Medical Examiner 9/6/19 by Daniel Pearson

MEDICALEXAMINER

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SEPTEMBER 6, 2019

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POSSIBLE/IMPOSSIBLE Have you tried Burger King’s Impossible Burger yet? If so, what was your opinion? If you haven’t, it may only be a matter of time before you sample something that pretends to be meat. Plant-based foods that masquerade as meat are about the hottest thing going in the food industry these days. In fact, just down the road late last month in Smyrna, Georgia, a KFC restaurant was repainted green & white instead of the typical red & white color scheme. The occasion: test marketing “Beyond Fried Chicken,” veganfriendly chicken-free fried chicken. And just like the pandemonium that was unleashed when Popeye’s rolled out a new chicken sandwich (made from actual chicken), the KFC experiment was greeted with lines so long that police had to be called out to direct traffic. Nutritionists and dietitians have been encouraging us all for years to make our diets more veggie-centric. Longer life and better health is clinically proven to be linked to plant-based diets. The media hype suggests that this is a pivotal moment. A corner has been turned in the direction of healthier eating. Or has it? If you take a look at the nutritional profile of a regular Whopper versus an Impossible Whopper (see below), it’s a lot like the two burgers pictured. CAL

FAT (g)

630

680

SAT FAT (g) TRANS FAT (g) CHOLEST (mg) SODIUM (mg) CARBS (g) FIBER (g) SUGAR (g) PROTEIN (g)

SCRB19012CR-Medical Examiner-SEPT-outlines-PRINT.pdf

CMY

Which one is beef and which one is a plant-based patty that merely looks like beef? It’s not easy to see a significant difference, either in the photos or the nutritional data. (And if you’ve noticed, we’re not telling.) As our in-house no-nonsense nutritional consultant, Warren B. Karp, Ph.D., D.M.D., has pointed out (see his newest column on page 8), even if the Impossible Burger is significantly better from a nutritional standpoint than a regular beef burger (which, again, it is not), by the time you add cheese, French fries and a Coke (a Diet Coke, of course), you’re back where you started. As Dr. Karp has said, the real issue is not that Joe occasionally has a Whopper and Jack occasionally has the Impossible version. No harm, no foul. The issue is what Joe and Jack (and you and I, for that matter) do day in, day out. Our entire eating pattern is the key to success or failure, not the Glutton’s Pork Platter or the alfalfa spouts entree we only rarely feast on. So when you hear wild claims that the Impossible Burger is riddled with carcinogens or that it’s science project food created by mad scientists, you can rest easy knowing that it doesn’t hold a lofty enough place in your personal food pyramid to amount to a hill of beans — which, ironically, it’s made from. +

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AUGUSTAMEDICALEXAMiNER

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

PARENTHOOD by David W. Proefrock, PhD

Your 10 year-old son has always been a bit of a behavior problem, but you have recently noticed that he has been treating the family pets cruelly. He denies he is hurting them on purpose and claims he “accidentally” kicked or stepped on a dog. You are reasonably sure he is doing it on purpose. What do you do? A. Have a talk with him. Let him know that you think he has been hurting the pets on purpose and that you want him to stop. B. Spank him when you see that he has mistreated a pet even if he claims it was an accident. C. Take him to a mental health professional for an evaluation and then for treatment if needed. D. Put him on restriction and make sure he is not allowed family pets until you feel that he can be trusted not to hurt them.

SEPTEMBER 6, 2019

ON THIS DAY IN HISTORY

It was one year ago today that Augusta musician Phillip Lee Jr. (shown below onstage at the Imperial Theater with Ed Turner and Number 9) ended his life by suicide at age 29. Phillip’s story is not unusual in that hundreds of people were left grieving: parents, brothers and sisters, fellow workers (in this case, many musicians) and countless friends and acquaintances. Even his dog was affected: a month or two later when a friend returned a jacket Phillip had left behind someplace, his dog Jagger was both excited and confused as he sniffed the jacket, obviously remembering his master. People had their own conflicting emotions: shock, grief, regret, and guilt (“Could I have done something?” “Should I have spotted signs that could have prevented this?”)

SEPTEMBER 6

2018

These are common emotions: the U.S. suicide rate has tripled since 1999. It is the second-leading cause of death among 10- to 34-year-olds, the fourth highest cause of death for people aged 35 to 54, and for all age groups ranks as the 10th-leading cause of death. And as Phillip’s death illustrates, for every single suicide there are usually hundreds of additional victims. Considering that 47,173 Americans died by suicide in 2017, the toll is enormous. As bad as that

sounds, it could have been so much worse: according to the American Foundation for Suicide Prevention, there were an estimated 1,400,000 suicide attempts in 2017. What is the answer to this tragic scourge? While suicide is rarely caused by a single factor, there is a single number to call for help: 1-800-273-TALK (8255). Anyone can call, 24/7/365, including veterans (call the number, then press 1), anyone contemplating suicide, and anyone who needs advice to help a friend or loved one who is contemplating suicide. Not to be overlooked are the people who love us and would want to help in any way possible, if only they can be given the chance. Help is available. It’s waiting right now. +

If you answered: A. This type of behavior is too serious for a talk. Besides, if he is claiming that he is hurting the pets by accident, he already knows that you suspect he is hurting them on purpose. It’s too late for a talk. B. Using aggression to punish aggression is always a poor strategy. In this case, it is actually likely to make things worse. This behavior needs to be addressed by a professional. C. This is the best thing to do in this case. Cruelty to animals is one of the signs of underlying emotional and behavioral problems. Especially since he has shown other behavior problems, he should be evaluated by a professional. D. A restriction is not going to help even if it would be possible to enforce. If he were truly restricted from contact with the pets, how would you ever know that he was ready to be trusted? This is a serious problem and should be addressed by a professional. There are several behaviors that almost always indicate underlying emotional and behavioral issues. Cruelty to animals is one of those. When you see it, it must be taken seriously. + Dr. Proefrock is a retired child clinical and forensic psychologist.

