Medical Examiner 3-15-24

One of the cruelest ironies of healthcare is that the very people dedicated to helping those who are hurt and in pain are themselves the recipients of much hurt and pain.

The Journal of Emergency Nursing reported in May 2023 that 90% of emergency department employees had been exposed to workplace violence at least once, and 94.4% had experienced verbal abuse. The American College of Emergency Physicians says that 47% of emergency department physicians have been physically assaulted in the ED. Incidents of serious workplace violence, defined as those requiring days off for the injured worker to recuperate, are four times more common in healthcare than in other industries according to the Occupational Safety and Health Administration (OSHA). Healthcare is, in fact, the most dangerous occupation, accounting for 73% of all nonfatal workplace injuries and illnesses due to violence, more than any other profession, surpassing even law enforcement.

Why the increase in violence?

According to the American Association of Medical Colleges, “The reasons for aggression vary: patients’ anger and confusion about their medical conditions and care; grief over the decline of hospitalized loved ones; frustration while trying to get attention amid staffing shortages, especially in nursing; delirium and dementia; mental health disorders; political and social issues; and gender and race discrimination.”

paper edition will not be printed.

They put the spotlight on patients because surveys show 97% of violent acts toward healthcare workers are perpetrated by patients. But there are other sources: patients’ family members and friends, co-workers, and as we have sometimes seen in the CSRA,

domestic violence at a healthcare provider’s home can sometimes spill over into workplace confrontations.

What can help stem the tide of violence?

Complicated problems can’t be solved with simple solutions. But as is often the case when it comes to the treatment of patients, any number of options can contribute to a cure.

According to one survey, 69% of healthcare workplaces have established policies, protocols and training programs to prevent and address violence. That alone leaves plenty of room for improvement, but as one respondent noted, “There is policy but no training.” A recurrent theme was the need for more training on a regular schedule, beginning with new-hire orientations. Training should focus on protecting the health and safety of medical staff, de-escalation and calming strategies, and documenting and reporting incidents. Other components of a safer workplace: better lighting in parking lots, self-locking doors, emergency alert or panic buttons, and the around-the-clock presence of police and/or security guards.

When the Cleveland Clinic began a TSA-

Cases per 10,000 full-time employees

Violent Injuries Resulting in Days Away from Work, by Industry, 2002-2013

If so, we want to tell you two things:

1) Happy early birthday!

2) This is the year to take the next step in protecting your future and the future of your family.

You guessed it. This is the year you are eligible for Medicare. And we can be right by your side as you navigate the process. If you have any questions or just want to talk through your specific situation, we are just an email or phone call away.

WHAT IS WET OR DRY AMD?

There are drug commercials in heavy rotation on TV that are prescribed to treat AMD. What is it, and what are the wet and dry versions?

AMD is short for age-related macular degeneration, and it is a big deal because of the crucial importance of the macula to good vision.

The full-color, super high-resolution, auto-focus cameras we carry around in our heads depend on a healthy macula, which is the central part of the retina, directly opposite the lens and the pupil. As a result, the macula is where light and images strike the retina from things we’re looking at directly.

If this small portion of the retina, a circle roughly a quarter of an inch across, is damaged, central vision is impaired. In other words, a person cannot clearly see what they are directly looking at. They could look straight at the word straight, the one that’s italicized in the line above this, and be unable to see it and a whole circle of the words around it, but be able to see other words peripherally. It would be like watching TV with a large blurry spot right in the middle of the screen.

AMD is unfortunately quite common among people over 65. Dry AMD is much more common and slower in its progress, while wet AMD can cause more rapid and severe vision loss. Despite that, it’s the more treatable of the two.

What are the differences between wet and dry AMD? The differences are dependent upon how the macula is changed. Simply put, dry AMD results from stray clusters of fats and proteins that build up under the macula. So-called wet AMD is caused by irregular blood vessels growing under the macula. They can leak fluid into the retina, resulting in vision loss and scarring of the retina.

Some of AMD’s risk factors are difficult to avoid, like being white, over 50, and having a parent or sibling with AMD. On the other hand, smoking, obesity, and eating a diet high in saturated fats are controllable risk factors.

There are treatment options for wet AMD that can reduce the number of irregular blood vessels and stop further vision loss. There is no cure for dry AMD, but the Age-Related Eye Disease Studies (AREDS and AREDS2) discovered a supplement that can help. Talk to your doctor. +

PARENTHOOD

by Dr. Warren Umansky, PhD

You get a call from your 7-year-old child’s school counselor one morning. The counselor tells you that your child told the teacher she wants to jump off a building and kill herself. You’re not very concerned because she has threatened to kill you and her younger brother several times before at home when she’s angry, but hasn’t shown any actual aggression. What should you do?

A. Take it seriously. As soon as possible, see your pediatrician, who might refer you to a mental health professional.

B. The counselor is blowing it out of proportion. You know her better. Don’t worry about it.

C. Whenever she makes threatening statements, tell her you don’t like her talking like that.

D. Punish her by sending her to bed early for threatening herself and others.

If you answered:

A. These are not typical behaviors for a 7-year-old, and it should be taken seriously. Contacting your pediatrician is a starting place, and follow up with a mental health professional is important for identifying the source of her behaviors and the appropriate responses.

B. The counselor has it right. The behaviors are of concern. You must follow up.

C. She has made threats before and you tried to handle it. The level of concern is even higher now and cannot be ignored.

