May 17 19 by Daniel Pearson

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MAY 17, 2019

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BIRDIES FOR BRAIN HEALTH

FAREWELL ROBIN The large population of type 1, type 2 and type 3 diabetics in the Augusta area is losing a great advocate and ally at the end of this month with the retirement of Robin Petry, a Certified Diabetes Educator at University Hospital’s Columbia Road medical center. Over the years Robin has helped countless thousands of diabetics effectively manage their disease, control their blood sugar and operate and troubleshoot their insulin pumps, both in classes and support groups and through individual attention. Robin may not have worked 24 hours a day, but often it seemed like she did. She would sometimes urge new insulin pump owners to check their blood sugar level at set intervals around the clock and text her the results, even at 2 or 3 o’clock in the morning. She would respond whenever necessary no matter what time of day or night. Robin, thank you for all your tireless efforts. You will be missed. PS: If you’re wondering, type 3 diabetics are non-diabetic family members of people who have diabetes. +

Day One Fitness, a local exercise center dedicated to helping people with Parkinson’s and Alzheimer’s diseases is taking a different direction this coming Monday with its first annual ADPD* Birdies for Brain Health golf tournament at Woodside Plantation. The event is a departure because Day One Fitness isn’t known for fighting Parkinson’s and Alzheimer’s through golf. It’s known for doing so via boxing. Yes, boxing, the Muhammad Ali kind. Do not adjust your Medical Examiner. It all started ten years ago when SRS employee Tambra Wilkerson happened by chance to read an article about fighting Parkinson’s through exercise programs in Shape magazine. She was interested because she felt like doing something, making a difference, making a contribution. Soon after reading that article she saw a small roadside sign stuck in the grass advertising an upcoming Parkinson’s Move Day event. Seeing that sign was a sign. She attended the Move Day event, including one particular demonstration called Boxing for Parkinson’s. The fire was officially lit, especially when she discovered that despite its benefits, there was no such regular program offered in the Augusta area. It took plenty of planning and legwork, but Tambra Wilkerson gave up her safe and secure job at SRS and launched Day One Fitness, which has been offering boxing classes and much more for people with Parkinson’s and Alzheimer’s diseases since 2015. For the record, it’s non-contact boxing, not patient vs. patient. Read all about their many programs and watch videos at dayonefitness.org. + * ADPD=Alzheimer’s disease, Parkinson’s disease

ADPD BIRDIES FOR BRAIN HEALTH Monday, May 20, 2019, 12:00 pm Woodside Plantation Country Club 1000 Plantation Drive, Aiken, SC The tournament will be a four-man scramble, shotgun start, with longest drive and closest to the pin competitions. A raffle and silent auction will also be available, with quality prizes such as a $10,000 hole-in-one competition. First place team will win a $400 cash prize. All proceeds will be donated to Day One Fitness to further their mission of empowering people to fight back against Alzheimer’s disease and Parkinson’s disease through specific and rigorous plans of exercise that target the symptoms of these diseases. +

AUGUSTAMEDICALEXAMiNER

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD by David W. Proefrock, PhD

Your 13 year-old daughter says that she does not want you in her room for any reason. She says she wants her room to look the way she wants it to look and she doesn’t want you coming in to pick up or clean up. She doesn’t even want you coming in to get her laundry. She complains that she doesn’t have any privacy when you can come into her room any time you want. What do you do? A. Respect her wishes and her privacy. Stay out of her room. B. Teens have no right to privacy and too much privacy can lead to problems. Do not change what you have been doing in any way. Unless she’s changing clothes, go in her room unannounced at any time. C. Allow her a degree of increased privacy, but inspect her room for cleanliness and other problems on a regular basis. D. Agree to not go through her things and even to not go into her room when she’s not there, but do not agree to stay out of her room altogether.

MAY 17, 2019

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If you answered: A. Respect a teen’s right to privacy in some areas, but do not agree to stay out of her room altogether. That presents too much opportunity for activities that you are not monitoring. A. Too much privacy is an absence of monitoring and that is not a good thing. However, teens should be allowed some privacy. A. Regular inspections are probably too regimented and would most likely lead to regular arguments. Try something less formal. A. This is the best response as long as she hasn’t done anything to lose her right to privacy.

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Teens naturally want increased privacy and finding the balance between privacy and monitoring is a difficult balancing act. Most kids are going to resent you going through their things. It often works to allow them a drawer that is off limits to you except in an emergency. They should be allowed to keep their room the way they want it short of health and safety hazards. Talk with your teen in her room occasionally. That will give you a chance to look around without conducting a formal inspection. +

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EVERYBODY DOES IT. STILL...

