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NOVEMBER 16, 2012

Another respiratory enemy THE SKINNY

MIRACLE MILE WALK EXCEEDS GOAL TO FIGHT BREAST CANCER The fight to prevent breast cancer continues stronger than ever before thanks to record-setting support of University Health Care Foundation’s 12th annual Miracle Mile Walk. This year’s walk on Saturday, Oct. 20, at the Augusta Common: • Saw a conservative estimate of 9,000 walkers – compared to 7,000 in 2011 • Celebrated the 457 survivors who checked in – compared to 300 in 2011 • Raised $348,000 (and still counting) – compared to $288,000 in 2011 “What this tremendous support means is that no woman who needs a mammogram will ever be turned away – ever,” stressed Laurie Ott, President of University Health Care Foundation and Vice President of Community Services for University Health Care System. “We thank the many, many people who opened their hearts and opened their pocketbooks to assist University Hospital in the fight against cancer. You have joined forces with an incredible team, and together we save lives every day.” The Miracle Mile Walk is an annual three-mile fun walk in which women and men in the CSRA have the opportunity to support a family member, friend or coworker diagnosed with breast cancer. It begins and ends with celebrations at the Augusta Common. People who wish to support the effort to save lives can still give on line at www.themiraclemilewalk.org or by calling 706/667-0030. One hundred percent of the proceeds of this walk stay in the CSRA to help fight breast cancer. +

to get vaccinated against the flu and bacterial pneumonia.

This month a lot of attention is focused on the evils of tobacco use, which is as it should be: tobacco is a major cause of disease, disability and premature death. Meanwhile, another respiratory disease causes more deaths than any other infectious disease. Pneumonia is an infection of the lungs that is usually caused by bacteria or viruses. It can often be prevented and can usually be treated. Every 20 seconds somewhere in the world, a child dies from pneumonia. Many of these deaths are preventable through vaccination and appropriate treatment.

Types of Pneumonia You may have heard of community-acquired pneumonia (CAP). When someone develops pneumonia in the community (not in a hospital), it’s called CAP. Pneumonia developed during or following a stay in a healthcare facility (like hospitals, longterm care facilities, and dialysis centers) is called healthcare-associated pneumonia (HCAP), which includes hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). In the United States, the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) and the most common viral causes are influenza, parainfluenza, and respiratory syncytial viruses. In children younger than 1 year of age, respiratory syncytial virus (RSV) is the most common cause of pneumonia. Other common bacterial and viral causes of pneumonia in the United States include Staphylococcus aureus and adenovirus.Pneumocystis jirovecii, a fungus formerly known as Pneumocystis carinii, is a common cause of pneumonia in patients with AIDS.

What is Pneumonia? Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia. This includes adults 65 years of age or older and children younger than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia. Causes of Pneumonia When bacteria, viruses (or rarely, fungi) living in your nose, mouth, sinuses, or the environment spread to your lungs, you can develop pneumonia. You can catch the bacteria or viruses from people who are infected with them, whether they are sick or not. Encourage friends and loved ones with certain health conditions, like diabetes and asthma,

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Reduce your Risk Pneumonia can be prevented with vaccines. Following good hygiene practices can also help prevent respiratory infections. This includes washing your hands regularly, cleaning hard surfaces that are touched often (like doorknobs and countertops), and coughing or sneezing into a

ON PNEUMONIA

Each year across the globe, pneumonia kills more than 1.5 million children younger than 5 years of age. This is greater than the number of deaths from any other infectious disease, such as AIDS, malaria or tuberculosis. Access to vaccines and treatment (like antibiotics and antivirals) can help prevent many pneumoniarelated deaths. Pneumonia experts are also working to prevent pneumonia in developing countries by reducing indoor air pollution and encouraging good hygiene practices. In 2009, 1.1 million people in the United States were hospitalized with pneumonia and more than 50,000 people died from the disease. +

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AUGUSTA MEDiCAL EXAMINER

NOVEMBER 16, 2012

NOVEMBER IS LUNG CANCER AWARENESS MONTH

Tobacco use hits us close to home by Dr. Samir N. Khleif Director, Georgia Health Sciences University Cancer Center Smoking hits close to home for most Georgians. About one in five adults, one in four teens and one in nine tweens in the state are smokers. Smoking also hits close to home for cancer clinicians and researchers. We see the results every day: lung cancer (90 percent of which is caused by smoking) as well as cancers of the head, neck, esophagus, stomach, kidneys, bladder, cervix and blood—all of which share smoking as a risk factor. More people die from lung cancer every year (around 160,000) than any other, including cancers of the breast, prostate, blood, skin, colon and rectum combined. The best solution? Quit tobacco use and quit smoking. You may be surprised to know that quitting has immediate benefits. Within hours, the level of carbon monoxide in your blood begins to decrease. Heart rate and blood pressure, which go up while smoking, return to normal. And within the next weeks or months, you cough and wheeze less, while enjoying an improved sense of smell, which means food will taste better. In the long term, quitting helps reduce your risk of premature death—a 90 percent risk reduction if you quit by age 30, and a 50 percent risk reduction for those who quit by age 50, according to the National Cancer Institute. To help quit tobacco use, my colleagues and I at the Georgia Health Sciences University Cancer Center recommend two strategies, which can double your chance of success: 1) Behavioral skills training. Resources including your physician, hotlines (Georgia’s is 877-270-7867) and support groups can provide advice and support on tobacco cessation. 2) Medications. Nicotine replacement—available as patches or gums—can help overcome tobacco addiction over time. Another option is medication that targets nicotine receptors in the brain. (Talk to your doctor for more information.) But, because lung cancer still affects 40 percent of ex-smokers and 10 percent of those who have never smoked, research must remain an important focus. Lung cancer continues to lag behind in research funding. At least double the amount of research dollars (including $631 million in National Cancer Institute funding in 2010 alone) target breast cancer. Better funding means better treatment. If we are to improve the health of Georgians, smoking and tobacco cessation must be at the top of our to-do list. On the state and national level, we need more research funding. These additional dollars can yield new therapies that will reduce the number of deaths from lung cancer, and develop more community prevention strategies. On a personal level, education is nothing without action. Parents and caregivers, we encourage you to serve as healthy role models so your children never start smoking. If you do smoke, we invite you to take the first step in quitting: Call your doctor, call Georgia’s free quit line, or, if you’re ready, throw away that pack. Please take this step today, for better health and better quality of life for you and your family. + Dr. Samir N. Khleif has more than 22 years’ experience in cancer research and treatment, including in the Cancer Vaccine Section at the National Cancer Institute. The GHSU Cancer Center is working toward becoming Georgia’s second National Cancer Institute-designated cancer center.

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n the eve of the Great Amercian Smokeout, the Medical Examiner conducted a very limited poll of our largest area healthcare providers to gauge their official positions on smoking by their patients, employees, and visitors. We asked Trinity Hospital, University Health Care System, Georgia Health Sciences University, and Doctors Hospital for information about their campus smoking policies. Given the business they’re engaged in — healthcare —one would expect all hospitals to be completely smoke free, including veterans hospitals. To us, it seems incumbent upon any and all individual physicians, and especially large groups of physicians and all their attending allied health professionals —in other words, hospitals, to say nothing of physicians in private practice — to be completely, 100 percent smoke-free. Unfortunately, that isn’t the case. Two of the four hospitals we surveyed allow smoking in designated areas. Although Doctors Hospital has been officially smoke-free for three years this month, “we have

a small designated smoking area at the back of our campus,” says Barclay Bishop, Doctors’ public relations manager. “The policy is enforced by security and employees of the facility.” At University Hospital, director of corporate communications Rebecca Sylvester says, “We discourage use of tobacco products, but allow smoking in designated areas.” Whereas Doctors has “a small designated smoking area at the back of our campus,” at least one of University’s designated smoking areas is in a very public major pedestrian traffic area: patients and visitors leaving the rear entrance of its (fairly) new Outpatient Center or Professional Building 1 to go to the pharmacy a few feet away often walk into a cloud of cigarette smoke. A narrow sidewalk leads to the pharmacy through the gauntlet of a designated smoking area. An odd place for a designated smoking area, to be sure. As for enforcement, says Sylvester, “If we see people smoking in undesignated areas, we ask them to move to designated areas. Our policy does not address ‘penalties.’”