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SEPTEMBER 6, 2019

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DECIPHERING HEALTH MYTHS, SNAKE OIL CURES AND OLD WIVES TALES BY “DOCTOR” TRACEY BUSBEE, M L I S, AUGUSTA UNIVERSITY

HEAD LICE PREFER BLONDES September is National Pediculosis Prevention Month/ Head Lice Prevention Month. As soon as I started researching the current literature and thinking about it, my head started itching. Nonstop. What are some of the old wives tales you’ve heard about head lice? My favorite is that they prefer blondes. While this is not true, they are definitely more visible in blonde hair. I remember sitting next to a friend at school and seeing them crawling in her gorgeous flaxen hair. I can’t remember if I caught

them that time or not. But almost every year an outbreak would occur. Letters would go home to parents and the next day half of the class would be absent while their parents frantically scoured, poisoned, and de-nitted the children and house. We also line up and had lice checks performed by school nurses. One fairly recent article about head lice appeared in Pediatric Nursing (September/October 2014). The researchers explored misinformation surrounding head lice. Here are some of the

common myths: that lice jump, they’re highly transmittable, nits/eggs mean live infestation, animals carry lice, the environment must be treated, dirty people get lice, communication of lice occurrences reduces lice cases, everyone who has come into contact needs treatment, and pediculicides (lice killers) are dangerous. Lice are not sentient creatures, nor apparently as agile as we’ve imagined. They are not going to spot blonde hair and spring from one head to another. In fact, a louse is most likely transmitted from head-to-head contact. There is truth that those with straighter hair, which is determined by the shape of follicles, are more likely to be the hostess with the mostest for lice. Another creepy fact is that lice don’t always just itch; they may tickle. That feeling is from them crawling through your hair. Their Please see LICE page 6

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WHY IS MY TEMPERATURE 98.6°?

Well, your temperature might not be 98.6°. But it’s somewhere in the vicinity. “Normal” body temperature can vary from one person to the next, even in the same person at various times of the day or night. But to even be in the same range as 98.6° is amazing when you consider that we rarely spend time in any environment that’s even close to our body temperature. Many homes and offices stay about 30 degrees cooler than our body temperature. How does it do this? The broad term for this kind of thermal equilibrium is homeostasis, although that includes the body’s maintenance of pH and fluid balance, sodium, blood sugar and oxygen levels and more, all at factory pre-set levels. Humans are endotherms (or “warm-blooded”), meaning we can internally generate our own heat (and cooling). Ectotherms (called “cold-blooded”), on the other hand, need outside sources like sunlight or a warm rock for their heat, and cool water or shade to reduce their body temperature. In humans, the brain’s hypothalamus acts as our thermostat. The two most simplistic examples of its work would be sending signals to muscles to shiver when it detects we’re too cold, and when we’re too hot it tells glands all over the body to release perspiration to cool us down. Other commands it can send out: to dilate blood vessels near the body’s surface. Increasing blood flow there (which makes us look red and “flushed”) takes advantage of the cooling effects of perspiration. Cooling is important since the body continuously generates heat. Every cell in the body produces heat as it burns energy, some more than others. Some cells generate heat via chemical reactions, while in others, like muscles, the heat is generated by movement. That includes not only the muscles involved in hard work, but also the constant motion of cardiac muscles as the heart beats non-stop throughout life. To keep us from getting too hot, the circulatory system dissipates this heat throughout the body, and the hypothalamus uses tactics as described above — and countless others. +

MEDICALEXAMINER

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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

(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. © 2019 PEARSON GRAPHIC 365 INC.

SEPTEMBER 6, 2019

AUGUSTAMEDICALEXAMiNER

#98 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

hen something you invented is still going strong more than a century after your death — and has probably been bought and consumed by every person reading this article — it’s safe to say your invention is quite successful. That is certainly true of this man’s contribution to the world. And it all started not far from here, in Knoxville, Georgia, an unicorporated community just west of Macon. That’s where John Stith Pemberton was born in 1831. Like baby boomers born just in time to be sent to Vietnam, Pemberton was the perfect age to be caught up in the Civil War. Prior to that, however, he had earned a medical degree in 1850 at the tender age of 19 at Macon’s Reform Medical College of Georgia. His medical specialty was chemistry. By 1853 he had married, and in 1854 their only child, Charles (“Charley”), was born. After briefly practicing medicine, Pemberton opened a drug store in Columbus. It was during and after the Civil War that his background in medicine and chemistry converged. Defending his city as a lieutenant colonel in the Confederate Army during April 1865’s Battle of Columbus, Pemberton sustained a near-fatal saber wound to the chest. He was soon addicted to the morphine used to treat his pain. Seeking a cure for his addiction, Pemberton turned to his knowledge of chemistry and began experimenting with various therapeutic concoctions, many of which contained amounts of then-legal cocaine. The first formulation he considered worthy of commercial exposure was “Pemberton’s French Wine Coca,” which was advertised as an “intellectual beverage” and “invigorator of the brain.” In addition to alcohol, it also contained kola nut, noted by herbalists for its medicinal properties (and its caffeine), as well as extract of Damiana, a reputed aphrodisiac. If all that isn’t a formula for success, what is? Alas, the temperance movement forced Pemberton to retool his concoction and make it alcohol-free. By 1885, he was selling a temperance-approved syrup formula with all the requisite ingredients (cocaine, caffeine, sugar, etc) to drug stores, where it was mixed with carbonated water as a soda, ideal temperance drink, and “brain tonic.” The formula contained extracts of kola nut and cocaine until somewhere around 1903 to 1905 (historical account differ), when Asa Candler replaced them with other ingredients. Candler entered the picture in 1888 when Pemberton sold him the business for $1,750, roughly $50,000 in today’s dollars. With Atlanta’s prohibition laws overturned, Pemberton planned to create other new beverage formulations, but death intervened on August 16, 1888. He was only 57. His son Charley, who had been part of the family business, died soon after, in 1894, at age 40, reportedly of a drug overdose. Pemberton was a trustee of the Emory University School of Medicine, was one of the founding members of the Georgia pharmacy licensing board, and also founded a laboratory still operated by the Georgia Department of Agriculture that conducts tests of soil and crop chemicals. +

HOSPITAL FOOD, PART I by Marcia Ribble Food at [the rehab/nursing facility operated by one of our major hospitals, both of which shall remain nameless] is the thing they get the most complaints about, and those complaints are well deserved. The food is uninspired at best and truly gross at worst. Even the simplest of my requests took almost the entire time I was there to be implemented. For example, I treat all breakfast cereals as hot cereal like oatmeal, served in a bowl with room for milk, sugar, and maybe a little bit of butter. The last three out of the twenty days I was there I got cereal in a bowl. The rest of the timemy breakfast was slopped on a plate with what passes for eggs and perhaps a piece of bacon. Not bacon plural, mind you! They call some eggs scrambled and others hard eggs and neither bear any resemblance to eggs at all. They are dry, tasteless, a penalty for being sick. I would have paid fifty dollars for a couple of over-easy eggs with buttered whole wheat toast! Someone could easily make a fortune by selling black market real eggs to patients, with real toast — nice, crisp, even slightly burned toast would have been a treat! In addition to the rehab facility, the hospital also serves those awful eggs. Cruelty to patients who long for the eggs they get at home or at good restaurants seems to be the norm at all hospitals and care facilities, not just the one where I was incarcerated I’m sure there is a corporation somewhere that makes a fortune convincing hospitals and nursing homes to buy their products, which are probably more expensive than cases of real eggs would be. They should be banned from existence. We live in Georgia, right? I was in hospital and rehab care from July 12 through August 14, and I did not get one single bite of a sweet, juicy, wonderful Georgia peach! Nor did I get a spoonful of a Georgia peach cobbler.

