June8 18 by Daniel Pearson

MEDICALEXAMINER

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JUNE 8, 2018

AIKEN-AUGUSTAʼS MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

DRIVE RIGHT T

o carjack a quote from Martin Luther King, “The time is always right to drive right,” he said, “unless you’re passing another vehicle or preparing to turn left.” What Dr. King said so eloquently (from which we borrowed and ever so slightly edited) is also borrowed and used much less eloquently in the state traffic laws of both Georgia and South Carolina (and most other states). As you can see in the box, the laws state that drivers should be in the right lane — period — except for

GEORGIA LAW EXCERPTS Upon all roadways a vehicle shall be driven upon the right half of the roadway, except as follows: • When overtaking and passing another vehicle proceeding in the same direction; • Upon all roadways, any vehicle proceeding at less than the normal speed of traffic then existing shall be driven in the right-hand lane except when overtaking and passing another vehicle or when preparing for a left turn. • No two vehicles shall impede the normal flow of traffic by traveling side by side at the same time while in adjacent lanes. SOUTH CAROLINA LAW EXCERPTS Upon all roadways any vehicle proceeding at less than the normal speed of traffic at the time and place and under the conditions then existing shall be driven in the right-hand lane then available for traffic. +

DRIVE SAFE

common but temporary forays into the left lane. But on many (if not most) area roadways these laws are routinely ignored. Left lane drivers will putter along at or below the speed limit, seemingly oblivious to the line of cars stacked up behind them, and sometimes they’ll drive side-by-side with another vehicle, blocking passage of all traffic. It should be noted that you will find no reference to speed limits in the laws, only the speed at which traffic is then traveling at that time and place. In other words, if someone is driving along in the left lane at 70 mph in a 45 and somebody is tailgating them because they want to pass, the lead car is guilty of two offenses: speeding, and a left-lane impeding traffic violation. Here is the 64-dollar question, though. Why should we care? What does any of this have to do with health and wellness? Why is it a topic in this newspaper devoted to health, medicine and wellness? Why it matters Our three 64-dollar questions add up to $192, so already you can see the importance of this subject. Honesty compels us to report, however, a total of just three traffic citations for left lane law violations in Richmond and Columbia Counties combined since January 1. (At press time we’re still waiting for statewide stats from the Georgia State Patrol.) If cops don’t care, why should you and I? Please see DRIVE RIGHT page 2

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AND LEFT

here is a Move Over law on the books in every state which says any driver approaching a stopped emergency vehicle must move one lane over to the left (to the right if they’re stopped on the left shoulder), or if that is not possible, to slow down below the posted speed limit. Some states mandate both slowing down and moving over What many people don’t know is that the laws got their start in South Carolina. In 1994, Lexington paramedic James Garcia was struck and seriously injured by a passing motorist at the scene of a crash. That particular accident was the trigger because the guilty party, according to laws then on the books, was Garcia, not the driver who hit him. Garcia, whose reaction was literally, “You gotta be kidding me,” launched a campaign after he recovered from his injuries to enact a law to protect all roadside workers: police, fi re, ambulance, rescue, tow truck, highway, and utility. The rest is history: nationally, only Washington, D.C. does not have a Move Over law. These laws are the ultimate expression of lane courtesy because they truly matter: obeying them literally saves lives. Failing to do so costs lives. In the past decade nationwide, 126 law enforcement officers were struck and killed by a vehicle. Just last March (2017) three SCDOT workers were struck on Augusta Road, killing two at the scene and injuring the third. Although two dozen citations for this infraction have been written so far this year in Richmond County alone, why are Move Over laws even necessary? Why isn’t moving over plain old common sense and simple Golden Rule courtesy, something every driver should do and would do with or without a law? +

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DRIVE RIGHT… from page 1 Let’s not forget that traffic accidents are a huge public health issue and a significant source of injury, long-term disability, and death. The US highway death toll for 2016, the most recent year for which statistics are available, was 37,461. And it has been going in the wrong direction: the number of fatalities in 2015 was more than 10 percent higher than the 2014 rate, and 2016’s toll was more than 5 percent higher than 2015. What is the connection between lane usage and accidents? How much time do you have? There are lots of connections. According to the National Motorists Association, which has designated June as Lane Courtesy Month, left lane drivers make roadways less safe and less efficient for everyone. We have all seen first-hand how left lane drivers block the smooth flow of traffic. They cause, no doubt unintentionally in most cases, risky behaviors like tailgating and weaving in and out of traffic as other drivers try to get around the rolling roadblocks left lane drivers create. Left lane drivers are a source of irritation to many motorists and, justifiably or not, are an undeniable source of road rage. The simple and courteous act of moving to the right lane can eliminate much driver stress and conflicts. For the sake of illustration, let’s dispense with major multilane highways and think about a basic two-lane blacktop, just a plain and ordinary country road. Many of these roads have 55 mph speed limits, so it’s safe to assume many cars going opposite directions are bearing down on each other at 60 mph or better. What keeps them from colliding? Other than the drivers themselves, all the highway itself provides is a flat strip of paint. In this era of driverless cars — no, not the official kind; we’re referring to the kind where the driver is barreling along blind while illegally texting and posting pictures on Instagram, etc. — the more separation there is between opposing lanes of traffic, the safer it is for all concerned. The Medical Examiner’s nominating committee has given Blue Ribbon status to three roadways in our area — in no

particular order Riverwatch Parkway, I-20, and Jefferson Davis Hwy (US Rte 1) — for designation as Wrong Right Award recipients. It’s the other right lane, people. You’ll note that none of them have significant exposures to oncoming traffic and the need to stay to the right for that reason. But all of them are common havens for drivers who seem to view the “fast lane” as their personal private property: not only do they inhabit the left lane exclusively, but they can be observed tailgating left laners they come up behind and then whipping around them as soon as they’re able (even if it’s unsafe to do so) pulling back in to the left lane as closely as they can to the front bumper of the other left lane driver to teach them a lesson. This, friends and neighbors, is how breaking the left lane law creates accidents and road rage incidents. And that is a key point to bear in mind: it is the law. Driving primarily in the right lane and reserving the left lane for temporary visits like passing or preparing to turn left may not be what you’re used to or what you prefer, but at least it’s legal. Human nature being what it is, if we find ourselves in the left lane of a highway - and maybe we’re driving at or above the speed limit - and some jerk bears down on our back bumper and tailgates, the last thing we may want to do is reward his jerk behavior by obediently moving out of his way. However, staying in the left lane simply creates stress and friction and makes our roads more dangerous for everyone. None of this should be construed as an endorsement of the idiots who tailgate left lane hogs and unsafely zip around them. They are reacting unsafely and immaturely to a common and benign situation and demonstrating a serious lack of the emotional fitness needed by any good driver. In addition to various fines, they should face mandatory return to driver’s ed for remedial training. The thing is, if we’re obeying the law, we won’t be in their way very much anyway. + For more lane courtesy info, see our Facebook page (facebook.com/AugustaRX) for an informative lane courtesy video. And don’t miss our June 22 issue and several first hand accounts from local EMS workers about driving ambulances around cars.

