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MAY 7, 2021
AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006
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To take or not to take. The vaccine, that is. That is information. Specifically, snags with the one-dose the question, and it is being pondered in the minds Johnson & Johnson vaccine raised fears among many of millions of people around the world every day. about the safety of the J&J vaccine, as well as the To be sure, no medical treatment is for everyone, others not affected by the side effect. and no sane adult should be forced to receive any To quickly recap what happened, 17 women expemedical intervention against their will, even if it’s rienced a rare and very serious form of blot clots aflife-saving. As any oncologists can tell you, people ter receiving the J&J vaccine, and 3 of them died. In refuse life-saving radiation and chemo every day of response, the CDC promptly halted all administration the week. They have their reasons. It’s their choice. of the J&J vaccine while additional research was con What doctors like to know, however, and work ducted. Since then the J&J vaccine has again been to ensure, is that their patients are making solid, given the green light, but before the pause nearly 8 informed choices based on accurate million doses had been administered. information. So asking questions While the 3 deaths are tragic and and doing research is good. In verlamentable, they represent a 0.00003% sion.2021, a degree of vaccine hesitanincident rate. ASK QUESTIONS cy is also good. It shouldn’t be shoot How does that compare to other first, ask questions later (see clever medical interventions? Let’s put it this graphic, right). way: plain old aspirin wishes it had a Of course, there can be problems safety record as microscopic as the J&J SHOOT LATER with doing research and asking vaccine. Here is a quote from an article questions. One is when the researchin the National Library of Medicine, er seeks information from dubious part of the National Institutes of Health: information sources. For example, in “Death rate attributed to NSAID/aspirin searching for information about herd immunity here use was between 21.0 and 24.8 cases/million people, at Medical Examiner world headquarters, we came respectively, or 15.3 deaths/100,000 NSAID/aspirin across an image of a syringe and vaccine vial illususers. Up to one-third of all NSAID/aspirin deaths can trating an article entitled, “The Lie of Herd Immunibe attributed to low-dose aspirin use.” ty.” The source? The World Health Organization? No. Oddly enough, some of the same people who Harvard Medical School, the CDC or Mayo Clinic? don’t hesitate to regularly use aspirin view the No. It was on the website of an organization called COVID vaccines, especially J&J’s, as highly dangerthe Utah Gun Exchange. Probably not the first place ous. A strong counterargument could be made that you should visit for expert vax facts. if the CDC was willing to suspend its approval based Another potential problem is when we seek only on a 0.00003% rate of serious side effects, the vacinformation that supports our preconceived notions. cines are extremely safe. We are convinced that vaccines are safe, so we won’t Incidentally, those initial 8 million J&J shots that reread anything that discusses anything cautionary. sulted in 3 deaths also saved a projected 5,000+ hospiConversely, if we’re against vaccines, we won’t talizations, prevented more than 1,400 ICU admissions, consider any evidence to the contrary, no matter its and are estimated to have saved more than 600 lives. source. In either case, why do research in the first So is it wise to question vaccine safety? Absolutely. place? It is more or less pointless if we’re not going But once the vax facts are in hand — from medical to accept and digest solid information from wellexperts, not social media posters of unknown and informed, credible sources. dubious qualifications — the prudent course is to Recent vaccine news has offered an excellent optake action to stay safe and salubrious. Ask questions portunity for us to use our brains to ingest and digest first. Shoot later. But soon. Don’t wait. +
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MAY 7, 2021
THE FIRST 40 YEARS ARE ALWAYS THE HARDEST
SLEEPY PARENTHOOD KIDS by David W. Proefrock, PhD
You recently woke up to noises late at night and discovered your 16 year-old daughter coming into the house. She did not have permission to be out and had obviously been drinking. What do you do? A. Call the police and have her arrested. B. Have a long and firm talk with her about sneaking out and drinking and the dangers associated with both. C. There is no point in trying to deal with this while she has been drinking. Send her to bed and decide on consequences in the morning. D. Tell her that she has just lost every privilege she ever had and that she will only get them back when she has shown perfect behavior. If you answered: A. This is pretty drastic unless her sneaking out and her drinking has been a chronic problem. If this is the first time, it is better to handle it yourself in the morning when she is sober. B. This is not the time for a long and serious talk. She has been drinking and you are likely to be too angry. Wait for the morning and talk with her about the consequences of her behavior. C. This is the best response in this situation. There need to be consequences, but they will be decided in the morning when she is sober and you are not as angry. D. It is not a good idea to assign serious consequences like this in the moment without considering what would be best. Losing every privilege for an indefinite period of time is not going to be the most successful consequence. You probably do not make your best decisions in the heat of the moment, and she probably will not handle her consequences best when she has been drinking and has been caught sneaking out. In the morning when you give consequences, remember that the purpose of them is to teach her more responsible behavior, not to punish her. +
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PART 1
by Warren Umansky, Ph.D. “What time does your child go to bed?” I ask. It’s a question I include in all of my diagnostic interviews. I often ask the same question at every follow-up appointment. I’ve learned not to be astonished by the responses. The mom of 4-year-old April says, “10:00.” Parents of 7–year-old Demetrius respond, “We start at 9:30.” The mom of 14-year-old Chloe responds, “I’m not sure. I go to sleep by 10:00 and I don’t know what she is doing in her room. I have to work in the morning.” Parents of 8-year-old Ryan respond, “When he gets tired”. These responses often underlie the reason parents wind up in my office with their children. Children aren’t getting enough sleep and this may be reflected in problems with academics, behavior, attitude, and mood. It may not be the only reason for problems, but once parents realize the importance of a child getting enough sleep and apply strategies to make this happen, problems are likely to lessen. How much sleep do children need? There are rules of thumb and exceptions HOURS OF SLEEP based on the needs of individual children. The AGE sleep recommendations shown in the chart are 4-12 months 12 to 16* from the American Academy of Pediatrics, and as it shows, kids need a lot of sleep to be pleas- 1-2 years 11 to 14* ant and productive at home and successful at 3-5 years 10 to 13* school and in extracurricular activities. It is the parents’ job to make sure their children get 6-12 years 9 to 12 enough sleep. It begins with you establishing an end-of13-18 years 8 to 10 the-day routine for your children that has a set bedtime (7:30 pm for kindergarten children Hours of sleep per day * including naps and younger, for example, and no later than 10:00 pm for a high schooler). Then, work backward to get in homework, playtime, dinner (everyone eating together at the table), bath/ shower time, and in bed (without TV, tablet, or phone). Yes, there might be pushback initially, and some modifications might have to be made on days with late soccer or gymnastics practice. Your goal is to maintain a routine as best you can. Your children will benefit in many ways and you will benefit as well. Here’s something to do before you read Part 2 in the next issue: Take note of how many hours your child sleeps when they dosn’t have to get up at a certain time in the morning. This can be a good indicator of how much sleep your child actually needs. In Part 2, we will address individual sleep differences and how to establish routines. In Part 3, we will address questions parents ask about their children’s sleep. + Dr. Umansky has a behavioral health practice for children and adolescents in Augusta.
