Medical Examiner 1-19-24 by Daniel Pearson

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JANUARY 19, 2024

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NOWHEARTHIS In case you haven’t heard, research published last week has shown a clear and beneficial link between hearing aid use and mortality. The study is significant because hearing loss isn’t exactly rare: it affects approximately 40 million adults in the U.S. But only about 1 in 10 people who need hearing aids use them. Hearing loss is far more than simply the inability to hear sounds. Research has shown that untreated hearing loss can and does result in depression, social isolation, and dementia. For those reasons and others, hearing loss is conclusively linked with reduced life spans. But here is the surprising good news from the University of Southern California study published this month in The Lancet Healthy Longevity: Adults with hearing loss who regularly used hearing aids had a 24% lower risk of death over the years of the study than those who never wore them. The health benefit for people who never wear hearing aids and those who use them only occasionally was the same: it was non-existent. The research has been called the most comprehensive analysis ever undertaken examining the benefits of regular hearing aid use, encompassing nearly 10,000 study participants over a period of more than two decades. Its message is clear, so listen up: if you have hearing loss, get a hearing aid and use it regularly. +

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WATERPROOF If it’s proof you want that bottled water isn’t a smart buy, there was no shortage of information before last week. But the latest news is perhaps the biggest smoking gun yet: a typical bottle of store-bought water, just a single liter, contains about a quarter of a million detectable plastic fragments according to researchers at Columbia and Rutgers Universities. For comparison, a 2018 study found an average of 325 pieces of microplastics per liter of bottled water. At the time, that number was considered alarming. Multiply that figure by about 75,000 to reach the new average. Considering the microscopic size of tiny plastic particles, it’s no surprise that they are turning up everywhere, including in people’s lungs and bloodstream, human placentas, oceans, rivers and lakes, and our drinking water, even when we pay a premium for supposedly pure filtered bottled water. To counter the proliferation of environmental plastics, the beverage industry has responded by reducing the amount of plastic in bottles. The sturdy bottles of yesterday have been replaced with very thin and crinkly bottles which, ironically, can result in more of those ultra-microscopic plastic particles entering the environment. What’s the solution? If you don’t trust tap water or like its taste, do this: buy a water filter (Brita, Pur, etc.) and a stainless steel water bottle. From that point on, your water will cost you pennies per gallon, you’ll no longer be paying good money to drink hundreds of thousands of plastic particles per liter, and you won’t be adding to the glut of plastics invading every corner of our planet. +

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JANUARY 19, 2024

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

MEDICAL MYTHOLOGY

PARENTHOOD by Dr. Warren Umansky, PhD

After an exhausting day of work and fussing with your three children about what seems every single daily task (getting up and ready for school, out the door on time, homework, chores, mealtime, bath or shower, getting ready for bed and into bed on time, and on and on), you’ve come to a realization: Being a parent hasn’t been as enjoyable as you had hoped and everyone is miserable. What can you do to change it? A. Aunt Melba is coming to visit in a few months and she’s always fun. She’ll help straighten things out. B. Be firmer, louder, and more forceful when talking to the kids. They aren’t dumb. They’ll get the message. C. Start planning game and movie nights, eating meals together, and having regular family meetings. D. Send the children to their grandparents to take care of them for a while. If you answered: A. Do you really want to wait and let Aunt Melba be the only source of cheer? Probably not. As the parent, the responsibility for the solution is yours. B. That is not likely to work. It is more likely to add conflict and more unhappiness. Plus, you probably don’t want to bully your kids into submission. That doesn’t make for a happy environment. C. This is a great start. When the children see you can do fun things together and communicate more, the building blocks of a happier home begin to fall into place. D. You signed up for the job of parent. Handing the kids off is not the solution. Being a parent can be overwhelming. Taking time for fun and for talking together is so important and shouldn’t be lost in the whirlwind schedule of work, school, and home responsibilities. + Dr. Umansky has a child behavioral health practice in Augusta.

OH, THOSE SENIOR MOMENTS Have you ever had one? We can confidently state that you have without even knowing who you are or what your age is. That’s because “senior moments” are largely a myth. “So wait. You’re saying senior moments aren’t real?” Well, yes and no. Remember taking true or false tests in school? If the slightest, most insignificant part of a statement was inaccurate, the correct response would be False. In the same way, as a broad brush term, so-called senior moments are incorrectly labeled — unless the person having one is actually an older adult. The term is incorrect because anyone of any age can have such a moment. And they do. Little kids forget things, and so do teenagers. Twenty-somethings drive off for work or class and forget their laptops. People in their 30s believe in the hereafter, because they have walked into another room and then suddenly thought, “Now what was I here after?” These moments start early in life and never quite go away. Scientists have finally identified the reason behind these moments by discovering what everyone so afflicted has in

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common: it turns out they all happen to be human beings. So maybe “I’m having a human moment” is a more accurate phrase. True, we might get more forgetful as we get older, and when that happens people are often concerned that it’s an early sign of something serious, like dementia or Alzheimer’s disease (two conditions which are not synonymous, by the way). Equating forgetfulness and dementia is sort of like comparing Delta Airlines with Delta Faucets. There are similarities, but also huge differences. One example often used to explain the differences is the

common action of losing car keys or a remote control. This happens to virtually everyone. No one would schedule a doctor appointment based upon misplacing car keys.. What would make such a visit a priority is not just losing the keys, but having no idea what they are used for. Forgetting something important but not even realizing you forgot it could be another red flag. Someone who is having a human moment might struggle to remember the name of a long-time friend they haven’t seen lately. A person with dementia not only can’t remember the person’s name, they may have no recollection of ever having known the person. Most of us find moments of forgetfulness to be frustrating, inconvenient, and sometimes embarrassing. You start talking and suddenly you can’t remember the point you opened your mouth ten seconds ago to make. It happens to everyone. Don’t worry about it. On the other hand, when human moments increase in number, when they start happening in new or unusual ways, or when they interfere with normal life and even basic safety, it definitely wouldn’t hurt to have a medical checkup. Can they be prevented? Only for non-humans. Otherwise, get plenty of rest. Focus: do one thing at a time. Work to avoid or minimize stress. Reduce mental clutter by using to-do lists and calendars. Eat a healthy diet. Exercise regularly. Finally, always....uh...never mind. Forgot the last point. +

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JANUARY 19, 2024

AUGUSTAMEDICALEXAMiNER

#205 IN A SERIES

Who is this?