BINGEREAD

For something so universal and seemingly simple, going to the bathroom is surprisingly complicated on numerous levels, many of them psychological. Just ask IPA, the International Paruresis Association. What is paruresis, you ask? That is the official word for bladder shyness, the syndrome where people experience anxiety about going to the bathroom when other people are nearby. Julie Beck, a writer for The Atlantic, has explored this subject in several articles in which she cites numerous scholarly articles and whole books exploring this common experience. In one article she writes that when Oprah Winfrey had jury duty in 2004 she couldn’t use the jury room bathroom unless her fellow jurors sang loudly to mask any noise. And it’s not just Oprah. Paruresis, what some people call “pee shyness,” is listed in the DSM-V, the American Psychiatric Association’s diagnostic guide, as an official social anxiety. The IPA says 220 million people worldwide suffer from paruresis to some degree, 20 million of them in the U.S. For some the syndrome is a mild inconvenience; IPA says others are so paralyzed by their anxiety that they have to self-catheterize to void their bladders when bathroom privacy is unavailable (although the IPA doesn’t explain how there can be enough privacy to insert a catheter but not enough to simply go). A very common related syndrome is parcopresis, what some call bashful bowels, although the IPA says it’s rare for someone to have both it and paruresis. Because bowel movements are less frequent and easier to hold, many people could be said to practice voluntary parcopresis: barring an emergency, they never go “number two” at work, at school, in an airport, on a plane or anywhere at all except home. This leads to the quite common “there’s no toilet like home” experience: walking in the door to your house — especially after being on a trip — triggers a nearly automatic urge to poop, almost like our intestines have eyes. Aside from the mechanics of evacuating — or at least trying to — there are numerous social rituals that public restroom etiquette requires: avoid using a stall immediately next to a stall that is already occupied; always leave at least one urinal between you and someone else using another urinal, and so on. Sure, everybody goes. But that doesn’t mean it’s simple. +

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MAY 17, 2019

AUGUSTAMEDICALEXAMiNER

#91 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

emember when this series first started? Back in olden times (the summer of 2015) it was foolishly given the title “Who is this man?” That was quickly changed. And the early subtitle was “Important people you’ve never heard of.” In the 90 previous installments before today we have profiled plenty of women, and this gentleman would certainly not qualify as someone the average person has never heard of. You might not recognize him from the photo above, but this handsome young man often had an A-List Hollywood beauty on his arm, and in fact, he was a Hollywood studio owner, a real estate mogul, and a business tycoon whose various endeavors added up to a personal fortune well beyond $6 billion. His name: Howard Hughes. Why are we profiling him here, in a health and medical context? Because of his medical philanthropy, which continues to this day. Born in 1905, Hughes suffered the loss of both parents while he was still a teenager, his mother from complications of an ectopic pregnancy in 1922 and his father from a heart attack in 1924. Those unexpected deaths apparently inspired Hughes, at age 19, to arrange for the eventual establishment a medical research laboratory bearing his name. Many distractions intervened over the years, but finally in 1953 the Howard Hughes Medical Institute (HHMI) was launched when Hughes transferred all the stock of Hughes Aircraft to the institute to fund its endowment. The move was highly scrutinized. If Boeing or Microsoft suddenly became tax-exempt charities, it would understandably be questioned. The same was true of Hughes Aircraft and HHMI; it was promptly viewed as a tax haven for Hughes’ huge personal fortune and was an immediate target of the IRS, whose doubts may have had some validity: over an eight year period beginning in 1954, HHMI had spent only $5.7 million on its operations, yet during the same period Hughes Aircraft amassed $76.9 million in profits. There was undoubtedly some creative accounting involved in the establishment of HHMI, but its current standing in the medical research community is unquestioned. After Hughes’ death in 1976, the HHMI board of trustees sold Hughes Aircraft to GM for $5.2 billion, allowing the Institute to grow dramatically. Today a number of world-class medical researchers and 29 Nobel laureates are affiliated with HHMI as Investigators, and the Institute spends about $1 million per Investigator per year. And the Institute continues to grow. From just FY2017 to FY2018 alone, its assets grew by $1.1 billion. The HHMI endowment is the fifth-largest in the world, and is bigger than any other US foundation except the Bill & Melinda Gates Foundation. Its endowment is greater than the Robert Wood Johnson Foundation, The Pew Charitable Trusts and Rockefeller Foundation endowments combined. HHMI spends about $825 million per year in medical researcher and education. For more information, visit hhmi.org. +

by Marcia Ribble Picture this: You’re having a day where you are feeling really puny for whatever reason. You know that you are supposed to go grocery shopping because you are out of bread, eggs, fruit, and fresh vegetables, but the idea of going out is unimaginable. Even the thought of getting dressed casually is inconceivable. You don’t want to order from a meal delivery service because most restaurant food is way too salty for your no-salt diet. In addition, already prepared food will not address your need for the fresh ingredients on your grocery list. You also need a few other things you can’t get from a restaurant: glue, a pencil sharpener, and some Q-tips. What will you do? This is the ideal time to hunker down with your computer and invest in a small delivery fee and have groceries delivered to your door. Publix, Kroger and Walmart offer local delivery service in this area. I have used both Kroger and Walmart, so I can’t comment with any authority about Publix, but others tell me their service is also a good one. Walmart is a bit less expensive to order from than Kroger, but both employ courteous drivers who work hard to get your order right. Note that there are times when folks at both did not get the order right; however, they are both excellent about taking back items you don’t want. For example, at Christmas time I ordered a rib roast from Kroger that was on sale for $6.99 a pound. What they actually delivered was a rib roast for $17.00 a pound that cost $95. When I said take it back, I can’t afford it, the delivery woman said, “Well, sometimes people say, ok, I’ll keep it.” “Not me,” I said, “I cannot afford that much!” So one thing you will want to do is go through your order as you make it and indicate what, if any, substitutions you will allow and which ones are not acceptable. We all have food and brand preferences. Ordering normally allows us to indicate

