Sept18 15 by Daniel Pearson

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ow can someone be overfed and undernourished at the same time? It doesn’t seem possible, does it? Unfortunately, millions of people are proof that it’s not even improbable, let alone impossible. Mention the word malnutrition and we automatically conjure up mental images like the picture below: an impoverished child in Africa or Appalachia with a vacant stare, stick-like limbs and a distended belly, all classic signs of malnutrition. The surprising thing is that someone with a body like the one pictured in the lower right corner can also be suffering from malnutrition. If you’ve ever heard the term “empty calories,” you’re not far from understanding how an overweight person can also suffer from severe malnutrition. Yes, malnutrition doesn’t necessarily mean a lack of food. Like malfunction, malpractice, maladjusted, malcontent and other similar words, mal (as in malnutrition) signifies improper, inadequate or faulty. Many foods today are low-

oven doesn’t get much business any more. She’s so thin her friends say a strong wind could blow her away. Priority #1 isn’t nutrition; it’s not being hungry. The people in both of these examples — young mothers and children and the elderly — are quite likely to be healthcare consumers in the near future. That’s where healthcare providers — hospital dietitians in particular — can make a difference. One study1 found that fully one-third of hospitalized patients are malnourished upon admission. Those patients are at increased risk for readmission. Malnourished patients are twice as likely to develop pressure ulcers (“bed sores”) during their hospital stay.2 They have three times the risk of surgical site infections.3 And of patients who suffer a fall during their hospital stay, nearly half are malnourished.4 Are any of those statistics particularly significant to a hospital’s bottom line?

FED

cost, high-calorie, yet nutrient-poor. They can deliver plenty of sugar, sodium, saturated fats and other things we should not have in abundance. In some cases, the same food grandma enjoyed for its nutritive values isn’t as nutritious these days. Modern agriculture and food processing techniques have caused reductions in vitamins and minerals, including critically important micronutrients. Combine missing good stuff with abundant bad stuff, and you have the perfect recipe for being overfed and undernourished. In fact, scientists believe that processed foods and dietary habits play a huge role in two of the biggest and fastest-growing health problems today: obesity and diabetes. It turns out that some of the missing micronutrients are crucial to the body’s glucose metabolism and insulin

signaling pathways. The risk of type 2 diabetes is four times higher in obese patients, and the current hypothesis is that dietary deficiencies are one of the key contributing factors. One of the greatest enemies of your average nutrient is the process of refining foods, which can strip them of their best assets. “Enriched” is the food label word used to describe trying to put the genie back in the bottle. At its best, anything enriched is a poor and inadequate substitute for the original. Alas, refined foods are convenient; they seem inexpensive. Picture a couple of their most loyal users. One might be a single mom trying to make ends meet with several hungry mouths to feed. She doesn’t have time to cook. Fast food meals are quick and easy, and they’re cheap. Another is the stereotypical senior citizen. She’s on a fixed income. She’s cooking for one these days. Her

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AUGUSTA MEDiCAL EXAMINER

SEPTEMBER 18, 2015

Kid’s Stuff

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

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Low fat diets are all the rage. People assume that because their diet is low in fat, they will consume less fat, and hence be themselves less fat. The worst fats are artificially produced “trans fats,” which are converted almost immediately into stored fat in the body and are close to impossible to ever lose because the human body is not naturally equipped to metabolize trans fats. Avoiding consumption of trans fats is one of the best dietary decisions we can make for ourselves and our children. However, not all fat is bad. There do exist “good” fats (mono- and poly-unsaturated fats) that in moderation are considered healthful, such as those found in nuts, avocados, olive oil, cheese, and eggs. These fats are vital components to many substances that compose the body and contribute to healthy metabolism, including cell membranes and metabolic processes. Children’s growing bodies in particular need these healthy fats. Good fats, especially those in nuts like almonds, are full of fiber as well, which are difficult to break down and hence take longer to digest, thus making your body feel full faster and longer. Some products that are made artificially “low fat,” like cheese and yogurt products, will actually cause you to feel hungrier faster because they are broken down more quickly and don’t keep you as full for long. At this point, I must note that there is definitely such a thing as too much dietary fat, and there is wisdom in abstaining from fat if it’s not necessary. As pediatricians, we recommend children ages 12 months to 2 years of age drink whole milk because it contains good fat that helps kids grow and develop well. We theorize it also contributes to the proper development of the nervous system because it helps the nerve fibers complete growth of the myelin sheath, which is essentially a fatty protective covering that helps the signal transmit faster and longer. After 2 years, though, we advise switching to 2%, 1%, or skim milk to reduce the amount of fat being taken in by the child, or else the child could have difficulties with excess weight gain

• ACNE • SKIN CANCER SURGERY

• MOLE REMOVAL • PSORIASIS

in time. But returning to my earlier point, when “low fat” foods are made lower in fat, they lose some of the taste that keeps us buying those products. To compensate, food producers add more sugar or artificial flavors to the food to help preserve taste and appeal. An example: although frozen yogurt allegedly has less fat in it, it contains just as much sugar as regular ice cream, and all that sugar comes with its own set of negative health potentials. Furthermore, a lot of the reduced fat type products contain artificial flavors and sweeteners that the body has difficulty metabolizing. The body then has difficulty knowing how or if to store what it is being fed, and this can lead to dysregulation of calorie metabolism and weight gain as well. In a way, consuming real ice cream made from just basic cream, milk, sugar, and simple toppings, is better because these ingredients are recognized better by the body. Plus, they can be more satisfying to the body and can keep you full longer. The same goes for butter versus margarine – many arguments have been made for one or the other, but at the end of the day, butter contains more real ingredients. To go even further, olive oil is even healthier than butter, and can be used as a substitute in many (although not all) situations that would call for butter. I’m not advocating excessive consumption of butter or using ice cream as a meal alternative. What I am saying, though, is that if you do feel like serving a special treat to your family, choose treats that have the most natural ingredients in them because it will satisfy your body best and also be better for your body to metabolize. It is all about weighing one’s options (figuratively and literally) for food choices. And the best thing one can do for his or her body — or their child’s — is pay attention to what ingredients are being used to make food. The more natural they are, the more likely they are to be healthier for you and to keep your body feeling satisfied. At every age, we really are what we eat, and the better our fuel, the better our health. +

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Caring for Patients Since 1969