Heck, I would have been happy with South Carolina peaches or fresh peaches from Michigan. I didn’t care what parentage the peach might have, whether it was cling free or firmly attached to the pit, or even if it was a nectarine. Fuzzy or not, the skin type wasn’t important! It is clear that no cook who prepared any meal for me ever got within fifteen miles of a farmers market, instead preferring boxed, precooked, processed quasi-food over the real thing. And even when they had the real thing, they managed to kill it to the point of being unrecognizable. I had a “fried pork chop” one day that was double the thickness of cardboard and equivalently tasty. Whoever cooked it hadn’t learned that meat for patients ought to at the very least be chewable, especially for patients who have no teeth. The need to cook pork for hours no longer exists, but even when I was a child, my mom made pork chops so tender a toothless baby could gum them. She floured them lightly, browned them in butter, added water, and simmered them until they were well done and tender and juicy and covered in luscious pork gravy. A heavenly treat served with mashed potatoes and more pork gravy! They do serve mashed potatoes, but they served them naked. Flavorless. Unappetizing. Bland. Like I said, uninspiring! Sick people and old people need food that both tastes good and looks good. Sending them a tray of “food” that they will not eat enriches only garbage dumps, not people. I didn’t keep close track, but on average I’m guessing that I ate little beyond the vegetables most of the time I was in medical care. I still don’t have much in the way of an appetite, and nothing about the majority of food I was served was appetizing. I needed nutrition. I had a serious infection sapping my strength. But I could not force that food into my mouth! I have more to say! Tune in next issue. +

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SEPTEMBER 6, 2019

Musings of a Distractible Mind

years ago I left feefor-service medicine and opened my direct care practice. The reason was a depressing and anxietyproducing struggle with burnout. And it wasn’t just me; it was a problem throughout medicine. In the 7 years since I left, things have just gotten worse. A new survey by Medical Economics Magazine (full disclosure: I write for them) involving more than 1,200 physicians showed a deepening of the already bad situation of physician burnout. • 92% of surveyed physicians reported feeling burnout during their career. • 68% reported feeling burned out now. • 73% said that the feelings of burnout made them want to quit medicine. • Of those, only 13% sought professional help for dealing with their burnout.

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

There are many reasons for this growing despair among doctors:

MEDICALEXAMINER

• Too much paperwork and government/payer regulations.

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• Poor work-life balance/ work too many hours • Electronic Health Records • Lack of Autonomy/Career control • Insufficient pay/declining reimbursement • Overwhelmed by patient needs

The first five items on this list are not patientrelated. These are the things distracting the doctor before they come to the exam room to see you. Patients aren’t more needy than before; they just have a smaller and smaller portion of the doctor’s time and attention. Back then I probably spent 50% of my time on direct patient care, and saw between 20 and 30 patients per day, with the remainder of the day spent on documentation, billing, and making sure all the appropriate boxes were checked for the government. In contrast, I now spend about 80% of my time on direct patient care and see between 8 and 12 patients per day. But, I must confess, I still feel some of the emotional fatigue and claustrophobia I felt in my old practice. Perhaps it’s just PTSD from my past life as an abused fee-for-service PCP, but I think there’s something more than that. I was talking to a retired pastor recently, and the subject of burnout and professional fatigue came up. I mentioned the image of a never-ending line of needy patients and he nodded. “Yep. Pastors definitely feel that. You give your heart out to someone and then there’s another person coming in the room when they leave.” Teachers I’ve talked to about this deal with this as well. Add to that the stresses and strains of life we all face, and things get harder. I have big financial stress caused by the lean years as I started my practice. I also have aging parents I want to see as much as possible.

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And I went through a divorce (which I don’t blame on my work, but it definitely played a part). My life is not harder than most, but it’s not easy either. So I find myself having moments of struggle. Do I have it in my tank to do another week, month, year, or decade? I find myself wishing I didn’t care so much. I wish I could treat my work as a job — just a means to make an income. I guess I could do that. But I’d have to give up my soul. I’d have to give the compassion that drove me to risk everything by starting this new practice. I’d have to see this profession as a job, not as a calling. I couldn’t look at myself in the mirror if I did that. I know that doctors are not alone in these feelings, and am not implying that we are being victimized. But I am saying that the system as it stands works against the very type of doctor most people want: a compassionate person who listens and gives time when needed. Those doctors are eaten alive by the system and forced either to conform to the fast-moving conveyor belt of modern healthcare, or they retire early, work in corporate medicine, or escape completely (like I did). Like almost any field, medicine will always have some degree of burn-out. But we must find a way to reward doctors who are caring and compassionate, not chew them up and spit them out. It’s a hard job. Even the best of situations (like mine) can weigh heavily. Especially if you care. +

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LICE… from page 3

SEPTEMBER 6, 2019

saliva causes the itching. However, sensitization to the saliva is required. Some people who have lice for the first time may not even itch for weeks after initial infestation. The presence of nits, or eggs, is not indicative that there is a live infestation. The egg casing is often left behind after the lice have hatched. The best determination of a live infestation is a louse. A live louse. Children have often had lice for weeks before they are discovered. Surprisingly, a few studies have found that sending notes home and in-school checks are not helpful in curtailing the spread of lice. Also, schools are not the most common place for kids to catch lice from other kids after kindergarten. They are more likely to get them from relatives, and other children at sleepovers, camps, and so forth. An important misconception to address is to not stigmatize those who have lice. They are

not caused by uncleanliness and almost anyone can get them. If you find that your child has lice, speak to your pediatrician before going to the extremes of treating everyone in your zip code, burning the linens, and living your life in shame. Consider using an OTC product containing permethrin. Most research shows they are safe and more reliable than homeopathic remedies. But as always, if you have concerns, speak to your pediatrician. If you’re itching now like I am, it is probably all in your head. + References Pontius, D. J. (2014). Demystifying Pediculosis: School Nurses Taking the Lead. Pediatric Nursing, 40(5), 226–235. Retrieved from http:// search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103907384&site=eds-live&scope=site

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Your turn for what? To tell the tale of your medical experiences for Medicine in the First Person. 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. See our “No Rules Rules” below. Thanks!

“My leg was broken in three places.”