At Trinity Hospital, Rachel Covar, marketing director, reports that Trinity is a smokefree campus and has been since 2009, offering no designated smoking areas. Its policies are “enforced by Campus Safety officers and hospital personnel.” Finally, GHSU has had its tobacco-free campus policy in effect since 2007. It specifically addresses all areas of campus as being under the ban, including all buildings, parking lots, green spaces, and even inside the personal vehicles of employees and visitors. Enforcement, says the policy, is the direct responsibility of GHSU Public Safety or MCGHI Safety & Security. “Employees who violate the policy will be subject to appropriate disciplinary action...up to and including dismissal.” Perhaps by November of 2013 we’ll be able to report that all hospitals in the Augusta area are by policy and enforcement 100 percent smoke-free. + What’s a good way to approach someone smoking in a non-smoking area? Visit the Medical Examiner blog (www.AugustaRx.com/news) for tips.

Why subscribe to the Medical Examiner? Why would anyone pay for a subscription to a free newspaper? That’s certainly a legitimate question. The answer: as a major regional medical center, patients come to Augusta hospitals and physicians from all over the Southeast. The MCGHealth Medical Center alone sees patients from every single county in Georgia, not to mention South Carolina, Florida, and beyond. Add to that the regional reach of Eisenhower Army Medical Center and both Veterans Administration hospitals, the Joseph M. Still Burn Center at Doctors Hospital, MCGHealth Children’s Medical Center, Walton Rehab and University Hospital, and it’s clear that many people seeking treatment in Augusta are not local residents. Furthermore, some of our most loyal readers are in town only occasionally. Or their treatments and visits to Augusta are only temporary. Even local residents may find it more convenient to walk to their mailbox than visit one of our many newsstands. Subscriber copies are mailed the day prior to the issue date so they will be received by most readers no later than the publication date printed on the paper. Copies are sent by First Class mail in a sealed envelope so they’ll arrive promptly and in crisp condition. Rates are $16 for a 6-month subscription (12 issues), $32 for a full year (24 issues). Complete the form below and drop it in the mail with your payment. Thank you! + + +

What’s your story? Nearly all of us — even doctors and nurses — are sometimes patients. Perhaps you were recently injured playing your favorite sport, or years ago you somehow got hurt without even leaving your favorite recliner. Maybe you were diagnosed with a dreaded disease, mugged in a dark and lonely parking lot, or you stubbed your toe in the safety of your own bedroom. On the other hand, perhaps you needed medical attention 5,000 miles from home. Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale, bylined or anonymous. We’ll publish your encounters with the medical profession as often as we receive them. + Send your submissions for Medicine in the First Person to the Augusta Medical Examiner via e-mail: info@AugustaRx.com or to PO Box 397, Augusta, GA 30903-0397. (The Medical Examiner reserves the right to accept, reject, or edit any submission at its sole discretion.)

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NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

Hope IS Possible

Uncertainty breeds stress and anxiety Helen Blocker-Adams

he presidential, local and state elections have come and gone. For many of us, there is a sigh of relief. We have been hearing about politics, politicians and candidates everyday in the media for the past 18 months. And in the final weeks, it seemed the advertising was more vicious than we’ve seen in years. The rhetoric and messages were so unbelievable at times, one did not know what to think or believe. It was enough to impact one’s mental health! In Richmond County we have a new female county commissioner, a new male county commissioner and

another who served as a county commissioner in the past. In District 1, however, once again there is going to be a run-off and voters will get another chance to vote on Tuesday, December 4th In that particular race, there is uncertainty in the minds of some Augustans in the black community regarding the possibility of a white commissioner winning re-election in District 1. This district has almost 70% African-American registered voters. So the logic from their perspective is that this district should be represented by a black commissioner. In years past it has always been that way. But sometimes change can be good. But change is different for different people. There was another change in Richmond County, where voters overwhelmingly elected the first black sheriff in this county’s history, and it only took 230 years for that to happen. There are some people in the white community who do not seem happy about this change. Demographics in Augusta and all over the U.S. are changing dramatically. Hispanics have surpassed blacks as the largest minority,

and that will not change anytime soon. More and more voters use social media and the Internet to be informed about politics and candidates. Sites such as Facebook, MySpace, and LinkedIn are bringing people from all races and political ideologies together in a way one would not have fathomed a hundred, fifty, or even twenty years ago. Stress can really take its toll when a person frets over something he doesn’t have control over. Uncertainty breeds stress and Rob McPhillips, publisher of a website called Your Emotional GPS, says that “Stress is natural and helpful as a 2 or 3 minute burst of energy to move us out of danger. There are no harmful effects in that case. But prolonged stress causes us to drain our body’s resources. It’s much like having a hole in your pocket where your money falls out. Except it’s not money that you’re losing, but capability --physical, emotional, psychological and social capability.” McPhillips goes on to say that “Stress wreaks havoc on your body. Disrupting your normal bodily functions and

so damaging your health. The emotional effects of stress are that it makes you incapable of acting as a rational, balanced individual and turns you into an obsessed and neurotic idiot. It’s as if the thing that is stressing you becomes magnified in comparison to everything else. And so it takes up a far greater proportion of your attention and generates such strong emotions that it dominates you.” And so what happens is that you lose control of your ability to steer your own path and become like a dinghy flung about by the ocean. You feel powerless and trapped. Your emotions run out of control and run between fear, panic, frustration and anger. And so it is with politics and the outcome of political races. There are no guarantees in terms of knowing for sure if a person is going to win or not. We can only hope. And pray a lot too. Yes, there are pollsters, political pundits, over-zealous candidates, handlers and supporters. But at the end of the day, some candidates have won and some have lost; supporters and handlers have

to go look for another job and others are happy that they will be able to keep their job, at least until the next election cycle. If you live in Richmond County District 1, hopefully the candidate of your choice will win. Perhaps to help with your uncertainty you will roll up your sleeves and work with the campaign of the candidate of your choice. Then, whatever happens you will be able to say you helped in the effort and were part of the solution. On December 5th, the run-off will be over and you will have less to fret over. Here’s to your emotional well being. + Helen Blocker Adams is President/ CEO of The HBA Group, Intl and Executive Director of the Southeast Enterprise Institute, Inc. Visit her website at www.helenblockeradams. com. If you like politics, visit her blog at www.projectlogicga.com. You can reach her via email at hba@hbagroup-intl.com Helen’s new book, Unlikely Allies: 8 Steps to Bridging Divides that Impact Leadership can be purchased by visiting www.hbagroup-intl.com or www.authorhouse.com

