Medical Examiner 11-17-23

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NOVEMBER 17, 2023

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IT’S TIME! Well, it’s actually past time. Significant-

ly past. Sure, everyone knows this already, but there are procrastinators living among us. It’s our job as examiners of all that is healthful and salubrious to offer the single word above as an important, even urgent reminder (please note the exclamation point).

Quitting the smoking habit is an especially appropriate topic this week (not that it isn’t every week) because the Great American Smokeout falls on the Thursday See page 11 before Thanksgiving. That’s this week.

Even though the dangers of smoking are old news, let’s go ahead and mention a few of the reasons why no smoker should ever light up another cigarette.

The National Cancer Institute says “Smoking is the leading cause of cancer in the United States.” That’s a direct quote, but they probably should have said cancers, because smoking increases the risk of many types of cancer. Among them: lung cancer (all by itself the leading cause of cancer death in both men and women in the U.S.), throat cancer, oral cancer, esophageal cancer, stomach cancer, pancreatic cancer, kidney cancer, bladder cancer, and cervical cancer.

If seeing the word cancer 14 times in a single paragraph doesn’t convince someone to quit, don’t worry; there’s more.

A short list of the additional problems smoking exposes smokers to begins with heart disease, followed by stroke, emphysema, bronchitis, COPD, erectile dysfunction, birth defects, cataracts, and more others than we have space to list.

As mentioned above, everyone knows smoking is risky business. It’s especially unfortunate when people in healthcare smoke, but sadly, it’s not exactly rare to see medical personnel taking smoke breaks.

Your doctor and pharmacist are just two of the resources at your disposal if you are determined to quit smoking. Best wishes to you! +

A QUITTER’S CLASSIC

It was quite a shocking announcement from the Centers for Disease Control and Prevention (CDC) earlier this month: the U.S. infant mortality rate (IMR), which had been steadily dropping for more than 20 years, suddenly saw a 3% increase in 2022, a jump public health experts called statistically significant and disturbing. IMR over the years from 2002 to 2021 had fallen by 22%. Georgia was one of four states with the highest increase in 2022. Although it could be just a statistical oddity, preliminary data suggests the upward trend is continuing: infant mortality rates in the first quarter of 2023 are higher than they were at the same time in 2022 even though the overall U.S. death rate in 2022 dropped by 5%, a decrease attributed to the diminishing impact of COVID-19.

Two questions need answers: what exactly is infant mortality, and why should you and I care, especially if we are past child-bearing years?

First, IMR is defined very simply: it’s the number of infants who die before reaching their first birthday as measured per 1,000 births. The 2022 U.S. rate was 5.6. By comparison, the IMR in Afghanistan is over 120, and it’s above 109 in Niger and Mali. But of the world’s 27 most developed countries, the U.S. has the highest infant mortality rate despite spending more on health care per capita than any other country. Japan’s IMR is 2.21, Bermuda’s is 2.47, and Sweden’s IMR is 2.74, all less than half the U.S. rate. Georgia’s rate for 2022: 7.07, a 13% jump from its 2021 IMR. South Carolina’s: 6.75, 7% lower than 2021.

Over the past century and more, the IMR in the U.S. has dropped by 93%. In the 1850s it was estimated to be 216.8 per 1,000 white babies and 340.0 per 1,000 black babies.

Why should people care, and what can be done to reduce the risk of infant mortality?

Please see INFANTS page 3

OPEN ENROLLMENT IS HERE. NOW IS THE TIME TO CALL!

RENEA SOOS Renea Soos • Medicare Independent Broker Serving Georgia, South Carolina, North Carolina and Michigan • Email: srsoos@yahoo.com

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 17, 2023

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

MEDICAL MYTHOLOGY

PARENTHOOD

by David W. Proefrock, PhD

Your 5-year-old son is in kindergarten and has probably been told or figured out the truth about Santa Claus. He hasn’t said anything directly, but has let you know in other ways that he knows. You are concerned about what he might say in front of your younger children. What do you do?

A. Tell him a story about a boy who stopped believing in Santa and then didn’t get any presents for Christmas.

B. Tell him that you know that he has figured out about Santa Claus, but if he tells younger children, he will be in big trouble and won’t get any presents for Christmas.

