June17 16 by Daniel Pearson

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MEDICAL EXAMINER THE BIG O recipe feature PAGE 7

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HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

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nyone who follows health news even casually hears The O Word — obesity — constantly. Obesity is blamed for this malady and that one; obesity elevates your risk of suffering from this list of conditions, and that one too. More recently, simple obesity doesn’t seem to be big enough. We’ve now enlarged it to morbid obesity. A synonym for fat isn’t sufficient; now it needs to be morbid: “ghoulish, gruesome, disturbing, macabre,” as one dictionary defi nes the word, as in “Bob had a morbid fascination with torture and death.” Let’s clear the air: what exactly is obesity? And while we’re at it, what is morbid obesity? The basic determination starts with a person’s Body Mass Index (BMI), a general measurement of body fat derived from a simple formula based on height and weight. Simply put, BMI is weight divided by the square of a person’s height. The web is swimming with online BMI calculators, so it’s easy for anyone to determine their BMI. The numbers tell the story: • A BMI lower than 18.5 says you’re underweight. • A BMI between 18.5 and 24.9 is considered normal. • A BMI between 25 and 29.9 is defined as overweight. • A BMI between 30 and 39.9 is considered obese. • A BMI above 40 is defined as morbidly obese. Unfortunately, it doesn’t stop there. BMI readings above 45 belong in a beyond-morbid category called super obesity. There is a difference in the definition of morbid between your doctor and, say, Freddy Krueger. In the world of horror, morbid means “characterized by or appealing to an abnormal and unhealthy interest in disturbing and unpleasant subjects, especially death and disease.” In medicine, morbid indicates something “indicative of or characterized by disease.” In other words, someone who is morbidly obese is asking for trouble. In fact, obesity (even without the morbid add-on) is one of the leading preventable causes of death worldwide. In the United States, obesity and its resulting constellation of risks, problems, and actual diseases is estimated to be the cause of some 365,000 deaths each and every year. On average, garden variety obesity shortens life by six to seven years, while a BMI over 40 reduces life expectancy by an average of ten years. What causes obesity? At an individual level, most cases are Please see OBESITY page 16

Babies should sleep on their backs

Kid’s Stuff NOTES FROM A PEDIATRIC INTERN by Caroline Colden, M.D.

Sudden Infant Death Syndrome, or SIDS, is a heartbreaking topic. Unfortunately, babies still die of SIDS today, although the rates and statistics are improved compared to several decades ago. SIDS describes a case of unexpected, unexplainable death in an otherwise healthy baby less than 1 year of age, with no identifiable cause or reason for death. A great deal is still unknown about SIDS or why it happens. Most babies who suffer from SIDS will die in their sleep, and the most common age for SIDS to occur is among 3- and 4-month olds. Infants who seem to be at higher risk for SIDS include those babies who are born early and/or very low in birth weight. This suggests that their brains and thus the respiratory control centers are not fully matured and thus their breathing could be impaired. Other identified risk factors include exposure to tobacco or tobacco smoke

either during pregnancy or in the home; other substances such as alcohol or illicit drugs during pregnancy can negatively affect the baby’s growth and development as well. Breastfeeding has been shown to be protective in some studies. It is believed that infants sleeping on their bellies or sides contributes to SIDS, which brought about the “Back to Sleep” campaign. “Back to Sleep” encourages parents to place their babies on their backs for sleep so they do not accidentally suffocate themselves laying face down. Cribs or bassinets are also to be flat, not too soft, and free of excessive blankets/toys, etc. This reduces the risks of the baby’s nose and mouth being covered. The most important risk factor to avoid is cosleeping with the baby, or allowing the baby to share a sleeping space with anyone or anything Please see SIDS page 2

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SIDS… from page 1

REGISTRATION NOW OPEN! Camp IVEY is July 25-30, 2016 and registration is required. Open to children ages 7-14. Camp IVEY is an overnight, adaptive camp with the purpose of empowering high functioning children with developmental disabilities by promoting independence in life- skills, relationships, physical activity and leisure, communication, and self-confidence through recreation and the arts. Camp IVEY will take place on the scenic shores of Camp Lakeside at Lake Thurmond. Activities include archery, swimming, canoeing, disc golf, hiking, arts and crafts and more! Camp includes one overnight.

that could roll over on top of or against the sleeping baby and accidentally crush or suffocate it. For that reason, parents are highly advised against sharing a bed with the baby. Babies should also not share beds with other babies or siblings. That being said, sharing a room with the baby and the baby’s crib, is very much recommended to parents. This way they can much more closely monitor the infant during the night and intervene more quickly if needed. It is well-known that taking care of a newborn baby is exhausting, but parents are

encouraged to take care to not let themselves get too tired or else their vigilance and ability to protect their baby from risky situations could be affected. Similarly, over-heating and medications that increase a baby’s level of sedation and sleepiness should be avoided so that caregivers can ensure the baby’s sleeping pattern and location are safe. There are likely multiple

other factors that contribute to a baby’s risk for Sudden Infant Death Syndrome. Overall, there is much to still learn about SIDS. We still do not have all the answers or a fail-safe plan for parents to employ to protect their baby. All we can do at this time is use what we know and spread the word to as many parents as possible. +

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AUGUSTA MEDiCAL EXAMINER

The

PROFILES IN MEDICINE

Advice Doctor

presented by Queensborough National Bank & Trust Co.

The Great Escape

he life story of Augusta’s Dr. Hermann Orlet, a plastic and reconstructive surgeon with the Joseph M. Still Burn Centers, reads like a script for a Hollywood movie. It includes World War II and the Nazis. It has rags, if not riches. It has plot twists. There’s a love story woven through the action scenes. And it has a happy ending. It all begins just before World War II in Czechoslovakia (now known as the Czech Republic) where his German parents were living at the time of his birth in 1939. As a toddler, Dr. Orlet remembers a conversation his mother got into with another woman while waiting for a doctor’s appointment. “We should join with the Americans to fight the Russians and win the war,” his mother said. Two men there who happened to be Gestapo agents overheard her remark. They took down information about who she was and where the family

+ Dr. Orlet served as a flight surgeon in the USAF lived. Two short weeks later Mr. Orlet was inducted into the German Army, where he was captured on his very fi rst day of action and sent to Siberia. The family would not see him again until 1946. That began a vagabond existence across parts of Czechoslovakia, Germany, Austria and Hungary for the future doctor, his mother and siblings that lasted a year and a half. “We stayed wherever we could find food and shelter,” recalls Dr. Orlet. A chance event in Budapest after the war got mother and children back to Germany

and led to the family being reunited. In 1955 the Orlet family moved to the United States, settling in Toledo, Ohio. The future doctor worked as a teenager as a scrub tech at two hospitals, and although thousands of miles from his homeland, he found himself thinking often of his longtime girlfriend — and longtime is no exaggeration. “We met when we were 7,” explains the girlfriend, now Marianne Orlet. “In 1958,” says Dr. Orlet, [at age 19] I went back to see Please see PROFILES page 10

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

P R I VAT E B A N K I N G Queensborough Private Banking provides professionals and executives with a comprehensive approach to

Dear Advice Doctor, I have a long-time friendship that seems to be on the rocks. She has always had my back through thick and thin, but lately she will look cross-eyed at me over the tiniest offense. I’m not sure if she’s getting sick of me or if she’s just generally cranky, but I’m definitely getting sick of her — at least her attitude. Do I consider her a toxic friend and pull the plug, or should I trust that this will blow over? — Battered Friend Dear Battered Friend, I’m sorry you and your friend are going through this rough patch, but situations like this can usually be corrected, and ironically enough, a patch is often exactly what is needed. The technical term for what your friend has is strabismus (pronounced struh-biz-muss), a condition where one or both eyes don’t properly align. The non-aligned eye(s) may turn inward, outward, up or down. The result may be what people call crosseyed (one or both eyes looking inward, as at the bridge of the nose) or wall-eyed (one or both eyes looking outward). Sometimes people with strabismus will experience double vision, but the brain usually learns to disregard the visual input of the wayward eye. Treatment for strabismus can be surgical, but usually the preferred route is exercise to train and strengthen eye muscles. Covering the “good” eye with a patch for hours at a time forces the “lazy” eye to work, and over time that eye will properly align. Children with strabismus do not outgrow the condition. For adults, doctors say it’s never too late to get treatment. + Do you have a question for The Advice Doctor about love, life, personal relationships, career, raising children, or any other important life topic? Send it to News@AugustaRx.com. Replies will be provided only in Examiner issues.

