May3 19 by Daniel Pearson

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MAY 3, 2019

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by guest columnist Caroline Colden, M.D. With regard to the comments made by a certain senator regarding the worklife of nurses: anyone and everyone who has ever worked in a hospital in ANY capacity knows that nurses are among the most tireless, dedicated, selfless, and likely over-worked group of people who clock in to work day in and day out. I have worked in teaching hospitals and community hospitals, on the floor and in clinic. I’ve worked in Neonatal and Pediatric ICUs, and the Emergency Dept. I’ve been everywhere. I’ve seen nurses get kicked in the stomach and chest trying to give meds and vaccines to an uncooperative child, and I’ve seen nurses later hold that same child’s hand and comfort their distress. I’ve seen nurses pick up on physical exam findings that doctors missed. I’ve had parents confide and cry with nurses, and I have done the same myself with nurses. I’ve seen nurses stay calm while on the receiving end of ridiculous obscenities and jaw-dropping rudeness from patients and family members (for no reason at all), but who simply smile in response. The nurses I’ve worked with remained patient and sweet to me when I was a green, ignorant medical student, and continued to educate me as I moved through my years in residency. Today, they continue to give me strength and completeness as I still learn to navigate what it means to practice both the art and science of medicine. I emphasize the word “art” because I have found that the art of medicine cannot be learned from a textbook. It is humanity and grace I have really only witnessed and learned by working with and watching my nurses. The nurses I have worked with are my eyes and ears for my patients behind the scenes when I am not there. They are the very backbone — another word I’d like to emphasize — of medicine whether they have a single patient or an exploding census of patients. To my nurse friends and colleagues, I love and appreciate you all so much. Don’t listen to the ignorant comments anyone makes because the rest of us do know what you do and we are grateful. Let me emphasize that last word: GRATEFUL. + Dr. Colden chronicled her medical school journey in the Short White Coat in the Medical Examiner.

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PARENTHOOD by David W. Proefrock, PhD

Your 11 year-old son says that he has no friends at school and that his teacher doesn’t like him. It has been harder and harder to get him motivated to go to school every morning. This has not been a problem before. He says he would do better if you teach him at home. What do you do? A. Have him evaluated by a mental health professional to determine the problem and get recommendations. B. Home schooling might be a good idea. Give it a try. C. Home schooling won’t help him make friends. Tell him that he will just have to make the best of the situation at school and deal with it. D. Schedule a meeting with his teacher. Try to figure out what the problems are and make a plan to deal with them.

If you answered: A. You may end up doing this, but it is not the place to start. Meet with his teacher first. B. Home schooling can be an alternative when there are problems in a regular classroom, but usually not when those problems are not having friends. Start out by getting input from the teacher. C. There is something wrong and telling him to just deal with it is not being supportive and is not likely to help. Find out what the teacher thinks is going on. D. This is the best response. In a school-related situation always get input from the teacher before taking any other actions. This situation points out the importance of handling things in a manner that provides as much information as possible before developing a plan of action. An evaluation may be necessary, but not before consulting with the teacher. Home schooling or changing schools could be the solution in the end, but it’s not the place to start. + Dr. Proefrock is a local clinical and forensic psychologist

EYE OF NEWT AND TOE OF FROG? A dash of Arctic root, a pinch of St. John’s Wort, a dose of adenosylmethionine, and dried stigma of saffron sounds like a witch’s brew. Complementary and alternative medicine (CAM) for mental health have been popular for centuries. But is there any science backing the claims? And is it something we should be dabbling in without the consultation of a physician? The short answers are yes, there is some promising evidence and no, it’s not something to start without your physician’s input. CAM practices are a broad area of homeopathic care that are centered on the mind, body, and spirituality. CAM practices include aroma therapy, massage, herbs and supplements, reflexology, homeopathy, and acupuncture. A literature review of CAM practices and their effect on mood disorders was published in May 2013 in the journal Neuropsychiatric Disease and Treatment. A literature review is among the crème de la crème of scientific articles. The researchers sifted approximately 30,000 articles written between 1992-2012. The 213 articles selected for the review appear in English language, peer-reviewed journals.1 Some of the notable finds of the 2013 review are that for mild to moderate mood disorder symptoms, CAM practices

may be beneficial.1 Mood disorders include bipolar disorders, major depressive disorder, dysthymic disorder, and premenstrual dysphoric disorder.2 Omega-3 fatty acids, St. John’s wort, folate, exercise, mindfulness, and light therapy were found to be effective in treating major depression. However, it is noted by the American Psychiatric Association Task Force that more robust studies are needed.1 A word of caution is extended to those attempting to self-medicate without the provisions of a physician. People turn to alternative therapies in order to combat the cost of prescriptions, undesirable side effects, lack of adequate insurance, distrust of modern medicines or the industry, and complicated medical conditions.1 There are several factors that may be detrimental to those using supplements that are not regulated by the FDA. For example, contaminants have been found in herbal supplements from the People’s Republic of China, India, and even the United States. The list of contaminants are “dust, pollen, insects, rodents, parasites, microbes, fungi, mold, toxins, pesticides, mercury, cadmium, chromium, lead, arsenic, and prescription drugs”.1 Some of the possible adverse effects from these contaminants are meningitis, perinatal stroke, multi-organ failure, poison-

ing, liver or renal failure, and death.1 Also, it is best to discuss the possibilities of interactions with current medications, whether they are prescription or over the counter, as well as discussing all of your physical conditions before taking a supplement. Since 1949, May has been observed as Mental Health Awareness Month. Here are some quick mental health stat from the National Alliance on Mental Health: • 18.5% of adults in the United States experience some type of mental illness in a year. • Adults living with severe mental illness die 25 years younger than those without severe mental illness. • About 50% of those who experience chronic mental illness do so before the age of 14. • 18.1% of adults in the US have an anxiety disorder. • 6.9% live with major depression. • Depression is the “leading cause of disability” in the world. • 60% of adults and 50% of kids aged 8-15 with mental illness have not received care for it in the previous year. • 1 in 25 adults in the US lives with a serious mental illness. To talk to someone and get help, call the NAMI Helpline at 800.950.NAMI. Other resources are: Aiken Helpline at 2-1-1 and the Georgia Crisis & Access Line at 800-715-4225. If you or a loved one are in a mental health crisis, call 911. + References 1. Quereshi, N, Al-Bedah, A. (2013). Mood disorders and complementary and alternative medicine: a literature review. https://www. ncbi.nlm.nih.gov/pmc/articles/ PMC3660126/. Accessed April 9, 2019. 2. APA Dictionary of Psychology. http://dictionary.apa.org/mood-disorder. Accessed April 10, 2019.

