Nov6 15 by Daniel Pearson

F RE E!

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TAKE HOME T HI S C O P WITH Y Y OU !

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

AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

NOVEMBER 6, 2015

Part One of a series

16 for ’16

As the end of one year and the beginning of another approaches, it’s a fitting time to consider ways to start the new year in a better state of mind and body. Each installment of this series, now through February, will offer simple ways to do just that by cutting bad things and adding good things.

COVER!

+ #1 DRIVE, BABY, DRIVE When you’re driving, do just that: drive. That might sound obvious, but it is far from the norm. Look around at your fellow motorists as you travel city streets and interstate highways and you will be amazed by how many drivers are hurtling down the road while looking at a cell phone screen. Once upon a time, drivers were taught to keep both hands on the wheel at the 10 and 2 positions (comparing the steering wheel to a clock face), but for millions of distracted drivers it’s one hand for the phone, one for the steering wheel. According to a study by Carnegie Mellon University, driving while using a cell phone reduces the amount of brain activity directly associated with driving by 37 percent. Other studies have established that driving distracted is the equivalent of driving with a blood alcohol level of .08. That’s considered DUI in Georgia (although a fraction of that — .02 — is the limit for drivers under 21 years of age). Experts say there are three main types of distracted driving: Visual (taking your eyes off the road), Manual (taking your hands off the wheel), and Cognitive (taking your mind off driving). Texting while driving — illegal but still common — is especially dangerous because it

Please see 16 for ’16 page 13

he other day as I walked up to a doctor’s office, I saw two men having a conversation near the building’s front door; a woman with them stood nearby. As I walked past them toward the door, I noticed the woman had a strange look on her face. I wondered briefly if she was what we used to call retarded, or blind, or perhaps both: it’s hard to describe, but she was staring off into the distance in a way that seemed vacant and unseeing, yet also in mild distress. Just after I passed her, I heard the reason for the bizarre look on her face: she unleashed a mega-sneeze. When I glanced at her as I walked past moments before, she was in one of those pre-sneeze trances. Have you ever seen that? Please see COVER! page 9

HIGHLIGHTS: Baby Barf 101 • Page 10 Bad Billy talks about having kids • Page 5

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AUGUSTA MEDiCAL EXAMINER

BETTER BUSINESS

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2016 OPEN ENROLLMENT CHECKLIST

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Do you have type 2 diabetes? Do you have problems with your kidneys? If the answer to both questions is Yes, you may be able to take part in a clinical research study.

o prepare for open enrollment, group health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning Russell Head on or after January 1, 2016. Employers should review their plans and plan documents to confirm that they include these required changes. Employer Penalty Rules Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange. To qualify as an applicable large employer (ALE), an employer must have employed, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules, including for-profit, nonprofit

For more information please contact:

Masters of Clinical Research 1113 Garredd Boulevard, Suite A (844) 611-1196 An independent Ethics Committee or Institutional Review Board has approved the study. Janssen Research & Development, LLC

MCR

Out-of-pocket Maximum Effective for plan years beginning on or after January 1, 2016, a health plan’s out-ofpocket maximum for essential health benefits may not exceed $6,850 for self-only coverage and $13,700 for family coverage. The ACA’s out-ofpocket maximum applies to all non-grandfathered group health plans, including selfinsured health plans and

I N

T H E

F I R S T

insured plans. Also, effective for plan years beginning on or after January 1, 2016, the ACA’s self-only out-of-pocket maximum applies to all individuals, regardless of whether they have self-only or family coverage under a non-grandfathered plan. This means that, effective for 2016 plan years, non-grandfathered health plans are required to embed an individual out-ofpocket maximum in the plan’s family coverage when the family out-of-pocket maximum exceeds the ACA’s out-ofpocket maximum for self-only coverage. Health Flexible Spending Contributions The ACA’s limit on employees’ pretax health FSA contributions for 2016 plan years remains at $2550. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. Required Notices Open enrollment is a convenient time to provide employees with required annual notices. Group plan sponsors should check to see which of the following they are required to provide: • Summary of Benefits and Coverage • Grandfathered Plan Notice • Notice of Patient Protections • Annual CHIPRA Notice • WHCRA Notice • Medicare Part D Notices • Michelle’s Law Notice Russell T. Head is President with ACHS Insurance, Inc., Augusta’s largest risk management and employee benefits brokerage. He can be reached at 706-733-3459 or rthead@achsinsurance.com. Visit ACHS Insurance at www. achsinsurance.com. +

P E R S O N

Thank you!

If you choose to take part in the CREDENCE Study, you will be looked after by an experienced study team who will carefully monitor your health and support your diabetes management. You will continue to take your current diabetes medications.

and government employers. A one-year delay for mediumsized employers (those with between 50 and 99 FTEs) was allowed during 2015. However, all ALEs will be subject to the employer penalty rules beginning in 2016. Under the ACA, an employer’s health coverage is considered affordable if the employee’s required contribution to the plan does not exceed 9.5 percent of the employee’s household income for the taxable year (adjusted to 9.66 percent for plan years beginning in 2016). Because an employer generally will not know an employee’s household income, the IRS provided three affordability safe harbors that employers may use to determine affordability based on information that is available to them, including the employee’s W-2 wages, the employee’s rate of pay or the federal poverty level for a single individual. Under the ACA, a plan provides minimum value if the plan’s share of total allowed costs of benefits provided under the plan is at least 60 percent of those costs. The IRS and HHS provided the following several approaches for determining minimum value. In addition, any plan in the small group market that meets any of the “metal levels” of coverage (that is, bronze, silver, gold or platinum) provides minimum value.

M E DIC I N E

The CREDENCE Study is looking at an investigational (study) medication (taken as a daily capsule) that may help protect the kidneys in people with type 2 diabetes. We are looking for people who: • are 30 years of age or older • have a diagnosis of type 2 diabetes • have kidney problems related to their diabetes • are currently taking medicines to control their kidney problems

NOVEMBER 6, 2015

On Oct. 5, I was taken by ambulance to University Hospital and was treated there until Oct. 9. It was such an experience of kindness, respect and attention given to me. I was in the CV4, a new wing at the hospital. The doctors and staff are all first-rate. I could make them run to my room by moving my

I will never forget. arms or even just a finger. The staff was really alert to all my needs. I am home now

recovering, but I will never forget the wonderful doctors and staff and the excellent treatment I received. Everyone there is in my prayers. — Mayo Charles Chason, Sr Grovetown, Georgia

Send us your first person story! See page 3, upper right.

NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

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. +

Everything you need.

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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The Medical Examiner’s mission: to provide information on topics of health and wellness of interest to general readers, to offer information to assist readers in wisely choosing their healthcare providers, and to serve as a central source of news within every part of the Augusta medical community. Submit editorial content to graphicadv@knology.net Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com Augusta Medical Examiner photography: H + D Photography www.handdphoto.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net Opinions expressed by the writers herein are their own and their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., or its agents or employees take any responsibility for the accuracy of submitted information, which is presented for informational purposes only. For specific medical advice, diagnosis and treatment, consult your doctor. The appearance of advertisements in this publication does not constitute an endorsement of the products or services advertised. © 2015 PEARSON GRAPHIC 365 INC.

NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

#10 IN A SERIES

OLD NEWS

Who is this?

