Nov2 18

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HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

NOVEMBER 2, 2018

AIKEN-AUGUSTAʼS MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

WELCOME TO

EATING SEASON!

Do not attempt

AUGUSTARX.COM

veryone knows it really isn’t Eating Season.

Who ever heard of that? We just made it up. As we all know, it’s actually Overeating Season. There is a difference. Really, the whole year is Eating Season. But the coming weeks, unlike any other time of year, will include countless events where food and eating are the main attraction. Some of them might be major events, like family dinners with more food than an entire African village sees in a week and a half. Others can be pretty minor, like co-worlers or vendors bringing in goodies to the office day after day for weeks, puncuated by an official holiday party luncheon serving lots more food than we normally eat. Overeating Season offers food at every turn, culminating in a special Sunday in February that marks a unique national holiday centered around eating (mainly junk food) and watching TV. With this weeks-long event looming on the near horizon, the Medical Examiner is offering as a public service to our health-minded readership a number of salubrious suggestions from registered dietitians and other certified professionals to help us all nagivate the minefield ahead without having to just give in, break the bathroom scale, be forced to replace our entire wardrobe, experience a bloat factor of 8.6, and suffer from a precipitous drop in self esteem.

None of that is necessary. It’s all preventable.

Check out pages 2, 8, 9 and 10 in this issue.

Actually, every issue of the Medical Examiner yearround contains at least one article about healthful eating. After all, there is no better medicine than delicious and nutritious food. +

THANK YOU FOR LETTING US SERVE YOU

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ELIXER TRUE Health

DECIPHERING HEALTH MYTHS, SNAKE OIL CURES AND OLD WIVES TALES BY “DOCTOR” TRACEY BUSBEE, MLIS, AUGUSTA UNIVERSITY

If you celebrate Thanksgiving like many Americans, you’ll be enjoying a turkey-centered feast, the Macy’s Thanksgiving Day Parade, football, and the requisite leisurely nap. After all you’ll be especially tired after eating a heaping helping of turkey with all of that tryptophan, right? Well, yes and no.

You may be drowsy after the big feast, but research shows that no matter how you stuff, roast, or fry it, turkey is not the culprit.

Tryptophan is one of the nine essential amino acids that the body needs. Our bodies cannot make these nine amino acids and therefore our diets must supply them. The other essential amino acids are histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, and valine.1 Amino acids are the building blocks of protein. However, through a complex web of interaction between vitamins and minerals, tryptophan has other important functions. It is the sole precursor of serotonin, a well-known neurotransmitter.2 Serotonin is created from tryptophan in the brain stem and in gut neurons.3 Research has shown that serotonin may affect moods, cognition, circadian rhythms, learning, sexual behavior, relaxation of vascular smooth muscles — and sleep.2,4,5 If that’s the case, then why is turkey-induced napping not true? Mainly because it requires a leap in logic. A few things need to be understood in order to set the record straight.

First, there are two different forms of tryptophan, one that is purified and medical grade, and the tryptophan naturally found in foods. There is some debate about whether to view tryptophan as a drug or a dietary component. In the U.S., tryptophan may be sold as a dietary supplement. In Canada and some European countries, the purified form of tryptophan is treated as a drug and prescribed. Each form has a different effect on the brain.6 Tryptophan is found in a myriad of foods along with other amino acids. Each amino acid competes for absorption with the others. A pound of turkey breast has 410mg of tryptophan and 9,525mg of competing amino acids. Plasma levels of tryptophan do not skyrocket after eating turkey because in comparison to other amino acids, it is usually the lowest in quantity. While purified tryptophan does show up in plasma levels, there is no research showing that tryptophan from food does so. No boost in tryptophan leads to no boost in serotonin creation which leads to no sleepiness caused by turkey.6 I had hoped to find a timeline of how long it takes for the synthesis of serotonin from tryptophan found in food. I was not able to locate a concrete source. I would think it would take many hours though. Maybe one day I’ll find the answer.

But for now, don’t be one of the turkeys believing that turkey makes us sleepy. You might just be tired.

I wish you all a great Thanksgiving with lots of turkey, Tofurky, turducken and love. +

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Reference List 1. MedlinePlus. Amino Acids. Available at https://medlineplus.gov/ency/article/002222.htm.

Accessed October 10, 2018.

3. Jenkins TA, Nguyen JCD, Polglaze KE, Bertrand PP. Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis. Nutrients. 2016;8(1):56. doi:10.3390/ nu8010056.

4. Dfarhud D, Malmir M, Khanahmadi M. Happiness & Health: The Biological Factors- Systematic Review Article. Iranian Journal of Public Health. 2014;43(11):1468-1477.

5.Hall FS. Serotonin : Biosynthesis, Regulation and Health Implications. New York: Nova Science Publishers, Inc; 2013. http://ezproxy.augusta.edu/login?url=http://search.ebscohost.com/login. aspx?direct=true&db=nlebk&AN=601319&site=eds-live&scope=site. Accessed October 17, 2018.

6.Young SN. How to increase serotonin in the human brain without drugs. Journal of Psychiatry & Neuroscience : JPN. 2007;32(6):394-399.

COMMUNITY RESOURCES ...Y MUCHO MAS

Iglesia Casa de Refugio 3108 Milledgeville Road • Augusta

“Doctor” Busbee is an Academic Librarian with a passion for multidisciplinary research. In spirit of 19th century advertisements, medicine, and ensuing quackery she would like to remind everyone to evaluate what you hear, see, and read before you believe it. And always, have conversations with your doctors. There is no substitute.

2. Richard DM, Dawes MA. L-Tryptophan: basic metabolic functions, behavioral research and therapeutic indications. International Journal of Tryptophan Research. 2009;2:45-60.

