Nov17 17 by Daniel Pearson

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PAIN Pain

Pain is one complicated subject. It is generally viewed as unpleasant and to be avoided at all costs. On the other hand, there are situations where it is inflicted deliberately: parents spank their kids (or at least they used to); governments inflict pain and even torture upon combatants from enemy nations during war, and upon their own citizens who are convicted of criminal acts; some religious devotees willingly “mortify the flesh” (kill their sinful nature) by being flogged, by fasting or other forms of self-denial, by crawling on bare knees until they bleed as a display of their devotion. Others view this as highly admirable conduct. Some people can tolerate a tremendous amount of pain while others practically faint at the mere thought of certain painful injuries. Some pain is physical; some is emotional. Some pain is highly visible: the wound is jagged and bleeding. Other pain hides so well that sufferers have a hard time convincing others that their pain is real. Yes, some pain is neat and clean, black and white, like our title above. Other pain is rough and red and raw and ragged.

Pain is at the center of lots of national news these days: ironically, opioid pain killers are causing tremendous amounts of pain and suffering as a scourge of addiction and overdose deaths continues to grow. Another irony about pain is that it is actually a good thing — a very good thing — within reason. In everyday life, pain is indispensable. It instantly tells us to jerk our hand away from scalding water or a hot burner. Pain gives us immediate signals to hop off something sharp we’ve stepped on and keeps us from burning our tongue with hot soup or coffee. In clinical settings, pain is regarded as a clear and valuable indicator of a condition that needs medical attention. In that role it can prevent further injury or help halt the progression of disease. After treatment, perhaps surgical, pain is a great reminder to take it slow and give our body time to heal. It tells us to slow down; recovery isn’t complete. It’s important that we can feel that pain and that we heed it. For compliant patients, “know pain, know gain” are words to live by. But what about chronic pain that won’t Please see PAIN page 2

NOVEMBER 17, 2017

Kid’s Stuff

NOTES FROM A PEDIATRIC RESIDENT by Caroline Colden, M.D., Children’s Hospital of Georgia

Is it a milk allergy or lactose intolerance? Let’s discuss milk digestion issues in babies. Parents will often wonder if their baby’s fussiness, vomiting, constipation, diarrhea, difficulties gaining weight or other GI symptoms are possibly due to difficulties with digesting milk. Terms like “lactose intolerance” and “milk protein allergy” can get thrown around, and switches to soy or special formulas can be made with varying degrees of success. If true difficulties with digesting milk in a baby exist, milk protein allergy (MPA) is high on the differential. This is a literal allergy to the protein components of milk – casein and whey – that can worsen with repeated exposures. Babies can develop vomiting, diarrhea and/or constipation, colic and fussiness, as well other symptoms consistent with allergies. Some babies can have blood in their stool or skin changes. Most will have difficulty gaining weight. A family history of food or other allergies may be present, which increases the likelihood for a milk protein allergy to exist. Lactose intolerance, on the other hand, is totally different from MPA, in that it is an intolerance of the sugars (lactose) in milk, not an allergy to the protein. Lactose intolerance tends to run in families. However, it is very uncommon in children younger than 1 year of age. When it does occur it can cause bloating, gas, diarrhea, and abdominal discomfort Please see MILK page 8

AUGUSTA MEDiCAL EXAMINER

NOVEMBER 17, 2017

PAIN… from page 1 respond to any known treatment? Or pain whose cause no doctor can identify? In such cases, does a doctor have the right to question the reality of a patient’s pain claims? Maybe. But probably not. While there may be the occasional pain pill addict, the most reliable measure of pain is what the patient says it is. After all, there is no diagnostic tool that can accurately and unambiguously gauge pain the way a thermometer measures temperature or a bp cuff shows a visual blood pressure reading. Margo McCaffery, a pioneer in pain management nursing, may have expressed it best back in 1968: “Pain is whatever the person says it is, existing whenever and wherever he says it does.” Real-time MRI brain scans have been used to test this approach, and pain-related brain activity correlates well with patients’ reports of pain levels. This means that accurately reporting pain to our doctors is extremely important. Minimizing reports of pain to show strength or courage or stoicism is, ironically, only hurting yourself. Overstating pain is just as selfdefeating. Instead, a full, accurate and factual account of when pain started, where it hurts, what might have caused it (if known), how intense the pain is, any pattern it displays (whether continuous or intermittent, for example), and anything that makes it better or worse, all are very useful in helping your doctor make an accurate diagnosis and get help on the way. Adjectives are indispensable too: pain can be dull, agonizing, throbbing, burning, sharp, shooting, intense, heavy, blinding, minor, nagging, pounding, or any number of other varieties. Find the right words to describe your pain and tell them to your doctor. Pain management is a topic that is directly tied to everything in the preceding paragraph. Acute pain resolves itself quickly, perhaps on its own or with treatment as simple as an aspirin or two. Chronic pain, on the other hand, can be an extremely challenging matter.

What is chronic pain? Some define it very specifically: pain that lasts more than six months; others say it’s more than a year. The simplest definition might be the best: pain that lasts longer than it should, or longer than the expected period of healing. That’s a good definition. If you had a headache every day for 5 months, you wouldn’t appreciate a doctor who told you your pain wasn’t chronic because it hadn’t lasted six months yet. Chronic pain can be a complex affair for a medical team that might include a doctor, nurse, pharmacist, surgeon, anesthesiologist, psychiatrist or psychologist, occupational therapists and others. Success may be achieved, or despite all efforts relief might still be elusive. On the other hand, sometimes — even if briefly — pain management can be a very simple matter: most chronic pain sufferers have experienced relief merely from being so absorbed in an activity or an entertainment event that their pain is no longer felt, or is greatly minimized. Relief from pain is often championed as a basic human right, and many hold the view that chronic pain, even if its cause is unknown, should be considered a disease in its own right. And that pain medicine should have full status as a medical specialty, just like dentistry and oncology and orthopedics. It is so recognized only in China and Australia. The worst regimens for treating pain include the extremes of 1.) ignoring it; maybe it will go away; and 2.) taking medicine of unknown origin, or originally prescribed for someone else. Doing either of those might transform your physical pain into emotional pain for your soon-to-be grieving relatives. +

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AUGUSTA MEDiCAL EXAMINER

The

PROFILES IN MEDICINE

Advice Doctor

presented by Queensborough National Bank & Trust Co.

