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NOVEMBER 2, 2012

NUMBERS

Life in 2012 is all about numbers. The news is full of references to millions, billions, and sometimes even trillions. As Illinois senator Everett Dirksen is said to have once remarked, “A billion here, a billion there, and pretty soon you’re talking about real money.” In the world of medicine, amazingly large (and small) numbers surface regularly. Say what you want, but we contend that it’s the exceptional human brain that can comprehend the concept of a million, and even more so a billion. As for trillions and beyond, it’s quite possible that even people who think they understand such numbers don’t really. And so, here are a few numbers of interest, and pictures to put them into perspective. • The average scalp has about 100,000 hairs • An active person can produce a quart or more of sweat per hour. At rest, the figure is as little as 1/12 of an ounce per hour. • Fingernails grow 300 to 400 percent faster than toenails. • Soon after conception an embryo’s new brain cells increase at the rate of 250,000 per minute. • 250 million sperm cells are produced per day. • 29 pairs nerve bundles branch out from the spinal column via a 30,000 mile network that relays info instantaneously to and from the brain The pallet contains 100 million dollars in 100 dollar bills. On the ground in front of the pallet is a small bundle, one million dollars, and a packet containing 10,000 dollars • In 2009, the United States federal, state and local governments, corporations and individuals, together spent $2.5 trillion ($8,047 per person) on health care. • If a person spent one million dollars a day beginning on the day Jesus was born, he would not yet have spent one trillion dollars. • One square inch of skin has 700 sweat glands, 100 sebaceous (oil) glands, and 21,000 nerve sensors for detecting pain, heat, and pressure.

• There are some 50 to 75 trillion cells in the entire body. • Cardiac muscle fibers contract and release about 100,000 times every day, beating some 2.5 billion times in 70-yr lifetime, pumping 1 million barrels of blood. • The nose can detect scents at concentrations as low as one part in 30 billion. • The circulatory system laid end to end would circle the earth 3 to 4 times (depending on body size). Of its 60,000 average miles, only 1,000 are visible to the eye, the remaining 59,999 too small to be seen with anything but a microscope.

• Red blood cells die (and are replaced) at the rate of about 2 million per second. • Red blood cells outnumber white roughly 700 to 1. • The human brain has a huge number of synapses. Each of its 100 billion neurons has on average 7,000 synaptic connections to other neurons. It has been estimated that the brain of a three-yearold child has about 1 quadrillion synapses. That’s 1,000,000,000,000,000 synapses. That is equal to about a half-billion synapses per cubic millimeter. This number declines with age, stabilizing by adulthood. Estimates vary for adults, ranging from 100 to 500 trillion. • Each cell has about 250 million molecules • The bronchial tree in the lungs contains more than 1,000 miles of branches. Gas exchange takes 0.25 seconds. • The average person eats more than 20 tons of food in their lifetime. About 6 pints of highly acidic gastric juice are produced each day. • “Clustered at the back of the eyeball — a kind of biological movie screen — are specialized nerve cells, each packed with up to 100 million molecules of light-sensitive pigment that convert light into electrochemical signals.” • The ear translates sound waves into fluid waves, Please see NUMBERS page 15

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NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER GUEST EDITORIAL

Public Health versus Private Freedom by Peter Singer PRINCETON – In contrasting decisions in August, a United States Court of Appeals struck down a US Food and Drug Administration requirement that cigarettes be sold in packs with graphic health warnings, while Australia’s highest court upheld a law that goes much further. The Australian law requires not only health warnings and images of the physical damage that smoking causes, but also that the packs themselves be plain, with brand names in small generic type, no logos, and no color other than a drab olive-brown. The US decision was based on America’s constitutional protection of free speech. The court accepted that the government may require factually accurate health warnings, but the majority, in a split decision, said that it could not go as far as requiring images. In Australia, the issue was whether the law implied uncompensated expropriation – in this case, of the tobacco companies’ intellectual property in their brands. The High Court ruled that it did not. Underlying these differences, however, is the larger issue: who decides the proper balance between public health and freedom of Legal in Australia expression? In the US, courts make that decision, essentially by interpreting a 225-year-old text, and if that deprives the government of some techniques that might reduce the death toll from cigarettes – currently estimated at 443,000 Americans every year – so be it. In Australia, where freedom of expression is not given explicit constitutional protection, courts are much more likely to respect the right of democratically elected governments to strike the proper balance. There is widespread agreement that governments ought to prohibit the sale of at least some dangerous products. Countless food additives are either banned or permitted only in limited quantities, as are children’s toys painted with substances that could be harmful if ingested. New York City has banned trans fats from restaurants and is now limiting the permitted serving size of sugary drinks. Many countries prohibit the sale of unsafe tools, such as power saws without safety guards. Although there are arguments for prohibiting a variety of different dangerous products, cigarettes are unique, because no other product, legal or illegal, comes close to killing the same number of people – more than traffic accidents, malaria, and AIDS combined. Cigarettes are also highly addictive. Moreover, wherever health-care costs are paid by everyone – including the US, with its public healthcare programs for the poor and the elderly – everyone pays the cost of efforts to treat the diseases caused by cigarettes. Whether to prohibit cigarettes altogether is another question, because doing so would no doubt create a new revenue source for organized crime. It seems odd, however, to hold that the state may, in principle, prohibit the sale of a product, but may not permit it to be sold only in packs that carry graphic images of the damage it causes to human health. The tobacco industry will now take its battle against Australia’s legislation to the World Trade Organization. The industry fears that the law could be copied in Please see HEALTH VS. FREEDOM page 3

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HEALTH VS. FREEDOM… from page 2 much larger markets, like India and China. That is, after all, where such legislation is most needed. Indeed, only about 15% of Australians and 20% of Americans smoke, but in 14 low and middle-income countries covered in a survey recently published in The Lancet, an average of 41% of men smoked, with an increasing number of young women taking up the habit. The World Health Organization estimates that about 100 million people died from smoking in the twentieth century, but smoking will kill up to one billion people in the twenty-first century. Discussions of how far the state may go in promoting the health of its population often start with John Stuart Mill’s principle of limiting the state’s coercive power to acts that prevent harm to Not legal in America others. Mill could have accepted requirements for health warnings on cigarette packs, and even graphic photos of diseased lungs if that helps people to understand the choice that they are making; but he would have rejected a ban. Mill’s defense of individual liberty, however, assumes that individuals are the best judges and guardians of their own interests – an idea that today verges on naiveté. The development of modern advertising techniques marks an important difference between Mill’s era and ours. Corporations have learned how to sell us unhealthy products by appealing to our unconscious desires for status, attractiveness, and social acceptance. As a result, we find ourselves drawn to a product without quite knowing why. And cigarette makers have learned how to manipulate the properties of their product to make it maximally addictive. Graphic images of the damage that smoking causes can counter-balance the power of these appeals to the unconscious, thereby facilitating more deliberative decision-making and making it easier for people to stick to a resolution to quit smoking. Instead of rejecting such laws as restricting freedom, therefore, we should defend them as ways to level the playing field between individuals and giant corporations that make no pretense of appealing to our capacities for reasoning and reflection. Requiring that cigarettes be sold in plain packs with health warnings and graphic images is equal-opportunity legislation for the rational beings inside us. + Peter Singer, Professor of Bioethics at Princeton University and Laureate Professor at the University of Melbourne, is one of the world’s most prominent ethicists. He is the author ofPractical Ethics and Animal Liberation: A New Ethics for Our Treatment of Animals. © 2012 Project Syndicate, www.project-syndicate.org Reprinted by permission.