POINTS OF INTEREST TO FORMER KIDS by Trisha Whisenhunt, Senior Citizens Council

his noted physician and researcher wasn’t a veterinarian, but he is associated with dogs more than anything else. Originally interested in the priesthood, Ivan Petrovich Pavlov entered theological school to follow in the footsteps of his father, the village priest. He left without graduating, however, and instead enrolled in the university at St. Petersburg, Russia. Pursuing a mix of courses that included natural sciences, he gravitated toward physiology, the branch of biology that studies living organisms and the systems that contribute to their normal function. In 1884, Pavlov moved to Germany to work in a lab that was studying digestion in dogs using an innovative “exteriorized” section of the stomach (eventually known as a Pavlov pouch) that enabled viewing and measurement of digestive activity. In 1891 he was invited to direct the newly established Department of Physiology at the Imperial Institute of Experimental Medicine in St. Petersburg where he conducted the research for which he is still famous, and for which he was awarded the 1904 Nobel Prize in Medicine. As he had done earlier in Germany, Pavlov externalized a body function — in this case, dogs’ salivary glands — to examine digestion in an ongoing study. Prior research of a similar variety had been done using vivisection, meaning the animal research subjects were killed and studied by dissection. Pavlov’s ability to repeatedly study the same subjects led to his famous discovery that dogs would salivate at the mere suggestion of food; for example, when they saw the research assistant who normally fed them. Over time, Pavlov used various neutral, unrelated stimuli — the ticking of a metronome or blowing a whistle, for example — that were always employed at feeding time. Eventually, the dogs associated the sound with food and would salivate at the sound whether food materialized or not. Pavlov’s discovery of what is called classical conditioning might at first seem to be a mere historical curiosity, but most of us are affected by it throughout our lives. A person might view a certain regular activity — TV watching, for instance — as their cue to eat snack foods whether or not they’re hungry. A bad childhood experience — getting the flu after eating a sandwich, let’s say — could result in a lifelong aversion to peanut butter, or grape jelly. A public speaker who happens to have a panic attack at the moment he glances at a woman in the audience wearing a yellow blouse might have another attack in another venue months later at the sight of someone else wearing a yellow blouse. It’s all the same basic principle discovered by Ivan Pavlov more than a century ago. Pavlov was born in 1849 and died at age 86 in 1936. +

WHERE ARE THE FATHERS?

othing draws a heavy sigh from hardworking taxpayers like a story of unwed mothers struggling to care for their children. While some citizens may bear a measure of resentment over supporting children out of wedlock, I don’t believe any of us want babies going hungry or without medical care. Very often negative judgment lands on the mothers. What I want to know is: where are the fathers? What I have observed is some of the males who father these babies take the attitude that it is the girl’s decision on whether or not she keeps and raises the child while they walk away. I am not suggesting these young mothers have no culpability. There is enough access to free birth control and information on the proper use of it that no woman has to get or stay pregnant if she chooses not to. They should name the father, register with the state child support registry and hold the males accountable to support the child they fathered.

Why can’t we come up with a more constructive and enforceable system whereby the fathers are held accountable and made to support their children? Ideally, they should be present in the life of their child, but if that is not possible or desired, at least send the check every month so the rest of us don’t have to. The way it currently works, an unmarried pregnant woman can make an appointment with the DFACS office to sign up for Medicaid. She receives full medical care throughout her pregnancy.

Having kids doesn’t make you a father.

Raising them does.

Food stamps, WIC for the baby (before and after birth), medical care for the child, and often, federally funded housing are available. Should the pregnancy be high-risk, with delivery complications, the need for the baby to be in intensive care, and/or be placed on a prescription formula, the cost skyrockets, leaving taxpayers to pick up the bill. Sometimes dad is a high school dropout, unemployed, and in many cases either is in jail, going to jail, or just getting out of jail. In one situation I’m aware of, a young man showed up to view his offspring with his new girlfriend. These are not the scenarios of every unwed father, but it’s a large enough portion of them that it makes a serious impact on our economy and culture. Which begs the question for these young women: why don’t they pick someone with an education, some drive and initiative, the desire to marry them beforehand, and most importantly, to be a father? I am told things are “different” these days. I hear, “I’m not ready to get married.” But they’re ready to have a child? The age-old thread of marriage first and then family has been lost. There is a vast disconnect and I am not only baffled by it, I am tired of paying for it. +

MYTH OF THE MONTH Reading in poor light can ruin your vision This has been around for decades. We have all heard it — and maybe we even believe it. There is no doubt that proper lighting is a good thing. It makes reading easier and more pleasurable. Conversely, poor lighting makes reading more difficult and much more of a chore. But does reading in poor light have an adverse effect on vision? Can it damage our eyes? It might be interesting to ask those questions to police officers, night watchmen and others who work outside at night, sometimes for many years. To help us reason on this issue, imagine speaking to someone who wears thick glasses or who walks using a white cane. You ask what happened to their eyesight and they reply, “I

used to do a lot of reading in dim light, and this is the result.” You could ask a thousand people with poor vision what caused it, and not one of them would give you that answer. That is because our eyes adjust to and function well in varying light levels. Trying to read in dim light might result in temporary eye strain, but that is about all. That does not mean reading in bad light is a good idea. It is not. Turn on a reading lamp or sit by a window in the sunshine and enjoy a good book. + — by F. E. Gilliard, MD, Family Medicine 639 13th St Augusta, GA 30901 706-823-5250

NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

WHAT EVERYBODY OUGHT TO KNOW res?

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ver since Adam and Eve, people have had kids. It is instinctive, the way of life. Everybody wants their kids to be better looking, bigger, taller, and smarter than they were. They want their kids to not have to work as hard as they did, and have plenty of money to boot. Everybody wants their kids to be a better version of Mom and Dad. Usually kids don’t quite measure up to their parents. At least, not until their parents are deceased and then the kids have to grow up for real. If a kid is going to be a walking superlative, he must first pick the right parents. I did a heck of a job picking mine. Even though I was awfully young at the time, I picked parents who did not smoke, drink, use foul language, raise their voices in family conversations, inflict guilt trips on others, or bad-mouth those not present. I never heard either parent use a profane word in my life. I’ll be the first to admit I am not as good as my parents. Once a month, my parents took me to a one-room country church where they had footwashing, river-baptizing, gospel singing and where women wore hats and men frequently wore white shirts under their starched and pressed Osh Kosh overalls. Daddy said if your religion needed recharging more than once a month, you need a stronger religion. He also did not put much stock in any religion that prevented you from eating bacon. He said it just was not natural. Today, 42% of U.S. kids are born to unwed parents. In our nation’s capital, 80% are born into single parent homes. That is unthinkable to me. I grew up back when it was a family disgrace if an unwed girl got pregnant. (Unless, of course, the sperm donor made an honest woman out of her immediately, and then we acted like we did not notice that the first child took only 7 months of gestation and all subsequent pregnancies took 9 months. My first child took five years. I just did not get it, in more ways than one.) Back then, the nonlegitimized girl was sent away to live with Aunt Jenny up in Chattanooga, and the neighbors were told she had good job with a great future up there in a shirt factory. Decent neighbors actually believed such stories. The child? It was adopted out to “a good family who needed another child,” most likely to someone who was either blood kin or rich.