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WHAT EVERYBODY OUGHT TO KNOW ABOUT MAGIC CURES AND STRONG BELIEFS by Bad Billy Laveau

hen Kirk was a young man, he had two embarrassments. A wart the size of a garden pea grew on his third finger. Grade school girls did not find that sexy, so he suffered much socially. That was too much for his young ego. When he came to see me wanting it removed, I applied a good coat of salicylic acid and advised that it would be gone before long. He suffered through a strong burning sensation as smoky acid fumes drifted up toward the ceiling, while a few tears of pain silently drifted down toward the floor. I peeled away the wart and confidently gave assurance with reasonable medical certainty that the wart was gone for good. However, I was wrong. In two months the wart had grown back. This time, I sent arcs of electricity through the wart and gave Kirk more assurance it would certainly be gone - the way of the buggy whip gone. Again it stubbornly returned. Kirk did not bother to consult me again. Instead, he visited my mother, who was known to remove warts through a faith healing ceremony that she quietly did, but never bothered

to explain to me. A month later, Kirk and his mother and Willie, his Red Lord Amazon parrot, went to Fernandina Beach for a week. Kirk spent dozens of hours riding his bike on the beach with Willie perched on the handlebars. When he wasn’t on the bike it was extended dips in the ocean. The wart fell off. The tide swept it away. I pronounce that a certain cure because the wart has not recurred during the past 30 years. I think it has met the test of time. A couple years went by and Kirk developed hiccups. The hiccups lasted for days at a time. His diaphragm became painfully sore secondary to the repeated jerks. It was a social embarrassment, not to mention the problem of not sounding kool during his weekly radio show at a local radio station. Kirk tried every home remedy known to anyone he knew. He ate gobs of peanut butter. People beat him on the back. Friends unexpectedly screamed in his ear. He breathed in a paper bag. He jumped naked in an ice cold swimming pool in January. The local airhead homecoming queen declared she could cure him. She planted a passionate kiss on Kirk that

GOT A STORY?

Best made his sock tops roll up and down like window shades. That didn’t work either. However, not wanting to disappoint the homecoming queen, nor ruin her reputation as a remarkable kisser, nor wanting to make her out to be a liar, Kirk insisted on suffering through several profound therapeutic trials. She gave up when her boyfriend complained that Kirk seemed to enjoy the treatment too much. (Nowhere does it say all medical treatments have to be disagreeable.) The hiccups galloped on. The next week at the radio station, a fundamental religious lady preacher had a show right after Kirk’s show. She noticed Kirk’s predicament, grabbed him by the hand, pulled him aside, and let loose a long string of seeming unrelated but intense and high impact syllables. She was “speaking in unknown tongues.” It frightened Kirk not. He had heard her utterances numerous times before during

e n i c i d ME

her show, but this was the first time they were focused on Kirk’s innards. Instantly, the hiccups scurried off to Hell forever, she said confidently. For the past 25 years, they have not returned. That, too, is hereby proclaimed a cure. These days, we think hiccups are probably caused by gastric reflux. We prescribe acid blockers that seem to work fairly well. Acid blockers are cheaply available over the counter at the Dollar store. And now we have elegant creams that are supposed to kill the viruses that cause warts. (No, I do not believe handling frogs causes warts.) But none of these scientifically proven treatments carry the sensational sparks of magic that my mother’s silent ceremony and the faith healer’s speaking in tongues carried. While it is well established that placebo works about 30% of the time, it is 100% in the

grateful recipients of profound relief. Just ask Kirk. A cure is a cure, even if doesn’t make scientific sense and there is no ICD 9 number for it in the doctor’s code books of medical treatments. So after this last election, I look at what a sick mess we are in, and I think about Obama, Biden, Marion Williams and the like, I realize our ailment is not in the ICD 9 either. We cannot heal our unexplained debt sickness by borrowing or spending our way out. We are in such a mess, I fear neither my mother’s silent ceremony nor the faith healer’s speaking in tongues can save us now. So bring on the homecoming queen. At least we will feel good as we slowly drift away. In the meantime, ponder this: maybe Obama is the airhead homecoming queen, and we just have not realized it yet. + Bad Billy Laveau is a retired MD with a pointed sense of humor. Bad Billy speaks and entertains at public and private events for audiences not subject to cardiac seizure secondary to overwhelming laughter and glee BadBilly@knology.net or 706306-9397

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Gratefulness Fifteen things I’m thankful for

by Naomi D. Williams, MPH, CHES, CIC® Years ago I read an excerpt from a book about having an attitude of gratitude. One of the things that stood out to me the most was writing “Thank you” in the memo line on the check when paying bills. Now, I know this may seem weird, but I enjoyed doing it for two reasons: I was thankful to have a job and the money to pay the bills, and it just might have put a smile on the workers face that processed my check (it didn’t matter if they thought it was crazy or ridiculous). I was reminded of this silly act last week when I noticed a fad on Facebook, which started the beginning of November. It took me a few days to catch on to what the purpose was, but when I did I liked the idea. Several people would list what they were thankful for each day and try to continue Noah their list daily for the entire month. As Veterans Day has just passed and Thanksgiving Day is approaching I figured I would also chronicle the things that I’m grateful for. These are in no particular order. (1) A couple of weeks ago I took my son, Noah, to the NICU graduate baby come back party; being with the doctors, nurses and therapists aroused a host of emotions. Each time I think of them and the four months that we spent together I am forever grateful for the work they did to save my child, and for the tender loving care and dedication that they take in caring for the most fragile infants. (2) The presidential election is finally over and despite my excitement for its culmination I’m most thankful to live in a country built on a democracy. (3) With the freedoms that we have I’d be remiss if I didn’t mention my heartfelt gratitude to the men and women who have served and continue to serve in our armed forces. (4) I’m thankful that my military friends have returned home safely. In an act of appreciation for the fallen soldiers and to show support for those currently serving I ran a couple of laps with the Marines at Ft. Gordon for the Fallen Soldier run. (5) My church family has been a breath of fresh air and a source of strength beyond belief. Along with the church, my blood family and friends have become priceless. (6) I’m so thankful for the prayers, babysitting, encouraging words, and impromptu yet timely laughs that they have contributed this past year. (7) I’m thankful for those true friends in my life who accept and love me and Noah as we are; those who lend a shoulder when I need to cry and give their ear when I need to vent. (8) It goes without saying, but it needs to be said that I’m thankful for the ability to see, walk, talk, eat, breathe and hear independently. (9) I’m eternally grateful for my mom. The bottomless well of strength that she has been can’t be adequately described by words. (10) I am thankful for the times that she has stood in the gap throughout my life, but especially with all of the challenges and decisions regarding my son’s care. A mother’s job is truly never done and her love is never-ending. (11) I’m thankful to finally be content and be at peace with where I am in life and what I have. I’ve learned the lesson and received the gift of appreciating the here and now (I always strive to do and be better, yet I’m no longer negating what I already have, who I am, or trying to live up to someone else’s idea of what I should have or be). (12) I’m so grateful for my wonderful son. I’m glad that God trusted me enough to parent Noah. (13) I’m not thankful for his conditions or challenges, yet I’m thankful for the personal growth and development that has occurred because of them. (14) I’m thankful for the people that I’ve met and the friendships that have been fostered because of Noah. And even though we are nowhere near where I thought we would be in our life and his development, I’m thankful that we have made tremendous progress this past year. Who and what are you thankful for? Why not give a phone call, leave a note, or send a letter to those for whom you are most thankful? + Naomi Williams is a health educator by training, an entrepreneur by nature, mom, and advocate of the best kid ever, Noah Samuel.