UNIVERSITY ARCHITECT Somehow you can take one quick look at this photograph and an entire era is playing on the movie screen of your mind. You can almost see the fedora he probably wore every day. True enough, G. Lombard Kelly’s heyday was the 1930s, 40s and 50s. That might sound like ancient history to some, but Kelly was a man of action and a forward thinker in ways that still benefit the Augusta area today, 45 years after his death. Born in Augusta in 1890 mere blocks from an Augusta University administration building that would later be named for him, Kelly graduated from the University of Georgia in 1911 and entered Johns Hopkins Medical School that fall. Forced to withdraw due to illness, Kelly returned to medical school in 1914, this time with a new bride in tow in Augusta at what was then known as the Medical Department of the University of Georgia, later known as the Medical College of Georgia. When poor health once again prevented full attention

After a year interning in Augusta and another year as the city of Augusta’s official physician, Kelly accepted a position as research assistant at New York’s Cornell University, where he collaborated with Dr. George Papanicolau, the doctor who developed the Pap smear (previous profiled in the Medical Examiner’s page 4 feature, “Who is this?”). He was back in Augusta in 1927 as an associate professor of anatomy, and within two years he was head of the department, followed by another promotion to dean of the medical school in 1935. Brain surgery probably would have been easier than the task he now faced. Kelly inherited a medical school in disarray: the American Medical Association and the Association of American Medical Colleges had stripped the school of its accreditation in 1934, and the best two options at the time appeared to be either close the school or move it to Atlanta. Neither option was

G. Lombard Kelly to his studies, he left medical school for a second time, turning as he had during his fi rst hiatus to teaching in high school. He also dabbled in newspaper reporting. When his wife died in 1918, Kelly decided to volunteer for Army officer training, but that came to an end very soon after with the end of World War I. Returning to his medical studies in Augusta, Kelly spent the next six years working his way through med school, including four years as an instructor in anatomy. He was awarded his M.D. degree in 1924.

Please see PROFILES page 6

Editor’s note: this is a monthly series presented by Queensborough National Bank & Trust and the Medical Examiner profiling exceptional physicians and others of note in Augusta’s long and rich medical history.

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Dear Advice Doctor, My friend won two tickets to a Falcons game on a radio station but was unable to go. He offered to sell the tickets to me and said they were close to the field in a VIP area. When we got there the seats were way up near the top. The players looked like ants. I paid less than the face value of the tickets, but more than I would have paid had I known they were in the nosebleed section. Do you think I should ask him for a partial refund, or just keep my mouth shut? — Wish I Had Brought Binoculars Dear Wish, I’m sorry the game was somewhat spoiled for you. I once had a similar experience: my wife and I went to a Braves game and I was struck in the face by someone’s elbow while several of us tried to catch a foul ball. Epic nosebleed! Nosebleeds are not uncommon and happen for a variety of reasons. We’re entering into peak season for them: one of the culprits is very dry air (which we certainly don’t have during summer months), which can cause dryness of nasal passages and mucous membranes. Sometimes the cause is the combination of high blood pressure and medications taken to prevent blood clots or for other conditions, or even daily aspirin therapy. Sometimes a bad cold results in so much nose-blowing that a bloody nose occurs. Or a baseball fan hits you in the nose with his elbow. Whatever the cause, stopping it involves sitting up straight (do not put your head between your knees; that “cure” is a medical myth), leaning slightly forward, and pinching the nostrils shut while breathing through your mouth. Hold your nose closed for at least five minutes, longer if necessary. Afterward, avoid blowing your nose (unless very gently) and don’t lie down anytime soon. Keep your head higher than your heart. See a doctor if the bleeding doesn’t stop after 30 minutes, or if the cause is an accident or injury to your face. + 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 Examiner issues.

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#55 IN A SERIES

OLD NEWS

Who is this?

POINTS OF INTEREST TO FORMER KIDS by Trisha Whisenhunt

THE GEOGRAPHY OF FOOD

y one important yardstick, this physician is one of the biggest losers in medical history. Viewed another way, he is one of the greatest pioneers in the field. You have certainly heard his name: Harvey Cushing. He was a pioneer in brain surgery and is known as the father of neurosurgery. If you’ve ever heard of Cushing’s disease or Cushing’s syndrome, a somewhat rare problem caused by a malfunction of the pituitary gland, this is the man who first identified it. Dr. Cushing is known for developing or advancing the use of many of the basic techniques for brain surgery that are considered routine today, including the use of Xrays to diagnose brain tumors and developing and using electrocauterizing instruments to minimize bleeding in the brain. His efforts dramatically improved the odds of surviving brain surgery. He played a key role in introducing blood pressure readings as a diagnostic tool in 1900, something unknown in North America before Cushing saw an Italian physician using a sphygmomanometer he had invented. As chief neurosurgeon at Johns Hopkins Hospital (as of 1901), and later (in 1912) as professor of surgery at Harvard Medical School, Cushing was also the world’s foremost instructor of neurosurgeons in the early decades of the 20th century. With the outbreak of World War I, Cushing was commissioned as an officer in the U.S. Army Medical Corps, attached to a U.S. base hospital in France and as chief surgeon of a French military hospital near Paris. His field innovations including the use of electromagnets to remove shrapnel lodged in the brains of wounded soldiers. In Belgium 100 years ago this month during the Third Battle of Ypres, the terrible toll of casualties — nearly half a million combined on both sides — included Lieutenant Edward Revere Osler, son of Sir William Osler, known as the “Father of Modern Medicine” and one of the four founders of Johns Hopkins Hospital. Cushing treated the younger Osler, who did not survive his injuries. Harvey Cushing returned from the war in 1919. A prolific author of medical papers, he managed, in addition to his surgical and teaching workload, to find the time to write a comprehensive biography of Sir William Osler, a prodigious accomplishment that was published in two volumes. One source lists its size not in pages but by weight: 4 pounds. The work won the Pulitzer Prize in 1926. So how is this acclaimed physician, innovator and educator also one of the biggest losers in the history of medicine? In that he never won the Nobel Prize for Medicine despite being nominated for the honor nearly 40 times (the nomination process: all professors of medicine in Sweden, Denmark, Norway, Finland and Iceland, plus former Nobel laureates, may make nominations). Ironically, the only Nobel winner among neurosurgical pioneers, Antonio Moniz, won in 1949 for his promotion of frontal lobotomies, an intervention that was soon discredited and would not be considered prize-worthy today. Harvey Cushing died in 1939 at age 70. +

nternet dating is a sign of the times. There are many apps available for any age group and preference. One dating site is called HATER. It matches its users based on the things they hate. They can swipe to show approval or dislike for a person, activity, item or concept, all sorts of things, including food. Since February 2017, 600,000 people have swiped over 100 million times on the app’s 3,000 topics. HATER researchers turned the food-related data into a map of the U.S. showing which food each state in the U.S. hates the most. I accidently stumbled upon this fun list and it got my attention. The results are interesting: Alabama: Chipotle Alaska: Voss (brand) water Arizona: Chicken nuggets Arkansas: Cilantro California: Chick-Fil-A Colorado: Flaming Hot Cheetos Connecticut: Mayo on fries Delaware: Corner piece of brownie Florida: Licorice Georgia: Tuna salad Hawaii: Coke Idaho: Dim Sum Illinois: Biting string cheese Indiana: Charcuterie

Iowa: Quinda Kansas: Shellfish Kentucky: Hummus Louisiana: Cookies with raisins Maine: Asian fusion Maryland: Dab pizza with a napkin Massachusetts: Canned foods Michigan: Cold pizza Minnesota: Beans Mississippi: Sour cream Missouri: Last bite of a hot dog Montana: Pumpkin spice anything Nebraska: Chili peppers Nevada: La Croix New Hampshire: Expensive cocktails New Jersey: Gas station wine New Mexico: Kombucha New York: Ranch dressing on pizza North Carolina: Cottage cheese North Dakota: Tapas Ohio: Pesto Oklahoma: Veggie burgers Oregon: Any fast food Pennsylvania: Chai latte Rhode Island: Capers South Carolina: Maicha tea South Dakota: Expensive cheese plates Tennessee: Foraged food Texas: Well-done steak Utah: Balsamic Vinegar Vermont: Spray cheese

