June 7 19 by Daniel Pearson

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CBD

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JUNE 7, 2019

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The ABCs of

CBD: WHAT YOU NEED TO KNOW – PART 1: THE BASICS Written by Augusta pharmacists Chris and Lee Davidson

There is a new set of prodbut it is quickly going mainCB-2. ucts gaining huge popularity stream. Unfortunately, there CB-1 receptors are found in the nation that are being are not enough mainstream primarily in the central nertouted as being good for medical studies to back up vous system (CNS), which is almost everything that ails these fantastic claims, at least the brain, nerves, and spinal you. These products, based not yet. Research is having to cord. CB-2 receptors primarion different formulations of play catch up to this rapidly ly handle the peripheral nercannabidiol (CBD) oil (proevolving chapter in medicine. vous system (PNS) - essennounced can-uh-b -DIE-all), The purpose of the Entially everywhere else. There work by regulating the body’s docannabinoid System is to are more potential receptors endocannabinoid system. maintain homeostasis, or being studied, but they have The endocannabinoid system balance, within the body. The not been definitively identi(ECS) helps to regulate a receptors themselves are the- fied yet. Between these two broad range of physiological orized to be “smart” in that primary receptor types, virtuprocesses throughout our they are only able to act on ally all the body’s functionbodies. The latest research the bodily functions that are ing and responses, including shows that when the ECS is currently out of balance in motor functions, how pain is disrupted it can be associated order to maintain a precision felt, keeping digestive syswith a long list of common level of homeostasis. In other tems functioning, controlling illnesses and medical conwords, they work only when immune responses, moderditions. This is why there and where they are needed ating moods, enabling (or are claims made about CBD without going overboard. disabling) the ability to sleep, being a treatment for almost There are multiple types of helping to remember inforeverything. This type of treat- receptors in the ECS, but mation, etc., are managed. SCRB19012CR-Medical Ad-outlines-PRINT-2.pdf 1 the 5/29/19 There 9:14 AM is at least one group ment used to be reservedExaminer-June for there are two that handle the alternative medicine set, bulk of the work: CB-1 and of researchers who believe e

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that when the body cannot maintain its perfect balance, it may indicate that the person has clinical endocannabinoid deficiency – that they are either lacking enough of one or the other types of receptors or that they have too much of a specific enzyme that blocks the receptors. The theory is that with such a deficiency, a person may be more prone to certain conditions such as fibromyalgia, certain GI disorders (including IBS), chronic pain, migraines, depression, anxiety, and more. There also seems to be a strong connection between the ECS and the immune system, suggesting that the ECS may actually play a role in autoimmune diseases. CBD can be useful in the management of many conditions and is being investigated for potential benefit in many more. Again, there is a lot of anecdotal information available, but for the most part the scientific studies are ongoing. CBD products are marketed as supplements, not as over-the-counter drugs, so just like other vitamin and supplement products they cannot make any actual claims about curing or treating any

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disease. This also relieves the manufacturers of the obligation to publish dosing guidelines, so the best bet is to talk to your pharmacist and remember that each person is different. You may have to adjust the dose to find what works for you and your condition because there is no one right answer. Make sure to tell your pharmacist about your current medical history and other medicines you take since CBD can potentially interact with other medicines. Be particularly careful to mention seizure medications and blood thinners since these are two big areas of Please see CBD page 6

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THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

JUNE 7, 2019

Dr.busbee’s CELEBRATED

c C ELIXER of TRUE Health DECIPHERING HEALTH MYTHS, SNAKE OIL CURES AND OLD WIVES TALES BY TRACEY BUSBEE, MLIS, AUGUSTA UNIVERSITY

PARENTHOOD by David W. Proefrock, PhD

Your 8 year-old son has been prescribed glasses, but he hates to wear them. He says they make him look dopey and that the kids at school tease him. He admits that he can see better with them, but you have to force him to put them on in the morning to go to school and he often finds a way to lose or break them when he does wear them. What do you do? A. First, make sure that he knows that you understand why he doesn’t like to wear his glasses. Then make sure that he understands why he should wear them. Once these two steps are accomplished, work with him to make a plan. B. Buy a box of small, inexpensive toys and for every day that he wears his glasses to school and doesn’t lose or break them, let him choose a toy. C. Get him contact lenses. D. Talk with him about how glasses are actually stylish now, about how necessary they are in order for him to do good school work, and about how he should just ignore what the other kids say.

If you answered: A. This is the best answer. Make sure you both know the issues and you both understand the feelings involved. Then you can begin the process of making a plan. B. This might actually work, but first you should make sure all the issues and feelings are understood and that this is part of a plan you both agree to. C. It would be a rare 8 year-old that could handle the work and responsibility necessary to wear contacts correctly. Maybe a few years down the road, but not now. D. If he thinks they look dopey, telling him they are actually stylish is meaningless. He already knows that they are necessary to do good school work and still doesn’t want to wear them. Ignoring what the other kids say is not possible. Could you do it when you were 8? This response will never work. These glasses are a problem. The best way to solve any problem is to understand all the issues and to make a plan together that addresses them. It is important that the child actually participates in developing the plan. Otherwise it is not likely to work. + Dr. Proefrock is a local clinical and forensic psychologist

MANOPAUSE: MYTH OR REALITY? Since 1992, June has been recognized as Men’s Health Month as an initiative to encourage and educate use about health concerns affecting boys and men. Men die earlier than women on average, they compromise 92% of work-related deaths, have higher suicide rates, are less likely to see their doctors for routine checkups, have greater mortality rates in every age group, and are less likely to have insurance.1 When my topic came to mind, I took a quick poll on Facebook to garner some feedback on knowledge of manopause- guess how many males responded? Zero! I anticipated that outcome. I can’t remember when I first heard of manopause, male menopause, or more correctly andropause, but it was probably a couple of decades ago. The Mayo Clinic describes andropause as “aging-related hormone changes in men,” specifically testosterone.2 Some of the symptoms of low testosterone levels are erectile dysfunction, reduced sexual desire, sleep disturbances, sleepiness, decreased motivation, trouble concentrating, increased body fat, tender and swollen breasts, hot flashes, decreased bone density, and reduced muscle mass.1,3 On average, a male’s testosterone levels will de-

crease 1-2% every year after the age of 30.2-4 Testosterone deficiency may be treated with oral medications, injections, and patches; however, the success rate of treatment is not as effective as the hormone replacement therapy results for women.3 There are many hazardous side effects of testosterone replacement and the benefits may not outweigh the risks involved.5 Risks include cardiovascular disease, enlarged prostate, increased hematocrits and are somewhat mediated by the delivery method.5 Some of the potential benefits of testosterone therapy are improved bone mass, bone mass, body composition and strength and sexual function.5 Most of the benefits are described as inconclusive and were found in small studies while data on the risks are more conclusive.5 Some research literature bounces around the issue of finding conclusive evidence that andropause is a “real clinical syndrome” and attempting to differentiate it from a normal, gradual decline in functioning.3 Opponents to the idea that andropause is real point to the inconsistent data that correlates aforementioned symptoms in men with and without low testosterone levels. They believe that