D. This does not help you understand why she is saying these things.

Parents should be very aware of dangerous or threatening words and actions by their children. Parents should be insightful about whether their own words and actions at home are poor models for the children, and make changes as needed. But these behaviors in children cannot and should not be ignored. It should not take a call from school to put you in motion when such behaviors have been going on at home for some time.

Dr. Umansky has a child behavioral health practice in Augusta.

MEDICAL MYTHOLOGY LEMON LETDOWN

As you may have heard first-hand from a friend or read somewhere, lemon water is the new miracle cure. It can do so many things: cure indigestion, boost the immune system, increase energy, lower stress and anxiety levels, improve mood, cleanse and detox the liver, kidneys and blood, fight aging, improve metabolism, correct pH imbalances, create clear and glowing skin, improve overall health and promote weight loss. And that’s just a partial list.

In other words, all by itself a fresh-cut lemon squeezed into a glass of water could replace most of the drugs in medicine cabinets all across the fruited plain and eliminate the need for most pharmaceutical companies and pharmacies.

If the Medical Examiner was a 50-page publication we might be able to discuss all of the health claims ascribed to lemon water; alas, we have but a portion of a single page.

So let’s direct our attention to one claim: the purported weight loss properties of lemon water. Do a Google search on this subject and you will see dozens if not hundreds of images like the one to the right, plus others that are even more dramatic, such as “Lose

5 pounds in one night using this magic weight loss drink!” Others promise a weight loss of 2 pounds per night.

One TikTok video about all the magical properties of lemon water prompted one viewer to comment, “By drinking lemon water I won a $10 billion lottery today.” Hopefully the person was being facetious, but who knows?

Unfortunately, lemon water is not capable of accomplishing a fraction of the feats ascribed to it. That said, it is not harmful or dangerous. On the

contrary, it’s a great source of flavorful hydration that is not saturated with caffeine and/or sugar. Instead, the lemon gives it vitamin C and antioxidants and small amounts of other good things like riboflavin and vitamin B-6.

But ask any registered dietitian and they will tell you there is no research which shows that drinking lemon water is any more beneficial for weight loss than drinking plain water.

To that point, drinking water has definitely been clinically linked to weight loss through reduced food intake and increased fat breakdown. Drinking more water is also associated with healthier body composition: a 2019 study found that, as water consumption increased, body weight, body fat mass, and waist circumference all decreased.

In another study, participants who drank a full cup of pure lemon juice (not lemon water) had a lower blood sugar spike after eating a slice of bread compared to subjects who drank tea or water. The same study found that lemon juice increased gastric secretions and gastric emptying, both of which may support weight loss.

The bottom line is that drinking sufficient water is vital for good health, and adding lemon to that needed water is safe and healthful for most people. No one should expect the magical lemon water results promised here and there unless their lemon water habit is accompanied by habits like regular exercise, better nutrition that includes more fruits, vegetables, and whole grains, and less if any heavily processed, fried and fast food, and sugary drinks.

Lemon water’s hype calls to mind the saying, “If it sounds too good to be true...” +

Middle Age

BY J.B. COLLUM

In our last issue, we talked about how aging can make it more difficult to do what we used to do, and I shared our difficulties just getting to and into our condo at our Myrtle Beach destination as we dealt with my wife’s twisted ankle.

Next, we found ourselves finally ensconced in the warm and inviting confines of our high-rise condo with a beautiful view of the ocean — or at least we knew it would be a beautiful view when the sun rose in the morning. But it was nearly midnight and we were all tuckered out from just getting all of our voluminous baggage and my wife, in a clunky, unsteerable beach-type wheel chair up to the room.

sleep-deprived brain imagined I was the hero who had dispatched the dangerous animal that threatened my camp.

IT WAS THE WARBLE OF A DYING SMOKE DETECTOR

As we were moving the suitcases, food, drinks, blankets, pillows, and all the other assorted accoutrements of modern living and the support materials for caring for our 6-year-old granddaughter (which are not insubstantial), my easily distracted brain imagined a long line of porters on an African safari trail from one of the old movie serials I watched years ago at my grandmother’s house. I was only snapped out of my reverie when I realized I was playing the role of the porters, laden down with the baggage while the stars of the show walked along unencumbered. But I digress. At last, we could get our forty winks or so and be ready for another day of pain, sore muscles, and humiliation. I mean, a great day of vacation.

Alas, it was not to be. I mean the forty winks part. The sore muscles and all the rest were still on the agenda. At approximately 2:30 in the morning, I snapped awake but didn’t know why. As I lay there wondering what had so rudely awakened me from my much-needed beauty sleep, I began to use some inductive logic. Maybe it was someone’s kid on the floor above who had stomped around on his way to the bathroom, or perhaps it was an Olympic athlete practicing their triple jump.