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NOVEMBER 2, 2018

AREYOUREADY? If you’re a smoker, maybe this year you’re finally ready to throw in the towel on your habit. That’s the key, you know: when you are ready. Not when your spouse has guilted you into it, not when the Medical Examiner has badgered you with statistics about the folly of smoking, whether it’s from a health perspective or a financial one.

No, none of that really matters. Ask any ex-smoker and they’ll all tell you — or 97.8 percent of them will, anyway — that every attempt they ever made to quit in the past went up in smoke (literally) when they were doing it to please someone else. Some who

crashed and burned time after time say it was actually easy when they finally made

the decision on their own to quit.

Hopefully that describes you this year. It’s better to take your time and do it right than to start off with a half-baked approach.

Quitting isn’t easy for most people. It takes time and a plan, and even then, failure may happen on multiple attempts. That’s not something to worry about.

It’s just part of the process for many people.

If you’re thinking about joining the Great American Smokeout on Nov. 15, visit cancer.org for help. Click on the Stay Healthy menu, then “Stay Away from Tobacco.”

You can do this. Best wishes! +

November is also the month for our umpteenth annual call for University Hospital to banish smoking from its grounds. Bars don’t allow smoking, but a leading hospital does? What is wrong with that picture?

Everything. It’s 2018, not 1964.

University, not only should 2018 be your year to join the 21st century; this should be your month. Do the right thing. +

NEED HELP? Miller Drug is your go-to resource for Medicare Part D Open Enrollment.

Schedule an appointment with Dr. Neal any time to talk through your options!

WHAT IS CARDIAC CATH? Most of us are familiar with the word catheter (or “cath” for short). It’s a thin flexible tube inserted into the body for various purposes, and the purpose often defines the type of catheter used. After surgery, for instance, it is not uncommon for a urinary (or “Foley”) catheter to be inserted into the bladder to drain urine.

Although simple catheters made from plant stalks and reeds date back to ancient times, the modern medical catheter was invented in 1752 by none other than Benjamin Franklin, although Franklin may have merely modified another’s invention from around 1720.

“Catheterization” is the process of inserting a catheter.

In the case of cardiac catheterization (see why people say cardiac cath?), the catheter is inserted in a vein and threaded up into the heart. Once there, the catheter can get down to business. A contrast dye can be injected through the catheter that will make blood flow readily apparent, and more to the point, where any blockages from plaque or cholesterol are preventing normal and adequate blood flow. Pictures taken at this point are known as coronary angiography, or simply an angiogram.

Measurements can be taken inside the heart to gauge its pumping efficiency in all four heart chambers, as well as how heart valves are performing. Oxygenation levels can be measured too, and tissue samples can be taken to later be biopsied in the lab.

Cardiac cath isn’t all diagnostic. Problems identified during catheterization can be immediately fi xed. A blocked artery identified by contrast dye can be fi xed by angioplasty, a procedure where a tiny balloon inserted by catheter is inflated to restore better bloodflow at that spot. As long as all the equipment is already there anyway, a stent — a small tubular scaffold to help keep the vein open — can also be inserted to decrease the chance of a future blockage at that spot.

Considering everything performed, inside a beating heart at that, cardiac cath is generally considered an extremely lowrisk procedure that can eliminate or prevent some very highrisk events like stroke and heart attack. +

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NOVEMBER 2, 2018

AUGUSTAMEDICALEXAMiNER

#78 IN A SERIES

Who is this?

ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com

by Marcia Ribble

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his woman just might be the most amazing trailblazer most people have never heard of.

Susan LaFlesche was born in the summer of 1865 on the Omaha Reservation in Nebraska and grew up to make quite an impact on the world of medicine, becoming the first Native American to earn a medical degree. She accomplished this during an era when neither women nor Native Americans were accorded the basic rights extended to white males.

One of the turning points in her life, in fact, was as a child watching a sick Omaha tribe woman die because a white doctor refused to treat her.

Encouraged by one of her mentors, LaFlesche applied for a scholarship from the U.S. Office of Indian Affairs. For all those reading this with student debt, LaFlesche is said to be the very first person to receive federal aid for a professional education. She used it to attend, beginning in 1886, the Women’s Medical College of Pennsylvania, one of only a few schools in the nation at that time that accepted women. She also received financial support from the Connecticut Indian Association.

She graduated in 1889 as class valedictorian, becoming the first Native American (or according to some histories, the first Native American woman) to become a doctor, and was appointed as the physician for the Omaha Agency Indian School. The position carried with it a salary of $500 per year, one-tenth the pay for male doctors at that time in government service. The Women’s National Indian Association also contributed $250 per year for her services.

Although her position was officially limited to care of the children in the reservation school, LaFlesche cared for many residents of the community at large, a pool of some 1,200 people, both whites and Native Americans, scattered over 450 square miles. 20-hour workdays were not uncommon in an era when house calls were standard operating procedure.

That grueling workload led LaFlesche to champion a number of causes that were unusual for their time, starting with her personal life.

In 1894 she married Henry Picotte, a Sioux originally from South Dakota. In Victorian times, married women were expected to be full-time mothers and housekeepers, but Dr. LaFlesche, now Dr. Picotte, continued her medical practice in Bancroft, Nebraska, while raising two children and dealing with her husband, who was an alcoholic.

She became an advocate of the Temperance Movement, partly because of her husband but also because of alcohol’s toll on the Indian community as a whole. The scarcity of medical care on the reservation also caused Picotte to actively promote preventive measures like better hygiene and food sanitation, and a means to centralize care to avoid the time spent on house calls. In 1913 her efforts finally came to fruition with the opening of a small hospital in Walthill, Nebraska, for which she personally raised the funds. It was later named the Susan LaFlesche Picotte Memorial Hospital in her honor.

“Dr. Sue” lived a hard life of dedicated service and died of bone cancer in September, 1915, at age 50. +

Summer seemed so fi rmly in place that transitioning to fall seemed impossible, yet it finally happened. Such is the case with aging.