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MAY 7, 2021
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WHAT’SYOURSTORY? Nearly all of us — even doctors and nurses — are sometimes patients. Perhaps you were recently injured playing your favorite sport, or years ago you somehow got hurt without even leaving your favorite recliner. Maybe you have a personal COVID-19 story or one involving your family. Maybe you were diagnosed with a dreaded disease, were mugged in a dark and lonely parking lot, or you stubbed your toe in the safety of your own bedroom. On the other hand, perhaps you needed medical attention 5,000 miles from home. Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale, bylined or anonymous. We’ll publish your medical adventures as often as we receive them. Hopefully that will be often. + Send your submissions for Medicine in the First Person to the Augusta Medical Examiner via e-mail: info@AugustaRx.com or to PO Box 397, Augusta, GA 30903-0397. (The Medical Examiner reserves the right to accept, reject, or edit any submission at its sole discretion.)
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What if I decide to skip my second vaccine dose? The first question would be why? If your doctor advised against it for some reason (which would be highly unusual unless a patient had a severe allergic reaction to the first dose - also highly unusual), then you have to trust your doctor and his or her personal knowledge of your situation. Barring that, what are the most common reasons for skipping a second dose? One reason is having unpleasant side effects from Round 1, worse than you imagined they would be. To complicate things even further, everyone says the second dose will be even worse. Each person’s pain threshold and immune system is different, so no one should tell you that your side effects should be ignored: “suck it up and tough it out.” No, this is what you are experiencing, not them. For those of us in this situation, it is worth reminding ourselves that this pandemic is serious - still, in May 2021 and potentially fatal. Even in non-fatal cases, some people are miserable for weeks and have lingering symptoms for months. Taking the vaccine is kind of a sure bet: it’s trading a known one day of discomfort (or even two or three for some people) in exchange for protection from an unknown but possibly much worse fate. Another reason is simple logistics. Someone got their initial dose and at the same time an appointment for their second vaccine dose. Everything is fine, but then a relative falls sick or dies in a distant city and they are forced to leave town for an extended period of time. One solution: it may be possible to receive the second dose in the distant city of our imaginary scenario. Another option is to get the second dose as soon as the person returns, even if it’s not as originally scheduled. This is a clear situation for the old saying, better late than never. Another key factor to consider: Pfizer and Moderna vaccines are designed to be a one-two punch. Who ever heard of a onepunch? Only partial protection is offered by a single dose, and that protection will disappear sooner. So be safe: go one-two. +
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www.AugustaRx.com 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 salubrious news within every part of the Augusta medical community. Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397
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MAY 7, 2021
AUGUSTAMEDICALEXAMiNER
#138 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
T
his man, an Italian physician named Giovanni Borromeo, exemplifies far more than the best of the medical profession. He epitomizes the finest and most noble traits of humanity itself. Starting in 1934, Dr. Borromeo was director of Rome’s Catholic Fatebenefratelli Hospital, considered one of the best medical institutions in Rome. Under the direction of Borromeo (a Catholic himself) it also became a safe haven for persecuted Jews, a group of people in plentiful supply at the time as Nazi influence spread across Europe. On its staff, in fact, was Vittorio Sacerdoti, a physician Borromeo hired on the recommendation of one of professors during medical school at the University of Rome. The professor knew, as did Borromeo, that Sacerdoti was Jewish and therefore unhireable. Not a problem. They falsified his documentation and brought him on board. With Borromeo’s full knowledge and consent, Dr. Sacerdoti had Jewish refugees brought into the hospital as patients, which was an extremely dangerous proposition: in October 1943 Nazis conducted a massive roundup of Jews in the very neighborhood where the hospital stood. (1,023 Jews involved and sent to Auschwitz; 16 survived.) Operating literally in the shadow of occupying Nazi forces, Borromeo and his staff had no hope of escaping detection. A Nazi raid, officially an “inspection,” would happen. Knowingly harboring Jews would result in the prompt execution for any and all concerned. To prepare for the sceme’s inevitable discovery, Borromeo, Sacerdoti, and a third doctor, Adriano Ossicini (another Catholic), created a special ward just for Jewish patients, all of whom were suffering from “Syndrome K.” To anyone with a swastika on their clothing, Syndrome K was a highly contagious, disfiguring, and deadly disease. But everyone within the hospital knew “K” on a patient’s chart meant they were more or less healthy. They didn’t need treatment, but to make the cover story believable they had to be isolated from the rest of the hospital and its patients. And they had to be educated in how to act very sick whenever there were any German soldiers within the hospital. Perhaps the most audacious part of the plot was that the “K” in Syndrome K stood for either Kesselring or Kappler: Albert Kesselring, the Nazi commander in charge of Hitler’s Italian occupation, or Herbert Kappler, the SS chief of police in occupied Rome and the organizer of an infamous 1944 massacre of 335 Italian civilians. The ruse worked spectacularly. The Nazis “fled like rabbits,” Dr. Sacerdoti told the BBC in 2004. Untold Jewish lives were saved through the heroism of Borromeo, Sacerdoti and Ossicini. Ossicini later (in the 1990s) became Italy’s Minster of Health, and Borromeo (who died in 1961) was posthumously recognized for his heroism in 2004 by Yad Vashem, the World Holocaust Remembrance Center. One of the most amazing things about the plot is that it remained a secret for some 60 years. +