Virginia: Turkey bacon Washington: Keurig k-cups West Virginia: Tofu Wisconsin: Lunchables Wyoming: Gluten-free anything Washington DC: Hawaiian pizza I suspect a couple of these state’s choices may be politically motivated. I didn’t know what charcuterie is and had to look it up. (French for butcher shop or delicatessen dealing with pork, i.e., sausage, ham or cold cuts) Connecticut doesn’t care to put mayonnaise on their fries. I’ve never seen anyone do it. What is the problem with the corner piece of a brownie? I prefer it, actually. Why is the last bite of a hot dog objectionable? Kansas is land-locked so I can understand their lack of appreciation for shellfish. The term ‘Gas station wine’ is a new one for me and I had to laugh. New Jersey has a great sense of humor. Georgia doesn’t care for tuna salad; I was expecting Cream of Wheat because of the common comparison with grits. Minnesota won’t eat beans but they love Jell-O. I can’t eat it; it’s a texture thing. No matter where you are from, each geographical area has its food preferences and each area has their specialties they can boast about with pride. I can’t think of anything I hate but I am reluctant to try anything too exotic. A Japanese dish called Dancing Squid Bowl comes to mind. Go ahead and Google it. Yeah.......no, I’m not eating that. +

MYTH OF THE MONTH People shrink as they age This is no myth. It is true, and happens for several different reasons. One thing that is not true, however, is that this is a condition strictly affecting older people. In fact, people can begin to lose height as early as their 30s. Why do people get shorter? The main reason is that cartilage between joints begins to wear and grow thinner, particularly between the many bones of the spinal column. Osteoporosis causes bones to weaken and fracture, and this can also lead to loss of height. Especially if people don’t stay active as they

age, a decrease in muscle tone and mass can take away some of the support our frame uses to stand tall. Loss of muscle tone can result in a gradual but progressive slouch. It all might seem like just one more of the inevitable results of getting older, but exercise, good nutrition and avoiding smoking are a few of the strategies that can slow down the process of getting older — and shorter. + — by F. E. Gilliard, MD, Family Medicine 4244 Washington Road, Evans, GA 30809 706-760-7607

NOVEMBER 17, 2017

AUGUSTA MEDiCAL EXAMINER

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

o k

elinda’s bright smile hid a shy personality and nimble brain that did not chase after the latest fad or clothing style in her high school. But shadows lurked behind the bright facade. She fell in love and got bit by the pregnancy bug because she could not bring herself to tell her mother she had become sexually active with the young man she planned to marry. Her mother had warned her, but as is the case with many teens, one night it just happened. Instead of dropping out of school and going on welfare, Belinda gritted her teeth and gutted it out. She had spunk. Responsibility tugged at her heart. She wanted to do right and get back on the right track. A bit heavier, she graduated with child and academic honors plus a full scholarship. Belinda refused to abandon the unplanned child to her mother and dash off to college, so she declined the scholarship and took a Pizza Hut job, set up her own household, and paid her own bills. She did that for 10 long years, during which she had twins via C-section, worked her way through technical college, and got a degree in accounting and eventually landed a job with the State of Georgia. Then one day her dream job

ABOUT WAYWARD KIDS AND BELLY PAIN

materialized: Teaching math to special needs middle school students. Was everything pie in the sky and peaches and cream thereafter? You better believe it wasn’t. Her abdomen had a nagging, cramping, uncertain feeling that grew daily and interfered with her sense of well-being. And on top of that, one of her twin boys began emulating semi-hoodlums he saw at school. “Boy,” she told him, “you keep this up and you’re going straight to jail or hell! Or both. And I ain’t having it. I ain’t wasting my life raising street trash. Get yo’ butt in this car before I go up side yo’ head.” Fear and uncertainty leapt out of the abyss to grip his soul. He had never seen his mother in such a state. The High Sheriff met them at the Dairy Queen. The boy cowered before the Sheriff’s laser stare that could melt icebergs at 30 paces. The High Sheriff gave the thug-to-be a stern, threatening, hellfire-andbrimstone lecture about the horrors of boys jailed with real thugs. The boy was wild eyed, but still not totally ready to come to Jesus because he couldn’t imagine those horrors happening to him. Belinda thanked the High

E TH

t s e B Sheriff properly and hauled her son off to the second stop on her tour: the local funeral home. The Funeral Director stuck his massive finger in the boy’s chest and demanded, “Boy, come in here. Pick out a cheap wooden coffin for your burial. No sense in wasting your Momma’s hard-earned cash on a good one. Then, you show up here every Saturday at 6 AM to clean the morgue in exchange for an insurance policy to bury you.” The boy’s stomach churned. His face turned several shades of green. He tried to run away, but the Director grabbed his arm and took him into the morgue. Formaldehyde seared his nose. Four bodies lay on cooling boards. One was a teenage boy. “Boy, my wife gets a nice new car every year, and I send my kids to college off dead

e n i c i d ME

thugs like these. You wanta be one? I got another cooling board in the back room just waiting for you. You wanta try it out today?” Silent tears burned his eyes. His heart nearly exploded. He shook, but didn’t speak. His brain had severed its connections with his tongue. Belinda mercifully took him home. Behavioral therapy was over for the day. Hopefully forever, Belinda secretly prayed. Since then he has been a better, but not entirely perfect kid. Even though he doesn’t do his best every day, Belinda sees improvement. Better grades. No tattoos. No sagging pants. No gang slang. He talks about college. But Belinda’s belly still hurt. It was not psychosomatic. Her doctor said, “Adhesions from the C-section, but we have to rule out cancer.”

They operated for 7 hours. Busted up adhesion galore. Sent her uterus to pathology. No cancer cells found. As it should be: It just would not be right to deprive society of such a strong, forthright woman. One day Jesus will call her home to thank her personally. Her formerly wayward son was most attentive. He filled out college applications and sought scholarships to spare his mother financial worries. Belinda fully recovered from surgery, went back to the classroom and was at peace with the world. Her students were happy to see her, having no idea of the horrors she survived “while she was away.” Her tummy didn’t hurt. And her smile came back. Can we all do as well as Belinda? Depends upon how much we care. +

Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor - and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology.net or 706-306-9397. F REE T AKE-HO ME CO PY!