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TURNING 65?

ho is this? Depending upon who’s answering the question, he is either a visionary pioneer or a delusional quack. We’re going to lean toward pioneer because it’s unfair to judge people from earlier eras by standards and facts established decades or even centuries after their death. All of the greats of medicine have believed in “facts” that were later proven to be false, and that same fate no doubt awaits some of the accepted norms of today’s medicine. To that point, this physician — Maximilian Bircher-Benner — was born in 1867. Much has been learned since then, and he made an important contribution to it. But he didn’t do it through laboratory research or discovering some new disease. DR. BIRCHER-BENNER’S No, Dr. Bircher-Benner ORIGINAL MUESLI RECIPE made his mark in part • 1 tbsp. of rolled oats soaked in 3 by reinventing breakfast. tbsp. of cold water for 12 hours One source calls him • 1 tbsp. sweetened condensed milk “the first person to prove • Juice from half a lemon that fresh fruits and • 1 large or 2 small apples, freshly vegetables can actually grated whole with skin on cure disease.” • 1 tbsp. of ground hazelnuts or You could say he almonds invented the farmacy. Mix the condensed milk and lemAs our monthly feature on iwith the oats, and while stirring, puts it (see page 9), food grate the whole apple(s) into the is medicine, a concept mixture. Serve immediately. + championed by Dr. B at his clinic in Zürich, Switzerland. Patients there were served a diet beginning each morning with muesli, a dish developed by Bircher-Benner and given a name meaning “little mush.” He held various unscientific ideas, such as that cooking deprived foods of their nutritional content, and as a result much of his work was not accepted by scientists of the day. The German novelist Thomas Mann described BircherBenner’s sanitarium as a “health jail.” But the general public heartily embraced his ideas and served to popularize both vegetarianism and muesli (or as we often call it, granola). The discovery of vitamins in fruits and vegetables in the 1930s vindicated Dr. B, although his beliefs were debunked by emerging science almost as often as they were supported. Although he died in 1939, his sanitarium operated until 1994 under the guidance of his children and grandchildren. Interestingly, Max was born to the Bircher family, but when he married in 1899, he added his wife’s name, Benner, to his. +

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JANUARY 19, 2024

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ADVENTURES IN

Middle Age BY J.B. COLLUM

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ONLY NASCAR IS A BETTER ACRONYM THAN SAD

J.B. Collum is a local novelist, humorist and columnist who wants to be Mark Twain when he grows up. He may be reached at johnbcollum@gmail.com

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NAPPING: AM I DOING IT WRONG?

Many readers are screaming at this page, yelling Of course not! There is no wrong way to nap! Our research department tells us these are mostly people who have 9-5 jobs where napping could be a firing offense. Ok. We get it. There’s a little jealousy involved. Even for people like that there are rainy Sunday afternoons on the couch. For many of the people these days who work at home or from home, napping can be an option. And yes, it is possible to do it wrong. And right. The key questions to answer are these: are naps causing problems? For instance, after a nap do you go through a hatching period where you feel more tired than before the nap, almost like you’ve been drugged? Is napping during the day keeping you up at night, or interfering with the quality of the sleep you do get? Then you are indeed doing it wrong. But all is not lost. This can be fixed, maybe even by skipping naps altogether. Granted, nothing is more unpleasant and unproductive than struggling to stay awake, falling asleep right at your desk for a second or two and then being jerked back to semireality (sometimes with a snort). It’s no fun at all. Isn’t it better to just give in? Sure. But exactly how does one give in? One way could be to get up and go for a walk. Down the hall or around the block. Splash cold water on your face. Brush your teeth. All those strategies and countless more work. Repeat as required. The actions taken will work just as effectively as a nap to banish sluggishness. But if a nap is the chosen solution (and isn’t going to get you fired), keep it under control: set an alarm so you don’t sleep for an hour. Sleep experts say the ideal length is somewhere between 15 and 30 minutes, and the ideal time is mid-afternoon, around 2:00-3:00 pm. One more factor to examine is nightly sleep habits. A person might be zoning out mid-afternoons because they’re staying up too late at night. Going to bed at a decent hour and getting 7 or 8 hours of sleep might kill the urge to nap. +

FRONT DESK ! TURE A E F NEW

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can’t, so what do I do? Most folks seem to like spring cleaning, but for me, I like winter cleaning. I’m stuck in the house more and can’t stand the clutter around me. It adds to the depression. I throw things out that I will later wish I kept, and I’ll keep things that I later wish I had thrown away - until I finally do throw them away and then realize I needed them. It is a vicious cycle. In any case, I feel the need to stay busy and unclutter my life as much as I can. I may take advantage of the fact that we don’t have scorching heat to do some projects outside. After all, although it is bleak in the winter here, it isn’t like we live in an area where snow covers everything most of the winter and it is too cold to go outside and work. So, we can get some things done as long as we aren’t having one of those miserably cold winter rainstorms that drag on and freeze our roads and subsequently break tree limbs, which in turn bring down power lines. Coincidently, this also seems to cause runs on milk and bread at local grocery stores just like every other natural disaster in the south, real or imagined. I know that I’ve had the winter blahs for most of my life, but it seems to have gotten worse as I have aged. Perhaps it is a reminder that I am far past the spring and summer of my life and at least well into the fall and creeping up on the winter. It is a sad metaphor indeed if this progression continues. All is not lost though. I have used my extra indoor time to renew old hobbies, read good books, and do other things to keep my mind off the depressing state of the current season, both literally and in its metaphor for my life. Do you also suffer with this? Has it gotten worse with age? How do you cope with it? I’d love to hear back from you at my email address listed below. I might even share some of your observations. Until next time, fight the darkness. The days are getting longer, and the nights shorter, so maintain your hope and joy until the spring once again brings brightly colored flowers, warmth, bird songs, and a little golf tournament in April that seems to resurrect our area every year. +