C. Tell him that he is getting older now and that you want him to help keep Christmas special for the younger children.

Let him know that you are counting on him to let them continue to believe in Santa Claus.

D. Tell him that some people have doubts, but Santa Claus is real. You believe in Santa and he should not believe the kids who doubt him.

If you answered: A. This would be putting a young child in a serious bind.

Of course he wants Christmas presents, but he can’t continue to believe something that is a myth.

B. Never threaten something that isn’t going to happen. If you do actually withhold his presents while the other kids get theirs, you would be the worst kind of parent.

C. This is the best response. Enlist his help in keeping Christmas special for everyone.

D. In our modern world, even a 5 year-old would know that you are lying to him. This only makes you someone who can’t be trusted.

Santa Claus is a complicated mixture of myth and tradition.

Guiding young children through understanding it is delicate.

When there are even younger children in the home, it’s better to give them some responsibility in keeping the tradition alive. +

HOSPICE = DEATH IS IMMINENT Many people believe as above, that hospice care means that curative medical treatment is no longer an option, and therefore death is near.

Think back to last February when it was announced that 99-year-old President Jimmy Carter was ending curative treatments and transitioning to hospice care.

If you watch the news, you know that a number of local channels and national networks sent reporters and anchors to Plains for a vigil that would soon become onthe-scene reporting about the former president’s death.

Except that Mr. Carter did not cooperate. He’s still not cooperating, and the reporters have long since left Plains forr other stories. The Carters, meanwhile are not just clinging to the last shreds of life; they’re riding in parades and appearing at Peanut Festivals.

No one believes that Jimmy and Rosalynn Carter have an extended future ahead (even though he is already the most long-lived president in U.S. history, as well as laying claim to the longest post-White House retirement: 42 years so far), but his experience serves as a real-life lesson that hospice

care isn’t what so many of us think it is: a death sentence.

Jimmy and Rosalynn may both be alive and well a year from now, or even longer Of course, it could be argued — and you may be thinking as you read this — that the Carters are a statistically insignificant sample, and an abnormal one at that. After all, does the average person, whether age 29 or 99, get the level of healthcare that a former president does? You might think not, so a person could be forgiven for viewing Jimmy Carter’s hospice experience as merely anecdotal.

Actually, however, medical literature contains documented research proving what might be considered the unexpected: that patients often live longer

on hospice than if they had remained in curative care.

To take one example, in a large study of heart failure patients reported in the Journal of the American College of Cardiology (JACC), after discharge following a second heart failure episode, the hospice group had significantly fewer emergency department visits; days spent in the hospital; intensive care unit stays; were less likely to die in the hospital; and had longer median survival compared with the study’s non-hospice group.

Furthermore, the earlier statement that a former president gets a level of care not available to mere mortals is another example of medical mythology. Look back at the statistical outcomes for hospice patients cited in the JACC study. They describe the essence of hospice for everyone: fewer hospital and emergency room visits and overnight stays. Why? Because you have access to medical care right at your home. Less likely to die in the hospital? Again, that is the very definition of hospice.

No wonder people in hospice care live longer than those in a hospital setting.

Every case is different, but as illustrated so graciously and publicly by our neighbors down the road in Plains, hospice can last for days, weeks, or even many months. It all depends on the individual patient.

Despite the possiblie variations, what hospice always means — regardless of the time involved — is an opportunity for the patient and their family to enjoy whatever time remains in the most comfortable setting possible.

That’s really all anyone could ask for. +

Dr. Proefrock is a retired local clinical and forensic child psychologist.

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THANK YOU FOR READING!

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 17, 2023

INFANTS… from page 1 Why should someone in their 70s or 80s, or a young couple that has decided not to have kids care about rising rates of infant mortality?

Looking at the two faces illustrating this article would be a good place to start. We should all care simply because we’re fellow humans, and human nature sometimes includes a thing called compassion that moves us to help total strangers, donate to causes that don’t affect us personally, feel sympathy for the plight of people halfway around the world, and even go out on a limb (literally or figuratively) to save an animal in distress.

There is also the interconnectedness of us all. We are all part of a family. Those geezers that don’t care much about infant mortality would care quite a bit if their grandchild or great grandchild was a victim. Ditto for the young couple who ended up pregnant anyway, or whose little niece or nephew didn’t make it to age one.