ABOUT HAVING KIDS

I escaped that calamity. I married a virgin (age 18) who was much too good and too pretty for me. I was 21 and never understood why she married me in the first — or kept me for the next five decades, for that matter. I did not deserve that. And she is a damn good cook, too. Not everybody can say all that without lying. Without a doubt, I am one of the luckiest men alive. We had two kids: A boy who is a lawyer, and a daughter who is a school teacher. Both of them are better looking and smarter that I am, I am proud to say. And now I have a granddaughter who is smarter and better looking than the lot of us. She is six, going on seven, and knows things I never even heard of until I was in middle school or beyond. Here a few things you ought to know about having kids. 1. Kids are not glue. Pregnancy does not repair a broken marriage. Kids do not regenerate the hot bed of lust for a marriage gone cold. A new kid should be the result of love and commitment, not the recipe for it. 2. Kids should not have kids. Ovaries and testicles mature long before brains do. Sex education is not the answer to illegitimacy; pregnancy prevention is, be that abstinence or otherwise. Unfortunately, abstinence eventually fails in all of us. Therein lies the perpetual dilemma.

t s e B 3. ADD does not stand for Attention Deficit Disorder. It stands for Adult Deficit Disorder. The antidote to ADD is responsible parents who take care of and discipline kids who act up. Ritalin is no substitute for good parenting. 4. A teacher or principal spanking a kid who acts up in school is not an act of abuse. It is a teaching method that has worked for centuries and would work today if we had better and more responsible parents. Spanking is part of reward and punishment. When I grew up, if you got a spanking at school, you got another one when you got home. I deserved more spankings than I got at school and at home. 5. Every kid should have defined responsibilities around the house that he is not paid for doing. Why would you pay a kid to wash the car or mow the grass or iron his clothes? He lives and eats there, doesn’t he? He needs to pay his rent with sweat equity. Home is not a country club. 6. Kids ought to say ma’am, sir, and please. Being respectful

e n i c i d ME

and well-mannered never hurt anyone. And it will get them better jobs as adults. 7. Any kid who uses profane language need his butt tanned, immediately. And any parent who uses profane language in the presence of any kid is a disgrace and a failure. 8. Slang, like profanity, must be avoided. Both are prima facie evidence that the individual’s vocabulary is lacking. Being proficient in slang or profanity never got anyone a job, with the possible exception of the rap “music” industry which, by the way, is an oxymoron. 9. Grandkids are better than real kids. You can send grandkids home when they get fretful, and you do not have to pay for their orthodontist. 10. Do not tell your kids stories about how hard you had it growing up, how you had to walk five miles to school, in the snow, uphill both ways. Not even your grandkids will believe that. They’ll think

you saw it on Little House on the Prairie, just like they did. Besides your hair is not as long or thick as Michael Landon’s, so you would have frozen to death walking in all that snow and would not be around to tell about it. 11. Kids and grandkids are wonderful. Do not screw them up by thinking of yourself. Thank God every day that you have them. They are better than you deserve. 12. Always remember when your kids are acting up and you are disappointed or angry or upset with them, they could have been as bad as you were as a kid when your mother was not around. Now, I know you don’t want that. Do you? + Editor’s note: This encore column originally appeared in the June 5, 2009 issue of the Medical Examiner Bad Billy Laveau is a formerlyretired MD who wields a pointed sense of humor and now, tongue depressors too. He speaks and entertains at events for audiences not subject to cardiac arrest secondary to overwhelming laughter and glee. BadBilly@knology. net or 706-306-9397. FREE T AKE-H OME C OPY!

DICAL EXAMINER

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AUGUSTA MEDiCAL EXAMINER

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The Short White Coat A

s medical students, we spend the great majority of the first two years of medical school surrounded by textbooks and tests. Sure, we had some courses that allowed for patient exposure, but nothing that came close to what would follow during 3rd year. “Ms. Holloway,” I said proudly as I opened the door to the waiting area and called my first patient. (Name and details in this article have been altered to respect patient confidentiality.) I introduced myself and welcomed the patient, while directing her to the vitals room. Here, we became acquainted as I fumbled with the blood pressure cuff and asked her to step on the scale. She was patient and understanding throughout. I documented my findings and we proceeded to the examining room. Ms. Holloway did not appear to be in good spirits; she had a stern look. She walked straight to the examining table and sat

WE’RE BEGGING YOU!

down. “What brings you in today, Ms. Holloway?” I asked. “I have a terrible headache that won’t go away! It makes me want to stay in bed all day and has kept me from playing with my children.” There in the exam room, it was just her and me, two strangers. I asked more questions, not following textbook guidelines, but out of genuine concern. I wanted to know more about her pain; everything she could tell me was important. This patient was more than a chief complaint; she was a wife, a mother, and full-time employee. After a few more minutes of conversation, I learned that her husband had been badly injured in a car accident six months prior. She was in the back seat of the vehicle with their three-year-old son. Following the accident, she took care of her husband without thinking that she too might have been injured. She had not had imaging studies or

and after becoming comfortable she began openly discussing details about a traumatizing event. By the end of the visit we were no longer strangers. We were two human beings who have experienced pain, both physical and emotional; two people who also have experienced joy, compassion and empathy. When she left she grabbed hold of my hand and thanked me. As medical students, we should not forget that we have more in common with our patients than we may think. We can relate to them directly, through personal experience, or indirectly. Empathy goes a long way in our line of work. In this month of gratitude, I am blessed for the ability to serve as a listening ear for patients and show them compassion at every opportunity. +

A med student’s notebook a thorough physical exam since the accident. Her headaches had progressively worsened, and this was the first time she had presented at a medical facility. I stepped out of the room and presented the case to the preceptor. The preceptor physician and I returned to the room, where she repeated a focused history and physical exam. The differential diagnosis was then made, and the plan was executed. After my patient experience with Ms. Holloway, I realized that caring enough to want to know more is the primary ingredient in any case. Minutes before we had been strangers,

by Jasmine Rivas, a third year medical student at University of Medicine and Health Sciences, who is currently in a Surgery rotation in Augusta. Feel free to contact her with questions or feedback: jrivas@umhs-sk.net

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re you a New Year’s resolution fan? Or a resolution hater? Both sides in this annual discussion have their valid points. On the negative side, by the time you read this many carefully made resolutions may have already slipped a little. Statistically, by this date (January 9) 25 percent of all resolutions have already gone down in flames; that many usually fail within the first week. By the six-month mark the failure rate is about half. And by this time next year, the wreckage of 88 percent of all those shiny new intentions of last week’s New Year’s Day 2015 will lie strewn across the landscape. On the plus side, that means a fairly decent 12 percent of all resolutions are achieved after a full year. Building on that positive note, making New Year’s resolutions is evidence of one of the finest aspects of human nature — that we continuously evaluate ourselves and constantly strive to improve, to be better husbands or wives, better moms and dads, better employees, better bosses, and just better human beings. The typical resolutions reflect those basic desires: the #1 resolution every year is always some form of better health. Lose weight. Get more exercise. Eat less junk food or fast food. Eat less, period. Quit smoking. Drink less, or quit altogether.

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M A Measurable

Achievable

You really can’t fault anyone for such noble goals. After all, health is the ultimate wealth. It’s the currency that makes every other endeavor in life possible. Speaking of currency, improving finances is, broadly speaking, the second most popular resolution category. Common examples include establishing and/or sticking to a budget; saving more; cutting impulse buys; getting a better job, a raise, or a promotion. The third-most common resolutions might be categorized as self-improvement: read more; temper control/ anger management; reduce or manage stress; watch less TV; get more education: learn a new language, skill, or hobby; improve your marriage and other personal relationships, and so forth. All of these are worthy goals. They are well worth pursuing, even if that means getting past occasional setbacks. Since failure is always an option, it’s good to expect it and be ready to keep making progress. There is nothing magical about January 1. If you haven’t made some kind of self-improvement goal, it’s never too late. If you’ve started and failed already, restarts are always allowed. Whatever you set your sights on, keep the letters shown below in mind, as well as what they stand for. Please see RESOLVED page 2

Relevant

Time-specific

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MEDICINE IN THE FIRST PERSON Everybody has a story. Tell us yours! 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. Tell us if you want it “by you” or if it needs to be anonymous. Thanks!