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As any diabetic knows (or is supposed to know) blood glucose testing happens many times every day (or is supposed to). The drill is always the same: use the tips of your fingers to get that drop of blood, even if you play the guitar for a living. How about giving fingertips a break? What’s wrong with blood from elsewhere in the body? Isn’t a person’s blood the same no matter where it comes from? Fingertips have been the location of choice since glucose self-testing began for several reasons. Convenience is one: it’s obviously easier to test a fingertip than a big toe. Also, fingertips are rife with capillaries, so obtaining a drop of blood for the test is usually not a problem. Another factor is accuracy: testing with blood from the same place every time produces a uniform and consistent test result. The question remains, though: why fingertips? If the inside of the left elbow, let’s say, was the designated spot, wouldn’t all things be equal? Not necessarily. Clinical studies have compared blood glucose readings from fingertips against readings from alternate sites like the forearm, earlobes, the abdomen, calf and thigh. Because there are different types of tissue in various parts of the body — fingertips are different from tummy tissue — diffusion of blood glucose isn’t uniform throughout the body. That’s why some glucose meters specify that they’re calibrated for use involving fingertip blood only. Newer meters may be accurate with blood from alternate sites, so it’s worth checking your specific meter. Overall, however, blood glucose readings in many studies were not significantly different when using blood taken from fingertips vs alternate sites except when blood glucose levels are dropping sharply (such as after exercising) or rising rapidly (such as after a meal). In those instances, the profusion of fingertip capillaries means a more current and accurate reading, while results from alternate site testing lags behind. Put another way, a person with a very high or low reading from an alternate site should confirm the result with a fingerstick check. +

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MAY 3, 2019

AUGUSTAMEDICALEXAMiNER

#90 IN A SERIES

Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE

ictured above and below are two related giants in the field of surgery whose innovations continue to benefit millions of people every year around the world. The gentleman above, pictured with his invention, is Aladár Petz (1888-1956), a Hungarian physician, educator and inventor. If you have a sharp eye and a medical background, you might recognize his invention, although current models are much smaller and may even be disposable. For the rest of us, Petz’s claim to fame is the invention of the surgical stapler as shown above. He had observed first-hand the difficulties presented by gastrointestinal surgeries, not the least of which was the time-consuming process of manual suturing. Petz noted that sutures “risk consequent peritonitis” from infection, “prolonging surgery and increasing the risk of mortality for patients.” He borrowed a few ideas from another Hungarian, Hümér Hültl, who devised the first modern suturing machine in 1908. Weighing in at about 8 pounds, it was an ingenious device, but was too large and cumbersome to be of practical use. Even so, it was a start. A famous story is told of Hültl meeting Petz after Petz presented his invention at the annual Congress of the Hungarian Surgical Society in September of 1921. Hültl tried out the Petz stapler on the leather case for his spectacles, said, “It is better,” and promptly suspended production of his machine. After searching for a manufacturer for almost two years, the Petz stapler became common and popular, but curiously enough, only in Europe. For decades, American surgeons were patiently and laboriously suturing by hand while their colleagues across the water were quickly closing up their incisions with staplers. That changed when American surgeon Dr. Mark M. Ravitch (below) visited the Soviet Union in 1958 and noted the common use of staplers there. He obtained one of the devices, brought it back home, and along with his Johns Hopkins colleague Félicien M. Steichen, M.D., spent several years studying, refining, improving and testing surgical staplers. Their design reached the market in 1967, and soon became ubiquitous in operating rooms worldwide. Drs. Steichen and Ravitch are considered the fathers of modern surgical stapling. Ravitch, born in 1910, died in 1989 at age 78. Steichen, a native of Luxembourg, died in France in 2011 at age 84. +

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 As we age, we all go through various transitions whether we like it or not. We face them with as much equanimity as we can muster, but it is perfectly fine to take some time now and then to protest, especially when the changes we face include losses, even when there may be much to be gained as well. Downsizing is one aspect of aging most of us face. Downsizing often carries aspects of profound fear and excited anticipation for the future. One way to deal with these conflicting emotions is to face them head on and use old and well-practiced skills to lift the depression from losing parts of our past while making lists of the benefits we know will be part of growth for us. The two things I am dreading most are 1) dealing with my books, and 2) dealing with the paper trail from over 25 years of teaching. You might laugh if the number of books you have ranges from 10 to 30. Thirty might be considered a lot of books to some, but as a scholar and professor my books number in the multiple hundreds, and I hate to part with a single one of them. During one move I shipped over fifty boxes of books, and I have bought more books in the decades since then. To try to explain, I have eight bookcases overstuffed with books, even after giving away several hundred books. That’s about 200 linear inches of bookcase shelves. I think I’ll be able to keep four or maybe five of the largest bookcases. Even then I’ll need to sell or give away three bookcases and the

WHICH WILL IT BE?