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Kid’s Stuff

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

Teens and sleep Teenagers need a minimum of 8 hours of sleep per night, preferably more if possible. But most teenagers do not practice healthy sleep routines and do not get enough sleep. It is well-known that adolescence brings a change in sleep cycle and circadian rhythms, making teens more likely to stay up into the wee hours of the morning, even when already exhausted and sleep-deprived. It is very common for a teen to not be able to fall asleep before 11 pm, and sometimes closer to 1 or 2 am. Middle and high school schedules do not account for changes in sleep cycles of teens, however, and these kids generally must wake up between 5 to 7 am to get to school. So you do the math -- this adds up to not enough sleep!! Sleep-deprived teens are notorious for falling asleep during fi rst and second period classes, and will stay tired all day long. They will often take a nap when they get home after school as a result of being so tired. This makes it harder to fall asleep later in the evening, and also uses up time that could otherwise be spent doing homework, playing sports, or participating in other afterschool activities. Teens also frequently compensate for their sleep deficiency during the week by sleeping in on weekends, sometimes past noon, which further disrupts their sleep cycle as they will then not go to bed that night until very late. Vicious cycle! Other consequences of sleep

3 +

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JUNE 8, 2018

debt and poor sleep habits include (but are not limited to): 1. Sleep deprivation is very toxic for brain growth and development. And the human brain does not typically complete its growth and maturation until the mid-20s. So chronic sleep deprivation for years while the brain is still in formative, vulnerable stages can lead to long-term negative effects 2. Difficulties in school, especially with learning and storing new information, accompany sleep loss. Grades frequently suffer, and teens may try to compensate by staying up later and later to study, which again, is a vicious cycle 3. Inattention and inability to focus (as well as other ADHD-like symptoms) frequently accompany sleep deprivation also 4. Sleep deprivation commonly contributes to difficulties with weight management or loss. Various hormones are affected by disrupted sleep cycles and

sleep loss, causing cravings for sugar and carbs and making a person overall more likely to overeat 5. Weight loss is also more difficult as the body perceives sleep deprivation as a stressor and sort of starvation, tricking itself into storing rather than burning fat stores 6. Sleep deprivation causes changes in mood, making a teen feel more irritable, emotional, depressed, or anxious day to day. Teens can have a harder time getting along with or relating to friends and family members as a result. What can we do to make it easier for teens to get the sleep they need? A prudent fi rst step is to discuss these sleeping difficulties with the teen’s doctor, since underlying conditions (sleep apnea, narcolepsy, restless legs, etc) could be contributing and making matters worse. Limiting screen time (cellphones, tablets, tv, computers) for at least an hour or two prior to desired bedtime helps the brain and body calm down and prepare for rest. The blue light in electronics screens is believed to stimulate brain activity, thus making it more difficult to sleep and “shut off” the brain. Last, simply enforcing a routine with good bedtimes that will allow for 8-10 hours of sleep (or as close as possible) and enabling it to eventually become habit will in the long run be of great benefit. The body can be trained to go to bed at a reasonable hour, even if a teen initially is inclined to stay up all night. Attaining a good night’s sleep can be thought of as a reward to the body rather than a chore, and striving for a good routine can have a multitude of positive effects both at home and at school. +

Why is blood red? Good question, especially since there is a commonly held belief that blood is blue, at least while it’s inside the body. That is why our veins are blue, say those who subscribe to this belief. The explanation goes like this: venous blood only turns red when we bleed, when it leaves the body and air hits it, causing an instantaneous chemical reaction which transforms blood from its natural indoor blue to its outside red. It all sounds very logical, except for one minor detail: it isn’t true (unless you’re an octopus; they do have blue blood). The clearest evidence we’ve all experienced fi rst-hand comes from sitting in a doctor’s office while someone draws your blood for tests. The tubes they use for receptacles are vacuum sealed. They contain no oxygen (or anything else) for blood to react with, yet the blood sucked into them by the vacuum action is clearly red. Then why do veins near the skin’s surface look blue? Not because blood is blue. Blood is always red. Veins can look blue because of the weird way color works. As we all remember from school, natural light contains all colors, so something that looks yellow, for example, absorbs every color of the entire spectrum of color except yellow. Whatever color bounces back for our eyes to see will make the object appear to be that color — in this case, yellow. Applying that to our subject, red light has a long wavelength that is readily absorbed into our skin. The shorter wavelength of blue light is mostly reflected, and when it strikes an object just under the skin (like a blood vessel), even more of it will be reflected back to our eyes, making that object appear blue. But we still haven’t answered the original question. Blood is red because iron in red blood cells binds with what are called hemes, part of the protein in blood. Oxygen then binds with and reacts to the iron, and that gives blood its bright red color. The more oxygen, the brighter the red; the less oxygen (as in blood returning to the lungs to be re-oxygenated), the darker and deeper the red. Going back to high school chemistry, the different O2 levels alter how much and what kind of light from the red spectrum is reflected back to our eyes. +

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JUNE 8, 2018

AUGUSTAMEDICALEXAMiNER

#68 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

ave you ever saved a life? Perhaps you performed CPR or the Heimlich maneuver or saved someone during that summer lifeguard job years ago. It’s a great feeling, isn’t it? Imagine how would you feel if you saved the lives of 100 people. Or a thousand. The man featured here has saved tens of millions of lives by the most conservative estimates. Some say it’s more like 500 million lives. And you’ve probably never heard of him. Does the name Donald Henderson ring a bell? That’s what we thought. Donald Ainslie Henderson, often called D.A. by friends, was an epidemiologist with strong Georgia For those who believe vaccines connections. He was the director cause autism, it’s sobering to realize of the CDC’s Epidemic Intelligence if that belief was true, they would Service in Atlanta until being in effect reject autism in favor of a named to spearhead a World Health disease like smallpox with a 30% death rate among those infected. Organization (WHO) initiative to eradicate smallpox around the world. If that sounds like a vote of confidence in his abilities, it wasn’t. The initiative was proposed in 1966 by WHO’s World Health Assembly with key support from the United States. Considerable debate ensued. At the time, WHO was already knee-deep in a global malaria eradication program which was not going well, and WHO’s Director-General Marcolino Candau felt the organization’s resources would be spread too thin with the addition of a second massive program. He believed the smallpox effort would fail, reflecting poorly on WHO and the larger public health community. The debate in favor of the initiative raged on against his objections, so Candau relented, asking for an American to lead the effort — Henderson, specifically — so that when the program failed the United States could be blamed. Henderson wasn’t too keen on the idea, either. Aside from the divisive politics involved, the worldwide effort was given a paltry $2.7 million in funding. The most bare-bones estimate of just the vaccine supplies necessary to get the program off the ground would require far more money than that. Nevertheless, Henderson accept the challenge, and it was massive. Just one example: India was one of the epicenters of smallpox, so concerted efforts were made there, including one where healthcare workers made a personal visit to virtually every house in India within the space of 7 to 10 days in late 1973. To put that into perspective, the Indian state of Tamil Nadu alone was home to 50 million people. It’s amazing to remember that another man profiled in this very space, Edward Jenner, developed the smallpox vaccine in 1796. Yet as recently as 1967 there were still 15 million cases a year worldwide. Although today’s generation has no recollection (particularly in developed nations) of the scourge of smallpox, it killed between 300 million and 500 million during the 20th century alone. Survivors were often blinded by the disease and bore disfiguring scars. Henderson’s epic ten-year campaign, coordinated around the world without cell phones, email or other means of rapid communication in places like Bangladesh, Yugoslavia, Somalia, Ethiopia, and Pakistan, was a success. The last smallpox outbreak occurred in 1977, and the official declaration of its eradication came in 1980. (Note: see also this issue’s book review, page 11) +