some of the symptoms may be a result of normal aging and decreasing growth hormones, hypothyroidism, and diabetes. In addition, one study found that as much as 80% of erectile dysfunction is mental or emotional in nature, not physical.3 Some medical professionals accept that andropause is a real syndrome and others hesitate. There is not a definitive answer among the medical community. However, males should be encouraged to talk to their healthcare providers to see what options they have if they are experiencing symptoms of low testosterone. As always, be wary of online miracle medications, herbal remedies and self-treatments that may be ineffective and even detrimental to your health. Have a healthy, happy Men’s Health Month and don’t forget to wear blue the Friday before Father’s Day for awareness! + References 1. Men’s Health Month. http:// www.menshealthmonth.org/ 2. Mayo Clinic Staff Male menopause: myth or reality? https:// www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/ male-menopause/art-20048056 3. Pines A. Male menopause: is it a real clinical syndrome? Climacteric: The Journal Of The International Menopause Society. 2011;14(1):15-17. doi:10.3109/136 97137.2010.507442. 4. McCullars Varner J. CE Corner. MANopause (Andropause). Alabama Nurse. 2013;40(1):79. http://search.ebscohost.com/ login.aspx?direct=true&db=cin 20&AN=108010679&site=eds-li ve&scope=site. Accessed May 28, 2019. 5. Hijazi RA, Cunningham GR. Andropause: is androgen replacement therapy indicated for the aging male? Annual Review Of Medicine. 2005;56:117-137. http://search.ebscohost.com/ login.aspx?direct=true&db=mnh&AN=15660505&site=eds-live&scope=site. Accessed May 28, 2019.

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JUNE 7, 2019

HOW MUCH TIME DO I HAVE, DOC?

That question is probably in the script of dozens of old movies. In real life it’s also fairly common to hear people talk about predictions of death given by doctors. “They gave him six months, but he didn’t make three.” “Doctors told me I only had a year, and that was almost ten years ago.” We’ve all heard such comments, as well as the predictions where doctors give someone so many weeks or months to live and their prognosis ends up being — pardon the expression — dead-on accurate. Another phrase we often hear — “doctors have seen it all” — means they are in a better position than most to offer educated guesses about the immediate life prospects of a patient. Even so, most doctors wisely avoid making precise or dogmatic forecasts about impending death. They know there are almost as many unknowns and variables involved as there are patients. Some diseases send their hapless victims steeply and relentlessly downhill. Other conditions take patients on a roller coaster ride of ups and downs, the downs gradually but irregularly becoming longer and deeper. And there are probably one or two doctors out there, especially years ago, who may have tried to build a fire under a savable but noncompliant patient by painting a picture of their impending demise, hoping to avoid a preventable death. Rather than making exact predictions, most doctors treating patients with a limited future offer a typical range of survival, the best and worst case scenarios that would not be surprising outcomes. They avoid raising false hopes by describing cases of remarkable and unexpected recoveries. Patients and their families are entitled to the most accurate and realistic assessment possible. Many people find it difficult to discuss death openly with a dying person and actively discourage the dying person from facing their mortality: “Don’t talk like that! You’ll be fine!” However, people with a fatal condition usually do better when they, their family members, and their healthcare providers honestly and directly face the topic with dignity and respect. +

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#92 IN A SERIES

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

ver wonder why it takes years for exciting new drugs to actually reach the market and be available for patient use? It’s partly because of this woman, Frances Oldham Kelsey. She significantly changed the face of medicine (for the better, as you’ll see), yet it would be the exceptional reader who has ever heard of her. Born in British Columbia, Kelsey earned bachelor’s (1934) and master’s degrees (1935) in pharmacology from Montreal’s McGill University. She wrote a letter to noted researcher Eugene Geiling, just starting a new pharmacology department at the University of Chicago, asking for a position there doing graduate work. Unaware that Frances was the spelling of a woman’s name, Geiling hired Kelsey in 1936. The following year Geiling was asked by the Food and Drug Administration (FDA) to look into more than 100 deaths caused by a sulfonamide medicine. That research was significant for several reasons: Kelsey was involved in it; it led to her interest in drugs that could cause birth defects; and it exposed her to working with the FDA (and the FDA to her). While working with Geiling, Kelsey earned her Ph.D. in pharmacology in 1938, the same year the U.S. passed the Food, Drug and Cosmetic Act (sometimes abbreviated FD&C), giving the FDA broad authority to oversee the safety of, uh, food, drugs and cosmetics. During continuing studies (now on the University of Chicago faculty, where she was awarded her M.D. in 1950), Kelsey did research on drugs that were able to pass through the placenta and affect fetal development. In 1960, Kelsey was hired by the FDA as one of just seven full-time physicians reviewing new drug applications. Only one month after being hired, paperwork for a new drug called thalidomide (marketed under the name Kevadon) landed on her desk. It was the perfect candidate for quick approval: under various names the drug was already approved and in heavy use in nearly two dozen countries, including her native Canada. But Kelsey was unconvinced of the drug’s safety and wanted additional data from Richardson Merrell, its manufacturer. Meanwhile, 2.5 million tablets of Kevadon were distributed by the maker to 1,200 American doctors as a marketing tactic that would be illegal today. During the delay, Richardson Merrell applied intense pressure against Kelsey to rubber-stamp their application. Also during the delay, reports of devastating birth defects — babies born without arms and legs — began surfacing from around the world. Kelsey was vindicated. When the story broke in a front page story in The Washington Post, new and stricter drug safety laws were passed within weeks which continue to protect every one of us today. Kelsey retired from the FDA in 2005 at age 90, more than 40 years after her most noted case. She died in London, Ontario, a few weeks past her 101st birthday in 2015. + Above, Kelsey receiving the President’s Award for Distinguished Federal Civilian Service from President Kennedy in August 1962.

