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WHY?

MARCH 18, 2016

Why do we yawn?

mazingly enough, scientist aren’t sure. There are plenty of theories, but no conclusive answers. One thing’s for sure: yawning is contagious. Researching this article caused many yawns. Writing this article is causing still more. And just seeing the pictures on this page and reading the words yawn, yawns and yawning over and over again, well, get ready to yawn. But why? Conduct a Man On The Street poll and most people would probably say being tired or sleepy is the #1 producer of yawns. Fair enough. But then why do we yawn when we aren’t really tired or sleepy? Having said that, the annual coming and going of Daylight Savings Time and its attendant sleep disruptions for us all will no doubt make this week peak yawning season. But we yawn during other weeks, too. Obviously boredom isn’t the reason either. After all, you’re currently reading a scintillating article, yet you may have already yawned since you started reading. Yawning and stretching at the same In other situations, however, time is known as pandiculation. The boredom can contribute to gentleman above is pandiculating. yawning. But again, we yawn when we aren’t bored, so that doesn’t help answer the why question. For that matter, dogs and cats who lie around doing nothing for 20 hours a day yawn. Are they bored? Fetuses in the womb have even been observed yawning. And as we have all seen (and if not, see the photo to the left), newborns do plenty of yawning. Some people yawn when they’re nervous, such as before an important meeting or presentation. Paratroopers have been noted to yawn in the final moments before jumping out of a plane, says an article in New Scientist. That observation puts yet another reason for yawning as a boost for alertness. One study measured blood gases and determined that higher than normal levels of carbon dioxide were observed just before subjects yawned. From this it was theorized that yawning helps expel carbon dioxide and enhance oxygen intake. Further studies of Please see WHY DO WE YAWN? page 3

AUGUSTA MEDiCAL EXAMINER

MARCH 18, 2016

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

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There is a trifecta of evil among us that rears its ugly head and knows no bounds. People of any age, race, and sex can be affected, but it can be especially miserable for children. Sometimes the cold of winter makes it worse, but sometimes it’s the burgeoning spring that summons it. This threesome of mischief comprised of asthma, eczema, and allergic rhinitis is known by a single term: seasonal allergies. Fortunately, not all people are affected by all three conditions simultaneously. Some only have asthma or eczema, which are made worse by the blustery cold and dry air of winter, and many people have significant suffering as a result of the allergies that bloom along with the flowers and ragweed of spring. Some unfortunates suffer from all three due to the vastly allergic component of each condition, which sensitizes the whole body to any environmental provocation. Asthma is a disease controlled on two fronts: maintaining an environment that has reduced the amount of allergens and triggers present, and medications to help keep the inflammation and hyper-reactivity of the lungs in check. Medications are managed by doctors, but there are many things asthmatics can do on their own to help their symptoms. Triggers most often consist of cigarette smoke, dust, animal dander, and pollen. Keeping homes regularly

vacuumed and dusted cuts down on the amount of irritants inside, and showering after being outdoors for extended periods cuts down on the amount of pollen that is brought indoors on clothing and skin. Eczema is that dry, scaly, cracked, roughfeeling rash that persists, especially in creases or sensitive skin areas. And it can be very, very itchy. It is often worse when the affected areas are exposed to irritating soaps, scented detergents, animal dander, and dry air. Aggressive moisturizing with unscented, soothing lotions — brands like Aquaphor, Vaseline, Cetaphil, and Eucerin — can help a lot. The key is to keep the rash clean and well hydrated, as dirt and dryness can make it even more itchy and inflamed. Allergic rhinitis, or seasonal allergies, are primarily a reaction to environmental triggers, which for most people includes pollen and occurs most dramatically now and during the next month or more. Seasonal allergy symptoms consist mainly of runny nose, sneezing, coughing, itchywatery eyes, and itchy skin. Histamine is the main culprit responsible for these symptoms due to its release in response to pollen, etc and the effects it causes. A two-pronged approach tends to work well for most people (including me), and that includes a systemic Please see SEASONAL page 6

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AUGUSTA MEDiCAL EXAMINER

THE DOCTOR IS IN W

The

Advice Doctor

The Greatest Gift: Finding Balance

ith a soft smile as he clicked “Down” on the elevator at the Grand Hyatt Hotel in Dallas, the exam moderator was the last official person I saw after completing my Urology oral boards last month. As the elevator softly stopped on the ground floor, I stepped outside into the Texas sun. It was midday, and seemed very, very quiet. People were coming and going as usual, but as has happened after many exams I’ve taken before, it seemed even more quiet because my mind could finally downshift and find some peace. I sat on a bench and called my wife to check in, and felt that familiar sensation of postexamination euphoria wash over me. It’s over! For people in the medical field, the post-exam sense of relief is one of the most significant emotions that is honed from a very young age. I remember leaving the Kaplan testing center from my MCAT exam to walk into the streets of downtown Athens, people completely oblivious to the mental gauntlet just laid out for myself and my other colleagues taking the test. I remember thinking, “They really have no idea what just happened in there for the last eight hours!” Medicine becomes exponentially more rewarding both academically and emotionally the further one goes in the process. With national certifying exams used to stratify the burgeoning young minds of science, the struggle — and thus the reward — isn’t against your neighbor sitting beside you. It’s vastly more challenging than that. It’s the internal struggle to push yourself beyond your own familiar limits, sometimes at the expense of those around you. Ask any busy doctor in their thirties how many times a year they see their best friends from childhood or college, and the answer is almost exclusively in the single digits. As a medical student, it’s important to discipline oneself to study more efficiently and effectively than ever before. During the latter part of residency though, something interesting happens. As the specialty

content is mastered, among all the things that have been sacrificed along the years there comes a struggle to rediscover balance. Balance is the first thing sacrificed in the academic ascent of the medical field, so doctors don’t usually mind or even miss its lacking. In fact, its absence almost feels familiar because it becomes associated with the control we have taken over the will to succeed. “If a B+ takes five hours and an A+ takes fifteen, then fifteen wins.” This effect, compounded over years, stretching people to the limits of their mental, physical, and emotional capacities, all while trying to perform a greater good, often puts a doctor in a constantly tenuous state of mind. There is so much reward in the medical profession, yet sadly a lot of the other obstructions in the pathway cloud the true gift of a life in medicine, and for me that is the appreciation I carry for life in so many aspects. The perspective gained on the human condition and the respect and appreciation for so many aspects of life dwarf any other material or financial reward in this business. That is the greatest gift, and it isn’t written in any textbook, Powerpoint or marker board presentation. If you are in medical school or thinking about it, work hard, but most importantly stay balanced to enjoy to the simple pleasures of life in a quiet mind. It is the hardest lesson you’ll ever teach yourself, but you will never regret it. + Dr. Darren Mack is a graduate of the Medical College of Georgia and is a urologist with offices in Evans and Aiken. He may be reached at (803) 716-8712; via Twitter: @doctordmack and Instagram: @aikenurology The information provided in this article is not a substitute for an evaluation by a David Russell Photography licensed health care provider.