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I don’t know about you, but starting in January, I tend to get a little bit down. Depressed even. The trees look dead and barren without their leaves. There are no more college football games to look forward to. The holidays, with their accompanying time off to spend with family are now past. It is back to work time, but with dreadful weather, gray skies, short days, and long cold nights. It’s only the “winter blahs,” we tell ourselves, and we are probably correct most of the time, but sometimes it is more complicated than that. Sometimes it can turn into full on depression. They call it Seasonal Affective Disorder, or SAD for short. Never has there been a better acronym, except maybe for NASCAR (Non-Athletic Sport Centered Around Rednecks). The National Institute of Mental Health (NIMH), a part of the National Institutes of Health (NIH), (by the way, who let the acronyms out?) says that SAD typically begins when the days get shorter in the fall. But for me, it begins after all of the stuff we have come up with to make us forget about SAD comes to an end. You know, after Octoberfest, fall fairs, Halloween, Thanksgiving, Christmas, New Years, football. Think about it. All of these involve festive decorations and/or lights to brighten things up. I seriously believe all of these festivals or festive things were designed in some way to get people to forget how bleak the world looks and feels during late fall and winter. What do you think? I do know that what we call Christmas (but which really started as the pagan celebration called Saturnalia) was all about the shortest day of the year giving way to the days getting longer for the sun god, Saturnalia. So at least that one for sure we know was related to getting spirits up and providing hope that indeed, the sun was not dying, and that the days were once again getting longer. That’s why it is celebrated on a date close to the winter solstice and not anywhere near the actual likely birth date of Jesus, which was more likely around October. Or some time in the spring if you ask other folks, but definitely not December. So, for millennia we’ve dealt with SAD, but we just didn’t have an acronym or diagnosis for it until modern times. There are treatments for it, including light therapy, counseling, and more, but the best cure is probably to just move to the southern hemisphere for the duration, if you can afford that. I know I

...wherein we share amusing medical mis-speakings and misspellings we have overheard, or that have been shared with us.

“I once had a patient come in and say he was there for a walk-in chest enema. I did a double-take until I read his paperwork, which said he was scheduled for a chest x-ray. Thankfully, I was the only one who heard and the man’s embarrassment was at a minimum.” READERS: What have you heard? Please share! EMAIL: Dan@AugustaRx.com or MAIL: PO Box 397, Augusta GA 30903

AUGUSTAMEDICALEXAMiNER

JANUARY 19, 2024

ARE NEW THINGS IN MEDICINE GOOD? Recently, an 80ish family friend crushed her elbow during a fall at home. The elbow was maliciously shaped and technicolor. Looked like a prop for the Walking Dead. Family called her medical provider, who scheduled a home visit for the next day. Plan: Wrap elbow in ace bandages and take Tylenol. Result: 24 hours of severe pain. Next day: Elbow, you look terrible. Go to ER immediately for X-ray. After a 6-hour ER wait, X-rays reveal multiple fractures. Elbow put in splint and more ace bandages. Surgery scheduled seven days (that’s right, 7 days) later. Take Tylenol. Go home. Wait. Pain was severe. No one would give her stronger pain medicine. “It will be better after surgery,” they said. Then, surgery was pushed back two more days “because the OR schedule was busy.” Why not treat the patient and the injury rather than the OR schedule? Maybe they

BASED ON A TRUE STORY (most of the time) A series by Bad Billy Laveau

were busy doing gender reassignment surgery? Or emergency breast implants? It had to be something important to make an 80-year-old lady with two artificial knees and coronary artery disease wait 9 days to have her elbow surgery. I would publish a photo here, but giving you Stephen King-worthy nightmares doesn’t help anyone. Finally — 10 days after the injury — surgery happened with lots of plates and screws and wires. Truly, her surgeons were skilled. Then, a nursing home for six weeks of rehab. Medicare will pay for that. “We must keep you comfortable during your recovery.” That did not seem to be a priority during her week-and-a-half wait at

home. Everything went slowly … except the bills. They were came instantly, if not sooner. Everyone sent a bill. Hospital. ER doctor. ER. Family Doctor. Physical therapy. Anesthesiologist. Hospital Pharmacy. Hospital Surgeon. Hospitalist. Recovery Room. Not too long ago, before corporate medicine took over, she would have gone to ER immediately after the fall, be admitted after X-ray, and had surgery as soon as the following day. Nowadays, it seems paperwork takes priority over the patient. Is that progress? I think not. One wonders why there are medical malpractice lawsuits on the rise. How is she doing now, a year later? Technicolor struggles to look less than scary. Arm still hurts. Worse when it is cold. She dreads winter coming on. No more walks in light snow that she has enjoyed for decades. No more driving in traffic. No more light gardening. Can’t get in or out of apool without help.