Living vicariously can be a challenge for many seniors and others who can no longer do things they used to be able to do. For some, living through imagination, memories, or other processes can create sorrow over such losses. For others, those reminders can be sweet links to the past that can then be celebrated and enjoyed over again. For still others, those reminiscences can awaken such a strong sense of desire that those individuals start to actively plan ways to work around any handicaps and achieve greater abilities to participate in those remembered activities. Each of those responses is valid. Each is totally OK. We need to give ourselves permission to have whatever feelings we have without apologizing to anyone for them. And we need to remember that we can have all of them simultaneously. Often, well-intended folks will give us advice about what we “should” do, but they are not us. My kids have been bugging me about selling my home and moving into a senior community, so I toured several of those places. The one I can afford is overwhelmingly dark. As my vision becomes a little more iffy, I have every window without curtains, just shades, and the shades are rarely down. I also have the lights on every day all day long. I need light to define spaces, and keep myself from falling. There is only one window in the senior living apartment and that one is almost completely filled by the air conditioner. The window is also placed high in the wall, which would make it difficult
for me to even look out that window. I’m thinking about other options I might have. One would be to tutor kids whose reading and writing have fallen behind in the pandemic. I have a PhD in English with a specialization in teaching writing to individuals who have fallen behind their peers. But the very idea of sending for transcripts makes me woozy. And my car is sitting in my granddaughter’s driveway, not even able to start, so transportation to a job is a big issue. I’m all vaccinated now so they could perhaps come here. I’ll think about it some more. It might be that I have used up every smidgen of decision-making capacity I used to have. But the more likely reason is that I’ve always found it hard to make decisions, yet circumstances like needing to have a job to care for my kids took precedence over those uncomfortable feelings. At some point I learned that making some decision is always better than making no decision because I have the satisfaction of having a degree of personal agency, even if I made a bad decision. Once I have made a choice, I have taken control, and I always know how to create an escape clause that allows me to rethink that choice and change my mind. If I order a pair of shoes, I can always change my mind and send them back. And I pay special attention to those kinds of decisions from which no going back is possible. Like if I were to sell my house. I would have to move out even if I had changed my mind about moving. So I am still living in my home and enjoying it, even on the difficult days. +
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MAY 7, 2021
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AUGUSTAMEDICALEXAMiNER
ADVENTURES IN
Middle Age BY J.B. COLLUM
where she wants to go while we drive, but if we can’t come to a decision by the time we reach “our place,” then it’s settled. This cuts down on arguments and makes my life easier. I like this because, as I said earlier, I am mentally lazy. Okay, not just mentally. On this recent Sunday at
It is sad how much our bodies change as we age. I used to be able to drink a half gallon of milk and eat a half pan of brownies all in one sitting without upsetting my bowels or gaining any weight. If I did that today, I’d probably need a divorce lawyer. I would definitely need a new, larger wardrobe by the next day. It is sad how we not only lose our health, stamina, hair, and looks, but also the things that bring us pleasure, like being able to eat or drink whatever we want without serious consequences. Sure, even young people can gain weight, but it gets easier and easier over the years. I’ve become a master at it. I have to think about what and how much I eat and drink now, especially before bedtime. I have to take a pill half an hour before supper to make sure I don’t wake up with acid reflux during the night. No dairy for sure at supper time either unless I want to sleep in the guest bedroom. I know there is medicine for lactose intolerance, I just try to avoid expanding my cornucopia of pharmacopeia. Anyway, it may already be time to trade in my already SUV-sized daily medicine dispenser for the bus-sized model even though the new smell hasn’t even worn off yet on the old one. Well, as they say, growing older isn’t for wimps and it isn’t easy, but it usually beats the alternative. Before I wrap this up, I feel that the situation behooves me to make a public service announcement, so here goes: If I were you, I would still avoid a certain home improvement store in South Aiken for at least another week or two, but if you can’t, at least stay out of the tile department or swap your regular mask for a gas mask, just in case. You have been warned. +
THE
{
This past Sunday afternoon my lovely wife and I were shopping at a local home improvement store after I had eaten a delicious Cuban sandwich with lots of cheese on it. If you have an issue with lactose, you may think you know where this is going, and you are probably right, but first, let me set things up. For most couples choosing where to eat is fraught with danger. If I ask my wife where she wants to go for supper and she says something like, “You choose. Any place is fine,” she definitely does not mean what she said. I have learned that what she really means is, “This is your opportunity to prove how much you know me and love me by picking the perfect spot, reflecting both my taste in food and my current mood as ascertained from you listening carefully to what I have said recently, even when you were watching TV while I was talking.” After decades of marriage I finally happened upon the best way to handle this. And by “best way,” I mean the best way without having to carefully listen (at least not every word) or read her mind. Translation: the easiest way, because I am basically a mentally lazy person. If I can reduce decisions, I will find a way to do it. For example, if it were completely up to me, I’d have a closet full of the same outfit so I could get dressed each day without thinking about what goes with what or without having to ask my wife. Of course, my wife simply will not allow this. I should know, because I have tried (begged) for years to no avail. I try to find out her favorite date night restaurant at a time other than when we are already in the car and hungry. Then on date night, we immediately head toward that place as soon as we leave the driveway. This way, we don’t suffer the proverbial paralysis by analysis dilemma and sit in the car in front of the house for twenty minutes trying to decide. This pre-chosen restaurant has changed over time, but that is where I head to as soon as we leave. We can discuss
{
If I ate that I wouldn’t need a doctor; I’d need a good divorce lawyer.