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

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

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NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

Hope IS Possible

Keep a journal. Keep healthy. Helen Blocker-Adams

ctober is consumed each year with information and advocacy for National Breast Cancer Awareness month – and rightly so. But did you know that October is also National Domestic Violence Awareness month; Positive Attitude Month; National Information Literacy Awareness month; Bullying Prevention Awareness Month; National Disability Employment Awareness Month; Blindness Awareness Month; and Childhood Cancer Awareness Month? With the presidential election right around the corner I found it interesting

to find out that Celebrate Free Speech Week was also observed during October. All over the world bloggers and students wrote and submitted essays addressing what free speech means to them. Certainly in the heat of politics, there is a lot of free speech going on. Free Speech Week (www. freespeechweek.org) is celebrated during the third week of October every year. This year it was October 22 – October 28. All Americans can celebrate this important week. Free Speech remains ‘The Language of America.” As someone in the communications field myself, I value freedom of speech. It was designated by President Franklin Delano Roosevelt – a visionary principle that would inspire a nation and guide America through World War II and into the 21st century. Expressing yourself, especially during a time when you feel your life is in turmoil, can enhance your emotional well-being. Writing in a journal, according to mental health specialists, can be therapeutic. I love writing in my journal. Journaling also

means writing letters or in a diary. I tend to write about personal relationship issues versus professional interests. Writing my thoughts on paper, I believe, may be content for a book one day. But even if it never sees the light of day, writing also gives me peace. There are some noted health benefits to journaling and according to Maud Purcell, LCSW, CEAP, who writes for PsychCentral, they include: • Clarifying your thoughts and feelings. Do you ever seem all jumbled up inside, unsure of what you want or feel? Taking a few minutes to jot down your thoughts and emotions (no editing!) will quickly get you in touch with your internal world. • Knowing yourself better. By writing routinely you will

get to know what makes you feel happy and confident. You will also become clear about situations and people who are toxic for you — important information for your emotional well-being. • Reducing stress. Writing about anger, sadness and other painful emotions helps to release the intensity of these feelings. By doing so you will feel calmer and better able to stay in the present. • Solving problems more effectively. Typically we problem solve from a leftbrained, analytical perspective. But sometimes the answer can only be found by engaging right-brained creativity and intuition. Writing unlocks these other capabilities, and affords the opportunity for unexpected solutions to seemingly unsolvable problems. • Resolving disagreements with others. Writing about misunderstandings rather than stewing over them will help you to understand another’s point of view. And you just may come up with a sensible resolution to the conflict. It may seem cumbersome for some of you who

don’t generally write, but I recommend writing 15 minutes a day. And don’t be surprised that you will soon be writing for much longer than that. Choose a time of the day when your mind is clear enough for your words to flow. Don’t concern yourself about writing grammatically correct or dotting all your I’s and crossing your ‘T’s -- this journal belongs to you and is for your eyes only. Who knows, this therapy may do you good as we enter into the hectic holiday season. So what does Free Speech mean to you? Visit their website for some really cool information that you may not have been aware of before. + Helen Blocker Adams is President/ CEO of The HBA Group, Intl and Executive Director of the Southeast Enterprise Institute, Inc. Visit her website at www.helenblockeradams. com. If you like politics, visit her blog at www.projectlogicga.com. You can reach her via email at hba@hbagroup-intl.com Helen’s new book, Unlikely Allies: 8 Steps to Bridging Divides that Impact Leadership can be purchased by visiting www.hbagroup-intl.com or www.authorhouse.com

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NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW ABOUT THE DANGERS OF RETIREMENT by Bad Billy Laveau Grainge was getting long in the teeth and on in years. He had spent most of his adult life working on a cattle farm in east Georgia. It had been a good and fairly rewarding life leading up to semi-retirement at an appropriate age. He had not exactly planned for retirement. It just kind of happened. Once retirement was there, he spent a reasonable amount of time resting, taking naps, going for walks, and communing with nature the way most of us with advancing maturity tend to do. But there was a feeling that something was amiss. He missed the daily schedule of work, the responsibility of demanding farm work, the sense of accomplishment that comes with a job well done. True, his stamina was not what it used to be, but still he felt a hardwired need for the reward of a day’s work well done. His immediate needs were assured: a place to live that he called his own, food, medical care, etc. It came to him one day that a religious group had a large farming operation not too many miles away. And they had cows. That was important. Not being one to demand anything he could not get on his own, he walked a pleasant 3 miles through trails

designed by god’s creatures to the backside of the farm, transversed the fence without seeking permission, and put himself to work with the daily chores that cows require. With open arms the way children of God do, the religious group welcomed his sudden unannounced appearance. They did not question why he was there or his motives. He shared their work, their food, and their acceptance. But he was not up to the 7-day-a-week farm life rigors he had spent his young life doing, so he assigned himself a schedule of two days a week: Tuesdays and Fridays without fail. Quickly he came to relish the twice weekly walk through the woods, occasional stopping to watch and appreciate the wildlife along his trek. But trouble loomed. Occasionally as he walked to work, a crew of young malcontents wandering aimlessly, looking for mischief, invaded his space. Tones were threatening. Gestures unkind and disrespectful. He ignored them and hoped they would go away and leave him alone. He had not bothered them, and gave them no reason to bother him. But one day, the crew did not see it that way. They attacked him without warning,

GOT A STORY?