by Marcia Ribble Editor’s note: This is a revisitation of a Marcia Ribble column from the Medical Examiner in February 2014. Enjoy the time capsule.

There is a local woman who wandered away from her home and who was just found, a month after vanishing, despite many people who took their time and energy to look for her. She was a woman who contributed a great deal to our community. She deserved to be found, not just for her sake, but also for the sake of her family. Nobody deserves to get lost, whether due to Alzheimer’s disease or any other reason. While waiting for the ice storm to hit, I was thinking about them all, and praying that her family, friends, and people who knew a woman I’ve never met, but who will always matter. Just as all people matter. Waiting for the ice storm to arrive last week was an anxious time. I know the ravages a bad ice storm can visit on a community. One sunny Sunday, a rare February 29th, my Grandma died trying to lift herself up her front steps. The very next day it started to rain, an awful freezing rain that continued for the next three days. By the second day, trees began coming down, power lines came down with them, and I watched all night long as transformers exploded, wires arced and spewed giant showers of sparks, and it felt like maybe hell was arriving, or the end of the world. Our

house, and most of the homes in our city went dark, and all I could do was check on my four children in their beds and pray that the storm would end. It did end, eventually. Eventually the trees were cut down and piled at the curb, and the lights were restored, along with heat and hot water, cars could drive down the streets again, and everything was made right again, even though some things would never be the same. Most people sensibly left the wires alone, most people found places where they could be safe, warm, and dry, and most people survived a little wiser and more willing to listen to the weather folks warning us to prepare, and even those people who were not prepared managed somehow or another. That is one of the benefits of growing older. It gives us a perspective we wouldn’t otherwise have. This helps us to know how to deal with life events with a sense of peaceful purpose. A long time ago when I was fretting about all the suffering in the world, my oldest daughter told me, “Mom, you can’t fi x everything wrong with the world, so just pick out one little corner and go to work to make a difference there.” When storms end, we can all help to make things right again if each of us do a little bit to help ourselves and others. Eventually all our ice melted, the sun and flowers came out, and we could finally bury Grandma, who had spent the rest of that winter in cold storage. +

Ionized (alkaline) water is better

Which will it be? Turn our topic into a question — is ionized water better? — Googlize it, and you’ll be rewarded with a bevy of answers, most of which will say “Absolutely!” followed by serious sales pitches. Ionized water is big business, but then, so is kale. And so are corn dogs. Big doesn’t mean bad or good. It just means big. In the case of ionized water, the claims are big too.

(Chemistry class refresher course: Tap water has a neutral pH, around 7. Ionized or alkaline water comes in somewhere above 7; anything below 7 tends toward acidic.) Some companies sell ionizing machines you can install in your home that can cost $5,000 or more. For this, you get water that is said to taste better, hydrate the body better than ordinary water, and promote energy and focus. Beyond those claims, some believe ionized water helps lower cholesterol and blood pressure, can help slow bone loss, and can prevent acid reflux and even reduce the risk of cancer. A completely different picture

is painted by neutral websites like Mayo Clinic, The Wall Street Journal, and Huffington Post. All three report that clinical research to support the claims made by water vendors is lacking. The Wall Street Journal quotes a gastroenterologist who says all food and drink, no matter what pH it was when it entered the stomach, leaves with a pH of about 6.8. While various scientists interviewed by the WSJ used words like “rubbish” and “nonsense” to describe health claims of ionized water vendors, the bottom line is that research is needed to prove or disprove the claims. Until then, pure tap water is practically free. +

JUNE 8, 2018

Musings of a Distractible Mind

‘ve been thinking lately about my overall philosophy of medical practice. What are the rules that govern my time in the office with patients? What determines when I see people, what tests I order, and what I prescribe? What constitutes good care in my practice? So I decided to make some rules that guide what I think a doctor should be doing in the exam room with the patient. They are as much for my patients as they are for me.

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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Rule 1: It’s the Patient’s Visit The visit is for the patient’s health, not the doctor’s income or ego. This means three things: • All medical decisions should be made for what is in their interest, including: when they come in, what medications they are given, what tests are ordered, etc. • Patients who request things that are harmful to themselves should be denied. People who ask for addictive drugs or unnecessary tests should not get them. Patients who are doing harmful things to themselves should be warned in a way that is helpful, not judgmental. • All tests done on the patient should be reported to them in a way that they can understand.

TM T

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Rule 2: Minimize Many doctors and patients have a “more is better” mentality. This not only costs more money to the system, but it can cause harm to the patient. Here’s what I think should be done: • See patients only as needed. • Use as few medications as possible, and when necessary, use the cheapest one that will do the job. • Order as few tests as

possible. No test should be ordered for informational purposes only; the question, “What will I do with these results?” should always be answerable. If it is not, the test should not be done. • When changes are made, make only a few at a time. Many simultaneous changes make it hard to tell what helps and what hurts. Rule 3: A Relationship = Better Care Relationship is one of the best tools for achieving optimal care. The patient knows and trusts the doctor aand the doctor knows the patient. This does not happen with sporadic care, but instead with consistent, longterm care by one provider. This approach acknowledges that: • Patients with long-term significant medical problems should come in on a routine basis. • The best-case scenario for regular visits is that there are no medical problems, in which case the visit will be mainly social. • There is a medical benefit to the social visit, with the doctor understanding the patient better and the patient trusting the doctor more. • There are cases where the patient doesn’t think there is something wrong, but a regular visit reveals either serious problems, or allows intervention to prevent a serious problem. Rule 4: Keep Priorities Straight When a patient comes in with a problem, these are the goals: • Rule out bad things • Make the problem better • Make a diagnosis Rule 5: There is ALWAYS a Reason It’s easy to believe that