It’s really a subject that, the more it’s investigated, the more difficult it is to ignore. For example: worldwide 2.4 million children died in their first month of life in 2020, which sounds horrible until you discover that as recently as 1990 that number was 5 million. Around the world, approximately 6,700 newborns die every day. That represents nearly half of all deaths that occur under the age of 5.

It might seem that problems like this are so vast and complex that they’re beyond the ability of any one person or family to change.

Not so. True, experts can list dozens of factors that contribute to infant death, even

TURNING 65?

things like inflation, which sometimes forces people to choose between food and rent or medicine and healthcare.

But there is still plenty that every parent — or big sister or aunt or uncle or meemaw or even babysitter — can do.

In keeping with this week’s Great American Smokeout, do not smoke during pregnancy, which leads to shortened pregnancies and low birth weight, both risk factors for infant death. Do not smoke around children of any age, exposing them to second-hand smoke.

It’s better for all, and think of the money you’ll save.

Mothers-to-be can avail themselves and their unborn cargo of medical care regardless of their finances. Contact your family physician or the health department to get started on prenatal care. Healthful help is available.

Creating a safe sleeping environment might seem like a minor step, but SIDS (Sudden Infant Death Syndrome) is the third-leading cause of infant mortality in the U.S. SIDS is the unexplained death of an infant younger than 1 year of age that remains unexplained even after a thorough investigation. Since its cause is unknown, it can’t be decisively eliminated, but the risk can be reduced by placing babies on their back for sleeping and keeping the area free of loose bedding.

Another practical example of a simple but worthwhile step to take: using a proper infant safety seat, one that’s the right size, properly installed.

Yes, even baby steps can be big steps. +

MEDICARE CAN BE CONFUSING. CALL US TO HELP UNDERSTAND YOUR OPTIONS.

WHAT ARE BLOOD TYPES? Not very long ago it was believed that everyone’s blood is the same. Then along came Austrian physician Karl Landsteiner, who in 1900 discovered that blood from different people would clump together if in the same test tubes. But only sometimes. That was curious. Landsteiner wasn’t sure if the phenomenon was caused by “inborn differences between individuals,” or if some of the blood samples mixed together had been contaminated with bacteria.

Through additional tests he determined a small number of combinations of blood that would and would not clump together. Based on those combinations, Landsteiner identified three different blood groups that he named A, B, and C. By 1902, C had been renamed O after the German word Ohne for “zero” or “without,” and two of his students discovered a fourth blood type that became AB. Before those classifications were universally adopted, a Roman numeral system was briefly employed in the US and Europe. Its simplicity was obvious: I, II, III and IV; its flaw was that the European I was the American IV, and vice versa. Blood-typing errors created confusion and lifethreatening dangers before the ABO system was adopted.

What makes blood different from one individual to another? The presence or absence of A and B antigens in various combinations.

Type A has A antigens in red blood cells (RBCs) and B antigens in the plasma.

Type B has B antigens in red blood cells (RBCs) and A antigens in the plasma.

Type AB has A and B antigens in red blood cells (RBCs) and none in the plasma.

Type O has no (“Ohne”) antigens in red blood cells (RBCs) and both A and B antibodies in the plasma.

Although there are more than 600 other known antigens whose presence results in rare blood types, about 98.7% of us have one of the four blood types above. A protein called the Rh factor results in positive and negative types. Someone with O positive (O+) blood, for example, has the Rh factor; people who are O- (O negative) don’t have it. +

MEDICALEXAMINER

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www.AugustaRx.com The Medical Examiner’s mission: to provide information on topics of health and wellness of interest to general readers, to offer information to assist readers in wisely choosing their healthcare providers, and to serve as a central source of salubrious news within every part of the Augusta medical community.

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 17, 2023

Who is this? THECWORD

#201 IN A SERIES

Nationally in November, we raise awareness about carcinoid, lung, pancreatic, and stomach cancers, and recognize cancer caregivers. In this edition of The C Word, we discuss carcinoid tumors and lung cancer and share web-based resources that may help put your risk of cancer into context.

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his attractive woman may look fairly ordinary, but she is an absolute powerhouse of a human being who has dramatically changed the face of medicine. Here’s your first clue to the truth of that statement: in the photo above (taken in 2019) she was — what do you think? 60? 70?