brand preferences, sizes, weights, and quantities of an item. This takes extra time, but is more likely to create a true match between what we want and what is delivered. I drink Caffeine-Free Diet Dr. Pepper. Pepsi is also good, but I want my Dr. Pepper! No substitutions! When you live alone and want to make cooked cabbage and coleslaw you do not need a ten pound mega cabbage, so you specify that you want a one pound or two pound cabbage. Nearly out of toilet paper? Here you will want to specify both brand and quantity. If you do not have room to store a 16-roll package, specify that you want six rolls or eight rolls. But if you have room to store extra toilet paper, order the largest multipack they have, which may also be your cheapest option. At this point the grocery delivery services do not deliver prescriptions, but I am told that they are working on making this possible. Of course, some pharmacies offer delivery. But grocery stores do deliver nonprescription items from their pharmacies. This means you can order things like bandages, antacids, stool softeners, vitamins, that you regularly use and have them delivered with your groceries. They don’t include everything in their computer list of items. I tried last week to order a reacher/ grabber and was told that Walmart didn’t have this item. I know they have it. They just don’t have one in the computer to order, or I have not come up with the right name for it or the right brand. I was concerned at first about ordering meat and vegetables, but they normally deliver very high-quality items to my satisfaction. The take-away is that it is safe and convenient, most of the time, to order groceries to be delivered in the Augusta metro area. This makes it much easier at times for us when we are under the weather to obtain the healthy foods to sustain better health. +

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MAY 17, 2019

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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ne of my pet peeves is how most medical practices greet their patients when they call. Nearly all the practices I call insert the line, “if this is a medical emergency, please hang up and dial 911.” The problem with this is that the doctor’s office is asking the patient to evaluate their medical condition before talking to someone who can help them evaluate their medical condition. Some people are probably calling to figure out if their problem really is a medical emergency, but are told to doctor themselves before talking to a doctor. Phone systems are generally used as defensive weapons to keep patients away from doctors and nurses, instead leading them through a digital maze where they can leave a message and hope to speak to someone in the near future. Talking on the phone is not reimbursed (usually), and so the main goal is to get the person to make an appointment, where speech is reimbursed. This creates a very frustrating environment for people who have simple questions or who don’t know if they really need to be seen. In response to this, very early in my new practice I put the following on my voice message when people call: “I’m not going to tell you to call 911 if this is an emergency because I don’t think my patients are morons.” This got a lot of laughs and pats on the back from my patients. And that’s when all hell broke loose. I had a new canvas on which to paint my silliness, and so my phone messages became increasingly silly. Here are some actual examples of my office phone greeting:

Hi, this is Dr. Rob Lamberts and you’ve either accidentally or deliberately reached my office. Please listen to the message that follows because I worked hard on it and it would be a shame for you to miss it. Our office will be closed on Monday, July 4th to celebrate the day Will Smith saved us from aliens. This is Dr. Rob Lamberts, and you have reached my office. Thanks for calling in these, the dog days of summer. If you have problems with your dog, please contact your veterinarian. If your dogs hurt, please call your podiatrist. If your dogs are hot, get your buns over here so we can ketchup. I’ll pause for a moment so you can recover from that one. Hi, you’ve reached the office of Dr. Rob Lamberts. Our office will be closed on Thanksgiving day and the day after, so please keep your black Friday injuries to a minimum. Hi, this is Dr. Rob and this is my new phone message. I know there are lots of folks who enjoy listening to these messages, and frankly it worries me about the negative psychological effects I’m having on people. Anyway, you can celebrate this message in the usual fashion and listen to it for educational and entertainment purposes. Our office will be closed on December 24 and 25 for Christmas. We will also be closed on January 1 so we can all practice writing 2018 when we date things. Hi, this is Dr. Rob and you have either dialed correctly or you have gotten

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extraordinarily lucky. This is my new, and hopefully improved, voice message. If you are one of those who hate waiting through these long soliloquies, please memorize the options that follow and dial them immediately the next time you call and skip my nonsense. If you like these messages, I suggest you take up another hobby, such as stamp collecting, improv theater, or levitation. (People started complaining about my long messages, so I did this): You have reached Dr. Rob Lamberts’ office. To quiet all those who are complaining my messages are too long, I’ve put all the the good stuff at the end. (Insert options here) There, all you curmudgeons, how was that? Short enough for you? OK, you can hang up now. Go ahead. [Aside, as though to a staff member after thinking I had hung up]:Are they gone? Finally. Thought we’d never get rid of them. You just can’t make some people happy. I mean, here I have these voice messages that give people HOURS of entertainment (because some last that long) and yet they just moan, moan, moan, like I’d stolen their puppy or something. Well, I’m glad you stayed and have such a good sense of humor. There are more, but I think you get the picture. How did my patients respond to this? They absolutely love it, and play it for their friends. I had one person tell me that when she feels depressed, she just calls my office to hear the message. Given how disconnected people feel in our system, I think this is a very valuable thing. +

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MAY 17, 2019

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

“My leg was broken in three places.”