As I write this in mid-April, it’s another stormy day in the CSRA. We’re having heavy thunderstorms today with many tornado warnings, but so far, no tornadoes. Just straight-line winds of over 60 mph. My trees are bobbing and swaying, but nothing more than ballet from them. My dog KC has not left my side for three hours. She is both seeking protection for herself and trying to provide it for me. She is a good dog and such a comfort to have in my life. The rain is temporarily over, but we are still facing tornado watches for another five hours, so it is a time to remain cautious in as relaxed a fashion as we can muster. Funny, isn’t it, how much that relates to the aging process? The doctors and other health professionals tell us to go ahead and enjoy our lives while adding that we ought to maintain a cautious stance, aware of all the multiple issues that might occur as we age. The list is a long one! We need to self-monitor for heart disease, arthritis, a whole bunch of cancers, kidney problems, glaucoma, Alzheimer’s and other dementias, stroke, gastric distresses of various sorts, pneumonia, allergies, skin conditions, venous insufficiency, diabetes, ballooning of our multiple arteries leading to explosive and sudden death, gallbladder issues, pulmonary embolism, deep vein thrombosis, and the list goes on and on. And a surprise tornado can be just around the corner without a tornado warning. I’m not sure who I admire most, the individual who says, “Oh, heck, something is going to get me eventually,” and goes on just living a fairly carefree life, or the individual

who fusses and bothers through life aware of every little possibility for imminent catastrophic events. I think most of us fall somewhere in the middle. We’re cautious when we’re told of a need for caution, but otherwise we don’t bother scanning for storms. Most of us rely on our doctors to maintain the initial awareness, much like we rely on weather reporters to inform us about “the immediate threat of dangerous weather.” We may get up in the morning and watch the news or read the paper to check and see if the weather will affect our plans for the day, but other than that we figure out that we can just deal with whatever shows up. I think the healthiest attitude is to simply go ahead and live our lives as they present themselves to us. Creating our own joy proactively always trumps waiting for joy to come to us. That is why I always have some kind of chocolate candy in my desk drawer. I enjoy my one piece a day of sugar free chocolate. I look forward to it. Some days I am so busy I forget about it completely, but it’s always there as a small piece of consumable pleasure I can give to myself. I don’t need anyone’s permission to enjoy it. Today it was a piece of Russell Stover’s sugar-free pecan delight. Tomorrow it might be a peanut butter cup, a mint, or a coconut. It’s my choice. Those are not my only choices, though. I have some malted milk eggs, some hard candies, some orange and cherry slices. My great granddaughter who is four has not yet discovered Great Grandma Marcia’s candy drawer yet, but one day she will know about it and I can pass down the tradition of a stash of sweets to another generation. +

Higher SPF protects skin longer A large number of people (44 percent) believe the headline above. Are they right? Is it fact or myth? According to the Merck Manual, 44 percent of people say fact, and 44 percent are wrong. Any sunscreen product of any SPF (Sun Protection Factor) rating needs to be reapplied regularly according to product directions (usually every 1.5 to 2 hours). The common misconception that higher SPFs offer more lasting protection leads to yet another example of the Law

of Unintended Consequences: someone slathered in SPF 30 will stay in the sun longer than someone wearing a coat of SPF 15. Ironically, higher protection leads to higher exposure. And if not reapplied conscientiously, that same higher protection will lead directly to lower protection. Dermatologists and skin cancer prevention experts offer this reminder at the start of summer: sunscreen should never be your main line of defense against summer sun; it should be your last. The two best defenses are

WHICH WILL IT BE? chemical-free: 1. whenever possible stay out of the sun from late morning to early afternoon. Rule of thumb: try to avoid sun exposure whenever your shadow is shorter than you are. 2. when that isn’t possible wear loose, well ventilated clothes that offer maximum coverage. +

JUNE 7, 2019

Musings of a Distractible Mind

Dr. Rob: Long-time reader, first time writer! I want to know why my doctor makes me pay to get my own medical records. It seems like since they are my records, they should be free to me! Can you explain this? — Lucy Thanks, Lucy, for asking such an astute question that is near and dear to my heart. The best way to answer you is to look back into the past. Way back.

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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JUNE 7, 2019

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Hippocrates of ancient Greece gets the honor of bearing the title: The Father of Medicine. Given the way things are in our time, I wonder if he’d rather be something more honorable, like The Father of Deodorant or of the infomercial. You probably know him for his famous quotes that are his observations regarding patients, i.e. his medical records. The purpose of these records was not for the care of the individual patient, but for the furthering of medical science. Which brings us to the first fun fact about medical records: They are a place where observations are recorded. Fast forward a thousand years or so and we come to, what many diseases refer to as their “golden age:” the middle ages. It was, in fact, a really good time to be a bacteria, virus, or other pathogen. Humans, on the other hand, were the “Cancun spring break of germs,” a place where infectious organisms could live out their adolescent fantasies. The middle ages were the pinnacle of “germs gone wild.” The doctors of the day were not focused on observations, as observations would be far too depressing: “Bob, Judy, Sarah, BillyBob, Peggy-Sue, Enoch, and Archibald died today.” “Ed, Tony, Frank, Zippy, Polly, Buffy, and Samantha got growths on their heads today.” So Medieval doctors turned their sights to something different: intervention. The middle ages were the time when surgeons took to the forefront in the battle against disease, literally wielding lances, torches, knives, and swords against the armies of disease and pestilence. Which brings us to the second fun fact about medical records: They are a place where interventions are recorded. This continued (in various forms) for many generations until around the end of the 19th century, when doctors were finally given effective weapons against Joe Germ and Tommy

Tumor: science. Now doctors brandished microscopes, medications, and peer-reviewed studies. Physicians were not observers or technicians as they had been in the past, they became keepers of the “secret knowledge” of medicine. Diseases began to have cures, and the halls of medicine became sacred temples where people could be saved. Within medicine evolved a clerical hierarchy where specialists became elevated above generalists, and large referral hospitals (Johns Hopkins, Mayo Clinic) became the great temples where the greatest power resided. Medical records became sacred documents too. Doctors still recorded observations and interventions in these records, but began to use them as a place to plan the cure and to consult those with more knowledge when that plan was not evident. Which brings us to our third fun fact about medical records: Doctors view medical records as their property, where their plan to heal people can be kept. The “golden age” of medicine, where doctors were revered by the yearning masses was pre-empted by a small detail: money. All of this mystical healing that was going on in the sacred halls of health care began to stack up bigger and bigger bills. Modern health care was complicated and expensive and had to get paid for. This ushered in a new era of care: the insurance era. Third-party payors, funded by business and government, became the wires through which the currency of care flowed. By accepting money through these wires, doctors unsuspectingly handed control to those controlling the wires. To access their pay, doctors had to demonstrate the care given was worth payment. This demonstration happened via, you guessed it, the medical record. Payment was made in exchange for two things: documentation and codes. With the involvement of the government in this transaction, records became increasingly complex, and failure to comply with this complexity was considered “fraud” on the part of the government. That’s our fourth fabulous fun fact about medical records: Their main purpose is to justify payment. The final step in the evolution of records to its current state came with