Actually, she’s 99 years old in this picture. At the end of December she’ll turn 103. Between her birth in 1920 and today she has given hundreds of thousands of people a career in medicine and saved the lives of probably millions.

How did she do it?

It all started at age 16 when, as a high school graduate too young to enter a training program, she got a job as a nurses’ aide. The experience confirmed that she wanted to pursue nursing as a career, and she received a diploma in nursing from the training program at what is now Robert Wood Johnson University Hospital in New Nov. 12-18, 2023 Brunswick, New Jersey. is National Nurse Through the G.I. Bill she was able Practitioner Week to enroll at the University of Colorado (CU) and receive a degree in nursing with a Public Health Nursing certificate in 1949, a Master of Public Health Nursing Supervision in 1951, and a Doctorate in Education in 1961. By then she was already an assistant professor at CU’s School of Nursing in Denver.

But let’s back up for a minute. Throughout the 1940s and 1950s, our subject, Loretta Ford, worked as a public health nurse in rural areas of Boulder County, Colorado. There on countless occasions she saw deficits of care that she and other nurses attempted to fill through temporary health clinics.

The experience convinced her that with proper training, nurses could fill these gaps in healthcare delivery. She was in the perfect position to see the problem, and as a nurse educator, to do something about it. Together with pediatrician Henry Silver, she launched the nurse practitioner (NP) movement, an advanced role for nurses that they proposed in a 1967 article in the journal Pediatrics: “A program to increase health care for children: the pediatric nurse practitioner program.”

That same year, Boston College launched one of the first Master’s programs for NPs. As one might expect, the idea was initially met with plenty of opposition from standard nursing programs and prejudice that downplayed the abilities of nurses. Even so, within a decade there were some 15,000 NPs across the country, a number that today has surpassed 355,000 (including more than 8,000 in Georgia). Americans now visit NPs well over a billion times a year, according to the American Association of Nurse Practitioners (AANP).

Why are Nurse Practitioners so valuable? As more and more states allow them full practice primary care authority, NPs help fill the gaps caused by physician shortages in many communities. And the discipline itself is built around a holistic approach that emphasizes good health andprevention, not merely treatment of existing illness.

Still active in the AANP, Dr. Ford was inducted into the National Women’s Hall of Fame in 2011, and in 1999 was honored as a Living Legend of the American Academy of Nursing. With good reason. +

Carcinoid Tumors — Although rare and typically slow-growing, carcinoid tumors occur in hormone-producing cells and are referred to as neuroendocrine tumors. Carcinoid tumors most often form in the digestive tract such as the small intestine, appendix, rectum, colon, stomach, esophagus, pancreas, and liver. Risk factors include family history, race and gender (women have a slightly higher risk than men, and black people are more affected compared to white people) and other health problems such as pernicious anemia, and aging.1

assessments (breast, cervical, colorectal, kidney, lung cancer and melanoma) that identify factors that increase or decrease the risk of developing cancer. Note, the CancerIQ assessment comparisons are to the Ontario Canada population and Ontario-specific data.

If you are not from Ontario, are younger than 40 years, or have had cancer, the results will be less accurate. This calculator does not specify if you will or will not get cancer, but it highlights cancer risks and ways to lower the risk. Raising awareness about one’s own risk factors for cancer may spark action to reduce the risk.

Breast Cancer Risk Assessment Tool — National Cancer Institute – The risk calculator helps health professionals estimate a woman’s lifetime risk of developing invasive breast cancer over the next 5 years up to age 90.

Information about a woman’s personal medical history, reproductive history, and breast cancer history among first-degree family members (mother, sisters, daughters) is used to calculate the probability of developing invasive breast cancer. https://bcrisktool. cancer.gov

Lung Cancer — In 2023, in the U.S. an estimated 238,340 people will be diagnosed with lung cancer and 127,070 will die from this leading cause of cancer deaths.2 It is also one of the most preventable cancers since 80% of lung cancers are attributed to smoking Symptom Checker — Cedars augusta.edu/cancer/community tobacco products and secSinai – An interactive tool ondhand smoke exposure. Other risk factors designed for educational purposes only, helps include a personal and family history of lung users assess how serious their symptoms are, disease, environmental exposures to radon if a healthcare visit is needed, and steps taken gas, asbestos, air pollution, and contact with at home to relieve symptoms. Users pinpoint high levels of arsenic in drinking water. regions of the body by hovering the cursor over a male or female drawing, select from a Interactive Assessment Tools & Resources menu of symptoms to identify the first sympThe risk assessment tools described below tom, and can look up a doctor based on a city are for informational purposes only and are or zip code. cedars-sinai.org/health-library/ not a substitute for medical services. As with symptom-checker.html#!/start all web-based tools, reading the Terms and Conditions of Use is a wise idea.