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

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

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

Everybody has a story. Tell us yours.

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

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Ok, this might sound crazy but my family’s favorite salsa is made with green tomatoes. Not tomatillos, just go out in the garden and pick early green tomatoes kind. Our family loves this so much I try to can 15 or 20 pints each spring or late fall just before a frost when I still have green tomatoes. Green tomato salsa tastes similar to regular red ripe tomatoes, but the salsa has a hint of tartness and a thicker consistency than red salsa. In this recipe, the addition of onions, peppers, cumin, garlic, and cilantro all blend together to infuse a delicious traditional style salsa that you might become addicted to. The best part about using green tomatoes to make this salsa is how simple it is to make because you just quarter the tomatoes and toss them in a roaster with the other ingredients and allow to simmer for a few hours, then blend with your immersion blender and — presto! — you have salsa. There is no labor-intensive pealing off the tomato skins like you would in red salsa! There is a bonus for eating this salsa; it’s loaded with vitamin C. One medium green tomato provides about 48 percent of a daily value need. Vitamin C also helps the body better absorb iron from plantbased foods, such as beans and lentils, Green Tomato Salsa so green tomato salsa and beans make a • 1 teaspoon hot pepper flakes (more if you like it perfect pair when eating Mexican food. spicy). This recipe makes a big batch of salsa so you can freeze or pressure pot can any Instructions you do not eat right away. If you would Place all the ingredients into a roaster pan. like more information about canning your Cook on 250 degrees. Stir the mixture every 15 salsa be sure to visit my website. minutes to prevent sticking. Allow to simmer for 2 hours or until the Green Tomato Salsa tomatoes are soft and starting to fall apart. Use Ingredients hand blender stick to puree the salsa until it is • 11 cups coarsely chopped green smooth, yet slightly chunky. Freeze or pressure tomatoes can - see web site for instructions. + • 2 cups coarsely chopped onions • 2 cups chopped green chilies. If you by Gina Dickson. “As a mother of six who want it spicy use jalapeños, or mild beat cancer, I want to share with you what peppers if you don’t want heat. I learned through my journey. I know • 1 cup white vinegar healing from cancer can take everything a • 10 tablespoons freshly squeezed lime mom has, yet you still want to love and care juice for your family through the treatments. My blog is a • 10 cloves of garlic minced community full of encouragement for moms going • 1/2 cup chopped cilantro through cancer treatments who would like to use a • 4 teaspoons ground cumin plant-based vegan diet to complement their healing • 2 teaspoons pink Himalayan salt journey. www.thelifegivingkitchen.com

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MAY 17, 2019

YOUR CHILD AT RISK, PART 2 by Ken Wilson Steppingstones to Recovery

NOT EVERYONE

ARKS

SOME USE OUR DRIVE-THRU

“Children” covers a large age group. I want to give suggestions on how to speak to your younger child about drugs this month – there is no age too early to speak about this subject! It’s significant that even children in elementary school are learning to see themselves as separate and unique individuals. It is important to affirm children in their choices at this age. And the subject doesn’t even have to be about drugs! For instance, your son dresses himself one day in plaid pants, a polka dot shirt, and a Davy Crockett hat. Caution! You don’t have to express dismay! Please don’t! Because children at this age do want to please you, correcting him at this age could begin a series of decisions that transforms his personality. You could respond with “You express yourself clearly in your outfits! I’m proud that you don’t feel like you have to be like others.” Don’t worry: there’s plenty of social pressure to conform and he’s unlikely to keep up this habit very long. By honoring his choice to be different you give him the ability to avoid conforming, to avoid doing wrong “because everyone else is doing it”. You see, at this age a child does not start using drugs to deal with life, but for social acceptance. But hurray! Your child is not in great need of acceptance because you trained him to accept himself as you accept who he is! Ever notice how your children root out your inconsistencies? I’ve seen youngsters use chemicals because they

THIS IS YOUR BRAIN

A monthly series by an Augusta drug treatment professional say their parents do. Just look in the medicine cabinet. In fact, the home medicine cabinet is the #1 place where kids get drugs from. It is important that children get the message that just because it’s in a medicine bottle with an Rx label doesn’t mean it’s safe to take. Strictly speaking the only person who can safely take the Rx in that little orange bottle is the person whose name is on that bottle. This message needs to be loud and clear. The prescribing physician has taken into consideration the ailment, the gender, age, weight, and past history of that one person before prescribing the medication. In fact, it may come as a surprise that to be caught out in the real world with a pain pill, for instance, is reason enough to receive a felony charge! That news is a shocker to some who get such a citation. In fact, it is protocol to receive a felony for each pill. 10 pills, 10 felony charges. That will make it difficult to get a good job, ever. Such a discussion around the kitchen table is so appropriate for youngsters and parents to engage in.

