Mar16 18 by Daniel Pearson

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MARCH 16, 2018

AIKEN-AUGUSTAʼS MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

If he were alive today... Our last three issues, published in the general vicinity of Black History Month and Presidents Day, featured articles related to each in our award-wanting series, “Who Is This?” (See page 4 in every issue, or issuu.com/medicalexaminer to read back issues you’ve missed.) The profi les of the doctors who treated George Washington and Abraham Lincoln in their final hours (one got an F, the other a B+) got us wondering about the fate of other presidents who also lost their last election, if you know what we mean. For instance, what about William Henry Harrison? Exactly 177 years ago this week, he was enjoying his first two weeks in the Oval Office, and about to begin his final two weeks in office. Yes, he was president for exactly 31 days, from March 4 through April 4, 1841. Put another way, three different men served as president of the United States within a period of 5 weeks. But we digress. Harrison had been characterized by his rivals during the presidential campaign as a backwoods rube, so on inauguration day he felt he had something to prove. On a wet and raw March day, he delivered the longest inaugural address in American history, going on for almost 2 hours wearing neither hat, overcoat, nor gloves. He rode to the ceremony on horseback rather than in a closed carriage, then rode through the cold, wet streets of Washington in the inaugural parade. It was little wonder after all that, then, that when he took sick, people thought he had come down with pneumonia. But he was fine from the inauguration until feeling ill on March 26, three weeks later. His doctors employed all the standard treatments of the day for pneumonia — castor oil, leeches, opium, and Virginia snakeweed, among others — all to no avail. An intensive review of notes written by Harrison’s physician, Thomas Miller, were used to analyze the case in a 2014 issue of the journal Clinical Infectious Diseases. Jane McHugh and Philip A. Mackowiak wrote that, based on the treatment notes, typhoid fever was likely the correct diagnosis. Poor sanitation in the nation’s capital was the likely cause: the White House was downhill from a nearby spring which was its water source, and the spring in turn was downhill from a nearby field where the city deposited “night soil” each day. (“Night soil - noun: human excrement collected at night from buckets, outhouses, etc., and sometimes used as manure.”) If given the choice, Harrison would probably rather stick with the faulty diagnosis than the accurate one. The same cause — water contaminated by sewage — also claimed the lives of presidents James K. Polk and Zachary Taylor Another short-timer in the White House also ran afoul of the medical profession, but not because of inept care or malpractice; instead the cause was the limited knowledge of the day. James A. Garfield also took the oath of office on March 4, forty years to the day after Harrison’s inauguration. He died some 200 days later, 10 weeks after being shot at a train station Please see PRESIDENTS page 2

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PRESIDENTS… from page 1 in Washington while trying to leave town for the July 4 holiday. Those ten weeks were a slow and painful death, to be sure. It was a double dose of misfortune, because the initial estimation was that Garfield wouldn’t survive the next 24 hours, let alone 80 days. The assassin, Charles Guiteau, got off two shots. The fi rst bullet grazed Garfield’s arm, but the second struck him in the right side of the back. We hear today of doctors who opt to leave a bullet untouched in a shooting victim’s body because removing it poses risks of further injury, permanent damage, or death. There was no such thought in 1881. Understanding the bullet’s pathway, fi nding it and removing it were all of paramount importance. Alexander Graham Bell was even brought in with a primitive metal detector, but failed. As a result, no fewer than a dozen doctors probed Garfield’s wound with bare, unwashed hands and unsterilized instruments. It was the standard of care at that time, even though Joseph Lister’s findings about germs and sterile technique were already in the medical literature. The problem was, few physicians endorsed it in 1881, including exactly none of the doctors treating President Garfield. In the opinion of at least one physician today, Ira Rutkow, M.D., a medical historian and professor of surgery in New Jersey quoted in a 2006 New York Times article, “in today’s world, he would have gone home in a matter of two or three days.” Indeed, the bullet did not strike any major organs, arteries or veins, and came to rest in fatty tissue on the left side of the president’s back. Talk about dodging a bullet. But then medical care ensued. Dr. Rutkow noted in the same article that Garfield was systematically (if inadvertently) starved to death. His doctors insisted that Garfield be fed rectally, and in this manner he received milk, egg yolks, beef bouillon, whiskey, and opium. Between July and September on this regimen Garfield lost more than 100 pounds. When Garfield was still trying to take food by mouth, one of the mainstays of his diet was oatmeal, which he detested. When told one day that Sitting Bull, a federal prisoner, was starving, Garfield snapped, “Let him starve!” but then, after a moment’s thought he said, “No. Send him my oatmeal.” Despite all the well-intentioned efforts, Garfield finally breathed his last on September 19, 1881 in Elberon, New Jersey, where he had been taken by special train on September 5

from the heat and humidity of Washington. Ironically, part of Guiteau’s defense strategy was to attempt to get his charges reduced to assault since the real culprits, as this strategy went, were the doctors. As Guiteau himself said, “I just shot him.” What other presidents were, or could have been, affected significantly by interactions with the healing professions? It’s a safe bet that Ulysses S. Grant would have been advised to stop his #1 vice; cigar smoking. And it’s probably just as safe a bet that he would have struggled to heed the advice or ignored it. But advances in surgery and chemotherapy might well have prolonged his life. Franklin D. Roosevelt was another tobacco lover, which ultimately led to high blood pressure and cardiac issues and his ultimate demise from a cerebral hemorrhage. His last words were, “I have a terrific headache.” Perhaps he, too, would have benefitted from today’s knowledge of the link between tobacco use and a host of medical ills. Much earlier in life, at age 39 (1921), Roosevelt contracted a paralytic illness, thought at the time to be polio, that left him paralyzed from the waist down. If polio was the correct diagnosis, Roosevelt’s troubles were more than 3 decades before the discovery of the polio vaccine by Jonas Salk in 1953. (Many observers today, however, feel Roosevelt’s symptoms are more consistent with a diagnosis of Guillain-Barré syndrome.) Even so, his death at age 63 represented a longer life than the expectations of his era. William McKinley, another victim of an assassin’s bullet, was shot in Buffalo, New York, at the Pan-American Exposition in September, 1901. Fortuitously, an early working version of an X-ray machine was on display nearby, but it was never used. Again, infection, not the bullet, was the ultimate cause of death. Gangrene claimed McKinley’s life 8 days after the shooting. All in all, whether they died in office or afterward in private life, presidents have done well overall. We have all seen before-andafter photographs of presidents that seem to show accelerated aging due to the stress of the job. But grey hair is not fatal: consider that the average lifespan of the fi rst eight presidents was 79.8 years at a time when 40 years was the average life expectancy. Six presidents have lived into their 90s: George H.W. Bush, Gerald Ford, Ronald Reagan, Jimmy Carter, John Adams, and Herbert Hoover. +

