Sept21 18 by Daniel Pearson

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SEPTEMBER 21, 2018

AIKEN-AUGUSTAʼS MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

WATER LOGGED If you’re reading this in Flint, Michigan, fi rst of all, thanks for reading. If your house and kitchen hasn’t been home to countless cases of bottled water over the past year or two, something is wrong. But for many of the rest of us, bottled water is a puzzling commodity. Tap water is practically free. A household can run through tens of thousands of gallons of the stuff in a month and get a bill that’s lower than what they spend at Starbucks in a week. Flint, Michigan, aside, municipal water systems in this country are among the finest and most carefully regulated in the world — a fact not lost on bottled water companies. Many a $1 or $2 bottle of water, resplendent behind a label showing a crystal-clear mountain stream, will list “municipal water” as its source. It’s tap water. No wonder bottled water sales in the U.S. exceeded $18 billion last year. It costs pennies to produce yet brings in dollars in sales. People think this is a modern hipster phenomenon, but it’s far from that. Bottled water was sold in the U.S. as early as 1767. Back in the day, there were two kinds of customers: city dwellers who risked cholera and dysentery if they drank ordinary tap water in their crowded tenements and apartments; and the rich, who would travel to health resorts to revel in their healing waters, then take a few bottles back home to continue their rejuvenation. By 1856, upstate New York’s Saratoga Springs was selling 7 million bottles of its spring water every year. Sounds like a lot until you fast forward to 1978, when Perrier projected sales that year of 75 million bottles of its heavily marketed water, “Earth’s fi rst soft drink.” Other companies saw Perrier’s success and began to salivate, and the water revolution was well on its way, helped considerably by the notable inventor who patented PET plastic bottles (for more about his remarkable story, see page 4). Buying billions of bottles of water year after year is a

two-edged sword. First, we’re paying exorbitant prices for an incredibly inexpensive commodity, and that applies even when you get a super-duper deal on cases of the stuff at your local super-store. On average, in volume bottled water costs 10,000 times more than tap water. It’s far more expensive than gasoline. Secondly, what do we do with all our billions of empty water bottles? We toss them in the trash to the tune of 2.5 million bottles per hour nationwide. It hardly seems possible. Another source estimates 30,000,000 bottles end up in U.S. landfills every day; that same source says we only recycle about 5 percent of the plastic water bottles we use. (See page 3 for recycling info.) “But wait!” someone says. “You’re failing to mention that bottled water has surpassed sodas as America’s most popular beverage. Think of the billions of calories we’re saving, and the millions of cavities.” That is definitely a good thing. But why does the water we drink have to be commercially bottled? Here is a splendid alternative: stop buying bottled water and use the savings to purchase a quality thermos. Fill that thermos every day with fresh, ice cold tap water. Feel free to throw in some lemon wedges or other flavoring. The whole thing might cost you a nickel a day. “I’ve got a better idea,” says someone. “I’ll just wash and reuse my trendy bottle from the bottled water company. Two birds, one stone.” According to independent sources (not bottled water sellers), single-use water bottles are designed for, well, single use. While PET plastic is considered safe, over time chemicals in the bottles can begin to break down and enter the contents of the bottle in trace amounts. By all means let’s keep up our healthful and salubrious water-drinking ways. But there’s no need to waste our hard-earned money on a penny’s worth of tap water in a two-dollar bottle. — See also page 3 +

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SEPTEMBER 21, 2018

PEDIATRICS

TIPS, TRICKS & TALKS TO KEEP TOTS TO TEENS HAPPY AND HEALTHY

BY CAROLINE COLDEN, MD, PEDIATRICIAN

Pertussis, also known as whooping cough, is caused by the bacterium Bordetella pertussis. Known colloquially as the “100 day cough,” it has 3 stages beginning with the catarrhal fi rst stage (characterized primarily by the runny nose, typical cold symptoms with mild cough) that can mislead people into thinking this is a run-of-themill cold. The second stage, from which pertussis gets the name “whooping cough,” is the “paroxysmal” stage, because patients, especially the littler ones, will have spells (paroxysms) of coughing that are so intense and so prolonged that by the end, they are left gasping for air and literally “whoop” as they try breathe in through an inflamed airway. Children and babies frequently turn blue during these spells and may not be able to take in a quality breath for several minutes while coughing. These coughing spells can last anywhere from days to weeks to MONTHS, and can continue even after a patient is treated for pertussis. The final stage is the “convalescent” during which time the patient slowly recovers (if they survive). Yes, I just made the point that “whooping cough” can kill a patient, especially if that patient is a baby, and especially if that baby is younger than 4 months old. For one thing, the coughing episodes can be so severe that a baby infected with pertussis can develop respiratory distress and even

respiratory failure to the extent that ICU admission and mechanical ventilation are required for stabilization. Babies may breathe fast and hard and eventually exhaust themselves completely; other babies may have episodes where they stop breathing altogether (called apnea). Prolonged infection with pertussis can also lead to heart failure. The constant and prolonged coughing spells can make intake of fluid and nutrition difficult, and many babies require IV fluids and nasogastric tubes to maintain hydration and blood sugar and nutritional status. Post-tussive emesis, — coughing so hard that it causes vomiting — is another commonly encountered problem. In addition to all of those scary issues related to pertussis, one of the most feared of all complications associated with

“whooping cough” is neurological consequences. Pertussis can cause seizures and hypoxia (lack of oxygen) to the brain. I have personally witnessed patients in the Pediatric ICU with coughing episodes so bad that we called them death spells. During these, the oxygen saturation in the blood (normally around 98100% in healthy individuals) drops below 15-20% and stays there until the coughing episode resolves. A brain deprived of oxygen — especially the growing, vulnerable brain of a baby — may never fully recover and this can absolutely have devastating consequences: death by asphyxiation or permanent neurologic damage. What’s more, we have a vaccine to protect all of us and our little ones (especially the babies!!). It is is part of the DTaP vaccine (diphtheria-tetanus-pertussis combo vaccine) routinely administered at 2, 4, and 6 months of age, with boosters at 15-18 months and again at Please see PERTUSSIS page 6

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SEPTEMBER 21, 2018

How do sonograms work?