Would her after-life have been better had she promptly had surgery when indicated? Maybe. Maybe not. But she would not have endured a week and a half of severe pain while everyone mosied around unattentively in an ivory tower hospital. I refuse to believe a hospital with a covey of subspecialists and a truck load of “physician extenders” could not fix her elbow with in one or two days at most. We need specialists. But everyone being subspecialized is not always good, especially if and when it interferes with or inhibits patient care. But of greater importance, we need real doctors who treat whole patients. Doctors who know their patients. Doctors who have empathy and understanding. Doctors who identify with their patient. Doctors, ask yourself: When is the last time a grateful patient brought you vegetables from their garden? A handmade shirt? Personal monogramed garments? A hand written or crafted greeting card? If you answer never or seldom or can’t remember the last time, you are NOT practicing medicine properly. Beware! Most malpractice suits, according an attorney in my family, come from poor bedside manner and lack of identification rather than medical misadventures. Doctors, never ask a pa-

tient, “How are you today.” Always ask, “How are we today? How is our broken arm? How is our heart attack?” Your patient will feel your connection and your care. Train your staff to do the same. The “we” concept may keep you out of court. I know a doctor who always did that. His staff were trained to do the same. Ma’am, Sir, and Please (backed with a real smile) poured from their lips. He retired after 50 years … never had a single malpractice suit even mentioned. We must be careful to never let “progress in medicine” be limited to clinical and scientific advancements to the detriment of being real physicians when your patient is in need. Doing so is highly cost effective. Recently the aforementioned elbow catastrophe lady commented, “Used car salesmen are friendlier than most doctors.” Have you ever heard of a used car salesman offer a sales appointment a week later … and then put it off because the dealership was busy? I didn’t think so. Change by itself doesn’t mean progress. Different doesn’t mean better. Human compassion outweighs hardware every day. It was true a hundred years ago. And it is still true today: Patients have diseases. Diseases don’t have patients. Treat the patient. +

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CAESAR STEAK SANDWICHES These sandwiches hit the perfect balance between meat and vegetable intake. Ingredients • 1 pound boneless beef top sirloin or top round; cut ¾ inch thick or flank steak • ½ cup prepared non-creamy Caesar dressing • 2 cups coarsely chopped romaine lettuce • ¼ cup shredded Parmesan cheese • 4 hoagie rolls (6-inches long each), split, toasted

Kim’s note: This recipe is high in carbohydrate due to the hoagie roll. To make more room for the delicious fillings and decrease carbohydrate scrape out some of the inside of the hoagie roll. +

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JANUARY 19, 2024

DON’T JUST STAND THERE! DO SOMETHING! by Ken Wilson Steppingstones to Recovery

As we proceed through Dry January, some thoughts come to mind that I hope will be helpful. In my younger days, I was never good in sports, especially any game that involved a ball. I finally got an eye exam and donned some ugly glasses around age 10, and my game did improve some, albeit never enough to be chosen first for a team. I remember realizing the ball was coming my way when I played outfield and I would just freeze because I couldn’t see the thing well enough to act! A brand new leather glove for Christmas didn’t help either. My teammates got hoarse screaming, “Ken, don’t just stand there! Do something!” I wasn’t really sure what to do except hold my glove open and hope the ball would fall into it. When it comes to recovery, one never just falls into it. It

must be intentional, with a definite plan. I’ve seen people plan and plan and never make the first step, complaining that they want to find the “right” program for help, or go the “right” support group, or find the “right” church. They fuss and fuss about getting clean and sober via one of the following ways, plus some I can’t even remember! The “RIGHT” rehab program: there are all kinds out there – not all of them “rehab.” There is short-term detox and stabilization, inpatient, intensive outpatient, outpatient, free or nearly free, and some are as expensive as a house! The “RIGHT” church: One can visit churches until the cows come home and never find the right one. I’ve seen church attendance work for some, but statistically speaking church alone has not proven to be effective in the long run, at least not for recovery. Most preachers I know would agree.

DEAR READERS

The “RIGHT” 12-step group: “I went to NA but didn’t like it” is a line I often hear. Well, I didn’t like what the doctor told me the last time I went either. But he told me the truth. Sugar in my diet has just got to go. That hurt. Many with substance use disorders want to have their excuses to use drugs co-signed. A 12-step group is not the place to go to get that. The “RIGHT” counselor: Finding one with good knowledge of substance use disorders is hard to find, notwithstanding evidence-based figures indicate that 1-on-1 counseling is not a wise use of time and money compared to group therapy options in a substance abuse treatment program. A wise counselor will refer a client out to such a program if individual counseling is not effective within a relative short period of time. The “RIGHT” place to live: The “geographical cure” stab at sobriety rarely works in the

long run because people take their issues with them when they move. Of course, if one lives in a drug-infested neighborhood it is wise to re-locate to living quarters where chemicals aren’t in their face all the time. Not that sobriety in such a place isn’t possible – it is; it’s just not the usual case. The “RIGHT” job: Granted, many jobs have employees who use on the job, and even obtain their drugs in the workplace. Better go ahead and find another job. I knew a client — one client —who completed treatment and promptly got a job as a clerk in a liquor store and he’s still sober today, 20+ years later! But he went to AA and did everything his sponsor told him to do. The “RIGHT” halfway house: There are many flavors here… high cost, low cost, work programs, some have treatment programs, most utilize 12step support groups. For the

WHENEVER YOU HEAR

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THIS IS YOUR BRAIN A monthly series by an Augusta drug treatment professional

addict, the “right” one doesn’t exist – the one that allows cell phone use, the one that is co-ed, the one where you can sleep late in the mornings, the one that allows relapses, ad infinitum. If you find yourself wanting to try Dry January, go for it. If it doesn’t work for you, remember the ball is flying your way whether you see it or not. For your own sake, don’t just stand there, do something! Just something is a good start. +

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JANUARY 19, 2024

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FOODISMEDICINE Tasty tips from registered dietitians with the Augusta Dietetic District Association