“This was on my third day in Afghanistan.” “I lost 23 pounds.” “We had triplets.” “He was just two when he died.” “The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.” “I sure learned my lesson.” “The cause was a mystery for a long time.” “The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.” “I thought, ‘Well, this is it’.” seven years ago.”

“Now THAT hurt!” “OUCH!”

“Turned out it was only indigestion.”

“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”

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.

SEPTEMBER 6, 2019

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AUGUSTAMEDICALEXAMiNER

GARDENVARIETY

Bread Salad every five minutes. Remove from oven to cool when they are starting to toast and turn golden. Dressing Place 1/3 cup olive oil anchovy paste, red wine vinegar, minced garlic, fresh basil, salt and pepper into a small bowl and whisk. Set aside. Slice cherry tomatos in half, place in a bowl with capers, and sliced olives. Give the dressing another quick whisk then drizzle over vegtables. Toss in toasted bread cubes and serve. + by Gina Dickson. “As a mother of six who beat cancer, I want to share with you what I’ve learned. Healing from cancer can take everything a mom has, yet you still want to love and care for your family through the treatments. My blog is a community of encouragement for moms going through cancer treatments who would like to use a plant-based vegan diet to complement their healing journey. www.thelifegivingkitchen.com

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Instructions Preheat oven to 375 degrees. Cut bread into 3/4 inch chunks, place in large bowl, drizzle with 4 tablespoons olive oil and toss. Bake on cookie sheet in oven for approximatly 15 minutes, stirring

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Dressing • 1 medium clove garlic minced • 4 tablespoons red wine vinegar • 1/3 cup quality olive oil • 1 teaspoon anchovy paste • 2 tablespoons fresh basil cut into small ribbon size pieces with kitchen scissors. • Salt and fresh ground pepper to taste

I AV

Ingredients • 4 cups dry crusty Italian style bread • 4 tablespoons quality olive oil for toasting bread • 2 cups cherry tomatos in various colors and shapes • 2 tablespoons capers • 1/3 cup green olives sliced

Tomato season is winding down for another year, but somehow the cherry tomato plants don’t want to give up. I was trying to find a way to use them in a unique hearty salad. After researching some ideas, I discovered that Italians have a traditional dish called bread salad. Yes, you read that right, bread salad. It’s also known as Italian Panzanella which is stale crusty bread tossed in olive oil and herbs. Its roots are Tuscan, and it is a popular summer dish throughout Italy. The charm is in its simplicity; it’s inexpensive to make, uses up leftover dry bread, and is oh so delicious. The recipe is the base for a springboard of endless combinations to please everyone in your family. To make each bread salad unique, vary the toss-in ingredients to whatever happens to be in season. Grilled corn, roasted peppers, tomatoes, onions, squash, cooked eggplant, peas, or some fresh greens all are great choices. Basically whatever vegetable you have on hand or in abundance from your garden. I have also found a few recipes that included fruits like peaches, apples, and raisins. The combinations aree endless as long as you start with a robust hard crusty bread, and a good quality olive oil.

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ASK DR. KARP

NO NONSENSE

NUTRITION Charlene from Myrtle Beach asks: “What should I give my toddler to drink?”

Your question is very timely. It seems that everywhere you look these days, you see kids, including toddlers and babies, drinking trendy drinks instead of water or skim milk. You see these drinks not only in sippy cups, but in baby bottles, too. I can’t even count the number of times, for example, I have seen soft drinks, sports drinks and even sweet tea in a kid’s bottle. According to The American Academy of Pediatrics and other children’s health organizations,

AUGUSTAMEDICALEXAMiNER toddlers should be drinking skim or low fat milk or water. If you are simply worried about fluid replacement because of sweating, water would be the drink of choice. That’s it. Juice is not recommended as a routine source of fluids, but if you give juice, make sure it is 100% juice, in small quantities, infrequently, and not in sippy cups. Children who drink juices consume about 100 extra calories a day, a significant number of calories for their age and weight, which may lead to weight gain. The impact of the constant exposure of sugared or acidic drinks on toddler and children’s teeth is indisputable. If a toddler is suffering from dehydration, for example, due to prolonged vomiting or diarrhea, drinks like Pedialyte, are recommended for re-hydration. In fact, The American Academy of Pediatrics recommends oral re-hydration therapy over I.V. re-hydration, especially for toddlers who are mildly or moderately dehydrated. What about those zero-calorie, artificially-sweetened (and usually artificially colored) drinks? Is

that ok to give to toddlers? While it is true that they do not contain calories leading to weight gain and dental caries, there are three major issues with providing artificially-sweetened beverages to toddlers. 1) The drinks tend to take the place of calcium-rich drinks, such as skim or low fat milk, 2) The sweet-tasting, 0 calorie/0 sugar drinks reinforce sweet-seeking behavior, especially at an early age. You are not just giving your child something to drink; you are educating and reinforcing a child’s drinking preferences.

SEPTEMBER 6, 2019 These preferences will turn into adult preferences. 3) Finally, these “diet” waters and drinks usually have a very low pH; that is, they are acidic. That means that they can directly de-mineralize tooth enamel without the need for oral bacteria to produce these destructive acids biologically first. Remember, toddlers have actively growing skeletons and they need a constant source of daily calcium. The Recommended Daily Allowance for calcium in toddlers (ages 1 - 3 years) is 700 mg/ day. This is equal to a little more than 2 cups of milk per day. Substituting non-dairy soft drinks or juices of any type for low fat or skim milk makes achieving this goal difficult, if not impossible. An occasional soft drink is not an issue; however, people over-estimate what occasional means. It means once in a long, long while; infrequently. Certainly not routinely or every day. There is a worrisome trend in the U.S. of parents reducing milk and water consumption and increasing non-nutritious drink

consumption in toddlers and children. Allowing a child to have free access to non-nutritious drinks at arm’s length in a refrigerator or on a kitchen shelf is a recipe for problems. In addition, if you are a parent guzzling down soft drinks, sports drinks or flavored waters in front of your kids and expecting them to drink water and skim milk, forget it. Modeling correct behavior is what works, especially with kids. What’s the “No-Nonsense Nutrition” advice for today? It’s very clear. Toddlers have actively growing bones. They are not miniature adults. Toddlers need a daily source of calcium which they cannot get from juices, sodas and drinks, whether they are sweetened with sugar or sugar-free. Low fat and skim milk are readily-available and biologically-active sources of calcium. Dietary calcium can be obtained from other, non-dairy sources, but it becomes more challenging and expensive. Low calcium exposure early in life may be an important risk factor for bone fractures in adolescents, particularly adolescents participating in sports. If you are just concerned about replacing fluids from sweating, water would be the drink of choice in a normal, healthy toddler. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to insure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www.wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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Ask a Dietitian

got feet?