We know that aging and death are inevitable, yet even in perfect health we all have to prepare for a future we may find it hard to envision.

For some, chronic pain notifies us that the inevitable is drawing closer and it’s time to make decisions about what the future holds for us. Should we begin downsizing our homes, going through and eliminating unused “stuff,” preparing a living will, or all the above?

Medical providers ask if we have a living will. They raise important questions, the most significant of which is who among my relatives and friends is going to be able to support my wishes for health care as I age? In my case, a daughter and adult granddaughter are willing to carry out my choices if and when I am no longer able to be in charge myself.

While thinking about and talking about aging and death can be uncomfortable for everyone involved, it is comforting to know that our wishes will be supported, protected, and observed. At the same time, these discussions allow all involved to have deeper conversations about the meaning of life as well as the vagaries of dying.

One such conversation with my youngest daughter Vicki allowed her to ask me if I am afraid of dying. I told her I’m not afraid of death, but that I am afraid to be in a situation where I am incontinent and allowed to lie in my own wastes. I am afraid of being helpless and unable to control my life, but not of

dying. My advanced directive provides some reassurances that I can insist on what I want and have my wishes met.

I know there are some nursing homes where patients are neglected and even abused, but there are also places where wonderful care is given. I am more likely to be unable to afford good care than I am to end up in a highquality nursing home, so my favored option is to remain at home in my own surroundings with adequate support to do so. My granddaughter Yvette noted that I have five children and they would need to step up to ensure this desire of mine is met. I am glad we can talk about things like that, because it’s reassuring to understand that others will speak for me if I can’t.

One aspect of aging is the question of when to give up driving. At this point I cannot conceive of turning over my independence to anyone else, but that may be an option I must reluctantly consider in the future. Which of my family members has the courage to take my car keys from me? Will I be smart enough to recognize that time and voluntarily give up my car? When it happens, what are my options for transportation if family members are unable to drive me places I need and want to go to?

Planning ahead offers me the security of knowing rather than fretting about the inevitable but uncertain future. Planning with family members gives me a sense of being cared for even though I am able at this point to care for myself. I have a large and loving family, but there are other resources as well to support us as we age. We need to make sure we can access those resources when we have to do that. +

IT’S POLITE TO STIFLE A SNEEZE WHICH WILL IT BE? It may very well be, but this isn’t a column about manners.

From a medical and health standpoint, holding in a sneeze is not a very good idea at all.

The mechanics of sneezing mean that it is almost a violent act. People have their glasses fall off their face when they sneeze. Laboratory studies

have found that the velocity of the air expelled by a sneeze can be as high as 100 m.p.h.

Imagine trying to stifle that much force by keeping your mouth closed or pinching your nose.

All that dynamic energy has to go somewhere, and the only options are all somewhat delicate structures, places like the middle ear and the Eustachian tube. Ruptured ear drums are not uncommon

among people who hold in sneezes. Hearing loss can result from that, either temporary or long term.

Other fairly common side effects include ruptured blood vessels in the eyes; more unusual but possible are ruptured or weakened blood vessels in the brain.

Everybody sneezes. There is no social stigma attached to sneezing, so don’t be shy.

Cover, then go ahead and sneeze. +

NOVEMBER 2, 2018

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Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker.

Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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hate dealing with opioid pain medications. They are one of the worst parts of being a primary care doctor. Many patients come to my practice on chronic opioids, expecting me to continue these medications.

Other patients have the expectation that any pain should be treated with a narcotic. Some people sell the stuff, others continue in current pain despite being on daily medication. There are contracts to be signed, urine to be tested, and pain management doctors to consult, most of whom don’t prescribe narcotics.

Nobody is happy.

Many doctors “solve” this problem by not prescribing any pain medications, leaving patients to seek out someone who will.

This takes the headache away from that doctor, but creates significant problems to patients who have chronically been on these medications. Beyond that, it creates a culture of suspicion, as patients are often assumed to be manipulating to get more and stronger medications.

While there are certainly some patients who are aggressive and deceitful in their attempts to get narcotics, many others (most, in my opinion) are led down this path without their knowledge.

It goes something like this: Step 1: Patient has legitimate pain and is given a pain medication.

Step 2: Pain medication helps with pain, and has an added bonus: a euphoric effect, which the patient equates with pain relief.

Step 3: Patient develops worse chronic pain, and is put on a regular but low dose of narcotic, getting

some pain relief but acquiring a desire for the euphoria (which also helps deal with life stressors, etc).

Step 4: Patient develops a tolerance to the narcotic, requiring higher dose to get same pain relief/euphoric effect.

Step 5: Eventually patient gets to a high enough dose of narcotic that they have significant withdrawals if they miss a dose or two, making the need for medication even stronger.

This all happens while they are not getting adequate

No one is immune to the risk of addiction pain relief due to tolerance.

Are the patient’s actions nefarious? No. They have legitimate pain that they want treated, and are brought down a path to a place where they not only have that pain but also have a dependency on a dangerous drug.

The doctor may have been well-meaning at the start, but becomes careless, putting “keeping the customer satisfied” as a top priority. This isn’t nefarious either, given the time it takes to educate people in this subject and the small amount of time most primary care doctors have for actual patient care.

It is too difficult to do the right thing and address the pain properly (or explain that pain should be expected and doesn’t always need treatment).

A study presented at the American Academy of Pediatrics meeting in Chicago found that many adolescents become chronic opioid users after

DIALING ONE OF OUR ADVERTISERS? PLEASE LET THEM KNOW YOU SAW THEIR AD IN THE MEDICAL EXAMINER.

having common surgeries.

Legitimate pain (from surgery) leads kids into the slippery slope of chronic pain medication use. It certainly doesn’t seem unreasonable to give medication for postsurgical pain, yet this is a potential gateway to the dark world of dependency and addiction.