Best pummeling his body with coordinated violence. They enjoyed his vulnerabilities and took quick advantage of his age and growing infirmities. The religious group heard his cries for help, rushed to and rescued him, but not before several wounds had been inflicted. He spent healing days under their watchful care. Abrasions healed. He was attended to medically and spiritually. Bruises resolved. Lacerations recovered. Being God-fearing people, the religious group neither prosecuted, nor persecuted, the offenders. God would handle that in his own way and time. Grange did not question their decision. With time, Grainge recovered and returned to his Tuesday and Friday self-appointed chores. He is content with that. So are his benefactors. His physical scars are barely visible now. He dwells not on his mental scares. Instead

e n i c i d ME

he relishes a day’s work well done. All of that leads me to a few questions: When we retire, should we quit work completely? Probably not. We need regular exercise. We need direction. We need purpose. We need mental hygiene. We need discipline. Should we do volunteer work? Most definitely. It helps your fellowmen. It is food for your mind and soul. The world need more people giving and less people taking. When we go for walks, should we walk in isolated areas? Probably not. Parks and organized activity areas are safer, although they do not provided the mind healing solitude that a true nature walk provides. A walk along the canal is a great compromise. We need at least two miles a day to keep the heart fit. If we are injured should you return to previous activities? Yes. The sooner the better. That

is good for the mind and body. Grainge still lives at home, still walks through the woods twice weekly, still tends to the cows, and fears not a renewed attack. The malcontents have disappeared. Maybe they feel bad and are remorseful for what they did and will live better in the future as they grow up and become responsible adults. Let’s hope so. And I feel compelled to tell you that some facts I intentionally left out when writing this: Grainge is a border collie. The malcontents were a pack of wild dogs. The religious group are God fearing people who work, sweat, pray and read the Bible every day, the likes of whom we need more of. My final question to you is simple: should we not all follow Grainge’s example and do better in our older years? + Bad Billy Laveau is a retired MD with a pointed sense of humor. Bad Billy speaks and entertains at public and private events for audiences not subject to cardiac seizure secondary to overwhelming laughter and glee BadBilly@knology.net or 706306-9397

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NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER Editor’s note: Exceptional Living appears exclusively in the Medical Examiner each month, addressing issues that all of us can benefit from involving people with special — let’s call them exceptional — needs.

Adventures in Administration

Exceptional Living

Perfect in every way by Naomi D. Williams, MPH, CHES, CIC® Editor’s note: this installment of Exceptional Living originally appeared in the Nov. 4, 2011 issue of the Medical Examiner. It’s my favorite time of year again – Fall! I absolutely love ushering in this time of year. It’s cooler, the leaves turn to beautifully vibrant colors and most of all my favorite holiday, Thanksgiving, is around the corner. As I excitedly pranced out to get my fall décor I had an unexpected “ah ha” moment. “It’s perfect! It’s just what I wanted. The color is right. The shape is just right. There are no flaws or imperfections; it’s just perfect.” Now, I wish these were my initial thoughts as I was selecting my prized pumpkin. Instead my words were “I’ve got to find the perfect pumpkin. It has to be the right color (orange of course, but it has to be the PERFECT orange). It has to be the best shaped one in the patch, perfectly symmetrical. I want it to have no flaws; no scratches, dents or imperfections.” Then I heard a little voice, “Well, what about me, aren’t I perfect?” My next thought was “look at all of these odd shaped, discolored, atypical pumpkins in this patch. How many of them will find a good home?” How many people come to the patch looking for the worst, most beat up, odd-looking pumpkin? I’m pretty sure not many, if any. So it was with that final thought that I decided to take home an oddly shaped, flawed, non-perfect colored orange pumpkin. And I’m delighted to say I was and still am happy with my decision. You see, there was absolutely nothing wrong with any of the pumpkins in the patch. They grew to become what their seed was planted for. It’s not their fault their color may seem off to some, or their size appears abnormal to others. Although the outside may be different, when you open each of those pumpkins up they each possess the same insides – pumpkin seeds. When I heard that little inner voice I immediately thought of my little boy and then others who are differently-abled. It reminded me of what lens I was looking out of: my perfectionist, controlling and critical lens. Nothing in life is perfect. Everything and everyone is flawed – if that’s how you choose to perceive it. Paraphrasing Psalms 139:14 it says that we are all fearfully and wonderfully made and Genesis 1: 26, 27 says we were created Noah in God’s image. To me that means we were created the way God intended us to be. Believe you me, I struggle with that last sentence almost daily. I don’t understand the how or why of God’s decisions. What I do understand is the unspeakable joy that I receive from my child. On the outside he’s atypical, flawed, and imperfect in every way, yet spend just a moment with him (or any other differently-abled person) and glean that their insides are the same. They are full of personality as well as want to give and receive love and affection just as typically developed people do. As we enter the season of Thanksgiving pause and reflect on that for which you are thankful. Despite the ups and downs and mixed emotions that I have concerning my child’s situation, I’m thankful that I was chosen to be Noah’s mom. When becoming a parent you enter a new world; when becoming a parent of a differently-abled child you are thrust into a new universe, often clouded and overshadowed by the negative. Yet it’s paramount to focus on the positives and take nothing for granted. Give thanks for the ability to see, touch, smell, hear, talk, walk, run, taste, breathe, eat on your own, dress yourself, pick your nose, and use the bathroom without help. You know what, just give thanks for life. (This was written with my differently-abled, atypically developing child specifically in mind. However, this includes and applies to those who have become differently-able due to an illness like cancer or a stroke, an accident such as a car accident or a fall, or our military men and women who return home mentally and/or physically differently-abled than when they initially left). + Naomi Williams is a health educator by training, an entrepreneur by nature, mom, and advocate of the best kid ever, Noah Samuel.

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ost have heard the answer to the question, “What do they call the medical school student who finishes last in his class?” The answer: “Doctor.” Many years ago St. Joseph Hospital had a “last in his class” doctor on its medical staff. He was a bad doctor. You ask, “How did he get on the medical staff to begin with, and why would his removal be a topic of discussion?” Getting on staff was no problem. For a doctor to become a hospital medical staff member is almost a rubber stamp as demonstrated by the fact that almost every doctor in Augusta is on the staff of several hospitals. It is little more than a paper process. On the other hand, removing a doctor from a medical staff roster is a different story. To do so is at best difficult, at worst almost impossible. The doctor at St. Joseph who was bad was really bad, but who cared? Well, I did. The man’s quality of care was an embarrassment to the hospital and I was its CEO. His patients sometimes suffered and some allegedly died because of his care. And I could hardly be considered an innocent bystander. I knew that the medical staff had a very low opinion of him. But if I tried to remove him, he wouldn’t have gone willingly. My opinion would probably have been dismissed as that of a non-medical professional. Maybe this is all to say I was chicken. Our medical staff by-laws, the tools describing the mechanism for removing a doctor, were of high quality, ready to do their job. But lets face it, the doctors were as reluctant as I was to take action. His vitriolic nature would have quickly surfaced and those working selflessly would have become the accused. It was unfair to them and the process would quickly become nasty. Who, then, had the nerve and strength of character to take him on? St. Joseph Hospital had the best nursing care in the city. There were good reasons. The hospital’s size made it easily managed. Its focus was on a few specialties. Its tenured nursing leadership was strong. The hospital and the nurses took special pride in the nursing care. Yet there was not contentment. Finally the nurses stepped forward with the pronouncement that they, individually and collectively, would no longer tolerate the turmoil of intimidation and scapegoating. They decided that enough was enough. Something had to be done. A statement describing the doctor’s travesties was written by whom I know not and given to Dr. Bob Hill, then Chief of Staff. The mechanism was triggered. Committees were appointed, documents were gathered, witnesses were identified, arbitrators were selected, advocates appointed and more. It was a long, grueling process, a process that had to be followed meticulously. All those involved had to anticipate spending hours in deliberation. The deliberations were going to be fair and just. The goal was simple, to make St. Joseph Hospital better. The process took its course and the final determination was finally reached. The doctor had to be removed from the medical staff. The decision went to the Governing Board which took the recommended action. The doctor was gone. It was the right thing to do, but it wasn’t an easy thing to do. As an example for many who courageously contributed to this difficult process was one of St. Joseph’s young nurses, Catherine Doris. Despite pressures from some to avoid getting involved, Miss Doris testified with the conviction that “it was the right thing to do.” Looking back, she and the others who took the risk to speak up are some of my true heros. Our continuing gratitude flows to all those who did what they did because it was the right thing to do. + Editor’s note: This series is by Bill Atkinson, former CEO of Trinity Hospital (then St. Joseph Hospital), and the author of the comprehensive 2009 Medical Examiner series on the founding of the Augusta area’s major healthcare providers.