Wish we had more space to list local recyclers — perhaps we can do that at facebook.com/augustarx. One quick tip: Columbia County’s recycling center on William Few Parkway, just around the corner from the new Kroger, accepts 1s and 2s. Remember: plastic is perfect for recycling. We all should pitch in. +

CONTEST!

We’ve all been there. You’re making a presentation at a medical convention or an M&M conference and suddenly your mind goes blank...what is the name of that joint at the mid-point of the arm? Or what is the Hindi word for the five appendages on each foot? It can drive you crazy, can’t it? But no more, thanks to this highly useful anatomical chart of more than 30 important body parts. You’ll never forget the word ear again! Measuring 22” x 28” and printed on deluxe paper, it also features a handy hanging strap so you can impress all your friends, colleagues and patients. How can you make this coveted poster your very own? Simply spell as many legitimate words as you can using the letters in “Medical Examiner” and email your numbered list to Dan@AugustaRx.com, or mail it to Medical Examiner, PO Box 397, Augusta GA 30903. Entries must be received no later than Oct. 12, 2018. Additional details to the right. BEST WISHES TO ALL!

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FINE PRINT: Only the letters actually used to spell Medical Examiner may be used to spell normal English (not Hindi, unfortunately) words. For instance, two As and two Ms are available, but only one C and one D, and so on. Found more words after sending your entry? Multiple entries are ok. Words must be checkable against reputable standard dictionaries. In the event of a tie, a random drawing will determine the winner. The winner’s name and list of words will be published in the October 19 edition of the Medical Examiner.

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Sonogram technology, sometimes called ultrasound, has been around for quite a while, ultimately dating back to discoveries in 1880 by French physicist Pierre Curie. The first practical application of the technology in the form we recognize today was developed in 1940 by a professor at the University of Michigan. In simple terms, a medical sonogram is a procedure that uses sound waves — not in the spectrum that humans can hear, hence the term ultrasound — to create an image of what’s going on inside the human body. The handheld wand used by the sonographer, called a transducer, emits sound waves that enter the body and bounce off tissue, bones, organs and whatever else happens to be in its field of inspection. Sometimes it’s a growing baby! The same transducer is also able to retrieve and analyze the sound waves that reflect back to it. Using a complex formula the technology creates an image based on the echoes it “hears.” Sound waves bounce back instantly for something just beneath the skin’s surface versus something deeper. They are reflected differently by muscle compared to soft tissue, by soft tissue compared to bone. They can detect the presence of things that aren’t normally present in the body — like tumors, or the aforementioned future bouncing baby boy or girl. They can be used to detect heart and vascular issues, urological problems, internal injuries, gallstones, kidney stones, and to help make countless other medical diagnoses in a very simple and non-invasive way. Sonograms are also used in many industrial applications. One example is in inspecting aircraft components that could fail due to metal fatigue. Because sonograms are simple and painless, people sometimes forget that it is a very safe medical procedure, it isn’t completely without risk. For example, sound waves have been known to heat body tissues slightly. That is one of the reasons their use is limited in pregnancy, not performed with every prenatal visit unless there is some medical necessity. That rules out the overuse of ultrasounds, such as in commercial (not medical) enterprises that rent or lease ultrasound equipment for home use to produce “keepsake fetal videos.” +

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INER

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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 salubrious news within every part of the Augusta medical community. Direct editorial and advertising inquiries to: Daniel R. Pearson, Publisher & Editor E-mail: Dan@AugustaRx.com AUGUSTA MEDiCAL EXAMINER P.O. Box 397, Augusta, GA 30903-0397

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(706) 860-5455 www.AugustaRx.com • E-mail: graphicadv@knology.net www.Facebook.com/AugustaRX Opinions expressed by the writers herein are their own and/or their respective institutions. Neither the Augusta Medical Examiner, Pearson Graphic 365 Inc., nor its agents or employees take any responsibility for the accuracy of submitted information, which is presented for general 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. © 2018 PEARSON GRAPHIC 365 INC.

SEPTEMBER 21, 2018

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#75 IN A SERIES

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

by Marcia Ribble

epending on your point of view, this intriguing man is either one of the most influential shapers of modern life, or the creator of one of the greatest threats to modern life and planet Earth itself. He invented a product we all use, and billions of them are produced every year. He had an immense impact on pop culture. You see, Nathaniel Wyeth (above) is best known for inventing the plastic soda bottle. Considering his family background, that is an amazing accomplishment. His father was the noted artist N.C. Wyeth, who famously illustrated such classic books as Robin Hood and Treasure Island. His brother was an even more well-known painter, Andrew Wyeth. The entire Wyeth family is loaded with artistic talent, but in our Wyeth’s view they were all in the same field — creativity. The other Wyeths had the fame, though, so he often called himself “the other Wyeth.” His road to lesser fame began in 1967 when it struck him as odd that carbonated beverages were not sold in plastic bottles. He was told plastic couldn’t be used because the bottles would explode. Challenge accepted, Wyeth may have thought. That very day he bought a plastic bottle of detergent, replaced the detergent with ginger ale, and put the sealed bottle on a shelf in the door of his refrigerator. The next morning the bottle was wedged so tightly in the narrow space he had trouble removing it. The bottle’s expansion had to be confined. As a researcher for Du Pont, Wyeth was in a unique position to tackle the problem, with laboratory and materials resources readily available. Just as plywood gains its strength from utilizing wood fibers going in different directions, Wyeth knew the challenge he faced was extruding plastic in a way that stretched its fibers in two directions, adding strength by forming a crisscross pattern. He created a mold that resembled a large test tube with screw threads running in two directions, a double spiral, creating a diamond pattern. When plastic was extruded through that mold, its molecules aligned in the criss-cross pattern needed to strengthen the bottles enough to withstand pressure created by carbonated beverages. When he switched from polypropylene to polyethylene-terephthalate (“PET”), the result was a clear, lightweight, safe, practically indestructible container. As mentioned above, they’re used by the billions today in all shapes, sizes and colors. Does all of this make Nathaniel Wyeth Public Enemy #1 when it comes to plastic pollution in the environment? Not by a long shot. For starters, PET is eminently recyclable. According to Massachusetts Institute of Technology figures, about half the polyester carpeting in the U.S. today is made from recycled PET bottles. There are places everywhere (including the CSRA) that gladly accept PET containers for recycling. So could it be that Public Enemy #1 is made up of people who toss their plastic bottles instead of recycling them? (See page 1 for more info) +