We need to change our views on the use of these medications. I was taught that a patient with acute pain was not high risk to become an abuser. I was also taught that it was our duty as doctors to treat pain. Allowing a person, much less a child, to suffer in pain seems to go against compassion. But it seems that this misguided compassion is actually causing significant harm.

Our society also needs to change its views regarding pain. Pain is simply a part of our existence, and our desire to block out all pain with medications leads to even more pain in the end.

The solution isn’t to vilify the person on narcotics or the doctor prescribing them.

The solution is to realize that pain should be an expected part of life, and learning to live with it is far better than covering it up with substances. We also need to understand that nobody is completely safe from the risk of addiction.

I think there is a place for these medications (I certainly appreciated them when I fractured my humerus), but they need to be used as a last resort, not a routine approach to pain. They need to be reserved for severe acute pain, and should be very closely monitored and limited.

This isn’t easy for those of us taught to see pain as a “vital sign,” and were taught that acute pain should be treated. +

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NOVEMBER 2, 2018

MEDICALEXAM INER READEVERYISSUE

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SALUBRIOUSNESSWILLENSUE Some exclusions apply.

WE’RE BEGGING YOU We’re never too proud to beg. What we’re begging for is Medicine in the First Person stories. With your help, we’d like to make this a feature in every issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. Thanks!

“The cause was a mystery for a long time.”

“And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.”

“I was a battlefield medic.” “He was just two when he died.”

“OUCH!”

“It was a terrible tragedy.” “She saved “I sure learned my lesson.”

“I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.”

“It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.”

“They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

ambulance crashed.”

“Now THAT hurt!” “The “My leg was broken “I’m not supposed to be alive.”

“This was on my third day in Afghanistan.” in three places.”

“I lost 23 pounds.” “Turned out it was just indigestion.”

“At first I thought it was something I ate.” “The smoke detector woke me up.”

Everybody has a story. Tell us yours.

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

NOVEMBER 2, 2018

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AUGUSTAMEDICALEXAMiNER

GARDENVARIETY

One of my favorite parts about Fall’s cooler weather is having soup for dinner. I always like to officially kick off soup season when the temperature fi rst gets down in the 50s at night.

My Vegan White Bean Chili is perfect for a cozy flavor-packed dinner. I chose to use some of the top healthiest beans that pack a punch on nutrition. This recipe has no meat, so using beans as the main ingredient is an excellent source of protein First, I put in chickpeas, which have been shown to reduce weight, lower risk factors for heart disease, and potentially even cut the risk of cancer as a replacement for red meat in a diet.

Next, I added white kidney beans. They can help slow the absorption of sugar into the blood and therefore reduce blood sugar levels. (A study was done by the University of Cattolica di Rome, that an extract from white kidney beans may help reduce body weight and fat mass. Thirty overweight men and women who took the supplement for 30 days lost an average of 5.5 pounds more weight and significantly more fat mass and waist circumference than those who received a placebo.)

I also put navy beans in because they are packed with B vitamins and minerals. One cup has 64% of needed folate, 24% iron, 48% manganese, 24% magnesium and 29% White Bean Chili thiamine. Navy beans also appear to help reduce symptoms of metabolic syndrome, Instructions probably due to their high fiber content.

Heat olive oil in a medium-sized stockpot Best of all, this soup is delicious! over medium heat.

Add onion, peppers, and shallots, saute for Ingredients 5 minutes or until soft.

• 2 tablespoons olive oil Add garlic, cumin, and coriander and saute • 1 medium white onion, chopped for another 30 seconds.

• 1 shallot, chopped Next, add flour into vegetables, stirring • 1 red bell pepper, diced small constantly until all vegetables are coated.

• 3 garlic cloves, minced Slowly add vegetable stock while stirring, • 1-1/2 tablespoons cumin and then add in the beans and green chilies.

• 1 teaspoon ground coriander Turn heat to medium-high and bring to • 1/4 cup all-purpose flour a boil. Once boiling, turn the heat down to • 4 cups vegetable broth medium low and let simmer for 15 minutes.

• 1 - 15 ounce can great northern beans, Salt and pepper to taste. + rinsed • 1 - 15 ounce can garbanzo beans, rinsed

by Gina Dickson, Augusta wife, • 1 - 15 ounce can white kidney beans, rinsed mom and grandmother, colon • 1 - 4 oz can chopped green chilies, mild or cancer survivor, passionate medium about creating a community • 2 teaspoons hot sauce to help women serve healthy • salt/pepper to taste meals to their family. Visit my blog at thelifegivingkitchen.com

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ASK DR. KARP

NO NONSENSE

NUTRITION Brenda from Harrisburg asks, “Can Thanksgiving be both delicious and healthy?”

Yes! When it comes to Thanksgiving dinner, there are many ways to tweak a traditional Thanksgiving dinner to make it healthier.

This can be done without sacrificing taste. It’s not an “all-or-nothing” approach.

Even small changes can make big differences in the amount of calories, fat, cholesterol, sugar, and salt you serve.

As one example: one of the things that always gets compliments is the turkey gravy we serve. We don’t tell our guests the secret until after the “oohs and ahs.” We simply buy a jar of fat-free turkey gravy. We pour the gravy into a microwaveable gravy boat, add a few teaspoons of turkey drippings

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from our baked turkey and stir. We put the gravy boat in a microwave and heat it up and proudly serve it. People say it is the best turkey gravy they’ve ever eaten. By doing this, you have cut down on the fat, saturated fat, and calories, with no sacrifice in taste.

Another idea is to tweak that sweet potato casserole just a bit. Instead of the usual gooey, high calorie, high fat, high brown sugar, high butter version, try this idea: peel your sweet potatoes and cut them into bit-size cubes.