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NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

Ask a Diet itian W

hat’s that I hear: the crunch of fall leaves and screams of turkeys who just realized the farmer’s name is Butterball? No, it’s actually the rustling of Christmas lists and the expressions of sticker shock emanating from early holiday shoppers. I know, it should be illegal to talk about holiday stress as early as the first of November and, of all places, in a nutrition column. As tempted as I am to write about holiday survival and avoiding overindulgence, I’m putting that aside to instead suggest adding “health” to your holiday gift lists. No, I’m not advocating enrollment in a Fiber of the Month club, although with all the varieties of cereals on the market now, that would not be difficult to do. Instead, I’m suggesting giving a gift that will encourage your family and friends to prepare their meals in a healthier and hopefully easier fashion. Think of your friends who come home after a long day of work and are faced with preparing an evening meal for the family. Just the mere word “chop” may mean pizza and Pepsi from the local carry out instead of a home-prepared meal. Follow that with “sauté” and it’s all over: the keys are back in hand and the car is on auto pilot. Even a simple salad begins with “rinse.” So the question is, what kitchen item can help make meals easier and healthier? A good question deserves a good answer so I went to nutrition experts for suggestions. Following are some favorite, can’t-live-without items used in

the kitchens of local Registered Dietitians to simplify life and prepare healthy meals. Maybe one of these fits nicely with someone on your gift list: • I adore my salad spinner. I love buying heads of lettuce (versus the bagged lettuce), but washing and patting it dry with paper towels was always a chore. Well, once the salad spinner entered my life it was a chore no more. Rinse lettuce in your spinner, spin it dry, dress and eat...greens for everyone! Kim Beavers, MS, RD, LD, CDE University Hospital EatingWellwithKim • One of my most-used kitchen gadgets is our mini food processor—it greatly simplifies chopping. We make our own hummus out of canned chick peas (garbanzo beans, lemon juice and garlic) which is much less expensive than purchasing hummus dip in the deli section! It is also great for making coleslaw using fresh cabbage vs. the bagged type, which can sometimes have a sour smell. Making my own dishes allows me to control the ingredients. I can add carrots, apple, onion, and red pepper to customize a salad or slaw. It’s quick and easy and only one container to clean (some are even dishwasher safe). Because they are so simple to use, mini food processors prompt you to add more vegetables to the diet. Although most mini food processors are electric, the Pampered Chef has a non-electric (hand powered) version which is a great little gadget as well. Jeanne B. Lee, MS, RD, LD Augusta Area Dietetic Internship University Hospital

• There are so many options it’s difficult to narrow it down. Here are two of my favorites: A micro plane is the best of the best for grating and zesting foods such as cheese, chocolate, and lemons. They make easy work of adding a burst of flavor to dishes. Another great way to add a flavor boost is by using whole spices ground at home in a coffee bean grinder. Use one with the grinder on top so you can see the spices as they process. W. Tyler Livingston, RD, LD GA Food Service, Inc. • I have several kitchen items that make my time in the kitchen easier and more enjoyable. My favorite, though, would be color coded paring knives and cutting boards so I can use one color strictly for meat, one for vegetables, etc. This greatly reduces the chance of cross contamination and saves time when preparing a meal because I don’t have to stop and wash the board to switch to another food item – like meat to vegetable. However, you do still have to stop and wash your hands. Also I recently began using a “Salad Bag.” This is a terrycloth bag used for storing washed lettuce in the refrigerator. The moisture from the wet lettuce gets absorbed into the towel which helps keep the lettuce crisp for a longer period of time (usually more than a week). Finally, I also appreciate the narrow, oblong measuring spoons that will fit in small round spice bottles. This eliminates trying to pour spices

out onto a spoon which can result in overflow and spills. Karen Cota, R.D., C.D.E. Clinical Dietitian Charlie Norwood VAMC • One of my favorite items is the Misto oil sprayer. This is a non-aerosol bottle to which you add your favorite oil, such as olive or sunflower. The top portion is a pump that you prime a couple of times to activate the spray. Using a spray mist gives better control of how much oil you add to your dishes and makes greasing a pan a snap. Since there are no propellants, you don’t get that tacky buildup common to some canned oils. The Misto canisters come in different colors so you can code your oil choices (i.e. red for olive, blue for sunflower, etc). Local shops that carry the Misto include Marshalls, Ross, Costco, and Bed Bath & Beyond. Another favorite item is stoneware cookery. I use this for everything from cookie sheets to roasters. The beauty

of stoneware is that food items don’t stick, foods stay moist, and the pans self-season … the more you use them the more seasoned they become. Especially handy is the toaster oven sized stone from Pampered Chef (small bar pan). Finally, for cold winter days there is nothing like a hand blender for pureeing soups to desired consistency (such as bean and squash). These have many other uses as well from mixing beverages to dips. Cindy Elia, M.S., R.D., C.D.E. Area Agency on Aging Hopefully some of these ideas will take care of the people on your holiday list or, perhaps, are interesting enough for you to add to your own wish list. Remember, good health is the gift that keeps on giving. + Author Cindy Elia, M.S., R.D., C.D.E. is the Nutrition Specialist for the CSRA Area Agency on Aging, your gateway to aging resources. Got a question? Drop us a line: info@AugustaRx.com.

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

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

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

NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

P harmacy 411 EDITOR’S NOTE: Very little if anything about healthcare is inexpensive, and that includes medicine. Tiny pills can command large prices. Over-the-counter medications may be less expensive, but are they also less effective? Find the answers to lots of your drug store questions in this column written by Augusta pharmacists Chris and Lee Davidson exclusively for the Medical Examiner.