I have encountered some sad stories over the years… stories of kids around age 12 being given pills by their parents that were prescribed for their parents. Good intentions but sometimes with permanent harmful results. Sometimes these pills are cut in half or in quarters to make the dosage “safe,” but cause permanent damage to the undeveloped adolescent brain because they are then given over a longer period of time than originally intended. Then tolerance sets in and what used to be half a pill given turns into a whole pill and it’s downhill from there. I know of a case where a well-meaning parent even watered down whiskey and mixed it with juice to give a baby to get him to stop crying and go to sleep. It is no wonder he was in treatment for alcohol dependence at age 16. Next month I’ll give some ideas of how to speak to older children and teens about this subject which is in their face constantly these days. Hey, you were a kid at one time! Aren’t you glad for good tutoring on all this you got back then? +

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

HOW TO FIND RELIABLE NUTRITION INFORMATION ONLINE by Hannah Burman, MS-Dietetic Intern

There is an overwhelming amount of information about nutrition online, some factual and some not so factual. Blogs, ads, social media, and even news outlets are riddled with nutrition information. Considering these sources are often not regulated for accuracy, the information might be rooted in scientific evidence or just based on opinions without any scientific evidence. People can proclaim themselves as nutrition experts to promote the use of various fad diets and nutritional supplements. Websites may promote miracle methods for anything from weight loss to cancer “cures.” The internet is a helpful resource for nutrition education, but guidance is

needed for understanding what information can be trusted and what can’t. Additionally, there are many controversial topics in nutrition that science has yet to find conclusive evidence on and is therefore still theoretical. In these cases the pros and cons, risks and benefits should be clearly stated so readers can make an informed decision for themselves. Nutrition

is a science, not an opinion, and science requires factual evidence. To determine inaccurate or biased information about nutrition and health, articles and websites should be evaluated based on the information source, author, and content. Following are some pointers on how to evaluate the credibility of information posted, and filter science from opinion. Check the source of the information. Websites ending in .gov, .edu, and .org are regulated to ensure they contain factual data. Commercial websites ending in .com are not regulated for accuracy, and often contain advertisements. This includes blogs and popular health websites. Information from these websites may be biased or have conflicts of interest between the authors and funding sources (including advertisers). For example, an article about the benefits of a supplement written by the owner of the supplement company or on a website covered with advertisements for the supplement should raise red flags for bias. Readers should always check the credentials of authors of online nutrition information. The often-used title “nutritionist” is not reg-

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MEDICALEXAMINER

MAY 17, 2019

ONLINE… from page 9

ulated, and in some cases may be used by somebody who has only a basic understanding of the science of nutrition. There are licensed nutritionists, but licensing is not standardized as to what level of knowledge a nutritionist needs to have. Some nutritionists may present very factual, evidence-based information, but others may not. On the other hand, registered dietitian nutritionists (RDs or RDNs) are thoroughly trained and credentialed in the field of food and nutrition. The information they learn and provide is evidence-based. These individuals also must hold a minimum of a bachelor’s degree, complete an internship, and pass a national board registration exam. Registered dietitian nutritionists are also held accountable for the nutrition information they present since they can lose their license for professional violations. Registered dietitian nutritionists are the only healthcare professionals with highly specialized training the science of nutrition. Lastly, online nutrition information should be evaluated based on its content. Check the date the information was posted to ensure that the evidence is up to date. Beware of claims that sound too good to be true or offer a miracle cure. Look for information that has been backed up by cited sources such as research articles and expert reviews. For example, an online article about the keto diet claimed that the “keto diet can reduce concussions and aid in brain recovery.” The article cited one source, a small animal study. Evidence from animal studies may not always apply to humans. For guidance, the gold standard of research proving factuality is reviews which have compiled the results and data of multiple studies. In conclusion, the internet is a valuable tool that presents a great opportunity for self-sustained learning. To ensure learning is productive, one should evaluate the source, author, and content of online information in order to identify accurate, useful articles. A great place to start when searching for nutrition information on the internet is eatright.org. This is the website of the Academy of Nutrition of Dietetics and postings are written by RDNs. Harvard University Nutrition Source (hsph.harvard.edu/nutritionsource) is also a recommended source. This website includes a variety of reviews, including a “Diet Review Series,” in which popular fad diets are scrutinized by a team of nutrition experts at Harvard. The information presented includes a summary of the pros, cons, risks, and benefits. If needed, an RDN may help to clarify questions about nutrition by providing science based information. +

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The blog spot — posted by Trisha Swift, DNP,RN, on May 7, 2019