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

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

#24 IN A SERIES

Who is this?

OLD NEWS +

POINTS OF INTEREST TO FORMER KIDS by Trisha Whisenhunt, Senior Citizens Council

THE MTV GENERATION AND MONEY FOR NOTHING

his gentleman is one of the more curious figures in the history of medicine. As you may be able to see from his signature, his name was William Gull. Sir William W. Gull, in fact, 1st Baronet of Brook Street Born to a humble family, Gull rose through the ranks of the medical world to the point where he received an honorary appointment to the medical staff of Her Majesty Queen Victoria and also successfully treated the Prince of Wales during a life-threatening bout with typhoid fever. Gull was born aboard a barge, The Dove, owned by his father on the last day of 1816. By age 21 he was an apprentice at Guy’s Hospital under the sponsorship of the local rector’s uncle, the hospital’s treasurer. With this experience and support, Gull received a degree at the recently founded University of London in 1838 with honors in physiology, comparative anatomy, medicine, and surgery. He returned to the university for his M.D. degree, earned in 1846. Gull distinguished himself in several ways during his decades in medicine: he advanced the knowledge and understanding of Bright’s disease, myxoedema, paraplegia, and anorexia nervosa (a condition for which he coined the name). He was also noted for his support of women in medicine at a time when women were discouraged from entering the profession. He was vocal in his support of female physicians and helped establish a medical scholarship for women named after Frances Helen Prideaux, a gifted University of London medical student who had recently died from diphtheria. Gull left behind a number of aphorisms that are still relevant today. Among them: • “Fools and savages explain; wise men investigate.” • “I do not know what a brain is, and I do not know what sleep is, but I do know that a well-fed brain sleeps well.” • “The foundation of the study of Medicine, as of all scientific inquiry, lies in the belief that every natural phenomenon, trifling as it may seem, has a fi xed and invariable meaning.” • “Never forget that it is not a pneumonia, but a pneumonic man who is your patient. Not a typhoid fever, but a typhoid man.” Most curiously, Gull has been intermittently suspected in dramatic and fictional accounts of being the infamous London murderer Jack the Ripper of 1888. He has been exonerated by historians about as often as he has been accused, but the suspicion seems to continue to linger. Gull died in 1890 at age 73 after suffering a series of strokes. +

esse Watters, a correspondent for Fox News, conducted an informal poll of several people in New York City’s Central Park. The questions were: What would you like to see the government give you for free? and, How do you think it will be paid for? Those polled were Millennials, members of the generation born between the years 1982-2002. There are more than 81 million of them and they are now the largest generational group in the United States. Wikipedia labels them as the worst generation. That remains to be seen, but they aren’t off to a very good start given the attitude of some. In answer to the question, “What would you like to see the government give you for free?” the answers ranged from massages and yoga classes to food, specifically bacon and alcohol/marijuana. Also thrown in the mix were health care, housing and college tuition. One man said the government should provide “All of our necessities but at a much higher standard than the

Salvation Army.” How did they think all of this would be paid for? The gentleman with the Salvation Army comment said the money would come from the U.S. Treasury. All others, with a shrug of the shoulders or a giggle had no answer; no clue as to who would pay their bills - just not them. Before we despair of the future of the nation, not all Millennials have such a sense of entitlement. There are plenty of good kids out there, going to school, working, and setting admirable goals for themselves. Let’s keep a good

thought that one of them will make it to the White House one day. Here in Augusta, it sometimes seems as though many of our young people are either in jail, going to jail or just getting out of jail. Maybe if there was more support from the judicial system to keep families intact instead of being so ready to send our most precious resource through the pit of the penal system, more of them might stay in school. If the school system reflected the desires of the parents (as they are intended to) it would certainly help as well. In fairness, teachers do have their work cut out for them, but they don’t pick up the phone to call as they once did. No one is checking to see if Johnny is really home sick or is out running the streets. Too busy they say; then hire a person to make the calls. There needs to be a stronger partnership between the schools and home instead of just throwing them into detention, suspending, or expelling them and throwing them out. This is not merely a family problem; it’s community problem. These young people with their focus on themselves will be in positions of power and responsibilityeventually and if we expect to see compassion for the sick, disabled and elderly, we better start getting the message across quick that there is no free lunch. This country was build from hard work and sacrifice. It didn’t get downloaded from an app. +

MYTH OF THE MONTH Milk: in sickness

and in health?

It’s a common belief in some circles that it’s a bad idea to let children drink milk when they have a cold. The reasoning goes that the milk will cause them to have more mucus and thus worsen the cold. Is that fact? Or myth? The truth is, there is nothing about milk that will induce mucus production. Drinking milk will not thicken existing mucus, nor will it cause or exacerbate chest congestion. In fact, when children have a fever they often refuse to eat. Fevers have a way of

taking away appetite. In such cases, milk is a good choice by providing a food that is easy to sip and which provides protein and hydration. You can make it even better by throwing in some honey or banana and blending the mixture into a healthful shake. The exception would be if a child is vomiting, in which case clear liquids are temporarily a better option than milk. + — by F. E. Gilliard, MD, Family Medicine 4244 Washington Road, Evans, GA 30809 706-760-7607

JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW res? k good eno r skin can ugh cer? son.”

o k

omen: Smelling good and looking good will put a man in your bed. Cooking good will keep him there. Men: If your woman washes your clothes, cooks your food, and warms your bed at night ... and if sometimes she gets out of sorts and gives you some lip about something you did or did not do ... take it like a man and do not talk back. She deserves better than you, and you are lucky she will keep you. Men & Women: If the grass looks greener on the other side of the fence, make sure it is not over a septic tank. Women: Never invite a man who does not have a shaving kit in his car to spend the night at your place. There are probably other things he is not properly prepared for as well. Men: When dining with a lady, always eat the peas or beans ... never mind that you don’t like them. They are a good source of protein and vitamins and she will think you are healthy eater ... when

ABOUT WISDOM FOR THE MODERN AGE

compared to whatever jerk she dated before you. Women: If you cook beans for a new man and he eats one helping, he is being polite. If he goes for seconds and is not a vegetarian, you are high up on his list of things to do. Men & Women: If some club or group does not invite you to be a member, don’t worry about it. It probably was not worth the effort anyway. And if they do invite you, be careful. Obviously they think your membership will improve the club. That means most of the members are less deserving than you, so you may not want to be a member of any club that would accept you. Men: If you think a certain woman looked better the night before than she did the next morning, don’t be harsh. Most likely she is thinking even worse of you. Women: Don’t date any man who does not like children. Remember, he used to be a child and if he did not like himself as a child, he is not a good candidate

t s e B for marital bliss. And if you think “I change him,” you are wrong. Men & Women: What do you call couples that use the rhythm method of birth control? Parents. Men: No woman wants to see dirty underwear on the floor. Women: Three things you should keep well fed, fat and happy: Puppies, ponies, and husbands. Men & Women: The smell of tobacco smoke never turned anyone on. Men & Women: If you are fat and ugly, getting a tattoo on your ankle when you turn 40 will not make you sexy. Men & Women: Getting

e n i c i d ME

a tattoo in some foreign language that you cannot read does not make you spiritual ... or intellectual. Women: Wearing bootcut jeans and high heels is advertising. Wearing slim fit jeans and spike heels is solicitation. Ladies advertise. Ladies of the Night solicit. Men: When trying to predict what your lady will look like in 30 years, look at her mother. Men: After you finish eating a home-cooked meal, scrape you plate clean in the trash can, and put your empty dishes in the sink. Do not put them in the dishwasher. Every woman knows men do not know how to load a

dishwasher properly. It is not in their genes. Women: If a man will not go to church with you, you should not go to bed with him. Women: If you are divorced and have kids ... and your new man of interest does not like your kids, keep your panties on and your skirt down ... and block his number in your phone. Men & Women: Beware of the person who seems to know everything. The wisest of men know very little because they realize how much they don’t know. + Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor - and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology.net or 706306-9397. F REE T AKE-HO ME CO PY!