Calling all Bad Billy fans! More than two dozen of Bad Billy’s personally handpicked stories are collected together in his first book. Get yours today at amazon.com or barnesandnoble.com For personalized autographed print copies, call 706-306-9397

MEDICAL EXAMINER

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AUGUSTA MEDiCAL EXAMINER

PROFILES… from page 3 acceptable to Kelly, whose response was three-fold: to recruit the best faculty possible; to increase the number and quality of research studies; and to enlarge the school through the establishment of new departments. That was an extremely ambitious plan of attack for a school that had no accreditation. It could not have been easy to recruit top physicians, researchers and professors to a school that lacked the most basic stamp of official approval, but primarily due to Kelly’s dedication and persistence he pulled it off. The Medical Department of the University of Georgia had its accreditation restored in 1937. But the challenges were just beginning. At that time, clinical experience for medical students was gained at the school’s neighbor, University Hospital. Conveniently, another title G. Lombard Kelly had (from 1936 to 1941) was superintendent of University Hospital, unoffically known by some as City Hospital. If you think the city of Augusta’s recent interest in getting into the ambulance business is a new wrinkle, you may have missed a few chapters of Augusta history. In the early to mid-1940s, Kelly was faced with the problem of excessive political interference from the city in the operation of the hospital. By around 1945 the situation had deteriorated to the point that the management and operation of the hospital was compromised and patient care was being affected.

M E D I C I N E Kelly turned his full attention to improving the operation of the hospital and relations with the city, and by the end of 1945 matters had greatly improved. Even so, the episode highlighted a glaring need for the school to have its own dedicated teaching hospital. Kelly had been laying the groundwork for this under the capitol dome throughout the 1940s by campaigning for the medical school to become an independent institution within the University System of Georgia. That was finally approved in 1950. The Medical Department of the University of Georgia was replaced by the Medical College of Georgia, and Kelly’s title changed from dean to president. That step by the University System paved the way for further investment in the Augusta campus, and it didn’t take long: the Georgia legislature approved the construction of the Medical College of Georgia’s own hospital the following year (1951). Dr. Kelly retired in 1953, and spent a few years in private practice, specializing in marital counseling, a subject he had written about in several successful books. He continued to write for pleasure in retirement (including short stories and children’s books) and served as a medical advisor to the Columbia, SC, offices of the Veterans Administration. He died at age 82 of atherosclerosis on October 24, 1972, and is buried in Westover Cemetery. + Source: The New Georgia Encyclopedia

I N

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F I R S T

P E R S O N

A Cut, a Cousin, and a Can of Instant Tire Cement One sunny summer day, our family was on the way to a boat ride on the lake to celebrate the 15th birthday of my twin and I. My cousin, of about the same age, happened to grab a can of instant tire cement from the floor of our van, and, thinking it very funny for its random appearance, joked that if anyone cut their foot at the lake, he would seal the wound with that can’s contents. A few hours later I wondered if his prediction would come true. “Hey!” I hollered at the top of my lungs. “Hey, I’m hurt!” I had jumped into the lake and sunk my foot onto a knife-like rock. My sister and cousin came and peered over the ledge at me as I thumbed my flapping skin closed and dog paddled in the water below. “Can you climb up?” they asked. The thought of them hauling me out of the water was an absurd one, so I managed to work myself back up over the ledge. We had a ways to go through woods to get to help, so I grabbed my foot and started hopping through this rough terrain. Huge fallen trees and deep creek ravines quickly stopped me. “Climb on my back. We can do this!” my twin said as I grabbed her shoulders. Well, we couldn’t. My cousin intervened after letting us try, and I gratefully got onto his back. As we started back up again I said, “I think I’m getting blood all over you!” “Yeah, whatever!” he laughed. My uncle and dad temporarily butterflied the cut closed, and I think they were in more pain than I was while they did it. I even told them to stop being so agitated, because I felt nothing. It wasn’t until we got in the van to drive to the ER and saw the tire cement again that we realized the irony of my cousin’s earlier reference to a cut foot, even though we didn’t use it to close the wound. My cousin stuck with me even through to the ER trip. I was hungry, and he bought us all chocolate bars from the vending machine in the waiting room. Probably because it had been a long day and I hadn’t eaten substantially, I was hyper-sensitive to the shots and the stitches, even though the wound had been numbed. My cousin, on the other hand, videoed the stitches procedure, much to

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Quinoa is a wonderful, year-round dish. It is gluten-free, relatively high in protein and one of the few plant foods that contain all nine essential amino acids. It also provides some fiber, magnesium, B-vitamins, iron, potassium, calcium, phosphorus, vitamin E and various beneficial antioxidants. Quinoa is a grain crop grown for its edible seeds. In other words, it is a seed that is prepared and eaten like a grain. Since quinoa basically takes on the flavors of the ingredients added to it, you can just keep creating recipe variations until your imagination runs out! Think of your favorite salad toppings and homemade dressings and add those to cooked and drained quinoa to add a boost of easily-absorbed, plantbased protein to your diet. You can also serve a quinoa dish like this one on top of mixed salad greens for added nutrition. I would recommend if you do so, make a bit of extra dressing, toss the mixed greens in it and place the quinoa combo on top. Quinoa comes in different Sweet & Savory Quinoa colors, with white, red, and black being the most Add in walnuts, cranberries water (I used 1/2 of each, but commonly cultivated. Most and cooked sweet potato cubes plain water works just fine) grocery stores also carry a and toss. • 3/4 cup dried cranberries tri-color option. There are Whisk together dressing • 3/4 cup walnuts, roughly slight differences in cooking ingredients in a small bowl chopped times and chewiness; white and pour over top...gently mix. • 3 ounces fresh baby spinach quinoa, the most common, is Serve immediately (slightly DRESSING: Daniel Field the mildest and least crunchy, DANIEL VILLAGE warm or room temperature). • 3 tablespoons extra virgin 76 Circle K and cooks up the fastest, in 10 Refrigerated leftovers are great olive oil BARBER SHOP to 15 minutes. Black is on the for a couple days! + • 3 tablespoons white wine other end of the spectrum—it vinegar Medical Complex WRIGHTSBORO ROAD Augusta Mall might need 5 minutes or so Cinde White is a • 3 tablespoons orange juice longer and is the crunchiest of • pinch of sea salt certified health/ Tue - Fri: 8:00 - 6:00; Saturday: 8:00 - 2:00 the three, with red somewhere recovery coach in the middle. Instructions: (myhdiet.com) The sweet potatoes in this Position an oven rack just and a certified recipe take on a savory flavor above the center of the oven introductory wellness chef facebook.com/ when roasted with thyme and and set oven to broil. (cindewhite.towergarden.com AugustaRX sea salt. Combined with the Place cubed sweet potatoes or cindewhite.juiceplus.com condensed sweetness of dried on rimmed baking sheet. and southerngirlseatclean.com) cranberries and some roughly Drizzle with 2 T. olive oil and chopped nuts for crunch, this sprinkle with thyme, salt and is a fi lling and delicious meal pepper. Toss to coat evenly. or side dish, perfect for your Put under broiler for 5 minutes Thanksgiving table. and check, then for a minute This is yet another easy or two at a time until sweet opportunity to get more of the potatoes are tender but not 7-13 daily servings of fruits mushy and slightly browned and veggies recommended on the edges--approximately by the FDA. The recipe is 10-12 minutes. (You can delicious and can also be a also roast at 425° for about spring-board for your own 20 minutes, but I find they tasty, nutritious ideas. get cooked without getting TWO CONVENIENT LOCATIONS: browned, and this is a faster Ingredients: way to prepare them). 990 Telfair Street downtown • 2 large sweet potatoes, Meanwhile, rinse quinoa in peeled and cubed into small 706-724-0900 cold water in a fine mesh bite-sized pieces strainer. • 2 tablespoons extra-virgin Bring broth or water to a 3954 Wrightsboro Road (just off olive oil boil and stir in the quinoa. Jimmie Dyess Parkway) • 2 heaping teaspoons Simmer, uncovered until 706-863-9318 fresh thyme leaves, roughly tender...about 10 minutes. The chopped, or 1 teaspoon dried grains will look like small thyme leaves spirals. • 2 teaspoons sea salt and a Drain in large fine mesh sprinkle of freshly ground strainer and gently mash black pepper liquid out of quinoa. • 1-1/2 cups quinoa of choice Place in medium bowl while More details in our ad on page 10! (I used white) warm and add baby spinach, • 4 cups vegetable broth or tossing to wilt it.