Getting back on one’s feet after a hospitalization takes time and effort but is well worth it! Today I managed to go grocery shopping and do my own walking through the store. A couple of weeks ago just walking in my own house would leave me breathless and I would have to sit down and rest between each of the exercises the physical therapist asked me to do. I felt frustrated doing the smallest task like making coffee because it tired me out. I laugh remembering how angry the nurse made me by asking me to get up and walk ten feet just after returning home from the hospital. Just sitting in my chair made me tired. All I wanted was for her to go away and stop asking me questions and stop asking me to do things. Being rude to her was uncalled for, and I was very rude, because I just wanted to be left alone so I could sleep. She needed to do an assessment to see what I needed to do to recover my strength, and recommended that I be seen by a physical therapist. At fi rst, I was not thrilled when the physical therapist came and asked me to get up and walk around in my house. I did not want to do the chair exercises. It was all such a bother because seven days in the hospital had zapped my strength more than I understood at the time. Today I am glad that they ignored my whining and just insisted that I do the exercises. Those exercises were exactly what I needed to do to regain my independence.

Doing my own grocery shopping feels like a very different experience than making a list and sending someone else to buy groceries for me. A much better experience! Shopping myself allows me to see something I hadn’t put on my list and slip it into the cart. Today I saw two little raspberry-fi lled sugar cookies for my greatgranddaughter and it was fun knowing she would enjoy the little treat. No one shopping for me from a list would have been so inspired. When I saw the bacon on my list, I was able to go through multiple packages to find one with just the balance of meat and fat I like. Someone else shopping for me might have just grabbed any old package of bacon and thrown it into the cart. It would still be bacon, but perhaps not the bacon I wanted. The bacon I choose depends on my purposes for it. The bacon I buy for BLTs is different from bacon for liver and onions, or for German potato salad, or to create a base for an entree. All the different packages of bacon are good, but they work differently. Then there were all the various frozen vegetables on my list. There are certain brands of certain vegetables I like more than the same vegetables from other brands. Adding all that information to my shopping list would have taken too much time and energy. It was much easier to pick what I wanted myself. I am grateful for all the help I’ve received to get back to speed, even if I haven’t always shown how grateful I am. +

CAFFEINE WILL STUNT A CHILD’S GROWTH WHICH WILL IT BE? 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 fi rst. For kids, however, it’s a completely different delivery system. They think sodas and energy drinks, and

for the most part they’re not even aware they come with a big dose of caffeine on the side. 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 a single serving 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. A single 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. +

SEPTEMBER 21, 2018

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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ait. When did you say you started that medication?” “Two weeks ago.” “And when did you say you started having those symptoms?” “Uh...about...uh...let me think...it was...two weeks ago.” This kind of circumstance is my holy grail. It is my ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have been taking medications started by other physicians within the time frame of those symptoms. One of my rules of thumb (I don’t know how the thumb always gets involved) is when in doubt, blame the medication. And, yes, stopping the medication in these circumstances fi xed the problems the patient was having. It doesn’t always work that way, but it often does when you listen enough. I recently had a diabetic patient come to me embarrassed with his poor blood sugar control. “Why have you been having such a hard time lately controlling your diabetes?” I asked. “Well,” he said, looking down at his hands as he spoke, “I just haven’t been taking my medications over the past month. It’s hard for me to take them.” “And why is it hard for you to take them?” I pressed. He shuffled in his chair. Looked up at me, and then said, “I can’t swallow pills. The metformin. They are so big. I just have a hard time getting them down. So I just gave up taking my pills.” I looked at him and smiled. “You do realize that you can cut those pills into halves and quarters?” He looked down.

Obviously not. “Okay,” I said, “let’s come up with a plan that doesn’t require you to swallow big pills all the time. I know that it’s not easy when you have a strong gag reflex and you have to take big pills. Let’s find something that works well for you.” He smiled broadly and seemed to relax. I actually listened to him. I took the time to find out why he wasn’t taking his medication

I just listened instead of judging his suboptimal diabetic control like he expected me to do. That’s what people want. They want to be listened to so that they are understood. It’s not just being heard that is important; it is being heard and appreciated that’s the key. Everyone has a story to tell, and everyone has a reason to be in the place they are in at the moment they interact with you. It’s your job as a clinician to figure out what got them there and what exactly they are looking to accomplish at this moment. My patient really did want to control his diabetes, but was very much prevented from doing so by his inability to swallow large pills. He believed (falsely) that this was a complete roadblock to good diabetic control and had given himself up to amputations, dialysis, and other inevitable complications of poor diabetic control. All I needed to do was to listen a little and his myth was dispelled. One of the big unfortunate things about the medical system is that it turns listening into a rarity. “You are the only doctor who has ever listened to me,” I’m often told. Really? To me that’s like being told that I am the only chef who has ever cooked food for someone. Isn’t listening the