the invention of computers. Computers allow people to do things that we previously thought impossible. For example, it was previously impossible to tell the entire world when you were going to the bathroom, and now it can be done with the swipe of a finger. In the past, we were limited to family movies of our own cats, but now we can dedicate our lives to intense study of other’s cats via YouTube. Computers do three things really well: 1. Organize information 2. Make huge tasks easier 3. Share information (and cat videos) with nearly anyone. So when applied to the increasingly complicated transaction of health care, computers seemed to be the perfect solution. Doctors could generate all the coding and note-taking requirements the insurance companies wanted. But things are never as simple as they seem, and so once the payment bar became easier to get over, it was simply raised, requiring eve more information and codes. The result: Computer generated notes became bloated by algorithm-generated words and codes. Payor required data become the new commodity for which doctors were paid. So, the final fun fact about medical records is: They have little to do with patient care. Back to Lucy’s question (you remember Lucy?): why do doctors require payment for medical records? The complicated answer is: They contain the doctor’s observations about the patient, some of which could be embarrassing to the patient, + and others which could make the doctor look dumb. Hence, things are written in a way that is difficult for anyone to understand (which makes them seem smart). Since records are meant to justify payment, they are largely financially-motivated and not clinical documents. They don’t do well when it comes to understanding the two things patients want to know: what’s wrong with me, and how can I feel better? Computer generated notes are enormous in size but very small in useful information. So, Lucy, consider it a blessing that your doctor doesn’t release the notes without the required ransom. They are not really about you, and they are not really going to be of much use to you anyway. +

AUGUSTAMEDICALEXAMiNER

CBD… from page 1

concern for interactions. Although some CBD companies may list their products as having “no interactions,” as new information becomes available researchers are discovering that CBD may in fact interact with different classes of medications. As always, it is best to include your physician in your decision to add CBD to your regimen. Your physician should also always have the complete list of ALL OTC medications due to the potential for benefits and interactions. CBD itself is not exactly a new discovery, although it has only recently become a mainstream topic. It has been around for many decades, along with its cousin THC (which you may recognize as the psychoactive compound from cannabis). While cannabis is still considered a federal Schedule I controlled sub-

stance (along with heroin, LSD, Ecstasy, etc.), as part of the 2018 Farm Bill, industrial hemp and its associated derivatives were moved to a legal non-controlled status. Industrial hemp is now defined as having a THC level of 0.3% or less. This is where the picture gets a little blurry. Individual state laws vary greatly from one to another. You should consult your local pharmacy for laws in your state. In Georgia, for exampIe, the zero-THC CBD-only products are generally accepted as legal throughout the state. The federally legal “broad spectrum” options (less than or

equal to 0.3% THC) cannot currently be sold in pharmacies due to the Georgia Drugs and Narcotics Agency disagreeing about what constitutes the definition of the illegal Schedule I products versus the newly categorized non-controlled product. There are many different options available that sound similar, but knowing what you are looking at makes a difference. They are not interchangeable. Hemp seed oil, as it sounds, is derived from just the seeds of the hemp plant. It can be “refined” or “unrefined.” Unrefined is a cold pressed hemp seed oil that is green

JUNE 7, 2019

in color and has a nutty flavor. It may be used similarly to coconut oil, avocado oil, or olive oil as an additive or replacement for frying or even salad dressings. Refined hemp seed oil, on the other hand, is not intended for food products. It is usually used for skin care products, fuels, lubricants, and other industrial applications. It may also be used as a carrier oil for essential oils or for massage oils. CBD Hemp Oil is much different and is what we are focusing on here. The oils are extracted from the leaves, buds, stalks, and stems of industrial hemp plants and/ or medical cannabis plants. It may be pure CBD extracts or may be a full spectrum

high CBD oil which contain CBD oil and other cannabinoids (like THC), terpenes (another natural hemp plant product), flavonoids, etc. Both the pure CBD extracts and the full spectrum CBD have their appropriate places in the product lineups. Stay tuned for CBD Oil — Part 2: What You Need to Know – in the next issue of the Medical Examiner, where we will go further into what conditions CBD is being marketed for, discuss the different available formulations of CBD products, dosing recommendations, and more. + Questions or comments please email us at cjdlpdrph@bellsouth.net

· NOTE: None of the information provided here is intended to be a claim that these products do or do not work for the uses listed. It is intended only to create awareness of what the currently available products are being suggested/recommended for, and the research that is currently being done. This is a quickly changing area of medicine and it is therefore recommended to do your own additional research and consult with your healthcare provider before choosing to use any of the products.

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

“My leg was broken in three places.”

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

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

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

Everybody has a story. Tell us yours.

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

JUNE 7, 2019

7 +

AUGUSTAMEDICALEXAMiNER

GARDENVARIETY

Sometimes my recipes emerge because of the ingredients I happen to have on hand. This recipe for Roasted Carrot Chickpea Salad is one of those, and I must say it was a real winner. I enjoy roasted carrots and wanted to create a recipe using them as a main dish salad ingredient. My hydroponic tower garden has really been producing this spring; however, I knew I needed to use up the kale and mint growing in it before the temperature got too hot for them. I came up with a combination of roasted carrots, chickpeas tossed with a warm mix of seven grains, kale, and tart pomegranate seeds then drizzled it with a sweet spiced maple dressing to create a healthy, filling salad. Here is the big bonus, this salad is packed with good-for-you ingredients. Chickpeas are a great source of fiber, potassium, vitamin C and B6 and a whopping 39 grams of protein per cup. The carrots are packed with vitamin C, an antioxidant that helps boost the immune system. Also, besides helping our Roasted Carrot Chickpea Salad vision, evidence suggests that eating more Preheat oven to 400 degrees antioxidant-rich fruits and vegetables, Line cookie sheet with parchment paper such as carrots, can help reduce the risks Peel carrots and cut lengthwise into quarters. Place of cancer and cardiovascular disease. As on cookie sheet. Lightly season with a dash of a colon cancer survivor myself, I have cumin and salt. learned that adding the beta carotene Roast carrots for 15 minutes, then add chickpeas. found in carrots to my diet may reduce the Continue to roast for 10 more minutes or until risk of my cancer returning. One last tip: carrots are soft. to make this salad quick and easy I used a In a pint jar add 2 tablespoons olive oil, maple pre-cooked bag of Nature’s Earthly Choice syrup, cumin, coriander, chili flakes and chili Organic Blend of Seven Grains, which you powder, mint leaves, and pomegranate seeds. Place a can pick up at your local grocery. lid on the jar and shake well. In a medium saucepan over medium-low heat, Roasted Carrot Chickpea Salad sautee kale in 1 tablespoon of olive oil until just tender. Add Seven Grain Blend and pecans, stirring • 1 lb organic carrots for one minute Place contents in a large bowl and • 1 16 oz can chickpeas, drained then add the cooked carrots and chickpeas. Shake • 1 bag Earthly Choice Organic Seven dressing, pour over and toss. Serve warm. Top with Grain Blend or 2 cups of a cooked grain of a few pomegranate seeds and chopped mint. + your choice. by Gina Dickson. “As a mother of six who • 1 cup chopped kale beat cancer, I want to share with you what • 1/4 cup pomegranate seeds I’ve learned. Healing from cancer can take • 2 tablespoons finely chopped mint everything a mom has, yet you still want • 1/4 cup toasted finely chopped pecans to love and care for your family through • 1 1/2 tablespoons maple syrup the treatments. My blog is a community full • 3 tablespoons olive oil of encouragement for moms going through cancer • 2 teaspoons coriander powder treatments who would like to use a plant-based • 2 teaspoons cumin vegan diet to complement their healing journey. • 1/2 teaspoon chili flakes www.thelifegivingkitchen.com • 1/2 teaspoon chili powder

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ASK DR. KARP

NO NONSENSE

NUTRITION Marianne from Savannah asks: “Is there a way to tell if a commercial diet plan is good or bad?”