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

What’s your story? All of them are: under the terms of the Affordable Care Act, Medicare and Medicaid no longer pay for hospitalacquired conditions such as pressure ulcers, falls and hospital-acquired infections. Hospitals are also penalized if they have excessive readmissions — patients having to return to the hospital within 30 days of being released. Nutrition is squarely at the center of overfeeding and undernourishment, both sides of the malnutrition issue — a no-brainer there — but that is just the tip of the iceberg. Public health analysts point to diet and nutrition as the core issue in stopping the runaway growth of chronic diseases like diabetes, heart disease, and the multiple issues spawned by obesity, which all by itself is “projected to soon surpass tobacco use as the most important modifiable risk factor in public health and disease,” according to the NIH. That puts dietitians in a more important role than ever before. After all, what makes more sense: treating an existing life-threatening disease, or preventing it in the first place? That doesn’t mean someone has to be admitted to the hospital to get the benefits of a dietitian’s professional expertise. Many of Augusta’s countless dietetic professionals consult with regular folks and help them make wise food choices for themselves and their families. A few of the better reasons to consult a registered dietitian: • you’re caring for an aging parent • you have cardiovascular disease, diabetes, or high blood pressure • you’re pregnant or trying to get pregnant • you’re breastfeeding your baby

• you’re over- or underweight • you have digestive problems If you think having a personal dietitian sounds expensive, compare the cost of good groceries with the cost of a lifetime of heart disease or diabetes. There is no comparison. You go to the doctor when necessary, don’t you? No one would ever call that enjoyable, however necessary it might be. Food, on the other hand, is enjoyable, and it’s the best medicine we can take (until we really need medicine of the pharmaceutical variety, at least). In fact, the cost issue is a commonly raised roadblock to good nutrition. It’s the old gallon of milk versus a gallon of Coke argument. Why is the good stuff always more expensive? Answer: it isn’t. Check out the images above. If they’re too small to read, try the online version of the Examiner at issuu. com/medicalexaminer and use the [-/+] slide button below the left-hand page to enlarge the images. But even

As part of their observance of Malnutrition Awareness Week, GRU dietitians will hold a free food demonstration at The Veggie Truck in Harrisburg on Sept. 29. For more information visit The Veggie Truck on Facebook or growharrisburg.org. +

on this page you can see the comparisons: you can buy one or two less-than-healthy options or quite a few much healthier options, each for about the same amount of money. Please be sure to note that the healthier options are not foods like rice cakes, tofu and Brussels sprouts (not that there’s anything wrong with any of those). They’re just ordinary, real, healthful foods. (Note: for more on “real” food, see “Kid’s Stuff” to your left, page 2. Also please note, the images above found online have no dates attached to them, so the Medical Examiner has no idea if the prices shown are relatively recent or five years old. Either way, the basic point remains: healthy options are available at moderate prices.) How can dollars for good and healthy foods stretch farther at the grocery store? Here are a few ideas: • buy in bulk when items are on sale, freezing fresh foods for later use • ditto for cooking: double or triple a recipe your family likes and freeze the extra for quick meals down the road • buy less-expensive store brands; get savings from store loyalty cards, coupons and in-store specials • canned and frozen foods can be more economical than fresh foods • by far the most expensive foods of any kind are foods you buy and then throw away, so manage leftovers and serve them promptly at upcoming meals • similarly, don’t buy more food than you can reasonably use while it’s still fresh and edible In summary, remember that no matter the price, good food is always a better buy than junk food. Lowcost, high-fat, high-calorie nutrient-poor foods are the underlying cause of many diseases. Fruits, vegetables,

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.)

AUGUSTA

MALNUTRITION… from page 1

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. +

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www.AugustaRx.com 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

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nuts, beans, seeds and whole grains are all good medicine — and they’re tasty, too! They’re generally devoid of illness and disease triggers like chemical additives, saturated fats, cholesterol and added sugars. Food can be likened to a marriage. Our food choices can have a “for better or for worse” element attached to them. How sad it would be to live in the breadbasket of the world, to even be overweight or obese, and yet suffer from malnutrition. But such a predicament,

surprisingly common though it might be, isn’t merely sad, it’s unnecessary. Every one of us has the power to modify and improve our eating and exercise habits. For more information on healthy eating, visit the following: • eatright.org • health.gov • cdc.gov • surgeongeneral. gov • malnutrition.com • nutritioncare.org + 1. Allaudeen N, et al. J Hosp Med. 2011;6:5460. 2. Banks M et al. Nutrition 2010;26:896–901. 3. Fry DE, et al. Arch Surg. 2010;145:148151. 4. Bauer, JD et al. J Hum Nutr Diet. 2007:20:558-564.

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

#6 IN A SERIES

Who is this?

OLD NEWS +

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

DIVORCING? WHO GETS THE DOG?

veryone has heard this man’s name, or at least a shortened form of it. Born in 1883 on an island off the coast of Greece, he received his M.D. from the University of Athens in 1904. During the Balkan War, 1912-1913, he served as a second lieutenant in the medical corps of the Greek army, and afterward he and his wife visited America, landing on Ellis Island on October 19, 1913 speaking no English and having only enough money for their visas. His first job in the US was as a rug salesman. He also played violin at restaurants, and was a clerk for a Greek-language newspaper, while his wife worked as a tailor. He soon found appointment as assistant in the pathology department of New York Hospital, and in the Department of Anatomy at Cornell Medical College of Cornell University. When World War I broke out in 1914, he decided to stay in the USA permanently, and the couple obtained American citizenship in 1927. Four years before, he told an audience of incredulous physicians that examining vaginal cells under a microscope could identify even early-stage uterine cancer could be diagnosed. At another physicians conference in 1928, this doctor, Georgios Nikolaou Papanikolaou, introduced again his low-cost, easily performed screening test for the early detection of cancerous and precancerous cells. The presentation was again met with skepticism, a situation which continued until the publication in 1943 of Papanikolaou’s book Diagnosis of Uterine Cancer by the Vaginal Smear, written with gynecologist Herbert Frederick Traut. Even so, it was not until the early 1950s that the Papanikolaou Test, shortened to the more convenient Pap test or Pap smear became routine, resulting in historic drops in the incidence of cervical cancer among American women. Papanikolaou also laid the foundation for the modern medical specialty of cytopathology with the publication of another noted research book in 1954, Atlas of Exfoliative Cytology. Papanikolaou moved to Miami, Florida, in late 1961 to head up the new Papanikolaou Cancer Research Institute at the University of Miami, but died just months later of a heart attack on February 19, 1962 prior to the Institute’s opening. He was 78. +

hen children are involved, the answer is easy: the pets usually go where the kids go. Today, more and more couples are opting to remain childless, instead adopting a pet early in the marriage. When divorce occurs, the battle lines are quickly drawn over Fido. There was a time when it was unheard of to consider pets in a divorce settlement. In the last five years, however, divorce attorneys say they have seen a 50% increase in custody fights over the pets, according to a survey done by the American Academy of Matrimonial Lawyers. As a matter of course, one of the the first questions a divorce attorney will ask is if there are children. Today that query is followed up by asking if there are fur-babies as well. While dogs make up 88% of the custody battles and cats 5%, they aren’t the only pets people are willing to go to war over. Attorneys are filing suit for custody of iguanas, pythons, African