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

HEART AND SOUL

The mid-1980s was an incredibly exciting time in the world of medicine, and Augusta was one of the epicenters of the excitement. Thoracic surgeon G. Lionel Zumbro (above) performed the fi rst heart transplant in Georgia history (and one of the earliest ones anywhere in the world) at University Hospital in Augusta on June 27, 1984. The recipient was Tyronze Ingram (shown in the portrait above behind Dr. Zumbro), a then 31-year-old employee of E-Z-Go Textron. The milestone in Georgia and Augusta medical history was actually a truly unlikely event. Zumbro, the architect of a program that set a number of medical fi rsts in both Georgia and the Southeast at large, should probably never have even heard of Augusta, let alone practice medicine here for decades. Born and raised in Murfreesboro,

Tennessee, Dr. Zumbro attended Middle Tennessee State University there, earning a degree in mathematics in 1960. From MTSU, an interest in possibly pursuing a career in dentistry led to a course adjustment into medicine. He graduated first in his class from the University of Tennessee College of Medicine in Memphis in 1965, then started a lengthy association with military medicine: internship at Walter Reed Army Medical Center; a 4-year general surgery residency at Tripler Army Hospital in Hawaii; a 2-year cardiothoracic surgery residency back at Walter Reed; a 13-month stint in Korea; and another at Brook Army Medical Center in Texas. But nothing was happening anywhere near Augusta until a relatively brief posting (1972-1973) as a consultant in cardiac surgery at Ft. Gordon’s Eisenhower Army Medical Center near the end of his military duties. “There’s no way this little town can support an open heart program,” Zumbro remembers thinking upon his fi rst trip to Augusta. History was to disprove that statement, and Dr. Zumbro wrote the history himself, although he had lots of help from colleagues and University Hospital. The transplant era was a dramatic time, but it was no stranger to controversy. For starters, heart transplants were still in Please see PROFILES page 10

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

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Can people who are in a coma hear what is being said around them? Can they hear what is being said? Absolutely. Do they hear? It depends. Every person and every situation is different. Most hospitals stress proper protocol for every interaction between healthcare provider and patient, beginning with a courteous introduction and giving continuous updates to the patient about the purpose of the visit, as in: “Good morning, Mr. Jones. I’m Sue Smith, your nurse for this shift. Let’s see what your vitals are this morning, okay? Let me start by taking your blood pressure...” Many hospitals emphasize that this rule of respect and etiquette applies to everyone, even patients who are comatose. There are no exceptions. Every patient deserves to be accorded the same dignity as any other. On one website that provides a forum for dialogue on medical topics, an occupational therapist related her experience working with an older woman who had recently regained consciousness after 3 months in a coma. Although her speech was still affected, she managed to convey that she urgently needed to see her attorney. Her doctor arranged it, and the therapist was asked to be in the room to help her communicate. She related to her attorney that her three children had visited during her coma and conferred with the doctor while in her room. They asked the doctor to remove her from life support. The doctor refused because she still had brain activity. Her children complained that, brain dead or not, her expensive care was eating up their inheritance. She instructed her attorney to remove all of them from her will. In another incident from the same forum, a physician related his “aha moment” on this subject: while in the room with a comatose patient, he related to a colleague that he had lost his wallet and was dismayed at the thought of having to get a new driver’s license, cancel and replace his credit cards, etc. Weeks later the same patient, now recovered, shocked the doctor by asking, “Did you ever find your wallet?” +

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MARCH 16, 2018

#63 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

hances are that you have heard of this doctor, but you didn’t know what you read or heard was his name. It is sometimes seen capitalized — MOHS — leading some people to believe it’s an acronym for some complex procedure or diagnosis, maybe something like Molecular Obstreperous Hemolytic Syncopation. It sounds like it could be serious. In truth, it’s nothing more than this noted physician’s last name. He is Frederic E. Mohs, and his name is attached to a simple but ingenious advancement he introduced for treating skin cancer. Anyone who has had part of their epidermis shaved off or scooped out knows the drill: the doctor is trying to walk the delicate line between removing as little tissue as possible for the sake of healing and future scars, and as much as is necessary to get all the cancer cells. They might take more than is necessary to be on the safe side, and to prevent having to go back for a second procedure. To illustrate Mohs’ technique, consider this apple. Sad to say, it may have cancer. The slice taken from it has been sent off for biopsy. As you can imagine, no one will be able to look at the round sample and determine exactly where it came from on the apple. In other words, if the sample showed cancer cells were right up to one edge, no one could accurately say if that edge was at the 12 o’clock position, at 6 o’clock, or someplace else. Before Mohs came along, the only option would be to go back and dig a wider and deeper hole in all directions. Mohs surgery takes the disc and cuts it into 4 pieces, marking them so the exact location 1 2 of anything that needs to be looked at a second time will be precisely known. 4 3 Granted, this is an oversimplification of Mohs surgery, but the benefits are clearly evident: without it, the thought would be that it’s better to remove more than might be necessary, erring on the side of caution. Using Mohs, the doctor who does the initial procedure can excise the minimal amount of tissue, and if a need to remove more is identified, it isn’t a fishing expedition; the exact location is known. It minimizes tissue removal twice. Mohs developed this technique in the 1930s and for decades was the only person in the world practicing it. Even so, it ended up changing medicine in some fundamental ways. Once, dermatologists didn’t perform surgical procedures. They were dermatologists, not surgeons. Instead, patients were referred to surgeons who, for their part, were not too enthused about learning skin pathology. Over time, it was realized that dermatologists were the physicians best trained to recognize skin cancers, so they should also be the best at removing them. That realization took more than 30 years, but by the mid-1960s, dermatologists were routinely performing the procedures they had formerly referred to surgeons. Mohs lived to see the progress: he died in Madison, Wisconsin, in 2002 at age 92. +