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NOVEMBER 16, 2012

ave you ever wondered from what source the Joint Commission (the accrediting organization for America’s health care industry) recruits its high powered, omniscient, sometimes cocky surveyors? I was out of a job, living with Nancy up in the mountains of Georgia in our vacation retreat shack of a cabin. My friend, Jim Manry, one of Atlanta’s “Buckhead Boys,” owned and operated Hall’s Boathouse Marina just down the road from where we lived. I went to Jim and asked if he would put me to work and that I would do anything and work for anything. This was in 1989. I did not expect Jim to take me so literally. He hired me at $5.00 an hour to do anything from clean latrines to tuning up Merc 120s. It was hard, dirty, yet adventuresome work. Many times I have said that it was my best job ever. After 10 months working for Jim on the lake, flippantly, I picked up the phone, called the Joint Commission headquarters in Chicago and said I would like a job. The operator plugged me into the supervisor of administrator surveyors and, after I was asked a few questions, he said, “When can you start?” From a nobody to a powerful “somebody” overnight! I actually rose to be a survey team leader and also to chairman of the Surveyor Advisory Committee. I quickly went from cleaning potties to engaging the likes of Dennis O’Leary, the Joint Commission’s president. Surveyor assignments were varied but almost always matched the surveyor’s background. As a non-doctor and as a non-nurse, for example, I would never be asked to judge the quality of a hospital’s surgery or drug administration. Accrediting organizations like the Joint Commission are non-governmental and not-for-profit. They are invited, never imposed (subsequent article will explain). Their standards are created by those being surveyed. Peers critique peers. I was kept well within the bounds of my education and experience. However, exceptions occur. Here is an example. Occasionally an organization was sanctioned so severely that a follow-up visit was required to re-address major blunders. That was the case with a renowned East Coast medical school complex. Its infectious control program was deemed below standards. The Joint Commission survey team (I was not on that team) swept in to find that this mega-complex was nearly perfect and craving the designation of being “accredited with commendation.” However, the MD surveyor apparently saw or did not see something that caused him to write them up. Infection management is a big-ticket issue for any accrediting organization. When the report arrived at the organization, there was an explosion that could be heard all the way back to State Street. With dispatch, O’Leary rushed into the fray and soon became the pivotal point for the challenge. The circumstances were ideal for a one surveyor site visit. The re-visit was planned and scheduled. It was certainly to be made by a doctor, perhaps an epidemiologist. A physician surveyor had slammed the organization and it would certainly be a physician surveyor who would be assigned to return. But that didn’t happen. It was to be me. Not a epidemiologist, not a doctor, not a company officer. To my amazement, I was the one selected to return for the followup. The assignment came to me without explanation. I simply received it and started to travel. As I traveled I started my review of the positions of both parties and the magnitude of the task. I was not unafraid. The task was formidable. I arrived and, without any pomp, was ushered into a boardroom with a huge table surrounded by about 25 chairs, every one filled with white-coated credentialed physicians, faculty, nurses, and laboratory researchers. I think the door was locked behind me. In short order it was explained to me that they not only considered their infection control program to be above reproach but a breakthrough in dealing with infectious diseases. I sat there for what seemed like forever listening to one after another individually telling about the virtues of his or her contribution and how superior it was. I was blown away. Listening intently, I started to see through the disparity between their program and the results of the first survey. I took all the pieces, stacked them in order, found gems here and there to exploit and drew some sweeping conclusions. At the end I re-established the virtues of their program, gave them accolades and left the room a hero. It was an experience of a lifetime. So was working at the marina. There have been many times over the years when someone would say to me, “Oh sure, I’m familiar with that marina. I had my boat repaired there.” I would ask, “Is it still running?” The answer, “Sure is.” Then I would respond, “Well then, it wasn’t me who fixed it.” + Editor’s note: This series is by Bill Atkinson, former CEO of Trinity Hospital (then St. Joseph Hospital), and the author of the comprehensive 2009 Medical Examiner series on the founding of the Augusta area’s major healthcare providers.

NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

Don’t Lick the Beaters and other interesting food facts

by dietetic interns with University Hospital’s Augusta Area Dietetic Internship Program

Milk does a body good. Right? We have all heard how important calcium is for our bones. Indeed, we need a certain amount of calcium throughout life to build and maintain our skeleton. When we are children and teenagers, we need ample calcium to reach our peak bone mass, which will decrease the risk of developing osteoporosis later in life. In our early 20s, we all stop building bones and it’s a long, slow decline from there. However, taking in sufficient calcium to maintain blood calcium levels will prevent our body from stealing calcium from our bones and expediting this process. So what can you do to make sure you are getting enough calcium? If you have trouble getting enough calcium from food sources alone, you may want to talk to your doctor about taking calcium supplements. Make sure to discuss all of your medications with your doctor to avoid harmful drugnutrient interactions. However, most people should be able to consume adequate amounts of this mineral, as there are plenty of excellent food sources. Nonfat and low-fat yogurts, along with cheeses, are great sources of calcium, although hard varieties of cheese have more calcium per serving than soft ones. Many breakfast cereals are

also fortified with calcium, and many canned, bone-in fish such as salmon are good sources as well. Even though yogurt and some varieties of cheese have more calcium per serving, the most popular and the most publicized source is milk. These days, however, there is not just one variety of milk. There’s soy milk and almond milk, whole, 2%, 1%, and skim cow’s milk; lactosefree cow’s milk, etc, etc. The list does not end there, but these are the varieties most often found in grocery stores today. Not all milk is created equal, though. Of the five cow’s milks, skim milk and skim lactose-free milk are the healthiest options in terms of fat, protein, and calcium content. Both are lower in saturated fat and higher in protein and calcium compared to 1%, 2%, and whole milk varieties. In fact, the higher percentage of fat in milk, the lower the protein and calcium content, so do not believe those who say skim milk is watered down whole milk (if there is no fat then there is more room for other nutrients in a glass).

Lactose-free milk is nutritionally identical to cow’s milk, except that the milk sugar called lactose has been broken down via the addition of lactase, an enzyme that lactose intolerant people lack in their digestive tracts. Soy milk is available both fortified and unfortified, fat-free or plain, and in a variety of flavors. Fat-free fortified plain soy milk is lower in calories than skim cow’s milk, but has less calcium per serving. Regular fortified plain soy milk has about the same amount of calcium per serving as skim cow’s milk, but has more calories. In addition, it has 2 less grams of protein per serving than cow’s milk. Finally, soy milk tends to cost about twice as much as regular moo juice. Almond milk is another common dairy alternative found in the grocery store. However, like soy milk, almond milk is lacking when compared to the original cow’s milk. This dairy-like product contains almost no protein, usually only about 1 gram of it per serving. Though it does typically have fewer calories than skim milk,

regular almond milk is also usually very low in calcium. There are, however, a few fortified varieties that boast of having 50% more or even double the calcium of cow’s milk. Don’t fall for the hype, though, because your body can only absorb a cup of cow’s milk worth of calcium at a time and the rest is simply excreted. The kicker, though, is that almond milk tends to cost three times or more than cow’s milk. Though it may be tempting to lean towards man-made dairy alternatives in this new age world of food information and misinformation, cow’s milk is currently nutritionally superior. As for feeding infants, formula sure comes close, but can’t beat the original breast milk for price and quality. The old excuse that humans are the only mammals who drink milk after infancy really is not

relevant. Humans are the only mammals who engage in many activities unique to our species. When was the last time you saw a squirrel driving a car, a bird flying to the moon, or a fish videoconferencing his buddies? Cow’s milk is the cheapest, easiest way to get quality calories and calcium together in a natural package. Just don’t go looking for that unpasteurized stuff, because no one needs to get listeria. For those who prefer not to partake of dairy products for personal reasons, who enjoy the unique taste of dairy alternatives, and/or have a cow’s milk allergy, then the myriad of non-dairy calcium drinks are perfectly acceptable options. The moral of the story is to simple: get enough calcium. + — Stephan Henson University Dietetic Intern

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P harmacy 411

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

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

Plus... 500+ doctors offices throughout the area for staff and waiting rooms, as well as nurses stations and waiting rooms of area hospitals.

NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

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

MEDICARE PRESCRIPTION COVERAGE: ARE THERE ANSWERS? The Medicare open enrollment period for prescription drug coverage is coming to a close soon. As of December seventh the period to select a plan for the upcoming year will close. Seniors have to be asking themselves, is there anywhere they can get clear and accurate information? I had an insurance agent for a Medicare DECEMBER Part D plan (Medicare Prescription Drug) FRIDAY come in asking to set up a table in my pharmacy to give out information packets. Knowing how strict the rules are on insurance agents and their actions and that the generic drug copay was zero, I asked what I thought was a simple question: MEDICARE OPEN What is the brand name drug copay? ENROLLMENT ENDS After asking twice I realized he was not going to give that piece of information to me, and I invited him to leave the pharmacy and go elsewhere. The reason I mention this is that he was employed by Part D plan XYZ to sell their product. It did not matter who you were because, to them, XYZ is the best plan for everyone. Do you know why? Because they would be receiving everyone’s insurance premiums every month. I know an insurance agent in town that helps people by providing the same service that retail pharmacies have been providing for years, checking your prescription profile against all the Medicare prescription plans to see which one is the best. What’s different about the thirty (no joke) plans offered in this area? Several items factor into the total patient cost of a Medicare drug plan. It starts with the monthly premium and the annual deductible, just like on everyone’s private healthcare policies throughout their lives. Here is the catch: each family of plans offer different copay structures for generic and brand name drugs. The formularies of different plans can be greatly different with a single drug commanding a large difference in monthly copays on different plans. Multiply that difference by the number of medications you might take, and by twelve months in a year, and the total difference between one plan and another can be in the thousands of dollars. Other factors in total cost include any assistance in the coverage gap you may or may not receive from your plan. The coverage gap is closing but not yet eliminated. Your pharmacy can be a tremendous help if you are not

Sparkle

computer friendly. They can check you prescription drug profile by using Medicare’s website to compare all thirty plans and come up with the best choices for you based on total cost to the patient. Make sure that your pharmacy has all your prescription information, including those filled elsewhere or thru mail order. Be aware that a pharmacy cannot select a plan for you or sign you up for a prescription plan. You may use an insurance agent or contact the chosen plan directly. A third option is to call 1800-MEDICARE(633-4227) and go directly thru the Medicare operators. Be prepared for a long hold time if you choose this option. When looking at the printout your pharmacy provides you, take note of the premium and deductible information as well as the total cost per month for the year. If you see that certain months are going to exceed your budget then look for an alternative plan or check with your pharmacy or doctor to look at changes that can be made to your medication profile. Also make sure that your preferred pharmacy was selected so that you know you will not have to switch pharmacies to get full benefits from your plan. I ran a sample list of medicines thru the website for this article and found three plans with different features that were similar in total cost for the year. The least expensive plan included a monthly premium of thirty-two dollars and a three hundred dollar deductible approximately. The other two plans had no deductible but higher monthly premiums. The tricky part is that the highest single month cost was with the least expensive plan. So in my sampling, I would have to plan ahead for that extralarge pharmacy bill in January. Please check with your pharmacy soon as time is running out. Also there are plans that offer you choices on where to shop when it comes to prescriptions. Do not let an insurance company tell you to accept worse customer service due to a preferred network. Your pharmacist stands ready to help you. Questions, article suggestions or comments on this article email us at cjdlpdrph@bellsouth.net Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson (cjdlpdrph@bellsouth.net )

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NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

NOVEMBER IS AMERICA’S NATIONAL FAMILY CAREGIVERS MONTH

It’s time to salute family caregivers by Kathy Crist Owner, Right at Home of the CSRA It’s a perfect time to be thankful for our family caregivers. Since November Crist is America’s National Family Caregivers Month, set aside a time to recognize and celebrate the nearly 66 million family caregivers in our country. Many of these individuals tirelessly assist loved ones with a disability, serious illness or limitations of aging – right in our own community and neighborhoods. Caregivers serve quietly and selflessly every day in homes, assisted living centers, hospitals and other places from cities to rural

In addition to family support, make sure he or she knows about free support services and online resources that encourage and equip caregivers. Some of these include: • Family Caregiver Alliance – www.caregiver.org; 800-4458106 • National Alliance for Caregiving – www.caregiving.org • National Family Caregivers Association – www.nfcacares. org, 800-896-3650 • Centers for Medicare & Medicaid Services – www. medicare.gov/caregivers +

settings. Family caregivers need and deserve encouragement and assistance in the challenges they face. All of us who champion the special role of

caregiving know how valuable it is to have handy resources that offer the best care possible to loved ones. These resources help maintain caregivers’ own personal commitments, health and well-being. Right at Home encourages our entire community to recognize the dedication and loving attention of caregivers they know. Tell them “thank you!” and lend a hand, not just during National Family Caregivers Month, but any time of year. + Right at Home of the CSRA, a leading provider of in-home care and assistance, supports America’s National Family Caregivers Month and honors the continual dedication of family caregivers everywhere. To contact Right at Home call 803-278-0250 or visit them on the web at www.csra. rightathome.net

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NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

‘Tis the season to be prepared by Pam Tucker, Director Columbia County Emergency & Operations Division It’s true that there’s no place like home for the holidays. With the temperature dropping, there’s nothing like bundling up with the family around the fire to enjoy some holiday cheer. However, the open hearths, candles and holiday cooking also bring an increased risk for house fires. According to the U.S. Fire Administration, an estimated 2,000 Thanksgiving Day fires in residential buildings occur annually in the United States, resulting in an estimated average of five deaths, 25 injuries and $21 million in property. The leading cause of these fires is cooking. Here are the top five cooking safety tips from Columbia County EMA to help you avoid a holiday disaster: 1. Make sure you have smoke alarms on every level of your home, outside each sleeping area, and in every bedroom. Test smoke alarms monthly and replace them if they are 10 years old or older. 2. Never leave cooking food unattended, and keep a lid nearby to smother small fires in pans, such as grease fires. Be particularly careful with oil-based turkey fryers, which present numerous burn and fire hazards. 3. Don’t wear loose sleeves while working over hot stove burners - they can melt, ignite or catch on the handles of pots and pans, spilling hot oil and other liquids. 4. Have a “kid-free zone” of at least 3 feet around the stove and areas where hot foods and drinks are prepared or carried. 5. Plug cooking appliances directly into an electrical outlet. Never use an extension cord for a cooking appliance. It can overload the circuit and cause a fire.

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Other holiday safety tips • When choosing a live Christmas tree, pick one with green needles that don’t fall off when you bounce the tree trunk on the ground. Keep it away from heat sources in your home, and water it frequently. • Check your holiday lights for frayed wires and other damage. Never link more than three light strands together. • Make sure your holiday decorations are nonflammable.

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• Consider using battery-operated flameless candles instead of real candles. • Don’t burn wrapping paper in the fireplace; it could create a large blaze that could spark a chimney fire. Also, never leave a fireplace burning when you go to sleep. Also, remember to protect your plumbing and the environment by recycling your cooking oil if you’re frying your Thanksgiving turkey this year. Read on.

USED COOKING OIL RECYCLING EVENT If you have plans to deep fry a turkey in the coming week or two, you’re in for a treat. But what will you do with all the oil or grease left over after cooking? Well, here’s what not to do: if NOVEMBER FRIDAY you pour grease or cooking oil down the drain or into a storm sewer, it gels and solidifies into thick layers inside drain pipes, sewage mains, and sewage lift 8:00 AM - 5:00 PM stations. The resulting blockages can back up home plumbing, DECEMBER sewer lines and lift stations, SATURDAY causing overflows into homes, streets, and yards. It’s unsanitary, messy, smelly and expensive — and unnecessary. Residents of Richmond and 8:00 AM - 12:00 PM Columbia Counties can bring their used cooking oil to either the Augusta Utilities Department at 1820 Doug Barnard Parkway or the Columbia County Water Utility office at 4325 Evans to Lock Road during the days and hours above. Eligible oils that can be recycled are peanut oil, sesame oil, canola oil, corn oil, lard, olive oil, soybean oil, sunflower oil, vegetable oil and grease from animal fats (such as bacon grease). Oils to be recycled should be free of water, food scraps, and soap suds, and should be brought to the event in a clean, non-breakable, leak-proof container with a tight lid.