grey parrots and even turtles. It may seem petty, financially wasteful and silly to some, but consider how quickly a person can become attached to an animal. It can happen in a matter of hours. Some wouldn’t dream of letting go without a fight any more than they would with a child. Custody is the most difficult issue to deal with in any divorce and is no less emotionally draining when it is over the family pet. The subject of money becomes front and center in any custody discussion. Pets

are not excluded from this line item. They are living, breathing beings and must be fed and will require medical care just as a child would. There may even be costs for obedience classes, daycare or a hired dog walker. Lawyers call it “Doggie Support.” The cost of care for an animal can be expensive and will rise with the size and breed of the dog. If the dog (or cat) is show quality and it competes, the cost associated with that, including the travel required, can be daunting. If it’s an exotic pet we’re talking about, a special diet may be required or controlled temperature housing. General maintenance and medical bills for such a pet can be huge. Unfair as it may seem, the disproportionate share of the financial support will fall to the spouse who is the larger wage earner. What about visitation for the non-custodial petparent? A visitation schedule or joint custody must be worked out. In instances where one person moves away, hammering out a travel schedule for regular visits, holidays and who is paying what portion of those travel costs are true road blocks to be dealt with. It may all seem ridiculous, but it’s a money making twist to an old legal wrangle. And just as with any divorce, it’s the lawyers who are the only ones to walk away happy. +

MYTH OF THE MONTH Caffeine is not for kids! It will stunt their growth. If this was actually true, it might be a good thing. Alas, it’s another myth. You might even say the opposite is true: for kids, caffeine accelerates their growth, but not in a good way. When adults think of caffeine, coffee might come to mind first. For kids, however, it’s a completely different delivery system, and it is not one they associate with caffeine: sodas and energy drinks. Red Bull, Mountain Dew, Mellow Yellow, Pepsi, Mr. Pibb, Coke and dozens of other popular drinks deliver lots of caffeine. Some energy drinks pack as much caffeine into one servings as four or five cups of coffee. But no one ever has ever claimed caffeine is

fattening. That’s because it isn’t. No, what is making kids grow — sometimes outward at least as much as upward, it seems — is the sugar packed into these popular drinks. Cherry Coke, for example, has nearly nine teaspoons of sugar per serving. One can of Red Bull has more than a third of an entire day’s recommended limit on sugar. Not a healful option for anyone. For the record, kids can process caffeine as well as an adult. + — by F. E. Gilliard, MD, Family Medicine 639 13th St Augusta, GA 30901 706-823-5250

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

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

harlie showed up in my office one day with a prematurely graying but strikingly beautiful schoolteacher in a professional blue pants suit. She had a body that would make Wonder Woman jealous and make a foot-washing Baptist preacher want to run away from home. Mother Nature had certainly worked overtime on her. Jennifer was demure, well mannered, and thoroughly ladylike. Her eyes were downcast. You couldn’t tell it at that moment, but Jennifer had a mild case of the pregnancy. I could see why Charlie would want her. But for the life of me, I couldn’t see why she would want Charlie. Or me, for that matter, even on my best day. Charlie was a man. But during moments of high stress, his rough edges crept through his education and upbringing. He was a well-respected pharmacist of good standing. “I guess we’ll have to name the baby Asphalt. Her ass. My fault,” said Charlie Jennifer’s ears ignored k

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the crusty remark. Her eyes searched the floor as if looking for a lost diamond. A quick physical and UCG confirmed the forgone conclusion: Eight weeks pregnant. Good health. Adequate pelvis. Lumpfree breasts of outstanding quality. She was a near-perfect mother-to-be. I cut right to the chase. “Abortion? Adoption? Marriage?” This was back before the days of freelance sperm donor “baby daddies” and “baby mamas” who suffered from perpetual loose morals and who routinely popped out kids as a way to keep from working and to get food stamps, Section 8 housing, and to get government checks for being sorry excuses for parents and human beings. (Hey, some may say I am opinionated. But I say if it’s true, it’s not an opinion, it’s fact. And in our present world of social spins to protect degenerates, malcontents and the guilty, we need facts. Lots of facts. And reality.) Charlie and Jennifer were both professionals and FREE T AKE-H OME C OPY!

MEDICAL EXAMINER

t s e B responsible citizens. In unison, they said, “No abortion. No adoption.” I laid out a weight control plan, proper nutrition for pregnancy, instructions for her to walk two miles each day, and set up an appointment schedule. My nurse took a Polaroid of Jennifer and instructed her: You will gain 17 pounds of baby, placenta, and fluids. Anything over that is mostly fat, so hold your weight gain to 20 or 25 pounds. For your six-week postpartum visit, wear this same outfit. We will take a second Polaroid. If you do it right, you will weigh the same then as now and your pictures will be identical. That will earn you a place on our Wall of Fame. The Wall of Fame was neatly covered with near identical pairs of pre- and post-baby Polaroids. Mothers were

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proud of them. I was proud of them. Husbands were really proud of them. They got married and in seven months Baby Girl arrived, healthy and screaming. Jennifer’s six-week postpartum Polaroid differed from the first one only in the hand-written date at the bottom. Decades have passed. Charlie’s hairline has receded. Jennifer’s near perfect 9.5 figure is now a 7 and her hair has a bit more grey. She does not resort to hair dye, and never has. It is matter of principal with her. What is is what is, she says. While it is certainly true that in their youth Charlie and Jennifer succumbed to premarital hormonal rages, they did act responsibly. They did not resort to abortion. Nor did they sign up for every government program imaginable, forcing you and I and other employed citizens to pay the bills from their social misadventures.

To this day when I see them in private, they sometimes mention that night in the middle of a cornfield where the wind was so still you could actually hear the corn grow, where they spread their blanket under a near full moon and indulged in a few moments of exquisite pleasure that began the adventures of a lifetime. Baby Girl is now a UGA graduate with a degree in pharmacy and the mother of one. She neither smokes, drinks, nor votes for Democrat liberals. Baby Girl works every day, pays taxes, and goes to church on Sunday. Baby Girl is thankful for the stillness of the cornfield and the pleasures of the moonlit blanket. And she is thankful her parents had character, determination, a sense of responsibility, and true grit. + 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.