The other day I was at the dentist’s office waiting while my grandson had a tooth pulled. An elderly gentleman came in asking a lot of questions. The receptionist very patiently answered his questions over and over again. “I am confused,” he said. I was so proud of her for remaining in control, and never once having an edge in her voice. He needed some work done on his teeth and wasn’t sure if he would get general anesthesia or a shot. She must have explained to him fifteen times that he would get local anesthesia. Finally it was his turn to go back and have his work done. It wasn’t long at all before he was done and left quite intact. Before long the nurse told me that my grandson was out of surgery and I could drive around the building to pick him up. He was more than a little wobbly when they helped him to get in the car, but we needed to go and drop off his prescription before I could get him home so he could rest. On the way out to the main road I hit a culvert I didn’t know was there. My wheel made a lot of metal scraping noise, but seemed to be OK—for a couple of blocks. Then it began that familiar thumping, softly at first, then much louder, and I turned onto a side street, hoping that no one would hit us and stopped the car. My grandson looked distressed, but until I got the tire fi xed, we were stuck. I called AAA and they determined where I was and said they were sending someone

out to help me. So we sat and waited. Before long a man and his wife pulled up behind us. I rolled down the window to tell them that I had a flat tire. He took a look, and agreed that was the problem. He swiftly got into the trunk, pulled out the spare tire, and began the task of changing the tire. When he got the old tire off I was pretty amazed by how hopelessly shredded it was. I called AAA and let them know someone was helping me, while he worked to put on the new tire. Meanwhile, his wife told me a story about a time when her military husband was on deployment and her cars got two flats at the same time. One of his soldier buddies came over and fi xed her tires for her. She told me her husband believes in helping people, and that he was distressed because with all the people passing my car no one had stopped to help. She said he knew we were in some kind of trouble because we were stopped in a place with no parking. I thanked them both for stopping to help us and we all continued our journeys. I dropped off his prescription and finally he was able to get in bed and go to sleep. A few hours later he insisted that he was OK and left for his own home. My day turned out to be pretty special. I love it when people show me the best of humanity when they clearly have other options available. That special feeling continued when my son-in-law came over, got my dead tire, and put a new tire on for me. It’s amazing when my guardian angel shows up in so many disguises and makes sure I’m OK. +

MYTH OF THE MONTH Natural is always better Believe it or not, this is a myth. It’s hard to believe when the word is splashed across seemingly half the packaging in grocery stores, seemingly all the good stuff too. The mere word can command a higher price tag compared to nonnatural, heavily processed competitors, assumed to be swimming with chemicals and bereft of natural, wholesome goodness and nutrition. But hold on for a moment. Isn’t gravel allnatural? Gravel must be loaded with minerals. But who would eat it? Arsenic is natural too. Poison ivy is purely and completely natural. What about rattlesnakes and

scorpions? Mosquitoes? Termites are all-natural. Nicotine is a deadly poison, but it’s a natural component of plants. Plants are natural. Diseases like smallpox and the flu are natural. Conversely, cancer may be feared, despised and unwanted, but at least it’s natural. Chemotherapy, on the other hand, is not. Diseases in general are natural, and many (if not most) medicines are crafted in laboratories. They aren’t natural, but they are certainly beneficial to the millions of patients whose lives are improved — and often saved — by their use. Natural is better — sometimes. Not always. +

MARCH 16, 2018

Musings of a Distractible Mind

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he consultant’s note in the patient’s file read:

Weight 250 lb. BMI 40.3. Patient is morbidly obese. Counseled on the dangers of excess weight. Counseled to increase exercise and decrease calories.

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

MARCH 16, 2018

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AUGUSTAMEDICALEXAMiNER

I walked into her room. She smiled at me as I walked in, a lovely smile that reached her eyes. I scanned her record. She was in my office for an ankle injury. Blood pressure normal. Weight 248 lbs, BMI 40. When I looked back at her, she was still smiling. “I lost another ten pounds,” she said proudly. I looked back in her records, noting steady weight loss over the past two years. She started at... “Goodness. You have lost over 100 pounds! Amazing!” Her grin persisted as we started talking about her ankle injury. Numbers. We obsess over numbers. Is BMI over 30? Obesity. Is it over 40? Morbid obesity. No doubt these numbers are important, but in reality they are just points on the timeline. People come for care with an entire lifetime of narrative in tow. Yet most of the care that is given is ignorant, sometimes intentional and sometimes not, to the whole story of what is going on. My patient went to the specialist and was labelled as being “morbidly obese,” and given counseling on the obvious (although I suspect the specialist just checked the box to avoid censure...and financial penalty). Yet this woman knew far more than anyone

who could have counselled her. She had lost a quarter of her body mass and was continuing to lose. She was a hero, yet to anyone who didn’t look back on her timeline, she was simply another data point proving the failures of our society. The irony is that the way that she accomplished her

She did it by trying to win a small victory each day weight loss was to focus on each day separately, ignoring her past history and trying to have a small victory each day. I’ve often used the analogy of a baseball player who does what he should do: get a hit. A single is no big deal, but if that player gets hits in every game for a week, for a month, his season (and that of his team) can be significantly altered. But each game, each at bat, is a single data point where he’s only asked to do something unspectacular. But do something unspectacular for enough days, you have something transformative. We live in a world where patience is a diminishing commodity. We want each day to wrap up neatly like an episode of a TV show. We want to figure out the solution to our problems, meet our soul-mate, elect the perfect candidate, and live the rest of our lives happy and contented. But every story has many pages, every timeline has many data points, and every life is made up of many days, many decisions.

As a human, I do best when I understand that I live in a timeline, and that my solutions take a series of decisions, not just one. Yet I also do best when I try to win only the day’s battle, not the whole war. Today matters only as a piece of something much bigger, yet today is the place where my pen is writing, and where the story is created. As a doctor, I also do best to consider both things. We want to criticize people for where they are without considering where they’ve been. I am constantly frustrated by ER and Hospitalist providers who ignore the care I’ve been giving for years (and sometimes decades), viewing only what is now in front of them. Our job is to recognize that everyone comes to us with a narrative, to enter that narrative, and to direct it in the best way possible. It’s their narrative, not ours. But we can have a huge impact on people if we listen, understand who it is we are seeing, and help them write today’s narrative in a better way. I know this sounds a little ethereal or overly philosophical. But this woman will get discouraged if nobody sees where she’s been and what she’s accomplished, only to criticize today’s number. Her exhilaration at my recognition of her incredible accomplishment will likely give her much more motivation and help than if I had lectured her on “eating less” and “getting more exercise.” We do our best work when we appreciate the fact that we are simply a point in the timeline. +

