the liver, even as much as 75 percent of it, and it can grow back to its pre-surgery size within weeks. Otherwise, a problem liver has to be replaced with a healthy one. But a complete transplant isn’t the only option. Just a piece of a living donor’s liver can do the trick. You can see its location highlighted in the graphic, high in the abdomen on the right side, well protected behind the ribs. It is the body’s largest organ other than our skin, and fittingly so: it has a big job. The liver filters harmful things from the bloodstream, helps digest the foods we eat and make nutrients available to the body, and is conservatively estimated to regularly accomplish some 500 different tasks. Its resume includes destroying bacteria by sending out phagocytes, which are cells that eat invaders. The liver also keeps blood healthy by destroying old or damaged blood cells, and it creates clotting factors that prevent or stop bleeding. Many body systems are involved in homeostasis, a fancy word for maintaining the body’s status quo. When it’s hot, for instance, perspiration cools us down; when it’s freezing, the body has systems that generate warmth. The liver is part of the operation too. It stores about a day’s worth of blood glucose in the form of glycogen. If a person doesn’t eat for a while and their bood sugar drops (while asleep overnight, for example), the liver chemically changes its stored glycogen back to glucose and releases it back into the bloodstream. The liver also stores most of the iron we consume through food and handles the job of dispensing it. It does the same with iron, folate, and vitamins A, D, and B12. Speaking of food, much of what we eat containing cannot be digested without the liver’s help. It produces about a quart of bile every day, then sends it through bile ducts to the small intestine where it helps break food down so its nutrients can be utilized by the body. This article barely scratches the surface of what this incomparable organ does. Protect the liver by avoiding threats to it like obesity and heavy alcohol consumption. Since the liver is our filter #1, not following dosing instructions for dietary supplements, and prescription and OTC medications puts an unnecessary workload on it, increasing the risk of drug-related liver cancer. Yes, taking care of our liver heightens our chances of being a liver.

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Your 14 year-old son is caught shoplifting and has been referred to Juvenile Court. He has not been in serious trouble before, but he has admitted that he was trying to steal the items. What do you do? A. Get an attorney and fight the charge. A juvenile record might hurt his chances to get into a good college or get a good job. B. Work closely with him and with Juvenile Court to deal with the consequences of his behavior and to plan for his future. C. Do everything you can to keep this whole thing quiet so the family won’t be embarrassed any more than it already has been. D. Encourage the Court officials to be as hard on him as they can. He needs to learn this lesson before he becomes a hardened criminal.

If you answered: A. This choice is focusing on the wrong priority. If you are successful in getting him off for stealing, the lesson he learns is that he does not have to take responsibility for his behavior because you will take care of it for him. B. This is the best response. Juvenile Court officials do not want to ruin the lives of young people, they want very much to work with families and with youth in order to ensure an honest and productive adulthood. C. This choice is really focusing on the wrong priority. It is most important for him to learn that he is responsible for his actions. The family being embarrassed is not what is most important now and will be of little consequence in the future. D. He does need to learn a lesson, but it is a lesson that should be taught by you at home. It should not be up to Juvenile Court to make him an honest citizen. That is your responsibility. Positive values should be taught in the home. Juvenile Court is there to try to teach them if parents cannot or will not, but that is not what they do best. What they do best is to work with you to make sure that kids grow up to be productive and useful citizens. +

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JULY 26, 2019

Let’s hope the worst of the summer heat is behind us and we won’t be suffering again until next year. As long as we’re at it, let’s hope we win the Publishers Clearinghouse Sweepstakes, too. Exposure to summer heat can be life-threatening, but the trouble with advice about coping with triple-digit heat and humidity is always those unfortunate people who cannot follow the advice, people like construction and highway department crews, garbage truck workers, tree surgeons, and so on. They can’t stay out of the sun or go indoors between 10 am and 2 pm, not if they want to keep their jobs. On the other hand, they are also the very people who are accustomed to regularly working in Saharan heat. It’s not as unbearable for them as it might be for people whose only exposure to the heat is a few seconds spent walking from their 68° house to their air-conditioned car and then from it to their air-conditioned workplace. But all of us are exposed to the heat to some degree. We have to cut the grass and grill those burgers. We have to walk half a mile to and from work to our assigned parking lot. We have to boil for a day or two for the repair people to get to us on their list if our AC unit goes out. On the hottest days, things can go south in a hurry. So what can we do? One of the keys is air movement. In the absence of air conditioning, a fan helps by helping sweat evaporate, which cools the body. If possible, place a bag of ice or a big bowl of ice in front of the fan to offer some heat relief too. When working, taking breaks helps the body cool down. It’s better to take ten minutes longer to do a job than suffer heatstroke (which the CDC says kills more than 650 Americans every year). Spraying or even misting yourself with a garden hose is cool too. You’re drenched already, so don’t be shy. Perhaps the most important strategy is staying hydrated, what we called “drinking water” back in the day. But it doesn’t have to be water. Sports drinks replace lost fluids and electrolytes. The older we get, the harder it is to adapt to heat. And a number of medications can further impair this ability. That’s why it’s a good idea to check in on elderly ones in very hot weather. Other factors that increase the risk for heat stroke for anyone, young or old, are obesity, diabetes and heart disease. +

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WHAT ARE DVTs AND PEs?