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The Augusta Medical Examiner’s publisher, Daniel Pearson, has continuously published a newspaper in Augusta since 1990, longer than any other publisher in Augusta except the gentleman to the right, publisher of The Augusta Chronicle, “The South’s Oldest Newspaper,” founded in 1785. We’re still wet behind the ears, but proud to have served Augusta area readers for more than a quarter of a century.

William S. Morris III Founder, chairman and CEO of Morris Communications and publisher of The Augusta Chronicle.

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AUGUSTA MEDiCAL EXAMINER

Metamorphosis of My Greatest Fear by Naomi D. Williams My greatest fear acknowledged well before conception Only to enter the parenting world via rude introduction. A rollercoaster of emotions from one end of the spectrum to the other Arms and legs wrapped tight as I cling and smash against this violent pendulum called life.

THE MONEY DOCTOR Why Your Savings Rate Matters In previous articles, we have discussed the importance of understanding different metrics (net worth, savings rate, withdrawal rate, tax rate, etc.) given your financial situation. Let’s take a deeper dive to help you understand the importance of your savings rate. Your savings rate is the percentage of personal income saved based on your total gross personal income received during a period of time. A negative rate means you spend more than you receive. So, if you receive $5,000 this month and save $1,000 your personal savings rate equals 20 percent. For those in the accumulation phase, we like to see a 15-20 percent savings rate toward retirement. Your overall savings rate may be more than 20 percent when you include all other savings goals and debt payoff. So why the 15-20 percent savings rate? The math behind reaching financial independence is fairly simple. By making a few basic assumptions in this case a 5 percent real investment return and 4 percent real withdrawal rate you come up with the accompanying chart. Using the chart you can see how it works, if you make $100,000 per year and save 50 percent then you only need your investments to provide $50,000 per year in income and you can reach that point after about 16 years. If you save 10 percent then you need your investments to provide $90,000 of income which would require 50 years of savings. For a person that starts working around the age of 18 to 22, saving 15-20 percent each year will help you reach financial independence in 36 to 42 years or between 55 and 65 years old. When you are young starting the saving habit from day one, doing it consistently each year, and not touching the money are key. As your savings start to add up, working with a fee-only financial planner to help you understand all the other items you need to consider will help keep you on track. It is important to note that the chart and example above over simplify retirement planning as it excludes pensions, Social Security, tax planning, long-term care planning along with many other factors that we help our clients consider when planning for retirement or other saving goals. The numbers in the chart give you a feel for how important saving consistently over time can

be. They also demonstrate how living below your means and on a smaller part of your income helps you save more and reach future goals quicker. Beyond reaching financial goals, saving money as part of your lifestyle has other significant benefits. Psychologists have studied the impact of individual’s financial habits on their overall health and wellbeing for many years. They have found that practicing good financial habits such as having a healthy saving rate will help you experience lower levels of stress. Dr. Utpal Dhalokia says, “making saving a part of one’s lifestyle has broad-based psychological and tangible benefits”. These tangible benefits are something all members of your family will benefit from. It is not surprising that studies have found a link between saving habits and the health of children or our future generations. A recent study by UCLA researchers found that children in households with less than three months of savings had a substantially higher risk of obesity and chronic illness and worse overall health than households with more money set aside. Given that children learn the majority of their financial habits from family and friends, it is especially important that we take the time to monitor our own saving habits which will help us demonstrate and teach future generations the habits which will lead to a healthy lifestyle. Savings rates are something we really enjoy helping clients evaluate and understand. The discussions we have with clients provides an overall peace of mind, promotes living a healthy lifestyle, and ensures they pass on positive habits to future generations. This summer is a great time to evaluate your savings rate as you may be surprised what you find. A few small changes can make a big difference over time not just for your financial picture but also for the health of all members in your family. + by Clayton Quamme, a Certified Financial Planner (CFP®) with Preston & Cleveland Wealth Management, LLC (www.prestoncleveland.com). Preston & Cleveland is a fee-only financial planning and investment advisory firm with offices in Augusta, GA and Columbia, SC.

My greatest fear realized and reluctantly accepted It’s not you that I’ve feared yet the treatment you’d receive from others that would have me in tears. The misunderstandings, the snickers, the deafening stares, the isolation, the potential abuse and uncontrollable laughs resulting in my momma bear stance. What I’ve come to learn and you taught me this son, Life is what you make it and we’re living it well. We don’t dare give up and never give in We’re a damn good team in having fun and raising all kind of sand. My greatest fear acknowledged, realized, and accepted metamorphosed into an exhilarating unspeakable joy not understood by most You’re my prince and I will always celebrate you Clamoring over inchstones as I know it’s a milestone for you Initiating and having the muscles in your legs to activate and fire Putting in the work, showing will, heart and a lot of desire I can’t do it justice to express how excited I am that at almost 7 you took your FIRST half, sorta, kinda of a step! When doctors said you wouldn’t you’re showing them you can It takes time and opportunity to morph into all that you can My greatest fear metamorphosed into my most exhilarating unspeakable joy

•

Note: Working my way back to a true love! Several years ago I wrote a column titled Exceptional Living for the Augusta Medical Examiner. It was my way of enlightening others as I processed raising a differentlyabled child. I took a break from writing as life and processing became very difficult. A lot has transpired in our world during my writing absence. A piece I wrote a while ago was entitled Raising My Greatest Fear. This poem reflects the metamorphosis of my fear. — Naomi D. Williams

JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

Southern Girls Eat Clean IS YOUR GARAGE DOOR South of the Border Layered Dip You’ve probably enjoyed some type of layered Mexican dip in the past. My eyes light up and my mouth starts watering when I see one. Layer upon layer of delicious and colorful ingredients that are sure to add the perfect starter or side dish to your summer cookout or Mexican meal. Unfortunately, sometimes those layers are constructed of un-appetizing guacamole from the frozen food section, a thick slathering of sour cream, and three or four types of heart-clogging dairy cheese on top. For those who are either lactose intolerant or who have made an intentional decision to get their calcium from greens and other plant-based sources (plant milks, for example), I was determined to find a version of this dish that would “ditch the dairy” but be as satisfying as the original. My search ended when I found a cashew-based cheese sauce that would replace the sour cream and cheese, and then used the other healthy layers of past versions. The result was a delicious burst of flavor combinations with every bite! This cheese sauce is so delicious, I promise you won’t miss the grated stuff. You’ll never want to go back to the old version again.