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essence of care? How could so many people go through our system feeling like they never get listened to? Yet they do. It is incredibly sad. It causes a huge amount of pain. It probably kills a fair number of people. But if we are actually rewarding doctors for spending less time with people, what do we expect? If we are making computer time more profitable than patient time, ICD more important than bowel sounds, Medicare compliance more important than the emotional state of the person in the room with you, then it’s hard to blame clinicians for ignoring patients. They are just doing what they are told. They have bosses too. Our system needs to be better than that. The reason I can spend time with people is because I don’t have to worry about the income-producing codes I can generate from each visit. I don’t have to worry about Medicare audits, or meaningful use, or MACRA. I just focus on the person in the room with me. I’m lucky that way. I’m lucky that I raised my middle finger to the system that required me to spend so much time documenting that I could no longer give care. I’m lucky that I walked away from a system that made profits for me when my patients had pain or illness, and hurt me when they were healthy. Yep. I am lucky. Pure luck. But in any situation, even in one where profits are paramount, listening is always best. When we listen we can understand. When we listen we can solve. When we listen we can make good plans of action. Without listening we are left to become boxcheckers, form-fillers, and data entry monkeys. We don’t want that, and I’m pretty sure our patients don’t want that either. +

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PERTUSSIS… from page 2 4-6 years. A total of 5 doses are considered necessary to confer immunity in children under 7 years of age. Older children (and adults too) get the Tdap vaccine as a booster at 11 years or later. In adults, pertussis is much milder and can be more difficult to diagnose since the “whoop” of the cough is more tolerable and more likely to be ignored (hence the “100 day cough” label). However, infected adults are the #1 source of infection to vulnerable babies with their smaller, more fragile airways, especially those babies who have not yet received all their vaccines. It is recommended for pregnant women to get a Tdap every pregnancy (regardless of when her last shot was) to protect her newborn in case she gets sick; furthermore, any other person who will be in contact with the new baby (siblings, dad, grandparents, etc) should also receive a Tdap so that they do not risk infecting the new baby with pertussis. Yes, pertussis can be (and is) treated with antibiotics once diagnosed. The tricky part is diagnosis at an early enough stage in infection for treatment to really make a difference in the clinical course. Because as stated above, the first stage of infection with pertussis usually presents like any old regular cold. By the time the paroxysms of the whooping cough stage arrive, antibiotic therapy is less likely to help prevent the feared complications. So then, what’s the best approach to prevent pertussis? Vaccinate, vaccinate, vaccinate. Remember: babies can get a DTaP vaccine starting at 2 months, but are NOT completely protected by a single innoculation. Also remember: babies are our most at-risk population. For them, this “100 day cough” could be much more than “just a cough and could potentially mean brain damage or even death. Let’s do what we can to keep them safe! They deserve that. They’re depending on us. +

SEPTEMBER 21, 2018

MEDICALEXAMINER

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

“The cause was a mystery for a long time.” “And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.” “I was a battlefield medic.” “He was just two when he died.”

“OUCH!”

“It was a terrible tragedy.” “She saved “I sure learned my lesson.” “I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.” “It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.” “They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

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

“This was on my third day in Afghanistan.” in three places.” “I lost 23 pounds.” “Turned out it was just indigestion.” “At first I thought it was something I ate.” “The smoke detector woke me up.”

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

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Do you ever go through a phase where you just crave Mexican? I sure do. Loads of chips and cheese sauce can be quite unhealthy though, so I try to fill my tacos with a variety of unique ingredients that are healthy and pack a punch of flavor. For my vegan tacos, I add a little something out of the ordinary: seasoned mushrooms, kale, and my favorite part, fried cashews with Mexican seasoning. To make dinner prep easy, I used my instant pot for the pinto and black beans. I try to make beans the main ingredient in my tacos because as a colon cancer survivor I realize how important it is I have beans and other legumes as part of my regular diet. In a study examining dietary patterns and disease risk at Adventist Health Study, it was found after a 6-year study that individuals consuming legumes > 2 times/week were 47% less likely of developing colon cancer when compared to individuals consuming legumes never to < 1 time/week. Also, it has been found that half a cup of cooked pinto beans a day for two months could mean a 20-point drop in our cholesterol. Beans are, after all, one of nature’s most perfect foods; the whole plant in just one little package. Low in fat, no cholesterol, high in fiber and protein. So just like we can improve the nutrition of any dish by adding greens and other veggies, we can do the same by adding beans. VEGAN TACOS Ingredients • 1 cup dried pinto beans • 1 cup dried black beans • 1/2 cup chopped onions • 1 teaspoon pink Himalayan salt • 4 cups vegetable broth • 2 cups sliced mushrooms • 1 tablespoon olive oil • 1/3 cup of raw cashews • 2 tablespoons olive oil • 1 small package of whole wheat soft taco shells • 1/2 cup shredded lettuce • 1/2 cup chopped kale • 1/3 cup chopped yellow and green peppers • 1/3 cup chopped onions • 1/4 cup chopped cilantro Cashews Place 2 tablespoons of olive oil into a small saute pan, heat to medium-high heat. Add cashews and stir until light golden brown. Remove from oil and sprinkle with taco seasoning.

• 2 tablespoons taco seasoning

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Mushrooms Add 1 tbsp olive oil to saute pan, heat to medium. Add mushrooms and saute until soft. Sprinkle with taco seasoning.

Notes Condiments could be sliced jalapenos and salsa. +

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Instant Pot Beans Place beans, salt, and 1/2 cup chopped onion into the instant pot. Follow manufactures directions for processing set up. Cook beans for 45 minutes and then allow pressure to come down slowly about 20 minutes.