They are kind of a big deal. We all regularly hear these abbreviations during various drug commercials on TV, and many of us know what they stand for: deep vein thrombosis and pulmonary embolism. But knowing what the letters stand for isn’t exactly the same as knowing what the letters really mean, what to do when they become part of our personal medical portrait, and even more important, how PEs and DVTs can be prevented. Simply put, a thrombus or thrombosis is a blood clot, and an embolism is the blockage of an artery. In the context of this article, it’s a blockage caused by a blood clot. Specifically, a pulmonary embolism is a former blood clot that has broken free and started to travel, but ends up blocking arteries in the lungs, which can be serious, even fatal. The good news is that DVTs are preventable. But plenty of us are at risk. Among the major risk factors are conditions that limit our ability to get up and move around: surgery and prolonged bed rest and/or hospitalizations; pregnancy; obesity; old age; and long-distance travel. Other risk factors include smoking, cancer and cancer treatment, and some illnesses and medications. For some time, doctors have been alert to get people up and walking as soon as possible after surgery and childbirth. They also deploy boots that regularly inflate and deflate for us while we’re stuck in hospital beds. Most travelers know that it’s recommended to get up and walk the aisle during long flights, as well as regularly stretching and flexing their leg muscles while seated. Compression stockings are a simple but effective way to help improve circulation, which reduces the chances of DVTs. Some people wear them only in certain circumstances (like on a long plane or car trip or when standing for long periods of time), while others wear compression stockings every day. If a person has already experienced DVTs, the likelihood of a recurrence is high. For that reason, doctors usually prescribe blood thinners or anticoagulants. The best medicine is prevention: be regularly active, maintain healthy weight, and protect vascular health by not smoking. +

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

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JULY 26, 2019

AUGUSTAMEDICALEXAMiNER

#95 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 guy, Sir William Cubitt (1785-1861), may look pleasant enough, but one of his major claims to fame was figuring out how to make prisoners suffer. Cubitt didn’t invent the device that tormented prisoners; its history dates back to Greek and Roman times where it was often used to pump water uphill and grind grain. During the Middle Ages construction of soaring Gothic cathedrals required this machine to lift heavy stones and wooden arches into place. And interestingly enough, just about all of us have used one of these devices. Many times. We’ve paid to use them, in fact. Back in Cubitt’s day, the Industrial Revolution had given birth to sprawling cities. Rising crime rates were a big problem. Shipping criminals off to the huge penal colony known as Australia worked for a while — until Australia decided it no longer wanted to be Britain’s dumping ground for criminals. The answer: build more prisons and expand the ones already in use. During the 35 years beginning in 1842, Britain built or enlarged close to 100 prisons. Aside from more cells, the public clamor for law & order required a three-pronged approach to prisoner treatment: hard fare (a bland and monotonous diet), hard board (bare boards for beds, not mattresses), and Cubitt’s specialty, hard labour (note the British spelling). Cubitt’s idea was to use a “tread mill.” His design (see illustration below) was a long cylinder equipped with steps that extended its entire length. Prisoners climbed these stairs to nowhere for up to ten hours every day, usually for no other purpose than to make their life dull, miserable and monotonous as a deterrent to future crime. It may not sound like the worst form of prison labor ever devised, but when Oscar Wilde spent two years on a prison treadmill for “gross indecency,” he was said to be shattered by the experience and never recovered; he died three years after his release from prison at age 46. One author said it wasn’t medieval-style agony that bestowed such infamy upon the treadmill; it was the “monotonous steadiness and not its severity which constitutes its terror.” Britain banned the use of tread mills in prisons in 1902. But as early as 1910, heart disease was already the #1 killer in the U.S., replacing diseases like influenza, tuberculosis and pneumonia. Conveniently, the treadmill was waiting in the wings, ready to transition from a torture device to, well, a different kind of torture device. +

Going out to retrieve the newspaper before sunrise this morning, the street lights were still on and a haze of fog surrounded them, casting murky shadows like one of the first scenes in the first Harry Potter movie. The feeling was so similar that I half expected a character from the movie to emerge from the shadows and capture the lights from all the poles on my street, snuffing out the lights, so Hagar could safely deliver the infant Harry Potter to his Muggle aunt and uncle. I remembered how the mystery of that moment took time to unfold and create understanding, and the laughter later as the owls brought hundreds of letters from Hogwarts for Harry. I might forget what I had for breakfast yesterday morning, but those memories of having a rich imagination are such a pleasant diversion. Feeling that playful imagining as throwback to childhood, it set me to giggling and enjoying the déja vu of the moment. Even at my age it’s still fun to recognize the child parts of myself that all those years of living, no matter how difficult they may have been, have not managed to snuff out. Being in touch with the person that I still am, linked up to a long chain of memories. Drinking my coffee I retrieved the memory of sobbing when Heidi was finally able to go back to her beloved Grandfather and her real home in the mountains. I remembered her taking a soft white bread roll to Peter’s grandma who had trouble eating the rougher doughs of the whole grain breads available to the mountain people. That thought connected to today’s world in which we now choose to eat those whole grain breads because they are actually healthier for us. Go figure! I am obviously not a child now or I wouldn’t have survived and raised five children. But in order to be a whole person at my age, all