+ Dear Advice Doctor, I have been unemployed for almost a year, but recently I heard about a job opening in my field. I applied and was invited for an interview, during which I discovered that a close friend of mine works there too. He promised to put in a good word for me, but he has since been fired. Now I’m holding my breath, wondering if I still have a chance after what happened to him. Any advice? — Needing This Job Dear Needing, I normally hear from parents when it comes to this topic. Usually the concern is over a toddler — typically someone living through the so-called Terrible Twos — who is throwing tantrums and holding their breath until they get their way. If they’re stubborn enough, they can hold their breath until they actually pass out, which is understandably a frightening thing for the parents to see. The body’s need for oxygen is constant, and it will attempt to overpower any obstacle that stands in the way of satisfying this need. If a person deliberately holds their breath too long, the body takes over. If unconsciousness sets in, normal breathing immediately resumes and the person will soon regain consciousness. Clinical studies have attempted to determine if repeated or prolonged breath-holding negatively affects the brain, blood pressure, the heart and vascular system, the lungs, or other parts of the body. While no one would suggest it’s a great idea, there is no conclusive evidence that holding your breath holds serious risk for most people. Some studies have found no resulting damage, others seem to indicate possible changes in the brains of free divers. The best advice I can offer is to breathe normally — for as many years as you possibly can. + Do you have a question for The Advice Doctor about love, life, personal relationships, career, raising children, or any other important life topic? Send it to News@AugustaRx.com. Replies will be provided only in Examiner issues.

AUGUSTA

WHY DO WE YAWN?… from page 1

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www.AugustaRx.com subjects breathing enhanced air (higher levels of oxygen and reduced carbon dioxide) showed no reduction in their yawns. So much for that theory. The one theory about why we yawn that seems to have the most clinical and anecdotal support is perhaps the most surprising: yawns cool down the brain, an organ that operates best within a narrow and precise temperature window. The evidence in support of the brain-cooling hypothesis is considerable, but by no means are all yawn researchers convinced. Much of the research is based at its most simplistic level on the contagious nature of yawns. Study subjects are put through various tests while looking at pictures of people yawning. People doing this outdoors on a cool day in one study yawned almost twice as much as people looking at yawn pictures on a hot day. Brain

cooling at work? In another study, people in two groups were shown videos of people yawning. The group with cold packs held to their foreheads (evidently not in need of brain cooling, therefore) yawned considerably less than the ordinary hot heads in the control group. In animal studies there are also more yawns in cool or cold environments than in hot ones. All told, scientists have identified nearly two dozen possible reasons for yawning. Some researchers are trying to prove a single-reason theory; others believe that we yawn for many reasons and yawns serve multiple functions, including many that are social or behavioral, not physiological. In summary, there seems to be a yawning gap in our knowledge of yawning. +

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

(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net Opinions expressed by the writers herein are their own and their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., or its agents or employees take any responsibility for the accuracy of submitted information, which is presented for informational purposes only. For specific medical advice, diagnosis and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2016 PEARSON GRAPHIC 365 INC.

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

#18 IN A SERIES

Who is this?

OLD NEWS +

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

DRUG ABUSE IN THE WORKPLACE

ere we have the lovely visage of Anna Morandi Manzolini, gazing at us all the way from Italy in the 1700s. Ms. Morandi was born in 1716 in Bologna, in a traditional home where her future was laid out for her at birth: marriage, children, and all their attendant chores. Her marriage at age 20 to her childhood sweetheart, Giovanni Manzolini, seemed to solidify her life’s path. He was the son of a shoemaker, and grew up helping his father in the family business. After just five years of marriage, Anna and Giovanni were the proud parents of six children. As shoemakers sometimes do, Giovanni decided at age 40 to become a painter, and was taught at the studio of Ercole Lelli, known as much for figure sculptures as for paintings. A purist, Lelli also taught anatomy as the true foundation for figure studies. Giovanni excelled at figure sculpting and modeling to such an extent that within three years he was Lelli’s chief assistant, creating commissioned wax models for the anatomy museum of the Academy of Sciences of the Bologna Giovanni Manzolini Institute. However, Giovanni felt that Lelli took all the credit for his work, and quit to form his own studio in 1746. Anna enters the story more prominently at this point, learning modeling, anatomy, and even dissection to help her husband. Together, the husband and wife team of Anna and Giovanni Manzolini were recognized throughout Europe, and soon, as noted as Giovanni’s talents were, they were surpassed by his wife. In fact, although Giovanni was appointed Professor of Anatomy at the University of Bologna, she is the one who actually gave the lectures. When he became ill with tuberculosis and was unable to work, she not only continued their work on her own but at this point was forced by circumstances to learn dissection, something she initially found distasteful and repulsive. But she conquered her fears and trepidation and became such a skilled and meticulous practitioner that she discovered several previously unknown anatomical structures. Her knowledge of anatomy resulted in wax models that were indistinguishable from the body parts they were modeled after and were considered the gold standard for others. Although her work inspired her husband to return to work, he died in 1755 at age 55. At the time Anna was only 39. That same year, however, she was appointed Lecturer in Anatomy by the Institute of Bologna and was awarded a lifetime annual stipend by Pope Benedict XIV. She was later named a member of the prestigious Academy of the Arts, part of the Institute of Science. In 1760, she was named Chair of Anatomical Modelling at the University of Bologna, all rare and unusual achievements for a woman at that time. + Anna Manzolini died July 9, 1774 at age 60.

any things have changed in the workplace. One of the most glaring changes is it has become common-place to have a co-worker who can’t do their job, prioritize tasks, get anything done, or who forgets important details and misses a lot of work days. If this seems confusing to the average worker, the answer is simple and sad. Prescription drug abuse has become widespread in the workplace. Of course, there is the caveat that it may be an organic problem with some, but increasingly, opiate use is the culprit. The most common opiate drugs prescribed are morphine, hydrocodone, Vicodin, Oxycodone, Oxycontin, Percocet and codeine. Is abuse a problem? In Indiana, the National Safety Council reports that 80% of employers there say they have observed an issue with painkillers among employees and it is a fireable offense. I could do a whole column on alcohol, which is the #1 drug abuse problem in America and results in 500 million lost

workdays each year. But we are talking about painkillers today. A study published in the journal Pain Medicine found that prescription opiate abuse represents a substantial and growing economic burden. The CDC reports there were 47,055 deaths in the U.S. caused by drug overdose in 2014. 61% of those involved opiates. Researchers write, “The increasing prevalence of abuse suggests an even greater societal burden in the future.” Despite the high risk of addiction, doctors still prescribe opiates for pain. The Workers Compensation Research Institute reports that 65-85% of injured workers were prescribed opiates from 2010-2012, with workers in Arkansas and Louisiana the most likely to be prescribed. Why this geographical area is hardest hit is unknown. The Centers for Disease Control and Prevention calls this a

“Prescription drug abuse epidemic.” Regardless of the potential cost, most employers aren’t screening for prescription painkiller abuse. Testing firm Quest Diagnostics says only 13% of the 6.5 million workplace drug tests they perform each year screen for prescription painkillers. In addition to those who become addicted from legally obtained prescriptions, the problem grows when you add in those addicted to painkillers obtained through other means. I did a short interview with an anonymous source and was told one 30-mg Xanax or Oxycontin can sell for $20 to $30 on the street. If you receive a prescription for a one month supply of 60 pills/capsules (2 a day for 30 days) and sell them for say, $25 each, that’s $1,500. This is a tremendous amount of money and when you look at the numbers, it’s no wonder it is a sub-culture problem about to go mainstream — if it hasn’t already. For those who end up with an addiction stemming from a legitimate starting point, this result is unexpected. For those who seek out the drugs for recreational use and end up addicted, my question is this: “You knew the first time you put the first pill in your mouth where this could go. Why do it?” Once we figure out the very complicated answer to that question, perhaps we really can change the drug culture in our country. +

MYTH OF THE MONTH “I can adjust to my irregular sleep schedule.” It’s a nice thought, and it’s noble to give the body such credit. The human body, in fact, is amazingly resilient and adaptable. The old saying somes to mind: “No matter how you treat the human body, it will last a lifetime.” Ah, but how long will that lifetime last? And what will its quality be? Medical research has established rather soundly that sleep is one of the most important elements of good health. If you have everything else going for you except for good sleep habits, you are not likely to be healthy — and if you are, you’re definitely playing a dangerous game that will probably not have a good ending: the

body will never really adjust to sleep deprivation. Even people who say they can get by on a few hours of sleep per night are fooling themselves. If that situation describes you, it would be an excellent idea to talk to your doctor about it. Find out why you cannot or are not getting the full amount of sleep your body requires. Do that and you might discover a whole new world, one for which you’ll be sound asleep. + — by F. E. Gilliard, MD, Family Medicine 4244 Washington Road, Evans, GA 30809 706-760-7607