Just as my ruminations began to lull me back to sleep, I discovered the thief of my sleep. I heard that sickening little warbling beep of a smoke detector with its battery in its death throes. Of course, with the frequency of the beep and the short duration, finding the exact smoke detector that was to blame was difficult. There were four of them in the condo. After much silent searching so as to not wake everyone up, I finally figured out which one was the guilty party. I took it off the ceiling, removed the battery and then heard the beep again. I figured that they were able to beep without the battery for a while, so I wrapped it up in a towel and then put it into the cabinet under the bathroom lavatory. Everyone else still seemed to be asleep, so I slipped back into bed, content with myself as my thoughts drifted back to that safari. My

I was drifting off to sleep with that comforting thought when I heard the beep again. My first thought was that the towel, cabinet door, and bathroom door were not enough to suppress the piercing sound and I would need to toss the smoke detector off the tenthfloor balcony. This was something I was seriously contemplating as I got up to handle the situation. However, it turned out that I had somehow jailed the wrong suspect. I wasn’t sure at first, but I traced the beeping to the other room where my daughter and granddaughter were sleeping. I gave it the same treatment as the other smoke detector, and it joined its partner in crime behind bars so to speak, wrapped in the towel, inside the cabinet, under the lavatory, also with its battery removed. I was taking no chances. That took care of that problem, and we were able to sleep after that.

The next morning, our son came over and made breakfast for us, and then I was off to rent a real wheelchair for my wife. I was tempted to get a powered one, but my desire to save money overcame my innate laziness and the result was that my sore muscles later refused to talk to the cheap part of my brain. After delivering the wheelchair to the love of my life, I moved myself and my laptop over to our son’s condo since I had to work for the day and wanted less distractions and a better internet connection. The day was uneventful and served as a good rest from my porter duties.

The next day I awoke early, got myself a caffeinated beverage, put my headphones on and began my usual Saturday morning vacation routine of wasting the morning away watching YouTube, browsing the web, listening to or sometimes making a little music, and playing online chess. After about an hour of that, everyone else got up and, much to my horror, I was informed that we had a big day planned. By “big day,” I don’t mean hours of relaxing on the beach having adult beverages and listening to music and the sounds of the ocean lapping against the shore, as our late great friend and inspiration Jimmy Buffett taught us so well. Nope, I mean a day full of me pushing my wife around in a wheelchair, chasing down a rambunctious 6-year-old at outlet malls, Ripley’s aquarium, and various other places. My back and feet started to hurt just thinking about it. I tried, to no avail, to talk everyone out of the plan. I was doomed, so I figured I’d just have to make the best of it, which I did. After another breakfast prepared by our son, we were off on our adventure. I’ll spare you the details, but I’ll

Who is this?

The tragic death of Laken Riley, the Augusta University nursing student murdered in Athens on February 22, calls to mind the death of another college student, Jeanne Clery (above).

On April 5, 1986, Clery was murdered after being tortured and raped. She was a freshman, just 19 at the time of her death. A fellow student was convicted of her murder and sentenced to death (later changed to life without parole).

The assault occurred in her dorm room on the campus of Lehigh University in Bethlehem, Pennsylvania. As her parents, Howard and Connie Clery, learned more about the circumstances surrounding her death, a disturbing picture emerged. At seemingly every turn they uncovered an increasingly clear picture of lax campus security combined with deliberate suppression of facts related to campus crime. The Clerys believed that the university covered up and underreported crime, and failed to take action to ensure the safety of students and faculty.

Among their findings, Clerys discovered 38 violent crimes that had occurred on campus in just the three years prior to Jeanne’s murder. Had that information been known, they say their daughter would never have enrolled at Lehigh.

Jeanne Clery’s murder happened when she awoke to find a burglar in her room. The killer gained access to the dormitory through an entrance door that had been propped open, a common practice on campus. Clerys discovered that campus security had previously documented 181 instances of autolocking entrance doors being propped open.

In the aftermath of Clery’s murder, Lehigh University’s position was that campus security was “more than adequate, reasonable, and appropriate for our setting and our situation.” The university’s vice president stated, “You can’t prevent everything from happening.”

Howard and Connie Clery sued Lehigh for “slipshod” security and underreporting crime statistics. They won a judgment which they used to launch a non-profit organization called Security on Campus. Through its efforts, a federal statute known as the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act was signed into law in 1990. Known as the Clery Act, it requires all colleges and universities that participate in federal financial programs to accurately compile and annually publish information about crime on or near their campuses.

The Clery Report is available online at augusta.edu by typing “Clery Report” into the search bar. The report lists criminal offenses ranging from manslaughter to burglary to stalking for the previous 3 years, and offers specific stats for the Health Sciences and Summerville campuses and AU’s College of Nursing campus in Athens.

Earlier this month, the US Department of Education announced a $14 million fine against Liberty University for Clery Act violations. In the past, the actions of Larry Nassar and Jerry Sandusky resulted in millions in Clery Act fines being levied against Michigan State and Penn State Universities, respectively. +

Lessthan

just say that we ended up buying a tube of Diclofenac Sodium at the end of the day since I had left mine at home. If you’re unfamiliar with the product, it’s like the industrial-strength version of Ben-Gay.

The end of the day was the most pleasant part. We went to our favorite Myrtle Beach watering hole, Boardwalk Billy’s, where we were able to relax and enjoy a great meal, or as much as our

granddaughter allowed us to. It really wasn’t too bad since our daughter took the brunt of that workload for us. I don’t know what we would have done without her.

All good things must end, so on Sunday morning I reprised my role as a porter, and we packed back up to head home. After a loud and life-threatening but delicious breakfast at Waffle House, we did a little more shopping, this time at the mammoth Bass Pro Shops Outdoor World, where my wife was able to use one of the electric carts to allow my middle-aged body some rest. She found me some good and inexpensive tents - I mean T-shirts - but at 3XLT, they really could do double-duty as tents or blankets for normal-sized people. After that experience combined with that of the previous day, I made a mental note to get the electric wheelchair if there is ever a next time.