Assemble tacos Place beans into soft taco shells. Add mushrooms, lettuce, kale, peppers, and onions. Top with cilantro and cashews then serve.

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SEPTEMBER 21, 2018

THE MYTH OF DETOX by Ken Wilson Executive Director, Steppingstones to Recovery

I’m both amused and frustrated by calls I get daily wanting “detox” from cocaine or from meth or even from opiates, and even from marijuana. Certainly most people who realize they have become dependent on chemicals and want to be free from the clutches of habitual and compulsive use want to “get the chemicals out of my body and live a normal life.” There are three problems with this thought however. First, subconsciously at least, most people who are in this state actually want to be able to use their drug of choice – even alcohol – in a controlled manner again. They may consciously say they want to be entirely free, but the mind works in strange ways with addictive diseases. Most people who come

into treatment are mandated to do so by the boss, wife, employer, judge, or other similar motivation. As a result, in countless group meetings I have lead I ask for a show of hands of those who came through the front door thinking something like this: “I’m going to do this program...I’m going to get my boss off my back...I’m going to get my DOT license back... I’m going to get mom to quit hassling me about my drugs... and after a short of sobriety I’m going to use again — but this time I’m going to control it!” Most of the time there is 100% agreement! Second, the belief that “If I can get this drug out of my body, I’ll be fine” is a myth. In 31 years working in this field I’ve observed that you can get a drug out of the body relatively easily, but getting it out of the mind is a whole different story! Change takes place very slowly and

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the mind is slow to accept the truth that a drug-is-adrug-is-a-drug, and the fact that one can’t be substituted for another, and that taking no drug is much easier than taking even one drug. This mental and emotional process takes months, years, and yes, sometimes even decades to fully accept. And some minds never fully accept it. Third, another myth is, “I’m going to check myself into a hospital for a few days and use my insurance benefits to get detoxed. After all, I have the coverage so I might as well use it.” Not. Back in the day (25 or 30 years ago) an addict or alcoholic could place his or her insurance card on the admissions desk of a hospital, pay his or her 10-20% co-pay amount and stay inpatient in a program for 4-6 weeks. That was when dinosaurs roamed the earth. Not so today. Insurance policies may

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DON’T LICK THE BEATERS Useful food facts from dietetic interns with the Augusta University MS-Dietetic Internship Program

TIPS FOR A HEALTHY FALL by Allie Teilhaber, MS, Dietetic Intern A rack of ribs. A juicy burger and chicken wings. A slice of peach pie with a scoop of vanilla ice cream. “It’s okay, swimsuit season is over, so calories don’t count!” Yes, it can be tempting to indulge in delectable high calorie foods and beverages. In the South, some people hibernate near an air conditioner during the summer and resume picnics and parties in cooler fall weather. Social eating can often make it difficult to stay on track with healthy eating patterns. While it is acceptable to have a treat here and there, certain situations may lead to poor choices regarding low nutrient dense and high caloric food items. Here are some tips to help you stay on track. First, eating healthy throughout the day and bringing healthy snacks to a party, picnic or potluck can help offset the urge to overindulge or to make poor food choices. Looking around the table to see the options that are available before picking up a plate can help in making wise decisions too. There is no need to stress out if healthy food options at a picnic or party are limited. If you especially like a certain dish, ask for a to-go box. Eat a little today and a little tomorrow. Or ask for the

recipe so you can make it at home with modifications such as less sugar, fat and salt. Sometimes we lose the eat-light-battle. When this happens put it in the past and move on to making better choices in the future. Physical activity is a very important component of a healthy lifestyle. If you’re not a fan of being drenched in sweat, cooler fall weather is a great time to resume your physical activity schedule. If you don’t have a schedule, develop one. Your activities may include swimming, bicycling, or taking brisk walks around the neighborhood. Exercise helps to reduce the bloated, lethargic, or uncomfortable feeling after a large meal. Family and friends frequently grill during fall and football season. To ensure that food prepared is both enjoyable and safe to consume, food safety guidelines must be followed. Start off by making sure your grill is cleaned and free of char that forms when cooking meat at very high temperatures. It’s a toxic compound known to increase cancer risk. Lining the grill with foil and cooking meat at lower temperatures for a longer period of time will decrease the formation of toxic

compounds. Don’t forget to poke holes in the foil used to line the grill. Practicing safe grilling by avoiding cross-contamination is vital to a healthy and safe meal. Have raw meat, poultry, and seafood stored separate from vegetables. Use a thermometer to check storage and cooking temperature. Poultry should have an internal temperature of 165°F; ground meat should be 155°F, and seafood is safe for consumption at 145°F. Healthy and colorful meals to bring to autumn gatherings: • Watermelon Pizza: watermelon, low-fat plain yogurt, blackberries, strawberries, mint, and honey • American Flag Skewers: blueberries, raspberries, and banana • Fruit Skewers: blueberries and a heart shaped watermelon cut-out • Red, White and Blue Popsicles: raspberry, Greek yogurt and blueberries • Watermelon Feta Blueberry Salad Remember, balance and moderation are important to achieve a happy and healthy fall season. For more information on a healthy diet, contact a Registered Dietitian Nutritionist. They are experts specifically in the science and application of nutrition and food. + References • Cristi-Montero, C., Munizaga, C., Tejos, C., et al. (2016). Variations of body composition, physical activity and caloric intake in schoolchildren during national holidays. Eating and Weight Disorders, 21 (2), 251-255. https://doi.org/10.1007/s40519-015-0229-5 • DuVal, L. (2017). Tips to avoid overeating during the holidays. Retrieved from https:// www.uchealth.org/today/2017/12/06/overea tingduringholidays/ • Skerrett, P.J. (2016). 5 tips for healthy grilling. Harvard Health Publishing: Harvard Medical School. Retrieved from https:// www.health.harvard.edu/blog/5-tips-forhealthy-grilling-201305276318 • Thorpe, M. (2003). Prevention of foodborne illness and the role of the dietitian. Journal of the American Dietetic association, 103(1), 20-22.