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U.S. Surgeon General issues call to action: walk! One out of every two U.S. adults is living with a chronic disease, such as heart disease, cancer, or diabetes. These diseases contribute to disability, premature death, and health care costs. Increasing people’s physical activity levels will significantly reduce their risk of chronic diseases and related risk factors. Because physical activity has numerous other health benefits—such as supporting positive mental health and healthy aging—it is one of the most important actions people can take to improve their overall health. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities recognizes the importance of physical activity for people of all ages and abilities. It calls on Americans to be more physically active through walking and calls on the nation to better support walking and walkability. The purpose of the Call to Action is to increase walking across the United States by calling for improved access to safe and

convenient places to walk and wheelchair roll and by creating a culture that supports these activities for people of all ages and abilities. The Call to Action includes five strategic goals to promote walking and walkable communities in the United States: make walking a national priority; design communities that make it safe and easy to walk for people of all ages and abilities; promote programs and policies to support walking where people live, learn, work, and play; provide information to encourage walking and improve walkability; and fill surveillance, research, and evaluation gaps related to walking and walkability. Action by multiple sectors of society, as well as by families and individuals, will be needed to achieve these goals. Why Focus on Walking as a Public Health Strategy? Strong evidence exists that

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physical activity has substantial health benefits. People can get these benefits through brisk walking or by adding brisk walking to other physical activities. Walking is an excellent way for most Americans to increase their physical activity. It is also a powerful public health strategy for several reasons. Walking does not require special skills, facilities, or expensive equipment and is an easy physical activity to begin and maintain as part of a physically active lifestyle.Most people are able to walk, and many people with disabilities are able to walk or move with assistive devices, such as wheelchairs or walkers. Walking has a lower risk of injury

decline in older adults. In children and adolescents, some evidence suggests that physical activity can lower levels of anxiety and depression. When schools encourage participation in physical activity as part of physical education, recess, classroom lessons, or extracurricular activities, students can also improve their academic performance. Despite the health benefits, only one-half of U.S. adults reported levels of physical activity consistent with the guideline for aerobic physical activity in 2013.34 Adults who were male, younger, white, or Asian or who had higher levels of education were more likely to have met the aerobic physical activity guideline. Only 27% of high school students reported levels of physical activity that met the guideline for 60 minutes of physical activity a day in 2013. Male high school students and students in lower grade levels were more likely to meet the guideline. +

than vigorous-intensity activities.5,37 Walking also may be a good way to help people who are inactive become physically active because walking can be easily adapted to fit one’s time, needs, and abilities. Walking is a common form of physical activity. In 2010, more than 60% of adults reported walking 10 minutes or more in the past week for transportation or leisure. Benefits of Physical Activity Regular physical activity helps prevent risk factors for disease (such as high blood pressure and weight gain) and protects against multiple chronic diseases (such as heart disease, stroke, some cancers, type 2 diabetes, and depression). Among adults, physical activity is associated with improved quality of life, emotional well-being, and positive mental health. Regular physical activity is also important for healthy aging and may delay the onset of cognitive

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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.

-HOM E CO P Y! TM

• MED

JANUARY 9, 2015

ICINE

• WEL

LNESS

Who is this? See page 3.

S Specific

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

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

Southern Girl Eats Clean

Stuffed Jalapeño Peppers with Garden Fresh Veggies

Recently, we had an office party at our house. Everyone was to bring a side dish and I provided the main course. We had a variety of dishes, some healthy and some not so healthy, but all were tasty and typical of what you would normally see at a bar-b-cue. One particular food item was the hit of the party, especially for the men: Stuffed Jalapeño Peppers, stuffed with cream cheese, sausage and parmesan cheese and then baked in the oven until they were ooey-gooey and amazing. These peppers were so delicious for sure even though they were not so healthy or clean. I went to bed that night and actually laid awake thinking of how I could make this appetizer more nutritional, clean and healthy, but still taste wonderful and creamy. Yes, I am a foodie geek. I knew that I had to add some veggies in place of the meat and a different type cheese. I decided that organic goat cheese was an appropriate substitute for Philadelphia brand cream cheese. I sprinkled just a dusting of gluten free bread crumbs on top and then baked • 1-2 small cloves of garlic mixture. the peppers until they were • 1-1/2 Tbsp. of fi nely Sprinkle a small amount of slightly browned. In case you chopped fresh cilantro bread crumbs on top of each are worried that this recipe • 1/4 cup of gluten free pepper. might be too spicy, the heat of bread crumbs (I used Rudi’s Place baking dish into the peppers go down quite a multigrain bread and placed the oven to bake for 15-20 bit once they are cooked. in a high speed blender) minutes until the bread My friends, this healthier • Sea Salt or Real Salt brand crumbs are slightly browned. version of stuffed jalapeno and cracked black pepper to (Watch closely so that they do peppers came out just as taste not become too brown before yummy and fabulous as the peppers are done. You the sausage/cream cheese may want to tent dish loosely Directions: ones. Perfectly flavorful but with foil if they are becoming Preheat the oven to 425 healthy and clean. too brown.) degrees. This recipe would be great Once done, remove from Slice the jalapeño peppers for your tail-gating parties oven and allow to cool for 5 lengthwise and remove this fall! Enjoy! minutes. seeds and stems. Place into a Transfer peppers to a tray Ingredients: shallow baking dish. and serve immediately. + • 4-5 jalapeño peppers, Place softened goat cheese seeded, stem removed and cut into a mixing bowl along Alisa Rhinehart writes in half lengthwise with carrots, red bell pepper, the blog www. • 4-5 oz. of organic goat purple onion, garlic and southerngirleatsclean. cheese, softened cilantro. Add a pinch of salt com She is a working • 1 Tbsp. of finely grated and pepper to taste. Using a wife and mother carrot large spoon, stir to mix all the living in Evans, • 2 Tbsp. of finely chopped ingredients well. Georgia. Visit red bell pepper Using a small teaspoon, fill her blog for more recipes and • 2 Tbsp. of finely chopped the jalapeno peppers with information on clean eating. purple onion the goat cheese and vegetable

Stuffed Jalapeño Peppers

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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 • Eisenhower Hospital, Main Lobby, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • GRU Hospital, 1120 15th Street, South & West Entrances • GRU Medical Office Building, Harper Street, Main Entrance • GRU Medical Office Building, Harper Street, Parking Deck entrance • GRU Hospital, Emergency Room, Harper Street, Main Entrance • GRU Children’s Medical Center, Harper Street, Main Lobby • GRU, 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.

SEPTEMBER 18, 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.

ARE MY DRUGS SAFE? ARE THEY WORTH THE PRICE?

e are fortunate in this country to have a very safe prescription drug supply compared to other places around the world. That comes with a price, however, as any prescription purchaser has seen at the pharmacy register. So let’s look at the safety of prescription drugs available in the U.S. and what the current advances are in safety. Then we can look at why prescriptions cost so much here. Late in the 20th century the Food and Drug Administration (FDA) closed the U.S. drug supply after numerous complaints of counterfeit drugs being shipped into the U.S. Since then, the FDA must approve manufacturers, and will periodically inspect their manufacturing facilities to ensure compliance with government regulations. This is not to say that plants will not get fined and/or closed down from time to time. This is done to prevent problems and is a normal part of the FDA’s processes. Inspections normally turn up nothing more serious than a lack of record keeping, not serious infractions like a deficiency in an active ingredient. But even small paperwork or record-keeping violations, if not corrected, will shut down a company’s production facilities. But what has appeared since the Eighties that we all use and hear about every day? That’s right, the Internet. There are tens of thousands of websites selling drugs from beyond our borders, and these sites are for the most part beyond governmental control. Many of these websites display foreign country’s flags and are listed as approved by their local government (Canada, for instance). While Canadian pharmacies tend to have fairly safe drugs, online pharmacy sites are very unsafe in many situations. So be very careful about buying prescription drugs from online sources. Good things to look for when dealing with online pharmacy sites include a pharmacist available to answer questions, a license