“our place,” I chose the Cuban sandwich, which immediately elicited “the look” from my wife. She knows what the cheese in their Cuban sandwich does to my digestive system and she didn’t want to suffer on the way home. I reminded her that we had to do some shopping before we got home, so she wouldn’t be stuck in the car with me when it happens. I got another look, but she let it go for the time being. We finished our early supper and made it to the home improvement store across the street without incident. Once there however, nature took over. It was a good thing we were in a lonely area of the store when it happened. Otherwise I could have been charged with war crimes due to the use of chemical and biological weapons. When it began, I was pushing the buggy and tried to hang back a bit as my wife looked at tile samples. Unfortunately, the fumes reached her, and she went from smiling at a tile sample she particularly liked to giving me a look that would kill a person who wasn’t already somewhat immune to her angry looks through years of exposure to them. I hung my head and apologized while she looked around to make sure there was no collateral damage — bodies of other shoppers strewn across the floor perhaps, others gasping for air. I was looking around too — for someone else to blame.
J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.com
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by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb
BEEF & SPINACH LETTUCE BOWL Have a “bowl” with this delicious salad carefully disguised as a veggie-filled Mexican inspired lettuce bowl). Ingredients • 1 teaspoon extra-virgin olive oil • 1 small onion, chopped (or 1 cup frozen chopped onion) • 1 pound extra-lean ground beef • 1 cup frozen chopped spinach • 1 (1-oz) packet reduced sodium taco seasoning or homemade mix (recipe below) • 1 cup reduced sodium chicken broth (or water) • 1-2 cups chopped lettuce • 1-1/2 cup chopped tomato • 1 avocado 3/4 cup reduced fat Mexican cheese • 6 tablespoons sour cream • Green onions and cilantro (edible garnishes) • Lime wedges Instructions Place a nonstick skillet over medium heat and add oil. Once oil is hot add the onion, ground beef, and spinach. Break the meat into small pieces as it cooks using a meat chopper. Add in the seasoning packet after about 5 minutes of cooking. Stir in the broth or water and allow the meat to cook down until most liquid is absorbed (about 3 more minutes). Place 2 cups of lettuce into a bowl, top with ¾ cup meat mixture, 1/6 avocado,
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1 tablespoon sour cream, 2 tablespoons cheese, 1/4 cup tomatoes and edible garnishes as desired and serve with lime wedges.
Carbohydrate Choices: 1 Carbohydrate Diabetes Exchanges: 3 Vegetables, 2 lean meat, ½ medium fat meats, 1 fat
Yield: 6 lettuce bowls Nutrient Breakdown: 280 calories, 13g fat (4.5g saturated fat), Cholesterol 55mg, Sodium 580mg, Carbohydrate 16g, Fiber 5g, Protein 22g. Percent Daily Value: Nutrition Bonus: 80% Vitamin A, 50% Vitamin C, 30% Calcium, 15% Iron.
HOMEMADE TACO MIX 2 tablespoons chili powder 2 teaspoon ground cumin 2 teaspoon garlic powder 1 teaspoon oregano 1/2 teaspoon onion powder 1/2 teaspoon salt 1/2 teaspoon smoked paprika 1/4 teaspoon red pepper (or to taste) +
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ASK DR. KARP
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NUTRITION Brian from Valdosta, Georgia, asks: “Should I go on a gluten-free diet? I see so many gluten-free products in the stores that it has me wondering. Can you give us an update on gluten?” For most of us, the answer is, “No, we do not have to avoid gluten.” Yet the general
public seems concerned about “gluten sensitivity,” especially if you use supermarket food marketing as a guide. Walking down the aisles you see the phrase, “gluten-free” on product after product. What’s going on? Have we all suddenly mutated into gluten-avoiding mammals? We have not. “Gluten-free” marketing is a fad, and like most diet fads it does have some truth to it. Yes, there is a very small percentage of the population, specifically people with celiac disease, who need to avoid gluten. For the vast majority of us, however, gluten is not something we have to worry about. The prominent and much-hyped “gluten-free” designation is just one more advertising campaign in a long line of marketing schemes such as “natural,” “antioxidant-rich,” “energy drinks,” even the simple word “diet,” and many others. Now, let me explain. Yes, if you have celiac disease, eating products containing gluten can cause very serious health problems. Celiac dis-
? ease is an inherited immune disease which, thankfully, occurs in less than 1% of the US population. People with celiac disease (also known as sprue) are allergic to the gluten found in wheat, rye, and barley. In addition, gluten is sometimes added to foods as a stabilizing agent. Gluten may also be found in beer, soy sauce, ice cream, ketchup and other foods. When a person with celiac disease consumes a product with gluten, serious damage to the intestine may occur, which can lead to decreased absorption of important nutrients. In addition, if celiac
MAY 7, 2021 disease is undiagnosed and untreated, it can trigger other immune diseases and osteoporosis. Celiac disease is diagnosed with blood tests to see if gluten antibodies are present in your blood. If you do have these antibodies, the next step is to have an endoscopic biopsy performed to confirm the diagnosis and to examine the extent of intestinal damage. The remarkable fact is that if a person with celiac disease avoids gluten, even a seriously damaged intestine can heal within 6 months and the person can go on to lead a mostly normal life. So, what does all this mean? It means that if you have celiac disease, you definitely need to eliminate gluten from your diet. Having foods clearly labeled as “gluten-free” is very important for people with celiac disease. The FDA has gluten-free food labeling guidelines, which serve to standardize the term. Is it okay for a person with celiac disease to consume food supplements? Be very careful. Although food
labeling guidelines should also be applied to the vitamin/supplement industry, the FDA does not have direct jurisdiction over this industry. Wheat-based fillers and pill coatings are often found in supplements. In addition, many dietary supplements come from countries where quality-control standards are below U.S. standards and all ingredients do not appear on the label. What is the “No-Nonsense Nutrition” advice for today? Presently there is no substantial evidence to show (or even suggest) that if an average person without celiac disease consumes a gluten-free diet, s(he) will be healthier, that it will aid digestion, or support a healthier digestive tract. And recently, evidence is accumulating that people who go on a restrictive gluten-free diet are more prone to nutritional deficiencies. In other words, there is proven nutrition risk of a gluten-free diet without proven benefit. Most Americans should not go on a gluten-free diet. +
Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to ensure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www. wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.