Depression is incurable

That is what many people think. In fact, only one out of every four people with depression seeks treatment. That is unfortunate,

number of books they hold. Anticipating leaving behind a third to a half of my books is painful. The other furniture is a lot easier to deal with because it doesn’t carry the same weight of emotional connection books do. Things are just that. Things. Books, on the other hand, carry life in their pages, life, and old friends, and a few enemies—those books I thought I ought to read, but have never made it past the first chapter. Others are books that have been a part of me since early childhood, nursery rhymes, fairy tales and folk tales that when I read them, I can still hear Mom and Dad’s voices reading to me, singing to me, and telling all kinds of stories. The rest fall into academic, pleasure, and cookbook categories. The papers should be somewhat easier, since they are of little use to me now that I no longer teach. Except. Except for paper copies of stories, poems, and books I have written. Those will be impossible to part with! I still ought to be able to cut 80 percent of the papers filling drawers and file cabinets. I am hoping, for instance, to condense all my paper records to fit a small plastic set with nine drawers, each four inches tall. There are tax records which are no longer relevant. Copies of insurance policies no longer in force still clutter my drawers and my desktop. I am giving myself three months to practice eliminating those things which have cluttered my life and my home. At that point I should be decluttered enough to actually decide whether to move or to stay, unencumbered with extraneous stuff! +

because recovery from the vast majority of mental health problems, including depression, is not only possible, it is actually likely. It is the expected outcome when people get the specific kind of help they need, even in cases where the situation seems chronic or severe. That does not mean that depression is not serious, or that it is not a real illness. It is. It is not something that

someone can “just snap out of,” or that is the result of laziness, weakness of character, or “just a phase” someone is going through. “Try harder” is not a recipe for ending depression. Myths and misinformation about depression falsely brands people who have it, and can shame them from getting the help they need, another factor behind the only-onein-four statistic mentioned earlier. No one feels ashamed because they have the flu; it should be the same with depression. Help is available. Get it. Ask your doctor. +

MAY 3, 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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want to tell you my story now,” a patient recently told me, a woman who suffers from many physical and emotional ailments. She had the diagnosis of PTSD on her problem list, along with hospitalizations for “stress,” but I never asked beyond that. “OK,” I answered, not knowing what to expect. “Tell me your story.” She paused for about 30 seconds, but I knew not to interrupt the silence. “I killed my husband,” she finally said. That was unexpected. She went on to explain a horrible set of circumstances involving alcoholism and physical violence, that resulted in her shooting her husband in selfdefense. She spent the two following years on trial for murder, eventually being cleared on all accounts. Despite this, the rifts in her family continue, and she (obviously) still relives this terrible moment. Deep breath. How could any emotional instability ever be held against this woman? Who wouldn’t struggle? It brings me back to my oft-repeated mantra: everyone has a backstory. Not all backstories are so dramatic. One woman, who is very lovely and vibrant from first meeting, revealed that it had been ten years since she was intimate with her husband. She does her best to hide the pain, but the toll of feeling unloved and rejected over ten years has taken a heavy toll. In some ways, her skill at hiding the pain inside causes even more pain, as she faces the daily need to screw up happy emotions she doesn’t have. In her own way, this pernicious pain of rejection has made her walk through life feeling distant from everyone. She smiles to everyone, but the pain doesn’t leave. How can I know what this is like? But in a way, I do know, as backstories are not limited to the patient side of the equation. I know physicians and nurses dealing with empty marriages, the demons of addiction, rebellious children, the deaths of parents and children. As professional as I try to act, there is no way I cannot bring my own pain to my relationships with patients.

Perhaps there’s a mention of something by a patient that triggers memories, or perhaps the pain in my life drives me to seek emotional harvest from the praise I get from my patients. As hard as we all try to do otherwise, our encounters between doctors and patient are human to human, frail to

“I killed my husband.” frail, broken to broken. We strive for objectivity, but are always looking up from our own valleys of circumstance. So is this a bad thing? Is the ultimate ideal one of objectivity and clinical impassivity? Does it hurt me to feel deep compassion for those people in such pain? Does it hurt my patients to have me bring my own pain into the patient encounter? As always, the answer is probably “yes and no.” Clinicians often don’t know how to handle when patients don’t act predictably. Noncompliance with medication, diet, or other advice often elicit complaints, frustration, and even dismissal from the practice. Just as my emotions toward that idiot who cuts me off on the street jump to the conclusion that the he is either mentally deficient or is out to get me, the doctor often assumes the noncompliant patient is either stupid, apathetic, lazy, or out to waste the doctor’s time. I’d probably be less mad at the guy who cut me off if I knew that his wife had just died. In the same way, compassion gives slack to the rope when dealing with our patients. The very word “compassion” suggests feeling emotion alongside another person. It’s not an emotionless understanding, but an acceptance that the person got the way they are for a reason. I can only truly understand that through the lens of my own pain. In this way, our bringing our own pain to the exam room can be a great asset. Obviously, there is a limit to this. This is a job for which I am being paid. I must always strive to give the best care possible. My emotions, negative or positive, should not cloud my clinical judgment. Regardless of the severity of my bad day, I must try to hear what

the patient is saying and try to understand it. This doesn’t mean I always give in to their demands or to protect them from pain. Sometimes the confession of “I can’t do anything more” hurts to say, but it is better than giving false hope. I believe that many of the worst over-prescribers of pain and anxiety medications do so because they hate for people to be mad at them, and so can’t refuse people’s inappropriate requests for these medications. This not only puts the patient at risk, it legally and professionally puts the physician’s career in jeopardy. But even when I rebuff requests for unnecessary treatments, testing, or inappropriate medications, I must be aware of the patient’s emotional state. It sucks to have pain. It hurts to be anxious. Loneliness makes us look for escape. I find that, more than anything, people want understanding. People accept my answers much better when I show that I understand their pain, and hence their desire to get rid of it. Which brings me to the most important issue: relationship. Our current system has stripped healthcare of its heart. We are judged by the codes and data we submit, not the care we give. We follow the recipe for treating a condition or avoiding certain meds, not paying attention to the huge underlying issues. We fragment care between providers, and have ripped away any opportunity to hear and be heard by requiring obtuse documentation and profuse data submission. So how can we ever expect good care to happen? My patients listen to me because I listen to them. My patients believe me because I know them. I can tell the person they don’t need more narcotics because they know I care about their pain (even if I can’t do anything about it). This takes time. It can’t be measured. It is not a computerized task; it is a human relationship. That’s what good care is: human to human, frail to frail, broken to broken. If my patients know I’m human, they don’t ask me to be superhuman. It’s that simple. It’s that difficult. +

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MAY 3, 2019

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Questions. And answers. On page 13.