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NOVEMBER 16, 2012

11 +

AUGUSTA MEDiCAL EXAMINER

The blog spot — Posted in March 2012 at angienadia.blogspot.com

IF PEOPLE WANT TO DIE, HEROIC MEASURES WON’T GET IN THEIR WAY I was working in the Intensive Care Unit (ICU) the other day and as I counted, I found that more than half of the patients there, for lack of a better term, brought the condition upon themselves. I sound harsh, but there was no better way to put it. I was taking care of Mrs. B, a 60-year-old lady with COPD who called EMS for shortness of breath. As EMS readied to take her to the hospital, she said, “you all are gonna have to wait until I finish my cigarette.” She has been intubated many times for COPD exacerbation, visited the ICU a hundred more times. She said if she got out, the first thing she would do would be to smoke a cigarette, but she did not believe she would make it this time. After multiple weeks on continuous BIPAP with spurts of intubations in between, she told us to quit and let her die. Looking around the ICU that day, there were multiple stories like her – a cirrhotic who was actively drinking despite his varices bleeding to death after 30 units of various blood products that turned out to be futile, a 20-year-old diabetic with recurrent admission for diabetic ketoacidosis who left against medical advice the minute he found out he would not get any intravenous dilaudid, a gentleman admitted with pulmonary edema every 3 days because he refused to go to dialysis. As days passed, I realized that these patients were common – I was being trained to undo what these people did to themselves, so that they can leave the hospital to do it some more. Some has hurt themselves so many times it could not be undone, despite many resources wasted and much money spent. I watched 30 units of blood passed through one end of our patient only to flow right out another, and I wondered if there was not someone else out there who would not undo our efforts, our blood products, our precious resources. More importantly, I wondered if we could ever draw a line, where we say enough is enough, where we say you do not get a second chance at life so that you can just kill yourself in the end, where we say there comes a point when heroic measures cannot cure how people want to live their lives. Before medical school I always thought that medicine was made to promote health, but in the light of reality I have learned that my job in the ICU today is really to prolong death, so that in the end people can crash and burn a bigger flame, taking much needed resources with them. Mrs. B knew in her heart that smoking would be her death, yet smoking was the one thing she pined for. I wanted to tell Mrs. B that if she wanted to die, I was in no place to stop her. I might have had a shot as her primary care doctor before she picked up her first cigarette, but that time is long passed. In the end when the BIPAP came off, she became unconscious and passed away peacefully. I wanted to ask if we should have stopped sooner, maybe two intubations ago, but I will never know. +

“

Medicine versus lifestyle

”

The author is an internal medicine physician at Yale, New Haven.

wake up early “ If you wouldn’t to do something, you probably shouldn’t

“

stay up late for it either.

From THE Bookshelf At first glance, this seems like it would be a nice book for families with inquisitive little children. Upon further review, it’s just as appropriate for families with no kids. The reason: this book is full of the kinds of questions kids ask all the time — and that even very well-educated parents don’t have a clue as to how to answer. Could you, for example, give a factual answer to why blood is red? Or if any other animals have blood that isn’t red? Are there still any undiscovered animals? Where does wind come from? Why can’t I tickle myself? Why did dinosaurs go extinct, but not other animals? Why is the sky blue? Why are planets round? How come none of them are pyramidshaped or square? How do they know that no two snowflakes are alike? Why can’t we live forever? Where do hiccups come from? Why do people have different-colored skin? Can a bee sting a bee? How do lost cats and dogs always find their way home? Do numbers go on forever? Why do penguins live at the

South Pole but not at the North? Will we ever be able to travel back in time? Why is urine yellow? Why do we sleep? Who invented chocolate? What causes lightning? How far away is space? Why is the ocean salty? How have fresh and salt water kept separate for thousands of years? How come snails have shells and slugs don’t? As any fool can plainly see, these are tough questions. As one of our celebrated page 12 word puzzles once noted, some anonymous sage once observed that “A child can ask questions that a wise man cannot answer.”

True, indeed. Except that this book does provide the answers. SOme of them are a little on the fanciful side, but for the most part they are simple but accurate and thorough explanations, proffered by experts. That doesn’t necessarily mean you can look at the table of contents and recognize each expert who has been experly paired with a specific question. For example, the answer “How long would it take to walk around the world?” begins like this: “I don’t know how long it would take to walk around the world but it took me 1,789 days to run. I wore out fifty-three pairs of shoes.” That was written by Rosie Swale-Pope, who did, indeed run completely around the world, a feat you and I were unaware of until this moment. So in summary, here’s a fascinating book for inquiring minds, whether little people are part of the equation or not. + Big Questions from Little People - And Simple Answers from Great Minds, compiled by Gemma Elwin Harris, 336 pages, published October 30, 2012 by HarperCollins

the

Clipping File Exercise and depression Contradicting the findings of earlier studies and widely held popular science, a new Danish study has found little evidence that aerobic exercise helps treat depression. Here’s how this study was conducted: a small group of depressed people (115 of them) were divided into two groups; one participated in a strenuous aerobic exercise program for three months, three times a week at 30 minutes per. The “control” group did stretching exercises on the same schedule. Many previous studies have compared idle control groups with exercise groups, setting up a possible placebo effect in the exercising group. The Danish study was designed to avoid that. Stretching didn’t burn calories or improve cardiovascular fitness, but it’s not complete idleness either. The results: both groups were slightly less depressed, but there was zero difference between them. In other words,

although this is just one study, and a small one at that, it suggests the beneficial effects of aerobic exercise may be more psychological than physical. It’s the idea of exercising that confers the benefit, not necessarily actually becoming more fit. Revised smoking statistics Smoking reduces life expectancy by ten years in Japan, but much of the risk can be avoided by giving up smoking, a paper published in late October on bmj.com shows. Previous studies in Japan suggested smoking reduced life expectancy by only a few years compared with about ten years in Britain and the USA. The new report, from researchers in Oxford and Japan, investigates the impact of smoking on mortality in a large group of Japanese people who were living in Hiroshima or Nagasaki in 1950. The Life Span Study (LSS) was initiated in 1950, tracking over 100,000 people. Surveys carried out later

obtained smoking information for 68,000 men and women, who have now been followed for an average of 23 years to relate smoking habits to survival. The younger a person was when they started smoking the higher the risk in later life. Older generations did not usually start to smoke until well into adult life and usually smoked only a few cigarettes per day. In contrast, Japanese born more recently usually started to smoke in early adult life, much as smokers in the USA and UK. These differences in smoking habits are reflected in the mortality patterns. Smokers born before 1920 lost just a few years. In contrast, men born later (192045) who started to smoke before age 20 lost nearly a decade of life expectancy, and had more than double the death rate of lifelong non-smokers, suggesting that more than half of these smokers will eventually die from their habit. Results on the few women who had smoked since before age 20 were similar. +

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NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS

THE MYSTERY WORD

by Dan Pearson

Wasn’t today your follow-up doctor From my fall last appointment? month. Sure was.

How did it go?

Fine. I just keep my ankle wrapped for another week.

Do you have to go back again?

I guess not. He said “See you next trip.”

The Mystery Word for this issue: SANNPRATTL

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

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A R N A

— Author unknown

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above. Once any letter is used, cross it out

in the lower half of the puzzle. Letters may be used only once. Black squares

Solution p. 14

indicate spaces between words, and words may extend onto a second line.