WHERE IS THE NURSES’ LOUNGE? If you have worked in the hospital setting for any length of time, you likely are aware of the physicians’ lounge. It’s the protected space where the hard-working medical staff can escape to catch a break or grab a hot beverage. The physicians’ lounge is absolutely necessary. Medical staff members need a space where they can refuel and exhale the stresses that caring for the sick and dying will often place upon their shoulders. My question is: Where is the nurses’ lounge? Nurses make up the bulk of the hospital workforce and as any good physician well knows, [they are] the mortar that holds things together for the care team and patient. We do not do a good job at providing protected space for nurses to take the same break and exhale as we do for medical staff. I struggle to understand why. Nurses are often unable to take a break and must answer call lights, phone calls, and accept admissions during what should be their protected and uninterrupted break time. In fact, many hospitals and health systems have found themselves in lawsuits for not affording their nursing staff protected and uninterrupted break/meal time. This is unfortunate, but completely preventable. It is time for health care leaders to demand spaces and time for nurses to take a break, to cry, to meditate, or to close their eyes for 5 minutes. The nurse does not see their patients only during rounds or when something has gone wrong; they are by the patient’s side for hours at a time taking care of the needs of patients and their families. They are the constant providers of care, encouragement, counsel, accommodations, and prayer. Nurses truly give away a piece of themselves to each and every patient and should be provided protected time and space to regain the mental energy needed to fulfill this type of role. There are many ways to offer protected space and time for nursing staff, and many health care organizations have already put forth efforts to do so. A nurses’ lounge is one option, but it should be in a neutral location away from the care delivery areas. A nurses’ lounge should be equipped with resting spaces, privacy, and refreshments. Meditation sanctuaries, relaxation chairs, or virtual reality rooms are other options. Finding the space for a nurses’ lounge is the easy part of the equation. Logistically, adding break relief nursing staff will ensure staff nurses are able to hand off ownership of care and truly take a break. In summary, doing something to protect nurses from making errors and getting burned out is better than doing nothing at all. It will take some investment that will certainly show its return. Nurses take care of all of us, and it’s due time we take the actions to care for them as well. + Trisha Swift is a health care executive.

WANT THE EXAMINER IN YOUR MEDICAL OFFICE? Let us know and we’ll send our paperboy right over. Sorr y we’ve been missing you. Let us know how we can correct our oversight. Our phone and email contact info is always on page 3.

From the Bookshelf The dilemma of what treatment option to pursue is well known to doctors: the standard course is to begin with the most conservative and least invasive option. If that works, well and good. Everyone likes a happy ending. But it’s not always that simple. Take prostate cancer as one example. There are at least half a dozen recognized treatment avenues to take, each with its own unique set of advantages and disadvantages. The one determined to be the best option for Mr. A may not be best for Mr. B. The advantage of one option over another may rest entirely with clinical factors. But many other factors can enter the picture. Does the patient have an overriding fear of surgery? A distrust of pharmaceutical companies? Does he come across as skeptical of whatever is suggested, or is he willing to do whatever the doctor says, no questions asked? Are his religious views a factor in making the decision? Does his extended family — distant cousins and faraway in-laws —

appear to have as much say in the matter as he does, perhaps even more? What about the cost of the procedure and payment of the balance not covered by insurance? The husband-and-wife team who wrote this book (Groopman’s previous books have been reviewed here) address how patients can sort through the sea of conflicting options. It’s not a simple process. And it hasn’t been made any easier in the Internet era. A couple of decades ago and before, patients took whatever their doctor said as gospel truth. Nowadays, we’re likely to Google everything from our symptoms to various Mayan

folk remedies. There is an endless flow of information out there. Even if all of it was accurate — which it isn’t — the sheer volume can be crippling, and certainly not conducive to good care. Do you take the medicine that has as a side effect of increased risk of causing a heart attack, or the one with a higher risk of causing internal bleeding? What if the one you didn’t choose is actually more effective in treating the primary condition you have? Well, the good doctors don’t have a crystal ball for their readers, but they do offer plenty of sage advice on how to make thorny decisions, as well as a simple formula that can help patients wade through all the conflicting advantages and disadvantages of any collection of medical advice. Maybe the book could have been entitled Your Made-Up Mind. + Your Medical Mind, How to Decide What Is Right for You, by Jerome Groopman, M.D. and Pamela Hartzband, M.D, 320 pages, published in September, 2011 by Penguin Press.

Research News Heart attack recovery When someone survives a heart attack, they are at present left with permanent structural damage to their heart courtesy of scars which can themselves trigger future heart failure. That is not the case everywhere in nature: fish and salamanders can regenerate fresh heart tissue from birth until death. Taking that as a cue to what might be possible, researchers at King’s College London have identified a means of completely regenerating damaged heart tissue. Using genetic material called microRNA-199 administered to the damaged heart tissue, the results after just one month were almost complete recovery of cardiac function. The procedure has been tested on mice, and more significantly in large animals too (pigs). The study was published in the May 8 issue of Nature.