AND CALL ME IN THE MORNING. Prefer paper? We’re all over town. If you prefer our digital version, we’re all over the world. The Medical Examiner is always available on your favorite device at ISSUU.COM/MEDICALEXAMINER or at the Medical Examiner blog (www.AugustaRx.com/news) on issue dates. Click directly from any Examiner page directly to websites listed in ads and articles. You can easily view back issues, too. +

Read the Examiner — and lots more — online at AugustaRx.com/news

NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

Southern Girl Eats Clean Roasted Beet Salad with Pecans & Goat Cheese

With the arrival of Autumn we are blessed with cooler weather, beautiful changing leaves and a harvest of fabulous root vegetables in abundance. I love turnips, parsnips, carrots — and beets. Red beets are typically seen on tables this time of year, however golden beets have quickly become a favorite of mine. As a child, I remember my mom serving pickled red beets. You know, those sugar-loaded, super-sweet pickled beets that everyone served right out of the jar? I loved them. This was my only experience with beets of any kind until I started on this clean eating journey. I was determined to add as much variety to my diet as possible and beets were one of the many new foods that I experimented with. My favorite way to enjoy beets is to roast them in the oven. They become so tender and sweet and there is no need what-so-ever to add refined sugar, they melt in your mouth all by themselves. Golden beets taste pretty much the same as red beets with only a slightly milder earthy note and minus all the red juice that stains everything it touches. This salad combination is super quick and easy and the flavors truly compliment each other. I hesitate to even call it will come off very easily. sliced very thin a recipe; It is simply a salad Slice the beets and set aside, • 1/4 - 1/2 cup of chopped that I enjoy on a regular basis keeping the golden and red pecans during the fall months. It’s no beets separate. • 1/4 cup of goat cheese more difficult than layering Arrange dark spring greens crumbles a few items on a salad plate. on 4 salad plates. • A drizzle of red wine I drizzle a dab of my favorite Artfully place beets on top vinaigrette. (Go to my blog for red wine vinaigrette to the of the greens. the recipe or use your favorite top for the perfect lunch time Add preferred amount of pre-made all natural red wine salad. This salad would be red onion slices to each plate vinaigrette) delicious as a side for your and sprinkle pecans and goat Thanksgiving dinner this cheese over the beets and Instructions: year. Wash the beets and trim the greens. If you are not a beet lover I Drizzle red wine vinaigrette ends. hope you’ll reconsider and try Wrap each beet in a piece of dressing over top. some roasted beets soon, red Serve immediately as an foil and place into a shallow or golden it does not matter. entrée salad or a side salad. + roasting pan. You will love them, I’m sure of Place the roasting pan it. Enjoy! Alisa Rhinehart writes in a 425 degree oven for the blog www. approximately 40-50 minutes Ingredients: southerngirleatsclean. or until you can pierce the • 1 container of spring greens com She is a working beets with a fork. or any dark greens wife and mother Remove beets from the oven • 3 or 4 roasted beets; use living in Evans, and remove foil from beets a combination of red and Georgia. Visit and allow to cool completely. golden her blog for more recipes and Using a paper towel, wipe the • 1/4 of a small red onion, information on clean eating. skins from beets. The skins

Roasted Beet Salad with Pecans & Goat Cheese

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OUR NEWSSTANDS Medical locations: • Children’s Hospital of Georgia, Harper Street, Main Lobby • 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 • Eisenhower Hospital, Main Lobby, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • Augusta U. Hospital, 1120 15th Street, South & West Entrances • Augusta U. Medical Office Building, Harper Street, Main Entrance • Augusta U. Medical Office Building, Harper Street, Parking Deck entrance • Augusta U. Hospital, Emergency Room, Harper Street, Main Entrance • Augusta U., 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 • GRU Summerville 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 • Parks Pharmacy, Georgia Avenue, North 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... 800+ doctors offices throughout the area for staff and waiting rooms, as well as many nurses stations and waiting rooms of area hospitals.

NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

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

MEDICARE OPEN ENROLLMENT IS ENDING

oon — in about a month — the open enrollment period for Medicare will be closing for the 2016 plan year. If you have Medicare, make your decisions quickly to avoid being without prescription insurance for next year. But how do you make the right choice? We discussed Medicare prescriptions plans versus the all-in-one Advantage plans in a previous article. Whichever choice you made, this article is about how to choose the right prescription coverage. Medicare’s website (www.medicare.gov) has a link in the top left quarter of the home page to Find Health and Drug Plans. Use this link and follow the prompts to enter your medication list. Be sure to enter everything you take on a regular basis and anything that you will fill several times a year. This ensures that the plan you choose will cover your prescriptions with no major surprises. On the next page enter your pharmacy. There is no advantage in finding the best plan if your pharmacy does not accept it. You are then left with trying to find a new pharmacy and having to rebuild those close bonds you had developed with your old pharmacy. As you enter your information, the website will assign you an identification number and password. Make note of these numbers to allow you to recall your information at a later time. You will then select the type of plan and get a list of results based on your prescription profile. Comparing these results can be tricky, but look first at the annual cost, which includes premiums, deductibles, and copays for the year. Make sure you can afford the annual costs or you may be forced to try to change your prescriptions to a less expensive set of drugs. Do this only with your doctor’s advice, since saving money is not worth significant health consequences. Look at the differences between a deductible and a no-deductible plan. Your prescription list will determine which is best for you. Before choosing a plan there are a few other options to check. Check the star rating for the insurance plan and make sure you are comfortable with the service provided by the plan. The

ratings go up to a five-star rating. It is up to you to decide how low a rating you will accept. Also check the monthly drug costs and determine if the premium and monthly drug costs are within your budget. With a deductible plan, the first part of the plan year can cost significantly more due to paying the deductible. If you take brand name drugs you make enter a coverage gap and be paying high prices for brand name medicines. I entered several sample prescription lists just to get a general guide on costs, and had varying results as far as which plans was best. A prescription profile consisting of seven low-cost generic drugs came back with a deductible plan being the cheapest; it cost less than $400 for the year. When one of the generics was replaced with a comparable brand name drug and a second commonly used brand name drug was added to the profile, the no-deductible became the best option. The annual cost increased to over $2,000 even though the monthly premium was decreased due to the higher copays associated with brand name drugs. The under-$20 to over-$30 premiums with the all-generic profile became anywhere from the same under $20 up to $70 per month. For diabetics who are on the same medicines as the previous two examples but are also on 2 types of insulin, the annual cost increased even further to approximately $4,000, and the deductible plan once again became the best option. As this illustrates, the process is not as simple as whether you take brand name or generic medicine, so take the time to enter all of your medications and find your best personal results. Under no circumstances should you allow an insurance company or agent to sell you a plan without doing this comparison for you. If nothing else, run your own comparison and use it to evaluate what your insurance agent is offering you. + Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson. Questions, comments and article ideas can be sent by email to cjdlpdrph@bellsouth.net

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NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