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

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

Steve and Karen are a successful couple. They live in early retirement. They have a reasonable retirement home with some acreage, children that don’t cause too much trouble, and a dog. Most of the time, Steve wears a highly unkept beard that struggles somewhere between I-haven’t-shavedin-days-because-I don’thave-to-any-more and If-Brat-Pitt-can-have-a-stragglybeard-and-still-sleep-withAngelina-it-must-be-alright. Most of the time, I overlook Steve’s beard, not just because I like him, but because Steve is a retired Crew Chief from the Air Force. He is heavy duty with a socket wrench and an M16. He has been in hot spots in the Middle East and has been shot at on more than one occasion. He knows the sound of incoming rockets that jerk you violently from nervous sleep when they hit your building. One such attack herniated some lumbar discs, but Steve did not cop out to an instant stretcher, a medial discharge, and a pension. He fulfilled his responsibilities first. He had taken on responsibilities, so he performed, no questions asked. He could complain of pain on his own time, after the attack was over. Steve reminds me of the front tire changer in a NASCAR k

ABOUT JOBS, DUTIES AND RESPONSIBILITIES

race I once saw. It is the front tire changer’s responsibility to change the front tires when his car comes in for a pit stop. In this race, his car brushed the wall and pushed the fender in on the right front tire. The friction set the tire on fire. Smoke billowed up and flames erupted. The car dove into the pit. I ask you: What did the front tire changer do? Your snap answer most probably was HE PUT OUT THE FIRE, STUPID! All 43 pits have that high octane gas everywhere. We don’t want all 43 pits going up in flames. Fire balls. Explosions. Ambulances everywhere. Helicopters coming in. SO PUT OUT THE FIRE! If the front tire changer had a job, that might have been what he did. But he did not have a job. Just like Steve, he had a responsibility. Let’s analyze this: If his car comes in for a routine pit stop, he changes the tires. If his care comes in with a bent fender, he changes the tires. So when his car came in with a tire on fire, what did he do? He put on fire gloves and changed the tire. The car was gone in 14 seconds. Then he had about 20 minutes to put out the fire and get ready for the next

t s e B pit stop. It was not his job. It was not his duty. It was his responsibility. Back to Steve: he is not the only one in his family who shoulders responsibility. Karen had a routine medical checkup appointment. The evening before her appointment, her Yorkie began wheezing and refusing to move. What did she do? Let’s analyze this: She bought the dog, took him into her home, assumed responsibility for his wellbeing, and reared him as a family member. Now, the dog is in respiratory distress. (Not an uncommon event for Yorkies; they are prone to collapsed tracheas.) Karen did the only thing possible for one who has responsibilities rather than a job or duty. She rescheduled her own appointment and took her Yorkie to the vet. She could attend to her own less pressing

e n i c i d ME

needs at another time. Steve and Karen reared their children the same way. While most teenage boys are hanging out in the mall playing arcade games or searching the internet looking for soft porn or have their faces stuck into Facebook or Twitter, their oldest son, Kyle, will soon graduate from Airborne Mission System school in the Air Force. Kyle is well on his way to becoming a Crew Chief like his father. And guess who will deliver the graduation address to the class? Why, Steve, of course. The Base Commander said he wanted someone who had been there and done that. He preferred someone who knew responsibility, rather than a pretty uniform mouthing a canned speech. These events illustrate and expose the weakness within a huge segment of our society. Our society has become too self-centered. We spend our

lives in jobs or duties. We are obsessed with what our entitlements are. We fail to easily shoulder responsibilities. We must become more concerned with what our contributions to our families and society should be. Therefore, when you face a choice between a job, a duty or a responsibility, always take responsibility. It will require much more from you, but in the long run you and everyone around you will be better for it. Take Steve’s word for it. And when it comes to medicine, select a doctor who takes your healthcare as a responsibility rather than a job or duty. And certainly you should do the same: take your healthcare as a responsibility. After all, your body and your mind are the most precious things you have. + Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology. net or 706-306-9397. FREE T AKE-H OME C OPY!

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AUGUSTA MEDiCAL EXAMINER

SEASONAL… from page 2

The Short White Coat

anti-histamine medication, and a local symptom controller. The systemic medication choices include over-the-counter products like Claritin, Zyrtec, and Allegra. These are taken by mouth and cut down on histamine effects all over the body. The local meds include nasal sprays like Flonase and Nasonex, which act mainly on the inside of the nose to reduce irritation and inflammation there. Together, they work very well to reduce the symptoms of allergies. This column is not intended to be a global prescription for all people suffering from these conditions, and changes in any health management plan should be discussed with a doctor. But sometimes understanding a disease can be good ammunition in fighting it. May everyone enjoy the coming of spring with less sneezing and itching! +

THE VALUE OF TIME by Jasmine Rivas It was my first day working in the ICU. Not knowing what to expect, I swiped my badge and walked in through the double doors. The intern spotted me, pointed at the white board filled with room numbers and patient names, and told me to choose a patient. I chose the first name I saw and began my research. The chart had notes dating back three weeks and by the time I was done with it, the day had only begun. Once I knew the background information, I had to assess his current status, what medications his body was receiving and how it was responding. The next step is formulating a plan of care for the patient and comparing it to that of the intern. This last step is where you pat yourself on the back for the points you hit head on and are simultaneously humbled by the ones you missed. There is a science to

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16 for ’16

As the end of one year and the beginning of another approaches, it’s a fitting time to consider ways to start the new year in a better state of mind and body. Each installment of this series, now through February, will offer simple ways to do just that by cutting bad things and adding good things. + #1 DRIVE, BABY, DRIVE When you’re driving, do just that:

COVER!

drive. That might sound obvious, but it is far from the norm. Look around at your fellow motorists as you travel city streets and interstate highways and you will be amazed by how many drivers are hurtling down the road while looking at a cell phone screen. Once upon a time, drivers were taught to keep both hands on the wheel at the 10 and 2 positions (comparing the steering wheel to a clock face), but for millions of distracted drivers it’s one hand for the phone, one for the steering wheel. According to a study by Carnegie Mellon University, driving while using a cell phone reduces the amount of brain activity directly associated with driving by 37 percent. Other studies have established that driving distracted is the equivalent of driving with a blood alcohol level of .08. That’s considered DUI in Georgia (although a fraction of that — .02 — is the limit for drivers under 21 years of age). Experts say there are three main types of distracted driving: Visual (taking your eyes off the road), Manual (taking your hands off the wheel), and Cognitive (taking your mind off driving). Texting while driving — illegal but still common — is especially dangerous because it Please see 16 for ’16 page 13

he other day as I walked up to a doctor’s office, I saw two men having a conversation near the building’s front door; a woman with them stood nearby. As I walked past them toward the door, I noticed the woman had a strange look on her face. I wondered briefly if she was what we used to call retarded, or blind, or perhaps both: it’s hard to describe, but she was staring off into the distance in a way that seemed vacant and unseeing, yet also in mild distress. Just after I passed her, I heard the reason for the bizarre look on her face: she unleashed a mega-sneeze. When I glanced at her as I walked past moments before, she was in one of those pre-sneeze trances. Have you ever seen that? Please see COVER! page 9

HIGHLIGHTS: Baby Barf 101 • Page 10 Bad Billy talks about having kids • Page 5

REMEMBER, GENTLEMEN:

WE HAVE SCRUBS FOR YOU AS WELL!