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Ingredients: CHEESE SAUCE: • 1/2 cup raw cashews, soaked in water at least 30 minutes, drained and rinsed • 1 TB. tahini (sesame butter) • 1 roasted red pepper (rinsed and drained from jar or prepared from fresh) • 1/4 cup nutritional yeast flakes (I use Red Star brand) • 1 TB. tamari (or Bragg’s liquid aminos or low-sodium soy sauce) • Zest and juice of 1/2 lemon • 1/4 tsp. cayenne pepper • 1/4 cup water BEAN DIP: • 1 16-oz. can vegetarian refried beans • 1 cup prepared or fresh salsa (desired level of heat) • 1-1/2 tsp. chili powder GARNISHES: (I like to layer these on top for an array of color and nutrients!!) • Sliced avocado • Rough-chopped cilantro • Sliced green onions • Diced tomatoes (or pico de gallo)

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some or all of the cheese sauce over top (if you decide not to use it all, the extra can be used over veggies later or as a stand-alone dip). Garnish with the items listed above and serve with a healthier version of chips (like low-salt organic blue corn/tortilla chips). + Cinde White is a certified health/recovery coach (myhdiet.com) and a certified introductory wellness chef as well as a representative for Tower Garden and Juice Plus (cindewhite.towergarden.com or cindewhite.juiceplus.com and southerngirlseatclean.com)

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

Pharma cy 4 11

Looking for Likes in all the right places.

Very little if anything about healthcare is inexpensive, and that includes medicine. Tiny pills can command large prices. Over-the-counter medications may be less expensive, but are they also less effective? Find the answers to lots of your drug store questions in this column written by Augusta pharmacists Chris and Lee Davidson exclusively for the Medical Examiner.

SKIN CANCER AND ITS TREATMENT

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n the last issue we talked about how to prevent skin cancer. Hopefully everyone has started paying attention and is actively taking measures to protect their skin from the sun. For those of you who have not taken precautions, let’s discuss the ramifications of unprotected sun exposure. There are three major types of skin cancer caused by the sun. These are basal cell carcinoma, squamous cell carcinoma and melanoma. There are also pre-cancerous lesion known as actinic keratosis. These can be disfiguring to your appearance and also hazardous to your health. Treatment of these cancers can be costly and time consuming. Basal cell carcinomas are usually localized and constitute the most common type of skin cancer. These tumors rarely spread and can usually be surgically removed successfully using one of a variety of techniques. Medical therapy can also be utilized, but the medicines required do not represent a significant cost savings over surgery, whether using oral or topical medications. The medicine is usually applied twice a day several times a week for at least six weeks if using the topical medicine. Surgery does have one major advantage over medicine and that is that the site is clinically examined to make sure that all of the affected skin is removed. Squamous cell carcinomas are treated very similarly to basal cell carcinoma.

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Melanoma treatment starts with removal of the tumor and can be used in combination with chemotherapy and other anti-cancer therapies. Long-term survival depends on the type of treatment used. Chemotherapy alone does not have a high rate of improvement in survival. This type of treatment can be used with other medicines that stop new blood vessels from forming to supply the tumor. Other types of treatment for melanoma can include immunotherapy that triggers your body’s immune system to fight the tumor. These therapies offer good results in successfully treating melanoma and improving long-term survival. Targeted therapy such as gene therapy is the more revolutionary, cutting-edge type of treatment. These therapies offer good results but are often for short-term benefits only. So you now know about the costly treatments for skin cancer. Let’s look at how to minimize the negative outcome of sun exposure. The recommendation is to perform a head to toe self-examination of your skin monthly. This will allow you to detect any spots or lesions that are either new or that have changed recently. Either of these options should be reported to your doctor immediately. There are instructions at skincancer.org on how to perform a thorough self-exam, as well as a printable map to document findings. Additional information about treatments and preventative steps is available online. Remember that prevention is the best policy, followed by early detection and prompt treatment. + Questions about this article or suggestions for future columns can be sent to us at cjdlpdrph@bellsouth.net Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson (cjdlpdrph@bellsouth.net )

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

Ask a Dietitian IS THIS FOOD HEALTHY?

LER

GIC

Is this (food) healthy? It’s a question dietitians get ALL the time. Usually my initial thought is, “If you have to ask that, it probably isn’t.” However, I rarely give that answer since it does little to educate on whether a food is healthy or not. People seem to be more interested than ever in eating right, and food marketers are doing their part, placing key nutrition information on the front of packaging. Knowing how to evaluate a product comes in handy amid all that marketing. Also, keep in mind it is primarily packaged foods that illicit the is-this-healthy question to begin with—fruits and veggies don’t need labels and of course are healthy! The fi rst step in determining if a packaged item is healthy or not is to mentally go through the food groups: vegetables, fruits, protein, grains, dairy, and healthy fats. Does the food in question fit into one of those groups? If so, that is an indication it could be a health promoting food. Next, proceed to the ingredient list and the nutrition facts panel. Let’s do an example using food bars. Bars are popular, which makes them a good choice for this exercise. There are granola bars, energy bars, fiber bars, breakfast bars, protein bars — and drinking bars (note: we are not talking about the drinking kind in this article). Product Example: Quaker Protein Baked Bars Step one: Does this food fit into a food group? Answer: Kinda. You have to look at the ingredients on this product to identify what food group it belongs to. It has oats and nuts, so “yes” it fits into two food groups (grains and protein). Step two: Evaluate the ingredient list a little closer. Evaluation: More than 20 ingredients (usually less is better—so this is not looking great). Whole oats are the fi rst ingredient which is good, sugar is the second which is not good, (there are 4 different kinds of sugars). Fats include

by Kim Beavers MS, RDN, LD, CDE University Health Care considered completely healthy. However I would not consider it totally unhealthy either. See the scenarios below. When would this be considered healthy? • If this food were to replace something else “less healthy,” such as a candy bar, then it would be a “healthier” choice. • If this is used as breakfast when normally breakfast is skipped, or if this were to replace the typical glazed doughnut break room breakfast. • If this were in a vending machine (it would be one of the healthiest options).

some hydrogenated and palm oil, also not great. Step three: Evaluate the Nutrition Facts Panel. Keep the ingredients in mind as you read the nutrition facts so you can identify what ingredients the numbers are representing. Evaluation: The calories are reasonable at 190, fat content is fair at 7g total and 1.5g saturated (from nuts, a good source, and hydrogenated and palm oils, not as good). The carbohydrate content is not unreasonable at 24g, but a lot is from added sugar. Fiber is okay at 2g (but I’d like that to be higher since it has whole grains and nuts). The protein content is good at 10g, and is how this product is marketed. Is this a healthy food for you? Answer one: It depends on what is currently in your diet. Answer two: Ultimately it has too much added sugar to be

Better options: • A bar with less sugar and with a higher ratio of real ingredients, such as a Strong & Kind bar or Nature Valley Trail Mix, Kashi Chewy Granola bar, or Larabar Fruit and Nut bars • Whole fruit with good quality nut butter or cheese • Quaker instant oats packet + dried fruit and nuts • Edamame (individually portioned packs available in Costco’s freezer section) • Greek yogurt (unsweetened) or Siggi’s Icelandic style yogurt, my new favorite because it has very little sugar and no artificial sweetener. The question “Is this healthy?” is multifactorial, but important to ask. The savvy shopper needs a process by which to evaluate the thousands of products that are introduced to the market each year. I hope my three steps help. Good luck out there! +

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JUNE 17, 2016

PROFILES… from page 3 her, and we got married in 1961.” Marianne worked as an RN, helping provide income while Hermann attended medical school at Loma Linda University in California. Upon graduation he interned with the US Air Force, then was trained as a flight surgeon stationed, in a full-circle kind of way, at Ramstein Air Force Base in Germany. (A fl ight surgeon, for the record, does not operate aboard flying aircraft — although that’s not out of the realm of possibility — but instead serves as a regular crew member and the primary care physician for the flight crews of the squadron and their families.) After 5 years of service in the Air Force, Dr. Orlet settled into a solo plastic surgery practice in Santa Barbara, California. But how that happened — and how he came to Augusta — is really the story of Dr. Orlet’s second great escape. “I had plans to become a cardiothoracic surgeon,” he says. “Back in Cleveland as a scrub tech I had become generally familiar with the procedures, and it was the elective of my junior year of medical school.” For a short time during this period Dr. Orlet trained under a cardiothoracic surgeon he practically worshipped, and by chance about two months later he met his son. “I said to