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.

MAY 3, 2019

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GARDENVARIETY

I was looking for a way to get my family to eat more fresh vegetables besides the usual salad. That’s when I came up with the idea of creating a recipe for vegetable spring rolls with yummy peanut sauce. They are a delicious and easy way to get a rainbow of veggies all wrapped up into one eye-popping meal. The great thing about spring rolls is you can make them any way that suits your diet needs. They can be keto, gluten-free, paleo, FODMAP friendly, or vegetarian, whatever suits your desire. Spring rolls are a fantastic way to wrap up great nutrition for an appetizer or a meal. This recipe packs a good for you punch in every bite. Mint – antioxidants + calms the stomach Cilantro – Vitamin C + antioxidants Bell Pepper – vitamin C, carotenoids + fiber Mango – vitamin C, fiber + antioxidants Carrot – beta carotene + vitamin A Basil - magnesium + vitamin K Watermelon Radish - fiber + vitamin C The star veggie in this recipe is the watermelon radish. If you have never had one before, give it a tray. You can purchase them at our local farmers market or some local grocery stores carry them. The watermelon radish is a member of the mustard family, which includes arugula, broccoli, and Vegetable Spring Rolls turnips. It has an edible round white julienne cut root with a green stem and leaves. The • 3 small watermelon radishes sliced with a inside flesh is rimmed in white with a mandolin (carefully) dark pink circular pattern, resembling • 1 ripe mango, peeled and cut into small cubes a watermelon; hence it’s named. You • 8 ounces cooked rice noodles will enjoy the radish’s crisp, sweet, • 1 small bunch of cilantro mildly peppery taste. When picking out • 1 small bunch of basil watermelon radishes, select those that are firm, without bruises or cracks. Keep • 1 small bunch of mint them in the refrigerator vegetable drawer Peanut Dipping Sauce until ready to use. • 1/2 cup salted natural peanut butter, no sugars added Vegetable Spring Rolls with Peanut • 1 tablespoon soy sauce Dipping Sauce • 1 tablespoon brown sugar • 1/2 medium lime, juiced Ingredients • 1 clove garlic minced • 7 spring roll rice papers • One-fourth each of a yellow, red, green • 1 teaspoon fresh grated ginger and orange pepper, seeded and sliced in • 1 teaspoon Sambal Oelek Chili Paste • hot water to thin as needed thin strips • 2 small rainbow carrots, peeled and Please see GARDEN VARIETY page 10

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ASK DR. KARP

NO NONSENSE

NUTRITION

Sally, a student at Augusta University, asks: “Are there foods or supplements that can prevent, slow down, or reverse aging?”

The answer to this question is a simple, “Yes and No.” See how simple? If you think that you can eat certain “superfoods,” “anti-aging foods,” free radical scavengers, supplements, and vitamins to prevent, slow down, or reverse aging, then the answer is a big, “NO.” But if you understand that what you eat throughout your entire life, your activity level, and your weight during most of

your life will affect how you age, then the answer is a big, “YES.” If someone were to ask me what is the most important nutritional factor related to aging, I would have no hesitation to say, “your weight.” Being overweight, fat, or obese ages your body. So, that cartoon you see of a plump grandma or grandpa retiring to a rocking chair on the porch to “take it easy” as s(he) gets older…that is “backwards thinking.” Hey, grandma and grandpa, lose weight and get off that rocking chair if you want to live longer, age better, and feel better. There is a lot of scientific data supporting the idea that being at the low end of your reasonable body weight (being skinnier) is associated with being much healthier and living much longer and better. In contemporary America, where many people are either on the high end of their reasonable weight range or overweight or obese, it means that in the coming years we will be around a lot of people who are aging very badly In addition, being overweight is a sure recipe for joint problems as you get older, whether it is an ankle, a knee, or a hip. Did you know that the very best thing you can do for your joints is not being overweight? Joint health has nothing to do with taking

those popular glucosamine/ chondroitin supplements. In fact, the science shows that taking glucosamine/chondroitin supplements has no effect on joint health, either preventing joint problems, or helping to repair joints once they are damaged. So stop believing those commercials. And that goes for those pet commercials about joint health, too. If Alzheimer’s disease runs in your family, the most important thing you can do to decrease your risk of this disease as you age is to live a healthy life. All the factors related to heart disease, stroke, and diabetes are also related to the development of Alzheimer’s disease, factors such as being overweight, having high blood cholesterols, and being inactive. Have you been sitting in a chair doing crossword puzzles or sitting in front of a computer doing those “mind games,” thinking that doing mental exercise is the way to prevent Alzheimer’s disease?

MAY 3, 2019

The science shows that it’s physical exercise, not mental exercise, that is the most important type of exercise for brain health. Get up from that computer or TV chair and go outside for a walk instead. In addition, make sure you are controlling other cardiovascular risk factors, like your blood cholesterol and your diabetes. Guys, if you want to continue having a great love life as you get older, stop eating all those hamburgers and fries, lose weight, and start running, walking, jogging, cycling, or swimming. Cardiovascular disease is a major cause of erectile dysfunction as we age. Erectile dysfunction is so strongly related to cardiovascular disease that even young men with erectile dysfunction are routinely worked up for heart attack and stroke risk. To keep on getting high love scores from your significant other, be healthy. Don’t damage blood flow by clogging your arteries with fat, smok-

ing, having diabetes, or having uncontrolled high blood pressure. These are guaranteed ways of making you feel real old, real fast, especially in the love-making department. One of the biggest areas of quackery when it comes to nutrition and aging is thinking that you can take certain supplements and antioxidants to retard aging. It just ain’t so. It’s how you’ve been living your life for the 75 years before you are 75 that most determines how you have aged and the quality of your life for the rest of your life. The idea of “anti-aging” supplements and/or foods is just wishful thinking, sorry to say. And if you think you can smear vitamin and mineral-enriched ointments and creams onto your skin and retard skin aging, think again! Try sunscreen instead. So, I hope I have helped you get this aging and nutrition idea into perspective. The bottom-line, “No-Nonsense Nutrition” advice when it comes to aging? Your weight, your activity level, and how you live your life as you age… these influence how you age, not some silly supplements or superfoods. Age well, my friends. I want to have you around reading my Medical Examiner columns for many years to come. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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SET YOURSELF UP FOR SUCCESS WITH SMART GOALS by Valerie Lively RD, LD, CDE MOVE! Coordinator at Charlie Norwood VA Hospital