ICU care. A collaboration of medical expertise from the ICU experts as well as a multitude of subspecialists is needed. Nevertheless, the extent of ICU management extends beyond what can be found in vital signs, lab values and other diagnostic studies. For some patients in the ICU, the medical staff is all they have; for others, we’re just a part of the big picture. Patient in room 612 has had over ten visitors in the last few days; yet for the patient in room 604, we are her visitors. As medical students, we cannot put in orders or perform procedures to help improve the quality of life of our patients. However, we can work hard to ensure that they feel cared for and learn as much as possible from them. Some of these patients arrive to the Emergency Department with an altered mental status and awaken with a tube in their throat, hooked up to drains and IV lines. It can be terrifying. Unfortunately, seeing a friendly face or hearing a familiar voice at the bedside is a gift not every patient has. During my time in clinical rotations I’ve learned the importance of communication. Sometimes we feel we have so much to say that we forget the power of listening. An openended question provides an opportunity for the patient to elaborate on their thoughts and personal concerns.

What:

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Prefer paper? We’re all over town. If you prefer our digital version, we’re all over the world. The Medical Examiner is always available on your favorite device at ISSUU.COM/MEDICALEXAMINER or at the Medical Examiner blog (www.AugustaRx.com/news) on issue dates. Click directly from any Examiner page directly to websites listed in ads and articles. You can easily view back issues, too. +

Aspects of patient care such as medical treatment compliance and understanding of their condition and its potential complications can be assessed. We are taught to learn from our patients. The course of their illness, and how it is managed and treated is essential to the foundation of our training. Nevertheless, we are also reminded to sit and listen to them. They will not be able to point out the vital data from lab results or interpret the diagnostic imaging findings. However, they will be able to provide the pieces to the puzzle needed to understand what brought them to this point. The value of a listening ear is emphasized during our training, as it should be. We might not realize the impact we can have on a patient from the standpoint of a student, but I know that small things can mean the world to one person. Listening takes time and what has greater value than the gift of time? + by Jasmine Rivas, a third year medical student at University of Medicine and Health Sciences. Feel free to contact her with questions or feedback: jrivas@umhs-sk.net

CSRA Parkinson Support Group

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A med student’s notebook

Mark Barlow of Home Instead Senior Care will present “The 40-70 Rule: An Action Plan for Successfully Aging”. Good planning is based on good communication during difficult times, and this plan helps families start critical conversations about the future. It offers conversation tips and considerations for a wide variety of circumstances that help families put their wishes and desires into action.

When: Tuesday, March 22, 2016 at 6:00pm Where: St. John Towers dining room 724 Greene Street Augusta, GA Contact: Mary Ann Navarro (706) 364-1662 +

Read the Examiner — and lots more — online at AugustaRx.com/news

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

Southern Girls Eat Clean Mexican Chicken Casserole

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My earliest recollection of any southwestern or Mexican food was when I was in the fourth grade and my mom brought home from the grocery store the newlymarketed Old El Paso Taco Kit. She was very excited to introduce me to tacos. My parents had previously lived in El Paso, Texas, when my dad was in the Air Force. It was there that my mom grew to love the flavor of Mexican food. It may sound strange that I was in 4th grade before I knew what a taco was, but back then we did not have Taco Bell’s and Mexican restaurants on every corner as we do now. In fact, we rarely ate out at all. My mother cooked a meal every evening and it usually consisted of a meat and two vegetables. Nothing near as exciting as tacos! I am positive that I inherited my mom’s taste buds and her love of southwestern flavors and spicy food. This Mexican casserole ticks all the boxes for me when it comes to flavor. The garlic, tomatoes, onion, green Mexican Chicken Casserole chilies and spices make my into the bottom of a 9 X 13 organic/pastured chicken (I palate so happy, happy, happy. casserole dish. Then add a layer used a rotisserie chicken from The fact that this is a oneof chicken, 1/3 of the beans, the market deli to save time) dish meal makes it super easy corn and black olives. • 1 can of organic pinto beans, to prepare ahead of time and 7. Next you will place the corn rinsed and drained freeze. You can also put this tortilla layer. You will need to • 1 can of organic black beans, meal together very quickly on cut one tortilla in half in order rinsed and drained a weeknight, throw in a green to cover all the vegetables as • 1 1/2 cups of frozen organic salad and feel good about shown in the photo. corn (May use canned if you serving a healthy clean meal to 8. Repeat the layers again and prefer) your family. That is important then a third time, but on the • 1 can of sliced black olives if you are like me and work last layer do not put the corn • 1 package of sprouted corn away from the home. The tortillas on top tortillas leftovers are amazing for lunch 9. Cover the casserole dish with • 3/4 - 1 cup of shredded grass the next day too. Enjoy! foil and place into a 400 degree fed sharp cheddar cheese F. oven for 20 minutes. • Fresh cilantro and avocado to Ingredients: 10. After 20 minutes, uncover garnish • 1 Tbsp. of organic coldand place the cheese on top and pressed extra virgin olive oil or return to over for another 5-7 Instructions: grapeseed oil minutes until cheese melts and 1. Heat the oil in a large sauce • 5 cloves of garlic, crushed casserole starts to bubble. pan over medium to high heat. • I package of sprouted corn 11. Remove and allow to cool 2. Add chopped onions, bell tortilla’s (I used Food for Life slightly. pepper and garlic and cook brand) 12. Serve immediately and stirring often until softened. • 1 organic sweet yellow onion, garnish with fresh cilantro and Approximately 5-7 minutes. chopped fresh avocado. + 3. Pour in the box of chopped • 1 organic green bell pepper, tomatoes, tomato sauce, green chopped Alisa Rhinehart is half of the blog chilies and stir to mix well with • 1 24.6 oz. box of Pomi southerngirlseatclean. the other vegetables. chopped tomatoes com She is a working 4. Add the cumin, smoked • 1 15 oz. can of Tomato sauce wife and mother living paprika, cayenne and salt to • 1- 4 oz. can of chopped green in Evans, Georgia. taste. Stir well and reduce heat chilies Visit her blog for to low. • 1 tsp. of cumin more recipes and 5. Allow the tomato mixture to • 1 tsp. of smoked paprika information on clean eating. simmer for 15 minutes. While • 1/2- 1 tsp. of cayenne pepper simmering, shred chicken and (according to taste) grate the cheese. • Salt to taste (I used 6. To assemble the casserole, approximately 1-2 tsp.) ladle 1/3 of the tomato mixture • 2 1/2 cups of shredded

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OUR NEWSSTANDS Medical locations: • Children’s Hospital of Georgia, Harper Street, Main Lobby • Department of Veterans Affairs Medical Ctr, 15th St., Main Entrance • Dept. of Veterans Affairs Medical Center, Uptown Div., Wrightsboro Rd., main lobby • Doctors Hospital, 3651 Wheeler Rd, ER Lobby Entrance • Eisenhower Hospital, Main Lobby, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • Augusta U. Hospital, 1120 15th Street, South & West Entrances • Augusta U. Medical Office Building, Harper Street, Main Entrance • Augusta U. Medical Office Building, Harper Street, Parking Deck entrance • Augusta U. Hospital, Emergency Room, Harper Street, Main Entrance • Augusta U., Laney-Walker Boulevard transit stop, Augusta • Select Specialty Hospital, Walton Way, Main entrance lobby • Trinity Hospital, Wrightsboro Road, main lobby by elevators • Trinity Hospital Home Health, Daniel Village, main lobby • University Health Federal Credit Union/ University Hospital Human Resources, 1402 Walton Way, Main Lobby • University Hospital, 1350 Walton Way, Emergency Room lobby area • University Hospital, 1350 Walton Way, Outside Brown & Radiology/Day Surgery • University Hospital - Columbia County, 465 N. Belair Road, Main Lobby • University Hospital Prompt Care, 3121 Peach Orchard Road, Augusta