And who am I kidding?

We’re not getting any younger, and there will be a next time and most likely I will be the one in the wheelchair, so I’ve already started doing a little online window shopping and found one that folds up small enough to fit into the trunk of a subcompact car, is made of carbon fiber, and weighs well under 50 pounds with a battery that can go over 16 miles. I’m going to start saving now for that one. Why?

Because I am bound and determined to not let my age and infirmities keep me from getting out there and living my life to the full, even if a big part of me would rather stay home and be a couch potato

+

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

WE’RE BEGGING YOU

We’re never too proud to beg. What we’re begging for is “Everyone Has a Story” articles. With your help, this could be (should be) 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. See the No Rules Rules below, then send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. Thanks!

“And that’s when I fell.”

“He doesn’t remember a thing.”

“I was a battlefield medic.”

“It was a terrible tragedy.”

“I retired from medicine seven years ago.”

“She saved my life.”

“I thought, ‘Well, this is it’.”

“They took me to the hospital by helicopter.”

“Now THAT hurt!”

“OUCH!” NOTHING SEEMED TO HELP, UNTIL...

“The cause was a mystery for a long time.”

“The nearest hospital was 30 miles away.”

“He was just two when he died.”

“I sure learned my lesson.”

“It seemed like a miracle.”

“We had triplets.”

“It was my first year of medical school.”

“It took 48 stitches.”

“The ambulance crashed.”

“I’m not supposed to be alive.”

“This was on my third day in Afghanistan.”

“I lost 23 pounds.”

“At first I thought it was something I ate.”

“My leg was broken in three places.”

“Turned out it was just indigestion.”

“The smoke detector woke me up.”

TRYTHISDISH

by Kim Beavers, MS, RDN, CDCES

Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

Pizza is a comfort food for many and this recipe increases the nutrient value, making it a nutrient rich comfort food.

Ingredients

• 1 12-inch pre-made pizza crust (preferably thin whole wheat)

• 2 teaspoons extra-virgin olive oil

• 1 (14.5-ounce) can roasted tomatoes with garlic

• 1 cup chopped fresh spinach (tightly packed—it’s okay to use more spinach)

• 1 (14.5-ounce) can artichoke hearts; drained and chopped

• ¾ teaspoon Italian seasoning

• ¾ cup mozzarella cheese (substitute some mozzarella with feta for a twist)

Directions

Preheat oven to 425 degrees.

Place pizza crust on a pizza pan and brush with olive oil. Mix the tomatoes with the spinach and spread evenly across the crust. Next, top with artichoke hearts, seasoning and cheese.

Bake for 8-10 minutes until warm and cheese is slightly melted

Yield: 6 Servings

Nutrition Breakdown: Calories 230, Fat 7g (3g saturated), Cholesterol 10mg, Carbohydrate 32g, Fiber 4g, Sodium 830mg, Protein 12g.

Percent Daily Value: Vitamin

Carbohydrate Choices:

Diabetes Exchange Values: 1 Starch, 3 Vegetables, 2 Fats

by Ken Wilson Steppingstones to Recovery

My dad, now deceased, never accepted or discussed his mortality. At age 92 he started shoveling dirt out of his basement to pour a concrete floor to expand his piano-tuning business! He refused to accept retirement at age 65, saying “it’s not in the Bible! Whoever started the idea anyway?” He did start collecting Social Security then, although he kept working long hours. He would’ve had a great time with Clint Eastwood, who told songwriter Toby Keith that he kept going by “getting up every day and being productive and not let the old man in.” Toby loved the answer and wrote his famous song “Don’t Let The Old Man In,” which Clint included in the “The Mule,” the movie he starred in and directed – some of it filmed right here in Augusta.

I like to think, though, that it’s a wise man who realizes when he is too old to do tasks he used to do. My daughters have strictly prohibited my going up on roofs to patch up things at age 72, for instance, even though I still cheat when they’re not

looking. Though I can putter all day in my shop, I have accepted not doing hours of hard physical labor in a day unless I want to pay dearly for the indulgence the next day.

So it was with great surprise that I received a phone

ther complicating his quest for sobriety.

call last week from a dear friend of 30+ years, about my age, who announced his doscovery of something I have known about him for 20 years. He said, “Ken, I need help to stop drinking. I am too old for it anymore.

I have tried measuring my vodka, so know that I drink 4-8 ounces of it every day. I feel terrible in the morning without a couple of Bloody Marys. After that I feel fine.

Can you help me find a place to go to get this under control?” His admission made my job easy! He admitted to frequent falls, a motor vehicle accident and a near-DUI charge, feeling badly unless he drank, and less mental acuity. He lives alone, fur-

Reading up on the subject of alcohol and the elderly at the SAMHSA.gov and webmd.com websites, I have learned that science now recommends that men over the age of 65 should not drink over 1 ounce of alcohol per day, 2 at the max, and no more than 7 ounces per week – provided he isn’t on any medications, which can trigger an adverse effect to alcohol. An “ounce” would mean a literal ounce of vodka or liquor, 5 ounces of wine, or one twelve-ounce beer.

Reading about the side effects of beverage alcohol in an older person’s body could turn one into a tee-totaler overnight.

If seniors have other medical issues, alcohol compounds the problems. Regrettably, many live alone and find alcohol to be their best friend. Nobody is around to reflect on the negative effects of alcohol in the older body which doesn’t tolerate drinking anymore. I’ve known of scores of cases in which dad or grandpa hadn’t been heard from in a few days and a wellness check at their home found

a deceased dad or grandpa with bottles lined up on the bedside table.