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people’s actions revolve around you when you are a doctor. It’s not only human nature to take this view, but this state of mind results in bad thinking patterns like these: • If you can’t figure out why patients come in, then they are just wasting your time • If you can’t make sense of symptoms, then they are not telling the truth • If a person is acting in a way that is irritating and annoying, they are doing so by choice to bother you • A person who seems emotionally weak is that way by choice Avoiding these snap judgments will make care better, both in the ability to see things objectively and to offer care and compassion. Rule 6: If the House is Burning Down, Don’t Cut the Lawn Focus is one of the most important things in an office visit. Both doctors and patients can lose sight of the purpose of the visit. I use this rule whenever someone asks me about minor issues in the face of bigger things. Weight loss may be important in the long run, but it is not pertinent when a person is in the office with a heart attack. There are no quick fi xes or magic wands. Rule 7: Compliance Follows Communication I am not surprised when my patients aren’t compliant. My job is to help my patients see the benefit of compliance, not expect, perfect compliance. The best way to do this is to communicate. I need to communicate in a way that doesn’t just convince them of my opinion, but gives them reason to change theirs. +

AUGUSTAMEDICALEXAMiNER M E D I C I N E

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T H E

F I R S T

P E R S O N

The Sparrow Incident T

he following is a true story. There was still plenty of daylight left at seven o’clock on the evening of July 6, 2016. For seven days, I had been in room 204 of Anchor Health and Rehab in Aiken, recovering from a stroke that numbed my left hand. I was packing my belongings into a bag in anticipation of being released the next morning when I heard a few seconds of thumping and fluttering outside my window. When I turned to look, several small white feathers were floating to the ground, apparently the result of a bird fight just outside my field of view. Suddenly, a little brown bird impaled itself on the construction fence a few feet outside my building. (An

The next time I looked, the bird was gone. addition to Anchor was being built in the vacant lot next door.) The fence was made of a lightweight wire mesh stretched between poles, with the horizontal wires spaced about six inches apart and the vertical wires spaced about two inches. The bird was facing away from me and appeared to be totally immobilized with no sign of life except for a slight wiggle in his orange feet as they dangled near his tail feathers. The wiggling stopped after a few seconds, and I assumed the bird was dead.

I called to my roommate’s wife, tending to my roommate with the curtain drawn between our beds, and told her there was a bird caught in the fence outside. She came over to look and said it was a sparrow, then went back to her husband’s side. Thinking the sparrow was dead, I returned to packing my suitcase. The next time I glanced out the window, the sparrow’s body had turned to face me with his right wing hooked over a horizontal section of wire. He was completely motionless except for his eyes blinking every few seconds as if pleading for help. His unfortunate predicament called to my mind the crucifi xion of Christ. I wondered if Christ had looked as pleadingly at the crowd gathered below him and if anyone wanted to help him

JUNE 8, 2018 as much as I wanted to help that little bird. Unfortunately, I was required to use a walker every time I went outside my room, so it was not practical to navigate the hallway, a room full of tables, a concrete patio, and an uneven patch of ground to reach the bird. Nevertheless, I felt compelled to do something to help. I went to my door and called to a nurse who was coming out of a nearby room. I told her about the bird caught on the fence and wondered if someone might be available to go see about him. She said she didn’t know but would check. When I returned to my packing, the sparrow was still motionless except for blinking. As I pondered his sorry plight, a phrase from an old hymn I used to sing in my youth came to mind. “For His eye is on the sparrow, and I know He watches me.” Having done all I could to help, I went back to my packing. The next time I glanced out the window the little bird was gone A few minutes later, a second nurse came to my

room to tellme she and the fi rst nurse had gone onto the patio to see about the bird. In her words, “While we were watching, his sweetheart swooped down to him, and they flew off together.” I was heartened, though amazed, since it had looked to me like the sparrow’s condition was hopeless. Obviously, God’s eye had been on him. I wondered if this incident were a heavenly reminder that God was looking out for me, too. Would He help me escape being trapped with a numb left hand? I was not presumptuous enough to take the incident as a promise, but rather as a reminder that His eye was on me and He still had good things in store for me. + by Charles P. Reeve Aiken, SC Note: After three months, I had recovered about 80% of the use in my left hand. In the year or so since, I have seen no more improvement. I have resumed ten-finger typing, but now make significantly more mistakes.

WE’RE BEGGING YOU We’re never too proud to beg. What we’re begging for is Medicine in the First Person stories. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. Thanks!

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

“OUCH!”

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

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

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

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

JUNE 8, 2018

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AUGUSTAMEDICALEXAMiNER

Southern Girls Eat Clean Kale Apple Slaw Recently, I had lunch at a fabulous restaurant in our area, The Tropical Smoothie Café. On the menu are various healthy and nutritious food options. They serve delicious smoothies made with fresh fruits and real ingredients, wraps and sandwiches. One item in particular caught my eye: the Kale and Apple Slaw. It was absolutely delicious. One bite and I was hooked. I simply had to try and recreate this at home. I have no idea what ingredients are included in the restaurant’s version of this slaw, but I put together something very close and it turned out fab, if I do say so myself. Of course, the combination of kale and apples always tend to compliment each other in any dish. With curly kale, Granny Smith apples, and carrots, this slaw is packed with nutrition. The kale alone is full of antioxidants, calcium and iron and is low in fat and calories. The dressing I chose to use for the slaw does include some dairy even though as a rule, I try to limit dairy in my diet due to the fact that it has been proven to be a highly inflammatory food for most people. As Americans, we consume large amounts of dairy, and with the increase of dairy in our diets, our disease rate has gone up too. Occasionally though, I will add a small amount of dairy to a recipe if I feel that • 2 Tbsp. of apple cider a substitute would not lend the peeler down the carrot. vinegar (Not as much if you well to the flavor of the dish. Place into the bowl with the prefer a less tangy dressing) In this case I used a low-fat kale and apple. • 1 1/2 Tbsp. of local honey Greek yogurt to dress the In a small bowl, whisk slaw but there are many other • The juice of 1 lemon together the remaining • 1/2 tsp. of celery seeds options out there that may ingredients to make the • 1/2 tsp. of kosher salt work well. Non-dairy yogurt dressing. • 1/4 tsp. of cracked black is available and Veganaise Pour the dressing over (Vegan Mayonnaise) might be pepper the kale, apples and carrots. another choice. Toss to coat well. Place in the Instructions: I hope you’ll enjoy this refrigerator for about an hour, Wash Kale and drain to dry stirring occasionally to help recipe! then remove stems and chop tenderize the kale. the kale into small pieces and Ingredients: Remove and serve slightly • 1 bunch of curly kale, stems place in a large bowl. chilled. + Without peeling the apples, removed and chopped into Alisa Rhinehart writes the blog cut them into thin julienned small pieces www.southerngirlseatclean. pieces and place into the bowl • 2 Granny Smith apples, com She is a working wife and with the kale. julienned mother living in Wash and peel the outer • 2 carrots, use a veggie Evans. Visit her layer from the carrots and peeler to create thin ribbons blog for more recipes discard that layer. Then using • 1/2 cup of organic plain and information on the veggie peeler, create thin Greek yogurt clean eating. ribbons of carrot by running 2 Tbsp. of Dijon mustard