FILLING IN THE DIETARY GAPS: FOOD, SUPPLEMENTS, OR BOTH? by Natalie Smith, MS, RD, LD Children’s Hospital of Georgia

One question people are often asked this time of the year is “What is your goal for 2024?” The typical answers are often health-related, which is fantastic, but how do we zero in on how to improve our health? The first couple of things that come to mind are diet and exercise, but exactly how do we truly improve our diet? Globally, people are turning to quick solutions to balancing their diets such as adding dietary supplements into their daily regimen. In the U.S, the four top vitamin/mineral deficiencies are Vitamin D, Folic Acid, Vitamin B6, and Vitamin B12. Vitamin D strengthens and maintains bone and muscle functions, especially in growing children. Folic acid is most important in pregnancy to prevent neural tube defects in infants. Vitamin B6, pyridoxine, is essential for brain development and prevention of heart and blood vessel diseases. Finally, B12, cyanocobalamin, is required for red blood cell formation, preventing a certain type of anemia, and maintaining nerve cell function. According to a STATICA report projection, by 2028 the dietary supplement industry will have grown from a $152 billion dollar industry to a $300 billion dollar industry, almost double over just 7 years. Post-COVID, people are focusing more on health and preventive measures, even when it comes to diet and dietary supplement intake. How effective are dietary supplements compared to eating nutritious whole foods? First, let’s look at bioavailability. According to The Journal of Nutrition, “The commonly accepted definition of bioavailability is the proportion of the nutrient that is digested, absorbed and metabolized through normal pathways.” This proportion can differ between whole food products and dietary supplements like individual vitamins and minerals. If you have ever spoken to a dietitian who has recommended eating whole foods or increasing your daily fruit or vegetable intake there is a reason behind it. There is a higher percentage of bioavailability in whole foods versus dietary supplement forms. Depending on the nutrient, a whole food may provide 85100% bioavailability of one nutrient while a supplement may provide 30-85% bioavailability. Typically, when you eat whole foods, you will absorb more of a nutrient than in supplemental form. In times of increased needs such as pregnancy, illness, etc, you may need to supplement nutrients if you are unable to get everything in your diet, daily.

This year, try focusing on increasing nutrient-dense foods such as fish, leafy vegetables, berries, and seeds. If you are concerned that you may have a nutrient deficiency or want to make sure you are taking proper preventive measures in disease prevention, contact your local health provider and dietitian to assess your diet, medical history, and current medications. In conclusion, more research is needed to assess the effectiveness of dietary supplementation since the bioavailability of each supplement can vary to a high degree. While using dietary supplements may greatly benefit some individuals, it is also important to also take note of your current diet and to take note of the upper limits of these micronutrients, that is the max daily amount. More information on upper limits of micronutrients for adults can be found online at the National Institute of Health Nutrient Database. + For additional reading: • Djaoudene O, Romano A, Bradai YD, Zebiri F, Ouchene A, Yousfi Y, Amrane-Abider M, Sahraoui-Remini Y, Madani K. A Global Overview of Dietary Supplements: Regulation, Market Trends, Usage during the COVID-19 Pandemic, and Health Effects. Nutrients. 2023 Jul 26;15(15):3320. doi: 10.3390/ nu15153320. PMID: 37571258; PMCID: PMC10421343. • Dietary Supplements Market Size, Share and Trends Analysis Report by Ingredient (Vitamins, Minerals), by from, by Application, by End User, by Distribution Channel, by Region, and Forecasts, 2022–2030. [(accessed on 9 November 2022)]. Available online: https:// www.grandviewresearch.com/industry-analysis/dietary-supplements-market • The conference “Bioavailability of Nutrients and Other Bioactive Components from Dietary Supplements” held January 5–6, 2000, in Bethesda, MD. This conference was sponsored by the Office of Dietary Supplements, National Institutes of Health and Life Sciences Research Office, American Society for Nutritional Sciences. Conference proceedings are published as a supplement to The Journal of Nutrition. Guest editors for the supplement publications were Mary Frances Picciano, Pennsylvania State University, University Park, PA and Daniel J. Raiten, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

SHORTSTORIES

WHEN YOU REGRET SAVING A PATIENT The paramedics brought her in from a nursing home and they had been doing CPR for a while. The patient had been in and out of perfusing rhythms the entire time. She looked very old and very frail and chronically ill. I asked the medics if she had a DNR (Do Not Resuscitate) order and they just rolled their eyes. The lead medic told me that they asked the same thing but the nursing home staff couldn’t locate the paperwork, and because they couldn’t be sure they initiated resuscitation. We didn’t have anything on record either, but I wasn’t really committed to CPR and shocking and all the drugs necessary to keep this poor woman alive when her quality of life was likely so bad. I decided to give one round of drugs and then stop if there was no response. We did just that, and much to my surprise she responded. Her heart started out slowly and gained momentum. Within a couple minutes she had a stable blood pressure. After a while she even began to attempt breathing on her own. It wasn’t long before the family started arriving, and they told us that the patient’s wishes were to not be resuscitated. They told us that she would never want to be kept alive this way and demanded that we stop the ventilator and medicines. So that’s exactly what we did. Despite stopping all support she continued to live. Ultimately, we admitted her to the hospital and she continued on in a sort of half-life state. This went on for days. I went to see her and the family a few times when they were there in the hospital and just felt terrible for them all. They were unhappy with me, but they also understood why we did what we did. Ultimately, they sort of took it out on the nursing home staff and not the medics or me. Eventually she died with her family all around her. Several members were able to travel in to say goodbye before she passed away because of her hospital stay. I suppose it all worked out the way it was supposed to. I still regretted it though. +