Myocardial infarctions or heart attacks strike more than 23 million people worldwide every year. Cancer in the morning, not in the afternoon? This isn’t an article about a cancer cure effected in less than a day. Instead, it’s about a University of Pennsylvania School of Medicine study which found that patients who see their primary care doctors early in the day are more likely to be recommended for cancer screening than those seen in the afternoon. Researchers have some theories about their discovery. The truth will have to await further studies, but among the working hypotheses might be so-called “decision fatigue,” sort of an “I’ve been making this call a lot today. These people can’t all have cancer.” Another possibility is plain old “doctor fatigue,” as overworked clinicians fall

behind as the day progresses. Whatever the cause, the results noted were significant: among patients where cancer screening was indicated, breast cancer screening was ordered more often for patients seen during the 8:00 a.m. hour (64 percent) versus those seen during the 5:00 p.m. hour (48 percent). For colorectal cancer screening it was 37 percent in the 8 o’clock hour and 23 percent late in the day. The screenings ordered include mammograms, colonoscopies, sigmoidoscopies, and fecal occult blood tests. Patient compliance with ordered tests also dropped as the day progressed. Researchers believe patients seen early in the day can coordinate tests with other departments the same day, while those seen late in the day must follow up the next day, leading to lapses in compliance. +

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AUGUSTAMEDICALEXAMiNER

The Examiners

MAY 17, 2019

Have you heard that hilarious joke going around?

Which one would that be?

by Dan Pearson

Oh, I know! Then Right, right! I think the best meow max and zones part is when meow max says that meow max go to earwaxes is meow! and she tells him to It really is funny!

Yes! It is hilarious! Especially the part where The one about the someone says meow max Mueller Report. and then meow max...

The Mystery Word for this issue: WINKLAG

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

20 21 ACROSS 1. Beginning for apple or car 23 24 5. Area abbrev. 9. Bulge 26 27 14. Not fer 32 33 34 35 15. Fracture type 16. Els of the PGA 37 38 39 17. Central part of a church 42 43 44 18. Podiatry focus 19. Travels on 47 48 20. Fencing sword 50 51 21. Suitable; apt 23. Crazy (in country slang) 56 57 58 59 25. Synonym for 23-A 61 62 26. Appropriate beginning 27. Cape ___ 64 65 28. Nestling falcon 67 68 32. Pharoah’s land 35. Satisfy fully by Daniel R. Pearson © 2019 All rights reserved. 36. Upcoming 37. Eye movement during sleep DOWN 38. Spoil the quality of 1. Victim of a Super Bowl 41. The drink of the South “wardrobe malfunction” 42. Inflammation suffix 2. Wide open 44. Scottish blackbird 3. Small arboreal African 45. Word in nutritional mammal requirements 4. Patella 47. Indian garment 5. World’s most common 48. As needed (med.) beverage after water 49. Ball belle, in brief 6. Swiftness 50. Monetary unit of Angola 7. Spool 52. Jason, former Augusta 8. Something given to (and Pittsburgh) Pirates counteract a poison (adj.) catcher 9. Letter cross-line 56. Predominant; prevalent 10. Not oral 60. Off-Broadway theater 11. Inside prefix award 12. Stead 61. Savannah ______ 13. To a smaller extent 62. Having wings 22. Citadel student 63. Relocate 24. TV’s home & garden 64. Not concealed network 65. Pleasing 27. Monument of stones 66. At any time 29. Abominable snowman 67. Augusta actor Joe 30. Jump in figure skating 68. Grasp 69. Loch_____

WORDS

NUMBER BY

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, JUNE 3, 2019

We’ll announce the winner in our next issue!

E X A M I N E R

22 25 28

36 40 45

41 46

49 52

THE MYSTERY WORD

60 63 66

4 5 2 2

4 9 2 6 5 5

8 5

8 7

9 6 1

8 6 2 4

S 4 U 5 D 7 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.

QUOTATIONPUZZLE

31. Command to Fido? 32. Greek goddess of discord 33. “____ _ life!” 34. Giant in Norse myth slain by Odin 35. Disinfecting agent 39. Architect of Broad St. plaza 40. The first home 43. Like a senior’s hair (poetic) 46. Stomach 49. One of more than 350 in a circle 51. Having benign skin growths 52. Talent 53. Over 54. Resides 55. Ogles 56. Support 57. Split apart 58. Level 59. Hip bones

— Oscar Wilde (1854 — 1900)

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.

A 1

1 2 3 4

R 1 2

2 7

T C 5 6 7

1 2 3

O 1 2 3 4 5 6 7 8

1 2 3 1

I 2

V 1 2 3 4 5

A 1 2 3 4 4

1 . D O R I M A N S A N I T 2 . I T R E E TO E D I 3 . V G W E R N I S M 4 . A A D E E E G 5 . I T R I N 6 . S N N C 7 . I S H A 8 . LO E 9 . N D

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

MAY 17, 2019

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

Moe: Why did the lawyer go to culinary school? Joe: I give. Why? Moe: He wanted to become a sue chef.

The

Moe: I heard this really great joke about unrefined oil. Joe: So let’s hear it. Moe: No, it’s too crude.