Ask a Dietitian GERD AWARENESS WEEK IS COMING

by Nicole M. Moore, MS, RD, LD Georgia Regents Center for Obesity and Metabolism Every November during the week of Thanksgiving, GERD Awareness Week is observed. Gastroesophageal Reflux Disease (GERD) is when stomach contents come back up the food pipe (esophagus). Symptoms of GERD include heartburn, belching, increased saliva production and trouble swallowing. Treatment for GERD may include medications, lifestyle changes, diet changes and even the option of surgery. If you suffer from GERD, there are some lifestyle habits you can work on to help you deal with your symptoms. To decrease pressure on your abdomen, wear loose clothing. Obesity and smoking can make symptoms worse. If you smoke, strongly consider trying to quit. Weight loss can also help with reflux symptoms. If you get reflux at night, consider raising the head of your bed so you don’t lay flat. Dietary changes can also help with reflux symptoms. First, try eating small meals throughout the day to avoid overeating. Also, avoid laying down right after eating. It is best to try to wait at least three hours before laying down to sleep. A high-fat diet has been shown to increase GERD symptoms, so try limiting fats and oils, high fat dairy, meats, fried foods, nuts and nut butters, pastries and high fat desserts. There are foods that relax the lower esophageal sphincter, allowing stomach acid into the

esophagus. You may want to try to avoid some of these foods and see if you feel better. These foods include peppermint and spearmint. I have had patients notice their reflux symptoms are worse when they chew on mints or gum after eating. Other foods that may aggravate GERD include caffeine, alcohol, chocolate and pepper. Use these foods and drinks sparingly. Some people also report symptoms with other foods. You may consider keeping a food and symptom diary, whether on paper or through an app, and track what foods make your symptoms worse to help you avoid them in the future. By making some lifestyle and diet changes along with medical treatment, you may feel better! +

COVER!… from page 1

What do these droplets look like under a microscope? See the photograph on page 1.

The better way to cover is shown above. Another option is to sneeze into a tissue or paper towel, then throw it away. So this cold and flu season, remember: cover! It’s not just basic good manners. It’s one of the best ways to avoid getting — and giving — the flu. +

HUMERUS

There is ample time to cover, but instead it’s as though the impending sneeze takes over all conscious thought and induces paralysis. The most basic element of common courtesy and etiquette in such a situation — covering your sneeze — doesn’t happen, even if the person is in a public place or in very close quarters with others, such as in an automobile. For any person who happened to be in seasonal denial before this past weekend’s time change, early darkness is a

daily reminder that cold and flu season is definitely here, and along with it Cover Your Cough & Sneeze Season. Why is CYCSS so important? Perhaps you happened to see the Mythbusters episode where they undertook to measure how far zillions of tiny cold- or flu-virus droplets can travel from an uncovered sneeze. The unsettling finding: 17 feet! (See photo below. There is also an amazingly disgusting yet enlightening video online from which the photo above left was taken. If you’re interested, search YouTube for “sneezing in ultra slow motion.” Hopefully no one who watches it will ever let loose an uncovered sneeze again.) If you cover your sneeze with your hands (not recommended, but better than doing nothing), wash them as soon as possible, touching as few surfaces as possible before doing so.

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NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

HOPE Through Adversity by Helen Blocker-Adams

FAREWELL FOR NOW

have had the pleasure and honor of writing for this wonderful publication for more than five years. Being able to pursue my passion - writing - and write about a subject dear to my heart - mental health/mental Blocker-Adams wellness, has been a blessing. I have entered another chapter in my life which is requiring a considerable amount of my time. Not only am I teaching, mentoring and coaching at an Augusta career college, I am also a student. Getting a Master’s degree has been something I have wanted to do for years, but there simply

wasn’t the time. Well, the time is now. Several months ago, I enrolled in a 17-month online program pursuing a Master of Arts degree in English. I am also studying to take a test in November to become Certified as a Microsoft Office Specialist (MOS). I am very excited about these opportunities. This is just a small sampling of what is going on in my world, but I can truly say that life for me is so good and I give God all the glory and praise. Regrettably, I will no longer be able to write columns for the Augusta Medical Examiner. I pray that I have blessed someone over the years. I thank you from the bottom of my heart for reading them. I also want to thank my dear friend, publisher Dan Pearson, for giving me the chance to write for the AME. May God continue to richly bless you and your vision for this publication. + Godspeed to you all, Helen

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Kid’s Stuff

NOTES FROM A PEDIATRIC INTERN by Caroline Colden, M.D.

Babies are often 2-way streets for food. Sometimes food goes into their mouths, sometimes it doesn’t. Sometimes they swallow what they eat, and sometimes it comes back up. Babies spit up all the time, it’s true. But where do you draw the line between normal and too much? It is hard for parents to not get concerned when their baby spits up, especially when it happens with every meal, and especially when it’s a large amount. When a newborn only takes in 2 ounces each feeding and then spits about an ounce of milk with every feed back up, it can be concerning. Why do babies spit up in the first place? Adults can eat and drink without regularly having our stomach contents come back up, so why can’t babies do it, too? As it turns out, there is a muscle at the end of our esophagus called the lower esophageal sphincter (LES). It is basically a band that wraps around the tube (the esophagus) that carries food from our mouths to our stomachs, and it strategically relaxes (to let food pass into the stomach) or squeezes tight (to keep it from coming back up). Babies have very weak muscles, which is why they cannot sit without support or lift their head up for their first few months of life. Their global weakness in muscle tone includes their LES, too, which is why if you lay babies flat as soon as they are done

feeding, the milk is almost guaranteed to come back up. This is also why burping babies between ounces, keeping them upright, and not feeding them too fast helps decrease spit ups significantly. Smaller, more frequent feeds (rather than large feeds all at once) can be helpful, too. Baby tummies are small, so avoiding giving too much milk all at once helps with digestion and prevents over-filling. Of note: vomit or spit up that is GREEN in color is NEVER normal, and should ALWAYS be brought to a doctor’s attention or to an ER immediately. “Normal” nonserious spit up consists only of milk-colored spit up that is not green (bilious) and not bloody in color. Thickening feeds with rice cereal can help because thicker feeds stay in the stomach better and are harder to reflux up into the esophagus. Some formulas (such as Enfamil AR)

are specifically made to help with reflux because they are mixed with rice cereal or other substances that thicken the milk once it hits the stomach. Adding rice cereal helps add calories to a baby’s diet as well, so if the baby is struggling to gain weight because of how much is spit up, thickening the milk can kill many birds with one stone. Sometimes when babies spit up a lot, doctors may label it reflux and prescribe a medication like Zantac. This is the same medicine adults take when they get heartburn, because it decreases the amount of acid production in the stomach. Acid is produced by the stomach to help digest food, but when it refluxes up into the throat it can burn the lining of stomach, causing the painful sensation known as heartburn. Babies can suffer from heartburn, too. While medications like Zantac do Please see SPIT-UP page 13

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NOVEMBER 6, 2015

11 +

AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — Posted by Connie Shi on October 30, 2015 at kevinmd.com