Now in my 37th year of alcohol and drug counseling, I have seen some sad stories of good people who simply let their tolerance for alcohol get away with them. Their untimely deaths were not from digging dirt out of a basement at age 92 or directing a film at age 90, but from “natural” causes, a vehicle accident, falling and hitting their heads on a piece of furniture, alcohol poisoning, and the list goes on. Good people who got up one morning expecting to live years longer and not living until dinner time.

If you’re a senior citizen or know of one who is in this predicament, call me or another professional in the treatment field. You’re certainly not too old to do that.

FOODISMEDICINE

“BEYOND THE TABLE”

THE THEME FOR NATIONAL NUTRITION MONTH 2024

by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author

Let’s go beyond the table to talk about Chrononutrition, that is, how the clock and eating are related.

“COME and get it!” “Time to eat!” Ring-ring, ring goes the dinner bell. Those are just some of the ways we let people know it’s time to eat. There is new research investi gating when is the actual best time to eat.

Chrononutrition evaluates how timing of food ingestion affects health. Two popular approaches to chrononutrition are circadian rhythm eating and time-restrictive eating (TRE).

TRE focuses on the hours each day during which eating can occur, along with the number of hours of fasting. TRE may limit the time window for eating anywhere from 4-12 hours. This could mean eating only between the hours of 10:00 am and 8:00 pm (a 10 hour eating window), with fasting between the hours of 8:00 pm and 10:00 am (a 14 hour fast).

• What does the research suggest?

hormones, neurotransmitters, and gene expressions to help regulate metabolic processes. We also have circadian clocks in our peripheral tissues (those outside the brain and spinal cord). These two clock systems are triggered by different situations. The light and dark cycle are the main cues for the master clock in the brain, whereas eating is the main cue for the body’s peripheral clocks (liver, pancreas, gut, muscle, and adipose tissue). When the master clock and peripheral clock are out of sync, normal body systems that regulate blood pressure and blood sugar are less effective.

• What does the research suggest?

According to research, TRE aids people in spontaneously reducing their calorie intake by 350 to 500 calories a day. It makes sense that limiting the amount of allowable time for eating can reduce late-night snack attacks. One bowl of late-night ice cream can exceed 300 calories.

• How is this helpful?

Tracking calories can be a very useful tool when trying to lose weight, but it is a bit laborious. The simplicity of TRE can be an easier way to cut calories.

• How much weight is typically lost?

Short-term studies have shown TRE produces a 2-4% weight loss within 4-16 weeks,just shy of the 5-10% weight loss that is considered clinically significant.

• Is TRE a better way to lose weight than a traditional reduction in calories?

That depends. Does this type of eating/fasting fit your lifestyle? If it does, it may indeed be helpful. But if the time constraints of TRE are a burden, then it may not be a sustainable option.

Circadian rhythm eating focuses on when fasting and eating occur with the purpose of aligning eating patterns with the body’s natural rhythms, consuming most of the day’s calories during the daylight hours and fasting during the evening hours. This is similar to the old adage, “eat breakfast like a king, lunch like a prince, and dinner like a pauper.”

The brain contains a master clock that triggers

Late-night eating decreases the levels of leptin (the satiety hormone) and increases ghrelin (the hunger hormone). This increases hunger levels during the day, making it easier to overeat. Eating according to the circadian rhythm helps to improve the leptin and ghrelin hormone ratios, making it easier to manage hunger. Evidence also suggests that greater weight loss can be achieved when the majority of daily calories are consumed earlier in the day versus later in the day, even when total calories are the same.

Eating that aligns with circadian rhythms has also been shown to improve the gut microbiome. This can help re-establish normal cycles of hormone signaling in the gut that may influence insulin sensitivity.

• How is this helpful?

Shifting food intake up earlier in the day may naturally help with hunger management and weight loss. Eating that is aligned with circadian rhythms may also help improve insulin sensitivity (help in the regulation of blood sugar).

The bottom line

No one eating pattern is right for every person. Certain health conditions, medication, shift work, or lifestyle may make either of these eating patterns a challenge. It is also important to remember that in both TRE and circadian eating the quality of the diet is overlooked. Time of eating will not outweigh the effects of a poor diet. To implement either of these eating styles, consult your primary care provider or dietitian for guidance.

Sources: Karen Collins Nutrition: Link for her more indepth article: Chrononutrition: Time-Restricted Eating vs Circadian Eating (karencollinsnutrition.com) Breakfast Like a King, Lunch Like a Prince, Dinner Like a Pauper (nutritionfacts.org)

CRASH COURSE

More Americans have died on US roads since 2006 than in World Wars I & II combined

If you follow the local news, you know that pedestrian fatalities in the Aiken-Augusta area are not exactly rare. It’s a trend that is being repeated in cities around the country and all over the world.

To take Georgia’s statewide statistics as an example, this is what Peach State pedestrian fatalities have looked like in recent years:

YEAR DEATHS

2019 239

2020 281

2021 321

2022 335

Georgia is in good company: from 2010 through 2022 pedestrian deaths have gone up by a shocking 77%, compared to a 25% increase in traffic fatalities from all other causes. The Georgia increase in pedestrian deaths from 2021 to 2022 alone was 14 people, a 4% rise.