Put them in a microwaveable and ovenproof dish with a little water and microwave, covered, until soft, but not mushy. Drain the water. Spray the entire dish with butter spray and then sprinkle on a little brown sugar, some chopped walnuts, add miniature marshmallows here and there, a few streaks of lite maple syrup and sprinkle on the cinnamon. When you are done, you should see MOSTLY sweet potatoes and just a few marshmallows and nuts. While the turkey is cooling, simply pop the sweet potato dish into your oven and top brown until it looks wonderful. You will end up with a beautiful, delicious and healthier sweet potato casserole which is not the usual overdose of butter, sugar, calories and salt.

Need a few more hints? One nice thing about Thanksgiving dinner is that there are so many casseroles around, if you are a vegetarian and don’t want to eat the turkey, no problem. Just don’t make a big deal about it. Simply eat the non-meat casseroles and opt out of the turkey.

NOVEMBER 2, 2018 Another great idea is to use egg substitutes or egg whites instead of whole eggs; use no-trans-fat and low saturated fat margarines instead of butter; and add herbs and spices instead of “bacon, bacon, bacon” and salt. Then Thanksgiving becomes a win/win for both you and your guests.

Finally, forget about deep frying. Bake it. Deep frying not only adds all that addition fat, but also cooking at a very high temperature creates cancercausing free radicals in the food. In addition, discarding that used oil becomes an environmental concern.

What’s the “No-Nonsense Nutrition” advice for Thanksgiving? If being overweight, having high blood pressure, diabetes or cardiovascular disease have become “traditional” in your family, then maybe it’s time to serve new, healthier “traditional” holiday foods.

Make sure to pass these healthier tips and recipes on to your children and friends.

Have a happy, delicious and healthy Thanksgiving. + Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook. com/AskDrKarp) or email your Dr. Karp question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to ensure your privacy. Warren B. Karp, Ph.D., D.M.D. is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at The Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health.

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Ask a Dietitian

Have you heard?

WHAT TO SERVE THE LOW-CARB, NO-CARB CROWD

by Jeanne B. Lee, MS, RD, LD Consulting Dietitian

Chex mix®.

For the main course you can serve several low carbohydrate vegetables such as broccoli, asparagus, Brussels sprouts, green beans, spinach, kale, collard greens, tomatoes and beets. Steam or roast your veggies and garnish with toasted almonds or crumbled bacon instead of bread crumbs and heavy sauces.

Mashed potato alternatives include mashed cauliflower or mashed winter squash. Recipes for these are abundant on the internet and are proven favorites of those on low carb diets!

Copy this link (or click here if you’re reading the online version) for Kim Beavers’ Roasted Brussels Sprouts with Pomegranate Reduction If you think you don’t like Brussels sprouts, give this recipe a shot. It will turn you into a Brussels sprout eater in no time: https://www.universityhealth.org/roastedbrussels-sprouts-with-pomegranate-reduction Another favorite side dish for turkey dinners is hot baked fruit. Again, get out the iPad and you will fine numerous variations of this lovely and yummy dish. My favorite is one

by Paula Dean which includes curry powder and you can make it lower in carbohydrate and fat by reducing the amount of sugar and butter without compromising the taste! Hot baked fruit can be tailored to your palate using your family’s favorite fruits and spices.

If not using fresh fruit, be sure to buy the fruits packed in natural juice and not the ones packed in heavy syrup. You can change it up and add other fruits besides the usual pears, peaches, apricots, and pineapple, like adding fresh apples, cranberries or dried plums. It is permissible to mix canned, dried and fresh fruits since you are baking the dish long enough to cook the fresh ones. You can make this in a covered microwave dish in a fraction of the time and not have to fret about oven space!

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Help! What do I serve my “carb fearing family” for Thanksgiving dinner?

As you begin planning your holiday feast, don’t panic when you are faced with what to prepare for those guest who, for whatever reason, are on the “no carb or low carb” list.

You may have enough nutrition knowledge to know that carbohydrates are one of the nutrients that supply the body with energy, and that are found in a wide variety of plant foods.

To explain why some carbs are better for you than others and to stress that all carbs are not “bad,” it is easiest to remember that simple carbohydrates like sugars, high fructose corn syrup found in sodas, and refi ned highly processed carbs like white flour, and most snack foods (chips, crackers) are the ones to limit or avoid.

The more complex carbohydrates found in whole grains and the higher carb vegetables like peas, beans, and many root vegetables are the “good” carbs. They provide energy while also providing many important vitamins, minerals and fiber in the diet. Fruits also contain carbohydrates in the form of fructose, and are also an excellent source of many necessary nutrients like potassium, vitamin C, and folate, just to name a few.

This year you can fi ll your Thanksgiving table with some healthier carbohydrates and assure your carb-fearing family that these dishes are just as tasty but not as carb-loaded as the traditional dressing, mashed potatoes, macaroni and cheese, and brown & serve rolls that usually grace the table!

You may have guest who are always a little late or may just like to have a few appetizers on hand for those extra hungry grandkids. A bowl of hummus with raw carrots, celery and red peppers and whole wheat pita chips or whole grain crackers makes a nice side table appetizer.

A fun way get the children involved is to have them make some fruit and cheese kabobs with apple slices, grapes, pineapple chunks and cheese cubes skewered with a toothpick.

These appetizers will sneak in some nutrition and still be less carb-ladened than the bowl of

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LOW-CARB… from page 9 Lastly, don’t forget to stock the fridge with some beverages that are lower in carbohydrates as well. For instance, “light” beers will contain 3-5 grams of carbs per 12 oz serving, while others may have 1015 grams for same amount. IPA beers may contain up to 20 grams per serving due to the higher quantity of hops used to produce an IPA. A 5 ounce glass of wine, whether red or white, will contain 3-5 grams of carbohydrates, with champagne having the lowest, only 1 gram of carbohydrate per 5 ounce serving. Make sure you have diet soft drinks and zero calories flavored seltzer

waters on hand as well as unsweetened iced tea for those who are counting carbs.