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NOVEMBER 17, 2017

AUGUSTA MEDiCAL EXAMINER

MASTERS OF CLINICAL RESEARCH 706-210-8890

Attendees will be eligible for a $50 gift card raffle!

MILK… from page 1 within 30 minutes to several hours after consuming dairy products. Lactose intolerance is caused by a deficiency in an enzyme called lactase, which helps digest the lactose. Inability to digest lactose results in the unwanted symptoms; however, these symptoms are not considered to be related to any true allergy (unlike milk protein allergy). Milk protein allergy can occur with breastfed and formulafed babies alike. If breastfeeding mothers are worried that their babies are not tolerating milk well, it does not mean she has to stop breastfeeding. Eliminating dairy and milk from her own diet can allow a mother to continue to breastfeed with resolution of the allergic symptoms, but this should be discussed with the care provider fi rst. When treating a milk protein allergy, the gut instinct is to switch to a soy-based formula with the intention of avoiding dairy. Interestingly, however, milk proteins are very similar to soy protein, and often cross-reactions can occur, eliciting the same symptoms and allergic reaction to the soy milk. True milk protein allergy in an infant is treated instead with special formula with proteins already broken down (called hydrolyzed formula) so that the baby’s gut does not have to. If true MPA exists, then switching to this special formula will resolve symptoms within several weeks. Note: instantaneous relief is unlikely to occur, as the offending milk protein needs to be cleared from the system and the inflammatory, allergic response subsequently calms down. If milk protein allergy is diagnosed in a baby, it does not mean that milk and milk products will need to be eliminated from the diet forever. Frequently, children can tolerate reintroduction of milk products into the diet gradually at 1-2 years of age after a period of time of milk-free diet. Lactose intolerance, on the other hand, may or may not get better in time, but because it affects older children rather than infants, this is not an issue that would be present or a cause of concern with a symptomatic baby. Symptoms of colic, vomiting, diarrhea, poor weight gain, etc., are not guaranteed to be caused by milk protein allergy or lactose intolerance. Just because a baby is fussy or having GI symptoms does not automatically mean that the formula needs to be switched either, although of course it is a possibility. The main take-home message is that suspected difficulties digesting milk can manifest in a variety of ways, but other causes for a set of presenting symptoms need to be explored by a child’s pediatrician as well. +

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NOVEMBER 17, 2017

AUGUSTA MEDiCAL EXAMINER

Ask a Dietitian THE KETOGENIC DIET:

Its Evolution from Epilepsy to Weight loss and more by Nicole LeBlond, RD, LD Pediatric Clinical and Ketogenic Dietitian An avocado is the only single food perfect in its macronutrient composition of fat, protein and carbohydrate for the classic ketogenic diet ratio...Holy guacamole! It might surprise you to know the ketogenic diet dates back almost 100 years. It was originally designed in the 1920s by Dr. Russell Wilder at the Mayo Clinic. The diet found itself on the back burner by the 1940s, but regained popularity in the 1990s. The diet was originally intended for use in children who had seizures that were difficult to control, but some adults find it beneficial too. The ketogenic diet is a high fat, adequate protein, low carbohydrate diet used to treat refractory epilepsy. Shifting from a typically carbohydratedominant diet (45-65%) to one high in fat (70-90%) causes an alteration in our body’s main source of fuel: from glucose (or glycolysis), to fat broken down to ketone bodies (or ketosis). Ketone bodies in the bloodstream aid in the reduction of seizure activity. Scientists don’t understand the precise reasons, they just know that it works. Several studies show the ketogenic diet consistently demonstrates a 50-75% improvement in seizures among infants through adults. Additionally, one of the more well known studies on children by

Johns Hopkins researchers showed that about one third of patients experienced over 90% improvement in seizure activity, while another third experienced over 50% improvement, and the remaining third discontinued the diet due to intolerance or side effects. The ketogenic diet is not one-size-fits-all. There are actually five versions of the ketogenic diet for the treatment of epilepsy: the classic ketogenic diet; modified ketogenic diet; medium-chain triglyceride (MCT) oil supplement diet; low glycemic index diet; and the modified Atkins diet. Which one is best for an individual depends on age and tolerance or compliance. The classic ketogenic diet is the most restrictive, ranging typically from a 4:1 to 3:1 ratio of fat to combined protein and carbohydrate. Heavy creams, nut and seed oils, mayonnaise, and butter are essential staples at each meal. Carbohydrate-rich foods such as our beloved Oreos, Chick-fi l-A waffle potato fries, Lucky Charms cereal, maple syrup (if you’re from the North) or Aunt Jemima (if you have poor taste) and other carbohydrate and

sugar-rich foods such as candies, rice, pastas, breads and pizza are prohibited on the diet. Each meal must be specially prepared using a gram scale to weigh each food to prepare meals approved by a ketogenic Registered Dietitian. Even hygiene products like toothpaste and mouthwash; beauty products like shampoo, conditioner, lotions, sunscreen, lipglosses; and medications and supplements are restricted to certain brands and are taken into consideration for their carbohydrate content. This diet may be too restrictive for some children, requiring a downgrade to a less restrictive diet for better tolerance and adherence. Less restrictive ketogenic diets include the modified ketogenic diet, MCT oil supplement diet, low glycemic index diet and modified Atkins diet. These range from a 2:1 to 1:1 ratio of fat to combined protein and carbohydrate. Lower ratio ketogenic diets are also effective at controlling seizure activity, but the higher the ratio, the higher the level of ketosis and theoretically, better control of seizure activity. Please see KETOGENIC page 10

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KETOGENIC… from page 9

THE KETOGENIC DIET SIMPLIFIED

As the ketogenic diet regained popularity over the past two decades in the medical community for the treatment of intractable epilepsy, it has also grown in popularity in the world of fad weight loss diets such as the South Beach, Atkins and the Paleo diet. From a dietitian standpoint, I wouldn’t recommend the ketogenic diet for weight loss. Though many see initial weight loss in the fi rst few weeks, most of this loss is water weight, which is best explained by the decrease in carbohydrate intake. Cutting carbs, especially to the extreme extent of the ketogenic diet, also limits the volume of food one can consume. Fat yields 7 calories per gram, and carbohydrates and protein both produce 4 calories per gram; therefore, those experimenting with the ketogenic diet for weight loss may end up overeating their usual caloric intake due to smaller portions. Another reason the diet should be considered cautiously for weight loss: it is not complete in essential nutrients like Vitamin B, Vitamin D, calcium, and iron (if avoiding meat), requiring supplementation and a daily multivitamin. Constipation is also a major side effect for any version of the ketogenic diet because of its restrictive carbohydrate content and accompanying low fiber content. For safe and effective weight loss, the carbohydrate limitations in the ketogenic diet are too extreme and are not sustainable over time. An ideal meal plan for weight loss is something that is sustainable over time for that individual. It is not a “diet,” but

The

Advice Doctor ©

Will he ever get one right? +

Probably not.