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MAY 7, 2021
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AUGUSTAMEDICALEXAMiNER
THOSE PANDEMIC POUNDS
by Jeanne B. Lee, MS, former Director of the Augusta Area Dietetic Internship In an early April edition of The Week, there was small sidebar related to the pandemic that caught my attention. This reputable news publication cited a survey by the American Psychological Association that found “42% of those surveyed gained weight while stuck at home during the pandemic. On average, people gained 29 pounds.” As one who has dealt with the problems associated with unwanted weight gain throughout her career this was a disturbing but not surprising find. What was it during this past year of the Covid- 19 pandemic that caused so many to gain weight? With many restaurants closed or open only for take out, did we eat more fast food? Morning talk shows had segments on how Americans were cooking more at home, sales of cooking utensils and small appliances were booming, and on-line ordering of groceries and pre-assembled meals was growing considerably. Did we exercise less? Likewise, sales of bicycles, home exercise equipment like and exercise apparel were booming. Gyms were closed for part of the year, and then limited in capacity when reopening. Many smaller businesses like neighborhood yoga studios did not survive. Having interviewed hundreds of weight management clients over the years, I suspected stress to be a major factor contributing to the weight gain of many, along with a possible increase in caloric intake and/or a decrease in exercise. I decided to conduct my own poll using the popular social media communication route. I posted a photo of a delicious looking dessert to get attention, and then asked my network of family and friends to answer two questions. “What is your favorite comfort food?” and “ Did you gain weight this past year during the pandemic?” Not surprisingly, my small poll was similar to the one in The Week! Of the 51 who responded, 26 (50%) indicated that they had gained weight this past year. However, several indicated they had since lost the pounds they had gained. This was not surprising to me since many of my friends are also health care professionals and may be more inclined to rid themselves of excess weight knowing the risks that are associated. The comfort food question also revealed answers that were not surprising. The most popular comfort foods named (70% of responses) would fall under the carbohydrates category. They included complex carbs: mainly pasta, potatoes and breads (51%) and more simple carbs or sweets, specifically ice cream, cookies and chocolate (21%). This small survey had similar findings of another one I found with a much larger cohort indicating pizza as the top “comfort food” followed by ice cream. Wikepedia defines comfort food as food that has a nostalgic or sentimental value and may be high in carbohydrates, or is a simply
prepared food. A WebMD article describes comfort foods as those that can combat stress by producing more seratonin which results in a calming effect. Seratonin is a hormone that is thought to stabilize our mood or produce a feeling of wellbeing. It makes sense that during a year like this past one, people might consume more comfort foods, including more carbohydrates. Many may have turned to food to help deal with anxiety and stress that can arise from having one’s routine significantly altered. Carbohydrates prompt your brain to produce more seratonin, sometimes referred to as the “feel good” chemical. Simple carbohydrates (like cakes and cookies that contain high amounts of sugar) digest quickly and can cause a spike in seratonin, but that good feeling one may experience doesn’t last long. That’s because it will also lead to a spike in your blood sugar level, something you want to avoid. Consuming complex carbohydrates such as having a bowl of oatmeal or split pea soup (sometimes listed as comfort foods), can also produce a rise in seratonin and thus a calming effect, but they provide a more gradual increase in blood sugar and a longer lasting satisfying sensation. As for exercise, many who responded to my question regarding weight gain had actually discovered more time for taking walks, gardening, or riding bikes. However, some felt more like “couch potatoes,” watching more Netflix or missing their gym workouts. It should be noted that seratonin levels can be increased with some medications, but a better and drug-free way to increase this hormone (other than eating more carbs) is through regular exercise. Spending time in nature and practicing meditation have also been suggested as ways to accomplish improving one’s mood and dealing with stress. Since stress can sometimes be connected to weight gain, it is important for both mental and physical well-being to control stress. During the past year if you have experienced the Covid-19 pounds predicament resulting in weight gain, stress is very understandable. But it is never too late establish healthier habits. You can love chocolate, but it does not love you back. If you must have it, try keeping a bag of dark chocolates in the back of the bottom drawer of your refrigerator, and the next time you have a need for comfort, slowly eat one small piece while walking around the house during that 3 minute commercial break. In that short time you will take approximately 250 steps, so in a 30 minute program you can walk 1000 steps or more! Rather than reaching for that bag of chips or cookies and reaching for the TV remote, fill your fridge and pantry with healthier comfort foods and find a way to increase your steps and heart rate! +
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CRASH
COURSE
More Americans have died on US roads since 2000 than in World Wars I & II combined
T