It has happened to us all… We start the year off strong in January. We set a New Year’s Resolution, something that feels like a goal that we want to accomplish in the calendar year! The resolution may sound something like this: This year I will… “Lose 30 pounds” “Get fit” “Improve my health” “Run a 5K” It may even be something that is not directly health related, such as: “Save money” “Move to a better location” “Go back to school” Then time slips by and next thing you know… The temps are warming up and summer is right around the corner! Half the year is gone and NO PROGRESS! How does that happen? Everything listed above is a really good intention. Unfortunately, intentions sound like goals, but because there is

no specific action behind the intention they don’t necessarily move us in the direction we want to go. How can our intentions

be transformed into SMART Goals? Putting action behind our intentions will get us where we want to be. SMART Goals are kind of like directions on a map. For example, if I said “I want to go to New York,” that is pretty broad. I might start off driving north and figure I would (maybe) end up in New York eventually, but it would take me a lot longer to get there than if I had a plan. Plus, I would not know when (or if) I had arrived as I didn’t have a specific end point in mind.

But if I said “I am going to the Statue of Liberty” and I enter that into my map app, I will get a specific set of turns to get me there. I will also be aware of how long it will take me to reach my destination because I have a specific driving plan. Parts of a SMART Goal SMART is an acronym for a goal that you set for yourself based on your lifestyle and the things you want to accomplish. No one knows us like ourselves, therefore, when it comes to making life changes, we do best when we set our own goals. This is also part of the heart of Motivational Interviewing. When we decide what and how we want to change, we are much more likely to do it. Now you are ready to set some goals! Lets look at what makes a SMART goal so you can get moving toward your good intentions. Please see SMART page 10

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Frank K. Beech Island, SC

H H H H H 4/27/2019 I saw a sign in the window of a business today. It said “We deliver.” That is not only disgusting; it’s frightening. I mean, can they do that? It’s illegal, right? + H H H H H 4/27/2019 Ok, so when I hear “liver and onions,” is that two organs or whatever, you know, like “heart and lungs,” or is it a food? If it’s a food, it doesn’t sound like anything I would eat. +

Leon R. Evans, GA

H H H H H 4/28/2019 If someone told me I was lily-livered (I’m not saying they have, I just mean if they did), is that something I can treat on my own, or would that require medical attention? Is it possible that I’ll have to have surgery? Anyone who has been diagnosed as lily-livered, please post here or PM me. +

Kerry K. Aiken, SC

H H H H H 4/29/2019 Dude, you’re hilarious. That’s an insult, not a medical condition. Are you for real? +

Adam P. Augusta, GA

H H H H H 4/29/2019 We were in London on vacation earlier this spring and I was surprised to discover they do not have a blood bank in England. They do have a Liverpool, though. +

Ronaldo J. Grovetown, GA

H H H H H 4/30/2019 I don’t know a lot about the liver and what its purpose in the body is, but it can’t be too important if the term liverwurst describes it. So it’s the wurst organ in the body. Wow. +

Geraldine Q. Martinez, GA

H H H H H 4/30/2019 Now that I’m getting older, I’m getting these spots on my hand that my doctor has misdiagnosed. He says they’re liver spots. That’s crazy. I hate liver. I haven’t eaten any since I was a kid. +

Barry C. Augusta, GA

GARDEN VARIETY… from page 7

Add all ingredients into a mixing bowl except the water. Whisk together until creamy and smooth. If needed add warm water a tablespoon at a time until desired consistency is achieved. Set aside. Spring Rolls Prepare all vegetables and fruit as directed, place all together in preparation for rolling. Fill a cookie sheet 1/2 way with warm tap water. Submerge one rice paper in water to soften for about 20 seconds then lay on a damp towel, fill and roll. See my web site (below) for detailed rolling instructions. Serve with Peanut Dipping Sauce. +

Abdominal gland and biochemical factory Working now? Always Take-Out Available? No Good for: Digestion, bile, hormone production, glycogen storage and more

Kenneth A. Augusta, GA

MAY 3, 2019

H H H H H 5/1/2019 I said something to this friend of mine that I guess he didn’t like. His response was, “What am I, chopped liver?” I don’t get it. Have you ever seen chopped liver? There is no comparison. +

MEDICALEXAMINER

FRIENDREQUEST Drop by Facebook today and click “Like” on our page. Thanks in advance!

www.facebook.com/AugustaRX

by Gina Dickson. “As a mother of six who beat cancer, I want to share with you what I learned through my journey. I know healing from cancer can take everything a mom has, yet you still want to love and care for your family through the treatments. My blog is a community full of encouragement for moms going through cancer treatments who would like to use a plant-based vegan diet to complement their healing journey. www.thelifegivingkitchen.com