Whatever you plan for your holiday dinner, your menu should have a variety of foods with lots of different colors, textures and tastes. By offering several different sides dishes of vegetables and salads, your carb-counting guests will not be staring at plate of just plain baked turkey! You will also be providing your guests with a healthy nutrient-dense meal and perhaps they will praise you for the alternatives to those highcarb culprits!

Bon Appetite! +

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There was a man at the fair who was born without arms, but he could do anything with his feet we do with our hands... handle a knife and fork, drive a car, use a hammer, even write. They said his “handwriting” was perfect. I don’t know about that, but his footwriting was better than mine. + Butch T. Augusta, GA

H H H H H 10/27/2018 This new neighbor of mine asked if I could lend him a hand. No way! I use mine every day.

Plus I hardly even know the guy. What if he didn’t bring it back? Then what? I got a family to feed. +

Alex S. Graniteville, SC

H H H H H 10/29/2018 I love sports, but I find it odd that only two body parts are named in sports: football and handball.

Why is there no legball, stomachball, earball, kneeball or cheekball? Maybe I’m missing one besides hand and foot. +

Holly G. Martinez, GA

H H H H H 10/29/2018 Whenever I hear someone use the term hand-wringing, I think, “If you people would use a handbag to keep your hand dry, maybe you wouldn’t need to do do any hand-wringing in the first place.”

But I guess they could also use a hand dryer. +

Michelle T. N. Augusta, SC

H H H H H 10/30/2018 I bet in some way or another, 99 percent of the world is hand-operated. +

Missy D. Waynesboro, GA

H H H H H 10/31/2018 I just heard a new term for the first time today: “hand-crank.” I guess hands have moods too. +

Michelle T. N. Augusta, SC

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The blog spot From the Bookshelf — posted by Caitlin Bass, MD, on October 22, 2018 (edited for space)

I’M YOUR DOCTOR, NOT YOUR NURSE. It’s 8:00 p.m., hour 14 in my 28-hour call shift at the large suburban hospital where I’m an intern.

You demand to speak with a doctor now, right now. You cannot wait. Your mother is sick, and you want to know exactly what is going on. It doesn’t matter that we already spoke at length by phone earlier this afternoon. It doesn’t matter that it’s 8:00 p.m. It doesn’t matter that I don’t have any updates to give you. You want to speak with a doctor, your mother’s doctor now, right now.

Luckily for you, that’s me. I’m here in the hospital. I’m between codes and crises and admissions and can come right now to discuss your mother’s case in person. I know your mother’s case — I’m her doctor. She’s my patient. I know her story like the back of my hand.

When I get there to speak to you, it’s not just you. It’s you and your wife and your mother’s boyfriend and your uncle and your mother’s caretaker. There are so many of you that half of you are in the hallway because you don’t all fit into your mother’s tiny hospital room. All of you are here because you’re worried about her. That’s why you need to see a doctor now, right now. Because every one of you has a question or a concern or a tidbit you think that I should know.

I shepherd all of you into the family room so that we can talk more easily. This way, at least we all fit in the same room. I introduce myself to each of you in turn. “Good evening, I’m Dr. Bass.”

We talk for quite a while. I answer each of your questions until I’m sure that you get it. You all thank me before I leave.

“Thank you, Miss Bass.”

“Yes, thanks for taking the time to come and talk to us, Miss Bass.”

“We appreciate your thoroughness, Miss Bass.”

Miss? Miss? You’ve got to be kidding me.

You demanded to speak to a doctor, your mother’s doctor, now, right now, and I came and answered your questions politely and with patience — and yet I’m still not the doctor?

I probably could have corrected you and said, “No, it’s doctor,” but that didn’t occur to me in the moment. I mean, how many times do I have to introduce myself as “doctor” before it sticks?

At least once more, I guess. Because this happens all the time. I’ll introduce myself, and the patient or family member will say, “And your first name is?” And boy, do I want to say: “doctor” — but I don’t. Wouldn’t want to be antagonistic ... can’t threaten that doctor-patient relationship.

Then there are the times when I’ve just met a new patient in the hospital and introduced myself, and I’m asking about his condition, and he’ll say, “Oh, yes — I need to mention that to the doctor when he gets here.”

Then I do say, “Me, that’s me! I’m your doctor.”

I always wonder who these people think I am as they calmly and forthcomingly answer my extraordinarily probing personal questions.

Being mistaken for the nurse doesn’t bother me. At least if they think I’m the nurse, they’ve realized that I’m part of their care team, which is better than being some random “miss.”

My mother is a nurse. My sister is a nurse. My grandmother was a nurse. Nursing is a noble profession.

Nurses are some tough, loving, caring, amazing people — but I’m not your nurse.

I’m your doctor. +

I should have said, “No, it’s doctor.”

Caitlin Bass is an internal medicine resident.

It’s not that we’re on a plague kick or anything just because the book review in our last issue was about the great Spanish Influenza outbreak one hundred years ago. It’s just that it’s easy to look on a shelf for an interesting book and find a related book about a similar subject right next to it.

And so this time we’re opening the covers on yet another frightening ride by the pale rider (which, incidentally, is the title of another book about the plague of 1918).

Barbara Tuchman’s epic history A Distant Mirror — The Calamitous 14th Century embraces the entire century that brought us the Black Death, so it devotes only a few chapters to this particular calamity of 1347 and 1348.

Here is a more detailed look at a milestone moment in world history that even very recent events tell us we still need to learn from.

People thought it was the apocalypse, the end of the world, and in some places the devastation almost equalled the Biblical description of the flood of Noah’s day: “All

flesh died that moved upon the earth.” And it wasn’t only people who were struck down, author John Kelly reminds us: “Along with people died dogs, cats, chickens, sheep, cattle, and camels.”

People were so desperate for a cure that “crowds crouched over municipal latrines inhaling noxious fumes in hopes of inoculating themselves against the plague.” That’s pretty bad.