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H H H H H 9/13/2018 This kid at my school told me he’s going to beat my brains out tomorrow. What did I ever do to him? I told him either you figure out what word is spelled incorrectly in the dictionary or I’ll be the one beating you. That should keep him busy for awhile. +

Edwina Y. Augusta, GA

H H H H H 9/15/2018 When someone says, “it’s not rocket surgery,” does that mean they have brain damage? +

Jack H. Waynesboro, GA

H H H H H 9/15/2018 Ok, so the brain is supposedly the most complex matter in the entire universe. You hear all these amazing things about the brain all the time. But what is the source of all this pro-brain propaganda? The. Brain. Hello! Wake up people. The brain is so full of itself I can’t stand it. The next time you hear the term “brain trust,” don’t. Just don’t. +

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H H H H H 9/16/2018

withdrawals could cause death. So there is really little or no medically monitored detox from opiates on an inpatient basis anymore. Yet where there was 1 person addicted to opiates 10 years ago, there are 400 addicted to opiates today! For insurance companies that would cause some serious bankruptcy, I guess. However, there are other options. With luck, and I mean very good luck, a good medical doctor might be able to prescribe certain medications that can minimize uncomfortable withdrawals from a number of addictive drugs. This outpatient route should be taken only under the watchful care of trusted family members who need to securely hold the medication and dispense it exactly as prescribed on an “ambulatory” at-home detox basis, and only if inpatient detox is not indicated by medical necessity or allowed by one’s insurance policy. Why under the watchful eye of loved ones? I know of a case or two over the years in which detox meds were prescribed and the doctor told the alcoholic to “take as directed” and didn’t know how an addict/alcoholic thinks! In two cases the patient got the prescription, went home and took it...not over 7-10 days as directed, but in just a day or two while also drinking alcohol on top of the pills! They both died that day of unintentional overdoses. So this process is not done carte blanche and wholesale by all practitioners, but by medical doctors who know the patient and family well and trust the meds to be dispensed as directed. The addict or alcoholic who can find such a person to help is fortunate indeed. Next month we’ll talk about different drugs and their withdrawal effects and perhaps how to minimize the pain while coming off the drug. One thing is for sure: withdrawals are not a myth, and that is certainly a guaranteed promise indeed. +

I was reading about the blackpoll warbler. It’s this tiny bird that migrates thousands of miles every year over open ocean waters. How it navigates over this distance, flying non-stop for more than 72 hours, is a complete mystery to scientists. Obviously it has some sort of incredible innate intelligence. So the next time my husband calls me a birdbrain I’m going to say “Thank you!” + Leon M. Aiken, SC

H H H H H 9/17/2018 You’re going to think I’m joking, but I actually know a girl named Sarah Bellum. Unfortunately though, I think all her brains are in her name. +

Lola J. Grovetown, GA

H H H H H 9/17/2018 We’re building a new house in Columbia County with everything! I’m getting a dream kitchen that my husband said can include anything I want, like marble and granite countertops, stainless steel appliances, a Jenn-Air range, an island, a pantry, maybe even a brain drain. I don’t even know what that is, but I heard the term and I want one! +

Samantha K. Beech Island, SC

H H H H H 9/18/2018 Whenever I even think about exercise I get brain cramps. Just sayin.’ +

Kimber E. Harlem, GA

H H H H H 9/18/2018 I read a really interesting article about this new thing called brain mapping, but I can’t find it on Waze. Can anybody help me? +

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The blog spot From the Bookshelf — posted by Eunice J. Minford, MD on July 10, 2016

WHAT WE DO IS NOT WHO WE ARE Many doctors associate what they do with who they are. In other words, they consider their job to define them, that those two little letters — Dr. or M.D. —are them. To define ourselves by what we do is a disaster waiting to happen; it is a fragile platform to stand upon and one that can easily crack and crumble to ruin, leaving the person inside feeling lost, empty, insecure, uncertain, anxious and deeply unsure of who they are. Who we are is so much more than what we do. We are human beings before we are doctors, human beings who care, love, laugh, have relationships, fun and enjoy people. None of these things need to cease when we become doctors. We don’t need to put on our serious face or professional mantle; we just need to be who we are, be ourselves, be natural and let the love in our hearts shine through all that we do. When we stand on the rock of knowing who we are as human beings first and foremost, then we have no need to impress, be superior, look down upon others, be aloof and keep our distance. We know and can feel there is a place of greatness within us and within every human being, even if we are not all living that greatness. Just knowing it is there, to be tapped into and lived from as we choose to, can make all the difference. We know we are no longer dependent on two small letters for our sense of self and worth; for who we are already is so much grander than any amount of letters can bring, be they before or after our name. And so whilst it can certainly be challenging if we lose our job, are marginalized or made redundant, are suspended, or just retire, these challenges may be easier to deal with if we know that greatness is still there within, untouched and unaffected by any of that, for what we do is not who we are. And on the other side of that coin, bringing that greatness within to all that we do can transform our lives, our work, and relationships. There is a different but grander sense of purpose, a spring of joy in our step and a sparkle in our eyes when we know that what we bring does not solely depend on what we know, but instead who we are. We underestimate the healing power we possess when we are just ourselves, being human, being present, being the natural loving and caring beings that we are with grace and greatness, where the love in our hearts can shine through our eyes, our gentle touch or tender words. So by all means embrace the hard-earned title of “Dr.” and the responsibility it brings, but let us not misuse it, as I used to do to have power over others, to feel superior or better than, or to bolster a fragile sense of self. Know first and foremost that we are much more than what can be defined by two little letters or any amount of degrees — and when we bring that to the fore, we know nobody is nobody, and everybody is somebody — somebody great, wise and beautiful, just like us. +

Two letters do not define a person.