Good work South Carolina: that same yearto-year trend (2021 to 2022) in the Palmetto State saw 20 fewer people killed, representing a 10% reduction. Only New Jersey’s 27 fewer deaths was better, for them a 12% drop.

The lamentable fact when it comes to pedestrian fatalities is that the future doesn’t look hopeful. As recently as 2010 the nationwide total was “only” 4,302 deaths. The 2022 number was 8,126, pending final results. That broke the previous record peak set in 1980. Of course, the number of non-fatal injuries is many times higher, often causing crushing lifelong disabilities.

As bad as it all is, why do the prospects for improvement look so bleak?

Of the most common causes of pedestrian accidents, all but one of them are in play nearly all the time. The leader of the pack is distracted driving. Cell phones lead the way in that department, but newer vehicles have increasingly complex entertainment and navigation systems that take eyes off the road.

Another primary factor is speeding, a nearly universal practice that is cited in about 10% of all pedestrian fatalities, and the trend is inching steadily upward.

Weather is another top cause of pedestrian fatalities. Think about it: weather happens 24/7/365, and it doesn’t always mean icy roads or torrential rain. Especially this time of year, clear days can cause huge safety problems. How many times lately have you driven straight into the rising or setting sun, and done so at the peak of the heavy morning or evening rush hour traffic? There are times when the blinding glare would make a dump truck directly in a car’s path invisible, let alone an adult or small child.

And sometimes the cause of a pedestrian

fatality is the pedestrian. In Augusta’s congested medical district, for instance, have you noticed how many people walk around looking at their phones instead of their surroundings? There are crossing guards at major intersections in that area at peak times, but it’s very common to see people jaywalking across 15th Street in the middle of a block, and 15th Street is wide and heavily used, and many cars are speeding.

Really, drinking and driving is the sole common cause of vehicle-pedestrian encounters that is not an all-day, every day factor.

Interestingly, alcohol as a factor isn’t limited to drivers: in 2021, just over 30% of pedestrians killed on the roads had a blood alcohol concentration (BAC) of 0.08 or higher. By comparison, 19% of pedestrian fatalities in 2021 involved a driver with a BAC of 0.08 or higher.

There are other, less common contributors to car/human encounters that are absolutely endemic. One of the most significant is the ever growing size of vehicles. The largest cars, pickups, and SUVs offered by some car makers just a few years ago are now almost tiny by comparison. Bigger, heavier vehicles require greater distances to stop in time, and do more damage when they don’t.

Are there answers?

Transportation departments and law enforcement can’t do much about some people-car collisions. To take two examples, they can’t make people buy smaller vehicles or control glare from the sun. But there is much that can be done to reverse this deadly trend.

Road design plays a major role in the safety of both drivers and pedestrians. It may surprise you to learn that in 2021, 68.7% of pedestrian deaths happened on roads without sidewalks. That number has been steadily rising. For comparison, the figure in 2017 was 59.2%.

Since the majority of pedestrian deaths occur in darkness, adequate lighting is essential in areas where pedestrians are common. Speaking of lighting, pedestrian crosswalks should be equipped with flashing lights such as those on Laney-Walker Boulevard on the MCG campus.

High-pedestrian areas, particularly those where there is already a history of people being struck, should be regularly targeted for an increased law enforcement presence to slow vehicle speeds. That prevents accidents and makes those that do happen more survivable. People seem to openly flout cell phone use while driving even though it is illegal, providing another easy target for improving everyone’s safety through enhanced law enforcement.

Yes, there is trouble afoot. But it can be reduced when everyone does their part.

All statistics courtesy of the Governors Highway Safety Association.

MAKING THE OFFICE YOUR GYM

Maybe “gym” is too strong a word, but there are ways to transform a job that’s mostly sedentary into one that offers a fair amount of activity and movement.

Probably most of us would consider it extreme to install a stand-up desk and use that desk while walking on a treadmill (if management would even allowed such a thing), but there are people who have that set-up. It’s a definite possibility for those who work from home.

More realistically, what can the rest of us do? There are “sit-stand” desks that can easily be raised and lowered to get us out of our chairs at least part of the day. Researchers have linked sitting for long periods of time with heart disease, obesity and diabetes.

Other ways to get moving that don’t involve a specialized desk can be very simple. Make a rule to always stand up whenever you’re talking on the phone. That offers two benefits: getting moving, and quite possibly helping to keep the length of phone calls to a minimum.

Some people deliberately make things inconvenient. Their desktop copier gets moved to the other side of the room, or even into another room altogether. Their wastepaper basket or recycling bin can’t be reached without standing up and taking at least a step or two. It’s a small thing, but it’s simple, free, and helps prevent sitting for hours on end.

There are other time-honored options, like always taking the stairs, never the elevator. Some people get really creative and go for walks with colleagues for meetings rather than using the conference room.

You don’t have to move heaven and earth. Just yourself. +

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

I checked in a patient and he went to sit in the waiting room while I processed his paperwork. A few minutes later I had a question, so I said, “Sir?” No reaction. I repeated again, louder, “Sir?” He said, “Are you talking to me?” He was the only patient in the waiting room.

The blog spot

— posted by Ryan

McCarthy MD,

on Mar. 2, 2024 (Edited for space)

WHEN I GET ZERO STARS

I can’t stop thinking about “customer satisfaction,” which is weird because I don’t actually have customers. I’m a primary care doctor in Martinsburg, WV, and have been so for almost twenty years. At its core, my job is the opposite of having it your way, like I’m told you can do at Burger King.