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from their local board of pharmacy or other governing body, and the requirement of a prescription before shipping drugs. Avoid websites that are based outside the United States and those that do not have a physical address. The trend right now is for the active ingredients for prescription drugs to be manufactured outside the United States and then purchased to be included into American drugs. Two big countries in the drug manufacturing world are China and India. Both countries have serious quality control issues, so the need for oversight by US companies is growing. The latest Internet drug scare is fake Viagra that has turned out to be just a combination of assorted ingredients with one very important ingredient missing. Unfortunately, the missing ingredient is the active one. Media have recently reported on $400 billion counterfeit drug trade in the world and interviewed people who run these facilities. They were quoted as saying they supply the world but would not take the drugs themselves. They make whatever is in demand, but the ingredient makeup of all of their drugs are the same, they claim, with just the color and shape being different. The United States has recently passed a new security regulation known as the Track and Trace Law requiring each shipment of legally made drugs to be tracked from the manufacturer to the pharmacy. It will also require any drugs that look to be mislabeled or counterfeit to be reported immediately. Reputable pharmacies have always been on the lookout for bottles that didn’t look just right. Medication shipments now can be followed through all the intermediate steps of getting the prescription drug from manufacturer to consumer. The big question in this country is whether the increased safety of your prescriptions is worth the increased cost. That is up to you. In the next issue we will try to look at some of the market forces behind the prices of prescription drugs in our country. So until next time be careful and try to avoid medicines that will do more harm than good. + 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

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

Ask a Dietitian VARIETY: THE SPICE OF LIFE — AND NUTRITION! by Bekah Fortney, RDN Clinical Dietitian, Spinal Cord Injury Unit Charlie Norwood VA Medical Center Have you ever heard the saying: “Variety is the spice of life?” This may or may not be true about life, but it is definitely true about food and nutrition! Variety is one of the cornerstones of a healthy diet, along with moderation and balance. Consuming a variety of healthy foods helps ensure your body gets all the nutrients it needs while also making eating more interesting. Eating healthy doesn’t have to be a bore! Here are some simple ideas to add variety and nutritious taste to your diet: • Use the MyPlate icon to plan your meals. This is a simple tool developed by the USDA to aid in healthy eating and meal planning. This tool demonstrates appropriate food groups and portion sizes while giving you the freedom to choose a variety of different foods within each food group. Here are the basics: • Make half your plate fruits and vegetables. Enjoy experimenting with new fruits and vegetables you haven’t tried before! • Fill up a quarter of your

plate with grains, pasta, bread, or starchy vegetables like potatoes, corn or peas. Aim to choose a variety of whole grains, including whole grain bread, pasta, and brown rice. To add more variety, experiment with a new whole grain such as quinoa, bulgur, barley, millet, buckwheat, or wild rice. • Make a quarter of your plate lean protein. This could be lean beef, pork, chicken, or fish or a plant-based protein such as legumes, nuts, eggs, or soy products. Aim to vary your proteins! • Include low fat dairy and calcium choices several times a day. The number of servings of dairy needed will depend on your age and gender.

• Try 1 new fruit or vegetable each week. Possibilities are nearly endless,

as more and more exotic fruits and vegetables are becoming available in grocery stores. This is an excellent way to increase the amount of fruits and vegetables you eat and add some variety and nutritious taste to your diet! An added bonus is that fruits and vegetables are great sources of fiber, which helps you feel full and satisfied and promotes healthy digestion. Keep in mind that this is only the case if you eat the whole fruit or vegetable (with the skin/peel if possible). Juicing is actually less nutritious because it removes the fiber. Fruits and vegetables are also packed with vitamins, minerals, and phytochemicals (healthy compounds found only in foods) while being low in calories! Eating different colors of fruits and vegetables (dark green, red/orange, blue/purple, yellow, green, white) adds even more variety and aesthetic appeal to your meals while also providing more nutrient variety. • Experiment with new recipes if you feel stuck in a rut with your cooking. Look for new recipes online or in cookbooks (many are available at your local library). If you plan ahead, you can make a grocery list and buy all the ingredients ahead of time for the new recipe. This not only saves time but also typically saves money. Have fun and be creative with your new recipes! Consider trying ethnic recipes for even more variety. • Look for local and ethnic restaurants. These types of restaurants often offer choices that are full of fresh, flavorful ingredients.

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Whichever method you choose to vary your diet, remember that healthy eating should be an enjoyable experience and should fit into your lifestyle. Whether you consider yourself a healthy eater or not, it’s never too late to take small steps to improve your health and nutrition!

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Some local restaurants offer seasonal produce, which is often much tastier than the produce available in grocery stores. Many ethnic cuisines are packed with fruits, vegetables, whole grains, legumes, and lean meats, which are all important components of a healthy diet. Using herbs and spices for flavoring instead of fats, gravies, or sauces adds a huge amount of taste while avoiding the extra fat and calories often found in other seasonings. • Check out your local farmer’s market for fresh, seasonal produce. Fresh, local produce is much tastier, and the shorter time from harvesting to consuming typically means that more nutrients are retained. Buying in season is also a natural method to vary your food choices and incorporate more variety into your diet! Buying locally has the added benefits of supporting our

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SEPTEMBER 18, 2015 NEW FEAT U RE

AUGUSTA MEDiCAL EXAMINER

WHAT ABOUT BATH TIME?

eople take a bath at least every Saturday night, at least that’s the old-time custom. For dogs, it’s a little different (and we’re going where no man dares to go: bathing a cat). Often bath time for Fido comes when the smell get’s too much to bear. Odors that defy classification have an obvious solution; bathe the dog. Soap choice is where the confusion starts. In some situations it seems nothing but the harshest solvents will be adequate to clean your pet. It may also seem reasonable to use dish soap or a product designed for human hygiene, such as shampoo. That’s where people make their first mistake, say veterinarians. A mild hypoallergenic soap that’s formulated for veterinary use is all you need. In fact, look for those very words: “Formulated for veterinary use.” that signifies a product that’s designed to work with a dog’s body. Dish soap or your favorite shampoo might strip away the dirt, and more importantly the odor, from your pet’s coat, it will also strip natural oils from their fur and may irritate their skin.