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Southern Girls Eat Clean Greek Tuna Salad - A Classic Lunch Favorite with a Mediterranean Twist Tuna Salad is a favorite lunchtime meal. It is especially delicious in the spring and summer months when we look for quick meals to accommodate our busy schedules. Here in the South, tuna salad is almost always made with celery and onion, sometimes sweet pickles. Some “wild” southern women might even add a chopped boiled egg. But no matter how you prepare your tuna salad, Duke’s mayonnaise is a must here in the South. This tuna salad is a healthier alternative to the classic lunchtime favorite. It is a much lighter version of tuna salad. No matter whether you serve it on a bed of greens or on toasted sprouted grain bread...it is amazing. This recipe has a Mediterranean twist. The Kalamata olives, feta cheese, and capers give this salad a punched up amount of flavor. It is not only flavorful, it’s healthy and nutritious due to the wild caught albacore tuna and Cannellini beans. The dressing is light and lemony and a perfect compliment for the tuna. The tuna that I use for this recipe is Wild Planet brand tuna. Wild Plant albacore tuna is sustainably caught using only tuna sourced from “Pole and Troll” catch fisheries, which is the best method for • 1⁄3 cup of celery, finely 4. Add the drained capers sustainability. This canned chopped and feta cheese crumbles to tuna has more than the typical • 1⁄3 cup of red onion, finely the bowl and stir to mix all amount of Omega 3’s due to chopped ingredients well. the method in which they • 1⁄3 cup of high quality feta 5. Season with salt and pepper pack the tuna. Wild Planet cheese crumbles to taste. cooks their tuna only once • 1-2 Tbsp. of capers, drained 6. For the dressing: In a and packs it in its own juices • Sea Salt or Real Salt Brand separate small bowl, whisk rather than water or oil. I love salt and cracked black pepper together olive oil, Dijon this tuna, as well as their wild • 3 Tbsp. of extra virgin olive mustard, lemon white caught sockeye salmon. You oil balsamic, (or plain white can find this brand of tuna at • 1 Tbsp. of lemon infused balsamic and lemon zest), most supermarkets, but they white balsamic vinegar the juice of 1 lemon and fresh also have it at Costco for a (Alternately you may use plain chopped oregano. great price. white balsamic and 1 tsp. of 7. Pour the dressing over This tuna salad is such lemon zest) the Tuna mixture and stir to a delicious, nutritious, • 1 Tbsp. of Dijon mustard coat all ingredients with the flavorful and unique recipe • Juice of 1 lemon dressing. that I’m certain your family • 2 Tbsp. of fresh oregano, 8. Serve immediately on a bed and friends will enjoy. Give finely chopped of spinach, arugula, mixed it a try and bring a little spring greens or toasted Mediterranean flare to your Instructions sprouted grain bread. + lunchtime meal. 1. Remove the tuna from the can and place into a large Alisa Rhinehart writes the blog Ingredients mixing bowl. Break tuna www.southerngirlseatclean. • 2 - 5 oz. cans of Wild Planet apart and add the drained com She is a working wife tuna Cannellini beans. and mother living • 1- 15 oz. can of Cannellini 2. Finely chop the celery and in Evans. Visit her beans, rinsed and drained (I onion and add to the bowl. blog for more recipes used Eden Organic brand) 3. Coarsely chop the Kalamata and information on • 1⁄3 cup of pitted Kalamata olives and place into the bowl clean eating. olives, coarsely chopped as well.

Greek Tuna Salad

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Thank you for taking the time to listen to me during my last visit. Your concern is allowing me to trust you further as I rely on you, my primary care physician, to refer me to where I can get relief from my suffering. You see, for the longest time I was in denial. Of all people, you know that is true. My brain just cannot or will not see the truth about itself. Oh yes, many others have seen the truth about my addiction, but I couldn’t see it until I was in enough pain. Yes, pain has been my greatest teacher. Without pain I would never be admitting to you that I am what I am. All the years my parents, loved ones and friends have paid my bills, called into work for me as being “sick,” carted me around when I lost my drivers license, and put me up in their homes because I had no place to go...all that kept me sick. I think it’s called “enabling,” meaning “helping” – that is, helping me stay sick longer. When they pulled out on me and left me high and dry, I felt enough pain to see the truth about myself. And you know, it’s not a pretty picture. Coming out of denial and into the truth is a dismal sight, looking at the trail of messes I have left behind. It’s almost overwhelming, and when I think of it all I just want to curl up in a ball and cry, but I can’t seem to cry enough to make the pain of my conning them all go away. It has taken a long time for me to come to this reality and I feel more than naked...I feel naked and ugly. Please don’t judge me.

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THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional I have seen the disdain in your eyes as my believability slipped away, little by little. I see it in the eyes of your office staff, too. I mean, I can hardly blame, them but the judgment just oozes out of them. I think they suspect that I’m the one who swiped your prescription pad off the examining room table one day. I wrote prescriptions a number of times, but I never got the nerve to use one. We’re good, you see, at making a prescription look legitimate. I just place one of your real ones behind a blank prescription page and place it on a piece of glass and shine a light underneath it and just trace your name exactly...it would fool even you! I didn’t ask to become addicted. And I’ve learned that my addiction has changed my brain to the point where my conscience seems to have gone away, and for sure my ability to make good decisions has gone. I never thought it would happen to me. It all started legitimately – you even prescribed the fi rst pain killers I ever took! Then I lied and lied about the pain and you kept giving me the pills...I know now that had

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you known the truth you would’ve cut me off years ago. Yes, it’s been years. It’s gone from bad to worse, too. I just want my life back, and I know it’ll take years for trust to return. Just as it’s taken years for others to lose trust in me. I mean, I don’t even trust myself. I guess that’ll take years to get back, too. I’m tired, Doc. Sick and tired of being sick and tired. Every time I go a few days... I went two weeks clean once...even though I tell myself I’m making progress my real little inner voice is just whispering to me...”get rest, sleep, energy, and some money and use again...only the next time I’M GOING TO CONTROL IT!” I’ve done this scores of times. And every time I do the same thing...slip back, again. It discourages me from trying again sometimes. I’ll tell you what I think I need...but don’t believe me. You’re the medical professional...please, you tell me what I need to do. This time, I’ll do it. Promise in writing. In writing seems to make our deal more serious. I will go where you tell me to go to get well. Or you can fi re me...but you have to do it in writing. +

The

Advice Doctor

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Probably not. +

Questions. And answers. On page 13.