20% 5%

75%

FAT

PROTEIN

CARBS

rather a set of nutrition skills and education that will yield long-term healthier choices, such as limiting sweetened-beverage intake, incorporating more fruits and vegetables, choosing whole grains, selecting lean sources of meat and fish, and choosing healthier sources of fats like nuts and avocados. On a more promising note, the popularity and effectiveness of the ketogenic diet in recent decades is not limited to just epilepsy. It has also been used to help children with certain metabolic and mitochondrial disorders, and furthermore, it’s currently being trialed in autism, certain cancers and neurodegenerative diseases such as Parkinson’s, Alzheimer’s, and amyotrophic lateral sclerosis (ALS). +

FIRST PERSON… from page 6 the nurses’ intrigue. “Looks like we have a future surgeon here!” they said. When I had to get a tetanus shot, the nurse warned me that it would feel like my brother punched me, gesturing at him. No one ever guesses we’re cousins. It’s always either brother or boyfriend. As an active all-around athlete, it was a tough transition from total action to just sitting on the sidelines of my team’s soccer games. At the same time, however, I took it as a little vacation, and it did me good. Also, to this day, the occasion serves as a good memory between my cousin and I, and we still laugh about his ironic joke about the cut-foot-curing can of instant tire cement. +

Questions. And answers. On page 3. by Gemma Bernard of Augusta

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Carl is a recent winner of our celebrated Mystery Word contest and sent us this selfie sporting his sweet Medical Examiner jersey — plus he won gift cards from Wild Wing Cafe and Scrubs of Evans. Life is good when you’re Carl.

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11 +

AUGUSTA MEDiCAL EXAMINER

The blog spot From the Bookshelf — posted by A Country Doctor, MD, on Sept. 25, 2017

A DOCTOR GOES WITHOUT A WHITE COAT. HERE’S HOW HIS VISITS CHANGED. Something very interesting happened to my patient visits when I changed my office attire. My clean long cotton lab coats, hanging on the back of my office door, suddenly all seemed dingy when I set out to change lab coats about a week ago. I decided to pretend it was Saturday. On Saturdays, I usually wear a pocketed button-down shirt instead of one of my usual Jermyn Street ones. I skip the lab coat, hang my stethoscope around my neck, put some pens in my breast pocket and attach my magnetic name tag. I still wear a tie, but sometimes with a doctor motif or Snoopy (I miss my beagles). On Saturdays, I seldom have very serious visits. Most are physicals for working people and sick visits, sore throats, earaches and such. Nobody from the administration, lab or X-ray is in, there are fewer messages, no faxes, and no meetings. It’s just me, a medical assistant and the patients. It’s all very basic. So there I was, deciding to go coatless. I lined up the name tag and put the magnet inside my pocketless English shirt to hold it in place, draped the stethoscope around my neck, clipped a pen inside my pants pocket and entered the exam room to greet my first patient of the day. “Nice shirt,” said the sixty-something man. He was chattier than usual, I noted quietly. I had two more similar compliments that day, and I started to feel something was different about the dynamic in the exam room. Since then, I have had the distinct impression that my visits are more laid back, more intimate and less demanding. It’s as if my patients are relating to me in a more personal way, even though I’ve always felt very close to my patients. I have also not had a single patient try to cram in a long shopping list of concerns I couldn’t possibly address in a single visit. I feel as if everyone is viewing me as more human, just as competent, but not a healthcare robot or action hero. I still delivered good and bad news, I still explained the inner workings of the body in plain English, and I still typed away with only two fingers on the computer or my iPad. But I felt as if a veil had been lifted and my patients saw me as more than just their doctor, and dared to treat me that way. +

I felt as though a veil had been lifted

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes.

MEDICAL EXAMINER IS ONLINE

• issuu.com/medicalexaminer • •

This month is one of the two best times of the year to talk about quality sleep: a few hundred million of us have just had our normal sleep patterns disrupted by the semi-annual change to and from daylight savings time. Sleep is one of the most under-rated components of good health. We might eat well and regularly exercise, avoid tobacco, keep our weight, blood pressure and cholesterol, etc., under control, but if we’re chronically sleep-deprived, we’re likely to be and feel unhealthy. Sometimes poor sleep quality is caused by factors a doctor needs to look into. Other times it’s our own fault, watching scary movies right before bed, drinking coffee or alcoholic beverages late at night, keeping our cell phone or tablet turned on at our bedside. This book is a combination of My Big Wonder Book of Sleep (in other words, for everybody) and the kind of 368-page book you might expect someone with the letters PhD following their name to write. As such it’s thoroughly

fascinating at whatever level you might like to take it to. It has all the Year 2017 requisite explanations of challenges to our sleep and how they have evolved over millions of centuries, all the way back to how many hours of sleep primordial soup got on an average night (we might be slightly exaggerating), along with plenty of recent clinical studies that explore the truly fascinating subject of sleep. On a more practical note, one of the book’s better features are its “Twelve Steps for Healthy Sleep,” which are actually borrowed from the National Library of Medicine at the National Institutes of Health. A number of them are

routinely violated by many of us, who then wonder why we toss and turn or wake up three times during the night. But the Twelve Steps also include some things many of us overlook because we’ve never even thought of them. Example: we all set an alarm clock on most days for when it’s time to get up. It’s to the minute: exactly 5:45 or 7:10. But we take the other end of the equation very casually: who sets an alarm for bedtime? No one. Bedtime can vary in some households from 11:00 pm to 1:00 am for the same person. Yet the wake-up call never varies its time. That needs fixing. Many Examiner readers would undoubtedly enjoy this book, but if you don’t happen to get a copy, we can at least answer the cover question: Why We Sleep. To quote Augusta sleep expert Bashir Chaudhary, MD from a very early issue of the Medical Examiner, “We sleep because we are tired.” + Why We Sleep; Unlocking the Power of Sleep and Dreams by Matthew Walker, PhD, 368 pages, published by Scribners in October 2017.

Research News Textual harassment Mental health professionals say that conjoined twins — aka, us and our our cell phones — are psychologically damaging. Citing increasing evidence (which probably coincides with our ever-increasing dependence on our phones) a majority of people (65 percent) feel anxious when their phone battery levels get low. 43 percent felt “frustrated or anxious” when low on battery, and an equal number (42 percent) felt vulnerable when they completely lose battery power. Other emotions the 2,000 study participants described in a study by a charging technology provider: cut off, angry, isolated, scared. These emotions are especially high when people are traveling (72.6 percent) and home alone (50.9 percent).