SMART… from page 9

SMART stands for: Specific – This is the specific action you will take. Example: Avoid the salt shaker at lunch on Tuesday and Thursday. Measurable – It should be measurable, so you know you accomplished your target. Example: Walking 30 minutes at least 2 days per week Action oriented – The goal should make you do something different. Example: When dining out, I will order water instead of soda. Realistic - it should be within your ability to get it done. Also the goal should be something you can meet given your current life situation. Avoid setting your sights on things that aren’t realistic, you want your SMART goal to be something you can keep doing to help reach your desired target. Time sensitive – make sure your goal has some kind of time frame so that you know you got it done or made progress. Comparison is the Thief of Progress When setting SMART Goals, be careful not to judge yourself against someone else’s goals. For example, lets say you want to be more physically active. Try tracking your steps, and set a goal to add 500 steps to it at least 3 out of 7 days the following week. While that may end up not being as much as someone else, it really doesn’t matter. SMART Goals are about YOU and improving YOUR health. No one can set them for you but YOU! Set 2 or 3 SMART Goals We are much more likely to BE successful when we FEEL successful! So when setting your SMART goals, limit the number you set to 2-3 goals. Do not set a dozen of them! It might get so overwhelming that you quit. Instead, make 2-3 goals that you feel like you can live with. As you feel more successful, you will find yourself just naturally taking other healthy steps. Remember, today really is the first day of the rest of our lives… make these coming days your healthiest ones! + References: Rollnick, Stephen, William R. Miller, and Christopher Butler. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: Guilford Press, 2008. Print. Frates, E. P., & Bonnet, J. (2016). Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change. American Journal of Lifestyle Medicine, 10(5), 302–312. HYPERLINK “https://doi. org/10.1177/1559827616638013” https://doi.org/10.1177/1559827616638013

WANT THE EXAMINER IN YOUR MEDICAL OFFICE?

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.

MAY 3, 2019

The blog spot — posted by Emily Weston, FNP-C,RN, on April 22, 2019 (edited for space)

I SPEAK FOR THE NURSES “I would submit to you that those (small hospital nurses) probably do get breaks. They probably play cards for a considerable amount of the day.” – Maureen Walsh Recently, Washington State Senator Maureen Walsh implied that nurses already have too much time on their hands and, furthermore, we spend it playing cards. Why did tens of thousands of nurses on Twitter become infuriated? Because so many of us give our lives to this job and still feel we are failing our patients. We hate feeling inadequate. We hate it when our soiled patients have to wait, to lay in dirty embarrassment while we attend to something more important. We hate being late with our meds, knowing our patients are waiting in pain. We agonize over missing critical changes that tell us our patients are going downhill. We cringe when we turn a delicate elderly woman and find a new pressure sore, because we did not have time to turn her. When a family member comes in angry because no one is feeding his mom. All we want, all we’ve ever wanted, are the tools to do our jobs; to care for our patients and God forbid that involves hydrating ourselves. There is no data on how many nurses routinely do not eat during their shifts and neither has there been research done on how long the average nurse will keep working without stopping to pee or to change a tampon. But if you ask us, we will tell you. It happens all the time. In Maureen’s view, forcing hospitals in Washington to mandate breaks is appeasing an already lazy, and apparently gambling-prone population, ushering us into further ineptitude. In a nurse’s view, it guarantees we can take a bathroom break. A few years ago, I wrote a short story about a nurse. There’s a bit in there where the nurse sneaks into the med room to eat an illegal Clif Bar. When I read this at an awards ceremony, that part got a laugh. I was puzzled, and then I realized, my God these people don’t get it. They don’t know we actually aren’t allowed to eat in patient care areas. We might get a moment to sit down and chart, but some higher up entity has decided that it is dangerous for us to sip water or munch on a granola bar while we do so. Eating and drinking is required to take place in a separate area, and many nurses simply don’t get the time to go there. Because patients always come first. In our quest to manage pain, stop hemorrhages, restart hearts, catch babies, comfort children and hold the hands of the dying, we put ourselves last. Wouldn’t you? Don’t demean our entire profession and all of the amazing things we do by saying we play cards at work. All we’ve ever wanted is to be able to do our jobs; to take good care of our patients. We need intelligence, strength, teamwork and a whole lot of patience. Sometimes we need a water break. We certainly don’t need card playing skills, and we don’t need politicians who have no idea what nursing entails to make sweeping and derogatory generalizations about our profession. We need leadership who want what we want; good patient outcomes, and are willing to give us the tools to make that happen. + Emily Weston is a nurse practitioner who blogs at Nursing: A Confession.

SUBSCRIBE TO THE ONLINE EDITION! IT’S FREE! Just go to www.issuu.com/medicalexaminer and enter your email address.

11 +

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From the Bookshelf In just a little over 300 pages, this book will tell you everything you’d ever want to know — and a few things you’d probably rather not know — about what it’s like to be a shiny new doctor. People stereotype doctors as possessed of huge egos. Maybe that’s true sometimes. But as readers of this book will appreciate, long before the god complex surfaces, freshly minted physicians have to battle feelings of overwhelming panic, fear and insecurities, frantic schedules, utter exhaustion, and the distinctly dreadful feeling of being in way over your head in life and death situations. It doesn’t matter that on Day One of med school every student is already a college graduate, often on a premed track. It doesn’t matter that four rigorous years of training follow. It doesn’t even matter that upon graduation those two letters — M and D — now are an official part of your name. Despite all of that, a physician’s training is still a long way from complete. In some ways it’s never over,

but let’s not get ahead of ourselves; let’s stick with year one, the daunting road taken between the covers of this book. First-year doctors are also known as residents: during their 4th year of medical school, soon-to-graduate students are “matched” via a national program with a hospital residency vacancy from each resident’s own short list of preferences. There, as M.D.s, their training continues in a sort of on-the-job apprenticeship program. In all, from leaving high school to becoming a

full-fledged doctor takes a minimum of 11 years. Residencies can last from three to seven years, depending on the resident’s field of medicine. This book then, is a peek into Year #9 of 11 (or more) in the process of becoming a doctor. While this book tells of experiences that range from humorous to absolutely harrowing, it’s reassuring (for patients, at least) to have a bird’s eye view into how extensive and exhaustive (no pun intended) the training is to become a physician. If you’re about to graduate from med school or will be in a year or two, or you’re just someone who finds the medical profession fascinating, you’ll enjoy being perched on McCarthy’s shoulder for this very candid look at the trial by fire that is every physician’s first year in the trenches of medicine. + The Real Doctor Will See You Shortly — A Physician’s First Year by Matt McCarthy, M.D., 336 pages, published in April 2015 by Crown