Around town: • Barney’s Pharmacy, 2604 Peach Orchard Rd. • Birth Control Source, 1944 Walton Way • GRU Summerville Student Bookstore • Blue Sky Kitchen, 990 Broad Street • Columbia County Library, main branch lobby, Ronald Reagan Drive, Evans • Enterprise Mill (North Tower), 1450 Greene Street, Augusta • Daniel Village Barber Shop, Wrightsboro Road at Ohio Ave. • Hartley’s Uniforms, 1010 Druid Park Ave, Augusta • International Uniforms, 1216 Broad Street, Augusta • Marshall Family Y, Belair Rd, Evans • Mellow Mushroom, 12th and Broad Streets, Augusta • Parks Pharmacy, Georgia Avenue, North Augusta • Southside Family Y, Tobacco Road, Augusta • Surrey Center, Surrey Center Pharmacy, Highland Avenue, Augusta • Top-Notch Car Wash, 512 N. Belair Road, Evans • Wild Wing Cafe, 3035 Washington Road, Augusta

Plus... 800+ doctors offices throughout the area for staff and waiting rooms, as well as many nurses stations and waiting rooms of area hospitals.

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

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

COMBINATION MEDICINES: THEIR PROS & CONS One recent trend in pharmacy is to take the latest drug for a given condition and turn it into a combination drug. This new drug may contain two or three ingredients that work together to treat the given condition. Blood pressure medicine manufacturers have been doing this for a long time. It started with combining a blood pressure medicine and a diuretic for those patients that needed both. More recently, blood sugar medicine manufacturers have followed suit, using the newest guidelines for combination therapy to determine how to blend ingredients. The newest example of this trend is in the Alzheimer medicine market. Aricept would be prescribed for initial therapy and many times a doctor would add Namenda for additional benefit. Now there is a new drug called Namzaric that combines both medications into one pill. Is the combination drug plan a good plan for you? Let’s look at both sides of the story. Let’s start with the known advantages of combination drugs. The primary advantage is reducing the number of pills you must take per day. This allows a patient to be more compliant by reducing the complexity of their drug regimen. Let’s face it, it’s easier to remember to take one pill rather than going thru a half dozen bottles to pick out several medicines all for your high blood pressure. Some of the new three-in-one medicines allow you to take two blood pressure medicines and your diuretic all in one pill. Manufacturers are also now trying to make medicines that you only have to take once or

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HARMACY

maybe twice a day instead of multiple times. This also simplifies the taking of your daily medicines. Sometimes you cannot get around having to take a medicine multiple times a day, but as manufacturers continue to do research and improve on current medications the number of four-time-a-day medicines is being reduced. All the news seems great. Is there a downside? There is, but only if an unlikely string of events occurs — and it sometimes does. Let’s say you’re diagnosed with a certain condition and your doctor prescribes a combination drug for you. Then let’s say that you have an allergic reaction to that drug. In such a situation it becomes very difficult for doctors to pinpoint exactly which ingredient is the culprit behind your allergic reaction. Sometimes it’s nearly impossible, and the result is that for your safety, your doctor and pharmacy show that you’re allergic to every one of the many ingredients in the combined formulation. The way to prevent such a possibility is for your doctor to start you out with a single medicine and then add others if additional effect is needed. This allows the doctor to get you on the correct regimen, then switch to a combination pill to simplify your medication regimen if desired. This is a good way to go, but with the added downside that combination drugs are often produced only as the “brand name” drug whereas the individual components making it up may be available in generic versions. When that happens, going from generic versions to a single brand name drug, you may see a higher copay or have a harder time getting insurance coverage due to a higher wholesale cost for the insurance company. Most manufacturers have copay assistance cards to help offset this, but Medicare law forbids the use of copay assistance coupons for Medicare copays. So if a combination drug is useful for you, then by all means try to simplify your medicines where you can. We talked about how combination drugs can simplify your medicines and improve compliance. What are some other ways to improve a patient’s compliance with their prescribed medicine regimen? We will look at a couple of the options for patients and their caregivers coming up soon. In the meantime, talk to your pharmacy about whether a combination drug may help you, and any other options that your pharmacy offers. + Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson Questions, comments and article suggestions can be sent by email to cjdlpdrph@bellsouth.net

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MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

by Arielle Weekley, MS, Augusta University Dietetic Intern

Before making your favorite recipes, deciding which oil is best for you and your dish can make all the difference in the quality of your cooking. Not only do cooking oils differ in nutrient composition, oils also vary in heat tolerance. Some oils have a high smoke point while others have a low smoke point, which determine the temperatures an individual oil can withstand. For example, a cooking oil with a low smoke point should not be used to prepare fried foods or stirfried dishes. Those oils would be better suited for low heat or cold preparation foods. It’s important to be knowledgeable of exactly what you are working with before grabbing an oil at random. Yet, do not be afraid to try something new! The grocery aisle is filled with a plethora of oils these days. However without accurate information, it can be difficult to choose an appropriate cooking oil for your dish at hand. When using cooking oils as additives to your food, remember that oils are also obtained in foods as part of a daily diet. These oils can be found as both liquid and solid fats. Liquid fats include cooking oils, while solid fats generally come from animal sources like butter and shortening. The intake of these fats should be considered a part of your daily intake so that you do not consume excessive calories and

fat. The USDA recommends for average healthy adult women to receive 5-6 teaspoons of oil daily and healthy adult men to receive 6-7 teaspoons of oil daily (USDA 2015). Before pouring your favorite cooking oil, ask yourself if you are aware of the amount you are using- a teaspoon can be smaller than you think! If you are generally heavy handed, an oil dispenser with a slow flow spout could be a healthconscious purchase for you and your family. Common Oils and How to Use Them: 1) Canola oil is developed with the canola plant crossed with the rapeseed plant. It is low in saturated fat and rich in mono- and poly-unsaturated fats. It’s great for sautéing and coating pots and pans prior to use. 2) Olive oil is high in monounsaturated fatty acids, which can improve cholesterol levels. Virgin or extra virgin olive oils contain a fruitier flavor, less acid, and a strong smell. It’s important to know that light olive oil does not contain less calories, just less flavor. This is ideal if the fullbodied olive oil isn’t appealing to you. This oil can be used to replace saturated fats, but know it has a lower smoke point and may cause browning if cooked at high heat. 3) Like canola oil, sesame

FAT FACTS: KNOW YOUR OILS

E YG

Useful food facts from dietetic interns with the Augusta Area Dietetic Internship Program

DON’T LICK THE BEATERS

oil contains mono- and polyunsaturated fatty acids. The flavor is strong and nutty, and this oil pairs well with Asian cuisine. It has a high smoke point, so toss it in with some veggies and a protein to stir-fry a healthy meal. 4) Flaxseed oil contains omega 6 and omega 9 essential fatty acids. This can be a great alternative to fish oil. Flaxseed oil has a low smoke point and is good for drizzling over cooked grains. 5) Peanut oil contains phytosterols, monounsaturated fat, and the antioxidant vitamin E. Phytosterols may decrease absorption of cholesterol in the body. This oil has a high smoke point and therefore can be used at very high cooking temperatures. 6) Grapeseed oil is a new common favorite. This oil is made from grapes and is rich is poly-unsaturated fatty acids that can improve cholesterol. This oil is versatile due to its somewhat elevated smoke point. Try using it for sautéing or to make dressings. 7) Coconut oil has become a new trend. However, like palm oil and palm kernel oil, coconut oil is rich in saturated fat, which can impair heart health. Virgin coconut oil containing lauric acid is the better option if you consume coconut oil. Virgin coconut oil will increase good cholesterol as it also increases bad cholesterol. It is commonly used in the vegan diet to replace butter (AND, 2014). Remember have fun with your dish! Good food should be healthy and flavorful. The more you know, the more confident you’ll feel serving up your family’s next favorite meal. + Sources Academy of Nutrition and Dietetics. All about oils. 14 August 2014. Internet: http://www.eatright.org/resource/ food/planning-and-prep/cooking-tipsand-trends/all-about-oils (accessed 2 January 2016).