MARCH 16, 2018

Kid’s Stuff

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

Milk: it does a body good How many kids drink milk? Hopefully most of them! Since it is a good source for calcium and calories and fat to support growth, milk is very good for growing kids; some milk even has added Vitamin D to help the body metabolize calcium and make strong bones. But how much milk should kids drink? And when should they start drinking milk? What about breastfeeding babies, or babies who had formula instead? What about babies with milk protein allergy? Is one type of milk better than another? Is there such thing as too much milk?? Let’s answer each question one by one. • Babies under the age of 12 months should drink either breast milk or an approved infant formula that is either milk-based (such as Gerber, Similac, Enfamil brands) or, if necessary (for health reasons such as milk protein allergy or other metabolic requirement), specialized choices such as Nutramigen, Alimentum, Pregestimil, and others. • Cow’s milk should not be introduced before baby’s fi rst birthday. After that, the ideal recommended intake is 16-24

9 +

AUGUSTAMEDICALEXAMiNER

oz (about 2-3 cups) per day. • If a child cannot tolerate cow’s milk, alternatives such as soy, almond, or other milks are acceptable as long as they safe and pasteurized. • Soy or almond milk may be better tolerated by some babies. As a general rule, however, if a baby has been formally clinically diagnosed with milk protein allergy, a soy-based formula or milk will not alleviate symptoms, as 50% of proteins in cows milk are also in soy milk. If true allergy is suspected, almond milk may be a better choice in babies older than 12 months of age.

• There is definitely such a thing as too much milk! While milk is a wonderful source of nutrition for growing children, more is not necessarily better when the recommended 2-3 cups per day is exceeded. Why? Cow’s milk causes irritation of the GI tract when consumed in too large of amounts. This can cause micro-bleeding and blood loss (often unknown to parents), which can ultimately lead to anemia, which is not good for a developing brain. Children are routinely checked for anemia at their 12 and 24 month well child checks, however, so parents need not panic. • Milk protein allergy consists of a true allergy to the proteins in milk. This is different from lactose intolerance, which can develop in older children and teens as an intolerance of the sugars in milk (but is not a true allergic reaction). • If lactose intolerance is suspected (for example, there seems to be a clear relationship between cow’s milk consumption and stomach upset and diarrhea), soy or almond milk can be good alternatives. If parents still have questions about what type of milk their child should consume or have other concerns, please discuss them with the child’s pediatrician, as every child is unique and may have unique circumstances that should be considered. +

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MARCH 16, 2018

PROFILES… from page 3 their infancy, so the success rate was low. Although the idea was fi rst proposed in 1907, the fi rst human-tohuman heart transplant was performed by South African surgeon Christiaan Barnard in 1967. Several others around the world followed in quick succession, but survival issues led to a long dry spell in heart transplants that ended in June of 1984. The event was the FDA’s approval of cyclosporin, an immunosuppressant drug administered to prevent rejection of transplanted tissue. The fi rst successful heart transplant of this new era, a pediatric procedure, took place in New York City on June 9, 1984, and two and a half weeks later, Tyronze Ingram also had a new heart

in Augusta. “We’ll have him out of the hospital in two weeks,” Dr. Zumbro predicted at the time, adding that he expected Ingram would be able to return to work. Alas, that isn’t how things turned out. Ingram died in mid-August, about 6 weeks after the transplant. Other recipients suffered similar fates. Not everyone was on board, recalls Zumbro, including the hospital itself. Even some doctors thought transplant surgeons were playing God or getting rich off procedures that only extended lives for a few short weeks or months. “That was one of the great misconceptions of the program,” Zumbro says. Transplants were many things, but profitable was not

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one of them. “At the time heart transplants were considered to be an experimental procedure, so insurance didn’t reimburse expenses,” either for the hospital or the doctors. And there were plenty of expenses. “When we were notified that a donor heart was available, a private jet was on stand-by. Those flights cost the hospital $25,000 each.” Zumbro actually never got a penny over and above his salary for any of the 30 or so heart transplants he performed, at least not a penny that he put in his pocket. He and the other key surgeons on the team, including Ron Galloway and William Kitchens, established the Tyronze Ingram Heart Transplant Endowment to assist transplant patients, their families, and University’s Heart & Vascular Institute. Any and all extra pay the physicians received for anything transplantrelated was donated to the endowment. From a critic’s point of view — and they were in abundant supply — University’s transplant program was generating neither income nor surviving patients. Something

had to give. That something was named Linda Black. Literally on the eve of a meeting by University’s board to evaluate the transplant program’s future, a donor became available for Black, a patient on the waiting list for a heartlung transplant. On oxygen 24 hours a day and weighing only 80 lbs, Black knew both she and the program were on thin ice, and she told Dr. Zumbro before the operation, “You get me that heart and lungs and I’ll do the rest.” She kept her word, surviving 16 years with her new components. “I think she became the second longestliving heart-lung recipient in the world,” remembers Zumbro. Linda Black lifted the pressure from the transplant program and gave it new life. But like many recipients themselves, it wasn’t to last very long. In 1989, Don Bray, then University’s chief, pulled the plug. Dr. Zumbro had mixed emotions. The ride had been both exhilarating and exhausting. He had been the point man for every aspect of the procedures. Zumbro was more than just the surgeon who implanted new hearts; he was also the one who

removed donor hearts — even if that meant an emergency trip at the drop of a hat as far away as Canada. In fact, his recollection is that Augusta was the site of the world’s first “distal” heartlung transplant. At Stanford University, for example, the donor had to be no farther away than the adjacent OR. These days, about 3,500 heart transplants take place annually, more than half of them in the U.S. What was once earth-shaking news has become commonplace. Survival rates have also improved dramatically. The prognosis at 3 years is about 80 percent; 5-year survival is over 70 percent. Every one of today’s surviving patients owes a debt of gratitude to transplant pioneers like Lionel Zumbro and the patients themselves. In the days since the transplant era, Dr. Zumbro’s resume includes serving as chief of MCG’s Section of Cardiac and Thoracic Surgery, attending surgeon at Augusta’s VA Medical Center, operating a private practice in thoracic surgery in Hawaii, and then retirement. Since 2006 he has been back in Augusta, fully unretired, as director of Vein Specialists of Augusta and the Zumbro Vein Institute. +

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The blog spot From the Bookshelf — posted by Joan DelFattore, Ph.D. on Jan. 31, 2017

PLEASE, DOCTOR, DON’T RUSH ON MY ACCOUNT

Lots of people love spicy food, but that doesn’t mean a full cup of black pepper or garlic on their favorite food would make their dining experience better. Just the opposite would be true. In a similar vein, lots of doctors (and their patients) love antibiotics. Their emergence was a game changer in world health: 100 years ago the average life expectancy in the U.S. was 52 years. Today it’s that plus another 30. So the war on germs is a good thing. Or is it? As the authors of this book point out, it’s a war we will never win, nor would we want to. Bacteria outnumber us by astronomical proportions. There are far more bacteria on planet Earth than there are stars in the universe. For each and every one of the trillions of cells in the human body there are about ten bacterial cells sharing the same space in our bodies. We’re more bacterial microbes than we are human beings. In other words, avoiding bacteria is literally and physically impossible. But the