Eunice J. Minford is a general surgeon in the United Kingdom who blogs at the Soulful Doctor.

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During the holidays (which, unbelievably, are just around the corner) more than one person has paused to think, “There’s enough food on this one table to feed an African village for a month!” If you’ve ever had that thought, here’s the perfect book. Photographer Peter Menzel and his wife, Faith D’Aluisio, journeyed around the world — again — (he is also behind the fascinating globe-trotting books Hungry Planet: What the World Eats and Material World: A Global Family Portrait) to capture these images. Some might call it a coffee table book, but that would be an insult. It would imply that it’s lightweight fluff when actually its message could be life-changing. Why? Because What I Eat is an eye-opening look at the food du jour of people as varied as a glamorous professional model and a Maasai yak herder. Specifically, it’s a portrait of the food the people pictured on its pages eat in a typical day, whether they live in Boston or Bangladesh. You might think this would be the perfect opportunity to

sermonize about Americans and Europeans and their excessive diets compared to the crumbs that people in some other cultures must subsist on. What I Eat spends no time there. One reader might look at the daily diet of an African herdsman who lives on 800 calories a day and feel guilty because his drive-thru breakfast burrito contains 900 calories while the next reader might feel truly blessed and grateful for the abundance he enjoys. What I Eat leaves that decision to each reader without comment. As befits a book all about food, What I Eat provides food for thought. What those thoughts might be depend on who’s reading it. A parent, for

example, might use it to help their child appreciate how others eat and how much work is involved in some people’s quest to provide each day’s food. Although there is food pictured on every page, it’s supposed to be a feast for the eyes. So unless you literally eat the book itself (not recommended) it’s completely low-cal. What I Eat is also the poster child for real books. You wouldn’t appreciate this book one-tenth as much looking at it on some digital e-reader. Incidentally, we also highly recommend the other two books Menzel has published mentioned earlier. They are each fascinating visual studies of how the world lives. The tapestry of human life on Planet Earth is unbelievably rich, and Menzel has done a masterful job of giving us an enlightening and highly educational world tour in all his books. + What I Eat — Around The World in 80 Diets by Peter Menzel and Faith D’Aluisio, 335 pages, published in August 2010 by Material World.

Research News An unusual prescription Based on new pediatric research, doctors are encouraged to urge families to promote literacy. Published last week in Pediatrics, the study found that parents who spend time talking and listening to their toddlers paid off in better language skills and higher IQ scores more than a decade later compared to toddlers who aren’t engaged by their parents in conversation. As the study author expressed the findings, if a parent could feed a child food at age 2 that would still be benefitting their physical health at age 12, it would be a no-brainer for every caring and conscientious parent. The peak time for such interactions is from 18 to 24 months, a “period of language explosion.” The stark contrast between children whose parents engaged them in conversation and story time had study

authors using terms like “nothing short of remarkable” and “astounded” to describe their findings. The study was conducted by the LENA Foundation in Boulder, Colorado, and analyzed some 9,000 hours of transcribed day-long family recordings with later followup on the toddlers between the ages of 9 to 14. New guidelines in the treatment of sleep apnea New recommendations for treating sleep apnea have been published by the American Thoracic Society in the Sept. 15 issue of American Journal of Respiratory and Critical Care Medicine. The new guidelines are based on findings which make an even stronger connection than previously believed between OSA (obstructive sleep apnea) and being overweight or obese. The panel investigating the issue found that many

patients suffering from OSA were unaware that they were overweight or obese. Furthermore, few patients have been counseled by their doctors about the importance of weight loss. “Clinicians are often reluctant to give patients a diagnosis of obesity.” The guidelines recommend a comprehensive lifestyle intervention that includes a reduced calorie diet, increased exercise and physical activity No aspirin benefit? After decades of research finding that aspirin conveyed a host of curative and preventive benefits, a new study has found that daily low-dose aspirin had no beneficial effect on healthy older adults, specifically in prolonging independent living free of dementia or physical disability. The study did not say a lowdose aspirin regimen caused any harm. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS +

by Dan Pearson

I can’t believe you joined that gym. Their “Drop That is impossible 20 lbs instantly” ads to believe. That I joined a gym? are an obvious scam. Well, I did. And I have. The ads are true.

EXAMINER CROSSWORD

PUZZLE

The Mystery Word for this issue: REMUNST

! 3 E G A P E E S ! K A E R B N O

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

QUOTATIONPUZZLE

Click on “READER CONTESTS”

O S R T C O C C I O I O R N

M T T E M A P A O E D E E M N N I M E S R P S H N E R C O K N N T K H ;

— Benjamin Franklin

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

E X A M I N E R

1 9 7

9 8

1 1

7 7 8

S U D O K U

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

Use keypad letters to convert numbers into words suggested by the definitions provided. Sample: 742 (body part) = RIB. Solution on page 14. 1. 254642 (medical place) ______