“vehicular accident” rather than backovers specifically.) What makes these accidents so awful are the parties usually involved. The typical victim has only seen his or her first birthday (12-23 months is the most common age for backover victims), and in 70 percent of the incidents the driver is the parent or a relative. In most cases the vehicle involved is big: a van, pickup, or SUV. Presumably Mini Coopers are rarely involved. What is the key to preventing this terrible category of accidents? Train small children to step a healthy distance away from any vehicle when it is started up or that is running. Teach them to stand to the side where they are visible to the driver. Drivers should know who is in the vicinity and not start backing up unless they can account for everyone who is nearby, little ones in particular. Back up slowly. Since kids can move quickly and unexpectedly, keep looking back using mirrors and direct sight while backing up. Roll your window down while backing so you can hear what is going on around the vehicle. Teach your children to keep their toys and bikes out of the driveway, since these might create an incentive for them to dart into the path of a backing vehicle. Many cars are equipped with rear-view cameras and obstruction detection alerts. It is a mistake to rely solely on these devices. Whenever children are (or could be) nearby, it doesn’t hurt to walk around your vehicle before backing to make sure kids are safely out of the way. Incidentally, how many little kids do you think they were able to place behind a large SUV and still keep them in the vehicle’s blind spot? If you guessed 62, give yourself a gold star. +
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here is one accident type involving kids that is especially tragic. They are known as backover accidents, and the name makes this type of incident pretty self-evident. These are overwhelmingly driveway accidents, not highway events. Most tragically, the driver is usually a relative of the victim; in the typical scenario mom or dad backs over their own child. Of course, there are other backover situations. One of the most tragic local cases in recent memory was a fatal school bus backover on Wilkins Road off Wrightsboro Road in Grovetown a few years ago. When the father rushed to the scene after being notified, his devastated collapse onto the sandy road in grief was captured by an Augusta Chronicle photographer. Speaking of dramatic and poignant photographs, one safety organization created a public awareness campaign for backover prevention. The premise of their photographic message was to keep placing more and more toddlers behind an SUV to see how many children they could fit in the space before they would become visible to someone in the driver’s seat. Read on for the eventual total number. You won’t believe it. Something else you may find unbelievable: how many backover accidents there are. You might think this happens a few dozen times a year nationwide. Unfortunately, that guess is way too low. The United States Department of Transportation reports 17,000 injuries each year from backovers and over 200 deaths. Other organizations report lower numbers, but all the totals, large or small, are tragic. (Note: various health and safety organizations report that compiling accurate rollover accident data is complicated by the fact that many take place on private property, may not generate a police report or other official documentation, or may be entered into accident statistic databases by other codes, such as
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KIDS & CARS Part 2
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MAY 7, 2021
HUMAN BEHAVIOR There’s a lot of talk about mental THE OTHER SIDE resilience these days. But here’s one important thing you should know: by Jeremy Hertza, Psy.D. Mental resilience is not just being strong. It’s not about pushing through the tough times no matter what, straining every resource you have, or giving it all until you have nothing left. Sometimes, it’s also about giving yourself a break.
Why we’re all talking about mental resilience The COVID-19 pandemic has placed us in a mental health crisis. More of us than ever are looking for professional help to deal with anxieties that we’ve never felt before. The irony? Those of us who already had a therapist and already built up our support systems met COVID with some mental resilience already in place. But all of us are recognizing that the stress of COVID has made it harder to deal everything. COVID has also made us lose jobs, lose people we love, and upended our life plans in a million little and big ways. We want mental resilience because it means that we’re able to cope with these crises. We can do what we need to do without being overly influenced by emotion, we can mentally talk ourselves down from the negative effects of stress, and then, after it’s over, return to our precrisis state. In other words, if a loved one is sick, we’re able to manage our fears and make practical decisions to help care for them. If we’ve lost a job, we can marshal our initiative to apply to other jobs or find other work in the meantime. If we’ve had to postpone a wedding, we can be upset without having it ruin our lives for an extended period of time. How to become mentally resilient The good news is that you can learn to be mentally resilient. It can be developed both through life experience and practice. It starts with knowing yourself. Think about it: What stresses you out? What triggers you? What helps you be strong? Then, resiliency is built up through practice. What I mean is that it’s important to recognize when you don’t do well in a certain situation, and to practice how to overcome it. Say you don’t do well in confrontations. You can roleplay what that might look like, practice what you might do or say, so that you’re better prepared if or when it happens next time. Exercise also gives us a pretty good analogy. Physics says when we work out, the stress builds muscles back stronger. But if we work out constantly and don’t give our muscles a chance to heal, we can cause serious, long-term damage. To get strong, you need to give your muscles a break so they can build back that strength. In the same way, mental resilience also means taking a break when you need it, so you can come back clear-headed. It means giving yourself grace so you can come back stronger. We all know that life is hard and that handling stress can be a real test. This past year has probably been one of the hardest—if not the hardest—any of us have faced in our lifetime. But when life is hard and challenging, both emotionally and physically, we learn. Sometimes we make life hard on purpose, whether that’s learning a new sport, deciding to open our own business, or choosing to go to medical school. A lot of times, out of nowhere, life is hard all on its own. But no matter how it happens, we can learn from it and we can come out stronger on the other side. Next time, we may still buy as much toilet paper, but we’ll also be more mentally ready to meet the challenge. +
Jeremy Hertza, Psy.D., is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC, in Augusta, on the web at http://nbageorgia.com. Contact him at 706-823-5250 or info@nbageorgia.com.