The problem with these feelings and the device dependence they foster, say psychologists, is that people are losing their coping skills. The instant tweets and posts of support they receive when, let’s say their boss requests a meeting or one of their kids gets sick, are replacing people’s ability to think problems through — or think for themselves at all. This conclusion is borne out by numerous studies that show sharp spikes in anxiety and withdrawal-like symptoms when people are separated from their phones. The secret to fi xing the growing problem, say psychotherapists, is establishing digital detox periods: perhaps every weeknight after 10 pm, during all meals, and perhaps for an entire day each weekend. The experts say it’s a boost for mental health.

Moving prevents stopping This is nothing new. Exercise has long been known to prolong life and enhance the quality of life. But a new study released this month by Harvardaffiliated Brigham and Women’s Hospital has found even greater benefits from exercise than previously believed. Conversely, the same study also concluded that the lack of exercise or physical activity is estimated to cause as many deaths each year as smoking. That’s half a million in the U.S. alone. The Brigham and Women’s study used more accurate tracking methods to measure data on people’s exercise habits. In so doing they discovered a risk of death over a 4-year period that is 60 to 70 percent lower among even just brisk walkers compared with sedentary lifestyles. +

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NOVEMBER 17, 2017

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

by Dan Pearson

Read any good Not really. The last books lately? one was terrible.

What book was it?

What was so bad about it?

“50 Things To Do Before You Die.”

I expected at least one of them would be “Scream for help!” But no.

The Mystery Word for this issue: SEEY

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Peak 5. Assisted 10. Pins to hold a tent down 14. The slammer in England 15. Opposite of the expected result 16. Relating to the ear 17. Monetary unit of Peru 18. ______ up; spoil or ruin 19. Currency in Austria 20. Natal, at first 21. MCG’s Sydenstricker _____ 22. Leaning 23. Golf & _______ (used to be on Reynolds Street) 25. Scope or meter prefix 27. Brain activity test (abbrev) 28. Person who makes arrows 32. Guts; gumption 35. Local Bridge? 36. Chopping tool 37. Ancient coffin 38. Gill’s wife 39. By mouth 40. Bandage type 41. Compete, as for position 42. Lassie’s master 43. fire treatment ctr 45. pop ISP 46. Secondhand 47. Seat of Georgia county named for Daniel Webster 51. “We had a _______ time.” 54. Water barriers 55. Wonderment 56. Bereft (Literary) 57. _____ hug 59. Nonprofit legal grp. 60. Heroic 61. Garlic-flavored mayo 62. “Moonstruck” star 63. Hawaiian goose

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

VISIT WWW.AUGUSTARX.COM 1

T O I L V N L W I E L E Y Y V E F

Click on “READER CONTESTS”

QUOTATION PUZZLE 29

O F R A

Y W R E U E O U T N D R R E Y U U U H E B Y A L T I

— Vincent Van Gogh

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

64. Small forage fish 65. Cell prefix DOWN 1. Getting close to obsolesence 2. Capital of Crete 3. Prefix for boat or home 4. Biblical high priest 5. Sick 6. Golf clubs 7. Augusta’s Barnard 8. Lowest ranked naval offcr. 9. Former Richmond Academy player now in the College Football Hall of Fame 10. Type of justice 11. Sewing case 12. Female child 13. Resident of Glasgow 21. Masters _______ 22. It’s what’s in the Heart 24. Door ding 25. Factory 26. Sinus doc 28. Sumptuous meal

29. Hurt 30. Test 31. Depend 32. Recent wound reminder 33. CHOG special area 34. Person who takes drugs 35. Augusta’s ______ Park Ave. 38. “____ Girl” (2012 novel) 39. Lubricates 41. _____ about; almost exactly 42. Lower digits 44. Subtle difference 45. Axilla 47. Zahn or Deen 48. Fast heartbeat (in brief) 49. Young owl 50. Nervous system prefix 51. Small narrow valley 52. Thick cord 53. Ireland (Literary) 54. Entrance 57. Liquid or vapor used as fuel 58. Common tombstone abbrev. 59. Clemson conf.

X A M I N E R

4 1

1 5

8 4

U D O K U

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

Solution p. 14

Use the letters provided at bottom to create words to solve the puzzle above. All the listed letters following #1 are the first letters of the various words; the letters following #2 are the second letters of each word, and so on. Try solving words with letter clues or numbers with minimal choices listed. A sample is shown. Solution on page 14.

N 1 2 3 4

1 2 3 K 1 2 3 4 5 6 7

W 1 2 3 1 2 3 4 O 1 2 3 1 2 3 4

1 2 — Socrates

1 2 3 4 5 6 7

1.TTNIKIKOWY 2.NNNNOORISH 3.UUSTOOLE 4.WWHEYD 5.IIO 6.NMN 7.GG

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

THE MYSTERY WORD

NOVEMBER 17, 2017

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE

wo businessmen were walking through an airport terminal when a man walked up and asked them in Spanish where baggage claim was. Neither man knew Spanish, so all they could do was shake their heads and say that they didn’t understand. The man asked them again, this time in German. Again, the two men did not understand him. He tried asking in Japanese and then in French, but each time the men couldn’t understand him. He finally gave up and walked away, hoping to find someone who could answer his question. As they walked on, one businessman turned to the other and said, “You know, I might try to learn a second language.” “Why would you want to do that?” replied the other. “It would help out in situations like the one we just had.” “What good would knowing a second language be? That guy knew four and it didn’t help him.” Moe: What do attorneys wear to trial? Joe: Uh...legal briefs? Moe: No, law suits!

A 102-year-old man in a tiny town in the Georgia mountains is being interviewed for a story about old age. “Do you think there’s any truth to the belief that people from this area live a lot longer?” asks the reporter. The old man hesitates for a few moments, then says, “I’m really not sure. I guess we could ask my dad.” “Your dad?” says the reporter in disbelief. “Where is he?” Pointing to a boat in the nearby lake, the man says, “He’s fishing with my grandpa.” Moe: I finished 3 books this week. Joe: Wow, you do a lot of reading. Moe: Not really. They were coloring books. Moe: At the grocery store today this little old lady in front of me with her whole week’s groceries had her card declined. It broke my heart, so I offered to help. Joe: Aw, you paid her bill? Moe: No, I helped her put everything back. Moe: Mary Rose sat on a pin. Joe: And...? Moe: Mary rose. Handy tip: Don’t ever buy a keyboard on ebay.

ha... ha...

Moe: You’re in the Army, right? Joe: Yeah, so? Moe: So do you know the correct military term for a fat baby? Joe: I give. What? Moe: Heavy infantry.