35. Uncontrolled dependency 36. Arab mandolin 38. Serfdom 41. New Age singer 42. ___ Pack of the 50s 43. Speech 44. Earthen pot 46. Outlaw 50. Sound starter? 51. Affectedly quaint (British) 52. Prefix for ship 53. Brink 55. Not pro 56. Type of fist 57. Gusto 58. Manages, just barely 60. Possesses

DOWN 1. HPV, herpes, etc. 2. Nation governed by Mahmoud Ahmadinejad 3. ___ mater 4. Monetary unit of Lesotho 5. Southside Peach follower 6. Common solution 7. Capital of Yemen 8. Hereditary German title 9. Noah’s boat 10. Field scavengings 11. Take in 12. Tina Turner’s real first name 13. Spool 21. Family 22. Blacken 25. Epoch 26. Scope beginning? 27. Seating assistant 28. Chemical secreting organ 31. Rule of _____ (in burns) 32. Certain tactic 33. Curt

Solution on page 14.

9 4 7

X A M I N E R

9 6 8 6

3 5

5 3 9 4 1 4 5

2 7

9 7

8 7 4 3 7 6 5

U D O K U

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

Use the letters provided at bottom to create words to solve the puzzle. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving words with letter clues and entering unique and minimal choice numbers (such as 5 thru 8 in this puzzle). A sample is shown. Solution on page 14.

1 2 3 4 5 6 7

E 1 2 3 4 5 6

8 9 10 11

1 2 1 2

P 3 4 5

. 6

1.FIASCOE 2.RISTOOC 3.TRUMT 4.HPPG 5.EELI 6.DART 7.I 8.N 9.I 10.N 11.G

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

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

NOVEMBER 16, 2012

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE “I’ve never heard of that,” said the man. “It’s true,” said the woman. “The last time I went to my doctor we talked about my age. Then he asked if I had a driver’s license. I told him yes and showed it to him. He took a pair of scissors out of a drawer, cut my license into pieces and threw it into the wastebasket. “’You won’t be needing that anymore,’ he said. So I thanked him and left.”

ha... ha...

A man was sitting under a tree in his front yard after cutting the grass. Suddenly the quiet was shattered by the sound of screeching brakes, skidding, and then a car came crashing through his front hedge and came to rest on his lawn. He helped the elderly driver out of the smoldering vehicle and into a lawnchair. “My goodness,” he exclaimed after getting a good look at her. “Forgive me for saying so, ma’am, but you are quite old to be driving!” “Yes,” she agreed, “I’m so old I don’t even need a driver’s license anymore.”

Dr. Jones goes to the retirement home for his regular rounds. He sees Joe and asks him, “Joe, how much is three times three?” Joe responds, “Fifty-nine.” He goes over to Tom and asks, “Tom, how much is three times three?” “Wednesday,” Tom answers. He finally goes over to John and asks, “John, how much is three times three?” “Nine,” replies John. “Correct! How did you get that answer?” “Easy,” says John. “I just subtracted fiftynine from Wednesday.” +

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There is only one. +

MEDICAL EXAMINER Augusta’s only independent publication dedicated to medicine, health and wellness

The Patient’s Perspective by Marcia Ribble

little green gecko is climbing on the satellite TV dish of the folks next door. His or her green stands out against the aluminum tubing. I know geckos have that chameleon ability to change colors, but right now it’s a beautiful bright grass green. Another smaller brown gecko is leaping across the bushes, so easily able to hide that only its leaps show me where it is. After I fell, I appreciated some good things as a result: it was a good thing that my shoulder had healed, because I needed my arms and shoulders to protect my back from the continuous spasms in my spine. Now how on earth could falling and being in pain be a blessing? Well, it forced me to slow down, and that eased me into retirement. I couldn’t be on the go all the time, so I learned to enjoy what I was still able to do, like sitting at the computer and writing, reading and rereading books, and it also pushed me to learn to tolerate frozen meals and to delight in the voice of the man who delivers Meals on Wheels. I no longer could stand for long periods to cook, couldn’t put a pot on the stove filled with water for spaghetti, couldn’t put things in the oven or take them out without risking a fall from an unforeseen spasm. Even the short and simple task of heating up water in the microwave for coffee took more time than I could stand there waiting for it. I could, technically, still wash my clothes, but not get them out of the washer or the dryer, and then I couldn’t fold them or put them away. So I learned to accept a large pile of clean clothes on the little sofa which I could reach into to obtain clothes to wear. Driving was suddenly both difficult and dangerous, because I never knew if a muscle spasm in my back would steal my ability to brake. It never did, but I was

Talk is cheap. Not talking can be deadly.

always afraid that it would. So I learned to depend on my grandson to drive me places, get the groceries I needed, and help me out with tasks like taking out the garbage or replacing the furnace filter. That transition from being able to do everything for oneself to needing help from others is one of the most challenging things those of us with debilitating illnesses face. There is such a huge loss of control, some of which is irritating, some of which is really funny, but all of which is instructive. For example, I make a list for the grocery getter. I think my meaning is obvious. The grocery getter unfortunately goes to the store and buys Diet Coke when I want Diet Caffeine-Free Pepsi. I wrote “pop.” And soda is entirely lost in translation. I asked for breakfast sausage links. I received very spicy dinner sausages that hurt my stomach. I asked for a Boston Butt and got a piece of ham. But over time the messages become clearer and life relaxes until the next medical surprise comes calling. Which it always does as soon as I adapt to the last surprise. + Marcia Ribble received her PhD in English at Michigan State and recently retired from the University of Cincinnati where she taught composition. She taught writing at the college level and loves giving voice to people who have been silenced. She can be reached with comments, suggestions, etc., at marciaribble@hotmail.com.

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GRAPHIC ADVERTISING

Publisher of the Medical Examiner Proudly celebrating our 24th year in Augusta publishing, 1988 — 2012

+ 14

NOVEMBER 16, 2012

AUGUSTA MEDiCAL EXAMINER

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

...carefully hidden (in the border) in the page 4 ad for UNITED HOSPICE Congratulations to April Derryberry, who scores a $20 Wild Wing Cafe gift certificate, two free movie passes courtesy of Health Center Credit Union, a free Top Notch Car Wash gift card, and for coffee drinkers, a jar of Drug of Choice gourmet coffee. Win this stuff! The new Mystery Word is on p. 12. Start looking!

The Celebrated MYSTERY WORD CONTEST ...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then be the first to 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: gift certificates from Wild Wing Cafe, Top Notch Car Wash, and movie passes from Health Center Credit Union! SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (WInners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher.

The new scrambled Mystery Word is found on page 12

EXAMINER CLASSIFIEDS specific needs. Call 706-833-9787

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TOWNHOME large furnished room (dresser, bed, night stand, linens) for rent with private bathroom in convenient and very nice neighborhood near Doctors Hosp. $445 a month includes utilities and Internet service. Please contact 706589-0238 ask for May.