The burn center at Doctors Hospital has treated many well-known patients over the years, including musician Travis Barker, necrotizing fasciitis victim Aimee Copeland, and one of its earliest famous patients, Shirley Badke, pictured above with Dr. Orlet.

him, ‘Your father is a man I admire greatly. He is a great surgeon.’ The son said to me, ‘You probably know more about him than I do.’ That very day I had a talk with my wife and I decided family life would really suffer in this specialty.” Not long after, training took him to Travis Air Force Base in Texas, where one of the first patients he saw was a young soldier who had been struck in the face by a shell fragment. Dr. Orlet was immediately intrigued by the surgical challenges and the immense personal rewards for both physician and patient. After completing his training in plastic and reconstructive surgery came the pressurepacked interview with board examiners. “One of them asked me if I knew who Harold Gillies was.” He is the man widely considered to be the inventor of modern plastic surgery (see the Jan. 22, 2016, Medical Examiner, p. 2, at issuu.com/ medicalexaminer). Dr. Orlet knew the name, of course. Next question: “And who coauthored his textbook?” Dr. Orlet drew a blank, even though the book is one of the bibles of reconstructive surgery. As it turned out, the man asking the question was none other than Dr. Ralph Millard (19192011), the coauthor himself and a preeminent plastic surgeon in his own right. Despite that awkward moment, Dr. Orlet escaped the interview with his board certification in hand. Alas, the Air Force’s need for plastic surgeons wasn’t as great as the Army’s, which is how Dr. Orlet happened to be at Ft. Gordon as part of a 2-year stint in the Army, and by chance met Dr. Joseph Still in 1985. “We hit it off immediately,” Dr. Orlet reports, enough to join Dr. Still and settle in Augusta, which he says is “a great place to practice medicine.” Now semi-retired, Dr. Orlet divides his practice about half and half between burn reconstruction and cosmetic procedures, some at JMS in Augusta and some at one of the JMS satellite offices in Valdosta (other JMS satellite locations are in Atlanta, Charleston, Denver, Jackson, Mississippi, Plano, Texas, Miami and Tampa). This year will mark 70 years since Hermann and Marianne Orlet fi rst met — but only their 55th wedding anniversary. +

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THIS IS YOUR BRAIN

Intervention without drama by Ken Wilson Executive Director, Steppingstones to Recovery So. You have a friend or loved one with an addiction or alcohol problem and all efforts to gently nudge him or her to get help have failed. Such soft-pedaling almost always fails, in fact. Because these people are usually in denial – not living a lie, but their brains won’t let them see the ugly truth because if they did they’d be in pain themselves. Yep, the ol’ brain has to protect the ego. As a result, loved ones have to intervene in an effort to stop the insanity, the crazy things going on that would never have happened without alcohol or drugs. An intervention will take time and effort to pull off. Several things have to be researched before confronting a drug addict or an alcoholic: • Check out insurance – obtain their card and find an approved treatment center and they will inform you of deductibles and co-pay amounts in an effort to have a seamless transition from confrontation to treatment. (Yes, they probably need treatment; if they could have stopped using or drinking on their own they would have already done so. “You alone can do this but you cannot do it alone.”) • If they are not insured, find an alternative for needed help: a recovery residence/halfway house, a state program, a churchsponsored program... This can take days. Or you can talk to a professional and get referrals to appropriate agencies and save a lot of your hard-earned calories. Once you find a program, make sure a bed is available for admission immediately following the intervention. Immediately. No “sleeping on it.” • Get the players together, people who have actually seen and can document specific events where chemicals have been in the equation of unseemly behavior and who can sit in a circle and individually recite the event(s) quickly and passionately. Hopefully you can find Cool Hand Luke to stand behind your afflicted friend to keep the peace and say “Please listen until we are all finished before talking.” Before the actual play, there must be a practice session. Anybody not on board and who might waffle has to go home. The whole gig shouldn’t last more than 15 minutes or you’ll be reducing your effectiveness, “watering down your coffee.” • Schedule the intervention and do it when they are in pain...hung over usually. Never do an intervention when they are in their right mind. The Element of Surprise is your tool here. Maybe assemble in the living room when they get up on Sunday morning with a hangover or dead broke from a drug binge. • If your friend turns you all down, then go around the circle again and pull the plug. “If you don’t go get help, you can’t see your grandkids anymore.” “You can’t come to dinner at my house anymore.” “If I know you are driving intoxicated I will call 911 to save a life.” Follow through. Words mean nothing; actions mean everything. In a few days they will most likely call you and ask, “Where was that place you talked about?!!!” Last rule: no “buts.” That word negates all that was said in the first part of a sentence: ”I love you, BUT...” All your friend hears is “I don’t love or care about you.” Say instead “I love you AND because I care about you deeply, I can’t stand idly by and watch you hurting yourself like this.” This is a tried and true, proven formula that will work if you work it! But ONLY if you do it. +

JUNE 17, 2016

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AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — posted by Trina E. Dorrah, MD on Oct. 20, 2014

MED STUDENTS & RESIDENTS: IT GETS BETTER. REALLY. I recently attended my 10-year medical school reunion class party, and I have to admit, I had a great time. From the beginning, my class was special. We had 104 amazing people who were truly inspired to make a difference. However, regardless of how talented and hard working you are, medical school is one of the most challenging things you will ever do in your life. During our class party, we talked, laughed, reminisced, and caught up for hours. Many of us had not seen each other since graduation. The one thing that struck me was how incredibly happy everyone seemed. When I was in medical school, I frequently thought I’d made a terrible mistake by choosing medicine. When I talked to my classmates, I learned they often thought the same way. We all wanted to be doctors, but somewhere between anatomy and biochemistry, we wondered if we’d made the right choice. For me, college was great and I made some amazing friends. However, I was the only one in my circle of friends who went to medical school. After we graduated, they moved on with their careers and nice paychecks followed. We were all in our early twenties, and they were living it up. I, on the other hand, spent my days studying and stressing. I felt like I was in my own private hell that no one other than my medical school classmates could possibly understand. When I met doctors who were done with training, they would try to encourage me by telling me it would get better one day. Unfortunately, when you’re in the middle of the misery, it’s hard to believe that your situation will ever improve. Fast forward 10 years, and I can honestly say life is great. Not only am I a practicing physician, but I really do love it. I am so thankful that I didn’t quit. As I caught up with my classmates at our reunion class party, I heard the same story again and again. Despite how difficult med school, residency, and fellowship were, everyone is genuinely happy. We are all grateful to be physicians, and we truly feel that we made the right career choice. Many of us have discovered other interests within medicine, so we no longer see patients full-time, and that’s OK. To be honest, when I was struggling with my career choice, I wish someone had pulled me aside and told me about all of the cool things I could do with a medical degree that don’t involve one-on-one patient interaction. When you think about it, even if you are a health care consultant, researcher, instructor, or administrator, you’re still using your degree to fulfill the ultimate goal we all had on our first day of medical school — to help people. If you are reading this and you are a medical student, resident, or fellow who feels frustrated and burnt out and is questioning your decision to become a doctor, I have two words of advice: hang on. If you know someone who’s currently in this phase of life, send them this post as a way to encourage them. I know it is cliché to say it gets better, but it’s definitely true. The 60+ classmates of mine who came back for the reunion and are currently living their happily ever after can attest to that. The pain really is temporary. +

“I thought I’d made a terrible mistake by choosing medicine.”