“The C Word” is a news brief of the Georgia Cancer Center at Augusta University. For Know Your Chances — The National cancer information, visit: augusta.edu/cancer/ Cancer Institute (NCI) offers a web-based community.To request exhibits or speaking interactive tool to help assess the likelihood of engagements, contact Maryclaire Regan at mregetting cancer over the next 10 years.3 Select gan@augusta.edu or 706-721-4539. Arrange for from a series of four charts: (1) Big Picture virtual presentations in order to follow CoronaCharts showing the 10-year chances of dying virus precautions. from major causes, (2) Custom Charts enable Sources: selection of causes of death and a timeframe, 1. Cedars Sinai. Carcinoid Tumor. https://www.

(3) Your Chances displays the chances of cedars-sinai.org/health-library/diseases-and-condidying from the most common causes based tions/c/carcinoid-tumor.html on your age, race, and gender, and (4) Special 2. American Cancer Society (ACS). Special SecCancer Tables that compare the risk of diagtion: Lung Cancer. Cancer Facts & Figures, 2023. nosis and death for specific cancers. Smoking cancer.org/content/dam/cancer-org/research/canstatus (never, former, current) is factored into cer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cff-special-section-lung-cancer.pdf the risk algorithm.

My CancerIQ – Cancer Care Ontario — The website My CancerIQ offers a series of risk

3. National Cancer Institute (NCI). Know Your Chances: Interactive Risk Charts to Put Cancer in Context. https://knowyourchances.cancer.gov +

READ THE EXAMINER ONLINE!

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NOVEMBER 17, 2023

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AUGUSTAMEDICALEXAMiNER

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

“Can I get the flu vaccine and the RSVP vaccine together?”

The patient listed his occupation as a “night stalker” at Walmart.

YOUR MILEAGE MAY VARY

READERS: What have you heard? Please share!

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somewhat. Perhaps I am like a woman going through labor who says, “never again,” only to want another child a while later. I tend to have a photogenic memory. Not photographic, photogenic. My memory of bad aspects fade while pleasant memories grow stronger. Only when the time arrives for actually carrying out the plan does the little part of my brain that remembers all the bad pipe up to remind me of it. By then it is too late to back out.

I know that age is the primary reason for these changes in my attitudes and feelings, but Covid-19 did its part too: I got used to being a hermit. I fight the impulse and my wife also helps me with it. She helps by berating me for trying to get out of the plans, and making sure I know that as miserable as I expect to be by keeping the plans, she can make sure I’ll be far more miserable if I cancel. This particular wifely skill, unlike other skills we lose as we age, only seems to increase and grow as my wife ages. She has been going through menopause for a little while now, and that only seemed to raise her to a master at this particular art. I believe she has a black belt in it. I laughed when a close friend complained about his wife going through menopause a few years ago, figuring my easy-going better half would breeze right through it without me noticing any change at all. Well, I was wrong, but don’t tell her I said that.

I have tried to adapt though, and my selective hearing loss has gotten much better (or worse, depending on how you look at it).

Let’s just say that I have learned to act like I didn’t hear something, and on rare occasions that even works when one of the grandkids causes some emergency to distract her until I can make myself scarce. Sometimes I act like I didn’t hear her, and then find something that needs doing outside the house and swiftly head outside to do it as I tell her what I am doing. If it is something she has been waiting on me to do, she will then usually drop the other complaint and let me walk outside, unhindered, to get the chore done. Of course, I have learned that I don’t have to come right back in once I’m done. I try to gauge how long it will take for her to let it go. I’m not too good at that though. That is why I have a great back porch and deck so I can stay outside in comfort for extended periods. I’m thinking about storing a tent and some other camping supplies out there for the worst-case scenarios. I already have a fridge, three TVs, and a great sound system out there, so I can’t really complain about it.