ARE YOU READY TO QUIT? MAKE NOVEMBER YOUR MONTH Smoking and other nicotine use has been shown to affect nearly every organ in your body. The health hazards are undeniable. Smoking causes over eighty percent of all lung cancer deaths in the United States and ninety percent of all deaths caused by COPD (chronic obstructive pulmonary disease). COPD includes emphysema and chronic bronchitis, both of which reduce your pulmonary function. The total number of deaths caused by smoking is known to be near one-half million per year. Smoking affects other human diseases in a negative manner. It increases the risk of coronary heart disease and stroke by an estimated two to four times. A smoker is at a twenty-three time greater risk of developing lung cancer than a non-smoker and more likely to develop cancer throughout the body. Lots of money has been devoted to developing products that can help people quit smoking. These include the nicotine products including gum, patches, and most recently the electronic cigarettes. These products are only effective if the user is devoted to quitting, otherwise they become a second source of nicotine. Chantix is a prescription medicine that can block nicotine’s pleasurable effects in the brain thus decreasing the desire to smoke. Zyban is a medication that reduces the craving to smoke by working from an obsessive compulsive component of smoking as well as reducing withdrawal symptoms. So let’s look at which of these strategies may be best for you. Nicotine replacement therapy can be used to decrease cravings or respond with a lower dose of nicotine in response. If you smoke at a steady pace throughout the day instead of in response to stress and anxiety you may benefit from the patch. Nicotine patches release a steady stream of nicotine into the body. This is a decrease in amount from a day of smoking cigarettes and there are several strengths of the patch so that you can slowly taper off the nicotine and quit smoking. If you smoke in response to stressful situations then the gum, spray, inhaler, or lozenge may be better for you. This way you are only

getting nicotine when needed and you can gradually use the replacement product less often until you have quit altogether. Any nicotine replacement therapy is a step toward lowering your overall nicotine consumption if you use it as directed and not abuse it. These products are for people who are committed to quitting and not just finding another source of nicotine. The prescription alternatives to smoking should be used only after careful consultation with your physician. Any history of mental illness or depression should be discussed at this time as these medicines affect your central nervous system and can cause changes in mood or behavior up to suicidal thoughts. Whether these effects are the result of the medications or the result of chemical changes due to nicotine withdrawal is unclear. Chantix works on the nicotinic receptor and blocks the pleasurable effects of smoking in the brain. You should set a quit date and start Chantix one week prior to that date. As you reach a therapeutic dose of Chantix you begin to experience less pleasurable effects from nicotine and more undesirable effects such as nausea. This is a crucial time when you must choose to decrease your cigarette use and stick with your prescription therapy. No plan to quit smoking is going to work if you are not committed to quitting. You must find a support system and a reason that means enough to you to make you decide to quit no matter what the cost. Quitting is not something you decide to try. It is a struggle and you must stand firm but there are plenty of support systems available to you. So make November your month to quit! + Questions, article suggestions or comments on this article email us at cjdlpdrph@bellsouth.net Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson (cjdlpdrph@bellsouth.net )

your

You can read the Examiner online at www.AugustaRx.com/news

NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

is now

• Specialty Pharmacy • Home Infusion Ser vices • IV Nursing Same phone numbers! Same convenient location! 3630 Wheeler Road • Augusta, Georgia

CCH celebrates five years Christ Community Health Services, established in November 2007, this month celebrates its fifth anniversary of providing affordable quality primary healthcare to uninsured and under-served patients in the greater Augusta area. The clinic’s progress has been remarkable. In 2007, CCH had one location, four exam rooms, two physician providers and two support staffers. Five short years later, the service has grown to include nine medical staffers (six doctors, a physician’s assistant, and two Advanced Practice Registered Nurses) seeing patients in 22 exam rooms at two locations, the original D’Antignac Street location and the newer (well, if something built in 1818 can be called new...) Olde Town Community Health Center, (above) officially christened as the Ann Boardman Widow’s home on a sweltering day in July of 2011. The first full year of operation, the D’Antignac Street clinic saw fewer than 3,800 patients all year. Last year the figure was nearly 11,000, a number that will certainly be surpassed for 2012 (through September, patient visits for 2012 stood at 10,199). Year-end projections for 2012: 12,500 patients. That’s significant because the patient numbers, more than 41,000 since opening day, represent people who very likely would have fallen through the cracks in the healthcare system without Christ Community Health. More than half of their patients do not have health insurance. CCH offers their services (family medicine, internal medicine, pediatrics, and women’s health) at modest cost on a sliding scale based on the patient’s income, starting at $25.00 (although there is no charge for the homeless). Goals for the near future include establishing an in-house cardiac stress test program and hiring additional healthcare providers. For more information, visit www.christcommunityaugusta.org. +

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+ 10

NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

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Georgia Health Sciences University students will honor individuals who have donated their body to health sciences education at a 1 p.m. service Friday, Nov. 9 in the Natalie and Lansing B. Lee Jr. Auditorium of the GHSU Auditoria Center. The ceremony will include student and faculty perspectives on donors’ impact on education and musical selections performed by students. Attendees will then visit the cinerarium on campus, where donor ashes can be interred. “Students will always remember their cadaver as their first patient,” said David Adams, Coordinator of Anatomical Donation Services. “And what the donors teach students is better than any textbook, any lecture or any

Opening Doors to a Cure

video they can watch. The students have a tremendous respect for that.” Donors are needed for medical, dental and allied health sciences education. Students begin their dissection

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experience with a blessing of thanksgiving by GHSU Chaplain Erwin Veale and complete the course with another prayer and by cleaning the cadavers, often placing thank-you notes in the body bags, Adams said. The registry includes more than 10,000 people, but the average age of donors is young and the need increases as class sizes increase, Adams said. The Uniform Anatomical Gift Act requires donors to be at least 18 but there is no upper age limit. Infectious disease can preclude donation, as can serious trauma with multiple organ damage. However, donors who’ve had common surgeries such as hysterectomies or hip replacements are welcomed. GHSU’s Anatomical Donation Program provides transportation to GHSU, embalming and cremation. Ashes can be returned to the family or interred in the cinerarium. +

For more information about body donation contact Adams at 706-721-3731 or dadams@georgiahealth.edu or visit http://www.georgiahealth.edu/som/ cba/bodydonation/.

+ I

M.E.