WHAT ABOUT INTERMITTENT FASTING? by Jeanne B. Lee, MS, RD, LD

I was recently told by a friend that she has lost weight by “intermittent fasting” and recommended that I try it. It makes some sense but is it safe? Each of us make hundreds of decisions regarding food every day that contribute to our health and ultimately to our weight. We make decisions on what foods to eat and drink, how much of these to eat, where we eat them, how often or what times we eat, why we eat (hungry or not?) and how those foods are prepared. In counseling clients on weight management, a dietitian might help a person look at some of their choices and review changes that could be made to reach a healthier weight. Addressing what, an obvious change in decreasing calorie intake could be drinking more water and calorie free beverages instead of sweet tea and sugar-laden sodas. Another change one might make is to become more aware of where you are eating, and make it a firm rule not to eat in the car, on the sofa in front of a TV, or in the bedroom! Fasting addresses the problem of when we eat. Intermittent Fasting (IF)

is advocated by some as another way to lose weight with possible health benefits. Intermittent fasting addresses one of the decision making factors often associated with being overweight: eating late at night or eating and snacking too often throughout the day and evening and thereby consuming more calories than are expended, then storing those calories as fat. Intermittent fasting is a general term to describe various methods of restrictive eating. IF is when a person partially or entirely abstains from eating for a set period of time. During this time the person may consume water or non-caloric beverages but does not consume any foods or beverages that contain calories. How does it contribute to possible weight loss? When one goes without food for a longer period of time (normally 12 hours or more) your body begins to burn up glucose circulating in the blood, as well stored energy (glucagon) and this can result in lowered insulin levels and cause the body to begin burning fat for fuel. There are many forms of IF, with the simplest and most recommended for “beginners” being a 12-hour fast. Not eating anything

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after 8 p.m until after 8 the next morning would be considered a 12-hour fast. For most of us, this would be not eating for 12 hours after our evening meal (time when we’ll be mostly asleep). Some IF regimens restrict calorie intake for 16 hours (for example, from 8 p.m until noon the next day), some call for a 24hour fast on certain days of the week (consuming water and juices, but no food), and still others are “feast & fast” plans that instruct a person to consume no more than 500 calories per day (considered a “fast day”), alternating fast days with unrestricted calorie days (feast days). There are many popular books that address different kinds of fasting, but before reading any you might want to ask, what are the risks? Some of the side effects of IF include extreme hunger, mood swings, low energy levels, feeling cold, irritability, problems focusing leading to lower work productivity and problems with food obsession that may lead to binge eating later. Intermittent fasting is not recommended for many. Those who should not try IF are those who have any sort of disordered eating, type 1 diabetes, type 2 diabetes - medication controlled, pregnant or breastfeeding moms, athletes, those who have had surgery recently, or those with mental health problems.

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CRASH I

COURSE

n our last episode, boys and girls, we promised (or threatened) that the topic of this installment of Crash Course would be “the Cheetos Diet and traffic safety.” We keep our word. If you’re reading this newspaper it’s a fairly safe bet that you care about your health. You try to get regular exercise and plenty of sleep, you brush and floss and get regular checkups, and try to eat a healthy diet. But really, what’s the point? As we have previously said — and as we have all seen with our own two eyes — traffic laws are often observed only when it’s convenient to do so. When you’re running late and that light up ahead turns yellow and then red and you’re already speeding anyway, stopping would be so inconvenient. And those laws that say it’s illegal to talk, text, post on Instagram and Facebook and even so much as touch your device while driving, do they seriously expect people to obey those laws?

The apparent answer: only if it’s convenient. But what does all of this have to do with Cheetos? It’s very simple, really. On the one hand, more and more people are trying to be ever more health-conscious in their everyday eating habits. Still others are spending

buckets of money on designer water, gym memberships, and yoga classes. They invest major chunks of time in wellness pursuits. They are pro-life. They attend the church of their choice. But then they hop in their cars and proceed to merrily talk and text their way down the road, speeding and tailgating, including tailgating through red lights, playing follow-the-leader behind the two or three drivers ahead of them who also ran the light. They drive like they are pro-death, possibly their own, possibly someone else’s. They break the Golden Rule every time they’re behind the wheel. These are the kinds of things that have killed more drivers on U.S. roads since 2000 alone — 624,000 and counting — than died in both World Wars. It doesn’t make sense, does it? To be super health-conscious in a large part of your life, and then law-breaking and death-defying in another. It presents two choices for every driver. One: Stop ignoring the law; stop endangering yourself and others; start trying to drive legally and live salubriously all the time. Two, embrace the alternative: keep driving like you already are. Now you’re free to eat all the Cheetos sandwiches and deep-fried Oreos you want. Because after all, life is short. + Next issue: Red means GO GO GO!

Proudly affiliated with Dr. John Cook of Southern Dermatology in Aiken

SEPTEMBER 6, 2019

HUMAN BEHAVIOR

How neuroscience works in everyday life

Ever forgot someone’s name at work? Embarrassing, right? One of my patients came to me about this problem. He wanted to know what he could do to remember people’s names better, focus better, improve his thinking and just be better at his job. I outlined some simple strategies. “I’m too busy to work on those things,” he said. Is that your problem? It’s hard to change. But guess what? It can take as little as just three weeks to get into a brand-new routine that’s a better fit for you.

HOW TO WORK BETTER — AND SMARTER

What’s The Problem? When you’re stressed and overstretched at work, you feel it: Maybe you can’t sleep, you’re short with your kids or spouse, you’ve gained or lost weight, you eat more or don’t eat much at all, you experience headaches, stomachaches or other body pain, or you just plain feel exhausted and don’t know why. So here’s what you can do: Consider How You Work The #1 reason people struggle with staying organized at work is because they’re trying to force themselves to do things in a way that doesn’t line up with their strengths. For example, some people are serial processors—they like to finish one task before moving on to something else. Others do better by working in time segments—compiling a list of things to do, then working 20 minutes at one, 20 minutes at the next, and cycling through before starting all over again. So start by thinking about how you like to work, then try aligning your work process to make it a better fit for you. What’s Your Stress Level? Despite what most people think, stress and anxiety are not always bad. There are situations in life where we should be anxious and stressed out, like when facing that looming deadline at work. That doesn’t mean you’re coping poorly—it could mean you’re giving it your full attention. So give yourself permission to feel those things. The trick is not to react negatively to stress. Instead, manage your anxiety by pacing yourself. Talk to your boss or team members about what you might need, and remember that your company wants you to be successful. Also, good sleep and daily physical exercise—even if it’s just taking a few moments to walk outside in the sun—can do wonders to help manage and relieve stress. Pre- and Post-Work Techniques Every morning, plan what you’re going to do that day and how you’re going to do it. The drive to work may be a great time to do that. Keep your thoughts organized throughout the day on a notepad or a notes app on your phone. After work, make sure you don’t carry stress home. For example, listen to music you enjoy or call friends or family who always make you feel great. Or, call your spouse and let him or her know that you need a half-hour when you get home to