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ASK DR. KARP

NO NONSENSE

NUTRITION Mary Beth from Wadley, Georgia asks, “What are your thoughts on high fructose corn syrup?” Fructose is in the news quite a bit these days. It’s almost as if there is a battle going on between food manufacturers who use highfructose corn syrups (HFCs), and the natural and organic crowd, who are against its use. People are concerned about the perceived unhealthy effects of fructose and HFCs. The suggestion is often to use alternative “natural” sweeteners instead, such as honey, raw sugar and Agave syrup. What the scientific data show is that most if not all of the effects of HFCs can be explained by those extra

calories that come along with any high sugar foods and drinks, including the resulting weight gain. You may have read that fructose has been linked to the increase in diabetes and cardiovascular disease in this country. Again, it’s not the fructose; it’s the increased calorie intake and resultant weight gain that is the culprit. That means that if you are concerned about your fructose intake and its metabolic consequences, you need to reduce ALL sugars in your diet. Don’t just focus on fructose and HFCs. There is no need to jump on the “I hate fructose” bandwagon. I have no reason to defend fructose; I am simply telling you want the data show. It doesn’t make sense to worry about the perceived health effects of fructose, on the one hand, and replace the fructose with “natural” and “organic” sweeteners, such as Agave syrup, on the other hand. While most HFCs contains a mixture of about 50% fructose and 50% glucose, Agave syrup is one exception; it contains even more fructose than HFCs: 56% fructose and 20% glucose. Concerned about fructose and high fructose syrups? Then avoid Agave products. What about honey? A tablespoon of honey has 68 calories, while a tablespoon of white granulated sugar contains 49 calories. This is because honey has higher density and weight compared to sugar. Honey is also a mixture of fructose

JUNE 8, 2018 and glucose, along with other sugars. The USDA Dietary Guidelines and The American Heart Association recommend reducing your use of all sugary foods, without differentiating between any of the various types of sugars, whether table sugar, raw sugar or honey. The fact is that moderate fructose ingestion is not unhealthy. The fructose should come from fruit and other foods, not from sugar added to foods. Most health organizations recommend that your diet contain no more than 10% calories from sugar, about 200 calories per day based on a 2000 calorie diet. That means that even one regular soft drink will contain almost all the sugar you are supposed to consume all day. What’s today’s “NoNonsense Nutrition” advice? If you are worried about diabetes, heart disease and stroke, then worry about taking in too many calories, being overweight, and sitting by that computer or TV. Stop obsessing about fructose. It is easy to reduce HFCs and other high fructose foods in your diet by simply reducing sugary drinks and sweet foods. If you want to sweeten your cereal in the morning, add blueberries, raspberries and strawberries instead of using pre-sweetened cereals with HFCs. Cut out all those soft drinks, energy drinks, sports drinks juices, candies, granola and cereal bars and sweet baked goods. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D. is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at The Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for his public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles or books and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely-available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not intended to diagnose, manage or treat any patient or client. The views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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

SUMMER FOOD SAFETY by Amanda Reiter, MS-Dietetic Intern

A food thermometer is a useful tool Summer is just around the corner. Memorial Day and the Fourth of July are great cookout occasions. However, these celebrations can quickly go south if food safety guidelines are not followed. Food poisoning may be due to cross-contamination and time-temperature “abuse”. Cross-contamination can occur before the food arrives

at the cookout. Contaminated ingredients may be added to foods that received no additional cooking like potato salad or macaroni salad. Cross-contamination may occur when uncooked foods make contact with cooked or ready-to-eat foods. For example, cutting raw chicken next to lettuce and the fluids from the chicken drip onto the

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lettuce. Often individuals may What should you do to touch a contaminated food prevent food poisoning at your like raw hamburger and then next cookout? touch a ready-to-eat food like • Make sure raw meats are a head of iceberg lettuce to prepared away from the rest of put on the hamburger without the food washing their hands. • Do not use the same cutting Time-temperature “abuse” board, bowl, or cooking is a major cause of food utensil for raw meats and poisoning at cookouts. This ready-to-eat foods may occur when foods • Do not leave food outside are kept at temperatures for more than 2 hours that supports the growth or 1 hour if the outside of bacteria. These are temperature is higher than 90 microorganisms that cannot • Cook foods to their minimal be seen with the naked eye internal temperature using a and may not have an offensive food thermometer: smell. Therefore, food may be Poultry: 165° for at least 15 contaminated without looking seconds or smelling different. Bacteria Ground meat: 155° for 15 in food will grow rapidly at seconds temperatures 40 – 1400 F. Steaks and chops: 145° for This range is often referred to 15 seconds as the danger zone. At these Cooking on the grill is a temperatures, the amount of staple of all cookouts, but it bacteria present may double has the potential of causing within 20 minutes. Foods a serious health issue if not must be kept at the correct done correctly. Grills tend to temperature. Hot foods must cook at a higher temperature be kept hot and cold foods than the conventional oven, kept cold. Potato salad, a resulting in the charring holiday and cookout favorite, or blackening of meat. may be left out in the sun Heterocyclic amines (HCAs) resulting in its temperature and polycyclic aromatic increasing for bacteria to hydrocarbons (PAHs) are start growing. Raw or underchemicals formed when cooked foods high risks foods meats are cooked at high for food poisoning as bacteria temperatures and can cause may not be killed by cooking. Please see SUMMER FOOD page 10

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changes in our DNA that increase the risk of developing cancer. HCAs are seen when foods are cooked for a long time at temperatures over 300, like well-done steaks. PAHs are seen when meats are smoked or their juice drippings fall into the grill causing flames and/or smoke to develop and it adheres to the outside of the meat. According to research done on animals, those that consumed a high amount of HCAs developed breast, colon, liver, skin, lung, and prostate tumors whereas those fed PAHs developed leukemia, stomach and lung cancers. How can you minimize these in your food? • Avoid cooking over an open flame • Avoid prolonged cooking time • Flipping meat often • Remove charred portions While you enjoy the hot summer days, don’t forget to remain hydrated. Due to the heat we may be losing fluids faster. Water is an excellent fluid to consume to remain hydrated. Water is cheap, calorie free, and highly accessible. Alcohol consumption should be limited due to their diuretic effect on the body. Avoid sweetened beverages as they are usually very high in added sugars. Fruits are plentiful in the summer months. They are refreshing and will help to keep us hydrated. Dehydration can be dangerous for young children and older adults so fluid intake should be monitored in those individuals. Symptoms of dehydration include: extreme thirst, dizziness, confusion, and less frequent urination. These are some simple ways to prevent summer activities from becoming disastrous. Enjoy your time spent with friends and family during these summer months and remember to be aware of the food you are consuming as well as being adequately hydrated. For more information on health, food, and nutrition, visit www.eatright.org. References • Chemicals in Meat Cooked at High Temperatures and Cancer Risk. (n.d.). Retrieved from https://www.cancer.gov/about-cancer/ causes-prevention/risk/diet/cooked-meats-fact-sheet • Dehydration. (2018, February 15). Retrieved from https://www. mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/ syc-20354086 • ServSafe Coursebook: Updated with the 2013 FDA Food Code (6th ed). (2014). Chicago, IL: National Restaurant Association Educational Foundation. +