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“

Inflation is when you pay fifteen dollars for the ten-dollar haircut you used to get for five dollars when you had hair. — Sen. Sam Ewing

“

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NOVEMBER 2, 2012

11 +

AUGUSTA MEDiCAL EXAMINER

The blog spot — Posted October 9, 2012 by Karen Lynch at intentblog.com

ADVICE FROM A 2-TIME CANCER SURVIVOR On Thursday, July 17, 2003, I first learned that I had breast cancer. I was only 35 years old and had no family history of the disease. I sat at my kitchen table, clutching the phone handset in my shaking hands, trying to make sense of what I’d just heard. It sounded like I was going to be okay. The surgeon on the other end of the line said the cancer was non-invasive. 100% treatable. But still, I thought, breast cancer can kill. I have children, young children, I thought. Two boys. Two beautiful baby boys. They can’t grow up without a mother, I thought. I can’t die. I went through my treatment with this philosophy: I can’t control the cancer within me, but I can control how my children fare while I battle the disease. So right away, I began to research the best way to parent my kids through breast cancer. Here’s what I embraced: I decided right away not to try to protect my children from the truth, but to frame it in a way that wasn’t frightening. I used the words “breast cancer” freely, knowing that as children they had no preconceived notions about the disease being fatal. I even allowed my oldest to come with me to my treatment a time or two in an effort to demystify the entire experience for him. I explained things to my children using ageappropriate language, emphasizing the fact that breast cancer was not a contagious illness like the common cold or flu, but something inside my body that had gone wrong and needed the help of doctors to make it right again. I told them they’d be hearing a lot of conversation about breast cancer and that I’d be on the phone a lot, especially in the early days after my diagnosis. I told them that if they were quiet and patient while I was on the phone, I’d be sure to spend some time with them in the quiet when I was off the phone. I shared my tears with them and made it clear that they could share their tears with me, anytime, and we’d get through my treatment together. And we did get through it, with flying colors. But on Thursday, April 6th, 2006, I learned that my breast cancer had recurred. I sat at my kitchen table once again, listening to the nurse practitioner at my surgeon’s office explain that this time, the cancer was invasive. This time, I’d have a more aggressive treatment plan. This time, I thought, I’d have more questions from my boys because they were older. This time, I thought, I’d have to consider the needs of my daughter, brought home from China the year before after an international adoption. This time, I thought, was going to be harder. But I remembered how we got through my treatment the first time around, as a family. And I remembered how I parented my kids the first time around and decided not much had changed after all. My children still needed my honesty. They still needed my explanations. They still needed time with me in the quiet when we found it. They still needed to cry with me – and I with them. And once again, we got through it, with flying colors. +

“

I can’t die.

”

Karen Lynch is a two-time breast cancer survivor, wife and mother of three living in Connecticut, where she is a freelance writer and journalist. Her blog, Pink Ribbon Review, is dedicated to raising breast cancer awareness. The photograph is part of The SCAR Project by photographer David Jay

From THE Bookshelf Unfortunately, many of us need this book. The person who always knows just what to say and when to say it — not to mention how to say it — is the exception. For the rest of us, all kinds of situations can present a bit of a communications dilemma. Throw in something like bad news from some medical tests, losing a baby, finding out a friend has cancer, or any one of dozens of other health-related bombs that one of our friends may have dropped on them (including death), and it can be very difficult to know what to say. Sue Halpern to the rescue. Her book, The Etiquette of Illness, was born of personal experiences and those of her friends. And let’s face it: we’ve all been to these places. In one case, she had lunch with a friend who had been diagnosed with cancer and was undergoing treatment. One of this woman’s close friends, someone she regularly spoke with, hadn’t called or returned any of her calls in months, roughly since the time of her diagnosis. She didn’t know what to say, so she didn’t say anything. All of us can identify with that to some degree. It’s not always

easy to comfort someone who has experienced a death in the family or who has received some sobering and serious bad news from a doctor. Then again, neither do we want to rush in like a bull in a china shop in some imaginary race to be the first to reach out to someone. As the title reminds us, there is etiquette involved. No points are awarded for being the first to extend words of comfort, any more than they are for waiting months and being the last. It can be beneficial to get one’s thoughts together, perhaps do some research on the subject of the person’s diagnosis, and give careful thought to what you’ll say. That’s where this

book comes in handy. Halpern, a psychotherapist, social worker, and human being, offers lots of sound advice on great ways to avoid that nagging guilty feeling we get when we retreat from a friend in their time of need instead of reaching out to help. Granted, we could tweet our friend or send them a text, but that has to rank near the top of bland and impersonal ways to communicate. Nor is there any law against getting help from Hallmark — quite the opposite in fact — but simply buying a card and signing it, or adding a few words (“thinking of you at this difficult time”) is a poor substitute for a few warm words spoken directly to our friend. Better to call or visit and send a card. Ah, but what to say when you call? There is the rub. Fortunately for us all, here’s a book that offers “what to say when you can’t find the words.” And we’ve all been there — and will be again in the future. Unless, that is, we learn The Etiquette of Illness. + The Etiquette of Illness, What to Say When You Can’t Find the Words, by Susan P. Halpern, 208 pages, published in 2004 by Bloomsbury USA

the

Clipping File To call or not to call? That is the question. And what is the question about? About calling in sick. Or not calling in sick. An article last week (Oct. 24) in The Wall Street Journal explored the dilemma of sick days for employees and employers alike. It’s not a minor issue: “more than two-thirds of all health-related productivity losses spring not from sick people missing work, but from employees [with chronic or contagious ailments] who show up.” That’s according to a study reported in the Journal of Occupational and Environmental Medicine. Yes, those dedicated employees who prove their “worth” by showing up despite their cold and flu symptoms can be a double whammy: they work at half-speed all day; and they can easily infect countless others. Some companies have adopted unlimited (within

reason) “no fault” sick days to make sure they aren’t encouraging germ-spreaders to report for duty. Others have eliminated perfect attendance rewards, and still others encourage working from home when employees are contagious. Another study has found that about 15 percent of people who call in sick are just fine. Maybe they feel too good to work. One in 7 women has lied about being sick compared with one in 5 men, said the survey of 5,250 working professionals.

sudoku puzzles didn’t seem to have any measurable impact on brain size or brain shrinkage. Researchers aren’t sure why exercise prevents brain loss. Do people’s brains shrink, making them less inclined to exercise? Or is it the other way around: they exercise, increasing blood flow and oxygen delivery to their brains, which prevents brain shrinkage. Either way, the message is clear: exercise protects the brain and helps prevent or forestall thinking and memory loss.

Shrinkage is never good Especially in older adults. But BBC News online reports that an Edinburgh University study has shown that brain shrinkage is prevented, stopped or lessened by exercise among people in their 70s. At that age, we’re not talking about triathlons. Just going for a walk several times a week was enough to produce benefits. On the other hand, brain exercises like challenging crosswords and

One more reason to read the Medical Examiner In Britain, a National Health Service inspector told a dentist that the years-old magazines in her patient waiting room could be carriers of disease from patients past. Although the NHS later disavowed the inspector’s recommendations, it is worth noting that fresh, crisp copies of the Medical Examiner are delivered to more than 500 area doctors twice a month. +

+ 12

NOVEMBER 2, 2012

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

What a horrible accident.

What?

by Dan Pearson

This article is about a guy who was caught in some machinery.

He was practically twisted in two.

Oh no. What happened?

Oh my. That sounds gut-wrenching.