Trina E. Dorrah is an internal medicine physician

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The subtitle of this book is, in part, “The Making of a Medical Examiner.” I know what you’re hoping for: a fascinating book about the birth of this newspaper. So sorry to disappoint you. This is a book about the other kind of medical examiner, the kind, as the author puts it, “who cuts up dead people.” It’s a unique calling. After all, most people get into medicine to prevent death, or at least delay it. Not everyone is cut out to handle a patient caseload that is approximately 100% dead on arrival. Still, it’s an important and necessary specialty, and judging by decades of popular TV shows focusing on forensic medicine — both drama and reality — it is one many of us are fascinated by. In the case of our author, Dr. Judy Melinek, surgery was her chosen career, but it soon became apparent that a life of surgery would be, well, a life of surgery: mere 12-hour shifts were a rare luxury. More than once she wielded a scalpel for 60 straight hours, relieved only by a few brief stolen naps. 108-hour weeks

were the norm, although 130-hour weeks were not uncommon. Her schedule included exactly one day off every two weeks. Something had to give, and it did. She quit. But not before fainting at the end of a 36-hour shift and on another occasion performing surgeries while enduring a full-blown case of flu. Taking stock of things in unemployment, she thought about the pathology rotation she had enjoyed so much in medical school: “The science was fascinating, the cases

engaging, and the doctors seemed to have stable lives.” In fact, the director of the pathology residence program at UCLA had tried to recruit her during her last year of medical school. Maybe she could direct her to a pathology position somewhere that would accept a failed surgery resident. “Can you start here, in July?” the director asked. Raised in the Bronx, Melinek left New York for UCLA and the promised pathology residency, then returned to New York City to ply her new trade. This book details her two years of training as a newly minted forensic pathologist. Was this fi nally her ticket to the stable life she had abandoned surgery to fi nd? Sort of. Except that two months into the job September 11 happened. And then the anthrax attacks. And then American Airlines fl ight 587...and then... + Working Stiff: Two Years, 262 Bodies and the Making of a Medical Examiner by Judy Melinek, MD; 272 pages, published in August 2014 by Scribner

Research News Our most costly illness What malady do you think tallies up the largest medical costs? Cancer? Diabetes? If you guessed mental illness, give yourself a gold star. A recent paper reported in the May 2016 issue of Healthcare Economist says mental illness (which is admittedly a fairly large umbrella) is the most expensive disease, in part because treatment can be lifelong. Speaking of money... The Milliman Medical Index released its annual report last month analyzing healthcare costs. The results may not be much of a surprise, but they are nevertheless dismaying. The cost of providing healthcare to an average American family measured $25,826, a new record, and the first time costs have surpassed $25,000. Covering a family of four with a typical employer-sponsored “preferred provider plan” is

$1,155 higher than last year, and triple what it cost for the same family just 15 years ago (in 2001). 2016 marked the 11th consecutive year that the annual cost increase has been more than $1,100. Leading the charge are prescription drugs at $4,270 per family annually, nearly 17 percent of our total healthcare expenditure. That’s four times the average family drug bill in 2001. The Milliman Medical Index tallies the total average cost for health insurance premiums paid by both employer and employee, plus the actual expenditures paid by the insurance plan, and the out-of-pocket medical expenses of the insured family. Overall, employers pay 57 percent of total healthcare costs, down from 61 percent in 2001, the first year the Index was published. While Milliman analysts call topping the $25,000 mark “a significant and somewhat unsettling milestone,” they note that the 4.7 percent change between 2015 and 2016 marks

the lowest increase since the index began in 2001. The Index covers employersponsored healthcare coverage, the largest source of health insurance at some 155 million employees and their dependents. Not included are the roughly 77 million people covered by Medicaid and the 57 million or so covered by Medicare. The Index analysis notes that about 80 percent of all healthcare costs come from just 20 percent of the population. Country Mouse, City Mouse A June 3 report in Health Services Research (HSR) examined physician compliance with electronic medical records (EMR) adoption. Federal guidlines encourage EMR implementation by both subsidizing costs and levying gradually increasing penalties for non-compliance. The HSR study specifically looked at urban compliance versus rural compliance. Surprisingly, compliance is lower in urban practices than rural practices (47 percent versus over 60 percent). +

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS

THE MYSTERY WORD

I want to plant a row of boxwoods.

Sounds like a great project idea.

by Dan Pearson

Why don’t you do what I did when I planted my shrubs?

The problem is the expense involved.

I started a hedge fund.

What was that?

The Mystery Word for this issue: UNSIS

EXAMINER CROSSWORD

PUZZLE

Click on “READER CONTESTS”

QUOTATION PUZZLE

E M E R N F T K L N G N P U Y Y T T T A E O S E N R A T S R Y N O R E I H I I D E D A T M H H O E O S B O

— Cicero

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.

4 8

X A M I N E R

5 6

2 7

U D O K U

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

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

O 1 2 3 4 5 B 1

’ 1 2 3 4

1 2 3 4 5 6 7

3 1

1 A 2

V 1 2 3 4 5 6 7

— Leo Rosten

1.BBPCCMNH 2.AAAEOOUU 3.TVPINNNY 4.PEETT 5.HIRY 6.NET 7.RYE 8.S 9.S

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

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

VISIT WWW.AUGUSTARX.COM 1

ACROSS 1. Bowie hit 4. Mamie Eisenhower had one of these in Augusta 9. Comedienne who starred with Goodman 13. Lyric poem 14. Holy place, as a church or sanctuary 15. Meadow 16. ______ lab 17. Uncovered 18. Gordon, originally 20. Dietary abbreviation 22. Former Walton Way bakery 25. Road connecting Walton by Daniel R. Pearson © 2016 All rights reserved. Built in part with software from www.crauswords.com Way with Boy Scout Road 27. New prefix DOWN 31. Gave food to 28. Sweet _____ 1. Charles Walker’s erstwhile 33. Wily 29. Category of drinks newspaper 34. Fuss 32. Customary 2. Dental org. 36. Partridge ____ 35. Blonde Charlie’s Angel 3. Broad Street coffeehouse 37. Obamacare acronym 39. Summerville 4. Taxi 38. Type of code 40. Mona Lisa artist 5. Having wings 43. ___________ Mall 41. Extinct flightless bird 6. Avian influenza, in brief 46. Sickness adjective 42. Mr. Nelson 7. Notion 48. Globe 44. Crack 8. Silent signal 49. Walker start 45. Fed. intelligence agcy. 10. Budget rival 50. _______board 47. Also 11. Deep sleep ltrs. 52. Study, generally 49. Litigator 12. R of 11-D 53. Local Bridge? 51. Benedict last name 19. DDE nickname 54. Sharply curved 54. Big ____ 21. Regret 55. Metal fastener 56. Short letter 23. Dr. Milton _________ 57. Eggs 58. Susceptible to bribery 24. Downtown Augusta 58. Augusta has two 60. Prolonged watering hole 59. Shelter unconsciousness 25. Capitol of the last of the 61. Soccer’s Hamm 62. All About_____ original 13 colonies 63. Found attractive 26. Georgia county named for 64. Augusta’s old ___ Mill U.S. president #4. 65. Type of sale? 29. HPV is one 66. Technique 30. Exclamation of surprise Solution p. 14 67. Young hawk

WORDS NUMBER

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

JUNE 17, 2016

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AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

Why didn’t the toilet paper cross the road? It was stuck in a crack. If I had a dollar for every woman who didn’t find me attractive, they’d start to find me attractive. Moe: Chile is in South America, right? Joe: Probably. If not, I’m sure they have Applebee’s.

cop stopped a guy for speeding. “I’ve been watiing all day for someone like you,” the officer said. “That’s why I got here as fast as I could.” Shout out to all the people wondering what the opposite of in is. Moe: My good friend who works at the movie theater died yesterday. Joe: I’m so sorry. When are the services? Moe: Tomorrow at 1:30, 4:15, 7:05 and 9:20. My doctor told me I’m suffering from paranoia. Well, he didn’t actually say it, but I could tell it’s what the jerk was thinking. Moe: I’m only friends with 25 letters of the alphabet. Joe: How come? Moe: I don’t know y. T-Rex #1: I’ve always been curious about people with forearms. T-Rex #2: Why? T-Rex #1: I’ve only got two.