Another change is that it takes me far longer to recover from an illness. In point of fact, I am still fighting this sinus infection that I wrote about in the previous issue. I’m on my third course of antibiotics now and this is a

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We must adapt to change if we want to stay happy. I know I’ve written those words before. I also know that I repeat myself, because my wife tells me that all of the time, but this time, I’m doint it deliberately it because it bears repeating and I’ve had some recent reminders of this inescapable fact. What changes you ask? Let’s talk about a few that are currently on my mind.

Things that I used to look forward to are no longer as appealing as they used to be. They may sound great when I plan them weeks or months in advance, but as the day approaches, I wish I hadn’t committed to them. We may make plans for a cookout on our back deck for a large group of friends, and I can’t wait for the event to arrive...until the day before, when I wonder why I agreed to this plan while I’m grunting, sweating, huffing, and puffing while I’m cleaning up or doing some other work in preparation for the visitors. It isn’t that I won’t enjoy the company of my friends, I just start to think that maybe it could have been just a few people, or maybe only ones I don’t feel the need to clean up for. The ones that won’t judge me for staying in my pajamas all Saturday or, if I am feeling fancy, just wearing a robe over my pajamas and no shoes or socks. The ones I don’t have to shave for. We all have those friends. Or at least I hope you do. They are the best kind of friends.

We may buy tickets to a concert I think I’ll really enjoy, but as the day draws closer to get ready and actually go, I think about the driving at night that I’ll have to do. The fact that I will have to wear shoes and socks for a few hours and maybe even shave.

I’m starting to see some commonalities here. I fear being out late and how I might even fall asleep since I will be out past 9 pm.

I dread the traffic jam and the search for a parking spot and then the potentially long walk to the venue, usually in a part of town that is known more for its crime than its abundance of street lights and law enforcement personnel. And I can’t even carry a pocket knife since they have metal detectors at the gate. Thank goodness I can always just say my gout flared up and carry a cane. Of course, my gray hair and wrinkles eliminate any need for me to come up with an excuse to carry a cane now anyway. Then, if it is a loud concert (is there any other kind?) I have to worry about my right ear hearing static, so I hope that I remembered to bring ear plugs to reduce the sound level, but as mentioned earlier, I don’t have the greatest memory, so I usually don’t.

Don’t get me wrong, in both of the scenarios I listed above, I do end up enjoying myself most of the time and I rarely regret going, but there are usually enough difficulties involved that it does take away from the joy

FOLLIES

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TURE A E F NEW

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 17, 2023

WARNINGS & SIDE EFFECTS The FDA (Food and Drug Administration) makes sure that any drug brought to the US market is reasonably safe for the consumer. I am told that if you had a one–pill cure for cancer, it would take half a billion dollars and 5 to 7 years to get FDA marketing approval. That’s why every new drug coming to market is so expensive. Federal price fixing (for possible political reasons) makes it less likely we will continue at the present pace of new drug development.

Certainly we want the FDA to have prudent oversight of any new drug.

All bureaucracies, including the FDA, have a few things in common: their primary objective is survival, expansion of their bureaucracy power, and increasing their personnel.

For example, Homeland Security was set up to protect our airports from terrorist. Initial estimates indicated 15,000 employees could handle the

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

job. Two years later, Homeland Security had 65,000 employees and was still growing.

The good news is that we’ve had no major airliners blown out of the sky.

The FDA is gradually increasing its reach and grasp, which in many cases is a good thing. On the other hand, it is thought by some that if aspirin (acetylsalicylic acid) was discovered today it might never gain FDA market approval because of its side effects, such as gastric bleeding, cerebral hemorrhage, and interference with warfarin therapy for blood clots.

Or consider a better example: what if somebody came

out with tomorrow with a new product called alcohol.

With side effects such as cirrhosis of the liver, mental dysfunction, addiction, gastric ulcer disease, being a major cause of vehicle crashes, and the tendency to lead to marital disharmony, divorce, and the failure of many businesses…

Could alcohol survive FDA scrutiny and make it to the marketplace?

A decade ago, it was estimated that over 140,000 die each year secondary to alcohol, making it the fourth highest cause of preventable deaths, behind tobacco, poor diet/inactivity, and illegal drugs. (Now, illegal drugs — mainly fentanyl — rank first.)