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CRASH

! E R U T W FEA

JANUARY 19, 2024

COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined If you are a seat belt user, congratulations. You are doing one of the safest things a driver or passenger can do. And because you are who you are, you might assume just about everyone else uses seat belts too. On that score you would be wrong. The most recent data from the National Highway Traffic Safety Administration (NHTSA, often pronounced “Nit-sah”) found that in 2019 overall seat belt use was only 90.7%. That may sound pretty decent, but it’s surprising that the rates aren’t much closer to 100%. Compliance is highest in the West at 92.4%, and next-highest in the South, where it stands at 88.5%. The Northeast is lowest at 83.5%. NHTSA publishes annual reports on a variety of traffic safety issues. NHTSA research shows that over the past 15 years, seat belt use has consistently increased from lows in the 81% range in 2005 and 2006. What is interesting is pairing the annual numbers for seat belt compliance with the annual numbers for passenger vehicle fatalities. Whenever there is a dip in seat belt use, there is a corresponding increase in fatalities; whenever there is an increase in seat belt use, there is a matching drop in fatalities. Yes, seat belts save lives. It’s not a topic open to legitimate debate. Do fatalities occur in crashes when the driver and all passengers are buckled up? They do. It isn’t that seat belts magically provide complete immunity from serious injury and death, but they do drastically improve the odds of survival. How do they accomplish this? Data from the Georgia Traffic Injury Prevention Institute at the University of Georgia offers a very simple answer based on a very simple formula. The equation is W x S = CF. That is to say, weight (of a passenger) times speed equals crash force. To illustrate: if a 200 lb. driver traveling at 60 mph crashes, he will strike the vehicle’s interior surfaces, the windshield, or objects outside the vehicle (and without a seat belt, perhaps all three) with a force of 12,000 pounds (200 x 60). That would be exactly like something weighing 12,000 pounds (6 tons) striking the driver at a high rate of speed. Wearing a seat belt dramatically minimizes impact force, and usually any impact whatsoever other than the seat belt itself. It is so close to the body that little to no impact results from it. (Why use 200 pounds as the sample weight? No reason, except that drivers of pickup trucks have the lowest level of compliance of all passenger vehicles. Perhaps we are guilty of stereotyping.) Remember the old days before seat belts when as kids we would even stand up in the front seat as mom or dad drove down the road? And how they would reach over and try to keep us from hitting the windshield or dashboard when there was a sudden stop? That was an understand-

60 seconds of salubriousness

Be grateful for advancements in seat belt design over the years. able and automatic reflex, but it was completely useless: using the UGA formula, a 75 pound child in a car suddenly stopped at 35 mph would generate a crash force of 2,625 pounds. Unless mom or dad was a superhero, there was exactly zero chance they could do anything to help us or prevent us from sailing right through the windshield. About three dozen states including South Carolina and Georgia have so-called “primary enforcement” seat belt laws, meaning that a driver can be pulled over solely for being observed driving without wearing a seat belt. 15 states have “secondary enforcement” laws. Under those statutes, an officer can only cite a driver for failure to wear a seat belt if he has stopped the vehicle for some other violation, such as an expired tag. Only one state, New Hampshire, has no adult seat belt law. It is legal in the Granite State for anyone over 18 to drive unbelted. Wearing a seat belt is strictly voluntary, and as a result seat belt use there is by far the lowest in the country. Despite that, New Hampshire roads are comparatively safe and more or less in line with statistics from other states, but their lack of a seat belt law shows up in one startling number: 70 percent of their fatalities involve an unrestrained occupant, by far the highest of any state. How many of those deaths were preventable? No one knows, but one of the state’s leading newspapers, the Concord Monitor, observed not long ago that in New Hampshire more than any other state, “every crash is a tragedy.” +

Take a quick look at the two Nutrition Facts labels below. Both are for snack foods: potato crisps on the left, potato chips on the right. You’re a label reader when you shop, so you notice immediately that one has 30 more calories per serving than the other. Multiplied by the number of servings, that’s 720 calories for one bag and 1,050 for the other. Would you choose the lower calorie option? You would probably consider other factors, maybe carbs or sodium, before putting one or the other into your shopping cart. But don’t overlook — as many do — a vitally important part of the label: the ingredients list. Look at the list on the right side. No chemicals. No mystery ingredients. Nothing unpronounceable. Only three pure and simple ingredients. With the growing body of research on the negative impact of ultra-processed foods, when you see an ingredients list like the one on the right, you’re probably looking at a keeper. +

Read us online at AugustaRX.com

The blog spot — posted by Tom Bowen, a patient on Aug. 27, 2019 (excerpt)