German tourist travels to France. At the border a French immigration officer asks him, “Occupation?” “No,” the German says, “Just visiting.” A duck is standing next to a busy road, looking left and right as cars zoom past him while he waits for a break in traffic. A chicken walks up to him and says, “Listen to me, man. Don’t do it. You’ll never hear the end of it.” A woman walks into a gun store, where a clerk asks if he can help her. “I’m here to buy a gun, obviously,” she said with a nervous laugh. “Anything particular you have in mind?” wondered the clerk. “I’m getting it for my husband,” she said. “Oh. Then did he tell you what caliber to get?” asked the clerk. “Are you kidding?” she replied. “He doesn’t even know I’m going to shoot him.” Live in a car and people pity your poverty. Live on a boat and people envy your wealth.

Moe: You know what really bothers me? Joe: What? Moe: That someone could steal my identity and make thousands of dollars behind my back using my name. Joe: Why does that concern you so much? Moe: Because I have my name, and I can’t figure out how to do that. A horse walks into a bar where he’s a regular. “Hey,” says the bartender. “Sure,” replies the horse. Moe: Why did the communist spell his name with all lower-case letters? Joe: Tell me. Moe: He hated capitalism. “Mom,” said a young boy, “what is dark humor?” “Well,” she said, “Go over to that man standing over there with no arms and ask him to clap his hands.” “But Mom, I’m blind!” “Does that answer your question?” +

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, I was called in to work last week on my day off. It’s not like I was enjoying my day: I happened to be as sick as a dog. I said I couldn’t come in, but I was told it was an emergency and that if I could fix the problem I could go back home with a full day’s pay even if it only took ten minutes to fix. Well, when I got to work it really wasn’t the emergency they thought it was. When I pointed that out the manager rescinded his full day of pay offer. I know that isn’t fair, but is it illegal too? — Sick About It All Dear Sick, I sympathize with your sense of frustration, but I think the bigger question is why was the dog sick? How did that happen? In far too many homes, dogs are fed a steady diet of table scraps, and there is a lot of inherent risk in that practice. There is plenty people food that should never be dog food. What are some of the no-nos for dogs? Most people know chocolate is not good for dogs. Depending on the dog’s size and the amount ingested, chocolate can cause anything from vomiting and diarrhea to seizures and death. Ditto for anything containing caffeine. Does your dog sometimes lick ice cream bowls after the family dessert? That’s a tiny amount, which is good since dogs don’t have enough lactase to digest dairy. A dog that gets a treat of some leftover Sunday dinner might actually suffer severe liver and red blood cell damage if the dish contains onions and garlic. That probably means no pizza for Fido. This would be a good time to mention that tomatoes are toxic to dogs also. It might seem natural for a dog to eat raw meat, bones or eggs. Nobody cooks for dogs in the wild, right? Then again, no one would equate a wolf and a French poodle just because they’re both from the dog family. Raw meat and eggs can contain salmonella and E.coli. You’ll never know if a feral dog chokes to death on a bone but you certainly will if Fifi does. Most nuts are bad for dogs, especially macadamia nuts. This review of dog food taboos is only a partial list. In short, it turns out there’s a reason they call dog food dog food. I hope this answered your question. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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

BEFORE READING AFTER READING

+ 14

9 6 1

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

...cleverly hidden on the old man’s ear in the p. 15 ad for FITZPATRICK OPTICIANS

THE WINNER: BENJAMIN HAMILTON! Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

MAY 17, 2019

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED J A N E T

A G A P E

E R I S

G E T A

P R O P

R I V E

C I V E T

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

R E E L C A I R N I L I A

A N T I D O T A L K N A C K

S E R C I A F D E T E D D E E N G R E E

W R I T T E N

E N D O

L I E U

L E S S

Y E T A I B D A O B M O E V N E

A X E L

S T A Y

L I V E S

L E E R S

SEE PAGE 12

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

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

8 9 4 7 6 5 3 2

4 7 9 2 5 6 1 8

5 2 1 3 8 4 9 7

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

7 3 6 5 1 8 2 9

1 8 2 9 3 7 4 6

9 6 7 8 4 3 5 1

6 1 3 4 9 2 8 5

3 5 8 6 2 1 7 4

2 4 5 1 7 9 6 3

QuotatioN QUOTATION PUZZLE SOLUTION “Cynics know the cost of everything and the value of nothing.” — Oscar Wilde

WORDS BY NUMBER

“A mind stretched to a new idea never regains its original dimension.” — Oliver Wendell Holmes

READ EVERY ISSUE ONLINE WWW.ISSUU.COM/ MEDICALEXAMINER

MAY 17, 2019

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THEY’RE ALMOST READY! Our world-exclusive coffee mugs, being custom made for us by Tire City Potters in downtown Augusta, will be ready soon. All Mystery Word Contest winners beginning this past January will each get one, as well as future winners.

They’re cool! They’re hot! Earn the chance to win yours today!

Just unscramble the Mystery Word provided on page 12, then start hunting. Remember, the Mystery Word is always in an ad, and is always hidden. You’ll never see it in an article or in large letters.

EDICA M

MI NE

Once you find the word, head over to the Medical Examiner website (AugustaRX.com) to enter for your chance to win.

Spread the

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

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

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

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

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

SLEEP MEDICINE

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

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

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

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

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