All grooming products (human and animal) are designed to maximize cleaning and minimize irritation. Human products work best on human skin and veterinary products are designed to work best on dog skin. The chemistry of a dog’s skin and fur are different than the chemistry of a human’s skin and hair. Experts say it’s safe to bathe your dog with veterinary shampoo once a week. However, if the veterinary shampoo you’re using contains any medication or insecticide, follow the instructions provided by your veterinarian. Prescription shampoos treat specific problems and may necessitate bathing more or less oten than once weekly. Ask your vet. A helpful hint: comb their coat prior to bathing. Wet fur mats more than dry fur so a wet tangled coat is harder to brush out and will take longer to dry. This small detail can save you time and prevent an uncomfortable brushing for your pet. Make sure your dog is dry before you allow it back outside. +

THE DOCTOR IS IN Little Pills, Big Bucks by Darren Mack, M.D. The global pharmaceutical market will explode by $100 billion in the next three years to a whopping $400 billion-a-year industry. Not that long ago when I was in medical school, it was accepted doctrine that it took a mere $1 billion to bring a drug to the market. Recent research has shown that number to have increased to a soaring $2.6 billion investment on behalf of the pharmaceutical company. That’s per drug, with no guarantee of the drug’s market success As the costs of pharmaceutical development skyrocket, the retail price to the consumer has as well, sending many healthcare consumers to change their insurance entirely simply to be able to obtain life-sustaining medication. Employers are often torn between selecting insurance plans that offer either lower premiums, better access to specialists, or broader medication coverage,

but rarely all three. At the bottom of the pharmacologic food chain, the end consumer is left to shoulder that cost along with their insurance coverage, and the price is only going up. Technology has empowered drug companies to harness the mechanisms of genetic, infectious, and oncologic diseases to provide us with a booming designer drug market. In a matter of years, chemotherapies, antibiotics, and other medical treatments will be designed for the patient just as much as the disease. Antibiotics will likely be tailored to decreasing bacterial resistance based on protein expression, and cancer treatments will likely rely more on the body’s own immune system as much as their ability to kill cancer cells. It’s an exciting future, but it might be a very expensive one. I can’t leave the subject of drugs without a few words to the conspiracy theorists who cling to “the money is in the treatment, not in the cure” theory.

There are, in fact, great efforts in both academic and private sectors to cure the diseases that plague humanity. The challenge is that so many of them are controlled by such complex cellular processes we can only unlock pathophysiology one small step at a time. And it seems that the more we learn at a genetic and molecular level, the more complicated certain pathologic diseases become. As we move towards curing and more effectively treating human disease, the rising cost of development will surely reach a tipping point so that limited access to the costly medicines of the future becomes a thing of the past. + Dr. Darren Mack is a graduate of the Medical College of Georgia at Georgia Regents University and is a urologist at Augusta Urology Associates. He is accepting new patients at his Augusta and Evans offices and can be reached at (706) 722-0705

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11 +

AUGUSTA MEDiCAL EXAMINER

From the Bookshelf The blog spot — Posted by Grumpy,M.D., on May 11, 2015 at drgrumpyinthehouse. blogspot.com. Edited for space.

WHAT’S BAD ABOUT “PATIENT SATISFACTION” Veruca Salt is the poster child for spoiled kids. With her demands, manipulative behavior, and spineless father, she’s one of the most hated children of all time. Certainly, any parent (except her daddy) was thrilled to see her dumped down a garbage chute. That’s what you get when you give children everything they ask for. Trying to raise them to be responsible adults involves saying “no.” A lot. ÂBut in today’s world of health care, spoiling patients is apparently the goal. Even when it’s against their own best interests (such as keeping them alive). In case you haven’t been near a hospital recently, “Patient Satisfaction Scores” are now the big thing. This isn’t just publicrelations crap. Under the Medicare guidelines, 30% of a hospital’s reimbursement is based on them. As opposed to, say, surviving brain surgery with a good outcome because of excellent care. 30% of Medicare money is a pretty decent chunk of change for any hospital. So they go along with it. Because, ya know, if you hit the ER with crushing chest pain it’s more important that someone immediately offers you a light snack than slaps an EKG on you and calls a cardiologist. Of course, patient surveys don’t ask questions about “are you happy that you had a complete recovery after your cardiac arrest/ massive stroke/traumatic high speed rollover accident?” They ask if you were pleased with the food service. Or if the nurse smiled enough. Or if the call light was answered quickly. Perspective is important. If you’ve suddenly lost vision in one eye, or can’t move your leg, I’d hope they answer the call light quickly. If you’re ringing it because you can’t reach your iPhone, or your roommate is snoring too loudly, then a prompt response isn’t as critical. But try telling that to the whiny person who’s upset that no one answered her 5th call light in the past hour (this time to ask when Survivor comes on) because the staff has been running a Code Blue across the hall. Minor things like someone elses health, or even their own, are beneath them. The question about call lights is, really, on the survey. According to a recent article in the Atlantic, patient comments about “quality of care” have included: “My roommate was dying... his breathing was very noisy.” “The hospital doesn’t have Splenda.” “I didn’t get enough pastrami” (from a guy recovering after coronary artery bypass). The guy recovering from diabetic coma may be pissed we won’t give him cake and ice-cream, but that’s not in his own best interests. So we have to say “no.” He can hit Baskin-Robbins after leaving, but we can’t control that. Sadly, with patient satisfaction surveys, care takes a back seat. The guy who made it through a messy brain surgery may not be in a condition to fill it out, even though he had excellent care. But the junkie who didn’t get Dilaudid as often as he wants? You can be sure he’ll be ripping the hospital and nurses a new one. Patient satisfaction isn’t necessarily the same as good patient care. In fact, it may be the opposite. One study found that the patients who were the most satisfied also had higher rates of medication use, hospital admissions and death. Hospital CEOs, however, don’t see it this way. They care about getting that 30% out of Medicare’s coffers. So a nurse who provides excellent care and catches early stages of an MI is going to be worthless compared to one who mixes up the wrong medications but has a nice smile and gives the diabetic extra ice cream. THAT’S the nurse who’ll get the hospital a good survey score. +

Patient satisfaction isn’t the same as good patient care.

A compendium of excerpts from reviews of this book:

“[Au] has a quick eye for comedy and a wry wit that must at times have helped her get through the daunting responsibilities that come with the white coat. The emotional complexity of her work gets full weight in these stories . . . An engaging writer who knows how to entertain, she is also a young mom on a learning curve, a wife who has negotiated a complicated partnership with a professional peer, and a caregiver who has learned how much of compassion depends on sustained awareness that every patient has a story in which she is offered a small supporting role.” - The International Examiner “A refreshingly witty memoir . . . she tells her story with real wit and wisdom.” - Points North magazine “She is brilliantly funny, has enormous emotional wisdom beyond her years, and displays honesty and

humility that brings the reader to the center of her journey, rather than preaching from a false ivory tower of medicine . . . should be required reading for all women interested in medicine and/or starting a family.” - Mothers in Medicine “Honest, irreverent . . . hilarious and heart-breaking . . . this memoir is not just about how [Dr. Au] navigated the medical world. It’s about the life she wanted beyond the four walls of the hospital.” - StudentDoc.com