of me needs acceptance and love. And that awareness brings me to a new and delightful return to my childhood self—adult coloring books. Those coloring books make possible a lovely expansion of our present selves by reincorporating a childhood experience, while simultaneously upgrading that activity to a much more sophisticated level. When I first started to hear about them, I was hesitant to give them a try. I still recall my childhood experiences of coloring outside of the lines, feeling I had destroyed the page in the coloring book and setting it and my crayons aside as a worthless endeavor. I worried a little about whether I’d feel similar feelings of frustration and failure. But one day a few weeks ago I was at the store to buy a bunch of Pilot G2 gel pens for my puzzle books and I decided that I could afford a small investment in learning something both new and old. The coloring book, colored pencils, colored inks, and paint pens sat on my dining room table for close to three weeks before I sat down to try them out. Guess what? I still color outside the lines sometimes, but it no longer matters. I found out that I love seeing the colors emerge. I enjoy thinking about which colors are appealing when next to one another in the picture. Interestingly, the experts on healthy aging say that some ways to avoid or at least delay dementia involve being willing to engage one’s mind, to learn new things, to remain involved in the world. Applying a little creative imagination to coloring books is one of those ways. My friend Jerry quilts, and her quilts are a masterpiece of placing colors in juxtaposition. Her mind ought to last well into her centenary years. + Editor’s note: This installment of On the Road to Better Health is a vintage favorite from July of 2016.

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JULY 26, 2019

Musings of a Distractible Mind

Short-acting medications are a deal with the devil when used regularly for chronic pain. They create more problems and much, much bigger problems than they treat. In response to this, I have been known to send the following letter to my patients who are using medications like this on a regular basis: Dear <Patient’s name>

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

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I am sending this letter to patients who are using narcotic pain medications on a regular basis for chronic pain. I am doing so, not as an accusation or a sermon, but to educate you about why use of medications in this setting is not only risky, it almost always will cause problems down the road when taken for a chronic problem. This also does not imply that I won’t give prescriptions for these medications when you need them. I will give pain medication for appropriate pain, but I will also do everything possible to minimize the use of short-acting pain medications. What follows is an explanation as to why I think this is so important. Chronic pain is pain that lasts for a long time - more than a month. While it is OK to use short-acting pain medications (like hydrocodone or oxycodone) for short-lived pain (such as from an injury), it is not good use them regularly for long-term pain. • It may work for a short while, but the body develops a tolerance, requiring the dose to go up to get the same effect. • Going up on the dose will only work for a while, and then an even higher dose is required. • Eventually the person with chronic pain will require very high doses of narcotic to get even a modest effect. • Being at high doses like this comes at a cost: withdrawal. A person on high-dose narcotics (especially shortacting ones) will always experience withdrawal when the medication is stopped.

Withdrawal from narcotics is far worse than the pain for which the medications were given. • To avoid withdrawal, the person on short-acting narcotics must continue taking the medication, creating a

IT JEOPARDIZES MY CAREER. AND YOUR LIFE. dependency on the drug that is hard to escape, while at the same time offering little pain relief. It’s a horrible trap. • Additionally, patients who take large amounts of narcotics are often labelled as a “drug seeker” by any new doctor they see or hospital they visit. If this happens, it is much less likely the person will be taken seriously by the medical professionals. • Finally, the doctor prescribing pain medications in large quantities puts his/her career at risk by doing so. Careless prescription writing invites abuse by patients - something that can cause a doctor’s license to practice medicine to be taken away, and may even result in criminal charges. It is good to be concerned about a person’s pain, but prescribing short-acting pain medication for chronic pain only promises to add a new problem to the picture: dependency and addiction. The life of a person with chronic pain is bad enough without the dependency on narcotics, so the use of these medications except on an “as needed” basis for breakthrough pain is to be avoided. Can anything be done for the person with chronic pain? Yes, but the expectation should not be that the pain will be eliminated; it may only be reduced. Here are ways to deal with chronic pain without the regular use of short-acting narcotics: • Some antidepressants and seizure medications can

reduce the overall need for pain medication. • Treating the underlying problem (back surgery, for example) can reduce pain. • Injections of cortisone or local anesthetics, as well as procedures done to block pain by pain specialists can help in certain circumstances. • Long-acting narcotics (like Oxycontin, MS-Contin, or Duragesic/ Fentanyl patches) can be used to lower the overall pain level, allowing short-acting medications to be only used as needed for breakthrough pain. This is much less likely to cause dependency, relieves pain better than short-acting medications alone, and uses less medication in the process. These do, however, put the person at risk for withdrawal symptoms if stopped suddenly. If none of these work, the sad reality is that the person will have to live with the pain. Adding short-acting medication may offer shortterm relief from the pain, but the long-term problems it inflicts are far worse than any benefit they offer. I hope this helps you. I always want to have my patients feel the least amount of pain possible, but there are some things that may seem like they help in the short-term, but really cause problems much larger than the original pain. I will work with you to find ways to minimize the need for these medications. You should do everything you can to use them sparingly. Again, I am happy to take care of you, and this letter is an attempt to give you the best care I can. Sincerely: Robert Lamberts, MD I don’t want my patients to hurt, but I also don’t want to be party to hurting them more - even with the best of intent. I hope this letter helps them see. I hate to tell some people that they just have to feel pain, but unfortunately that is usually a better option than these medications. +

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IT’SYOURTURN! Your turn for what? To tell the tale of your medical experiences for Medicine in the First Person. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. See our “No Rules Rules” below. Thanks!

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.” “We had triplets.” “He was just two when he died.” “The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.” “I sure learned my lesson.” “The cause was a mystery for a long time.” “The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.” “I thought, ‘Well, this is it’.” seven years ago.”

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

Everybody has a story. Tell us yours.

Here’s our “No Rules Rules.” We’ll publish your name and city, or keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.