4 THINGS I WISH I HAD KNOWN EARLIER ABOUT CHRONIC PAIN I’ve been living with chronic pain for more than a decade. It began in 2009 with nerve damage after emergency surgery. Four years later, I fell and hit my head. That fall led to a constant headache, a whistling sound in my ear, back and hip pain, tingling and numbness in my hands and feet, electrical shocks in my legs, muscle soreness, and random pain and burning sensations throughout my body. Years later, after numerous doctor visits and tests, I was diagnosed with fibromyalgia, tinnitus, neuropathy, chronic fatigue, and depression. I had a hard time adjusting to the pain. I let my symptoms control me. My quality of life suffered along with my physical conditioning. Here are a dew lessons I wish I had known earlier in this journey, much of which I learned while attending a three-week outpatient program at the Mayo Clinic Pain Rehabilitation Center in 2012 and again in 2018. Each of these would have made my journey easier and might help others living with chronic pain. 1. Pain isn’t just physical. Chronic pain clearly affects the body, but it also affects emotions, relationships, and the mind. It can cause anxiety and depression which, in turn, can make pain worse. At work, I couldn’t handle the stress. I had trouble concentrating, missed deadlines, and made mistakes. At home, I didn’t sleep well and was irritable. I was plagued by negative thoughts like, “Do I want to live like this the rest of my life?” When I reluctantly quit my job at the recommendation of my doctors, I lost more than a regular paycheck and valuable benefits like health insurance and retirement savings: I also lost a sense of self-purpose and self-worth. As I came to understand the connection between pain and emotional issues, I included mental health care as part of my pain management program to help control my mood and manage stress. 2. Pain isn’t always curable. Medical professionals don’t have all the answers, nor do they always have cures. There is no magic pill or intervention that makes chronic pain disappear. Sadly, some people with chronic pain may never be pain-free again. I’ve bounced between all types of health care providers: primary care physicians, pain specialists, rheumatologists, neurologists, audiologists, physical therapists, surgeons, and psychiatrists. I’ve been through X-rays, ultrasounds, MRIs, CT scans, and all sorts of other diagnostic tests. I’ve taken opioid painkillers, non-opioid painkillers, vitamins, and herbs; attended professional lectures; spent countless hours searching the internet; and even had surgery. Some of these helped relieve pain, some didn’t, and some made things worse. Meanwhile, they all cost me time and money and delayed my pain rehabilitation. 3. Not all pain means harm. We learn at an early age that touching something hot hurts. But the presence of pain doesn’t always mean danger. There are two types of pain: acute and chronic. Being able to tell the difference between the two has changed how I react to chronic pain by not being so guarded or worried about it. 4. Move on. If chronic pain doesn’t mean more harm, and there aren’t any magical medical answers, what’s left to do? Accept the pain as the “new normal,” adapt to it, and learn how to manage it. Of course, that’s easier said than done. +

THE DOCTOR PRESCRIBED 1.2 MILLION DOSES OF OPIATES

Tom Bowen is founder of the Facebook group “Chronic Pain Champions — No Whining Allowed.”

11 +

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The Examiners +

You say you’re in the doghouse at home?

by Dan Pearson

Big time.

What did you do?

What did your wife do?

I switched our bed for a trampoline.

She hit the ceiling.

PUZZLE

20 21 ACROSS 1. Former Atlanta 23 quarterback 26 27 28 29 30 5. Gas company with a yellow and green logo 31 32 33 10. Area abbrev. 37 38 39 14. Country south of the Caspian Sea 41 42 15. Knight’s weapon 45 16. _____ house 17. Type of light? 48 49 50 18. Writer of metaphors 53 54 20. Harshness, acrimony 58 59 60 22. Interior 23. Challenge 62 63 24. Helmet-shaped; hooded 65 66 26. Louvre pyramid architect 29. Dead _________ by Daniel R. Pearson © 2024 All rights reserved. 31. Aptitude 33. Put down DOWN 34. Unhappy 1. Bob of This Old House 37. Repeatedly and rapidly 2. Colored eye membrane bring hands together 3. Stay at Mistletoe? 38. Spin 4. State of having more than 40. Type of list one needs or wants 41. Female fowl 5. _____ Witch Project 42. Stead 6. Equivocate 43. Vomit 7. Solely 45. Movie theater 8. On _____ ; pending 47. Salt of uric acid 9. North _____ 48. Impaired 10. Amen ________ 51. Has to 11. _______ Bifida 53. Efface 12. Adjust again 54. Absurd 13. Fancy word for cave or 58. Consolidate; streamline grotto 61. Actress Jessica 19. Greased 62. Indigo dye 21. Precipitation 63. Biblical king 24. Growl; snarl 64. Chafes 25. Nimble 65. _____-lift 26. Scratch 66. Type of office pool 27. Capital City of Maldives 67. Beatles’ yes? 28. Strategy 30. Pelvic bone

16 19 22 24

40 43 46 51

44 47

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

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, JAN. 28, 2024

We’ll announce the winner in our next issue!

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

32. Strong thread 34. Player with 609 career home runs, #9 all-time 35. Mine entrance 36. Quantity of medicine 39. Pay attention to 40. _____ care (advanced medicine) 42. Napoleon Dynamite feline 44. SC med school 45. Fortified feudal residence 46. River in South America 48. “Try the ______.” 49. Follower of James Brown 50. Start of depression? 52. Skin irritation; hives 54. Word sometimes paired with bug and fly 55. Hint 56. Swedish pop group 57. Whip 59. Expressions of contentment 60. Permit Solution p. 14

7 5 3 4 8 6 F 5G2 O 4O9 1 3 R 9U8 N 2 7 6 1

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

H 1 2 3 4 5 6 7 8 O 1 2 1 2 3 4 5

R 1 2 1 2 3 4 5 6 7 F 3 4 5 6 7 8 9 10 11

1 . C O A P T 2 . T R R E L 3 . E LO A H 4 . C A F E 5 . T H E R 6 . S I E 7 . S S N 8 . I G 9 . O 1 0 . N 1 1 . S

SAMPLE:

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

L 1

O 2

V 3

E 4

I 1

S 2

B 1

L 2

I 3

N 4

D 5

WORDS NUMBER

THE MYSTERY WORD The Mystery Word for this issue: YTMSMOSP

EXAMINER CROSSWORD

JANUARY 19, 2024

9 1 2 6 7 8 4 5 3

2 8 7 4 3 9 1 6 5

3 6 5 8 1 2 7 4 9

1 9 4 7 6 5 3 8 2

JANUARY 19, 2024

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

The

Advice Doctor

about my crippling fear of palindromes. Joe: Did he give you anything for it? Moe: Sure did. Xanax.