“In this treasure of a medical memoir, Au makes doctors seem fallible and funny. She opens her book with her attempt, as a third-year medical student, to retrieve a stool sample from a 300+-pound 85-year-old. After some epiphanies (“I hate working in the pediatric emergency room”), she switches from pediatrics to anesthesiology. Meanwhile, her boyfriend (now husband), Joe, picks ophthalmology, seemingly a good-hours specialty, but one that actually requires being on call every night for two years. After a colleague says he is sure she’ll find a “mommy job,” she does land a manageable-hour position. Au seems to strike a good balance between being a good mom, wife, and doctor, and stays humble in the process. Get ready for a new appreciation for the training and life of doctors.” — Karen Springen, Booklist This Won’t Hurt a Bit (and other white lies), by Michelle Au, M.D., 336 pages, published in May 2011 by Grand Central Publishing +

Research News The big news of the week The #1 health headline since our last issue is no doubt the announced results of a National Institutes of Health study about manging high blood pressure. The study found that keeping systolic blood pressure (the first and higher number) at or below 120 has significant benefits. 9,300 people over age 50 who had high blood pressure were involved in the study. Half of the group received medication that lowered their systolic BP to 140; the other half got medicine that lowered their top number to 120. Would the difference matter? Yes, and in a big way. Preliminary results during the term of the study showed a third fewer cardiac events — heart attacks, strokes and heart failure — and a 25 percent lower death rate for those with lower blood pressure. Although the difference seems big and the NIH even suspended the study earlier than it had planned to get the news out, they nevertheless cautioned doctors that the results are preliminary

and still require peer review, something that should take place within the next few months. Until then, doctors are cautioned not to alter their patients’ treatments yet. Among the possible snags as the research continues to be evaluated is the potential for side effects when patients who may already be on multiple medications take yet another one to lower their blood pressure below 120. Still, the news is significant and encouraging. The future is here In what our dearly departed grandparents would surely say is a page ripped out of science fiction fantasy, doctors in Spain used a 3D printer to print a new ribcage for a patient. The patient has a form of cancer that formed tumors in his chest. As a result, doctors needed to cut out a section of his ribcage and his sternum. Using CT scans, the doctors knew precisely where to cut the man’s ribcage and also exactly what the dimensions of the replacement parts needed to be.

The 3D printer used a highpowered electron beam to melt powdered titanium into the desired shape, which looks a more like an auto part than what it’s replacing. The joke isn’t a joke We all know the joke. Maybe we’ve even seen it happen: a full-sized person orders enough food at a restaurant to feed a small African village, then washes it down with a diet cola. It’s no joke: University of Illinois researchers followed 22,000 adults and discovered that diet beverage consumers tend to compensate for the absence of calories in their drinks by consuming extra food loaded with sugar, sodium, fat and cholesterol. Researchers aren’t sure why. Is it because they feel that by saving calories here they have “banked” some wiggle room there? Or is it because they feel less than satisfied — still hungry — and as a result eat more food? Maybe the next study will tell. +

+ 12

SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

by Dan Pearson

You think you have The preliminary discovered a cure studies sure look for cancer? that way.

Wow! Great! What is the success rate so far?

What!?! You’re curing 98% of the test cases???

I want to say... close to 98%.

No, heavens no. Nowhere near that. I said I want to say that many.

The Mystery Word for this issue: ETTLAB

EXAMINER CROSSWORD

PUZZLE ACROSS 1. _________ Royal 5. Desert region in Israel 10. Anemia preventer 14. Having wings 15. James Brown follower 16. Baseball team 17. Hip bones 18. Transmits 19. Gush; spurt 20. In-dash receivers 22. Dawg’s conf. 23. Soviet news service 24. Melt 26. Bro 28. State of Compromise? 32. Passes gradually into 36. Charlottesville sch. 37. Dental work 39. Make lace 40. Small child 41. _______ Week 43. Summerville inits. of yore 44. Period of history 45. Sound starter? 46. Bo Derek film 47. Ruler by inheritance 49. Medieval crossbow 53. Brain ___ 55. Title character of 2003 animated film 56. Type of office or card 59. Mr. Rogers 61. Hardy birthplace 65. Every 66. Overjoy 68. Former Russian assembly 69. Fraud; pretense 70. Helmet-shaped 71. Den 72. Brass wind instrument 73. Mountain nymph 74. Mongol tent

Simply unscramble the letters, then begin exploring our ads. When you find the correctly spelled word hidden in one of our ads — enter at AugustaRx.com All Mystery Word finders will be eligible to win by random drawing. We’ll announce the winner in our next issue!

VISIT WWW.AUGUSTARX.COM 1

QUOTATION PUZZLE 33

Click on “READER CONTESTS”

H C E G C A O N N T V I N Y E L U N S O S N K O O W E T V T T H E R G A F C Y N I T F E H D I O H

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 1. Two things grouped together 2. Earthen pot 3. Surprise attack 4. Characteristics 5. Bahamas’ capital 6. Before, to a poet 7. High-ranking officers (abbrev) 8. Finished 9. ________ system or tissue 10. Part of the foot 11. Kelly, talk show host 12. Singles 13. Building on Broad Street 21. Exclamation of surprise 25. Hand-arm connector 27. Periods on a planet when its primary star is above the horizon 28. Subdued 29. Soap brand 30. Lucifer 31. Venous starter 33. Washington, for example 34. Relaxes; reduces

— Oscar Wilde (1854 — 1900)

35. Slow down the growth of 38. Get to know 41. _____-see 42. Inseparable friend; literally “other self” 48. Respiratory disease 50. Decapitate 51. Doc’s org. 52. Arrogant 54. Grinding tooth 56. Annoying person 57. Capital island of Hawaii 58. Crust over 60. New Haven school 62. Hawaiian outdoor feast 63. Islamic chieftain 64. Chicago’s Merchandise ____ 67. Type of light, towel, or cup

X A M I N E R

3 3

9 9

8 2

1 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.

A 1 1

1 2 3 4 2

2 7

T C 5 6 7

1 2 3

O 1 2 3 4 5 6 7 8

1 2 3 D I 1 2

V 1 2 3 4 5

1 2 3 4 4

1 . D O R I M A N S A N I T 2 . I T R E E TO E D I 3 . V G W E R N I S M 4 . A A D E E E G 5 . I T R I N 6 . S N N C 7 . I S H A 8 . LO E 9 . N D

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

SEPTEMBER 18, 2015

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AUGUSTA MEDiCAL EXAMINER

THE BEST MEDICINE bonus blog spot ha... ha...

man knocked on my door this morning and asked for a donation for our new neighborhood swimming pool. I gave him a glass of water. Joe: I have a bad habit of screaming during rectal exams. Moe: Well, I suppose that’s understandable to some degree. Joe: Yeah, but it really upsets my patients.

you understand? This is a Catholic country; this city is the seat of Catholicism. People aren’t going to give you money if you sit there with a Star of David in front of you, especially when you’re sitting right beside a beggar who is holding a Cross. In fact, they would probably give more money to him just out of spite.” The beggar with the Star of David listened to the Pope, then smiled and turned to the beggar with the Cross and said,“Hey Irving, look who’s trying to teach the Goldstein brothers about marketing!” I hate Russian Dolls They’re so full of themselves.