What did the green grape say to the purple grape? “Come on! Breathe!” Why couldn’t the chameleon change color? Reptile dysfunction. Moe: My friend’s bakery burned down. Joe: Wow. I guess his business is toast. How my day went today: 1. Woke up 2. Went to work 3. Saw spectacularly beautiful girl 4. Kissed the girl Too bad it happened in the order 2, 3, 4, 1 A dog walks into a bar, hops up on a barstool and says, “Hey barkeep, today’s my birthday. How about a free drink?” The bartender turns, looks at the dog and says, “Sure thing, pal. The toilet’s down the hall on the right.” Correction: The second joke should have been, Shout “out” to all the people wondering what the opposite of in is. +

Why subscribe to the Medical Examiner? Because no one should have to make a trip to the doctor or the hospital just to read Augusta’s Most Salubrious Newspaper.

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ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble wrote a long-time column in this paper entitled The Patient’s Perspective reincarnated in this new format. Feel free to contact her at marciaribble@hotmail.com My middle daughter is getting married. I am excited for her and for the whole family. The man she is marrying is a nice guy and they are happy together. After their wedding the reception will be at Mistletoe State Park. What a beautiful spot for a celebration! It reminds me of a similar place for a reception I attended years ago with my two youngest children. That long-ago reception was also held in a park. The day was lovely and the children who were there had lots of room to run and play. And play they did. While the adults were having our own kind of fun, the children discovered a creek that was rich with adventures. It was shallow enough to splash in, and deep enough to have lots of wild critters for them to find. The creek bed was sandy, so they didn’t even get muddy, just wet, and the day was warm enough that being wet was fun, too. They found minnows, tadpoles, frogs, and crayfish, lots of them, and brought them to the adults with all the amazement children find in open spaces where they can touch, smell, and feel their environment, as well as see it. They were good stewards of their environment and returned all of their finds to where they had found them before it got dark and we all went inside to eat again, have wedding cake and ice cream, and dance. The whole day was delicious. The park was also perfect for hide and seek with big trees to hide behind, but also safe enough for the grown-ups to relax and just let the kids play. They played other games children played in the days before cell phones. Red Rover. Duck, duck, goose. Kick ball. Their happy yells made me laugh. “I caught you!” “No, you didn’t!” “You’re dead!” “Do I look dead to you?” I recall playing those games when I was a child, and I know my parents and grandparents played them, too. Can it really be called childhood if children no longer know the fun of counting: “Five, ten, fifteen, twenty, twenty-five, thirty, thirty-five, forty, forty-five, fifty....one hundred! Ready or not, here I come!”? I’ll be watching at the reception to see if folks have their noses stuck in their cell phones or smart phones instead of being full participants in the day’s activities. I’m hoping that the people at the reception will all enjoy the day’s fun. I’m looking forward to watching to see if anyone catches some fish (including me), if they notice the delicate scents caused by a shrimp boil, if they’ve put on their sunscreen. I won’t know some of the people who will be coming, but I hope that they will talk to one another and with me. +

MED ICAL EXAMINER CELEBRATES SWEET 16! Every Medical Examiner since issue #1 has been 16 pages — just the right size for busy people who care about good health!

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

THE MYSTERY SOLVED THE DOCTOR IS IN Rethinking prostate cancer screening

The Mystery Word in our last issue was: ALLERGIC

...very cleverly hidden (on the wings) in the p. 9 ad for WILD WING CAFE Congratulations to JUDY SMITH, who scores the current contents of the Medical Examiner goody bag. Sweet! Want to find your name here next issue? The new Mystery Word is on page 12. Start looking!

The Celebrated 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. 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.

The new scrambled Mystery Word is found on page 12

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oes your doctor discuss prostate cancer screening with you?” “I don’t know what they do. Maybe. I don’t know. What is a prostate anyway?” “Did your doctor perform a screening prostate exam?” “When I saw the doctor he did, but now that I only get five minutes with her PA, they don’t anymore” “Did you know that you are here because your PSA test is ten times the upward limit of normal?” “No.” June is men’s health month, and I have been paying special attention to the circumstances surrounding prostate health referrals. Unfortunately we are in the age where the U.S. Preventive Services Task Force (USPSTF) guidelines are leaning towards a state of misinformation towards screening mechanisms

that could possibly identify aggressive cancer at a stage where it has not metastasized and be cured. More importantly, these are the only tools that can currently be used in a cost-effective population based model to screen for the disease. The Prostate, Lung, Cervical, and Ovarian, or PLCO Trial, is the large, randomized study that showed a negligible difference in prostate cancer mortality that the USPSTF had relied heavily upon to make its recommendations. It does have some inherent limitations, of which I will not go into detail here, but the most striking of which is, it’s old. Imagine basing what you would wear today on what the weather was like in 1993. That’s what is happening with basing prostate cancer guidelines on how prostate cancer was managed in 1993. This simply doesn’t make sense. Active

EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC. FOR SALE 3 bedroom/2 bath, single garage Townhouse in Martinez. Master/ bath down, 2 upstairs bedrooms share bath, large loft for office, playroom, den; wood-burning fireplace, covered back porch. Freshly painted with new flooring, lighting and ceiling fans. Easy access to Riverwatch Parkway, Washington Rd, I-20,Augusta. 1987 sq.ft. $147,900. 706-836-7001. ROOM FOR RENT 1 room, private bathroom, 2bdrm MH on private lot. Clean quiet neighborhood. Non-smoker. $600 monthly. Must be stable, verifiable references and income. Cable and Internet included. Warrenville, 5 min from Aiken, 20 min to Augusta. (803) 270-2658 POND VIEW! Evans all-brick 2-story with solar panels. Avg. electric bill $170 in Northwood, 3,400 sqft. Call 1-800401-0257, ext. 0043 24/7 for price and details. AUGUSTAGAHOMESEARCH.COM Foreclosures • MLS • Builders • Rentals (706) 564-5885

MISCELLANEOUS SUNSET MEMORIAL GARDENS Opening and closing at Sunset Mem. Gardens in Graniteville. Sale: $760 (Value: $1520+) Call 706-736-0596 ANTIQUE maple dinette set with buffet corner cabinet table with pull-out leaves. Four chairs with two captain’s chairs. Excellent condition. $300. Double bed early 1930s with mattress spring coverlet shams $150. Call (706) 860-2170

Please see PROSTATE page 15

THE PUZZLE SOLVED

WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer. BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net CEMETERY SPACES (2) Sunset Memorial Gardens, Graniteville SC adjacent to lighted military flagstaff, includes granite bench with urn space, installation and inscription. All $4700 ($8600 value). Spaces only: $2700. Call (803) 2953033 FISHING CLUB wants more grey-haired members. Meet 2nd Thurs of month at Harbor Inn Restaurant, 12 noon. “Adventure Before Dementia” Info: (706) 736-8753 or (706) 829-1729 PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-8291729

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QUOTATION QUOTATION PUZZLE SOLUTION: “There is no duty more obligatory than the repayment of kindness.” — Cicero

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HOUSE CLEANING Your house, apartment, rental move-outs. Thorough, dependable. Weekly, or whatever schedule you prefer. References. 706-267-9947 BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673) F. E. GILLIARD, MD FAMILY MEDICINE Acute & Chronic Illnesses Occupational Medicine PROMPT APPOINTMENTS 706-760-7607