Thanks for the question, Marianne. These days, doesn’t it seem like there is an endless number of infomercials and ads about diet plans and diet books? Which ones are “good” and which ones are “bad?” Actually, there are easy ways to figure it out. There are certain things that set off red lights and alarm bells in my head when I review a diet plan. For example, does the diet plan recommend eliminating a specific food or an entire food

group? Nonsense examples of this that you see all the time include “beware of bananas,” “tomatoes cause inflammation,” “avoid dairy,” etc. When you come across a diet plan that vilifies specific foods or food groups, don’t walk away; run. Then there are those diet plans that do just the opposite. They tout “superfoods,” such as blueberries, kale, green shakes, quinoa, etc. These plans are just as bad as the ones demonizing foods. Stay away. Avoid diet plans that tell you that you don’t have to make changes in what you eat or how you move to lose weight. All you have to do is simply take this supplement or vitamin, get this B12 shot, or eat this herb. Many of these plans tell you that the supplements work by “speeding up your metabolism,” or “giving you energy.” Sound familiar? Why do people fall for these types of diet plans? It’s easy to understand. Who wouldn’t want to lose weight by simply popping a pill rather than exercising and choosing foods prudently? But does it work? No. What else sets off alarms in my head when judging a diet plan? One big area of concern is when the plan uses testimonies from their own clients to prove their results rather than data from independent, scientific, evidenced-based studies. It’s kind of like taking a used car sales-

man’s word for a car without bringing the car to your own, independent mechanic for evaluation. Think of the testimonies as used car salesman and think of your independent mechanic as the independent, evidenced-based medical literature. One modern twist on misleading diet plan claims is for the plan to create a fake scientific journal that looks real and then publish their findings in this fake journal. So make sure that the diet plan is backed up with evidence published in accepted, known, scientific medical journals. And never ever trust a person making money off the diet plan for information about that diet plan. That is called “conflict of interest.” Another sure way of judging if a diet plan is reasonable is to look for trendy, science-sounding words in their promotional material. Words such as “detoxify,” “purify,” “revitalize,” or “balance your body’s chemistry.” Another phrase to beware of is any plan that is “ahead of the science.” Sounds wonderful, but be careful. The fact is that you never want to be ahead of the science. You always want to have the science ahead of you. You might want to be at the cutting edge, but no further ahead

JUNE 7, 2019

than that. Look for diet plans that have a multi-faceted approach to nutrition involving your mind, your body, physical exercise, your spirit…not just your food. Seek plans that have registered dietitian nutritionists (R.D.N.) and other educated and licensed people as coaches. Make sure that the diet plan’s coaches are not “certified” by the very commercial plan that employs them. Seek diet plans that have provision for long-term follow up, not just temporary fixes. Avoid diet plans that tout interesting but as yet unproven dietary approaches, such as genetic testing (nutrigenetics) to determine what foods and way of eating is best for you. Nutrigenetics is at a very early stage of understanding and development, and the idea that it is ready to be applied to individuals is naive and misleading. Avoid diet plans which push foods that look more like snacks

or candy. Examples are those trendy bars or shakes containing high protein. Instead, examine what is in the food. Is it high calories? Does it contain moderate amounts of fat and mostly unsaturated fat? Is it moderate in sugar and salt? And don’t drink food. Chew it. Remember, it is pretty clear that if there, in fact, were a commercial diet plan that “worked,” then everyone would be on it and would lose weight. Have you noticed that with all the commercial diet plans around, Americans are still getting fatter and fatter with the passing of each year? What does that tell you? What’s the “No-Nonsense Nutrition” advice for today? The most important advice I can give you is to move away from the idea of a “diet plan” and move toward the idea a “way of eating and living.” Diets always seem so temporary, something you go on to lose weight and then go off once you have achieved your weight loss goal…only to then gain the weight back. Your nutrition health depends, instead, on the food and lifestyle choices you are making every day of your life, rain or shine, diet or no. +

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 the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no 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 meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, 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.

Dr. Karp

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Ask a Dietitian

What do people notice first?

ARE YOU GRILLING UP CANCER?

by Kim Beavers, MS, RDN, CDE Producer and Co-host of University Hospital’s Eating Well with Kim Follow Kim on Facebook @Eatingwellwithkimb or @Timetoeatwellwithkim

Don’t you just love grilling season? Don’t you simply hate cancer risk? Cooking meat, poultry or fish at high temperatures until well done can create heterocyclic amines (HCAs) and polyaromatic hydrocarbons (PAHs), both of which are considered carcinogenic. To honor grilling season, I am highlighting 5 strategies for successful grilling & food safety that will have you pulling delicious nutritious food off the grill all summer long. 1. Preheat your grill for about 10 minutes and then clean off the grill grates. It is easier to clean the grates of a hot grill! Once the grill is clean you will want to oil the grates to prevent food from sticking. To oil the grill, grab a folded oil-soaked paper towel with long-handled tongs and rub the oil-soaked towel over the grates. Use

an oil with a higher smoke point, like canola. Then commence cooking as directed. 2. Marinate and use lean meat and trim fat from meat prior to grilling. Marinating does more than infuse food with flavor. It also inhibits the formation of potentially carcinogenic HCAs. Marinating can reduce HCA formation by 90 percent. Alternatively, you can put a layer of herbs on the grill and lay the meat on top of the herbs (think rosemary) to infuse

herbiness (that’s a word, right?) and decrease HCA formation. Using lean meat and trimming fat from meat helps to minimize dripping of grease and flare-ups. Flareups contain PAHs and can char the meat which creates HCAs. 3. Use a meat thermometer. I know, I know, this is rather geeky sounding and very dietitian like…and there are really cool chefs who can simply touch meat and tell if it is done. I will have to sit in the, “rule-following dietitian” camp, on this one. Plus, who doesn’t enjoy avoiding food borne illness and eating juicy meat cooked to perfection rather than overcooked dried out meat? Due to this basic, properly cooked meat philosophy, I have run through many thermometers and have finally found one that works great. The Thermoworks digital is an instant