The Mystery Word for this issue: DIPMARCEA

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. Noted medical school 5. Anti-drug acronym 9. Tic 14. Highly excited 15. Man One 16. Unit of magnetic induction 17. Tolled 18. Title 19. Negatively charged ion 20. Near 21. Inseminate 23. Shows a cold symptom 25. Greek goddess of the earth 26. Popular ISP 27. For each 28. Word that defines media 32. Botch 35. “That ____ an option.” 36. Above-the-neck M.D. (abbrev.) 37. Malt beverage 38. Book before Matthew 41. Fish eggs 42. Structure for storing grain 44. Supporter 45. Die from H20 47. One of two equal parts 48. Deep sleep abbreviation 49. Natal start 50. Broad St.’s _____ Hollow 52. Dated term for conjoined 56. Haiti and the Dominican Republic 60. Wall column or pilaster 61. Bay window 62. Projecting edge 63. Inflammation suffix 64. Pertaining to mode or form, not substance 65. Penny _____ 66. Hawaiian goose 67. Exalt, place in the heavens (poet.)

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 TO ENTER! 1

34 38

48 50

Click on “Reader Contests”

QUOTATION PUZZLE 28

26 33

41 46

R W Y S T A A H

R T T L H V D S E I N G O U T I E E T F O O O E E T I N G I H Y R U F N H O — Author unknown

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

Solution p. 14

68. Nervously irritable 69. Energy units

DOWN 1. Tales 2. Once more 3. Long rope used to guide a horse in a circle 4. Slang term for an intellectual 5. _______ Village 6. 6th US president 7. Means of I-20 access 8. Room at hospitals 9. Tour de France leg 10. Nom de plume 11. Largest continent 12. Tab receiver 13. Long luxuriant hair 22. Planet after Venus 24. Move rapidly 27. Sacred song 29. Air prefix 30. Augusta winter rarity 31. British machine gun

32. Sour _____ 33. Hip bones 34. Exchange for money 35. Like some doctors’ handwriting 39. Honoree of the 755 Club 40. Notion 43. Time of lower demand 46. Variety of lettuce 49. Capital city of Niger 51. Bounce back 52. Sore arm protector 53. Go into 54. Burn 55. Reduces gradually (with “up”) 56. Lead-in for base or page 57. The “I” of Grovetown’s GIW 58. Caesar, to friends 59. Toward the mouth (Med.)

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.

X A M I N E R

1 5 3 7 4

3 2 7 9 1 5 8 9 2 6 8 9 2 5 8 9 2 1 3 5 6 5 3

U D O K U

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

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

O 1 2 3

1 2 1

G 2 3

1 2 3 4 1 2 3 4 5

T 1 2

1 2 3 4

1 2 3

1 2 3 4 5 6 7

T 1 2 3

— Jewish proverb

1. TTGIFDRYLAS 2. WOOOFREEII 3. GEAROVVU 4. KEEV 5. NE 6. G 7. E

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 2, 2012

13 +

AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE ha... ha...

“Mr. Clark, I’m afraid I have bad news,” the doctor told his anxious patient. “You only have six months to live.” The man sat in stunned silence for several moments. Finally regaining his composure, he apologetically told his physician that he had no medical insurance. “I can’t possibly pay you in that time.” “Okay,” the doctor said, “let’s make it nine months.” A husband and wife came in for counseling

after 20 years of marriage. When asked what the problem was, the wife went into a passionate, painful tirade listing every problem they had ever had in the 20 years they had been married. She went on and on and on: neglect, lack of intimacy, emptiness, loneliness, feeling unloved and unlovable, an entire laundry list of unmet needs she had endured over the course of their marriage. Finally, after allowing this to go on for quite a while, the therapist got up, walked around the desk and, after asking the wife to stand, embraced and kissed her passionately as her husband watched with a raised eyebrow. The woman quietly sat down as though in a daze. The therapist turned to the husband and said, “That is what your wife needs. And not just once in a blue moon. At least three times a week. Can you do this?” The husband thought for a moment and replied, “Well, I can bring her in on Mondays and Wednesdays, but on Fridays I usually go fishing.” +

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

The Patient’s Perspective by Marcia Ribble

he day before I wrote this column it was raining. It rained all night. The next day it was still raining. Because we are in extreme drought the rain has been a blessing for us all, and especially so for our farms and gardens and lawns that have been thirsty for three years. We normally respond to this kind of gift with thankfulness. If it’s spring or summer, we watch the grass turning green again, the leaves of plants plumping up, the fledglings taking their first uncertain flights, and we feel a little of the glee we experienced as children seeing life evolve around us. The other kind of raincloud that drops into our lives when we don’t expect or need or want it, illness, carries with it an entirely different set of responses, most or all of them negative. But is that a requirement? Are negative responses all there are to the inevitable aging of our bodies? We’ve all know people for whom that seems to be the case; however, there are alternatives. For me it all started in the summer of 2009 when I fell in my daughter’s driveway and broke my shoulder. I didn’t have time to deal with a broken shoulder. I was in Georgia to buy a home to retire to. And then I needed to drive back up to Cincinnati to finish my last year of teaching and fill boxes and boxes and boxes with my books and other belongings. There doesn’t seem to be much of anything positive in that. But from my perspective now there was a lot to be grateful for. The need to move around to pack and unpack boxes forced me to use my shoulder in ways I might not have used it otherwise due to the pain. Makes me recall the words from that old song, “lift that barge, tote that bale, get a little drunk and you land in jail” only I’d make it “lift that book, fill that box, stack them up and pay the movers.” When I finally moved here to Georgia a little less than a

Talk is cheap. Not talking can be deadly.

year later, my front bedroom and hall were full of stacks of boxes to unpack that I’d sent ahead of me and the movers. While I might have benefitted from a rehab regimen to regain the use of my shoulder, I could not afford the time to do that with those many boxes taking up space and containing things I needed to use. My daughter was coming in a few weeks to visit, bringing her son, two of my other granddaughters and my great granddaughter. I had to have places to put those live bodies, as well as to cook for them and feed them. I had to empty those boxes and to do that I needed to use my shoulder again. I lifted things out of the boxes and lifted them up into cupboards, closets and bookshelves. It was my rehab. One arm alone couldn’t do it, so both were required to work together. By the time they all arrived, most of the boxes were empty and there were plenty of places for my daughter and grandchildren to lay their heads. After they left to return to Michigan, I fell, hard, on my tailbone and caused myself months of pain from a degenerating spine with protruding disks and impingement on my nerves up and down my back. More about that next time. + Marcia Ribble received her PhD in English at Michigan State and recently retired from the University of Cincinnati where she taught composition. She taught writing at the college level and loves giving voice to people who have been silenced. She can be reached with comments, suggestions, etc., at marciaribble@hotmail.com.

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AUGUSTA MEDiCAL EXAMINER

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

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

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QUOTATION PUZZLE SOLUTION: Page 12: “The things you want to die for are the things you live for.” — Author unknown

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NOTICE! ATTENTION! If any current or past employer has failed to pay you min. wage or time and a half overtime pay, you may be entitled to an order from US Federal Court awarding you twice the amount of your unpaid wages plus atty. fees. For info, call Arthur H. Shealy, Attorney at Law, 803-278-5149, 1010 Plantation Rd, North Augusta SC 29841. You may be entitled to a similar award for unpaid wages if your employer required you to perform duties during your lunch hour, before clocking in, or after clocking out.