Research News Move it, ladies! A national survey of 19 million women by Johns Hopkins Medicine says the number of women who are not physically active enough is high and growing. Since those asked were women with preexisting cardiovascular disease, the findings have troubling implications. For one, their state of health might already be somewhat precarious. For another, the very women who are not exercising enough have most likely been counseled by their healthcare provider to increase their activity levels to maintain optimal cardiac health. Also, and not insignificantly, healthcare costs among patients who meet American Heart Association (AHA) physical activity guidelines are about one-third the cost of those who do not. While every patient’s case is different and each patient should consult with her own

doctor, the AHA offers the general recommendation of 150 minutes of at least moderate physical activity each week. That averages out to 30 minutes of brisk movement per day, five days a week. The AHA activity guidelines apply both as preventive medicine (to avoid cardiovascular disease or reduce a woman’s odds of developing it) and to aid recovery after a heart attack or stroke (known as secondary prevention). In 2006, 58 percent of women surveyed said they were not in compliance with AHA recommendations; by 2015 the number had risen to 61 percent. Study authors point to the increase as evidence that physicians whould continue to promote exercise as part of cardiac rehabilitation. Migraine decreaser A meta-analysis of numerous studies presented

last month at the annual meeting of the Endocrine Society says that for migraine sufferers who are overweight or obese, losing weight can decrease headaches. While the connection between migraines and obesity is not yet understood, weight loss was linked to headache frequency, pain intensity and disability, and attack duration. The benefits accrued whether the weight loss was achieved through bariatric surgery or diet modification. In addition to the migraine-reducing benefits, the study identified lessening of other significant health impacts associated with weight loss, including coronary artery disease, hypertension, diabetes, respiratory disease and stroke. Combined, all the benefits of weight loss translate to the possibility of major improvements in length and quality of life. +

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The Examiners

MAY 3, 2019

by Dan Pearson

Let’s see...I’ve got Country Crock...I Can’t Believe It’s Not Butter...They’re lower in Well, it isn’t the 1950s So do you have anything saturated fat than butter anymore, okay? for a burn or not? and cholesterol-free.

Have you got any butter? Butter? You don’t put butter on a burn! My grandmother I burned my finger. sure swore by it.

The Mystery Word for this issue: CESEPH

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Brown, for one 6. Deception 12. Garlic-seasoned mayonnaise 13. _____ oil 14. Girl’s stuffed toy 16. Phone or power company worker 19. Acute care dept. 20. Separated 22. New prefix 23. Wound reminder 25. Enclosed automobile 26. Fracture remedy 27. Islamic sacred book 29. Like some recruits 30. Dimwit 31. Expulsion, dismissal 33. Miscarriage (Latin) 35. Lump 37. _____ Ming (NBA) 38. Law 41. Senior senator from South Carolina 45. Brunswick alleys 46. Enemy 49. Sea or moon follower 50. Off-Broadway award 51. The Donald 53. Slim and fit 54. Lou Gehrig’s letters 55. Oakland players 57. Small lump 58. Similar to mesh 60. Pertaining to certain cats 62. Like some cereals 63. Stroke or seizure 64. Straighten 65. They can be of doubt

WORDS

NUMBER BY

1 11

24 28

26 29

32 35

33 36

53 56

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MAY 13, 2019

We’ll announce the winner in our next issue!

7 5

5 4 3 1 5 3 2

2 6 7 3 9 8

9 2 1

S U D O 4 K 6 U 2

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

DOWN 1. Team based on Walton Way 2. Assist 3. Ambiance 4. Riverside Smoke Bar-B-Que street (in downtown Augusta) 5. 25th metal? 6. Like many cots 7. Extraterrestrial 8. Sort 9. Famed Joanne Woodward film role 10. Remainder 11. Late AU Dean of the College of Dental Medicine 15. Answerable, responsible 17. Greek god of medicine 18. Short letters 21. First Lady in 1900, wife of William 24. Step up to the plate 26. Mongrel dog

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

E4 X8 A M I N E5 R

THE MYSTERY WORD

28. Ethiopian monarch 30. Portals 32. Decay 34. Papa had a brand new one 36. Help; support; reach out as an ally 38. Kettering partner 39. Marley & Me co-star 40. Casual shirt 42. Pretense 43. Type of Aiken racing 44. One belonging to a group 47. Mandolin or lute of Arabia 48. Vomitus 51. Film trilogy starring Liam Neeson 52. Cost 55. Religious practice 56. Satisfy 59. Biopsy destination 61. Mire

4 7 3 5 8 2 O T H 7O 4 P H 6Y 3 N E 1E 9 T E 2E 6 5 1 9 8 — Patrick Meagher

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.

S 1 2 3 4

1 2 3

A 3 4 5

2 1

S 2 3 4

6 5

3 — Gertrude Stein

1.AAAWIST 2.AGHLERN 3.MEEEWS 4.IEA 5.DY 6.SE

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

9 1 6 8 5 2 3 4 7

2 7 4 9 8 6 1 3 5

1 8 3 5 2 7 9 6 4

6 9 5 3 1 4 8 7 2

MAY 3, 2019

THEBESTMEDICINE ha... ha...

Moe: Do you know why tigers have stripes? Joe: Because they don’t want to be spotted.

truck carrying a huge load of aspirin crashed near a bakery, spilling its entire load onto the baker’s young assistant, who just happened to be standing outside the bakery. The headline read, “Pills bury dough boy.” Moe: What would you say is your favorite body part? Joe: I guess my pericardial sac is probably closest to my heart. Moe: I invented a new word! Joe: Cool. What is it? Moe: Plagiarism. Moe: Do you know why dogs float in water? Joe: No, why? Moe: Because they’re good buoys. Moe: How’s that support group you joined? Joe: The one for anti-social people? Moe: Yeah, that one. Joe: We haven’t met yet.

Moe: You know to get a mouse to smile? Joe: Sure. You say cheese.