Moe: Knock knock. Joe: Who’s there? Moe: My Momma loves only you. Joe: My Momma loves only you who? Moe: No wonder she’s overweight.

blonde woman is caught in a blinding snowstorm. She didn’t panic however, because her father had once told her. “If you ever get stuck in a snowstorm, just wait for a snow plow to come by and follow it.” Sure enough, pretty soon a snow plow came by, so she followed it. She followed the plow for about forty-five minutes. Finally the driver of the truck got out and came back to her car to ask what she was doing. She explained that her dad had told her if she ever got stuck in a snow storm, to follow a plow. The driver said, “Well, I’m done with the Wal-Mart parking lot here. Do you want to follow me over to Best Buy now?” “When one door closes, another one opens.” — Boeing Moe: Why do you think Boeing 737 Max workers are crazy? Joe: I never said they’re crazy. Moe: You most certainly did. Joe: No, I said they have screws loose. Moe: I finally went to see my doctor today

A boy brought his report card home to show his parents how well he did in math. It showed his math grade was 90/100. His father was ecstatic, but his mother was skeptical. She knew he was terrible at math. She looked closely at the report card and noticed that the 9 and the 0 looked like different handwriting styles. “Son, tell me the truth: Did you add a 0 to the end of your grade?” “No!” the boy replied. “I’m going to ask you again,” said the mom, “Did you add that 0 yourself?” “Mom, I did not add the zero!” The mom angrily cuts him off and says, “Ok, since you insist on lying to me, you’re grounded for a month.” “No mom! Please!” the boy begged, “I swear I didn’t add the zero!” “This is your last chance,” said the mom. “Tell me the truth!” “I didn’t add the zero. I added the 9.” I asked the gym instructor: “Can you teach me to do the splits?” “Are you pretty flexible?” he asked me. + “Well, I’m not free on Tuesdays,” I replied.

Why subscribe to theMEDICALEXAMINER? Staring at my phone all day has certainly had no Effect on ME!

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

Dear Advice Doctor, We have a fairly new employee in our office who is constantly bragging about all his accomplishments at his previous job. It was all very impressive until by chance I discovered that a friend of mine works at his old job. Turns out he was a complete disaster there and didn’t do any of the things he boasts about. The guy must have a screw loose, but I don’t know whether I should confront him privately, go straight to HR, or continue to bite my tongue and just let him self-destruct. Got any tips for me? — Co-Worker of Mr. Perfect Dear Co-Worker, You know the old saying that practice makes perfect? Not true! At least not always. Exhibit #1 is eating. We’ve all been chewing food on a daily basis since our baby teeth came in decades ago, and yet as you remind us, we all still accidentally bite our tongue from time to time. It’s a lot more common than you might think. People not only bite their tongue while eating, but also when playing sports, during a traumatic event like a fall or a car accident, after dental anesthesia, while sleeping, and for some, during seizures. The tongue is a body site that bleeds a lot, even if the wound is small, so the first step is to assess the injury. With clean hands and a clean cloth or gauze pad, apply pressure to the site to stop the bleeding. Wrapping ice or a cold pack in the cloth can also help. Cold and pressure for five minutes is usually enough to stop the bleeding, although sometimes it can take a few minutes more. Once the bleeding stops, expect it to take anywhere from a day or two up to a week for your tongue to heal. During healing, avoid rough or scratchy foods in favor of softer foods that are easy to swallow. Sucking on a piece of ice or a fruit-flavored ice pop can help alleviate both pain and bleeding. If the injury is more severe, if bleeding can’t be stopped, if the tongue is swollen or you still experience intense pain after a reasonable period of time, or if you suspect or see signs of infection, it’s time to contact your doctor or head to an ER or walk-in clinic for evaluation. I hope this answers your question. Thanks for writing! + Do you have a question for The Advice Doctor about health, 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.

SUBSCRIBE TO THE MEDICALEXAMINER +

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!

Why read the Medical Examiner: Reason #106 BEFORE READING

NAME ADDRESS CITY STATE ZIP Choose six months for $24 ____ or one year for $42 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

AFTER READING

+ 14

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THE MYSTERYRY WOSOLVED RD L E T S Y NO M

E U S S AST I

The Mystery Word in our last issue was: STATINS

S A W HT ERE

...cleverly hidden on the roof in the p. 7 ad for OVERHEAD DOOR OF AUGUSTA

THE WINNER: WILMA TSOPANARIAS! If that’s your name, congratulations! Send us your mailing address using the email address in the box on page 3. The new Mystery Word is on page 12. Start looking!

JANUARY 19, 2024

AUGUSTAMEDICALEXAMiNER THE PUZZLE SOLVED V I C K B P O I L C S R A I R A N L A N C E O P E N L I M E A L L E G O R I S T A S P E R I T Y I N N E R D A R E G A L E A T E I M P E I R I N G E R T A L E N T L A I D S A D C L A P W H I R L T O D O H E N L I E U E M E S I S C I N E M A U R A T E D A M A G E D M U S T E R A S E F A R C I C A L C E N T R A L I Z E A L B A A N I L H E R O D R U B S F A C E S T E N O Y E A H

SEE PAGE 12

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

...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.

3 8 5 4 1 9 2 6

4 6 2 9 3 8 7 1

1 2 6 7 8 4 5 3

8 7 4 3 9 1 6 5

6 5 8 1 2 7 4 9

9 4 7 6 5 3 8 2

2 9 3 5 7 6 1 8

7 3 1 2 6 5 9 4

QuotatioN QUOTATION PUZZLE SOLUTION The things you want to die for are the things you live for.

— Author unknown

WORDS BY NUMBER Teaching creates all other professions. — Author unknown

5 1 9 8 4 2 3 7

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EMF Safe Homes Sheila Reavill Certified Building Biology Specialist 209-625-8382 (landline) SURVEY•ASSESSMENT•REMEDIATION

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IN-HOME CARE

PHARMACY

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Janaki Nadarajah, DPM Wound Care Specialist P.A.D., Leg Pain

Guillermo Gallardo, MD Ophthalmologist and Retina Specialist

Harold Coleman, DPM Podiatrist, Foot & Ankle, Heel Pain

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