6. 88667 (medical diagnosis) _____

2. 24278 (medical record) _____

7. 96863 (injury) _____

3. 23858 (patient description) _____

8. 63783 (body part) _____

5. 63837 (medical device) _____

9. 32468 (patient feeling) _____

5. 22883 (medical adjective) _____

10. 78737 (diagnosis) _____

THE MYSTERY WORD VISIT WWW.AUGUSTARX.COM

ACROSS 1. Hyper letters 5. Relating to the foot 10. Kitty in an office wager 14. Hawaiian outdoor feast 15. Nimble 16. Doing nothing 17. Shakespeare was one 18. Collection of fact books 20. Large area employer 21. Matured 22. Pyromaniac’s deed 23. Go from first to second 25. Drug category, in brief 26. Type of net or pin 28. USC Aiken team 31. Liquid waste by Daniel R. Pearson © 2018 All rights reserved. Built in part with software from www.crauswords.com 32. Inventor profiled on p. 4 34. I Like _____ DOWN 30. Cranium (50s campaign slogan) 1. Hollywood’s Jessica 32. Cried 36. Assemble 2. Couple or pair 33. Ming, once an NBA star 37. Local Orchard 3. Longest-serving mayor in 35. TV award 38. Egg cell Atlanta history 37. Riverwalk, for example 39. NBC show 4. A flop 38. Home of Case Western 40. Aquatic opossum 5. Appease; placate Reserve University 41. Over or under follower 6. The Nile flows through it 40. Shouts 42. An ad (in the UK) 7. Gaming cubes 41. Walk in shallow water 44. Justly 8. Entirely 43. Truth 45. North American deer 9. Zodiac sign 44. In a very skilled manner 46. Type of spider identified 10. Georgia county named for 46. Word that can precede by this word (and its color) the 14th US president buffalo or snake 47. Sound of a bagpipe 11. Probability 47. Unexplained death of a baby 50. Having a sound mind 12. Potpourri (acronym) 51. What GRU became 13. Containing little fat 48. Make a sweater 54. Not divided into separate 19. Cabbage ______ 49. Notion parts 21. Aid intro? 50. Ballesteros, to friends 57. Sudden sharp pain 24. Seize (archaic or poetic) 52. Monte’s last name? 58. Eating regimen 25. Solemn promise 53. Lyft competitor 59. Abdominal landmark 26. Totals 55. Entry level nurse (abbrev) 60. Skin eruption 27. James Brown is one 56. Knock vigorously 61. Remain 57. Standardized admissions 28. Quarter bushel 62. Mimicry test (in brief) 29. Major local artery 63. Norse god of thunder Solution p. 14

TEXT

SEPTEMBER 21, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

asked me if I’d like coffee or water. I asked for water. He brought me a bottle and I poured it into a cup until it overflowed. The guy jumped up and started to move papers and wipe up the mess and he asked, “Why did you do that???” I said, “I always give 110%.” So yeah, I think it went great.

ha... ha...

“Mr. Jones, I’ve reviewed this case very carefully,” said the Divorce Court judge, “and I’ve decided to give your wife $775 a week.” “That’s very fair, your honor,” Mr. Jones said. “And every now and then I’ll try to send her a few dollars myself.”

esterday a friend of mine called to ask if I could loan her $500 so she could make her rent. I told her I’d have to check my bank balance, but I promised I’d call her right back. Before I could even log on to my account, her sister called and told me not to loan her a penny. “She’s lying,” she told me. “She’s going to use the money to bail her loser boyfriend out of jail so they can be together on her birthday.” After we hung up I thought about it and then called my friend back and told her I would give her the money. And I did. That was yesterday. Today she just called me again, this time from jail. She was screaming and crying and mad. “Why did you give me counterfeit money?” “So you and your boyfriend could be together for your birthday,” I told her.

Moe: My dad trusted absolutely no one. He even had a saying about it. Joe: What was it? Moe: I have no idea. He wouldn’t tell me. Moe: Are you still trying to sell your pet snake? Joe: Yeah, but it’s not going too well. Moe: Why not? Joe: People keep calling to ask me how big it is. I tell them it’s huge. Then they ask how many feet and I say, “None! It’s a snake!” Moe: You know what really sucks about a broken vacuum cleaner? Joe: Nothing.

Moe: I’m thinking of opening up a store to sell just bagels and donuts. Joe: Cool. Have you thought of a name? Moe: Hole Foods.

Moe: I hate mosquitoes. Joe: Yeah, they really suck. But did you Moe: How did your job interview go? know that Jello has created a dessert that Joe: Pretty awesome, I think. repels insects? Moe: What happened? Moe: That sounds very off-putting. + Joe: Well, just as the interview started the guy

Why subscribe to theMEDICALEXAMINER? What do you mean? Staring at my phone all day has had no affect on ME!

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

Dear Advice Doctor, My supervisor asked me to do a job that was his responsibility on the basis of an excuse that turned out to be completely bogus. Not to brag, but I killed it and he got all kinds of praise for the project, but he never told anyone that I actually did it. Not only did he fail to thank me (even privately), he offered a left-handed compliment about the job that was really more insult than commendation. Do you think I should go upstairs and tell his supervisor the whole truth? — Wants to Return the “Compliment” (if you know what I mean)

Dear Wants to Return, Once upon a time this would have been a simpler topic to discuss, but as more research is conducted and analyzed, some former “facts” are relegated to myth status by new and unexpected discoveries. Even so, very little about left-handed anything (except compliments) is carved in stone. For instance, in the days of old wishing left-handedness upon someone was like putting a curse on them: left-handers were believed to be more susceptible to sickness and have shorter life spans. Scientists now generally accept that being a leftie or a rightie has no effect on longevity. There are differences, however. Some studies (but not all) suggest that being left-handed affects early learning and school performance in areas like vocabulary, reading, writing, social development, plus gross and fine motor skills (not to mention scissor use). Oddly enough, ambidextrous or mixedhanded kids perform at a still lower level than southpaws. Some studies also suggest a link between left-handedness and a greater incidence of mental health issues like dyslexia, attention deficit hyperactivity disorder, and some mood disorders. Being left-handed may also be connected to a higher risk of breast cancer, sleep problems and a greater susceptibility to PTSD. On the plus side, being left-handed can help protect against arthritis and ulcers. But keep in mind that despite the findings of any ten studies, there are millions of left-handers who don’t exhibit learning disabilities, mental health issues, or any other negatives for which lefties are supposedly at higher risk. Ultimately, what researchers don’t know about this topic — including why some of us are rightie and others are leftie in the fi rst place — is far greater than what they do know. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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