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MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

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Why did the pie go to the dentist? It needed a filling. How do you stop your Medical Examiner from flying away in the wind? Use a news anchor. A little boy is watching CSI and crying when his mother enters the room. “Why are you crying, sweetie?”

“Justin Bieber just got shot!” “Don’t worry, honey. It’s only on TV!” “That’s why I’m crying!” “I always start crying uncontrollably whenever I am about to get intimate with my girlfriend,” admitted the guy to a few friends. “Anybody have any good tips about dealing with pepper spray?” Why don’t you see penguins in Britain? Because they’re afraid of Wales. +

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MARCH 18, 2016

11 +

AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — by Katie Lin, M.D. on Feb. 26 at kevinmd.com (edited for space)

NO TEXTBOOK TEACHES DOCTORS ABOUT GRIEF In medical school, they teach us how to break bad news. There are rules and etiquette that help to ease the process for families. But we’re never taught how to keep our own raging, desperate helplessness in check at moments when we realize that modern medicine cannot stop a life from slipping away. Experience has taught me that the stages of grief are messier and more heart-wrenching than any textbook could possibly convey. First, there’s denial. “I don’t understand. We were told just yesterday that he would be coming home soon.” “If we could fly him to the Mayo Clinic, do you think they’d be willing to operate on him?” “Are you sure you’re old enough to be a doctor?” Denial is best countered with patience, Kleenex and truth. Next comes anger. This happens when overwhelming sadness descends for the first time, but doesn’t yet have anywhere to land. “How can you just let him go like this?” “We don’t have time for this right now! You need to do something!” “Don’t you realize that his children and grandchildren need him? I need him ...” More patience. More Kleenex. And more truth. Then comes bargaining. Bargaining is hard, because saying no to a desperate loved one feels unbelievably cruel. “Why can’t we just do the surgery and see what happens after?” “Are you sure there are no surgeons in the city who would try?” “I’m sorry, but ...” is how most of my responses begin. Bargaining usually ends when families see what life support really looks like. Sadness comes next. Surprisingly, this is one of the easier stages to manage, because it is the one that most accurately reflects how we as physicians feel when we are helpless in the face of a patient’s death. I offer a few hugs before making my exit–an exit intended to give me a moment alone to breathe and reflect as much as it is to give the family some privacy. Finally, there’s acceptance. For me, this is by far the hardest. I can take rage or criticism in stride, because I know they’re not really meant for me. It’s the kindness that I find so incredibly hard to accept when I feel I’ve so utterly failed. Several hours have passed since I first walked into the room with Mr. Smith’s family. Talk is winding down; the morning crew begins to trickle in. And then Mr. Smith’s wife and son turn to me. “Thank you,” they say. “We’re glad that he had someone with him for his last hours. We know it’s been a hard night for you.” It’s this kindness that makes me curl into a ball when I finally arrive back home at the end of my shift. As I lie drifting to sleep in the dark safety of my room, that moment replays again and again in my mind. It nearly breaks me. The next day arrives. I put on fresh scrubs, sling my stethoscope around my neck and embrace the inevitable coffee lineup. My tears have been traded in for a fresh, albeit unsteady, smile. Sometimes it takes a lot of effort to remember that this job is worth it. As I walk past Mr. Smith’s room — his bed now occupied by another critically ill soul — the thank-yous still echo in my mind, but they begin to feel less hollow. They represent a moment shared, a life remembered and the human connection that runs deeply throughout these otherwise sterile corridors. Sometimes, it just is. Worth it, that is. +

Sometimes it’s worth it.

Katie Lin is an emergency medicine resident. This piece was originally published in Pulse — voices from the heart of medicine.

Death is never a pleasant subject to discuss, and can be a traumatic topic even for adults. So a book like this one that helps children understand what’s going on is welcome indeed. After all, what family is there which hasn’t been touched by death? There is not one, and sometimes death creates a dark labyrinth of sadness and confusion for children. This book gives death a face (literally) and a personality — and not a harsh and cruel one, either. Here is a review from Publishers Weekly:

and death cannot exist without the other. “What would life be worth if there were no death?” he asks. Finally, Death goes upstairs, telling the children the words of the title, which offer comfort in the following years. Pardi creates a cozy, lived-in ambiance in her pencil and watercolor art; Death’s almost grandfatherly persona suggests that there is a time to go gently into that good night. +

while drinking his coffee, Death tells them an allegorical story to illustrate how, like grief and joy or sorrow and delight, life

Cry, Heart, But Never Break by Glenn Ringtved; illustrated by Charlotte Pardi; 32 pages, published in February 2016 by Enchanted Lion Books

In this empathic picture book, first published in Denmark in 2001, Death—a towering, robed figure with a beaklike nose and sorrowful expression—solemnly sits with four children around their grandmother’s kitchen table. “Not wishing to frighten the children, the visitor had left his scythe outside the door,” writes Ringtved, providing a clue as to the figure’s tender nature. And yet, he has come for their grandmother, resting upstairs. The children refill Death’s coffee mug in an attempt to postpone the inevitable;

Research News A riddle for you What do cancer cells and a runny nose have in common? Snot. Or mucus, if you prefer. And earlier this month, researchers at the University of Oklahoma want to take advantage of this connection. Nasal mucus is good stuff — until there’s too much of it, that is. But when present in proper amounts, mucus protects nasal passages from drying out and helps trap incoming invaders like bacteria and viruses. As it turns out mucus (not the nasal kind, incidentally) plays a key role on a cellular level in helping to shield cells from invaders. Normally this is a good thing, but when the cell is cancerous and the invader is a chemotherapy drug, then mucus is just getting in the way. The Oklahoma researchers have found a way to break through this defense, particularly with pancreatic cancer, a particularly difficult cancer to treat. Initial results from their trials indicate that targeting

a specific gene that reduces mucus production not only helps medication penetrate cell defenses but also boots the body’s own tumor fighting capabilities. Books = brain food Education — both mental and physical — is a great way to maximize brain health. Taking the stairs is normally associated with robust physical health, but Canadian researchers say it improves brain health, too, making the brain functionally younger. And education doesn’t hurt either. Specifically, researchers estimate the brain decreases in age by almost a full year (0.95) for each year of education, and by 0.58 years for every daily flight of stairs climbed. The study was published in the journal Neurobiology of Aging. Bedside manner is a big deal In a study presented earlier this month at the annual meeting of the American Academy of Orthopaedic Surgeons, researchers

discovered that patients do better and are more satisfied with their care if they feel their doctor shows empathy. The study involved a small core of patients (112 of them) who had interaction with a hand surgeon. Patient satisfaction scores had nothing to do with wait times (whether calling for an appointment or physically waiting for one in the office), nor was the type of treatment or reason for the appointment (such as post-operative followup versus merely getting a second opinion) important. Instead, the research discovered that empathy accounted for fully 65 percent of patient satisfaction (whether for good or for bad). Good medical skills are important, say study authors, but “physician empathy is the best opportunity to improve the patient experience.” They also noted that it’s important for key employees of a medical practice —from nurses to receptionists — to excel in good communication and customer service. +

+ 12

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

by Dan Pearson

That’s a I’d like to get involved I’m really wonderful idea. Maybe cervical cancer interested in better in supporting a But which one? health cause. cervical health, too. awareness.