THE UNSETTLING INCONGRUITY OF A MEDICAL STUDENT’S “LUCKY DAY” “She has a pneumothorax. You ever placed one of these before?” The senior resident handed me a chest tube. An intern who had been standing nearby smiled and quipped, “It’s your lucky day.” Three weeks into my surgery rotation — my first rotation of third year — I was taking a night shift in the emergency room when paramedics wheeled Ms. P into the trauma bay, frail and bruised, hardly breathing. Too many individuals are frequently involved in codes for medical students to participate much in the patient’s initial survey, so I was surprised by the resident’s offer. In that moment, I would have been tempted to agree with the intern. I couldn’t deny the excitement I felt at the opportunity to try a procedure I had only read about and observed. Wasn’t this what I’d been working toward for so long — to finally practice clinical medicine as a third year? Yet when I looked over at Ms. P, her tiny frame overwhelmed by innumerable lines and tubes, panic and distress unavoidable in her gaze, I felt a pang of sadness and guilt. If this was a “lucky day” for me, it most certainly was not for her. The circumstances that were now providing me a significant opportunity in the course of my clinical training proved calamitous for her. It was an unsettling incongruity. In third year, the memorable “firsts” of learning clinical medicine — first IVs, first intubations — interface with the most difficult periods in the lives of patients and their families. Of the many challenges intrinsic to the transition from preclinical to clinical years, this was one that I was not particularly prepared to face. I remember feeling elated the first time I successfully intubated a patient. My preceptors cheered me on, and the nurses in the room congratulated me. Only later in the day did the nuances of the event begin to settle in. The patient I intubated had pancreatic cancer, and it struck me that my small success, as joyous as it was for me, could not undo the patient’s grief or worry, nor could it alleviate the suffering and pain yet to come. Prior to entering third year, upperclassmen and advisors offered tips on what’s expected of medical students on the wards, how to navigate the hospital, and how to integrate into clinical teams. But I wish I had known more about how to balance clinical learning in the context of human suffering as it evolves before me. I wish I had known more about what it means when moments of personal triumph in my training as a physician-to-be intersect with moments of unimaginable anguish for my patients. The third year means freedom from lecture halls and textbooks, but it also means navigating professional growth while remaining attuned to the raw emotion and vulnerability patients experience, minute-byminute. I didn’t end up placing Ms. P’s chest tube that night. The resident felt that there wasn’t enough time and decided to do it himself. I know that there will be many more opportunities for me to place my first chest tube. And when the time comes, I will cherish that milestone in my medical training — but only after remembering my patient’s vulnerability and acknowledging the privilege of learning from patients in their darkest moments. +

My opportunity was a calamity for her.

Connie Shi is a medical student.

We have all read countless online, magazine and newspaper articles about Hurricane Katrina and its grim aftermath. Its 10th anniversary was observed just a few weeks ago. It probably took author Sheri Fink most of the intervening years to research and write this hefty volume on one of the hardest-hit storm victims: New Orleans’ Memorial Hospital. After all, this book is all of 576 pages. It covers more ground than every news account you and I have ever read about Katrina combined and then some. It’s thorough. And it was named one of the New York Times’ Best Ten Books of the Year; it won the National Book Critics Circle Award for Nonfiction; the 2014 American Medical Writers Association Medical Book Award; the Los Angeles Times Book Prize; the PEN/John Kenneth Galbraith Award; it was named a Best Book by Time Magazine, the Chicago Tribune, the Christian Science Monitor, the Kansas City Star and the Seattle Times; and it was named an NPR “Great

Reads Book.” Other than that, people didn’t really care for it too much. Just kidding, obviously. We don’t have space for all the awards this book has won. It strikes us here at Medical Examiner world headquarters, living as we do in a major southeastern medical center (relevant digression: Augusta has 373 physicians per capita; by comparison, Atlanta has only 211; the national average is 244; Augusta has 408 hospital beds per capita; Atlanta has a mere 242), that a book like this should be on

the shelf of every hospital administrator and emergency preparedness professional in the CSRA. It’s a very detailed examination of what happens in a large hospital when things go wrong — as sooner or later they always do. The October floods of 1990 in Augusta and the recent floods across South Carolina caused by the remnants of Hurricane Joaquin are clear reminders that disasters can strike here. They already have. Lessons can be learned. This book, however, is about more than just the drama of a submerged hospital. It’s about the lives of individual patients and their families, about the nurses, doctors and volunteers trying to keep things together under unprecedented circumstances, and an entire city in need of care, reeling from one lethal blow after another. It’s a compelling story. + Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital, by Sheri Fink, M.D., Ph.D., 576 pages, published in 2013 by Crown Books

Research News America’s national pastime Investigators report a link between increasing hours of daily television viewing and a higher risk of death from most of the major causes of death in the U.S. Watching television accounts for more than half of the available leisure time for the average American and is the most prevalent leisure time activity, says the study, to be published in the December issue of the American Journal of Preventive Medicine. The study by researchers at the National Cancer Institute included more than 221,000 individuals aged 50-71 years old who did not have a chronic disease at the study onset. The data revealed that compared to those who watch television less than one hour per day, those who reported watching 3-4 hours per day were 15 percent more likely to die from any cause; those who watched 7 or more hours per day were 47 percent more likely to die during the study period.

Risk began to rise most sharply at the 3 to 4 hour per day mark for most causes of death included in the study. Statistically, older adults watch more TV than any other demographic group, say researchers. Given the increasing age of the population and longer life expectancies, researchers suggest replacing prolonged TV viewing with active pursuits “may be a more important target for public health intervention than previously recognized.” More aspirin wonderfulness? Time will tell. The largest clinical trial ever undertaken to investigate whether a daily aspirin regimen stops the recurrence of some of the most common cancers was announced last month by Britain’s NHS and Cancer Research UK. The 12-year study will recruit about 11,000 patients across the UK who at enrollment have recently had or will still be receiving treatment for bowel, breast, esophageal, prostate or stomach cancer.

Participants will take aspirin daily for five years, and data will be compiled to determine if it can stop or delay the return of cancers. Investigators caution that a daily dose of aspirin isn’t for everyone, and such a regimen should only be undertaken by someone with their doctor’s approval. Sleep well The two worst weeks of the year for sleep are the weeks following “Spring forward” and “Fall back,” according to the Augusta Medical Examiner. What’s a body to do? A study released on Oct. 30 by Johns Hopkins Medicine researchers says that not all sleep is created equal. Specifically, if two people get exactly the same amount of sleep in a night, the person who gets them without interruption is better off than the person who gets the same X hours, but who gets them in several increments. Waking several times per night is common for new parents, on-call workers and people with insomnia. +

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NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS

THE MYSTERY WORD

Nurse, what did you I told her she should tell that woman??? get a new child.

by Dan Pearson

Why on earth would Her son is eight you say that? years old, isn’t he?

What does that I’m so sorry. I keep have to do with reverting back to my last anything? job at a mattress store.

The Mystery Word for this issue: RUHUSEM

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

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. ____ Yoga, “the yoga of knowledge” 6. Soft shade of color 13. Unscrews, for example 15. Wardrobe 16. Farmland 18. W. Tennessee airport code 19. Smiley of PBS (to friends) 20. Artists follower 21. Up to, slangily 22. Olympic chant, sometimes 23. Exploit 24. Inhibitor start 26. Belonging to 27. Word before up or down 28. Southern general 29. Positions, technically 31. Each element in a list 33. Deranged 34. Instrument for measuring engine power output 35. Encircling 42. Lily Tulip product 43. Formerly (formerly) 44. They can be green 46. Capital of Ont. 47. Brewer’s tank 48. 3.14 50. Upon 52. Mischievous person 53. First lady of the McKinley administration 54. Dental org. 56. Type of bud 57. Saw start? 58. Richard Wright’s Native ___ 59. Boat race 61. The number of voters 63. Tall coniferous tree 64. Miscellaneous collection (with -ment) 65. Bloodsucking parasitic worm

12 16

25 29

26 30

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QUOTATION PUZZLE

E T T R N F O S E N G N P O T M T M E A E I K L N R A D S Y Y N O R E T B I I D E E A S Y H H O H O T U R

— Cicero

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.