JULY 26, 2019

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GARDENVARIETY

Summer is burger season so I whipped up these thick and delicious vegan black bean burgers which are crispy on the outside and juicy inside. Everything in them creates a healthy burger your friends will rave about. You might wonder why use black beans for a burger. According to Medical News Today, there are many benefits. * Maintaining healthy bones: The iron, phosphorus, calcium, magnesium, manganese, copper, and zinc in black beans all contribute to building and maintaining bone structure and strength. * Lowering blood pressure: Black beans contain potassium, calcium, and magnesium, all of which have been found to decrease blood pressure. * Managing diabetes: Studies have shown that individuals with type 1 diabetes who consume high-fiber diets have lower blood glucose levels * Preventing cancer: Selenium, found in black beans, plays a role in liver enzyme function and helps detoxify some cancer-causing compounds in the body. Vegan Black Bean Burger * Weight loss: Dietary fiber is commonly recognized as an essential Instructions factor in weight management by Pulse the oats, walnuts and turmeric in a functioning as a “bulking agent” in food processor until they are finely ground. Add the digestive system. High fiber foods onions, mushrooms, beans, tahini, and ground increase the sense of fullness. flaxseeds. Pulse until well combined. Add the So give them a try! Making remaining ingredients and pulse to mix well. vegan burgers is quick and easy. All Pinch some of the mixture between your thumb ingredients can be tossed in a food and index finger to test if it holds together. If the processor, pureed into a smooth mixture is too wet, add more oats. If it seems to mixture, shaped into patties and baked. dry add 1 tablspoon of water at a time until you get the right consistancy. Vegan Black Bean Burgers Divide the mixture into 4 equal portions. Wet Ingredients your hands and shape each portion into patties • 1 cup old-fashioned rolled oats about a 1/2 inch thick. Place on parchment-lined • 1/2 cup walnut pieces cookie sheet. Put patties in refrigerator for 1 hour • 1/4 teaspoon ground turmeric before baking. • 1/2 cup chopped oinon Preheat oven to 375°. Place patties on cookie • 1/3 cup chopped mushrooms sheet in oven and bake for 25 minutes, flipping • 1-1/2 cups cooked black beans, well the burgers halfway through the baking time. rinsed and drained Bake until hot and lightly browned. Enjoy! + • 2 tablespoons tahini by Gina Dickson. “As a mother of six who • 1 tablespoon ground flax beat cancer, I want to share with you what • 1 tablespoon nutritonal yeast I’ve learned. Healing from cancer can take • 1 tablespooon dried parsley everything a mom has, yet you still want • 2 teaspoons white miso paste to love and care for your family through • 1 teaspoon onion powder the treatments. My blog is a community full of • 1 teaspoon fresh minced garlic encouragement for moms going through cancer • 1/2 teaspoon smoked paprika treatments who would like to use a plant-based • 1 tsp crushed red peppers (optional) • 1 teaspoon Savory Spice Blend or your vegan diet to complement their healing journey. www.thelifegivingkitchen.com favorite spice blend.

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JULY 26, 2019

CONTRACT CONFUSION

that spell out “what now?” good idea. A few good expec It’s like the old story of a tations should do it. town with a sharp curve on And be sure to only write a road at the edge of town. down consequences that Many cars had been totaled you’re willing to implement! when their driver didn’t make Most teens these days hear by Ken Wilson it around the curve. The big admonitions from their Steppingstones to Recovery topic of discussion in the city parents, and when they keep council was whether to install practicing negative behavior I suppose contracts are a a guardrail at the top of the it’s because they don’t believe little like speed limits. We embankment, or to station their parent(s). Why? Bekinda don’t like ’em, but an ambulance at the bottom cause they’ve heard the rules then again we need ’em to of the hill to pick up injured SO many times, and consehave safe roadways. Conpassengers. quences that aren’t impletracts are meant to be win So there are often more mented. So they don’t believe win, not win-lose. All parties ways than one to accomplish mom and dad. Or the husbenefit from a contract. something. Either way, a band doesn’t believe the wife In fact, everyday life is all contract is a valuable tool you because she never follows about contracts. How about can use with your loved one through with her promises. that shiny car you’re drivwhen addressing chemical A major point here is to ing…remember the contract? use in the family. It could have a written contract…not a It says “pay your payment look something like the examverbal one. When working for and you can drive the car; A monthly series by an Augusta drug treatment professional ple shown. a carpenter I learned that “the if you don’t pay, then we’ll Whatever form it takes, thinnest ink is better than the sneak up your driveway and our relationship and it’s gopaid.” the point is to have a clear best memory. Measure twice, pull it back to the dealer!” ing to be a bad day for you!” Yeah, life is a contract. understanding of the rules of write it down, & cut once.” Are you married? RememOr something like that. How Over and over. There are engagement, written out A verbal contract is hardly a ber those vows? “Don’t kiss about your job? “Come to prophylactic contracts (literand signed by all parties in contract at all. It’s only conoutside the relationship and work and you’ll get paid;” ally, “to guard before”) and a time of peace and before fusion. all will be fine…kiss outside “skip work and you won’t get after-the-accident contracts drama happens. Now, how do I know my I’ve drastically shortened child is alcohol/drug free? LIVING CONTRACT the format here for the sake Well, by administering drug EXPECTED BEHAVIOR REWARDS CONSEQUENCES of brevity, but do make this screens of course! We’ll dis1. Be alcohol/drug free Car 1st relapse: Lose cell, deal short! I’ve seen parents cuss those next month. Talk Insurance computer 30 days have 2-3 page contracts. Not a about confusion. Whew! + Place to Live 2nd relapse: move out WiFi 3rd relapse: live in a Headquarters for the well dressed man since 1963 Etc., etc., etc. halfway house for a yr. 2. (your choice here and following – can include grades, chores, curfews, etc.)