I have major issues Oh really? Why? with neck pain.

The Mystery Word for this issue: GYENOX

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. It has 18 holes (with “The”) 6. Make into aw 11. Pale pinkish-violet 13. Budget alternative 15. It can blow its top 17. Sales agt. 18. Helper for an LPN 20. Beaver State abbreviation 21. “Over there” in the boonies 22. Stroke (med. abbrev.) 23. To be 46-D 24. Talk 26. Computer Dept. 27. Masculine pronoun 28. Tread add-on 29. Common suffix for 31-A 31. Common prefix for 29-A 33. Lowest cardinal number 34. Anti-__________ 35. Montana’s first name 36. It preceded GHSU 38. Front tooth 43. ____ sleep 44. Native of Edinburgh 45. Lyric poems 47. Conclusion, musically 48. It can come before a glance or every turn 49. 2009 Pixar classic 51. Nearly one-third of Earth’s landmass 53. Atomic weight abbreviation 54. “Star Wars” ltrs. (Military) 55. Chafe 57. Banned toxic chemical, once used in transformers 58. Mr. Gibson 59. Fuss 60. Simian 62. Handkerchief material?

10 15

6 12

25 29

26 30

27 31

VISIT WWW.AUGUSTARX.COM Click on “READER CONTESTS”

QUOTATION PUZZLE

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

9 14

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

P T B N D E P A F I I T W T W O F E O N O E W

46 51

52 57

E D E R S R E U P T O S ’

— Author unknown

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

64. 1.75 pints 65. Dixon’s partner 66. Oil-based alternative DOWN 2. Rapid in tempo (in music) 3. Start of game that ends with toe 4. Pigeon material? 5. Capital of Vietnam 6. Number often following 7 7. California city and county 8. From midnight until noon 9. JJ Cale song made famous by Eric Clapton 10. Assert or confess openly 12. Conflict; clash; inconsistency 13. Pertaining to building design 14. He is buried on Greene Street 16. Toward the mouth (Med.) 19. Luxor’s river 25. Bobby of note in Atlanta 28. Holstein comment 30. The ratio between a circle’s

T E O L E E M A S

circumference and diameter 32. Prefix meaning not; without 36. _________ oblongata 37. Nashville awards show, in short 39. Sometimes the beginning of doubt 40. When doubled, mediocre 41. Room within a harem 42. Breathe 43. City in NW Georgia 44. Cause to feel sorrow 46. Type of bed or day 47. Gordon, originally 50. Light enters through it 52. Where one may be who is 46-D 54. Monte _______ Ave. 56. Blocker beginning 61. Permit 63. Dot these; cross the T’s.

1 8

X A M I N E R

7 7 9

1 9

4 6

7 1

6 8 1

3 2 1 2

4 5 8 4 3

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.

Solution p. 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 1 2

B 1 2 3 4 1 2 3 4

G 1 2 3 4 5 L 1 2 3 4

B 1 2 3 4 5 O 1 2

1 2

U 1 2 3 4 5

1 2 3 4

1 2 3 4 5 6 7 8 9 10

1 2 3

I 2

— Will Rogers

1.BICCOOOOWAGTTTTT 2.HHHHHRIFFSAABNNE 3.NNNIEIEEALSOO 4.TUUMSYNDT 5.PIGT 6.D 7.A 8.T 9.E 10.S

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

THE MYSTERY WORD

MARCH 18, 2016

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

Joe: How did the clock get cancer? Moe: I give up. How? Joe: Second-hand smoke. Joe: What do painters do when they get cold? Moe: Put on another coat, I suppose.

he manager of a large office, a macho former Marine, noticed a new man one day and told him to step into his office. “What is your name, son?” the manager asked. “John,” the new guy replied. The manager scowled, “Look, I don’t know what kind of a namby-pamby place you worked at before, but I don’t call anyone by their first names. It breeds familiarity and that leads to a breakdown in the chain of command. I refer to my employees by their last names only: Smith, Jones, Baker, et cetera. And I am to be referred to only as Mr. Robertson. “Are we straight?” “Yes sir, Mr. Robertson.” “Now son, what’s your last name?” The new guy said, “Darling. My name is John Darling.” “Ok, John. Time to get back to work.” What did Captain Ahab say when he harpooned a whale’s tail fin on the first try? “Well that was a fluke.” What’s a dinosaur’s least favorite reindeer? Comet.

Moe: Did you hear NASA is sending a dozen cows into space? Joe: Really? Moe: Really. It will be the first herd shot around the world. Joe: Do you know how many bones you have in your body? Moe: All of them, I hope. Moe: You don’t look so good. What’s wrong? Joe: I had a terrible fall at the grocery store. Moe: Oh, no! Where were you hurt? Joe: Aisle 7. What is the best place to be during an earthquake? A stationary store. How can a woman who is single get rid of cockroaches? Ask them for a commitment. I asked my friend from North Korea, “What’s life really like there?” “Can’t complain,” he said. Does the five-second rule apply to soup? Seriously. Does anyone know? Please hurry. I need to know soon! +

Don’t feel like kissing your money goodbye? The Medical Examiner offers advertisers a focused, specific, targeted audience. If your marketing program values quality over quantity, the Examiner is just what the doctor ordered.. Call today!

CALL 706-860-5455

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

+ +

SUBSCRIBE TO THE MEDICAL EXAMINER 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

This issue contains a hidden Mystery Word. Details, pages 12 and 14

+ 14

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

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

...very cleverly hidden (in the bushes) in the p. 2 ad for SECURITY FEDERAL BANK Congratulations to BRENDA McCOLLUM, who scores the current contents of the Medical Examiner goody bag. Sweet! Want to find your name here next issue? The new Mystery Word is on page 12. Start looking!

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

The new scrambled Mystery Word is found on page 12

SENDING US A CLASSIFIED?

EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC. WANTED Room / roommate on The Hill, downtown, Martinez, West Augusta, or North Augusta. I can pay $100 - 150 per week or $400 - 600 per month. I’m a clean, trustworthy, business oriented, 52 yr old, social drinking, single male. You can CALL me between 11:00 am - 11:00 pm @ (706) 251-5554 I will pay a $20 - 50 referral if you know of someone looking for a good roommate or already has a place and I move in. Thanks. POND VIEW! Evans all-brick 2-story with solar panels. Avg. electric bill $170 in Northwood, 3,400 sqft. Call 1-800401-0257, ext. 0043 24/7 for price and details. AUGUSTAGAHOMESEARCH.COM Foreclosures • MLS • Builders • Rentals (706) 564-5885 HOUSEBOAT FOR SALE Tradewinds Marina, 30 minutes from Augusta. Live at the lake - or have a second home there with NO grass to mow! Recently upgraded. $65,000 Text me at (803) 640-9732 for pics

SERVICES HOUSE CLEANING Your house, apartment, rental move-outs. Thorough, dependable. Weekly, or whatever schedule you prefer. References. 706-267-9947 BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673)

WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer.

F. E. GILLIARD, MD FAMILY MEDICINE Acute & Chronic Illnesses Occupational Medicine PROMPT APPOINTMENTS 706-760-7607

BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net

MISCELLANEOUS ELIPITICAL IN EXCELLENT CONDITION Asking $75.00. Please call 706-306-4666 SUNSET MEMORIAL GARDENS Opening and closing at Sunset Mem. Gardens in Graniteville. Sale: $760 (Value: $1520+) Call 706-736-0596 KING-SIZED bed frame with rails, dark wood, some surface scratches but overall very good condition. $90 Call 706-3730193

CEMETERY SPACES (2) Sunset Memorial Gardens, Graniteville SC adjacent to lighted military flagstaff, includes granite bench with urn space, installation and inscription. All $4700 ($8600 value). Spaces only: $2700. Call (803) 295-3033 FISHING CLUB wants more grey-haired members. Meet 2nd Thurs of month at Harbor Inn Restaurant, 12 noon. “Adventure Before Dementia” Info: (706) 736-8753 or (706) 829-1729 PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-829-1729

TELL A FRIEND ABOUT THE MEDICAL EXAMINER! THE PUZZLE SOLVED

USE THE FORM BELOW AND MAIL IT IN, OR GO TO WWW.AUGUSTARX.COM AND PLACE & PAY CONVENIENTLY AND SAFELY ONLINE. THANKS!