I recently consulted a specialist at a major medical center in New York, and a few days later, here came a questionnaire in the mail. “How much time did I spend in the waiting area?” it asked. How long was I kept waiting in the examining room? How close to my appointment time did the doctor see me? The one thing it didn’t ask was whether I cared. There’s no mystery about why medical centers pay so much attention to wait times: patients demand it. During the months I underwent cancer treatment, I often overheard fellow patients complaining bitterly that they’d been sitting there for an hour, dammit. I wonder if they’ve thought that through. A surgeon I desperately wanted to see gave me an appointment on only two days’ notice. My medical oncologist spent extra time with me whenever test results required explanation; a hematologist squeezed me in at 7 a.m. one day. Each time one of my doctors makes time for me, other patients have to wait. When they make time for other patients, sometimes I have to wait. To me, there’s no contest: knowing that my doctors will be there for me when I most need them means far more than having them be prompt. Because, of course, they can’t do both. Responding to emergent needs is fundamentally incompatible with maintaining a rigid timetable, and cancer just doesn’t schedule well. I said some of that to a retired colleague who’d walked out of his doctor’s office after waiting half an hour. “They shouldn’t take so many patients!” he protested. “Then they wouldn’t be so backed up!” It reminded me of times when, as a college professor, I had some students begging to get into a course so they could graduate on time, while others complained that the class size was too large. If my surgeon and medical oncologist had been trying to shorten their wait times by turning patients away, I wouldn’t have made the cut myself, since my diagnosis is widely considered inoperable, and I live outside the usual radius for chemotherapy patients. There’s an old saying, “Be careful what you wish for, because you might get it.” If patients keep focusing on wait times, presumably our doctors will indeed be pressured into staying on schedule. So they won’t squeeze us in on short notice — after all, we can always go to the emergency room, to be seen hours later by a doctor we can only hope is familiar with the chemotherapy we’re taking or the surgery we’ve had. Doctors won’t accept us as new patients, no matter how badly we want to see them, if they’re already reached their limit; nor will they spend extra minutes with us when there’s a decision to make or news to absorb. Perhaps there’s no way to turn back the tide of clockwatching and bean-counting that physicians write about every week on KevinMD. If so, we’re facing a decline in the quality of American health care that no miracle drug or cutting-edge technology can compensate for. No matter how rarely I needed a quick appointment or extra time, simply knowing that my doctors would respond if a problem arose meant that I wasn’t out here all alone, adrift in an impersonal medical system. Now that I’m healthy and in remission, I’m classified as a patient who can wait — for hours, if need be — while more urgent cases are seen. I don’t mind. Sipping hot tea in a comfy chair in the waiting room, reading a book, I’m just grateful that, today, the emergency isn’t me. +

Hearing loss drug studied The Journal of Experimental Medicine reported last week on research that could save the hearing of millions of people. The study found that inhibiting an enzyme called cyclin-dependent kinase 2 (CDK2) protected mice from noise- and drug-related hearing loss by preventing inner ear cells from dying. If tests show the same results in humans, it would be significant, since there are currently no medicines approved by the FDA to treat hearing loss, a problem that affects nearly half a billion people worldwide. Chemotherapy and industrial noise above 100 decibels are among the causes of hearing loss that responded very well to the CDK2 inhibitors.

Joan DelFattore writes about single life, including handling illness without a partner.

Vitamin D threat Researchers at the

Being there and being prompt are fundamentally incompatible

common wisdom is that the only good bacteria is dead bacteria. Germ-free is good. Sterile wipes keep our kitchen surfaces clean, and more significantly, antibiotics enter our bodies in ever-increasing amounts at younger and younger ages. As the authors state, antibiotics may be the greatest medical advancement of all time, but they kill bacterial microbes indiscriminately, good and bad alike. The overall effect of our collective prevention efforts, ironically enough, is an increase in some allergies and diseases. Dubbed the “hygiene

hypothesis,” the general idea is that exposure to various germs, microbes and antigens results in a stronger immune systems, especially in children; conversely, trying to live in as sterile a world as possible results in an immune system that is ill-prepared for battle, doesn’t know or recognize the enemy, and is anything but combat-ready. The hypothesis, which gains more research support all the time, may explain why autoimmune diseases are on the rise in developed countries where antibiotics and strong emphasis on sterile conditions are common. For the record, this book is not suggesting that readers (parents especially) take its title literally. But it might make each of us stop and think each time a label shouts out the word “antimicrobial” as a good thing. Maybe it is sometimes. But sometimes it might not be at all. + Let Them Eat Dirt; Saving Our Children From an Oversanitized World by B. Brett Finlay, Ph.D., and Marie Claire Arrieta, Ph.D.; 448 pages, published by Penguin Press in 2015

Research News Intermountain Medical Center Heart Institute in Salt Lake City have discovered that open heart surgery significantly reduces patients’ vitamin D levels, but aggressive supplementation before and after surgery can eliminate the drop. The connection is important, since vitamin D deficiency is associated with increased risk of heart attack, stroke, congestive heart failure and other cardiovascular complications, including hypertension and diabetes. The romance cure Pain researchers at the University of Colorado at Boulder discovered an interesting thing when romantic partners hold hands. Exploring a phenomenon called interpersonal synchronization, researchers discovered that when a woman’s romantic partner

holds her hand, their breathing and brain waves synchronize. The more empathy the comforting partner feels for a partner in pain, the closer their brain waves fall into sync, and the more the brain waves sync, say the researchers, the more pain is eased. Merely being in each other’s presence, even without touching, created some brain wave synchronicity. Holding hands while in pain (administered in the study as heat on the arm) increased coupling the most. Depressing news Researchers at University College London and the University of Liverpool have analyzed data on more than 10,000 children born this century with unsettling results: 24% of the girls and 9% of the boys at age 14 suffer from depression. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

MARCH 16, 2018

THE MYSTERY WORD

You know that magazine called Garden & Gun?

Sure do. I love that magazine.

by Dan Pearson

They’ve been pressured I heard about that. Sort of. They’re about having “Gun” But they refused to changing the name to Am I supposed to feel safer now? in their name. drop the word, right? “Discardin’ Gun.”