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The blog spot From the Bookshelf — posted by Rakhi Dimino, M.D. on August 29, 2017 (edited for space)

THE FIX WHEN THERE’S NOTHING LEFT TO FIX Being a physician is hard. Really hard. Four years of medical school, multiple years of residency and perhaps fellowship training add up to years of working endless days in a row and powering through exhausting nights. But being a patient is harder. Being the daughter or son or husband of a patient is infinitely harder still. As our loved ones approach the end of life, our job as a family member is the most grueling, physically challenging and emotionally draining job that even residency never prepares us for. We are never really prepared for death. As physicians, we like to believe that we all gave it the good fight. We say we tried all that we could. We tell the family that it was for the better. And then we straighten our white coats as we walk into the next room with a fabricated smile on our face pretending that a piece of us did not get left behind in the last room. We have trained, sometimes for a whole decade, on how to fi x the body and how to cheat death for as long as possible. In all of my training as physician, even on my gynecologic oncology rotations in residency, we rarely talked about death and dying. We talked about saving. We talked about the surgeries, the medicines, and the care we would give to cheat death in its tracks. A few floors above us was labor and delivery — the happy place — except when it is not. How do you tell a mother or a father that they will not hear their baby cry? How do you explain that they will hold their baby’s lifeless body soon, or even worse, they will witness hours of agonal breathing and see their child’s heart slowly stop beating through its thin chest wall? There is nothing left for us to fi x, so we give her tissues to wipe away her tears of grief and we walk next door and push the celebration balloons aside on our way to handing over another beautiful son to nuzzle against his mother’s chest. As physicians, we are called to do more than fi x bodies. We are charged with taking care of people. Our patients and their families need us most when there is nothing left to fix but a breaking heart and all-consuming sadness. They need our presence sitting at the bedside even when there is no plan to explain. They need our touch on the shoulder while we spend a few moments keeping vigil with their loved ones. They need us to acknowledge that even when you know you gave it the good fight, it still aches viscerally. They need someone to show them that it is okay to laugh in between tears as they remember life’s good times. They need their physician, who they trusted to fi x them, to be the one who helps them see that death is not the failure of defeat. We need it too. We need the reassuring hug from the family acknowledging that we did not fail at the job we trained so hard to do. We need the expression of gratitude for helping them, even when we could not fi x it. We need to know there were good memories to hold on to. We need to be comforted by the family as we see a piece of our heart leave us in that room. We need to hold on to those thoughts as sleep eludes us in the night. We need to have closure too. So whether you are an intensivist or oncologist who witnesses death with some frequency or an obstetrician or pediatrician who does not, what will you do when your patient is nearing the end of life? How will you respond when your patient needs you the most? Will you escape quickly to the next room when you have nothing you can fi x? Or will you stay and keep vigil with the family for a few moments? They still need your kindness, compassion, caring, and knowledge to make it through this last challenge in life. You need them too. +

How will you respond?

Rakhi Dimino is an obstetrician-gynecologist.

What sets this book apart from many of its ilk — books about how this disease or that one was vanquished — is that most are written by researchers and historians; this one was written by the man who actually did the deed. If you read “Who is this?” on page 4, you’ve already met the author. He directed a ten-year worldwide effort that officially eradicated what had been a centuries-old plague (literally) on the human race, claiming half a billion lives in the 20th century alone. The thing is, aside from the obstacles already enumerated on page 4, no one involved really believed the effort could succeed. As Richard Preston recounts in the Foreword, respected scientists like René Dubos believed that even if eradication of smallpox was theoretically possible, from a practical and economic standpoint it was chasing after the wind. It would require an in-person presence in a million tiny and remote third-world villages in places like Somalia, India, Bangladesh, Pakistan, and Nigeria; and an equally impressive presence in teeming metropolises all over the world. It was an immensely

daunting task. Recording the story of its demise — the first time in human history a major pestilential disease had been eradicated — was another monumental task Henderson was eminently qualified to tackle. Very few people are alive today who have first-hand knowledge of smallpox, or any exposure to it that didn’t come from Google or a textbook. It’s impossible to comprehend in 2018 what it meant to vanquish such a hideous and devastating scourge — but this book does an impressive job. It is informative from the front

cover to its final page. For instance, a special twopronged needle — called a bifurcated needle, shown on the book’s cover — was invented specifically for administering the smallpox vaccine. It was so vital to the effort that when “Target Zero” was reached, those responsible were inducted into an elite group of Henderson’s creation, The Order of the Bifurcated Needle. This highly recommended book takes readers from the medieval history of smallpox, through the international 20th century effort to erase it from the face of the earth, and into the future and the thorny 21st century ethical questions about the use of smallpox as a biological weapon and its possible use by terrorists (the CDC and a Russian research facility still maintain viable samples of the smallpox virus despite international calls for the destruction of the samples). Henderson died in 2016 at age 87 due to complications from a fall. + Smallpox - The Death of a Disease by D.A Henderson, M.D., 334 pages, published in June 2009 by Prometheus Books

Research News Drink this for health A study we somehow missed that was published in the Journal of Immunology in April originated from — of all places — the Medical College of Georgia at Augusta University. The study concluded that drinking a daily dose of water with baking soda may help reduce the destructive inflammation of autoimmune diseases like rheumatoid arthritis (RA). The study is a complex look at the spleen and how baking soda converts immune cells called macrophages from a role that promotes inflammation to one that reduces inflammation. The Journal article did not specify a particular dose associated with the study, and baking soda is high in sodium, so it isn’t advised for everyone without first consulting with your doctor. Even so, baking soda, also known as bicarbonate of soda, is a longtime home remedy for

everything from brushing teeth to deodorizing the refrigerator, Now it may have another use in helping relieve RA. Tragic news Reviewing data from the CDC on all deaths in the US over a 16-year period, researchers discovered that in 2016, the most recent year studied, 20 percent of all deaths in the 20-35 age group were opioid related. By comparison, in 2001 only 4 percent of fatalities in that age group were opioid related. Save your money? A new Canadian study published late last month in the Journal of the American College of Cardiology examined the value of vitamin and mineral supplements. The research undertook a systematic review of existing data and published trials between January 2012 through October 2017. The data reviewed

produced a surprising result, one researchers were not expecting: taking multivitamins, calcium, and/or vitamins C and D — the most common supplements — provided no consistent health benefit. Researchers did not find that taking the supplements did any harm, but neither did they offer any benefit or advantage in reducing the risk of heart attack, stroke, cardiovascular disease or premature death, at least that researchers could detect or measure. Other less commonly taken supplements did offer some benefit: taking B vitamins with folic acid, or folic acid alone, may reduce the risk of cardiovascular disease and stroke. Researchers say the main takeaway from the study is that people should view a healthy diet — not pills or supplements — as their best source for vitamins, minerals and good nutrition. +

+ 12

AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

JUNE 8, 2018

I heard a pretty funny joke yesterday.