WHAT’S YOUR DRUG OF CHOICE?

Augusta Medical Examiner Classifieds

(OURS IS COFFEE)

CLASSIFIED ADVERTISING FORM Name Address Work number (if applicable) ( ) Home phone ( ) Category of ad (leave blank if unsure):

ANTIQUE maple dinette set with buffet corner cabinet table with pull-out leaves. Four chairs with two captain’s chairs. Excellent condition. $300. Double bed early 1930s with mattress spring coverlet shams $150. Call (706) 860-2170

P A T A L I V O L C O R E W A G C D R O O X

R C O A M M E P M

M E D U L L A

C L A Y

H A N O I

P I D

C G M S A A S D A D I N E S O N

C O N T R A D I C T I O N

A N N O

A R C H I T E C T U R A L

E L E V E N

N A C T A M O H P C N A A A I L M I L L O N E J O E

I S O P U B P E I T L A

O R D E S A S I A P C B L I K E E R D T E X

SEE PAGE 12

QUOTATION

In case we need to contact you. These numbers will not appear in the ad.

QUOTATION PUZZLE SOLUTION: “If we were meant to pop out of bed we’d sleep in toasters.”

AD COPY (one word per line; phone numbers MUST include the area code):

— Author unknown .25

.50

.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

5.25

5.50

5.75

6.00

6.25

6.50

6.75

7.00

7.25

7.50

7.75

8.00

8.25

8.50

8.75

9.00

The Sudoku Solution

COFFEE IS GOOD MEDICINE

(Copy this form or continue on additional sheet if more space needed.)

Send this form with payment to:

AUGUSTA MEDICAL EXAMINER, PO BOX 397, AUGUSTA, GA 30903-0397 Total ad cost by number of words as shown above: $

1 5 3 8 6 7 4 9 2

8 4 9 2 3 1 7 6 5

6 7 2 5 4 9 3 8 1

7 9 8 1 5 4 2 3 6

4 6 5 3 8 2 1 7 9

2 3 1 9 7 6 5 4 8

3 2 6 4 1 8 9 5 7

5 1 7 6 9 3 8 2 4

9 8 4 7 2 5 6 1 3

WORDS BY NUMBER

VISIT DRUGOFCHOICECOFFEE.COM

“The best thing about this group of candidates is that only one of them can win.”

Thanks for reading!

www.AugustaRx.com

Multiply by number of times ad to run: x

— Will Rogers

Total submitted: $

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 7 days prior to our publication date.

MARCH 18, 2016

15 +

AUGUSTA MEDiCAL EXAMINER

ON THE ROAD TO BETTER HEALTH

And the thought may very well be, “Seriously???” We’re looking for those things at the market or grocery store that make you think, “What is going on here?”

A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble wrote a long-time column in this paper entitled The Patient’s Perspective reincarnated in this new format. Feel free to contact her at marciaribble@hotmail.com by Marcia Ribble With chronic medical issues like mine, there’s a growth of understanding that slowly accrues. That means that gradually better control and better health should be an achievable goal, as my doctors and I negotiate things like medications, treatments, and attitudes. Neither they nor I can do it alone. They have information I don’t have, but I also have information they don’t have. When my legs are swollen and oozing, using standard gauze doesn’t work. It just increases the irritation and makes healing take longer. The gauze used most often by doctors and hospitals is loosely knit together and has a tendency to bunch up, loosen, slide down, and fall off. It further irritates already irritated skin. I found a different kind of gauze that is tightly knit, slightly stretchy, and forms a tight, smooth leg support that helps my wounds to heal faster. It doesn’t roll, bunch up, slide down, or fall off. That makes it far more comfortable for long term or short term treatment, and it feels so nice on healing skin, causing far less itching, and thus reducing the temptation to scratch at skin that is already fragile. I learned about the smooth gauze from my sister, who has suffered for many more years than I have with delicate skin that breaks down easily. I can’t say when or from whom she learned about it, but in my estimation it’s

a godsend. Using the usual gauze, my legs, when unwrapped, looked like seersucker cloth and often their condition had worsened due to restricted blood flow. When this smooth gauze is taken off, the skin underneath is smooth, so its effects are measurable, visible, and easily compared to skin after the other gauze is used. I’m pretty sure that if the differences between them was studied the smooth gauze would be found to promote faster healing. Because I’m a diabetic, this is the kind of thing that can make a difference between saving my legs and losing them. The Joseph M. Still Burn and Wound Clinic at Doctor’s Hospital, the burn floor, and the great folks who work there, have done a great job of keeping my legs healthy and bringing them back to health when they get into trouble. My next big project is to work with my doctors to get my fluid levels to behave, since retaining fluid is what causes my skin to break down. We know that my kidneys are working, so the doctors are suggesting a consult with a nephrologist to see if we can get better control of that issue and prevent skin breakdown instead of just reacting afterward when it does break down again. I feel empowered when I am a member of the team of doctors who work with me to improve my health. I am not helpless. I can proactively work on my own behalf to achieve better health. +

104 This is how many back issues of the Medical Examiner are available at issuu.com/medicalexaminer

How do you like the look of these Red Bell Peppers? +

Next time you see something on the grocery store shelf that’s a head-scratcher, whip out your phone, snap a picture and send it to: info@augustarx.com

THANKS IN ADVANCE! Happy shopping!

THERE IS NO “U” IN MEDICAL EXAMINER.

AND IF YOUR AD ISN’T ON THESE PAGES, THERE IS NO “YOU” EITHER.

LET’S FIX THAT. GIVE US A CALL TODAY! 706.860.5455

+ 16

MARCH 18, 2016

AUGUSTA MEDiCAL EXAMINER

PROFESSIONAL DIRECTORY DERMATOLOGY

ALLERGY

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

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

COUNSELING

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

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

DIABETES WOUND CARE

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

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

Aiyan Diabetes Center “A Comprehensive Diabetes Clinic” Dr. Janaki Nadarajah, DPM 706-868-0319 462 Furys Ferry Road

Floss ‘em or lose ‘em!

Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

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

YOUR LISTING HERE

This could be yyou.

Use the handy form on page 13

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

Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

Cornerstone Compassion Center 420 Warren Road Augusta 30907 706-228-5359 or 706-394-6518 Assisted Living • Personal Care

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

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

PHARMACY

VEIN CARE

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

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

WEIGHT LOSS

Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by tens of thousands of patients every month. Call the number in the yellow bar below, or write to Dan@AugustaRx.com

CALLING ALL M.D.S!

SENIOR LIVING

F. E. Gilliard MD, Family Medicine 4244 Washington Road Evans, GA 30809 706-760-7607 Industrial Medicine • Prompt appts.

Medical Center West Pharmacy 465 North Belair Road Evans 30809 706-854-2424 www.medicalcenterwestpharmacy.com

DRUG REHAB

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048

The Medical Examiner can be delivered right to your door!

FAMILY MEDICINE

Medical Weight & Wellness Specialists of Augusta Maycie Elchoufi, MD 108 SRP Drive, Suite B Evans 30809 • 706-829-9906 YourWeightLossDoctor.com

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