I don’t sell anything in my office except perhaps the benefits of good health. The medications I prescribe cannot be requested and are not for sale. I used to work in retail, so I know the dynamics of making customers happy and the practices of up-selling. I don’t offer fries or a large drink with that. I do, however, often tell patients which products they shouldn’t buy or use. I frequently deny requests for medications or tests, as they are often inappropriate, a waste of time and money, and some of them are risky. With a wealth of experience, I have a lot to offer my patients, and it’s a joy to do so.

Giving patients good advice is my primary goal, which seems obvious, but in an age of mistrust, we need to return to primary principles. In order to help my patients I must ask probing questions and then perform, when needed, an invasive examination.

This dynamic of me asking patients “nosy” questions and simultaneously not doing exactly what patients want is why I am ruminating over “customer satisfaction.” My patients—they will never be customers—receive an electronic survey after their office visit. You likely have taken one, and make no mistake, they are now a permanent fixture in American health care. Their existence is simultaneously hilarious and galling to me, for reasons that increasingly sit in the forefront of my mind.

Not long ago, a member of management, a “quality manager,” discussed with me how a group of my patients gave me low, and I mean low, ratings: zero stars. They were truly upset about the health care I provided them. And after a great deal of reflection, I want to explain why these zero-star reviews are a point of professional pride. Not shame. Not misunderstanding. Not an opportunity for improvement. Pride.

How is that possible? A hallmark of primary care is that the next patient can bring me any kind of concern. And boy oh boy do they. I care for sprained ankles, poison ivy, diabetes, asthma, obesity, high blood pressure, depression, I could keep going. This diversity is why I love internal medicine. So many of these situations are straightforward, but underneath lurk darker things, like patients trying to file an illegitimate disability claim, obtaining narcotic pain medication, or stimulants. I am often begged for inappropriate accommodation in the workplace or school setting, so someone can personally benefit.

In a nutshell, I am often asked—begged, chided, cried to—to do medically wrong things. It’s a small percentage of patients, but it is consistent and real. It’s also why some people give me, deservedly, zero stars.

It’s a judgment call about where legitimate care ends and the bogus claims and fraud begin. But after all of these years, I trust my gut. When things smell fishy I have a couple of choices. I can accommodate these requests and turn myself into the medical equivalent of a candy store, where patients receive the treats they want.

The other choice is for me to be courageous, a good steward of public resources, medical funds, and use of limited tests. This requires me to say no and accept zero stars. Patients do this to indicate their dissatisfaction. Turns out, I feel the same way.

+

Ryan McCarthy is an internal medicine physician.

style

policy for everyone entering their facility, they soon amassed a collection of thousands of confiscated items, including tasers, pepper spray, knives and guns

In addition to staff training, patients need to know through notices, posters, hand-outs, etc., that there is a zero-tolerance policy for any abusive behavior toward any staff member. Patients should know that the healthcare facility or provider will press charges. In addition, the individual victim, whether a nurse, doctor, food service or housekeeping provider, home health nurse, anesthesiologist, receptionist or someone else, has every right to press charges on their own behalf.

Targets of assault of any manner, whether it’s verbal abuse, spitting, physical assault or just threatening physical assault, should not be shrugged off as “just part of the job.” Incidents large and small should be documented. Employers should make this easy, having a clear and effortless reporting structure, as well as policies in place to inform

both management and law enforcement. If management expects employees to faithfully report and document incidents of workplace violence big or small, employees should receive reports to keep them informed of follow-up by management. Without this, the perception of inactivity will arise, the feeling that reports of violence are merely generated and filed somewhere without even being read or responded to. A policy of follow-through with victims that is strictly followed obligates management to take action, and it encourages employees to continue to comply.

Source: US Bureau of Labor Statistics

The bigger picture

As the trend of violence in medicine continues to worsen, healthcare delivery suffers for everyone. The field is already suffering from staffing shortages top to bottom, and even the threat of violence contributes to what has been called medicine’s “great resignation.” A 2021 study of healthcare staff retention found that each percentage point of change in RN retention or loss saves or costs the average hospital $270,800 per year. It can add up to $100,000 in total costs to replace a single RN.

Ironically enough, it’s in everyone’s best interests to fight violence.

Number of non-fatal workplace violent injuries and illnesses with days away from work,

I like these gummy worms.

What’s so special about these particular gummy worms? They’re all-natural.

You’re kidding me, right?

It says right on the label, “No artificial flavors.” So they taste as close to real worms as possible?

ACROSS

1. It has 18 holes (with “The”)

6. Make into law

11. Pale pinkish-violet

13. Budget alternative

15. It can blow its top

17. Sales agt.

18. Helper for an LPN

20. Beaver State abbreviation

21. “Over there” in the boonies

22. Stroke (med. abbrev.)

23. To be 46-D

24. Talk radio

26. Computer Dept.

27. Masculine pronoun

28. Tread add-on

29. Common suffix for 31-A

31. Common prefix for 29-A

33. Lowest cardinal number

34. Anti-__________

35. Montana’s first name

36. It preceded GHSU

38. Front tooth

43. ____ sleep

44. Native of Edinburgh

45. Lyric poems

47. Conclusion, musically

48. It can come before a glance or every turn

49. 2009 Pixar classic

51. Nearly one-third of Earth’s landmass

53. Atomic weight abbreviation

54. “Star Wars” ltrs. (Military)