The

Moe: Why was the blonde so happy when she finished a jigsaw puzzle in only 6 months? Joe: I give. Why? Moe: Because the box said 3-5 years.

13 +

AUGUSTAMEDICALEXAMiNER

Moe: What do you get if you cross a lion and a jaguar? Joe: Eaten. Moe: Where do you work? Joe: At CounterSync on Riverwatch. We build custom countertops. Moe: Do you like your job? Joe: I’m their #1 employee. Moe: You must be very counter-productive. Moe: I read a profile of Kim Jong-un. It’s kind of weird, but apparently he never cries at funerals. Joe: Huh. Wonder why? Moe: The article said he’s un-bereavable. Moe: Your wife is threatening to leave you??? Why??? Joe: I have this weird habit of wearing a different t-shirt every ten minutes. Moe: What are you doing to convince her to stay? Joe: I said, “Honey, I can change!” Moe: If you were in Walmart and heard them announce, “For the next two minutes, everything in this store is absolutely free,” what would you get? Joe: Probably trampled to death. +

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 recently mentioned to a friend of mine who is in advertising and marketing that I’ve always thought that’s an interesting field. A few days later, he called to ask me if I wanted to intern with the firm where he works. He stressed that it’s a full-time unpaid position, but it could lead to a job offer. Of course, there’s no guarantee of that. Should I take it to get my feet wet in the field, or wait until I can get a paid position? — I’ll Take Your Admonition Dear Admonition, I would advise you to take a lesson from the pages of history and reject the get-your-feet-wet option, or at least make sure it is a temporary situation. My reasons date all the way back to Napoleon’s disastrous invasion of Russia in 1812. It has been said that Generals Janvier and Février (January and February) defeated Napoleon. Cold and wet conditions, coupled with a lack of provisions, meant that tens of thousands of soldiers endured wet shoes, socks and feet for weeks on end. Wet feet were a significant factor in thousands of incapacitated soldiers and deaths. What they suffered from got the name we still use for it today more than a century later: trench foot. That name was born out of trench warfare conditions during World War I. Trenches were more than just protection from flying bullets; they were also rain collectors. Drainage systems were not possible, so soldiers slogged through mud and water for days on end. That prolonged situation, made even worse in cold weather, would cause feet to become numb and turn red or blue because of poor circulation. Open sores, blisters, necrosis (cell death), fungal infections, gangrene and amputations are all complications of trench foot, which is not unique to warfare: outdoor music festivals held in rainy conditions that turn fields into mud have produced many cases of trench foot. The best cure for trench foot is prevention, and prevention is simple. Keep feet dry whenever possible. Use walkboards or pallets to prevent having to stand in water. If feet do get wet, remove shoes and dry the feet thoroughly, then put on dry socks. Soldiers would put small candles in cans and put the cans inside their shoes to help them dry out as much as possible. The bottom line: happy feet are dry feet. I hope this answers 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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Does Dementia Equal Loss of Capacity? While I was at the Aging Life Care Association conference this past week I heard one of the speakers discuss “Capacity,” meaning someone’s ability to make informed decisions that factor in their personal choices and their right to self determi-

the capacity to remember what they ate for lunch yesterday, but that does not mean they do not have the capacity to choose what they eat for lunch every day moving forward. Just because someone loses the capacity to remember to pay their bills on time does not mean they’ve automatically lost the capacity to pay their bills themselves at all, it just means they need assistance in making sure they are paid on time and correctly. Further along in one’s dementia journey they may not have the capacity to choose the safest living environment for themselves, but they may still have the capacity to choose if they want the room to be warm or cold, making it our responsibility to ask them how they like the temperature to be and set the thermostat accordingly. The reality is that just as each person’s experience with

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dementia is different, so is their ability and capacity to understand and make decisions and then act on those decisions. We must look at every scenario and situation separately, understanding that someone’s capacity to make an informed decision could even differ from day to day depending on many factors. Dementia is unpredictable, so we must refrain from stereotyping and making assumptions about those who live with the disease, especially when it comes to their capacity. +

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IT’S A QUESTION OF CARE

nation. What she was saying was not exactly new information for me, but it framed the subject in a new lens. As soon as someone receives a dementia diagnosis of some kind, many people assume they no longer have Capacity. In short, their diagnosis means they need assistance in making all decisions. However, the speaker at the conference said when people ask her if someone has capacity her reply is always, “Capacity to do what?” She was speaking straight to my core when she said that! She made it clear that Capacity is not and cannot be an all-or-nothing trait for anyone, even someone living with dementia. When someone has dementia it means that they will lose capacity over time. It does not mean they lose ALL capacity all at once. Perhaps someone loses

MAY 3, 2019

Lori Beth Charlton, MSW, LMSW, C-ASWCM is an Aging Life Care Professional who assists her clients and their families in choosing the best care options for their needs. She is committed to ensuring that her clients receive exceptional care by managing all of the details that create a positive environment for care.

AD BUDGET? Works for us. Call 706-860-5455. Let’s talk!

PROFESSIONAL DIRECTORY +

ACUPUNCTURE

DENTISTRY

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

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

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

AMBULANCE SERVICE

IN-HOME CARE

Floss ‘em or lose ‘em!

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048 Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

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)

706-863-9800

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

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

Medical Center West Pharmacy 465 North Belair Road Evans 30809 Georgia Dermatology & 706-854-2424 Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) www.medicalcenterwestpharmacy.com Augusta 30904 Parks Pharmacy 706-733-3373 SKIN CANCER CENTER 437 Georgia Ave. ARKS www.GaDerm.com HARMACY N. Augusta 29841 803-279-7450 www.parkspharmacy.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

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

TRANSPORTATION Caring Man in a Van Wheelchair-Stretcher Transports • Serving Augusta Metro 855-342-1566 www.CaringManinaVan.com

VEIN CARE

PHARMACY

DERMATOLOGY

AMBULANCE • STRETCHER • WHEELCHAIR

SLEEP MEDICINE

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!

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