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NOVEMBER 2, 2012

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AUGUSTA MEDiCAL EXAMINER

The Short White Coat T he second year of medical school at MCG is organized basically into modules assigned to different organ systems of the human body, each module then covering the pathology, pharmacology, microbiology, and clinical aspects of each system. A few days ago, my classmates and I began the Gastro-Intestinal Module for this year upon completion of the Hematology section. Our geographic progression through the GI Module has been very orderly, starting first with discussions of the mouth, then the esophagus, stomach, small intestines, colon, liver, and so on. I have found the material to be very interesting as we cover some conditions both commonly and uncommonly encountered by Americans today. What is heartburn, and how do the medications for treatment of heartburn work? Why are “gluten-free” diets all the rage nowadays? How in the world does Pepto Bismol actually treat nausea, heartburn, indigestion, upset stomach, and diarrhea? (yes, I had to sing the song to remember the five conditions it “cures”) It is quite fun to go to class everyday and get the

answers to these questions that have crossed my mind when I see commercials for Pepsid Complete or glutenfree Chex mix at the grocery store. Our professors give us PowerPoints containing a series of slides discussing the various disorders of the GI tract. My classmates and I learned about Celiac disease, a disorder caused by a severe allergy to gluten, thus requiring a glutenfree diet. We also learned about Crohn’s disease, and how to distinguish it from another disorder of the colon, ulcerative colitis. And we found out that no one is actually quite sure exactly how Pepto Bismol works… it just does. Given our focus on the GI

tract, it was inevitable that our lectures would eventually turn to the subject of poop. One of our professors surprised us in class one morning with a few slides that were not included in our PowerPoints. These slides contained pictures of toilets, and these toilets contained stool. In medicine, poop is referred to as stool, but regardless of the word used, they both look the same in a photograph and elicit the same response from viewers. Initially, the class reacted to the pictures in much the same way an 11-year-old boy would. We laughed and were mildly shocked as we looked at the pictures, and the professor laughed with us in understanding of the situation. An air of seriousness returned to the classroom, however, as our professor explained to us how to interpret what we saw in each of the pictures and relate them to accurate diagnoses. While our teacher enjoyed adding a bit of levity to our lecture, he was not showing us these pictures solely for the purpose of making us laugh like 11-year-old boys. These pictures contained the same educational value as a

A med student’s notebook picture of a lung consumed by tuberculosi, a throat infected by C. diphtheriae, or an eye overwhelmed by a tumor; for patients with gastrointestinal disorders, it is just as necessary to evaluate their stools as it is to examine the blood smears of leukemia patients. Our professor was making a point to the class that, as doctors, it will be our responsibility to examine all necessary aspects of a patient to reach a proper and timely diagnosis. This could at some point include examination and testing of a stool sample; failure to do so could be potentially devastating. I am grateful for this reminder from my professor and will certainly keep it in the back of my mind as I continue my education in school as well as in practice one day. For better or worse, pictures of poop are not only educational, but also not easily forgotten. + — by Caroline Colden 2nd-year medical student at MCG

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THE AUGUSTA MEDICAL EXAMINER AUGUSTA’S MOST SALUBRIOUS NEWSPAPER

NUMBERS… from page 1 then electrical impulses, conserving 99.9% of incoming sound energy. • Bone is 5 times lighter than steel, 4 times more flexible and resilient than concrete • Within the liter and a half of human brain, serologic studies estimate that there are approximately 20 billion neocortical neurons, with an average of 7,000 synaptic connections each. The cerebral cortex alone has about 0.15 quadrillion synapses—or about a trillion synapses per cubic centimeter of cortex. The white matter of the brain contains approximately 150,000 to 180,000 km of myelinated nerve fibers at age 20, connecting all these neuronal elements. Despite the monumental number of components in the brain, each neuron is able to contact any other neuron with no more than six interneuronal connections—“six degrees of separation.” • How fast does information travel in the nervous system? Information travels at different speeds within different types of neurons. Transmission can be as slow as 0.5 meters per second or as fast as 120 meters per second. 120 meters per second is equal to 268 mph.

• How big is a neuron? Although all the neurons lined up side by side would stretch 1,000 kilometers, the line would be only 10 microns wide, invisible to the naked eye. To get an idea of how small a neuron is, the dot on top of this “i” is approximately 0.5 mm (500 microns or 0.02 in.) in

diameter. Therefore, if you assume a neuron is 10 microns in diameter, you could squeeze in 50 neurons side-byside across the dot. However, you could squeeze in only 5 large (100 micron diameter) neurons. +

For more information on numbers, including a graphic of one trillion dollars to compare to the 100 billion dollars shown above, visit the Medical Examiner blog at www.AugustaRx.com/news

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AUGUSTA MEDiCAL EXAMINER

NOVEMBER 2, 2012

OUR VIEW

This has gone on way too long The Medical Examiner was there for last week’s Azziz/ Save the A press conference announcing a compromise in the never-ending saga of the new name for Augusta’s two A-List universities. Names are important. Obviously. Just look at the animus this issue has raised. But Dr. Azziz and the Board of Regents have taken what should have been an extremely simple process, and through sheer pig-headed stubbornness have transformed it into a public relations disaster with no end in sight, at least not any good end — unless Pat Robertson’s attorneys ride in on white horses wearing shining armor. If the definition of compromise is a decision that doesn’t really satisfy either party, the new name does an outstanding job. There was actually a moment of stunned silence when the name was announced. This is the lamest name choice since all the way back to when they picked Georgia Regents University. Dr. Azziz said this finally is the name that will carry the institution forward with a branding that will resonate not just across the state of Georgia, but nationally.

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Why is Dr. Azziz wrong? It’s not just that it’s unimaginative; in terms of branding it does exactly the opposite of what they say it will do. To illustrate, here are the made-up names of some fictitious universities (except for one): • Iowa Great Plains University Dubuque • New York Arcadia University Albany • Maryland Seaboard University Baltimore • Washington Cascade University Tacoma • Georgia Regents University Augusta

Like all weak men he laid an exaggerated stress on not changing one’s mind. — W. Somerset Maugham +

What is the first impression you get from each of these names? You would immediately conclude these are all satellite campuses. The logical question they suggest is, “Where is the main campus? What city?” Think USC-Aiken. We continue to be baffled by the stubborn refusal to feature Augusta in the name, given this city’s international reputation. If you heard someone mention St. Andrews University, would you conclude it was a tiny parochial campus in a one-horse town? More likely, you would instantly think of the prestigious golf tournament held there. It would be a positive association, even if St. Andrews University has no connection with the game of golf whatsoever. That is the branding opportunity being missed by the original generic name. Tacking Augusta onto the same name as an afterthought does its own job of branding this university as a second-rate satellite campus. It’s utterly amazing that such a simple process with such a simple solution — the solution their own marketing research handed them on a silver platter — continues to be played out like a soap opera. +

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