55. Chafe

57. Banned toxic chemical, once used in transformers

58. Mr. Gibson

59. Fuss

60. Simian

62. Handkerchief material?

64. 1.75 pints

65. Dixon’s partner

66. Oil-based alternative

DOWN

2. Rapid in tempo (in music)

3. Start of game that ends with toe

4. Pigeon material?

5. Capital of Vietnam

6. Number often following 7

7. California city and county

8. From midnight until noon

9. JJ Cale song made famous by Eric Clapton

10. Assert or confess openly

12. Conflict; clash; inconsistency

13. Pertaining to building design

14. He is buried on Greene Street

16. Toward the mouth (Med.)

19. Luxor’s river

25. Bobby of note in Atlanta

28. Holstein comment

30. The ratio between a circle’s

circumference and diameter

32. Prefix meaning not; without

36. _________ oblongata

37. Nashville awards show, in short

39. Sometimes the beginning of doubt

40. When doubled, mediocre

41. Room within a harem

42. Breathe

43. City in NW Georgia

44. Cause to feel sorrow

46. Type of bed or day

47. Gordon, originally

50. Light enters through it

52. Where one may be who is 46-D

54. Monte _______ Ave.

56. Blocker beginning

61. Permit

63. Dot these; cross the T’s.

ATHEBESTMEDICINE

ha... ha...

guy was doing some curls at the gym when he caught a guy staring at him.

“Take a picture, pal!” he said. “Haven’t you ever seen a guy using hair rollers before?”

A bus driver got into a conversation with the passenger in the front row.

“Ever notice,” observed the driver, “that people only value things when they don’t have them anymore?”

“You mean like money, family and friends?” asked the passenger.

“No,” said the driver. “Brakes.”

Interviewer: Where do you see yourself in five years?

Interviewee: I’d say my biggest weakness is listening.

Doctor: Do you smoke?

Patient: Yes.

Doctor: Marijuana, cigarettes, cigars, vapes?

Patient: Mostly brisket and pork.

Moe: Sometimes I feel like a pelican.

Joe: How’s that?

Moe: Wherever I look I see a huge bill.

Moe: Why didn’t the dentist display his awards?

Joe: He wanted to avoid plaque buildup.

Moe: Where do dentists go for a good time?

Joe: Floss Vegas.

Moe: Why was the salami discharged from the hospital?

Joe: Because it was cured meat.

Moe: Why did the roll of toilet paper roll down the hill?

Joe: To get to the bottom.

Moe: How did the hacker escape from the police?

Joe: He ransomware.

Moe: That one guy in the band sure sucked at playing the trumpet.

Joe: Yeah, it just doesn’t work that way.

Moe: What do you call a policeman who won’t get out of bed?

Joe: An undercover cop.

Moe: I went to dinner at an outdoor restaurant last night. Terrible experience.

Joe: But it was pouring rain last night!

Moe: Tell me about it. It took me an hour and a half to finish my soup.

Moe: Taylor Swift is so cool.

Joe: Well duh. She has like a million fans.

Dear Advice Doctor,

The Advice Doctor

I have an ex-brother-in-law who should be on that TV show Biggest Loser. I’m not saying he’s fat; I’m saying he can’t seem to keep out of jail for more than a few months at a time or hold down a job. But for some reason he thinks we’re friends and that I approve of his loser lifestyle. Yesterday he asked me if he could borrow $500! I’m retired! Does he think I’m off my rocker? How can I shed this loser parasite from my life?

— Not Amused

Dear Not Amused, I applaud you! Here you are retired and presumably relaxing after years of hard work, yet you’re off your rocker! Well done! No doubt many of your contemporaries are sitting in theirs watching the world go by, but not you.

Here’s why you’re the smart one.

Any physical activity is better than none. If you can only walk for ten minutes a day, you’re that much ahead of everyone who stayed in their rocking chair all day.

Although there is nothing wrong with getting 10,000 steps per day, that target originated as a marketing gimmick, not a scientifically proven benchmark. In fact, researchers have found that significant benefits can come from far fewer steps. Generally speaking, however, more steps, and therefore more activity, translates into longer life and better health.

A Boston-based study of almost 17,000 women with an average age of 72 years examined their walking habits for more than four years. The women who averaged around 4,400 steps per day had a 41% lower risk of dying during the course of the study than those who took 2,700 steps a day on average. The greater the daily step count, the lower the risk of death, all the way up, found another study, to as many as 20,000 steps a day.

Another research finding is that a step is a step is a step. 100 steps slowly taken down your bedroom hallway and back is equal to the 100 steps taken by a person huffing and puffing at top speed down the sidewalk. At one time it was thought that step intensity amplified the benefits of walking, but research hass not borne out that belief.

The beauty of walking is that it’s free, simple, can be done at anyone’s individual pace, and has multiple health benefits. Again, I applaud you for being off your rocker and on your feet!

Thanks for writing. I hope I answered your question.

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.

...cleverly hidden in the balloons in the p. 3 ad for SCOTT INSURANCE GROUP

WE DID NOT HAVE A WINNER :-( 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!

...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

ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the

Guillermo Gallardo, MD

Specialist

Paul Butros,

Salman Mufti, MD

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

Chanelle Duchaussee, DPM

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

Risha Malik, MD

DeAnn Henderson, MD

Komal Quershi, MD