DOWN 2. Augusta’s most noteworthy dentist ever? 3. Large primate 4. Tidy, well-organized 5. Prefix related to blood vessels 6. Suppose 7. Capital of Jordan 8. Therefore 9. Nominal; in name only 10. Wiped clean 11. Canal keeper? 12. Hurt 14. Conceited 15. Six Flags, for one 17. Carbonized fuel 25. Very cold 30. Prefix meaning not 32. In the direction of 33. NE postal abbrev. 35. Wave riders 36. Film voiced by Ed Asner 37. Data printing 38. With 32-D, the end of a toast 39. Provided that

40. Alias of Thomas Anderson 41. Type of marker 42. Garden plant with colorful leaves 45. Quick!!! 46. Outer coat of a seed (Botany) 47. Steve Spurrier trademark 49. Standard of perfection 51. By mouth 55. Malarial fever 60. Where The Wild Things ___ 62. Negative vote

X A M I N E R

3 9 6 5 5

U D O K U

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

Solution p. 14

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

1 2 3 4 O 1 2 3 4

C 2 3

1 ’ 5

N 1 2

’ 4

’ 6

1 2 3 4

3 L 4 5

K 1 2 3 4 6

7 — Welsh proverb

1.SDYHJYMBN 2.OOOOEEEUI 3.AACCSUUTE 4.NRLAKTRS 5.EUNET 6.HTS 7.YE

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

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

NOVEMBER 6, 2015

THE BEST MEDICINE ha... ha...

hy did the pie go to the dentist? Because it needed a filling.

Moe: I’m not a fan of self-diagnosis, but I think I’m addicted to having money in the bank. Joe: What makes you say that? Moe: I really suffer from withdrawals. “I like my slaves like I like my coffee. Free.” — Abraham Lincoln What did Arnold Schwarzenegger say when he was asked to star in a Broadway play about the world’s greatest composers? “I’ll be Bach.” A rough gang of bikers walks into a truckstop. Just for fun they gather around a man sitting in a booth and start to harass him. One biker picks up the man’s iced tea and pours it in his lap. “You got a problem with that, pal?” he asks. The man just sits there. Another biker picks up the ketchup bottle and pours ketchup all over the man’s head. “How about now?” Still, the man just sits there. The bikers laugh and go sit down. The man quietly gets up and goes to the bathroom to clean

up, then he pays his check and leaves. The waitress walks over to the bikers to get their order. One of the bikers says to her, “That guy wasn’t much of a man, was he?” She looks out the window and says, “No, and he’s not much of a truck driver either. Look! He just ran over all those motorcycles.” How many vegetarians does it take to eat a bacon-double-cheeseburger? Just one if nobody’s looking. Moe: What are you so worried about? Joe: The boss said he’s going to fire the employee with the worst posture. Moe: So? Joe: So I have a hunch it might be me. A man walks into a bar and sees two pieces of meat hanging from the ceiling. He asks the bartender what they’re up there for. “Anyone who can jump up and slap the meat earns free drinks for the rest of the night,” the bartender told him. “But if you miss, you have to buy everyone else’s drinks for the next hour. Wanna give it a try?” The man looked up at the ceiling, thought about it for a moment, and then answered, “No, the stakes are too high.” Why don’t pygmies work in butcher shops? (See previous joke.) Moe: My wife thinks I’m too nosy. Joe: When did she say that? Moe: Well, she didn’t exactly say it. Joe: Then how do you know? Moe: She keeps writing it in her diary. +

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

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

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AUGUSTA MEDiCAL EXAMINER

STATE

ZIP

Choose ____ six months for $20; or ____ one year for $36. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

SPIT-UP… from page 10 not prevent reflux from happening, they can decrease the amount of acid in the contents that are refluxing up, thus protecting the throat and esophagus. Parents may notice babies seeming less fussy with feeds or spit ups, and this is likely related to the acid suppression. When babies continue to spit up despite lifestyle changes – ie upright positioning, burping, formula changes – other drugs called pro-motility (or “pro-movement”) agents can be used because they sort of speed up the transition food makes from stomach through the rest of the bowel, thus making it harder to go backwards and reflux up. These drugs are one of the last resorts that doctors will go to because they can cause many side effects, and the risks definitely should be weighed against the benefits. Why would doctors even want to treat spit ups and reflux? Doctors worry about spitting up the most when it affects baby’s weight gain; another area of concern is if it is choked on or inhaled into the lungs (called aspiration), which can cause lung damage or infections. When babies come in for check-ups, the first thing a doctor does is look at the growth curve that plots the weight and height of the baby for its age. If a baby tracks along his or her “growth curve” consistently, then spitting up with feeding is not as concerning because the baby is still getting enough nutrition to sustain growth. However, if baby fails to gain weight, “falls off the curve,” or drops too many percentiles below what was previously being averaged for weight or height, then spitting up can be a major issue. Different formulas will be tried since intolerance could potentially be causing the spit ups, or medical interventions may be needed. Every patient and case is different, so the approach is individualized each time. Most babies will outgrow spit ups by the end of their first year of life (sometimes as early as 6 months) because the muscle in the LES gets stronger and tighter. Transitioning to solid foods helps keep food down better, too. Most of the time, if a baby still continues to grow, gain weight, and develop normally, watchful waiting to see if the spit ups improve is completely acceptable. It is always better to be safe than sorry, though, and if ever there is a concern about a baby’s spit ups being different than normal, please consult the child’s pediatrician or physician. +

16 FOR ‘16… from page 1 combines all three. Distraction.gov says a texting driver is 23 times more likely to get in a crash than a non-texting driver. The CDC say that every day there are 9 deaths and 1,060 injuries in the U.S. caused by distracted driving. The remedy: just drive. + #2 GOAL LINE One of the best, most obvious (and most overlooked) ways to achieve wellness goals is to have them. Goals, that is. Imagine playing a game of basketball without actual goals. There would be constant confusion about whether any ball thrown up in the general vicinity of the imaginary hoop would count as a goal or not. It’s a lot easier with an actual goal in place. The same is true of wellness goals. If you’re thinking about coming up with some fresh ways to start 2016, make a list of possible goals over the next several weeks, and from that list pick just one, or maybe your top two or three. Don’t overwhelm yourself. You can always add more once the first achievements have been met. Goal(s) should meet the SMART test: They should be Specific, Measurable, Achievable, Relevant, and Time-Specific. To illustrate, “lose weight” or “get more exercise” won’t do the trick, but “lose 5 lbs by March 1” or “Walk for 20 minutes every Monday, Wednesday and Friday” will. See you in two weeks with more of the 16 for ‘16. +

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NOVEMBER 6, 2015

AUGUSTA MEDiCAL EXAMINER

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

...cleverly hidden (in the right border) in the p. 16 ad for ACHS INSURANCE Congratulations to VERONICA SAPP, who scores a coveted Scrubs of Evans gift card, 2 movie passes courtesy of Health Center Credit Union, and a $20 Wild Wing Cafe gift certificate. Want to find your name here next issue? The new Mystery Word is on page 12. Start looking!

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

The new scrambled Mystery Word is found on page 12

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

EXAMINER CLASSIFIEDS fabulous upgrades, custom kitchen and baths. Floor to ceiling windows, fenced yard. Partially furnished! 120k OBO. 803-507-6621.