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Tammy T. Aiken, SC

H H H H H 6/1/2019 I had to give a speech at work and I had to cancel because every time I even thought about it I got a lump in my throat. I made an appointment with an ear, nose and throat (ENT) doctor. I hope it’s nothing serious. + H H H H H 6/1/2019 To the previous poster, I don’t think it’s anything to worry about. My boyfriend proposed to me last month and he said the same thing later. But he said it went away as soon as I said yes. +

Wayne R. Evans, GA

H H H H H 6/1/2019 Yeah, well I proposed to somebody once too. We had been together for 5 years before that and it was great. Then as soon as we got married we were at each others throats all the time. +

Marian K. Beech Island, SC

H H H H H 6/3/2019 I hate my boss. He’s always jumping down our throats. +

Terry D. Augusta, GA

H H H H H 6/3/2019 I have one of those bosses who always jumps down our throat too. I was going to tell him off yesterday, but the words stuck in my throat. Now I think my throat is injured because of him. +

Rhonda G. McBean, GA

JUNE 7, 2019

GRILLING… from page 9

read thermometer, and is hands down my favorite. There are expensive and less expensive options. I use the $25-$30.00 version, it can be ordered at thermoworks.com/products/ low_cost/. • Chicken is done at 165° • Beef, pork, lamb (ground) is done at 160° • Beef, pork, lamb (steaks or chops) is done at 145° with a 3-minute rest. • Fish: is done at 145° (or until flesh is opaque and separates easily with a fork) 4. Flip frequently. Flip meat every minute or so. That helps cook it faster and decreases charring, both of which cut HCA formation. 5. Grill vegetables and fruit! Vegetables and fruits do not form these potentially carcinogenic compounds and since you have the grill fired up, go ahead and load it up with the whole meal. Recipes abound for grilled cabbage, zucchini and onions. There are many ways to cook vegetables, but one nice tool to have on hand is a vegetable grilling basket. This is especially true of vegetables that are in small pieces. Simply toss chopped veggies with oil and seasoning then add to the grill basket. Cook turning occasionally until the desired degree of doneness is reached. Fruits such as, pineapple, peaches and watermelon develop a rich sweet-savory flavor when grilled turning them into a decadent dessert. Try them directly on the grill, in a kabob or in a grill basket, you will not be disappointed.

H H H H H 6/4/2019 Ever get a frog in your throat? Where do these frogs come from? Asking for a friend. +

Bob N. Martinez, GA

H H H H H 6/4/2019 I bet doctors who remove tonsils are really cut-throat competitors. Ha ha! +

Ray Y. Grovetown, GA

H H H H H 6/5/2019 When I was little my parents made me eat all my vegetables. Man, I hated that. They would even shove asparagus down my throat. Not literally, of course. But still. +

MEDICALEXAMINER

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Grilled Zucchini and Tomatoes Very little seasoning is needed because grilling imparts a delicious earthy flavor to vegetables. These veggies are left in larger pieces so as not to need a grill basket. • 2 zucchini • 2 tomatoes • 1 tablespoon extra-virgin olive oil • ¼ teaspoon salt • ¼ teaspoon pepper • 2-4 teaspoons balsamic vinegar • Canola oil for oiling the grill grates Preheat the grill to medium heat. Cut the ends off the zucchini and slice in half lengthwise. Cut the tomatoes in half along the equator and use your fingers to get out the seeds of the tomatoes (you will lose them to the grill anyway). Brush the vegetables on both sides with oil. Place the vegetables on the clean, oiled and preheated grill cut side down. Grill for 3-5 minutes on each side. Note: the tomatoes should be grilled closer to the 3-minute mark and the zucchini can stay on the grill closer to the 5-minute mark. Remove from the grill to a platter and sprinkle with salt, pepper and vinegar. Yield: 4 servings Nutrition Breakdown: Calories 45, Fat 3.5g, Cholesterol 0mg, Sodium 160mg, Carbohydrate 3g, Fiber 1g, Protein 1g. Plate Plan: 1 Vegetable, ½ Fat Recipe courtesy of Eating Well with Kim: www.universityhealth. org/ewwk To find a local dietitian please visit: www.eatrightaugusta.org/ resources (referral list) +

JUNE 7, 2019

The blog spot — posted by Fred N. Pelzman, M.D, on May 30, 2019 (edited for space)

HOW DID WE LET INSURANCE COMPANIES DICTATE PATIENT CARE? Who works for who? How did we allow ourselves to let a system get built up around us that makes it so hard for us to take care of our patients? Our job is to advocate for our patients, to help guide them towards their best health, [and when] they are faced with a health challenge, to be there with them all along the way. But the bureaucracy from regulators and insurance companies has turned the healthcare landscape into a minefield. Every day, all day long, we are faced with these obstacles, sometimes small annoyances are placed in our way, sometimes major barriers or nearly insurmountable hurdles and barricades impede progress towards care. I understand that insurance companies are businesses that are beholden to stockholders, and they’re concerned with profits and losses, the bottom line. And certainly there is incredible waste in our healthcare system. But how did we let them, the insurance companies, get so intimately involved in what we think is the best care for our patients? I don’t disagree with the concept of having systems in place to provide some checks and balances, to make sure we’re not ordering an MRI on every patient with a headache, or ordering every lab test at every appointment. But if I, as a provider, have decided that the patient needs something, how is it that we’ve relinquished our ability to get this test, and even put this in writing in the contracts we sign with the insurers? Just yesterday, a patient of mine had a test recommended by a specialist, but it was denied by her insurance company despite multiple appeals requiring long waits on hold trying to speak to a live human being. My patient ultimately decided just to pay for the test herself. The fact that the finding was actually there is not the point of this; it doesn’t matter if the test turned out positive or negative. A really thoughtful, talented, intelligent expert in the field had decided that he needed this test for this patient at this time. That should be it. End of discussion. Most patients don’t have the wherewithal to pay for tests, but do it anyway and then hope to get them reimbursed if it is positive, and they can then make an argument to their insurer that they should’ve had it covered. I think we’re all willing to engage in reasonable discussions about the appropriateness of certain tests. But we are the doctors; we went to medical school; all we want to do is take care of our patients. I know that certain people will respond to this argument and say, “What’s going to stop every doctor in every situation from ordering every test possible? We are going to be flooded with unnecessary tests, false positives, incidentalomas, and as we all know, tests beget more tests.” A long discussion about defensive medicine and tort reform is in order, but that’s for another day. It’s time for the nickel-and-diming to stop. Someone’s got to clear away all of these rules and regulations, this endless bureaucracy, the paperwork, the interminable telephone trees and waits on hold to get our patients the care they need and deserve. We need to stand up and say, “This needs to be a system that lets us take care of our patients in the way that we think is best.” We can accept nothing less. + Fred N. Pelzman is an internal medicine physician