M.D. John Cook,

Pictured above (from left to right), John Cook, MD; Lauren Ploch, MD; Jason Arnold, MD; Caroline Wells, PA-C; Chris Thompson, PA-C

Please see HUMAN BEHAVIOR page 14

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The blog spot From the Bookshelf — posted by Cory Fawcett,MD, on December 22, 2017

DEBT: BAD SHOES ON NUMB FEET In a society living on credit, a government deep in debt, eight years of debt desensitization during training (something unique to doctors), rising tuition, and falling pay — it’s no wonder many doctors have a major problem with debt. Where will it end? Debt has become the norm. Will Rogers summed up this pattern of high consumption on borrowed money nicely: “Too many people spend money they haven’t earned to buy things they don’t want, to impress people they don’t like.” Most doctors have seen a long-term diabetic patient sometime during their career. After many years of out-of-control blood sugar, nerve damage begins to take place. The patient begins to lose feeling in his or her feet. Tim was one such patient with diabetic neuropathy, who bought a new pair of shoes for a vacation to Russia. He walked all over Saint Petersburg in those new tennis shoes. He came home and noted a fever and a bad smell coming from his foot. Those new shoes had caused a blister on his foot, but he couldn’t feel it due to the neuropathy. As he continued to walk on the blister, the damage got worse. Later, the blister popped and the wound became infected. The entire bottom of his foot was lost. Informing Tim of the need for a below-knee amputation was not easy. He would have none of that. No one was going to cut off his foot. He had been a diabetic for many years and took excellent care of his feet, despite the neuropathy, and he wasn’t going to lose one now. He couldn’t feel the problem, and he couldn’t see the problem, but the problem was there nonetheless. The top of his foot, which was all he could see, seemed a little red. I got a mirror so Tim could see the bottom of his foot. Only after personally seeing all the skin and subcutaneous tissue missing, and the tendons and bones visible, did he finally realize there was a problem—a serious problem. Tim’s situation is similar to what medical school debt is doing to doctors. We don’t see the problem, we don’t feel the problem, and so what’s the big deal? Everyone else is doing it. Doctors are suffering from debtabetic neuropathy: Debt is like poorly fitting shoes on numb feet. Your financial future is rotting away, and you’re not even aware it’s happening. Eventually, the smell gets your attention, but by then it’s too late. A bankruptcy (amputation), divorce, or even a suicide may be looming on the horizon. Don’t let debtabetic neuropathy get a foothold on you. +

Many doctors have debtabetic neuropathy

Cory Fawcett is a general surgeon and financial adviser and blogger

FASTING… from page 9 Much of the research on intermittent fasting has been done with animal studies and just recently research is emerging with human studies. Where advocates of IF make claims for weight loss, recent systematic reviews show the studies to be of short duration, with few participants and mixed findings. As one dietitian pointed out, “going without food means also going without protein, vitamins, minerals and phytonutrients,” making it difficult to make up for nutrients not consumed during fast. Having a big bowl of ice cream or eating a bag of chips while watching late night television is not a good habit for anyone. Being overweight is a chronic health problem for millions of Americans. Perhaps taking a look at a tool like Intermittent Fasting might be worth the time if mindless snacking at night is contributing to weight gain. A registered dietitian would be able to help you interpret which of your daily food decisions may be contributing to your weight gain as well as identifying ways to improve your health through nutrition. +

It’s hard to fill more than 300 pages with historical accounts of the worst plagues in history and keep things pretty. And sure enough, even positive reviews of this book use words like “morbid” and “gruesome.” On the other hand, there are also words like “selfless” and “heroic,” since the story is also about the healthcare heroes who helped stem the tide of the most epic disease outbreaks in human history. In some ways we are most fortunate to live in 2019. As Wright points out in her introduction, when she would tell friends she was working on a book about plagues, some would suggest including modern plagues. Like selfies. Or people being on their cell phones all the time. No, she said, I think I’ll stick with the kinds of plagues where open sores break out all over your body and within a few days you’re dead, along with countless people you know and love, all cut down in perfect health in the prime of their lives. Oh, that kind of plague.

One of the lessons of history is that people must learn from it. And another lesson is that frequently they don’t. In the context of plagues, Wright reasons that sometimes people think of plagues as infesting primitive, ignorant and superstitious cultures of distant centuries. And then a plague of some kind breaks out in the 20th or 21st century. That’s us. Are we primitive? Ignorant? Superstitious? We would be offended if people a century or two from now thought we were, yet we often consign

people of past generations to those categories. That, argues Wright, would not help us when (unfortunately not if) the next plague(s) strike. Example: in writing about the bubonic plague, Wright writes (right?) about the average medieval person who “latched on to treatments that were absolutely, utterly insane.” She goes on to list many of them, but the point here is that it’s exactly what many people do today: they ignore reams of scientific data and do things — or avoid things — that in the end have at best no benefit whatsoever and often make things worse. One thing you’ll enjoy about Get Well Soon: it is not written like a dry, boring textbook. It takes a special talent to write about polio, typhoid fever, leprosy and other plagues with lively wit, but Wright pulls it off. Kind of like, if you enjoy this newspaper, you’ll enjoy this book. + Get well Soon - History’s Worst Plagues and the Heroes Who Fought Them, by Jennifer Wright, 336 pages, published by Henry Holt and Co. in February 2017.