The Mystery Word for this issue: GUNLET

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Type of club 5. European capital 9. Collegiate conf. with its HQ in Greensboro, NC 12. First name of the 2009 Masters champion 13. Bane to Fido 14. Native of Bangkok 16. Job festival 18. Some clocks have two 19. Amazement 20. Converse 21. Kidney adjective 22. Scarf or shawl made of fur 23. A bunt is usually this 24. Religion founded in Iran 27. Augusta’s Blue _______ 28. Muse of lyric poetry 29. 2002-2003 epidemic (abbrev) 31. Ball position 34. Argument tactic 38. Restaurant or bar bill 39. Augusta’s NPR station 40. Prefix denoting tissue 41. Meeting of witches 44. Sticky pine excretion 45. Davidson’s first name? 47. Georgian who won the 1973 Masters 50. First part of Lew Alcindor’s adopted last name 51. Singular version of 58-D 52. Ocean 55. Housekeeper 56. Adorned with streamers 59. Palmetto state util. 60. Blocker prefix 61. It hangs above the throat 62. Where the Wild Things ___ 63. Family 64. Droops

QUOTATION PUZZLE

Click on “READER CONTESTS” 15

VISIT WWW.AUGUSTARX.COM

43 47

Y E B S N I N E B H T Y E M A V I H L L O M V T O S E E L I W L E O M K E O E E H E N A F D P

DOWN 1. Chew on 2. Fairy tale beast 3. Mr. Janzen of the PGA 4. Bend (alt. spelling) 5. Garbage, especially with animal entrails 6. Roofing stone 7. Flower wreath 8. Paddle 9. Seat of Clarke County (GA) 10. Constant; unvarying 11. Augusta _______ 12. “Obamacare” acronym 15. Doing nothing 17. 17th letter of the Greek alphabet 21. Site of the 2016 Summer Olympics 22. Satisfy to the full 23. The only baseball player to hit 60 or more homers in a season 3 times 24. Of the highest quality 25. Operatic melody

26. A soldier armed with a halberd 27. Norman of the PGA 29. Quick!!! 30. Curve 32. Former Peruvian money 33. English public school 35. Bob, winner of the ‘86 PGA Championship 36. Clot 37. Look or demeanor 42. Thick industrial gunk 43. Canaanite god (var.) 45. Poor actors 46. Manila hemp plant 47. Main artery 48. _____ Flu 49. Chafe 52. Cozy 53. Long fish 54. Dental org. 56. London-based broadcaster 57. Just one 53-D 58. Plural version of 51-A Solution p. 14

— Plato

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.

X A M I N E R

U D O K U

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

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

1 2 3 4

L 1 2 3 4 5 6

I 1 2 3 4

T 1

NUMBER SAMPLE: BY

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

D 1 2 3 4 1 2

F 1 2 3 4 5 W 1 2 3 4 5 6

1 2 3

1 2

1.PRIFFFILAST 2.HOOTIEESAI 3.WORMUKEN 4.LEEDRAP 5.ERTL 6.DE

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com

MARCH 16, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

You: “Police! Identify yourself!” Police: “State police!” You: “Police!”

ha... ha...

Moe: Why did the elephants get kicked out of the pool? Joe: I give. Why? Moe: They kept dropping their trunks.

Moe: What starts with “p,” ends with “orn,” and is big in the film industry? Joe: I’m not even going to attempt a guess. Moe: Popcorn!

man of some means who was known to be generous was about to embark on his latest epic vacation from his tiny village. A Moe: I wish I could help my friend. friend of his who happened to be a musician Joe: What’s wrong with your friend? asked him if he could do him a favor on his Moe: He’s addicted to ladders. trip, and the man was only too happy to help. Joe: Ladders? How can someone be At the end of his trip when the man landed addicted to ladders? at his hometown airport, he had two huge Moe: He uses them to get high. sacks slung over his shoulders. A customs agent asked him what he had in the sacks. Moe: My girlfriend broke up with me. “Cell phones,” was the man’s answer. Joe: Why? The customs officer was skeptical, so he Moe: She says I’m a compulsive gambler. asked to inspect the bags. Sure enough, they Joe: That’s rough. were both full of mobile phones. Moe: I know. All I can think about now is “And what do you plan to do with all these?” how I can win her back. asked the customs agent. “Oh, they’re not for me,” said the man. Moe: My wife and I just had a big fight. “They’re for my musician friend. He asked me Joe: How come? if I could bring him back a couple of sacks of Moe: She says I procrastinate. phones.” Joe: What did you say? Moe: I said, “Can we talk about this later?” When dealing with police in a crisis situation, always carefully follow their Moe: My friend offered to sell me a Bose radio instructions to the letter. Example: for a dollar, but the volume is stuck on high. Police: [pound on door] Joe: Are you going to get it? You: “Who is it?” Moe: It’s gonna be hard to turn down. + Police: “State Police! Identify yourself!”

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.

SUBSCRIBE TO THE MEDICALEXAMINER +

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

Dear Advice Doctor, My best friend and I work for the same company. We started on the same day in the same position. Since then, I’ve been promoted once (which came with a raise), and my friend has gotten two promotions and three raises. I don’t begrudge him his successes. I’m happy for him. What bothers me is that since his last promotion he’s gotten too big for his boots. He stopped carpooling with me and half the time he won’t even say hello. What is the best way to address this without coming off like I’m bitter or jealous? — Promoted on job, Demoted in life Dear Promoted, I have seen this situation in the workplace a number of times, and it always ends badly if someone doesn’t take prompt action. The longer a person waits, the worse the damage becomes. There is a high concentration of potential problems in this area. After all, the foot and ankle combined contain 26 bones (which is a fourth of the total number in the entire body), almost 3 dozen joints, and more than a hundred muscles, tendons and ligaments. Obviously if someone is too big for their boots (or any other kind of shoe), there are a lot of ways this can go south. What are some of the hazards of poorly fitting footwear? Let’s start with the simple and progress to the more serious. Sore feet, calluses and blisters are the early warning signs that your shoes are the wrong size, or that they’re worn out and need to be replaced. Prolonged wearing of improperly fitting shows can quickly escalate the problems to ingrown toenails, bunions and corns. Permanent and painful disfigurement can be caused by habitually crowding your feet into shoes that are too small. If you don’t believe your wise and trusted Advice Doctor, just check with anyone who has been around ballet dancers for years. In extreme cases, years of being too big for your shoes can result in improper gait, with a domino effect of injuries to the ankles, knees and hips. How are these problems avoided? Don’t automatically and habitually try on or buy the same size shoes. “I always wear a seven and a half.” Instead, always have your feet measured at the shoe store. Do your shoe shopping late in the day. When trying on shoes, make sure you’re wearing the kind of socks (if any) that you’ll normally wear with those shoes. Always try on both shoes, and go for a decent test walk on a hard surface, not plush carpeting. Don’t buy shoes that feel too small or tight in the belief that they’ll stretch. Bear in mind this rule to impress upon your mind the importance of proper shoe shopping: you do not have a shoe size; you have a foot size. Shoes should fit your feet, not the other way around. + 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.