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

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SUBSCRIBE TO THE MEDICAL EXAMINER By popular demand we’re making at-cost subscriptions available for the convenience of our readers. If you live beyond the Aiken-Augusta area or miss issues between doctor’s appointments — don’t you hate it when that happens? — we’ll command your mail carrier to bring every issue to your house! NAME ADDRESS CITY

ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble wrote a long-time column in this paper entitled The Patient’s Perspective reincarnated in this new format. Feel free to contact her at marciaribble@hotmail.com Recently it was brought to my attention that I have been living “under a porch.” I’ve always heard the term as “under a rock,” but I understood the comment anyway. It is meant to indicate that I am extremely out of touch with what’s going on in the world today. The reasoning was simple and based on the fact that I was not up to date on the movie, Thor: Ragnarok. Turns out that Thor: Ragnarok is the latest iteration of a movie series about the Norse god, Thor, who hurls his hammer at bad guys. So he’s kind of a pre-medieval hero to contemporary folks who are up to date regarding comic good guys and villains, which I am definitely not. I think the last time I read a comic book was in the 1950s when our family was on vacation and we were allowed to pick out one comic book apiece, while Mom allowed herself to buy a Redbook to read the stories in it. Other than on vacation, our reading supplies were limited to hard cover books from the library. I do not think of myself as antediluvian, but obviously, in terms of contemporary culture, I am not up to date; so imagine my responses when the ads for Thor invaded my TV screen. I was relieved to know that I was no longer completely ignorant, only somewhat so. Then I noticed that ads for movies like Thor rarely appear on my favorite channels, Food, HGTV, ESPN, and other sports channels, local and national news, and PBS. In fact, my fi rst Saturday morning task is to read the inside first page of the sports section to plan my watching of college games, football, basketball, or hockey. The only baseball games I watch are the World Series, which are hard to watch after they put me to sleep. Despite being an old fogey, I was glad to know what the movie Thor is about, so I could converse about it with my grandchildren, who are far more clued-in than I am. Keeping up to date on what kids are watching and listening to is important to us as we age, so we can talk with our families’ youngsters. One of my granddaughters used to come in after school, sit near me, and ask me to tell stories about the “old days” when my children were youngsters. She especially loved it if the stories showed her mom getting into trouble and me loving her anyway. We often are most connected to our families through the strings of our stories. Even my now very grown up kids enjoy me telling stories about their childhoods, whether they are the hero or the goat in the story. We’ll wonder: who shot who with the BB gun in their butt? Who pushed which other kid’s face into the bowl of strawberries? We’ll recall one child in particular who pushed a chair up to the door, unlocked it, and headed down the street to play with her friend, clad only in her panties, a sweatshirt, and her fi reman boots; the only clothes she could put on herself. We’ll remember the child who set a fire in our garage, and luckily put out quickly with no significant damage. We will roar with laughter, and nothing is healthier for us as we age than laughter. +

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AUGUSTA MEDiCAL EXAMINER

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

...cleverly hidden in the lower right corner of the p. 7 ad for WILD WING CAFE THE WINNER: KRISTIE EMERSON Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

THE PUZZLE SOLVED A

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The Celebrated WORDS BY NUMBER “The only true wisdom is in MYSTERY WORD CONTEST knowing you know nothing.”

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

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THE ILLUSION OF “INPATIENT” TREATMENT by Ken Wilson Executive Director, Steppingstones to Recovery On and off, all day long, I get calls from prospective client’s families (correct... the actual client rarely calls) wanting “inpatient” treatment. For some reason it is seen as a magic elixir to heal an addict or alcoholic...by “locking ‘em up and keeping ‘em safe for 4-6 weeks.” Not. Granted, next month I may write a column on the importance of inpatient treatment. But today, I’m going to try to dispel the myth that it’s a panacea. I wish I had the proverbial nickel for every time I enrolled a client in an IOP (Intensive Outpatient) treatment program on a Monday who had been

discharged from 30-45 days of inpatient treatment and who had, over the weekend, entered the free world and promptly relapsed. You see, there’s something in the mind of such a patient - consciously or not - that thinks “I’m gonna do this inpatient program and get my health back and then I’m gonna use again. But this time I’m gonna stay in control!” Again, “Not.” Even in an inpatient setting, the addict can find something to use to get high! No inpatient program uses handcuffs and chains... there are shopping trips, 12-step recovery meetings, bowling trips, visits from family or friends, all of which are opportunities to score. Granted, there is more inpatient supervision — an

IOP program only offers about 3 hours a day of supervision — and 21 hours back out there in the real world. There are really only two places a person can be kept under lock and key against their will: a state mental hospital or jail. HIPAA rules require inpatient facilities to let clients who wish to sign out of the program to be allowed to leave...provided they are not a threat to themselves or someone else. Keeping an inpatient against their will is an invitation for legal action nowadays. A big downside of inpatient treatment, if done out of town, is when the client is discharged to return home and doesn’t have a good support system in self-help groups - or even know the meeting

schedules or the personalities of different groups, and can be briefly lost until they figure it out. At some point, they have to return to their old stomping ground, in proximity to their old “watering hole” and they may not have developed the skills to deal with the return to real life as they might in an Intensive Outpatient program, one that guides, directs, supports and informs them of meetings akin to their personal style and which offers a quicker opportunity to find a sponsor. Then there’s the insurance dilemma. After detox (which is usually only for benzodiazepines and alcohol) no insurance company I know of will authorize 4-6 weeks of Inpatient care. Usually patients are discharged after

THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional detox and stabilization and referred to an IOP program - unless families will pay for continued stay inside a facility due to insurance plans not covering the “room and board” fee as they call it. Inpatient treatment usually costs about $1,000 per day or more, and healthcare nowadays is seeking ways to cut costs, understandably. So all that glitters is not gold. It just costs like gold. So what to do? Next month. +

PROFESSIONAL DIRECTORY ALLERGY

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

AMBULANCE SERVICE

AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

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

FAMILY MEDICINE

DENTISTRY

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

F. E. Gilliard MD, Family Medicine 4244 Washington Road Evans, GA 30809 Floss ‘em or lose ‘em! 706-760-7607 Industrial Medicine • Prompt appts.

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

DERMATOLOGY

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

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

SENIOR LIVING

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

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

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Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 Medical Center West Pharmacy 706-733-3373 465 North Belair Road www.GaDerm.com Evans 30809 Vein Specialists of Augusta Resolution Counseling Professionals 706-854-2424 G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 3633 Wheeler Rd, Suite 365 www.medicalcenterwestpharmacy.com 501 Blackburn Dr, Martinez 30907 Augusta 30909 706-854-8340 706-432-6866 Parks Pharmacy Karen L. Carter, MD www.VeinsAugusta.com www.visitrcp.com 437 Georgia Ave. 1303 D’Antignac St, Suite 2100 N. Augusta 29841 Augusta 30901 803-279-7450 706-396-0600 If you would like your www.augustadevelopmentalspecialists.com www.parkspharmacy.com medical practice listed Your Practice in the Professional And up to four additional lines of your choosing and, if desired, your logo. Directory, Keep your contact information in Steppingstones to Recovery Psych Consultants call the Medical this convenient place seen by tens of 2610 Commons Blvd. 2820 Hillcreek Dr Augusta 30909 thousands of patients every month. Augusta 30909 Examiner at Literally! Call (706) 860-5455 for all 706-733-1935 (706) 410-1202 706.860.5455 the details www.psych-consultants.com

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NOVEMBER 17, 2017