Let’s hear it.

by Dan Pearson

You wouldn’t get it. In fact, only anti-vaxxer’s kids will get it.

Well just pretend that’s what I am.

Polio and measles.

Ouch. Not funny.

The Mystery Word for this issue: SAGATUU

EXAMINER CROSSWORD

PUZZLE

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

Click on “READER CONTESTS”

QUOTATIONPUZZLE

U Y T B D B W E N A U I E I P O T I L L A O N

C S B T S F R H A Y T I O O C O T E T E E O F N F

— Unknown

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

E X A M I N E R

3 3

1 4

1 8

7 2

9 5

8 9

3 5

S 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 keypad letters to convert numbers into words suggested by the definitions provided. Sample: 742 (body part) = RIB. Solution on page 14. 1. 5864 (body part) ____

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3. 74685337 (body part) ________

8. 4678546 (prescription) ________

4. 97478 (body part) _____

9. 3769746377 (symptom) ___________

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ACROSS 1. Eyeglasses, informally 6. Swelling 11. Dr. of rapology 14. Unit of weight at Windsor Fine Jewelers 15. Wanderer 16. Like a bad deal 17. Express opinions 18. _____ off (like 17-A) 19. Press into service 20. Element number 73 22. Equine sounds 24. On sheltered side 25. “Feel the ___” 2016 slogan 26. Old type of radio 30. Intimate term for God by Daniel R. Pearson © 2018 All rights reserved. Built in part with software from www.crauswords.com 34. Break into a data system 35. Norse goddess DOWN 38. Leaping marsupial 36. Academic administrator 1. Native of Scotland 39. Fencing sword 37. Folklore fiend 2. Dad 46. Stage plays 38. He served before Tillerson 3. Ireland 47. Resin used in varnish 40. Pole on a boat 4. Quarrelsome 48. Exit 41. Psychic 5. Fast runners in baseball 50. Rods used to reinforce 42. Mimic often rack these up concrete 43. Colored part of the eye 6. Follows 52. Neck back 44. Vegetable like taro 7. It pairs well with gloom 53. Helper 45. Unnecessarily 8. Large flightless bird 54. Mountain range and river 49. Exhort 9. Polite that share the same name 51. Torn clothing 10. Venomous snake 55. Of ______ (recently) 52. Queasiness 11. Medicine 56. Earth’s satellite 55. Of tears 12. Like an impulsive decision 57. Exclamation of sorrow or 59. Atmosphere 13. Female sheep regret 60. Braves player who scored 21. Wreath of flowers 58. Usage that is the focus of the winning run of the 23. Not allowable in court page 1 articles in this issue 1992 NLCS 25. An Afrikaner 61. Trauma pt. destinations 62. African plague 26. The ones over there 63. Kissing in public, for ex. 27. Stormed 64. The main artery 28. A large farm is many-______ 65. Kettering partner 29. Number of Stooges 66. Snakelike fish 31. George Hallas team 67. Flowers with thorns 32. Culinary herb 68. Inward feeling 33. Restless; on edge Solution p. 14

TEXT

THE MYSTERY WORD

JUNE 8, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

Moe: I asked my boss if I could come in to work a little late tomorrow. Joe: What did he say? Moe: “Dream on.” Joe: That was sure nice of him.

ha... ha...

Joe: It’s impossible to lose a homing pigeon. Moe: How do you figure? Joe: If it doesn’t come back, it was only a pigeon.

guy bought his girlfriend a diamond ring with the stones arranged in the shape of a four-leaf clover. When they broke up, the girl took it to a jeweler to have the ring appraised. The low value surprised her. “What about all those diamonds that make up the four-leaf clover?” she protested. The jeweler told her those were actually rhinestones. “And it isn’t a four-leaf clover either,” said the jeweler. “It’s a sham rock.”

Joe: What has 18 wheels and flies? Moe: Uh...a garbage truck? Joe: I went to a revival last night where there was supposed to be a faith healer. Moe: Was anybody actually healed? Joe: Not a one. It was so bad one guy in a wheelchair got up and walked out. Joe: I had to spend the night in jail. Moe: What was the charge? Joe: Nothing. Apparently it’s a free service.

Years ago I took the entrance exam for medical school. One of the questions in the section on human anatomy asked us rearrange the letters PNEIS to spell “an important human body part which is best when erect.” Those who answered “spine” are now doctors.

Joe: What’s worse than raining cats and dogs? Moe: Hailing taxis. Moe: What does the food cannibals serve taste like? Joe: I would imagine it varies from person to person.

Kid: Mom, am I ugly? Mom: I told you never to call me Mom in public! Moe: Did you hear about that guy who was stabbed ten times in the stomach? Joe: Wow, somebody really hated his guts.

Moe: What do you call Mountain Dew when it goes flat? Joe: Plateau Dew. +

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

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

Dear Advice Doctor, There are so many problems in the world I’m sure you’ll never run out of subjects to give advice about. That’s why I’m writing. I recently inherited a sizeable sum of money. I know it’s a drop in the bucket in the grand scheme of things, but I’m willing to use all of it if it will make a difference somehow. How can I best take the pulse of our community and determine where I can be of the most help? — May I help you? Dear May, I applaud your desire, and I want to assure you that this should be a fairly simple matter. That’s because there are so many convenient places where the pulse can be taken. Wherever an artery travels near the surface of the body — and there are many such places — can be a good place to take the pulse. My personal favorite for ease of touch is the carotid artery, which can be felt (or “palpated”)a little to the left or right of the vertical midline of the front of the neck. Other sites include the wrist, the inside of the elbow, the back of the knee and the top of the foot. There are many reasons to take our pulse, and it can provide a surprising amount of information — starting with “Is this person alive?” Emergency responders check it immediately if a person is unresponsive. The standard measure is beats per minute (bpm). “Normal” bpm when a person has been resting for at least ten minutes ranges from 60 to 80, with variations beyond those broad limits for different age groups. A very rapid pulse (known as tachycardia) can indicate the possibility of dehydration, infection, cardiovascular issues, or sheer terror. An abnormally slow pulse (bradycardia) could be a sign of misfires in the heart’s electrical system, a drug interaction, or perhaps that the patient is a serious athlete: during his career professional cyclist Miguel Indurain had a resting heart rate of 28 bpm. As mentioned, lots of information can be gleaned from taking the pulse. For example, it can reveal the existence of an irregular heartbeat, alternating between fast and slow; another valuable clinical indication is provided if the pulse is strong on one arm and weak on the other; a weak pulse might mean low cardiac output, and indictates the need for further investigation. And it isn’t all about detecting trouble: runners and exercise walkers measure pulse to gauge the intensity of their workout. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

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Why read the Medical Examiner: Reason #63

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

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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

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THE MYSTERY SOLVED The Mystery Word in our last issue was: CRUTCHES ...cleverly hidden on the building the p. 8 ad for C & C AUTOMOTIVE THE WINNER: KAYLEIGH NEWBY 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

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.