MAY 7, 2021
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AUGUSTAMEDICALEXAMiNER
The blog spot From the Bookshelf — posted by Gretchen Arnoczy, MD, on May 2, 2021 (edited for space)
I MAY BE DAMAGING BY BRAIN, BUT IT’S NOT FROM WEARING A MASK A friend of mine asked me to weigh in on a letter sent to our local school board. It claimed that masks in school were a direct assault on human rights. The letter listed references for scientific studies that claim that wearing a mask will cause hypoxia (lack of oxygen) and brain damage. When I read it, I laughed. Then I sighed because, of course, it’s not funny. People are reading this. If wearing a mask causes hypoxia and brain damage, what does that mean for surgeons? People in operating rooms wear masks all the time. Long operations are incredibly technical work. Everyone who ever stepped foot into the OR as a student has to mask. If you walked into the OR and announced you wouldn’t wear a mask, the scrub nurse will eat you for breakfast. When you scrub in for a 9-hour Whipple procedure, your biggest concern is your bladder, not your mask. You’ll be fine. Relax. The discussion about masks has always been about whether they help prevent COVID-19. No self-respecting medical professional thought masks were causing hypoxia and brain damage. But you know what? Maybe I’m wrong. I read the articles listed in the school board letter. It was disappointing. The data was terrible. They claimed widespread agreement by the medical community about the harm of masks. With a little reading, you find that isn’t true. It wasn’t convincing. One reference was from Medical Hypothesis – an obscure journal whose claim to fame is publishing “radical new ideas and speculations in medicine which most conventional journals would reject.” Their publication fee is almost $2,000, which is generally a bad sign; high publication fees are often seen in predatory journals that publish anything for the lucrative fees. In the school board letter, the last reference was a YouTube video. My least favorite form of communication is when someone presses play on their phone and hands it to me, saying, “Here, you need to watch this.” Oh honey, no. Jesus, take the wheel. This is why we can’t have nice things. But maybe I’m wrong. So I read the articles. I watched the YouTube video, then wrote my letter.
If the claim is true, what does that mean for surgeons?
A compendium of excerpts from reviews of this book: The outstanding feature of Do No Harm is the author’s completely candid description of the highs and lows of a neurosurgical career. ... For its unusual and admirable candor, wisdom and humor, Do No Harm is a smashing good read from which the most experienced and the most junior neurosurgeons have much to learn. (AANS Neurosurgeon) This thoughtful doctor provides a highly personal and fascinating look inside the elite world of neurosurgery, appraising both its amazing successes as well as its sobering failures. (Publishers Weekly (Starred Review)) One of the best books ever about a life in medicine, Do No Harm boldly and gracefully exposes the vulnerability and painful privilege of being a physician. (Booklist (starred review))
Your Brain On Music) Henry Marsh describes the soaring triumphs and the shattering tragedies that are part of every surgeon’s life. A remarkable achievement. (Michael J. Collins, author of Hot Lights, Cold Steel)
When a book opens like this - “I often have to cut into the brain and it is something I hate doing” you can’t let it go, you have to read on, don’t you? (Karl Ove Knausgaard, Financial Times) Marsh, one of our leading neurosurgeons, is an eloquent and poetic writer. Do No Harm offers a rare behind-the-scenes look at the most mysterious part of human life. His descriptions of neurosurgery are at once fascinating and illuminating; a gripping memoir of an extraordinary career. (Daniel J. Levitin, PhD, author of The Organized Mind and This Is
I may be damaging my brain this year, but it’s not from wearing masks. + Gretchen Arnoczy is an infectious disease physician.
THANK YOU FOR THANKING OUR ADVERTISERS
Each story invites readers into the private thoughts of a neurosurgeon and astonishes them with the counterintuitive compassion required in the operating room. (Michael Paul Mason, author of Head Cases) + Do No Harm: Stories of Life, Death, and Brain Surgery, by Henry Marsh, M.D., 288 pages, published in May 2015 by Thomas Dunne Books
BINGEREAD
Dear School Board, This is bananas. Masks are not causing brain damage in our school children. Sincerely, Your friendly local infectious diseases physician
A soul-baring account of a practical-minded neurosurgeon who admits that a surgeon’s ultimate achievement is marked by patients who ‘recover completely and forget us completely.’ Readers, however, will not soon forget Dr. Marsh. (Katrina Firlik, author of Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside)
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The Examiners
MAY 7, 2021
THE MYSTERY WORD
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by Dan Pearson
How are you and your Great. As of yesterday girlfriend getting along? we’ve been dating for What do you like best exactly one year. about her?
I haven’t seen her mouth or nose yet, but her eyes sure are pretty.
That’s nice.
She has the most beautiful eyes.
The Mystery Word for this issue: RIPFEZ
© 2021 Daniel Pearson All rights reserved.
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
EXAMINER CROSSWORD
PUZZLE
ACROSS 1. Jump 5. Fundamental 10. Augusta West TV station 14. Scratch 15. Bacteria 16. Inwardly (literary) 17. Cougar 18. Mamie had one 19. Jeweler’s magnifier (var.) 20. _____ Club 22. Fish or dress starter 23. Leg joint 24. Tread ending 26. Magician or learned person (archaic or literary) 28. Founder of Islam 32. Fenway site 36. Egg 37. ______ Cinemas 39. Top movie network 40. Dull grayish-brown 41. Christian or Doug 43. Mars’ color 44. Medical College beginning 45. Poetic or literary word for a bottomless chasm 46. ____ liner 47. Local historian Ed 49. Effortlessness 53. On sheltered side 55. Tibetan oxen 56. _____ duct 59. Chatter 61. One of three words repeated on every Medical Examiner front cover 65. Ardent; eager 66. Fragrance 68. Hawaiian honeycreeper 69. Basic monetary unit of Ghana 70. Male singing voice 71. Like some pockets
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by Daniel R. Pearson © 2021 All rights reserved.
DIRECTIONS: Every line, vertical and horizontal, and all nine 9-square boxes must each contain the numbers 1 though 9. Solution on page 14.
by Daniel R. Pearson © 2021 All rights reserved.
DOWN 1. Kissers 2. Sewing case 3. Peak 4. Drug prefix 5. Pacify 6. Obamacare acronym 7. Weeps 8. Hip bone 9. Vermilion 10. Lincoln assassin’s middle name 11. Soon, in poetry 12. Adhesive 13. Class 21. Outer edge 25. Mr. Sconyers 27. Element #79 28. McCormick County town 29. Throat dangler
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We’ll announce the winner in our next issue!