11 +

AUGUSTAMEDICALEXAMiNER

From the Bookshelf This book took a bit of courage to write, and perhaps as much courage for a publisher to sign onto. Here is a super-brief synopsis: our “healthy” habits are killing us. Here at Medical Examiner world headquarters we couldn’t agree more. Not that there is anything wrong with exercise; it’s good. We recommend it. Habitually eating junk food is being an irresponsible body owner. Smoking and alcohol abuse are practically criminal. On the other hand, we seem to be a culture awash in idiotic trends and habits that are pursued in the alleged interests of better health. Examples: colon cleansing. Where did that come from? Juice fasts? Diets based on caveman cuisine? Eating regimens that eliminate entire food groups? A supplement industry that thins American wallets by billions of dollars annually? And yet, as Ehrenreich has observantly noted, humans keep dying. All of them so far, in fact. So she decided to step off the treadmill of preventive care and simply live. No, she’s

not suicidal. She has given this a lot of thought. Take mammograms as one example. The procedure, as she describes it, “amounts to a brute-force effort to render the breasts transparent.” After suitable flattening, each breast is then bombarded with ionizing radiation, “which is, incidentally, the only environmental factor known for sure to cause cancer.” Is that something a healthy and asymptomatic person wants to do? Not if her name is Barbara Ehrenreich. She takes the same approach to dental x-rays: if there is some clear reason to suspect trouble, fine, but just to satisfy some abstract standard of

care? No thank you. Bravery aside, this is not a battle she is fighting alone. Her book cites a number of physicians, researchers, and healthcare bloggers who go so far as to say don’t fear disease, fear healthcare. She cites an anecdote related from the podium at a medical conference of a patient who had her first mammogram at age 100. Yes, a growing chorus is being heard from the ranks of medicine itself which says overdiagnosis can fairly be described as an epidemic. Some “preventive” tests are particularly suspect. For example, men who get bad results from a PSA test are 47 times more likely to have invasive procedures than to have their lives extended (said a study published in NEJM). Ehrenreich doesn’t deny that we may be living longer thanks to medicine. Her question: are we living better? + Natural Causes - An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, by Barbara Ehrenreich, 256 pages, published in April 2018 by Twelve.

Research News Process this Since our last issue, the healthcare headlines have erupted with new information about highly processed (in fact, ultra-processed) foods. First, a definition: ultraprocessed foods are the opposite of the produce aisle or the farmers market. They are items like packaged bakery goods, sugary drinks and cereals, and ready-made meals with dehydrated ingredients. In other words, foods with an abundance of fat, salt and added sugars, but short on fiber and nutrition. Previous studies have linked highly processed foods with obesity, high blood pressure, high cholesterol and some cancers. The new studies focused on two areas, the first being satiety - the sensation of fullness. Researchers showed that ultra-processed foods delay this feeling, meaning that people eat more of the very foods that aren’t

healthful before feeling full. Since these same foods are high in fat, calories and salt, that finding helps explain why there is a direct link to obesity in consumers (and one of the recent studies said ultraprocessed foods account for anywhere from a fourth to 60 percent of daily energy intake in many countries). The second wave of headlines came from two large European studies that found a connection between diets high in ultra-processed foods and an increased risk of cardiovascular and cerebrovascular disease, that is, diseases affecting blood supply to the heart and brain, respectively. Conversely, the studies also showed reduced disease risk associated with diets rich in unprocessed or minimally processed foods. Secondhand smoke’s effects Are you a non-smoker who lives, works or carpools with

a smoker? Then chances are you have high blood pressure (hypertension). According to new research published last month, “even the lowest amounts [of secondhand smoke] are dangerous. “Passive smoking” at home or work was linked to a 13 percent increased risk of hypertension, a number elevated to 17 percent when the exposure lasts for a decade or longer. Bad at work, bad at home A new study published in the American Journal of Preventive Medicine found that employees at a large urban hospital who purchased the least healthy food in its cafeteria were also more likely to have an unhealthy diet outside of work, be overweight or obese, and have elevated risk factors for cardiovascular disease and diabetes. Our question: why does a hospital cafeteria offer unhealthy choices? +

+ 12

AUGUSTAMEDICALEXAMiNER

The Examiners +

What do you do for a living?

I’m a doctor.

by Dan Pearson

It’s okay. Most of my Do you enjoy that? patients are lame though.

PUZZLE ACROSS 1. ______ lab 5. Talus 10. Abrasion aftermath 14. Double curve 15. Study suffix 16. Blackbird 17. Type of Fiction? 18. Flat shelf 19. Helper 20. Eastern state 22. Common monoxide 24. Short nail 25. Sneaking coward 26. Salad green 29. Recognized authority 30. Path 31. Medical guinea pigs? 32. Incandescence 36. Flight of steps 37. Bleat of a sheep 38. Mexican painter (familiarly) 39. Long fish 40. Clue 41. Less common 42. Johnny Cash 2002 Video of the Year 43. String of prayer beads 44. Blind spot (med.) 48. Soviet news service 49. Buccaneer 50. Hill thoroughfare 54. Greek god of war 55. Cinema brand name 57. On sheltered side 58. Jazz singing style 59. Sound beginning 60. Title 61. Created 62. Ninth month of the Jewish calendar 63. Fall

WORDS

NUMBER BY

24 26

29 31

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

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, JUNE 17, 2019

We’ll announce the winner in our next issue!

E X A M I N E R

1 2 7 9 3 8 7

2 8 6 9

1 6

S 5 U D 4 O K 8 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.

DOWN 1. Resp. disease 2. Malarial fever 3. Inform 4. Liver inflammation 5. Comfort in misfortune or disappointment 6. Office person 7. Took the bus 8. Ovum 9. Ocular ministrations 10. Bright 11. Silk cotton 12. Zeal 13. Mix smoothly 21. Vacillate 23. Former abbrev. of school near 50-A 25. Gold coin 26. Scottish Gaelic 27. Short letter 28. Twofold 29. Huge

THE MYSTERY WORD The Mystery Word for this issue: SENO

EXAMINER CROSSWORD

JUNE 7, 2019

31. African musical instrument 32. Pasture 33. Monetary unit of old Italy 34. River in central Europe 35. Watchful 38. Ninth-graders 40. Arm bone 42. Flash starter 43. Type of sleeves 44. Tic 45. About 46. Mountain nymph 47. Flavor 48. Ornamental coronet 50. Where to find Love It or List It 51. Having wings 52. Finding ______ 53. Low in pitch 56. Biblical high priest

Solution p. 14

QUOTATIONPUZZLE I O H L E S A R T I T I W N S I E ’ C E S A D N A N T N E N T R H I T T I O I B

H G G E N N

— Henry Wadsworth Longfellow

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.