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AUGUSTAMEDICALEXAMiNER

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

HYPERTENSION AND THE DASH DIET by Isabelle Foster, MS-Dietetic Intern

Hypertension, also known as high blood pressure, is defined as having a blood pressure reading of 140/90 or higher. This condition affects over 100 million adults of all races, ages, and genders in the United States. High blood pressure can be caused by a number of factors, but is greatly influenced by the diet, lifestyle and genetics. Lack of exercise, overconsumption of foods high in sodium, sugar, trans- and saturated fats, excess intake of alcohol, and smoking cigarettes are all contributors to hypertension and its associated health conditions. Hypertension greatly increases the risk of heart failure, heart attacks, stroke, and kidney disease. Recommendations for those with hypertension include regularly exercising, losing weight if necessary, abstaining from smoking, limiting alcohol use, and following a healthy diet. The DASH (Dietary Approach to Stop Hypertension) diet has been proven to significantly lower blood pressure and improve health status when followed correctly. The focus of the DASH diet is on consuming a diet rich in natural, high fiber,

high nutrient-content foods such as vegetables, fruits, nuts, nonfat dairy, and lean meats while avoiding saturated and trans fats and excess sodium. Saturated fats are often referred to as the bad or unhealthy fats. They can be easily identified as the fats that are solid at room temperature such as lard, coconut oil, and meat fats. These should be avoided, or consumed in very small amounts. Sodium is an essential nutrient that is needed for

Please see DASH page 10

ARE YOU EXPECTING? WHY WAIT?

several important functions. However, excessive intake is negatively associated with several health conditions, including hypertension. The daily recommendation for sodium consumption is less than 2,300 mg per day, but data shows the average American consumes 3,400 mg per day. Many foods that don’t taste salty — like processed foods, frozen meals, and soy sauce — can be very high in sodium. Sugars in the diet should be limited and preferably should come from natural sources like fruits. It is essential that individuals make a habit of paying close attention to nutrition labels in order to avoid consuming foods with excess fats, sugars, and sodium. For example, a cup of soup with a turkey sandwich may have as much as 2,200 mg of sodium. Limit your intake of foods with 240 mg of sodium or higher per serving. A teaspoon of sugar is 5 grams, so a can of lemonade may contain as much as 7 teaspoons of sugar. In addition, limit eating out at restaurants, or choose places that provide nutrition information. Often the cooking process at dining establishments greatly increases the content of sugar, sodium and fat in foods due to the use of syrups, sugars, butter, oils, salt, and seasonings used to add flavor and color. Even seemingly healthy menu items may be poor choices due to high saturated fat, sugar and salt content. As one example, okra is a nutrient rich, low calorie vegetable. But when fried in batter, the fat and sodium increases: a cup of fried okra

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H H H H H 7/18/2019 Whenever I get a shot at the doctor, man, that like really gets under my skin, you know? + H H H H H 7/19/2019 I’m 83, and I still wear dresses that are skin-tight. Well, as tight as my skin, anyway. In other words, not really all that tight. +

Bertha T. Evans, GA

H H H H H 7/19/2019 I weigh 372 pounds. In my online dating profile I say I’m skinny, which is 100% true. After all, I’ve got more skin than any three or four of those stick-figure girls combined. +

Danielle G. Aiken, SC

H H H H H 7/20/2019 I had an appointment earlier this week with my dermatologist. She said I’m very thin-skinned. Personally, I find that comment to be highly offensive. +

Caleb M. Augusta, GA

H H H H H 7/22/2019 I’m in the Marine Corps, but currently I’m stationed at Ft. Gordon. In basic training we had to spend a week in the swamp down near Savannah. You don’t know survival training until you’ve had spiders and centipedes all over you while you try to sleep. That made my skin crawl. The rest of me did plenty of crawling too. +

Ann H. Martinez, GA

H H H H H 7/23/2019

Grant D. Beech Island, SC

JULY 26, 2019

I work in the emergency room at the largest animal hospital here in the CSRA. Why? Because people disgust me. Why? Because of something I used to think was just an old saying. But no, it turns out there really is more than one way to skin a cat. What is wrong with some people??? +

is approximately 250 calories with 80 mg of sodium. However, a healthier cooking method such as steaming will have less than 40 calories and 7 mg of sodium. Sauces and condiments are other sneaky high sugar, sodium, high-fat additions that may seem to be small quantities but can quickly add up and may impact blood pressure. Additional information on diet and health, can be found at www.eatright.org. The website is owned and managed by the Academy of Nutrition and Dietetics. They are the largest body of nutrition experts (Registered Dietitian Nutritionist) that are trained and certified in the field of nutrition and dietetics. +

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H H H H H 7/23/2019 On the 4th of July I suffered pretty extensive burns on my upper body in a fireworks accident. Well, there was some gasoline involved too. I’m slowly recovering, fighting off infections, working through the pain, the physical therapy, getting skin grafts. But hey, it’s no skin off my nose. It’s more like my arms and back if you want to get technical about it. +