Why read the Medical Examiner: Reason #41

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

...cleverly hidden on the Corvette in the p. 2 ad for OVERHEAD DOOR CO. OF AUGUSTA/AIKEN THE WINNER: APRIL S. HARTSELL Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED G A N C A A W B E S T

A R I A

H A M S

A B A C A

O L F O G E L F R E E R F E C H A S T O L H A I A T O S L E N T T B W A E S B A T R L E Y D U L I D B E E G B E R E C L

S L O A L E A T A I R H T R E E S I N G O O S A R S R E A T M C G H I R E A A R O N O V U M R I B B O T A U V A N S A

C H A N G E L E S S

C A N A L

I D L E

I N T I

E T O N

S N U G

E A E D L A S

SEE PAGE 12

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

WRITER WANTED

MARCH 16, 2018

“Some people find fault like there is a reward for it.” — Zig Ziglar

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

2 4 3 1 7 9 8 6 5

1 7 9 5 8 6 2 3 4

9 3 1 2 4 7 6 5 8

7 8 2 9 6 5 1 4 3

6 5 4 8 1 3 7 9 2

3 1 6 7 5 8 4 2 9

8 2 5 4 9 1 3 7 6

4 9 7 6 3 2 5 8 1

QUOTATION QUOTATION PUZZLE SOLUTION: “When men speak ill of thee live so nobody may believe them.” — Plato

The new scrambled Mystery Word is found on page 12

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MARCH 16, 2018

15 +

AUGUSTAMEDICALEXAMiNER

EIGHTH IN A SERIES

The vitamin alphabet As the old joke goes — you know, the one we’re making up for this introductory paragraph — this is the favorite vitamin of oncologists. (B-9 is also their favorite choice on juke boxes, by the way.) But let’s not let oncologists have all the fun. Everyone should love vitamin B9, aka folate or folic acid. This stuff is seriously important. Folic acid is necessary for the production of new cells and the maintenance of existing cells, and it’s needed to metabolize amino acids that are required for cell division. It’s essential for proper DNA replication, and when DNA doesn’t replicate properly, the word used to describe the result is “cancer.” Naturally then, folate is especially important when there is lots of cell division

and growth going on, such as during pregnancy and infancy. In fact, this vitamin is a commonly recommended supplement during pregnancy. Folate deficiencies during pregnancy can result in neural tube defects (NTDs) in the infant, the most common of which is spina bifida. In the very early stages of pregnancy, the brain and spinal cord are not enclosed. That changes soon enough (by the 3rd week of pregnancy), except in cases of folate deficiency, one of the main causes of neural tubes not fully developing. Anencephaly, the absence of all or most of the brain, is another NTD that can be triggered by a folic acid deficiency. Another role of folic acid is tied to production

is needed to avoid a folate deficiency. This vitamin gives us a clue on where we can find it in its name: folic derives from the Latin word folium, which means leaf. Give yourself 2 points if you concluded that folates can be found in dark green leafy vegetables like spinach. Yum! Other sources include such goodies as fruits and fruit juices, dairy products, meat, seafood, nuts, beans, eggs, poultry, avocados, asparagus, liver, baker’s yeast, and Brussells sprouts. Just to be on the safe side, folic acid is added to many cereals, breads and grain products. Adults should get 400 mg of folate in their daily diet, although pregnant women should get from 600 to 1000

of new red blood cells, so a deficiency leads to anemia. No wonder it’s considered to be so important. Thankfully, a healthful and balanced diet is all that

MEDICAL AUGUSTA’S MOST INFECTIOUS NEWSPAPER

mg per day. Humans have always needed folic acid; we just didn’t know it until the last eighty years or so. In 1931, the door cracked open a bit when British researcher Lucy Wills discovered that anemia and folate deficiency were not one and the same, as had been previously thought. In the early 1940s, folate was fi rst isolated by extraction from spinach leaves, which cleared the way for further studies into the exact role of folate in the human body. That, in turn, led to the synthesis of the fi rst cancerfighting drug, aminopterin, in 1948. The 1960s saw the link between folate deficiency and NTDs, and the mandate in the U.S. to fortify foods with folic acid only dates back to the 1990s. +

+ 16

AUGUSTAMEDICALEXAMiNER

MARCH 16, 2018

Why the opioid crisis? A year-long study conducted by Minneapolis Veterans Affairs clinics has found strong evidence against using opioids for chronic pain. Specifically, the study found that opioids worked only slightly better than overthe-counter drugs and other non-opioids in relieving pain. The tests compared such opioids as generic Vicodin, oxycodone and fentanyl patches against non-opioids including generic Tylenol, ibuprofen, and prescription pills for nerve and muscle pain. The study randomly assigned patients needing pain relief to take either opioids or non-opioids over a period of a year. The study’s lead author noted that opioids’ reputation

as the big guns of pain killing is undeserved. “That is not what we found.” Given their high risks of addiction and other nasty side effects (including death), it would be expected that opioids would be reserved for the most troublesome cases, the most resistant and stubborn cases of unrelenting pain, a drug of last resort used in extremely rare circumstances. All of that is exactly what federal guidelines recommended in 2016. Given their obvious societal cost, it’s surprising that prescribing rates have declined only slightly in the most recent studies, but are still much higher than they were two decades ago. +

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

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Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Parks Pharmacy Augusta 30904 437 Georgia Ave. 706-733-3373 N. Augusta 29841 www.GaDerm.com Vein Specialists of Augusta Resolution Counseling Professionals 803-279-7450 G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 3633 Wheeler Rd, Suite 365 www.parkspharmacy.com 501 Blackburn Dr, Martinez 30907 Augusta 30909 706-854-8340 706-432-6866 Karen L. Carter, MD www.VeinsAugusta.com www.visitrcp.com 1303 D’Antignac St, Suite 2100 Psych Consultants Augusta 30901 2820 Hillcreek Dr 706-396-0600 www.augustadevelopmentalspecialists.com Augusta 30909 Augusta Area Healthcare Provider (706) 410-1202 Your Practice Prices from less than $100 for six months www.psych-consultants.com And up to four additional lines of your choosing and, if desired, your logo. CALL 706.860.5455 TODAY! Keep your contact information in Steppingstones to Recovery this convenient place seen by tens of 2610 Commons Blvd. If you would like your medical practice listed in thousands of patients every month. Augusta 30909 the Professional Directory, Literally! Call (706) 860-5455 for all 706-733-1935 call the Medical Examiner at 706.860.5455 the details

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