QUOTATIONPUZZLE
30. Clock pointers 31. Compact 33. Opposite of nine? 34. Follows orders 35. Lymph structures 38. Dry red Beaujolais wine 41. Post _____ 42. Renounce or reject 48. Mr. Davis of Augusta 50. World’s largest desert 51. Eisenhower’s nickname 52. Class of drugs that includes aspirin 54. Dog-______ 56. Diplomacy 57. At any time 58. Helper 60. Skeleton piece 62. Stead 63. Affectedly dainty (British) 64. Rose fruit 67. Dad’s partner
N R I B E D E W E L F R
J A S K A E S R E E C A B F P U L U W T S P R L H N R I
by Daniel R. Pearson © 2021 All rights reserved
8 7 2 4 E T L3 5 1 9 M P A 6 8 Y W 5 2 I S4 3 9 1 7 6 — Anonymous
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.
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.
L 1 2 3 4 C 1 2 3 4
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1.BIWIWIMIMLLDNT 2.EEEEETTHHHOO 3.CAAVEEESS 4.DTTEENNAS 5.RUST 6.VS 7.EE
SAMPLE:
1. ILB 2. SLO 3. VI 4. NE 5. D =
L 1
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by Daniel R. Pearson © 2021 All rights reserved
WORDS NUMBER
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Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MAY 17, 2021
9 1 6 4 3 7 2 8 5
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2 3 9 6 7 8 1 5 4
MAY 7, 2021
AUGUSTAMEDICALEXAMiNER
THEBESTMEDICINE ha... ha...
A
math professor goes into a tattoo shop to get pi tattooed on his back. After about an hour of steady work he finally asks the tattoo artist, “What’s taking so long? It’s one little symbol.” “What? You just wanted the symbol?”
Moe: Why can’t cannibals have friends? Joe: Because they’re not allowed to play with their food. Moe: Why did the tree go to the dentist? Joe: For a root canal. Moe: Help me out with something. Joe: Sure, what’s up? Moe: If dentists make all their money from bad teeth... Joe: Wait...I don’t know if I agree with that... Moe: ...then why should we use toothpaste that 8 out of 10 dentists recommend? Moe: I called my wife last night on the way home from work. I asked her if she wanted me to pick up Fish and Chips on the way home. She just hung up on me. Joe: Why in the world...?
The
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Advice Doctor
Moe: I think she’s still mad that she let me name the twins.
©
Moe: My girlfriend didn’t show up for our date last night. Joe: Again? That makes, what, five times? Moe: I called her and suggested she should only date men in wheelchairs. Joe: Why? Moe: ‘Cuz she’s so good at standing guys up. Moe: I dated this one lady who always carried a taser for protection. Joe: Was she good looking? Moe: Oh, she was a stunner. Wife: Want me to fix you some dinner? Husband: What are my choices? Wife: Yes and no. A long-time bachelor finally got engaged, something his mother had been nagging him about for years. He was excited to show off his fiancée to his mother, so he called her up and said, “Mom, I’m going to bring home three girls in a little while, and one of them is my new fiancée. I want you to try to guess which one it is.” Twenty minutes later, the guy walks in the door at his mother’s house with three young ladies following behind him. “It’s that one,” his mother said without hesitation, pointing at one of the girls. “Holy cow,” said the man. “You’re right! How did you know it was her?” “Right off the bat I didn’t like her,” said the mother. +
Why subscribe to theMEDICALEXAMINER? What do you mean?
Staring at my phone all day has had no Effect on ME!
Because try as they might, no one can stare at their phone all day.
Dear Advice Doctor, You know that old saying about insanity? It’s doing the same thing over and over while expecting different results? By that definition, I work in an insane asylum. We are stuck in a rut that isn’t working, but my position gives me the authority to break the mold and start trying to fix things. I’m expecting major resistance, though. Old habits die hard, right? How can I improve my chances of success?
— Wielding the Power for Change
Dear Wielding, You should be applauded for your good intentions; breaking the mold is always a worthy effort since mold infestations in the home or office can cause chronic health problems. It’s not realistic to think that mold can be eliminated. It’s everywhere, in thousands of varieties, and in some situations it is quite beneficial. After all, we wouldn’t have penicillin if it wasn’t for mold. Problems arise, however, when mold is growing unchecked in an environment that regularly includes people, such as the office where you work, or your home. In such settings, you can be inhaling mold spores with every breath, non-stop, 24 hours a day. Depending on the size of the mold infestation, the health impact on people may be limited to wheezing, sneezing, and coughing. If it’s more serious the results can range from watery eyes, itching and other allergic reactions, to chronic headaches and even respiratory infections. As with many other things, mold prevention is the best option. Mold grows in damp, dark areas, so plumbing leaks, even a slight drip, should be promptly repaired. Exhaust fans in bathrooms reduce humidity after showers and baths, and a properly functioning air conditioner also reduces humidity, which helps inhibit mold growth. When a mold colony is discovered within walls or in a crawlspace, for example, the two primary concerns are removal of the mold, and elimination of the source of moisture which provided an environment conducive to mold growth. Visible mold on hard surfaces can be easily eliminated through regular cleaning, but sometimes porous surfaces like drywall, studs, and carpeting will need to be replaced. Thanks for writing, and I hope I answered your question. + Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.
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PRINT IS DEAD WELL, A LOT OF IT IS.
Augusta Office: There are others that have died in addition to the eight past publications pictured. The Senior News is no more. The Augustan (or “The New Augustan”) seems hard to find, but that could just be a temporary COVID situation. And many people say The Augusta Chronicle is a mere shadow of its former self.
Aiken Office:
GADERM.COM
YOU ARE ESSENTIAL DON'T DELAY. GET THE CARE YOU NEED.
The good news is that one area publication is alive and well and going strong, and for that we have our loyal advertisers and loyal readers to sincerely thank. If you’re wondering, the name of that publication is shown below:
MEDICALEXAMINER