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The blog spot From the Bookshelf — posted by Michele Luckenbaugh, a patient, on July 20, 2019 (excerpt)

THE WAIT IS AGONIZING What follows is a compilation of the thoughts and emotions that I have experienced as I “grin and bear it” on my trips to a lab annex or imaging department. I think I can safely assume that others will be nodding their heads in agreement as they read through what follows. The point being, doctors, nurses, lab techs, etc., we are indebted to you for your skill, knowledge, and training. But please realize that many times when we are scheduled for a medical test, we as patients catch our breath and do not exhale until we see results posted. Doctors, get back to us in a timely fashion with these results. At this point, be patient and compassionate as you interpret and discuss those results with us. Allow us to ask the questions we need to. We did not go to medical school, so what is common everyday language for you is not for us. Knowledge is a vital tool in knowing how to proceed and dealing with the problem. How you go about doing this, can mean all the difference in the world as to how the rest of our health story unfolds. I want answers. I want to know why this is happening to me. Facing the adversary directly is better than living in a state of limbo. I need the opportunity to formulate a plan of attack. I need to restore a degree of control. Hopefully, by coming to this place, I will have a chance for resolution. I sit anxiously awaiting to hear my name. Those around me also look to be in suspended animation. Each pausing his life to be here, each awaiting his turn to begin the unraveling, each wanting to be elsewhere. My name is called out, breaking the silence and tension in the room. I follow obediently back to an alternate space to have a small sample of my life’s blood packaged in a pristine vessel that is to be passed on to those who know. Will they be the ones to find answers for me? I leave with my mind filled with unknowns. I search to find other random items to fill the void. Trying to create a distraction, I walk along a woodland trail. There I see a pair of squirrels frolicking on the branches above my head unaware of my existence; a rabbit is joyously munching on virgin blades of grass. Life is simple for these creatures, each merely enjoying the present moment. They are unaware of the skirmish going on in my mind. I envy them. Minutes turn into hours as the hands of the clock move in slow motion. I want to know, but I find myself frozen in time. I try to be a participant in what is going on around me, but my mind is elsewhere, impinging on any sense of enjoyment. Others go about their routines without knowledge of the voices in my mind which are urging me to block the fear, the wondering and to move on with living. I acquiesce and check the site that tells my life’s story, at least that portion which pertains to my health. Theoretically, it is all-knowing, impartial, and void of emotion. I see an entry. Do I go further, or do I remain in a state of ignorance? I opt for the former since the day has dragged on far too long. As my eyes scan over what is before me on the cold and impartial screen, there are words that I cannot even pronounce, and there are words that make my heart pound faster, my breathing to accelerate: suspicious, inconclusive, cause for concern, further testing indicated. The hope that all would be resolved has been dashed. The power to make sense of this lies in the hands of my healer. For right now, I take a deep breath and gather the determination to undertake round two of the skirmish with the hope that I will receive my answers. And so I wait, alone with my thoughts. + Michele Luckenbaugh is a patient.

NEXTISSUEAUG9

Kirkus Review: “A doctor’s experiences in a unique corner of the medical world.” At Laguna Honda Hospital in San Francisco, the doctors and nurses provide long-term care for the sick poor; the working and living environments are unlike that of any other hospital in the country. Physician Sweet accepted a job at Laguna Honda since they were willing to offer her a part-time position (extremely rare at the time), and she was interested in continuing to practice medicine while simultaneously pursuing a doctorate in the history of medicine. What was originally supposed to be a months-long stopover turned into a career spanning more than 20 years and countless life-altering realizations about the nature of medicine. In the dozen or so patient success stories, Sweet’s warm, anecdotal style shines brightest. The author’s compelling argument for Laguna Honda’s philosophy of “slow medicine” will make readers contemplate if perhaps the body should be viewed more as a garden to be tended rather than a machine to

be fixed. UTNE review: At Laguna Honda Hospital in San Francisco, the last almshouse in the United States, health care is almost unrecognizably, well, hospitable. A nurse knits blankets for the patients in her care, and multi-bed wards invite positive social interaction between the long-term and the terminally ill. Time is an ample resource for gardening, for community, and, most importantly, for healing. But even this oasis of humane care is not free from the pressure to maximize efficiency:

A changing administration threatens to pull Laguna Honda into the fast-paced world of modern medicine, where doctor-patient relationships are sacrificed and hospital stays are cut to the minimum. This is where Dr. Victoria Sweet discovers that inefficient health care—the kind that allows a doctor to make an unhurried and accurate diagnosis, and to demonstrate commitment to the patient’s healing process—may be the most cost-effective approach. Sweet paints a dynamic portrait of Laguna Honda over a 20year span, taking sabbaticals for a PhD in Hildegard von Bingen’s premodern medicine and a 1,200-mile pilgrimage to Santiago de Compostela that inform her philosophy on the merits of slow medicine. God’s Hotel by Victoria Sweet is at its core testimonial to the body’s remarkable ability to heal when it is provided with the simple ingredients of time and care. + God’s Hotel — A Doctor, A Hospital, and a Pilgrimage to the Heart of Medicine by Victoria Sweet, 432 pages, published in 2013 by Riverhead Books