The Black Plague produced suffering and death on a scale that, even after two world wars and twenty-seven million AIDS deaths worldwide, remains astonishing, writes Kelly.

One of the curious things

about humanity is the dichotomy between how much we’ve changed and how little we’ve changed. People in the 1300s thought the plague was divine retribution from an angry God, and today people still chalk up both individual deaths and mass casualties to “acts of God.” In this age of weapons of mass destruction, the threat of terrorists using biological and biochemical weapons, and the sudden appearance of pernicious new diseases, seemingly out of nowhere, this “intimate history of the most devastating plague of all time” should be of interest to everyone who enjoys history, especially medical history. But it surely holds special interest for people involved in infection control, public health policy, and everyday healthcare in facilities that every day see thousands of patients and visitors.

We have a number of those facilities in and around Augusta. + The Great Mortality by John Kelly, 364 pages, published in January 2006 by Harper Perennial

Research News Tissue donor news On the heels of all the tissue donor information in The Death Issue (our previous issue, in case you missed it), new research published in the Clinical Journal of the American Society of Nephrology has found that many donor kidneys — called “a scarce and valuable resource” — are not being used and are, in fact, being discarded, because of procurement biopsy findings that appear to be systemically flawed.

Researchers from Columbia University and the Mailman School of Public Health found as many as 20 percent of kidneys were not used because of procurement biopsy findings, yet those results did not agree with more intensive reperfusion biopsies. In other words, whether the procurement biopsy suggested the kidney was good for donation or not had little connection with

whether it actually was (or was not).

The study recommended higher standards for procurement biopsies and for them to be read by experienced pathologists and The HSV1-Alzheimer’s link What causes Alzheimer’s disease? That has been a tantalizing question for researchers, and a newly published paper points to a surprising possibility: herpes.

Decades of research by Dr. Ruth Itzhaki published last week in Frontiers in Aging Neuroscience shows a striking correlation between Alzheimer’s risk and infection with Herpes Simplex Virus 1 (HSV1) among people carrying a specific gene.

Being a virus that never really leaves those infected with it, HSV1 stays in neurons and immune cells for decades, resurfacing in its trademark blisters or cold

sores when people are run down by stress or illness.

The working theory from Dr. Itzhaki’s 25 years of research is that each time HSV1 is reactivated, it causes damage that eventually leads to dementia. The upshot is that aggressively treating HSV with antiviral treatments can dramatically reduce the incidence of Alzheimer’s disease.

New cerebellum findings Long viewed as a part of the brain whose only function was controlling movement, the importance of the cerebellum has been overlooked by researchers.

That needs to stop, stay Washington University School of Medicine researchers who have discovered the cerebellum is involved in every aspect of higher brain function, including thought, attention, decision-making and planning. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS +

Why the frustrated look?

by Dan Pearson

I found two at the bookstore: So what’s the “Making Better Decisions” Which one did and you pick? problem?

“Better Decision Making”

I’m looking for a good book on decision making.

The one about how to make cat videos. © 2018 Daniel Pearson All rights reserved.

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. Stay at Mistletoe 5. Salt of uric acid 10. Moron 14. Minerals 15. More pleasant 16. Republic in SW Asia 17. Alpha follower 18. Dew, for instance 20. Sheep’s bleat 21. Dust particle 22. Collection of maps 23. Former Russian rulers 25. Stroke, in short 26. Danzig’s name in Poland 28. Most-decorated Olympian of all time 31. A rich tapestry 32. Flower segment 34. Tree of the genus Ulmus 36. Fight for breath 37. Shankar’s instrument 38. New York canal 39. Doc’s org.

40. With “The,” an Augusta golf course 41. Swelling of tissues 42. Dougherty County (GA) seat 44. Type of school 45. Cover 46. Ambulance feature 47. Indian, for example 50. Augusta _____ 51. Nickname of the 34th US president 54. Confederate facility in Augusta 57. Bucket 58. Fencing sword 59. Research deeply 60. Old cloth measures 61. He brought down Capone

ME

THE MYSTERY WORD The Mystery Word for this issue: REMUNST

!

K A E R B N O

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 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

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by Daniel R. Pearson © 2018 All rights reserved

by Daniel R. Pearson © 2018 All rights reserved. Built in part with software from www.crauswords.com

62. Congressman Rick 63. _____ of Man DOWN 1. #1 player for the Augusta Tourists 2. Part of CSRA 3. Of the foot bones 4. An ad for raising awareness (abbrev) 5. Open a wine bottle 6. Violent protests 7. Teen skin eruption 8. Mr. Turner 9. Before (to a poet) 10. Proximal’s opposite 11. Like most thermometers 12. Word with bank or base 13. Singles 19. Abdominal landmark 21. Spectrometer intro 24. Crack 25. Blacken 26. Very enthusiastic 27. Stage play

28. Egyptian deity 29. Plants that live from year to year 30. Ball prefix?

32. Feel compassion for 33. Abbrev. for “and the rest” 35. Type of market 37. Castle-building material 38. Verge 40. Troubled College 41. English nobleman ranking above a viscount 43. Shoulder bones 44. Jenkins County (GA) seat 46. Medicinal ointment 47. Sign on many doors 48. Deal with 49. Female sheep 50. Enterprise follower 52. While away, as time 53. Otherwise 55. Food label abbrev.

56. Famed Brooks 57. Noted architect Solution p. 14

— Confucius

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.

E X A M I N E R

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by Daniel R. Pearson © 2018 All rights reserved. Built with software from www.crauswords.com

S 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 keypad letters to convert numbers into words suggested by the definitions provided. Sample: 742 (body part) = RIB. Solution on page 14.