HOMES, APARTMENTS, ROOMMATES, LAND, ETC. HOUSE TO LEASE 2 bdrm, 2 full baths, fenced yard, hardwood throughout, screened porch, room for garden, sunny windows, close to Summerville and downtown campuses $750/mo 706-2317607 HOUSEBOAT FOR SALE Tradewinds Marina, 30 minutes from Augusta. Live at the lake - or have a second home there with NO grass to mow! Recently upgraded. $65,000 Text me at (803) 640-9732 for pics ONE BDRM COTTAGE FOR RENT with off-street parking/carport in Hill area 2 blocks from college. Washer/dryer. We furnish water, you pay electric. $675/$500 dep. No pets. (706) 736-7168; email: ronst79@gmail.com Pictures avail. AUGUSTAGAHOMESEARCH.COM Foreclosures • MLS • Rentals • Builders 706-564-5885 FOR SALE: GORGEOUS, immaculate, never occupied townhome located mins from Medical District. 2 bed, 2 bath, master en suite, walk-in closets, office. 1450 sq ft. hardwood floors throughout,

SERVICES HOUSE CLEANING Your house, apartment, rental move-outs. Thorough, dependable. Weekly, or whatever schedule you prefer. References. 706.267.9947 BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and Growth. Call 706-855-WORD (9673) F. E. GILLIARD, MD FAMILY MEDICINE Acute & Chronic Illnesses Occupational Medicine PROMPT APPOINTMENTS 706-823-5250

MISCELLANEOUS KING-SIZED bed frame with rails, dark wood, some surface scratches but overall very good condition. $90 Call 706-3730193 ANTIQUE maple dinette set with buffet corner cabinet table with pull-out leaves. Four chairs with two captain’s chairs. Excellent condition. $300. Double bed early

WHAT’S YOUR DRUG OF CHOICE?

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1.00

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1.75

2.00

2.25

2.50

2.75

3.00

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3.75

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9.00

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

PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-829-1729 GET RID OF UNWANTED STUFF Place your classified ad in the next issue of the Medical Examiner. Just 25 cents per word! Use the convenient form below.

J N A H O P A C R E R O W M A O I L O C D Y

T E S T A

C O L E U S

S U R F E R S

N E A T

A N G I O

I N A

U R R P E V A I D S O N O U O R T

S E L F I M P O R T A N T

T O U S

A M U S E M E N T P A R K

P R E S U M E

A S T E L M O I R E M T A V A U S E N L E E M A D T E R

D I F I D A E G A U L E

N G E E S O N T O E A R A T T A R I L E C H

QUOTATION PUZZLE SOLUTION: Page 12: “There is no duty more obligatory than the repayment of kindness.” — Cicero

The Sudoku Solution

COFFEE IS GOOD MEDICINE

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

Send this form with payment to:

FISHING CLUB wants more grey-haired members. Meet 2nd Thurs of month at Harbor Inn Restaurant, 12 noon. “Adventure Before Dementia” Info: (706) 736-8753 or (706) 829-1729

QUOTATION

AD COPY (one word per line; phone numbers MUST include the area code): .50

CEMETERY SPACES (2) Sunset Memorial Gardens, Graniteville SC adjacent to lighted military flagstaff, includes granite bench with urn space, installation and inscription. All $4700 ($8600 value). Spaces only: $2700. Call (803) 295-3033

SEE PAGE 12

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

.25

BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net

THE PUZZLE SOLVED

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

WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer.

Thanks for reading the Medical Examiner!

(OURS IS COFFEE)

Augusta Medical Examiner Classifieds

1930s with mattress spring coverlet shams $150. Call (706) 860-2170

VISIT DRUGOFCHOICECOFFEE.COM

9 7 3 2 4 8 6 1 5

2 4 6 9 5 1 8 7 3

5 8 1 3 7 6 4 9 2

6 2 9 7 8 5 1 3 4

4 5 8 1 3 9 7 2 6

3 1 7 4 6 2 9 5 8

1 3 2 8 9 4 5 6 7

8 9 5 6 2 7 3 4 1

7 6 4 5 1 3 2 8 9

WORDS BY NUMBER “Just because you’re not sick doesn’t mean you’re healthy.” — Welsh proverb

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

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month. Your ad should reach us no later than 7 days prior to our publication date.

Thanks for reading!

www.AugustaRx.com

NOVEMBER 6, 2015

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AUGUSTA MEDiCAL EXAMINER

This could be yyou.

SOUTHERN COMFORT SHOES COMFORT IS SOLD BY THE FOOT!

The Medical Examiner can be delivered right to your door!

• Comfort and therapeutic shoes, • Diabetic fittings boots and sandals • Board Certified Pedorthist • Twenty major brands, the largest • Walk-ins welcome selection in the CSRA • M.D., Podiatrist, Chiropractor, • Custom Orthotics and PT referrals welcome 11th Street at Walton Way

Use the handy form on page 13

(on 11th between Johnson Motors and the new Integrity Medical)

(706) 434-0129 MON-THUR: 9-4 • FRI: 9-2 www.southerncomfortshoes.com

PROFESSIONAL DIRECTORY DERMATOLOGY

ALLERGY

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

CHIROPRACTIC

Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com

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

Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

EMPLOYEE BENEFITS

FAMILY MEDICINE F. E. Gilliard, MD Family Medicine 639 13th Street Augusta 30901 706-823-5250 Industrial Medicine • Prompt appts. Urgent MD Augusta: 706-922-6300 Grovetown: 706-434-3500 Thomson: 706-595-7825 Primary Care Rates

CALLING ALL M.D.S!

MEDICAL MASSAGE Medical Massage Stuart Farnell L.M.T. 803-646-1846 jsfarnell@att.net www.FarnellClinic.com

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

Steppingstones to Recovery 2610 Commons Blvd. Augusta 30909 706-733-1935

Group & Benefits Consultants Inc. 3515 Wheeler Rd, Bldg. C Augusta 30909 706-733-3459 Floss ‘em or lose ‘em! www.groupandbenefits.com

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048

Ideal Image 339 Furys Ferry Rd Martinez 30907 1-800-BE-IDEAL • www.idealimage.com Schedule a FREE Consultation

OPHTHALMOLOGY

DRUG REHAB

COUNSELING

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

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) Augusta 30904 706-733-3373 www.GaDerm.com

DEVELOPMENTAL PEDIATRICS

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

DENTISTRY

LASER SERVICES

PHARMACY Medical Center West Pharmacy 465 North Belair Road Evans 30809 706-854-2424 www.medicalcenterwestpharmacy.com Parks Pharmacy 437 Georgia Ave. N. Augusta 29841 803-279-7450 www.parkspharmacy.com

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

...SENIOR LIVING

Cornerstone Compassion Center 420 Warren Road Augusta 30907 706-228-5359 or 706-394-6518 Assisted Living • Personal Care

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

THERAPEUTIC MASSAGE Centered in Georgia Diane Young L.M.T. 4488 Columbia Rd Martinez 30907 706-251-2244

VEIN CARE Vein Specialists of Augusta G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 706-854-8340 www.VeinsAugusta.com

WEIGHT LOSS Medical Weight & Wellness Specialists of Augusta Maycie Elchoufi, MD 108 SRP Drive, Suite B Evans 30809 • 706-829-9906 www.mwwsAugusta.com

SUPPORT YOUR PRACTICE - AND THE MEDICAL EXAMINER A simple listing in the Professional Directory is less than $100 for six months or less than $200 for an entire year, and puts your contact information in front of 30,000 readers a month. CALL 706.860.5455 TODAY AND BE IN THE NEXT ISSUE

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AUGUSTA MEDiCAL EXAMINER

NOVEMBER 6, 2015