WEST AUGUSTA Two bedroom townhome, quiet & clean units close to ASU, GHSU and hospitals. $645/mo. Call 706951-3598. 11112

FSBO SPRINGLAKES One story brick home built in 1981 Bonus Rm upstairs; 2,792 SF finished downstairs; MBR with two closets (one walk-in); 3 addl BRs; 2 Full Baths and 2 Half Baths; Formal LR and Dining Rm w/hardwood floors; Large Breakfast area with hardwood floors; Walk-in Pantry; Kitchen redesigned with Stainless Appliances & Granite tops (7 years old); Nice Laundry Room; Large Den with built-ins & fireplace with gas logs; Double Garage. 127 Reed Creek Rd Martinez, GA $229,900 Lot: .7 Acre with sprinkler system front and rear. Google the address and look for it on Zillow.com Phone: 706/863-0886

1.1.13

TOWNHOME 3 bedroom, 3 full bath townhome. 2 master suites, like new, end unit with extra parking, single garage, covered patio, $125,000. 706-799-0394

SERVICES

LAWN SERVICE Commercial, residential. Call Vince: (704) 490-1005

WEST AUGUSTA Luxury 3 BR / 2 BA Townhouse, 1-car attached garage located off Pleasant Home Road $725 /mo 706-228-4655

CAREGIVER Let me help you with your loved one. 24 hour care, very reasonable. Call 706-738-0851 CNA IN-HOME CARE I assist with daily activities, prepare meals, light housekeeping, grocery shopping, doctor’s appts. I will meet you to discuss your

(OURS IS COFFEE)

1.00

1.25

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1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

5.25

5.50

5.75

6.00

6.25

6.50

6.75

7.00

7.25

7.50

7.75

8.00

8.25

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8.75

9.00

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

Send this form with payment to:

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

A M A

M U

G L

W A

B A

U L

QUOTATION PUZZLE SOLUTION: Page 12: “Reduce everything you want to an action you can do right now.” — Author unknown

AD COPY (one word per line; phone numbers MUST include the area code): .75

S T

QUOTATION

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

.50

MATTRESS We have a Queen Pillowtop Set that is new and still in the wrapping $150 Call or Text 762-444-7615.

SEE PAGE 12

CLASSIFIED ADVERTISING FORM

.25

MISCELLANEOUS

THE PUZZLE SOLVED

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

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

SPARKLING CLEAN Looking for offices to clean. No contract req. Husband & wife team have years experience and give FREE on-request estimates. Call 706.831.8552 or 706.831.8553 NOTICE! ATTENTION! If any current or past employer has failed to pay you min. wage or time and a half overtime pay, you may be entitled to an order from US Federal Court awarding you twice the amount of your unpaid wages plus atty. fees. For info, call Arthur H. Shealy, Attorney at Law, 803-278-5149, 1010 Plantation Rd, North Augusta SC 29841. You may be entitled to a similar award for unpaid wages if your employer required you to perform duties during your lunch hour, before clocking in, or after clocking out.

TOWNHOME Great location, everything new, 2 master suites, sunroom, all appliances. $98,000 (706) 504-4023

SENDING US A CLASSIFIED? WHAT’S YOUR DRUG OF CHOICE? Augusta Medical Examiner Classifieds

BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673)

The Sudoku Solution

COFFEE IS GOOD MEDICINE VISIT DRUGOFCHOICECOFFEE.COM FOR YOUR REFILLS TODAY

WORDS BY NUMBER “Complaining is stupid. Either act or forget.” — Authos unknown

Multiply by number of times ad to run: x Total submitted: $

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 5 days prior to our publication date.

Thanks for reading!

www.AugustaRx.com

NOVEMBER 16, 2012

A NOVEMBER TRADITION, BACK FOR THE FIRST TIME SINCE 2010!

When you quit...

What is happening physically, including What you might feel like or experience, subconscious, internal including conscious, external effects effects Within 20 minutes Your bp drops to the level it was before you smoked your last cigarette. The temperature of your extremities, with blood flow no longer constricted by the effects of nicotine, begins to return to normal

15 +

AUGUSTA MEDiCAL EXAMINER

With your blood pressure back down to where it was before that last cigarette — a comfortable 240/160 — you no longer feel your circulatory system constricted by nicotine. Instead, your hands are constricted on the arms of your chair, your grip cutting into the armrest fabric and actually leaving deep impressions in the wooden accents — made of oak. Your vision is blurred and you’re beginning to drool slightly — tiny concessions for gaining freedom from cigarettes.

PNEUMONIA… from page 1 tissue or into your elbow or sleeve. You can also reduce your risk of getting pneumonia by limiting exposure to cigarette smoke and treating and preventing conditions like diabetes and HIV/AIDS. In the United States, there are several vaccines that prevent infection by bacteria or viruses that may cause pneumonia. These vaccines include: • Pneumococcal, • Haemophilus influenzae type b (Hib), • Pertussis (whooping cough), • Varicella (chickenpox), • Measles, and • Influenza (flu) vaccine. + — Information provided by the Centers for Disease Control (CDC)

Within the first 8 hours The level of the deadly carbon monoxide in your bloodstream drops to normal

Feeling the acute effects of dropping carbon monoxide levels, you have a strong urge to revert to old habits. But you’re determined. You fight the urge to suck the tailpipe of an idling car and instead chase cars through the neighborhood on foot, inhaling deeply.

Within 24 hours Your chance of a heart attack decreases

While your risk of a heart attack from smoking drops, the risk of a heart attack caused by not smoking skyrockets. Fortunately, you’re able to let off steam by screaming at your children, parents, marriage mate, store clerks, pets, neighbors, the TV, trees, rocks — and marriage counselors.

From 2 weeks to 3 months Circulation improves; lung function increases up to 30 percent

Circulation improves, and so does perspiration. Every time you even think about cigarettes, or pass within 3 miles of a convenience store, you break out in a cold sweat. You notice your improved lung function as you sob hysterically two to three times a day. Vomiting caused by withdrawal symptoms is now down to just twice a week.

From 1 to 9 months Shortness of breath, coughing, lung and sinus congestion, and fatigue all decrease. Tiny cilia in breathing passages regain their ability to eliminate mucus, dust and inhaled germs, reducing the chance for respiratory infections

Even though fatigue caused by smoking has decreased, you still experience a little fatigue due to waking up fifteen to twenty times a night from nightmares that you broke down and took a puff. Your lungs no longer feel choked, but for some reason you have a constant urge to choke the cat.

At the 1 year mark Coronary disease risk is cut by half

To celebrate your successful one-year anniversary and your reduced coronary risk, you celebrate at your favorite all-you-can-eat restaurant with a huge steak dinner, loaded baked potatoes, and three trips to the dessert bar.

YOU SUPPORT THE MEDICAL EXAMINER BY SUPPORTING OUR ADVERTISERS. WE’RE DEPENDING ON YOU! AND MOST GRATEFUL.

5 years after your last puff Your risk of stroke is now that of a non-smoker

You finally feel like you’ve turned the corner and mastered the art of non-smoking. Although you kicked the habit, you rarely kick the dog these days, and you hardly ever pick up cigarette butts off the sidewalk and fondle them anymore, savoring their aroma.

10-15 years after you quit Your risk of lung cancer is half that of those who continue to smoke. The risk of cancers of the mouth, throat, esophagus, bladder, kidney and pancreas all drop. At 15 years your risk of coronary heart disease is as low as a non-smoker’s.

As a confirmed and successful quitter, you adopt a smug and condescending attitude toward smokers and those struggling to quit, knowing you’re a superior being. Finally, at the fifteen-year mark you conquer every character and personality flaw associated with quitting and at long last regain your emotional equilibrium. You’re kind and considerate to one and all, and you unfailingly and uncritically do everything you can to support others who are trying to quit, doing so with loving encouragement and without critical judgement. After all, you tell people, it was easy. + — by Daniel Pearson

TO OUR READERS AND OUR ADVERTISERS

+ 16

AUGUSTA MEDiCAL EXAMINER

NOVEMBER 16, 2012

Life. Less complicated. Right at Home offers caregiving services for almost any family and practically any situation. Our in-home care lets loved ones enjoy life in the comfort of a familiar environment. And it lets you concentrate on caring instead of caregiving. Give us a call and let us develop a Custom Care Plan for your loved one today.

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BUT WHEN I DO I REALIZE I’M TOTALLY MISSING OUT WHEN I DON’T. www.AugustaRx.com/news