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

1 2

1 2 3

R 1 2 3

1 2 3 4 5

1 2 3 4 5 6 7

1 2 3 4

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

1 2 3 4 5

— Winston Churchill

1.AGITYGHK 2.EEOOFROH 3.LUEIREI 4.NONPL 5.UG 6.G 7.H

SAMPLE:

1 2 3 4

L 1

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

The

Advice Doctor

Moe: How do members of al Qaeda tell time? Joe: With a terror-wristwatch?

Moe: My wife is so annoyed that I have such a poor sense of direction. Joe: Well, are you going to do anything about it? Moe: Yeah. Last night I packed up and right.

hree women, a blonde, a brunette, and a redhead, are about to be executed. The guard brings the brunette forward and the executioner asks if she has any last requests. She says no, and the executioner shouts, “Ready... Aim...” Suddenly the brunette yells, “EARTHQUAKE!!!” Everyone is startled and throws themselves on the ground, and in the confusion she escapes. The guard brings the redhead forward and the executioner asks if she has any last requests. She says no, and the executioner shouts, “Ready... Aim...” Suddenly the redhead yells, “TORNADO!!!” Everyone is startled and looks around for cover while she escapes. By now the blonde has it all figured out. The guard brings her forward and the executioner asks if she has any last requests. She says no, so the executioner shouts, “Ready... Aim...” And the blonde yells, “FIRE!!!” Waiter: How would you like your steak, sir? Man: Like winning an argument with my wife. Waiter: Rare it is then, sir.

Moe: Did you get your pilot’s license yet? Joe: As a matter of fact I just did my final solo. Not sure why, but I had to fly a shipment of paint from here to Atlanta. Moe: Did you pass? Joe: With flying colors. Moe: How are you and your new girlfriend getting along? Joe: It’s over. Moe: Already? Joe: Yeah. You know her last boyfriend was a clown, right? Moe: Ah. So you had some big shoes to fill. Moe: They say now that being addicted to video games is an actual disease. Joe: Who? Moe: Correct. Moe: Do you know the last body part that still works when someone dies? Joe: I have no idea. Moe: It’s your pupils. Joe: Is that really true? Moe: It is. They dilate. +

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

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

Dear Advice Doctor, Can you help settle a little family situation we have going on? My husband was laid off from his job six months ago. You know how they say your new full-time job when you’re unemployed is finding a new job? He isn’t even doing that part-time. Meanwhile I’m drowning in work: two jobs that are both very demanding, plus I picked up a couple of housekeeping jobs on the side to help make ends meet. AND he still expects me to do all the cooking, washing, ironing, etc while he sits around doing next to nothing all day every day. Help! — Overworked & Underappreciated Dear Overworked, Thank you for writing and bringing up this very important topic? How important? It’s literally life-and-death, and we are right now at the very start of the season for this annual problem. If you follow the news, we have already had the first drowning of the summer at Lake Thurmond. Unfortunately, this is not a rare or unusual tragedy: drowning is the #1 cause of death in the United States for children ages 1 to 4 and second only to car crashes for children ages 5 to 14. Adults are not immune, however. Especially males: beyond age 1, 80% of all drowning victims are male. Another major risk factor is alcohol or drugs that affect judgment and alertness. Swimming alone and beyond the limits of your abilities as a swimmer also elevate the risk of drowning. Sadly, sometimes it isn’t drowning that presents the problem; it’s surviving drowning. By definition, drowning (and near drowning) means oxygen deprivation. Permanent brain damage can ensue. Sometimes the reason for a water emergency is a head or spinal cord injury resulting from diving and striking unseen objects underwater. Paralysis can be the result. Nearly all drowning deaths are preventable through the use of common sense alone. Be careful. Be safe, not reckless. Vigilant supervision of children in and around water — even if it’s only a bucket or a kiddie pool — is absolutely necessary. Life jackets or personal flotation devices are lifesavers. And one of the best and most overlooked prevention strategies is swimming lessons. I hope this answered your question. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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

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THE MYSTERY SOLVED The Mystery Word in our last issue was: WALKING ...cleverly hidden in the grass in the p. 7 ad for DANIEL VILLAGE BARBER SHOP

THE WINNER: HOLLY WALLACE! 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!

JUNE 7, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED C O P D

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

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

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QuotatioN QUOTATION PUZZLE SOLUTION “The best thing one can do when it’s raining is let it rain.” — Longfellow

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JUNE 7, 2019

IT’S A QUESTION OF CARE How do I deal with a loved one who wanders?

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AUGUSTAMEDICALEXAMiNER

Sometimes as people age and dementia creeps in, one of the symptoms is wandering. The person often does not feel as if they are “at home,” and so they search for surroundings that feel more familiar. If they are in their own home there are options that can be initiated to keep them safe. • Purchase a personal emergency response button with GPS. This can be worn around the neck or as a wristwatch. The hurdle can often be that the person does not want to wear the apparatus on their body. However, if you can convince them to do so it can be very effective if the person happens to wander, because you will know where they are. • Buy insoles with GPS to put in their shoes. This can work well if the person tends to wear the same shoes every day or they are being assisted with dressing, so they don’t choose their own

footwear • Today there are cameras, sensors, and alarms available that will alert caregivers and family members to a wandering person. (Just make sure that securing the home doesn’t make it feel like a prison.) • Install security features. Certain safety features can be placed on doors, such as handles that make them difficult to open. They are similar to an apparatus used when young, curious children are in the home. The person with dementia can’t figure these out. • Hire a caregiver. If a person is living in their own home, sometimes a caregiver needs to be hired to monitor them constantly when none of the above options are feasible. This is an expensive option, but often necessary. • Consider Assisted Living. If the above options have been tried and don’t work, or they’re not applicable

in your situation for whatever reasons, many families choose assisted living. They must choose a community that is secure so that their loved one cannot wander into other parts of the building or outside. Yes, if he or she wanders, they may still wander within the building, and that can present issues with the other residents. It takes commitment and attention on the part of the staff to know the whereabouts of the person who wanders and be ready and willing to redirect them at all hours – day and night. (Unfortunately, yes, people with dementia often wander at night, since that is when they can be the most confused.) + 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.

PROFESSIONAL DIRECTORY +

ACUPUNCTURE

DENTISTRY

Dr. Eric Sherrell, DACM, LAC Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707 www.AcuClinicGA.com

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

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

AMBULANCE SERVICE

IN-HOME CARE

Floss ‘em or lose ‘em!

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 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

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

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 706-733-3373 SKIN CANCER CENTER 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

Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE WOODY MERRY www.woodymerry.com Long-Term Care Planning I CAN HELP! (706) 733-3190 • 733-5525 (fax)

SLEEP MEDICINE

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

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!

PHARMACY Medical Center West Pharmacy 465 North Belair Road Evans 30809 706-854-2424 www.medicalcenterwestpharmacy.com Parks Pharmacy 437 Georgia Ave. ARKS HARMACY N. Augusta 29841 803-279-7450 www.parkspharmacy.com

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

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JUNE 7, 2019

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