Research News Save your money A massive analysis of nearly 300 clinical studies published last week by Johns Hopkins Medicine researchers has found that nearly all vitamin, mineral and other nutritional supplements and diets have no connection to longer life or protection from heart disease. Despite this study and many like it, statistics show more than half of all Americans take some kind of dietary or nutritional supplement daily. Collectively we spend $31 billion each year on such overthe-counter concoctions despite their questionable value. You might have noticed in paragraph one that nearly all supplements and diets have no value that can be clinically proven. There are exceptions, says Johns Hopkins. The analysis showed possible health benefits only from a low-salt diet, omega-3 fatty acid supplements, and possibly folic acid supplements for some people. Although most

supplement and diets were not harmful, researchers found that supplements combining calcium and vitamin D may in fact be linked to a slightly increased stroke risk. (See also following story.) Why cavemen died young? An Australian study published July 22 found that people who follow the Paleo diet (a diet that presumes to mimic the “cuisine” of Paleolithic times; also known as the caveman diet) have double the levels of a key biomarker for heart disease compared with people on a normal 20th century diet. Researchers theorize that the Paleo diet’s avoidance of whole grains might be the culprit. That absence was associated with a sharp decrease in beneficial gut bacteria and higher concentrations of bacteria that produces the heart disease biomarker. Researchers say these early findings may lead to the

discovery of other negative consequences from Paleo eating. Remember this The online journal of the American Academy of Neurology reported July 10 about a new study which has found that mentally stimulating activities like playing puzzles and games, using a computer, crafting, and participating in social activities are linked to a lower risk or delay in age-related memory loss (officially known as mild cognitive impairment, or MCI). What makes the finding significant, say study authors, is that there are currently no drugs that effectively treat MCI, dementia, or Alzheimer’s disease. The study found that the more activities people were engaged in, the less likely they were to develop MCI. Ity included some 2,000 participants with an average age of 78. +

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AUGUSTAMEDICALEXAMiNER

The Examiners +

by Dan Pearson

I’ve got a ton of stuff to do today... mow the Try to get as much done as you lawn, cut down that can before it gets too hot. And be sure to use sunscreen. dead tree...

No need for that.

Like you said, do it And you wonder before it gets too hot. I’ll why the neighbors probably have it all done hate us. before sunrise.

Why not?

PUZZLE ACROSS 1. Wound aftermath 5. Jefferson of note 10. _____ville, SC 14. _____ deaf 15. Show emotion theatrically 16. Still 17. Individual facts 18. Male servant 19. Sewing case 20. Backyard astronomer 22. Opposite one of two 23. “First, __ __ harm” 24. ______ ant 26. Fire residue 29. Lair 30. Final part 34. Lab test (Med.) 36. Maker of pewter utensils 37. Blocker beginning? 38. Augusta’s downtown and uptown _____ 39. A church’s central part 40. Supervisor 43. Academic essays 45. Architectural column in the form of a man 46. Period of history 47. Trauma pt. destinations 48. Think; be absorbed in thought 49. Short letter 51. One of the Jacksons 54. Red disk on a bicycle 59. Impressed 60. Christmas song 61. Home of Columbus 62. Inhibitor lead-in 63. Useful; advantageous 64. Contact _____ 65. Out of _____; not working well together 66. Tall and thin 67. Like a printer’s fingers

24 29

38 41

46 48 52

47 50

We’ll announce the winner in our next issue!

6 9

1 4

S U D O 4 K 9 U

5 9 6

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

DOWN 1. Genital herpes, HIV, etc 2. Outer garment 3. Rectangular pier 4. Facial hair 5. Former Augusta mayor 6. River in South America 7. Small burrowing rodent 8. Repeats 9. Adjust, as a clock or alarm 10. Gas used in metal cutting 11. Word before salt or mat 12. Cyanotic 13. Islamic chieftain 21. Deities 22. Leave out 25. Uncooked 26. Head of an abbey 27. “My mind is like a ____” 28. Vacation lodging 31. Efface 32. Not at any time 33. Apparel 35. Ambulance worker

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, AUGUST 5, 2019

E X A M I N E R

23 26

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

36. National standard? 38. Put on a pedestal 41. Porn 42. Greek goddess of the dawn 43. Aiken’s ______ Line Road 44. Detest 46. Envelop 50. Famous bacteria 51. Sticks 52. Out of town 53. Vegas trademark 55. Great Lake 56. At that time 57. Hog sound 58. Promising or optimistic, as a view of the future 60. Mongrel dog

Solution p. 14

QUOTATIONPUZZLE E N O V H N Y M I S E S E E

S R C T H E O W O U E A T G H E

R E S H

Y R S E V E E G E H

7 8 1 4 6 9 9 6 R P H 5 3 O W T 2 1 A P3 2 4 7 8 5 — Oscar Wilde

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

1. 356 (tree) ___

6. 54627 (tree parts) _____

2. 62753 (tree) _____

7. 8944 (tree part) ____

3. 625 (tree) ___

8. 7463 (tree) ____

4. 2275 (tree part) ____

9. 23324 (tree) _____

5. 945569 (tree) ______

10. 727723727 (tree) _________

INSTRUCTIONS: Use keypad letters to convert numbers into the words suggested by the definitions provided. There is often a theme linking all answers. Sample: 742 (body part) = RIB. Answers on page 14. The first issue of each month contains a “Words by Number” puzzle in this space; the second issue contains a “Text Me” puzzle.

TEXT

THE MYSTERY WORD The Mystery Word for this issue: RUTUES

EXAMINER CROSSWORD

JULY 26, 2019

2 3 5 7 8 4 1 9 6

3 7 8 4 1 6 9 5 2

9 5 4 3 2 7 8 6 1

6 2 1 8 9 5 7 3 4

JULY 26, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

f Jesus and Poseidon ever fought, Jesus would walk all over Poseidon.