Why did the golfer need to buy a new pair of socks? Because he got a hole in one.

“Hey grandpa, how come you have to wear glasses?” “It’s just what happens when you get older.” “But won’t you have perfect eyesight pretty soon?” “What makes you think that, child?” “My mom is always talking about adult supervision.”

Two beggars are sitting side by side on a street in Rome, Italy. One has a Cross in front of him; the other one is holding the Star of David. Many people go by, look at both beggars, but only put money into the hat of the beggar sitting with the Cross. The Pope comes by. He notices the steady stream of people giving money to the beggar who holds the Cross, while no one gives to the beggar holding the Star of David. Finally, the Pope approaches the beggar with the Star of David and says, “My poor fellow, don’t

A park ranger was giving a group of tourists an informative talk in front of Old Faithful. “Each eruption of Old Faithful gets a name, much like hurricanes. They are all German names like Hans or Fritz because Old Faithful was discovered by Germans.” Just then, right on cue, Old Faithful erupted. “What’s this one called?” asked one of the tourists. The ranger checked his watch and consulted a list on his clipboard. “Geyser Wilhelm,” he replied. +

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.

Posted September 3, 2015 at healthpopuli.com

Happy 1st Anniversary to CVS Going Tobacco-Free CVS quit selling cigarettes and tobacco products in 2014, made $139 billion, and saved 65,000 lives. That’s the best kind of retail health there is. It’s been a year since CVS quit selling cigarettes, I’m reminded by a one-page ad in today’s Wall Street Journal on page B5. This is a big investment in an ad for a business strategy that’s had a huge return-on-investment. The ad reads: “One year ago, we took a deep breath and quit selling cigarettes in our pharmacies. Now we’re working to create a tobacco-free world. We just want to help everyone, everywhere, breathe easier,” followed by the company’s tagline, Health is everything. This prompted an overall branding change from “CVS/pharmacy” to “CVS Health” At the time of CVS announcing this transformational change in February 2014, pharmacy industry analysts were concerned about how CVS could replace thebillion dollars in revenue CVS would forfeit by dropping tobacco from store shelves. Not to worry: 2015 revenues for CVS were enhanced by the company’s operations in other areas — especially via the prescription benefit management (PBM) company, Caremark, which helped drive CVS Health revenues to $139.4 billion for the year ended December 31, 2014, a total revenue increase of nearly 10% over 2013. Dr. Troyen Brennan, CVS’ chief medical officer, was quoted in USA Today saying if the results were extrapolated for pharmacies across the USA, it would lead to 65,000 fewer deaths a year. Health Populi’s Hot Points: CVS Health made a bet that rebranding would be good for business. It’s definitely been good for public health and individual smoke-quitters’ health outcomes, number about 65,000 consumers a year who will survive, work, pay taxes, raise families, and be able to shop at CVS. That’s a kind of brand-love in the making. There’s a move afoot among pioneering retailers who have quit tobacco like CVS has. You can check out the CounterTobacco.Org website for strategies on tobacco-free pharmacies. You can also visit the Campaign for Tobacco-Free Kids. Retailers, from pharmacies and grocers to discount and Big Box stores, are morphing into important health destinations for consumers seeking convenience, access, transparent prices, and high levels of customer service. Consumers are also buying more mindfully and consciously when it comes to shopping based on personal values. Witness the growth of Tom’s Shoes, Patagonia, Warby Parker, among other companies who seeks to share revenue with consumers who cannot afford to shop their brands. CVS’s move to quit tobacco falls into this category, as well. +

+ +

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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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

TO OUR READERS AND OUR ADVERTISERS, EACH AND EVERY ONE OF THEM.

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SEPTEMBER 18, 2015

AUGUSTA MEDiCAL EXAMINER

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

...cleverly hidden (in the lower right corner) of the p. 9 ad for SOUTHERN COMFORT SHOES Congratulations to PEARL DURAND, 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.

EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC. HOUSE FOR RENT IN N AUGUSTA For Rent: House: two bedroom, one bath, kitchen with stove and refrigerator, bonus room, laundry closet with washer/dryer hook ups, basement, screened porch, handicap ramp. New carpet in bedrooms and living room. Nearly new vinyl floor in kitchen, double pane windows. Near North Augusta Public Safety and NA Community Center. Within walking distance of Greeneway. Ideal for students, a couple or single person. Handicapped ramp entrance. $650.00 per month, a security deposit of $650.00 is required with first month’s rent. No pets! Rental Application required. Prefer 1 year lease. Call 803-599-0781 for appointment to see. 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, fabulous upgrades, custom kitchen and baths. Floor to ceiling windows, fenced yard. Partially furnished! 120k OBO. 803-507-6621.

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

$150. Call (706) 860-2170 WANT TO BE HEALTHY? (Energy, weight loss, mental clarity) Go to gethealthyat.le-vel.com See video and Facebook. Sign free as customer. BEING PAID WHAT YOU ARE WORTH? Then make more money! Watch movie all out interview: ExtraMoneyInterview.net 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 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 PET CARE in Martinez-Evans area. Dogs to 40 lbs, $9.00. Cats (1-3), $9.00 For interview/information, phone 706-829-1729

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 1930s with mattress spring coverlet shams

Thanks for reading the Medical Examiner!

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!

THE PUZZLE SOLVED

WHAT’S YOUR DRUG OF CHOICE? (OURS IS COFFEE)

Augusta Medical Examiner Classifieds

A W

E P

M A

M O

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

I T

M A

SEE PAGE 12

QUOTATION

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

QUOTATION PUZZLE SOLUTION: Page 12: “Cynics know the cost of everything and the value of nothing.”

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

— Oscar Wilde

.25

.50

.75

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

5.25

5.50

5.75

6.00

6.25

6.50

6.75

7.00

7.25

7.50

7.75

8.00

8.25

8.50

8.75

9.00

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:

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

WORDS BY NUMBER

VISIT DRUGOFCHOICECOFFEE.COM

“A mind stretched to a new idea never regains its original dimension.”

Thanks for reading!

www.AugustaRx.com

Multiply by number of times ad to run: x

— Oliver Wendell Holmes

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.

SEPTEMBER 18, 2015

15 +

AUGUSTA MEDiCAL EXAMINER

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At 16 pages every issue, we’re just right.

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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

SEPTEMBER 18, 2015

Lost in the maze? Why enter in the first place?

We know the way. EMPLOYEE BENEFITS • COMPLIANCE • WELLNESS • CONSULTING • EXCHANGES • PARTNERSHIPS • TECHNOLOGY

RUSSELL T. HEAD, CBC, CSA-PARTNER • 706-733-3459 • E: RTHEAD@GANDBC.COM • WWW.GROUPANDBENEFITS.COM