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surveillance, focal therapy, and refined surgical techniques have brought prostate cancer into the 21st century, yet they were not utilized as heavily or even at all in the trial. Further, prostate cancer treatment algorithms continue to be refined with the guidance of the American Urologic Association and National Comprehensive Cancer Network so as to not emphasize over or under treatment, and empower patients to make their own informed decisions. True, most men do not die of prostate cancer, but as a medical community we need to come together for the sake of saving lives, not dollars and treating patients like informed decision makers, not statistics. The last thing a primary care physician should feel is pressure from a government

Our next issue date: July 1

WORDS BY NUMBER “Money can’t buy happiness but neither can poverty.” — Leo Rosten

JUNE 17, 2016

PROSTATE… from page 14 entity mandating who should and should not know how likely they are to harbor prostate cancer. Cancers, like HIV, are their most lethal in a state of ignorance. It’s time to rethink policies like the USPSTF that are focused on the wrong goal and ultimately end in ignorance of a major area of public health. End the ignorance, and discuss the risks and benefits of prostate cancer screening with your health care provider. +

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AUGUSTA MEDiCAL EXAMINER

The Short White Coat W

e walked into the room just as the nurse said the patient was in pain and wanted medication. The other medical student and I introduced ourselves and proceeded to inquire about the pain and the remainder of the history. The patient had abdominal Dr. Darren Mack is a graduate of the pain and recent nausea and vomiting. Diagnostic Medical College of Georgia and is a urologist with offices imaging and a colonoscopy in Evans and Aiken. ruled out most of the medical differential diagnosis. He may be reached However, we agreed that at (803) 716more tests could be done. 8712; via Twitter: I thought I failed that @doctordmack day. Had it not been for and Instagram: my preceptor walking in David Russell Photography @aikenurology with us afterwards, I would The information provided in this article have missed a critical is not a substitute for an evaluation by a component of the history. licensed health care provider. The patient had a recent

psychological stressor that mimicked a traumatic event from two years ago. It was psychosomatic in nature. How do I know this? Because from the moment the doctor sat down you could see that she was giving the patient 100%. She was able to obtain a thorough and relevant history because she listened in a way that lacked judgment and impatience. The patient recalled feeling a similar pain when the original traumatic event took place and said no one else had asked her about it. As a medical student in clinical rotations, it can be difficult to ascertain what the true job description is. We show up for our shifts on time and stay late if need

A med student’s notebook be. For nearly a year now I have been trying to figure out what my place is on the medical team. Despite the medical field or setting, there is always a team of sorts and knowing how you belong can be difficult as a medical student. There are days when running around trying to help get the tedious work done seems to be all there is to it. And if one doesn’t pay really close attention, it will be too easy to miss out on

the real lesson of the day. Yes, that’s right! There is ALWAYS a lesson of the day, and not just as a medical student. It is understandable how we can get caught up in learning necessary diagnostic criteria or treatment regimens. However, I have come to realize that it is not the medical knowledge that offers the necessary lessons as much as the patients themselves. The medical knowledge will always be there to reference and having a solid grasp on it will only make for a better physician. Nevertheless, the patients themselves are what provide the true learning points. This isn’t a new idea, but now I understand fi rsthand why it is a worthy quest with a hefty reward. + — by Jasmine Rivas

PROFESSIONAL DIRECTORY ALLERGY

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

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

COUNSELING Resolution Counseling Professionals 3633 Wheeler Rd, Suite 365 Augusta 30909 706-432-6866 www.visitrcp.com

DENTISTRY

DERMATOLOGY

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 706-733-3373 www.GaDerm.com

DEVELOPMENTAL PEDIATRICS Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com

DRUG REHAB Steppingstones to Recovery 2610 Commons Blvd. Augusta 30909 706-733-1935

FAMILY MEDICINE

F. E. Gilliard MD, Family Medicine 4244 Washington Road Evans, GA 30809 706-760-7607 Industrial Medicine • Prompt appts. Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

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

PHARMACY

YOUR LISTING HERE

SENIOR LIVING

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

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

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

VEIN CARE

Medical Center West Pharmacy 465 North Belair Road Evans 30809 Vein Specialists of Augusta Dr. Judson S. Hickey Your Practice 706-854-2424 Periodontist And up to four additional lines of your www.medicalcenterwestpharmacy.com G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 Floss ‘em 2315-B Central Ave choosing and, if desired, your logo. or lose ‘em! Keep your contact information in 706-854-8340 Augusta 30904 Parks Pharmacy www.VeinsAugusta.com 706-739-0071 this convenient place seen by tens of 437 Georgia Ave. thousands of patients every month. N. Augusta 29841 Jason H. Lee, DMD Literally! Call (706) 860-5455 for all 803-279-7450 116 Davis Road the details www.parkspharmacy.com Augusta 30907 Medical Weight & Wellness 706-860-4048 Specialists of Augusta THE AUGUSTA Maycie Elchoufi, MD MEDICAL EXAMINER Steven L. Wilson, DMD 108 SRP Drive, Suite B Psych Consultants Family Dentistry Evans 30809 • 706-829-9906 AUGUSTA’S 2820 Hillcreek Dr 4059 Columbia Road MOST SALUBRIOUS YourWeightLossDoctor.com Augusta 30909 Martinez 30907 NEWSPAPER (706) 410-1202 706-863-9445 www.psych-consultants.com

WEIGHT LOSS

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M.E.

PSYCHIATRY

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JUNE 17, 2016

AUGUSTA MEDiCAL EXAMINER

OBESITY… from page 1 caused by a combination of excessive food intake and a lack of physical activity. A limited number of cases are caused by genetics, medical and pharmacological reasons, and even psychiatric illnesses. Other contributors are suspected, but there is no widespread agreement in the medical community beyond the two main causes mentioned initially. Far from being just an overused buzzword, obesity is a serious and potentially lethal trigger for a laundry list of problems across the entire spectrum of healthcare. The scope of its impact is rather stunning: Cardiology: Heart disease; congestive heart failure; high blood pressure; abnormal cholesterol levels; angina; myocardial infarction; deep vein thrombosis; pulmonary embolism. Dermatology: Stretch marks; lymphedema; cellulitis. Endocrinology & Reproductive medicine: Diabetes; insulin resistance; high triglyceride levels; menstrual disorders;

polycystic ovary syndrome; infertility; pregnancy complications; birth defects; intrauterine fetal death. Gastroenterology: Gastroesophageal reflux disease; liver disease; gallstones. Neurology: Stroke; migraines; carpal tunnel syndrome; dementia; multiple sclerosis; transcranial hypertension; meralgia paresthetica. Oncology: Esophageal cancer, plus colorectal, pancreatic, gallbladder, endometrial and kidney cancers; leukemia; malignant melanoma; hepatocellular carcinoma. Psychiatry: Depression, particularly in women; social stigmatization. Pulmonology: Obstructive sleep apnea; obesity hypoventilation syndrome; asthma; complications during general anesthesia. Rheumatology & Orthopedics: Gout; impaired mobility; osteoarthritis; low back pain; hip, knee and foot pain. Urology and Nephrology: Erectile dysfunction; urinary

incontinence; chronic renal failure; hypogonadism. That’s quite a list, isn’t it? And it’s not even complete. With diagnosis fairly simple (just calculate your BMI) and the cause in most cases fairly straightforward, everyone and anyone can and should get involved in tackling the problem of obesity. It pays dividends that can add years to life, and that add quality of life to those years. If you don’t know your BMI, figure it out right now.

Based on what you discover, figure out a plan of attack to lower it. Enlist the help of your physician. That’s always

a prudent course of action. With concerted effort, we can turn The Big O into The Slim Trim O. +

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