A guy hitchhiking finally got a ride. He got in the car and as the driver pulled into traffic he said, “Thanks! People sure don’t pick up hitchhikers like they used to back in the day.” “Yeah,” said the driver. “Seems like everybody’s scared that they’re going to pick up Jack the Ripper, you know?” “I know what you’re saying,” said the hitchhiker. “But realistically, how do you know I’m not a serial killer?” “I figure the odds of two serial killers being in the same car are astronomically low,” said the driver. Moe: I just spotted an albino Dalmatian! Joe: I suppose it was the least you could do. Moe: I don’t understand cloning. Joe: That makes two of us. Moe: Did you hear what happened to me last night? Joe: No, what? Moe: A burglar broke into my house in the

The

Advice Doctor

middle of the night looking for money. Joe: What did you do? Moe: I got up to look too.

Moe: My grandfather died last week in California. Joe: I’m so sorry to hear that. Moe: I’ll sure miss him. He always gave me words of wisdom. One of his favorites was, “Don’t be too quick to find faults.” Joe: Good advice. Moe: Not in his case. He was a fine man but a terrible seismologist. A couple moves into a new apartment and they decide to redo the wallpaper in their dining room. They meet one of their neighbors who has a dining room the same size with new wallpaper, so they ask,“How many rolls did you buy when you papered your dining room?” “Seven,” says the neighbor. So the couple buys seven rolls of expensive paper and they start papering. By the end of the fourth roll, their dining room is finished. Annoyed, they go back to the neighbor and say, “We followed your advice and ended up with three extra rolls!” “So,” he says, “that happened to you too.” A man walked into a restaurant and approached the hostess desk. “Hello, I’m John Smith and I have a reservation for 8 p.m. Is my table ready?” “Not yet, Mr. Smith, we’re running a little behind. Do you mind waiting?” “No, not at all.” “Great, take these salads to table six.” +

Why subscribe to theMEDICALEXAMINER? What do you mean? Staring at my phone all day has had no Effect on ME!

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

Dear Advice Doctor, I have been a manager for a number of years, and I always thought I had a really good knack for pairing the right person to the specific job that perfectly matched their skills. For the past couple years, though, it just isn’t working. My boss supports me: he says this new generation just doesn’t know the meaning of work. But I wonder if I’m losing my touch. Can you offer any advice? — Just not feeling it these days Dear Just, If it makes you feel any better, this is not exactly an uncommon experience. When you consider how many possible causes there are, it’s no wonder that most people have the same feelings you’re having — or actually not having — right now. Some of the reasons people lose their sense of touch are quite benign: it could be as simple as sitting or standing in the same position for a long time, or sitting with your legs crossed. That can cause someone to lose their touch temporarily. Some people lose sensation in their hands due to chronic repetitive motions at work (even simply typing on a keyboard)or from the vibrations from long-term use of power tools. Of course, there are medical reasons, too. Perhaps a herniated disc is putting pressure on spinal nerves, and the result could be numbness or tingling. Diabetics are all too familiar with peripheral neuropathy, a condition where nerves relaying sensations from the extremities — legs, feet and hands — are damaged. The loss of touch can have serious consequences. For example, a person with diabetes could walk around all day with a pebble in their shoe and not feel it. A sore could develop and become infected, and unless they visually inspect their foot they might never be aware of the issue. In extreme cases, amputations can result. The best strategy for loss of sensation is to seek medical care as soon as possible. Early diagnosis of the exact cause can reduce the possibility of further nerve damage and lead to the most effective treatment. I hope this answered your question. + 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 the Examiner.

SUBSCRIBE TO THE MEDICALEXAMINER +

Why read the Medical Examiner: Reason #208

By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area, or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY STATE ZIP Choose ____ six months for $20; or ____ one year for $36. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

4 7 +814 6

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

...cleverly hidden on the attorney’s blouse in the p. 7 ad for FLOYD & LEOPARD ATTORNEYS AT LAW

THE WINNER: CRYSTAL LYNN! 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 S T D S

C O A T

A N T A

A B B O T

S I E V E

H O T E L

J A M S

A W A Y

N E O N

B D E E A V R G A D O N D E P S Y A R S E A M O M U S E T D C I U C R

A M A Z O N

V O L E

I T E R A T P E V A S E R N E E N R E F A R O T I L E E D

S E T

O R M A I W T T R O L L E Y

A C E T Y L E N E

B A T H

B L U E

E M I R

E R A S E

N E V E R

D R E S S

O I N K

R O S Y

H A T E E C T O H L E I N

SEE PAGE 12

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

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

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

JULY 26, 2019

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QuotatioN QUOTATION PUZZLE SOLUTION “Some cause happiness wherever they go - others whenever they go.” — Oscar Wilde

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JULY 26, 2019

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An archive of past Medical Examiner issues is available online at

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

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They’re here! The world’s most salubrious mugs, created for us by the artists at Augusta’s Tire City Potters, are here! Win a chance to get one by entering our celebrated Mystery Word Contest!

JULY 26, 2019

THANKS ALSO TO OUR CONTEST CO-SPONSORS

LOOK FOR THE MYSTERY WORD IN EVERY ISSUE!

VISIT ISSUU.COM/MEDICALEXAMINER, WHERE MORE THAN 185 ISSUES OF THE EXAMINER ARE ARCHIVED FOR YOUR READING PLEASURE.

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