Research News The end of fillings is near At least that’s the hope of scientists from Zhejiang University School of Medicine in Hangzhou, China. The journal Science Advances reports that researchers there have developed a formula for mixing calcium and phosphate ions in an alcohol solution with a chemical called triethylamine. When brushed on teeth, within 48 hours it repaired enamel to a thickness of about 2.7 micrometers. Most significantly, the enamel regrowth duplicated the complex structure of overlapping microscopic rods found in natural enamel. As always, further study is required before your dentist is routinely using this procedure. Got the itch? It can be maddening, can’t it? To make matters worse, doctors, dermatologists and clinical researchers can’t

always determine exactly what causes a chronic itch. In general, however, itches are part of the light touch part of the touch spectrum, and that’s a highly important part. Light touch is what we use to pick up an egg without crushing it, how we feel a cool breeze or sense the mosquito that lands on our arm. Scientists at the Salk Institute have discovered that the sensation of itching is separate and distinct from other forms of touch, and is conveyed to the brain via its own specialized pathway in the spinal cord. The discovery may lead to a better understanding of how to treat or prevent chronic itch that plagues people with eczema, diabetes, some cancers, and other itchproducing conditions. Not all exercise created equal A study of nearly half a million people has found

for the first time that those with heart or vascular issues benefit more from physical activity than do healthy people without cardiovascular disease (CVD). It’s not that exercise doesn’t benefit everyone. It does. But researchers found that the greatest reduction in risk was among people with CVD. The research, said by its authors to tbe the first of its kind in comparing exercise benefits of people with and without CVD, was conducted in Korea. 441,798 people were enrolled in the study, of whom 131,558 had CVD and 310,240 did not. All participants were over 40; the average age was 60. Participants were tracked for six years. The study was published Aug. 31, 2019 in the European Heart Journal and presented at presented at the World Congress of Cardiology in Paris. +

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AUGUSTAMEDICALEXAMiNER

The Examiners

SEPTEMBER 6, 2019

But that was the best dinner you’ve ever made.

Even so...

by Dan Pearson

I just wanted to show my appreciation.

I get that too. But if you ever dump a keg of I thought since it’s Gatorade on me again, so help me... football season now...

I understand that.

The Mystery Word for this issue: CCELLVIA

PUZZLE

ACROSS 1. Former Augusta District Attorney 6. Shatter 11. Fat meas. 14. River in Paris 15. Craze 16. Operated 17. Late 18th century movement in arts & literature 19. Giant of note in baseball 20. Fuel Trump promised to energize 21. Join metals with high heat 23. Georgia, for example 24. South American country 26. Inhibitor lead-in 28. Downtown furniture store 29. Leader of a certain army 32. Excited; eager 33. Ernie of the PGA 36. Thinner 37. Doctoral associate 39. Organ of hearing 40. 27th US President (and a former Augusta visitor) 42. Minor details 43. Steps for scaling a wall or fence 44. Curved 45. Process of mountain formation 48. Mr. Brown 51. Concrete reinforcement 52. By mouth 54. Command to a horse 55. Sadness; gloom; depression 61. Donkey 62. Singer Fiona 63. Old way to settle disputes 64. Born 65. Rule of _____ (in burns) 66. Plant fiber

19 21

43 46

52 56

We’ll announce the winner in our next issue!

E X A6 M I N E R

5 8 7

2 1 3 6 3 7 2

S U D 2 O K U

5 9 1 4 5

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

DOWN 1. Area abbrev. 2. Speedwagon intro 3. Intention 4. Apathy in a situation that calls for a response 5. Seaport in NW Italy 6. Look happy 7. Shortened name for many computers 8. Black bird of South America 9. Sib 10. Farmhaus offering 11. Main Street Augusta? 12. Passover bread 13. Bury 18. Make lace 22. Mr. Floyd 23. Echolocation 24. Brain wave letters 25. Lara of Tomb Raider 26. _____ nurse 27. A of 1-D 28. Dull finish

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, SEPT. 16, 2019

30. CBS’ Dave 31. Milk (as a verb) 33. Cookie makers? 34. Cut of meat 35. Police team 38. Defamatory 41. Move through the air 43. Campus org. 45. What a person might donate 46. Summerville library 47. Corpulent 48. _______ Creek 49. Curve 50. Muslim messiah 53. Flower holder 56. On, upon or above prefix 57. RN colleague 58. The “A” of IPA 59. Permit 60. Sick

Solution p. 14

7 4 8 3 5 ?2 6 9 2I 5 4 1 3 8 9 6 1 7

— Eleanor Roosevelt (1884—1962)

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.

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

1 2 1 2 3

D 1 2 3 4

1 2 3 4

1 2 3 4 5 6

1 2 3 4 5 6 7 8 9 10 11

O 1 2 3

L 1 2 3 4 5 6 7

1 2 3

1 2

1.WIFIPRAITB 2.THEEHEDONS 3.SLOOREEN 4.PIPTA 5.LEO 6.NVE 7.SE 8.I 9.B 10.L 11.E

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

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

‘

EXAMINER CROSSWORD

THE MYSTERY WORD

9 6 1 3 8 7 5 2 4

5 4 3 2 1 9 7 8 6

1 2 6 4 7 8 9 5 3

8 9 7 5 3 6 1 4 2

SEPTEMBER 6, 2019

13 +

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

n his very first day working as a co-pilot, the nervous flyer looked down in the cockpit and asked, what are all these buttons for? “They keep your shirt closed,” said the pilot. To the person who stole my glasses: I will find you. I have contacts. Moe: I just called the paranoia hotline. Joe: So? Moe: So the guy who answered said, “How did you get this number?!” Moe: I got hit by a car this morning. Joe: Oh no! You don’t look hurt. Are you ok? Moe: Yeah, I’m autoimmune. Moe: My friend can’t afford to pay his water bill. Joe: That’s too bad. Can you help him? Moe: Yes. I sent him a “get well soon” card. Moe: A word to the wise for Medical Examiner readers in Aiken. Joe: And that would be what?

The

Advice Doctor

Moe: Never buy hay for your horses on Amazon. Joe: Why not? Moe: Because a few days later they’ll ask for your feed back. A guy goes in to a farm supply place and asks for a dozen bees. As the guy watches, the shopkeeper counts out thirteen bees and hands them to the man in a mesh box. “Excuse me,” the guy says, “but you’ve given me one too many. I only wanted twelve.” “That’s okay,” said the clerk. “That last one is a freebie.” A vegan, a runner and an anti-vaxxer walk into a bar. Everyone else leaves A man came home from work early and found his wife in bed with another man. The stranger challenged the husband to a duel. He agreed, so they walked into another room of the house where the man kept his guns and closed the door. The man quietly said to the stranger, “Look, why should either one of us die over this? Let’s both shoot into the air, then we fall to the floor and wait. She’ll run in, and whoever she goes to first, that man can have her.” The stranger agreed. They both shot into the air and fell to the floor. The wife rushed in, looked at the two bodies and called, “Sweetheart, you can come out. It’s safe now. They’re both dead.” +