M A

A W

I N A

M A

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SEE PAGE 12

The Celebrated TEXT ME 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!

JUNE 8, 2018

AUGUSTAMEDICALEXAMiNER

1. LUNG 2. NURSE 3. SHOULDER 4. WRIST 5. LIVER

6. ANGINA 7. FACE-LIFT 8. INSULIN 9. DROWSINESS 10. INNOCULATION

TheSUDOKUsolution 7

QUOTATION QUOTATION PUZZLE SOLUTION “Patience is the ability to count down before you blast off.”

READ EVERY ISSUE ONLINE

— Author unknown

The new scrambled Mystery Word is found on page 12

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JUNE 8, 2018

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AUGUSTAMEDICALEXAMiNER

#13 IN A 13-PART SERIES

The vitamin alphabet If our penultimate installment in this series was about vitamin E (and it was), and this final installment is vitamin K, then surely vitamins F, G, H, I and J feel left out. Or they would if they existed. They do not, however. The story of how we the vitamin alphabet skipped from E to K is a tale of international intrigue and espionage (but without the intrigue and espionage parts). Back in 1929, Danish biochemist Henrik Dam was doing research at the University of Copenhagen on chicks (of the farmyard variety). When scientists make a discovery that is published in the journals, standard protocol is for other

scientists around the world to attempt to replicate the study as a means of verifying the results. Dam was doing just that, repeating an earlier experiment performed by researchers in Ontario. There, chicks who were fed completely fat- and cholesterol-depleted chick chow began to experience internal bleeding in muscles and organs, and blood drawn for examination showed delayed coagulation. Surprisingly, when cholesterol was restored to their diet it did not stop the hemorrhages. The same was true of other deficiencies (such as vitamin C) thought to be part of the chicks’ limited diet. Working in concert with American biochemist Edward

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

Doisy of St. Louis University, Dam realized the process of removing fat and cholesterol from the chicken feed must have also eliminated some other element crucial to the blood’s ability to clot. That element was quickly named vitamin K because, as Dam said in his address accepting the 1943 Nobel Prize in Medicine for his discovery, “the letter K was the fi rst one in the alphabet which had not...been used to designate other vitamins, and it also happened to be the fi rst letter of the word ‘koagulation’ according to Scandinavian and German spelling.” Even though the discovery of vitamin K was put to immediate use (the fi rst published report of its use

to treat a life-threatening hemorrhage came in 1938), the precise mechanism of vitamin K’s function wasn’t discovered until 1974. In that year, the vitamin K-dependent coagulation factor known as prothrombin was identified. But vitamin K is about more than just preventing bleeding. The USDA’s Vitamin K Laboratory at Tufts University says vitamin K activates at least three proteins involved in bone health, a key finding for America’s growing population of aging Baby Boomers. Great sources of vitamin K include — what else? — kale and other dark greens like spinach, collards, mustard greens and lettuce, plus fruits like avocados, grapes and kiwi. +

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AUGUSTAMEDICALEXAMiNER

IT’S A QUESTION OF CARE What activities can an older person engage in while we’re on vacation together?

Caregivers for elderly loved ones in our lives often find themselves longing for a vacation. If that describes you, please consider taking your loved one along. If you decide to invite your elderly loved one on your family vacation, the front porch may be all that is required for them to participate as fully as possible. Consider this: You might have your 90-year-old mother or grandmother join you at your beach house. She can enjoy many facets of the vacation just sitting in the rocking chair on the front porch. She can hopefully see the ocean as the tides lap gently at the shore, perhaps her hearing is still good enough that she can listen to the surf, and maybe even see and hear her grandkids or great-grandkids playing and splashing in the water. She could certainly enjoy watching them come back from the beach, wet

JUNE 8, 2018

and tired and covered with sand but with smiles on their faces. She can sit on the porch and enjoy conversation with you and the rest of her family and sip sweet tea, lemonade or maybe a glass of wine. Perhaps she can watch the sunrise or the sunset. Maybe she enjoys playing cards, and you can invite her to join in a family game of cards as you sit on the front porch. Maybe she likes to read, and she can rock and read, even if she can’t walk on the beach like everyone else. There are ways to incorporate your family member who is not as capable physically or cognitively as they used to be. Just be creative, and they will be so glad that you included them. +

DO YOU LIKE OUR NEW WORD PUZZLE ON PAGE 12?

by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

Let us know at facebook.com/AugustaRX

PROFESSIONAL DIRECTORY +

ALLERGY

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

AMBULANCE SERVICE

AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

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

DENTISTRY

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

PHARMACY

Medical Center West Pharmacy 465 North Belair Road Evans 30809 Floss ‘em 706-854-2424 or lose ‘em! www.medicalcenterwestpharmacy.com

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

DERMATOLOGY

Parks Pharmacy 437 Georgia Ave. N. Augusta 29841 803-279-7450 www.parkspharmacy.com

PSYCHIATRY Psych Consultants 2820 Hillcreek Dr Augusta 30909 (706) 410-1202 www.psych-consultants.com

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 Augusta Gardens Senior Living Community 706-733-3373 3725 Wheeler Road SKIN CANCER CENTER www.GaDerm.com Augusta 30909 SENIOR LIVING COMMUNITY Resolution Counseling Professionals 706-868-6500 3633 Wheeler Rd, Suite 365 www.augustagardenscommunity.com Augusta 30909 706-432-6866 Karen L. Carter, MD www.visitrcp.com 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in Steppingstones to Recovery this convenient place seen by tens of 2610 Commons Blvd. thousands of patients every month. Augusta 30909 Literally! Call (706) 860-5455 for all 706-733-1935 the details

SENIOR LIVING

COUNSELING

DEVELOPMENTAL PEDIATRICS

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DRUG REHAB

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 Vein Specialists of Augusta G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 706-854-8340 www.VeinsAugusta.com

YOUR LISTING HERE Augusta Area Healthcare Provider Prices from less than $100 for six months CALL 706.860.5455 TODAY!

If you would like your medical practice listed in the Professional Directory, call the Medical Examiner at 706.860.5455