1. 233 ___

6. 727827 ______

2. 4255 ____

7. 25663 _____

3. 7666 ____

8. 8425 ____

4. 24278 _____

9. 782477 ______

5. 82538 _____

10. 633353 ______

All the words used in this week’s TEXT ME are things commonly found in hospitals.

by Daniel R. Pearson © 2018 All rights reserved

TEXT

NOVEMBER 2, 2018

NOVEMBER 2, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

him out.

The bartender can’t believe his eyes when he sees the man return for the third night in a row.

“Bartender!” says the man, “A drink for everyone and a drink for me!”

The bartender angrily asks, “What, no drink for me tonight?”

The drunk looks at him and says: “No man, you get way too violent when you drink.”

ha... ha...

A

n intoxicated but obviously wealthy and well-dressed man stumbles into a bar and immediately calls out, “Bartender! A drink for everyone, a drink for me, and a drink for yourself!”

The bartender pours all the drinks, the whole bar cheers, and they all drink. When the bartender hands the bill to the man, he shrugs and says, “Sorry, I didn’t bring my wallet with me tonight.” The bartender punches the man a few times in anger and frustration and physically throws him out onto the street.

The very next night the same well dressed but intoxicated man stumbles in.

“Bartender! A drink for everyone, a drink for me, and a drink for yourself!” the man happily announces as he walks to the bar.

The bartender thinks, “There’s no way this clown could be stupid enough to pull the same stunt twice. He probably came back to pay me.

Now I feel bad for hitting him last night.”

He pours all the drinks, the the whole bar cheers, and again everyone is happy. The bartender hands the bill to the man and he again shrugs and says, “I didn’t bring my wallet with me again. Sorry.” The bartender proceeds to beat the man up before kicking

©

Moe: They say 9 out of 10 people are stupid.

Joe: Well I’m glad I’m in the 1%.

Moe: What do you get when you spell “man” backwards?

Joe: Personally, flashbacks.

Moe: I had this dream where I weighed less than a thousandth of a gram.

Joe: Wow. I bet you were like 0mg!

Moe: What are you doing tonight?

Joe: Going on a date with that cute new girl from the office.

Moe: But she told you yesterday she would only go on a date with you on days that don’t end in Y. Joe: She did. I said, “Great! I’ll pick you up tomorrow!”

Moe: I need to know how many bones are in the human hand.

Joe: I have no idea.

Moe: Can you at least give me a guess?

Joe: I would say a good handful. +

Why subscribe to theMEDICALEXAMINER? What do you mean?

Staring at my phone all day has had no affect on ME!

Because try as they might, no one can stare at their phone all day.

Dear Advice Doctor, I’m seeing this guy at work that is — I can barely find the words! I love him! He makes my heart go all pitter-patter just walking through the room. The problem is, our company has a policy against dating coworkers. I guess we have two choices: one of us has to quit, or we can date on the sly until we’re sure it’s going to work out and hope no one finds out. Unless you can think of another good option.

— Dating Dilemma

Dear Dating, Before I address the main point you’ve raised, let me first take a minor detour. I’m not sure you’re even aware of one of the serious problems you may be facing. You mention being unable to “find the words.” This is a matter of some concern. Known as aphasia, it’s an inability to comprehend or formulate language. The typical causes include stroke and trauma to the head, in short, some kind of brain damage.

Have you been evaluated by a neurologist? The fact that you could write this letter suggests your condition may be mild, but it never hurts to check.

Now on to your main issue.

This too is a potentially serious problem. The medical term for a heart that goes “pitter-patter” is arrhythmia. As a side note, 99 percent of the population would spell it “arrythmia,” so it can be useful in winning bar bets, etc. Ah, but I digress.

Arrhythmia is a fancy word for an irregular or abnormal heart beat. They can range from harmless to potentially fatal depending on the type of arrhythmia, its cause, where it originates in the heart (in the atria versus the ventricles), how long it lasts, and other factors such as your overall heart and vascular health.

Arrhythmias are often long term problems, but sometimes they are the result of some underlying problem (medication side effects or overactive thyroid, to name two examples).

When that problem is removed or effectively managed, the arrhythmia may go away.

The short answer to any question about arrhythmias, however, is to see a doctor about the condition as soon as possible, or go the nearest emergency room. A heart arrhythmia is not something to take casually.

I hope this answers your question. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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IT’S A QUESTION OF CARE How can I get my home ready for holiday visits?

The holidays can be a wonderful time to enjoy visits with family, particularly with our elderly loved ones. These visits can present challenges

if your home is not set up for someone with physical or cognitive challenges.

You might consider hiring a caregiver to help you care for your loved one and buying or renting durable medical equipment so that your loved one has the equipment they usually use. This might be: • A recliner lift chair • A wheelchair • A hospital bed • A lift to help get them from the bed to a chair • A shower chair or bedside commode • Temporary grab bars in the bathroom/shower If your loved one is wheelchair bound, you can rent a wheelchair van so they can go with you on outings.

You can also rent a metal wheelchair ramp instead of building one.

If you have a loved one with

NOVEMBER 2, 2018

cognitive challenges, they may be confused as to where they are and possibly wander, so it’s important to have safety measures in place. You might put alarms that beep on the door, so you know when someone is coming or going.

If your loved one wears an Emergency Response button, make sure they wear it in your home and if it has GPS capability that is even better.

If they do not have one, this might be the time to introduce it. If there have been safety or cognitive issues related to driving, don’t leave car keys in plain sight.

It might be helpful to put a nice decorative sign on the door of the room where they will be sleeping so they know how to find their own room, and you can do the same thing with the bathroom.

Other decorative and useful

signs to direct them can be helpful as you examine your home’s layout with your loved one in mind.

Depending on individual circumstances, their medications can be left in a place where they’re sure to see them to help them remember to take them, or out of sight, which puts the obligation on others to make sure meds are administered on schedule. In a different environment, the second option is often the best.

Even though the idea of visiting in your home may be very alluring to your loved one, there are going to be complications, so it’s best to be prepared. +

by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

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