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

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

Dear Advice Doctor, My family has a severe case of over-achievement syndrome, if there is such a thing. And if there isn’t, there should be. I am a teacher, which I consider to be a noble and worthy profession. All my brothers and sisters, meanwhile, are surgeons and attorneys. My career pales by comparison. It wouldn’t matter if I was the national Teacher of the Year, I would still be the family underachiever. Any advice on how to deal with the ongoing abuse and condescension I get from my siblings? — Loser Among Winners Dear Loser, It’s good that you took the time to ask my advice about this important subject. In most cases simply being pale is not clinically significant, but there is always the chance that it’s evidence of something that should be addressed. As you note, you are merely pale by comparison. Your siblings may just be more olive-skinned or dark complected. Learn to avoid comparing yourself to others. A fair complexion is nothing to be ashamed of. But what about those cases when there is some medical issue that needs attention? Let’s take a brief look at those. Usually paleness is caused by illness. The point of concern is not the pallor itself but the reason behind it, such as a bad cold or the flu. In such cases, rest and drinking plenty of fluids is the best way to get better as quickly as possible and get that rosy glow of health back. Beyond simple pallor come more serious conditions like hypoxia, which describes a condition where the entire body or a portion of it is deprived of an adequate supply of oxygen. Cyanosis (a bluish appearance) of the affected area — often the extremities — is a common symptom. This is definitely a situation that should be promptly evaluated by a physician. Is this a pulmonary problem? A cardiac issue? A vascular problem? A dietary issue involving anemia? Any and all deserve attention. Underlying conditions like diabetes make the situation even more urgent. Hopefully your situation is nothing more than a naturally fair complexion. Thanks for your question! I hope my advice has been helpful. + 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 Examiner issues.

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Why read the Medical Examiner: Reason #371

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

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THE MYSTERY SOLVED The Mystery Word in our last issue was: MEASLES ...cleverly hidden in the ocean in the p. 9 ad for SOUTHERN COMFORT SHOES

THE WINNER: ROSALIND SIMMONS! Want to find your name here next time? If it is, we’ll send you some cool swag from our goodie bag. The new Mystery Word is on page 12. Start looking!

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AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED C R A I G S E I N E R O M A N A C O S T A M A O I A R N O L L E A N E E A R T S T O R O G E R E B A R G E E M A S S A N E E N

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The Celebrated TheSUDOKUsolution MYSTERY WORD CONTEST 7 4 9 5 1 8 2 6 3

...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. Limited sizes are available for shirt prize. 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. 8. Deadline to enter is shown on page 12.

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HUMAN BEHAVIOR … from page 10 decompress: Use that time to shoot some hoops in the driveway or play a video game before going inside (or out) to be the best spouse and parent you can be.

What Works For You? Finally, just be real about what you need. For years, my

QuotatioN QUOTATION PUZZLE SOLUTION “What would you attempt to do if you knew you could not fail?” — Eleanor Roosevelt

WORDS BY NUMBER “An idea isn’t responsible for the people who believe it.”

— Don Marquis

goal was to work out three times a week. But I almost never went to the gym, and I always felt guilty. After 10 years of doing this off and on, I figured out that I probably wasn’t going to change. So I hired a trainer who comes to my house three days a week. That makes it very hard to skip my workouts. So you have to real about it. Sometimes you need professional help to get you to where you want to be, to help you develop new habits. And that’s OK too. + Jeremy Hertza, PsyD, is a neuropsychologist and the executive director of NeuroBehavioral Associates, LLC in Augusta

SEPTEMBER 6, 2019

IT’S A QUESTION OF CARE How can I keep my love one safe and well cared for in an assisted living or nursing or home?

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1. Visit at different times of the day and different days of the week. This will ensure that you are not anticipated by staff and therefore able to see the care of your loved one is consistent and hopefully at the highest level of quality. 2. Get to know the direct care staff, which are the certified nursing assistants and caregivers. Recognize that they have a difficult job to do for which they are not well paid, yet we assign such intimate work to them. When you are in the unit visiting your loved one, offer to help the direct care staff do simple chores or care for your loved one. Several examples include putting away their clean clothes, helping dress them and

brushing their hair or teeth. These are all activities that the direct care staff often has to assist with, so by being willing to work alongside the staff, you show that you are invested in your loved one’s care. Getting to know the staff includes knowing the direct care worker’s first name when you communicate with him or her. This reinforces that you see them as a partner with you in caring for your loved one. 3. Get to know the administrator and the director of nursing. If a problem should arise, and you are unable to get it resolved after speaking politely to the direct care staff, you can then go to management and explain the situa-

tion. Since they know you, you will be more inclined to get assistance. 4. Post directives in your loved one’s room. Signs indicating laundry, food and television preferences can ensure consistency for your loved one’s care. Before posting, make sure to check and follow the facility’s guidelines in regards to how and where to hang signs, so that the directives remain posted and your directions are followed. 5. Be an advocate for your loved one while remaining considerate and polite with the staff. Sometimes complaints are necessary; it is how you deliver them that is important. It is best to ask questions —

like “How do you do things here?” — rather than assigning blame before you’re familiar with the community’s operational procedures. It is a balancing act between your expectations, your loved one’s needs, and how you ask for all of those to be met. Avoid becoming known as the difficult family member. Instead, be the observant, helpful, determined family member, who participates in their loved one’s care and will be purposeful about following through on requests and complaints. + by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

PROFESSIONAL DIRECTORY +

ACUPUNCTURE

DENTISTRY

DRUG REHAB

Dr. Eric Sherrell, DACM, LAC Augusta Acupuncture Clinic 4141 Columbia Road 706-888-0707 www.AcuClinicGA.com

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

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

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

AMBULANCE SERVICE

Floss ‘em or lose ‘em!

Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048 Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445

DERMATOLOGY AMBULANCE • STRETCHER • WHEELCHAIR

706-863-9800

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

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

IN-HOME CARE Everyday Elder Care LLC Certified Home Health/Caregiver 706-231-7001 everydayeldercare.com Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com

LONG TERM CARE

Georgia Dermatology & Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) WOODY MERRY www.woodymerry.com Augusta 30904 Long-Term Care Planning 706-733-3373 SKIN CANCER CENTER I CAN HELP! www.GaDerm.com (706) 733-3190 • 733-5525 (fax)

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

YOUR LISTING Augusta Area Healthcare Provider 4321 CSRA Boulevard Augusta 30901 706-555-1234 CALL 706.860.5455 TODAY!

PHARMACY

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

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

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

YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by thousands of patients every month. Call (706) 860-5455 for all the details!

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SEPTEMBER 6, 2019

“Soulful honey to the ears” - NPR

Lyceum Series

at Augusta University

12:45 p.m. Revisited and Reimagined: A Masterclass on Regional Folk Music in a Contemporary Context with Ranky Tanky 2:30 p.m. Workshop: Songs of the Sea Islands Tickets available at augusta.edu/maxwelltheatre or call 706-667-4100. RESERVED SEATING AU/EGSC students admitted with a valid JagCard.

Tuesday, September 24, 2019, 7:30 p.m.