Most likely alcohol, if approved today, would be a Class I Controlled Substance right alongside heroin. But because of politics and common use of alcohol, it is not considered a drug under FDA supervision.

Augusta Office: 2283 Wrightsboro Rd Augusta, GA

Aspirin and alcohol are easily obtainable.

The FDA requires that certain products have a “black box warning” attached to the label. Unfortunately, the general population does not read the black box warning much more often than they read the Constitution. That is a shame on both counts.

One the problems of reading black box warning, or looking on the Internet to find the side effects of certain medicines, is that the average person is not highly skilled at reading or understanding exactly what they mean. When FDA-approved clinical trials are performed, any side effect that occurs must be listed.

When s thousand patients are tested and one patient has nausea and vomiting, that must be included in the side effect list.

Does this mean that you will have nausea and vomiting if you take the drug?

No, it means you have a 1 in 1,000 chance of having that same side effect. Another way of putting it is that 999 patients out of 1,000 did not have nausea and vomiting.

Does that mean you should take the drug? Or should not take the drug? The individual decision needs to be made between the physician with years of experience and the patient with their personal

feelings, weighing the potential advantages against the possible disadvantages. It is not easily done. Medicine is an art as well as a science.

Testimonials are worthless.

When you take a medicine, you should educate yourself by speaking with your physician, your pharmacist, and reputable sources of information.

Side effects are usually serious business. However, because the side effect is listed does not mean it is likely to occur. Most listed side effects are of no great significance to the majority of the population.

On a much lighter and more humorous note, here is an Internet posting that circulated recently among many medical personnel: Why can’t we have just one drug warning label that says, “May lead to multiple, prolonged orgasms.”

After all, Viagra is marketed to treat erectile dysfunction (ED) by producing intermittent priapism. This was originally considered a negative side effect since the drug was designed to treat pulmonary hypertension.

Later, the pharmaceutical company figured out that they could make more money by marketing the side effect than the original hypertension application. +

GOT A STORY?

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AUGUSTAMEDICALEXAMiNER

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If using raw chicken, trim all visible fat from the chicken and season with spice blend and set aside. Place the peppers, tomatillos, and cilantro in a blender with about 2 tablespoons water. Blend until smooth and set aside.

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AUGUSTAMEDICALEXAMiNER

NOVEMBER 17, 2023

CURIOSITY KILLED THE CAT

by Ken Wilson Steppingstones to Recovery

I grew up hearing the headline saying when someone dared me to do the unthinkable. It was always followed by “but satisfaction brought it back!” Wikipedia says the first half of the saying has been around over 400 years and was used in a Shakespearean play. It was meant to convey the folly of unnecessary investigation and experimentation. The second half about satisfaction has only been around about 100 years and certainly varies in truth. And somewhere along the way the notion of cats having 9 lives added to the conundrum.

Today, however, I do not write about plays or dictionaries. Early Tuesday morning I received a call from one of my daughters who was crying… the one who is least prone to such an emotion.

She was passing on to me that a family member in his 20s who had been living in a halfway house and who was seemingly doing well in recovery had ordered some drugs online and used them on Monday evening. Unbeknowst to him, it was his last use: he fatally overdosed. He simply went to sleep and his lungs decreased in function, then his heart slowed to no beat at all and he passed away from this life. He never knew what happened. The funeral was this morning as I write this, attended by the parents whose guts felt kicked in by the tragedy, and friends all asking the same question: why?

Nobody really knows the answer. But everybody knows that for some reason he listened to his addictive voice one time too many.

This family was but one of 106,000 families in the United

States alone who experienced this devastation in the past year. I rarely turn on TV news without hearing of another fentanyl bust. Last week a commentator broke it down into simple terms: a quantity of fentanyl similar to 10 grains of salt will kill a human. One tiny drop of carfentanyl (used as an elephant tranquilizer), will kill. Backyard chemists and compounders are not exactly counting particles as a governed lab in a legitimate pharmaceutical company would do. Drugs of all types are being laced with the drug to boost their effect.

Every day I tell my clients, “these days, any drug use is too much…you never know what’s in it.” Neither did the 106,000+ who fatally overdosed in the past year. I continue, “If you need a rush, find something else to do!” At times, I think some actually listen and change their

choices!

The National Institute on Drug Abuse (.gov) reports that 187 people die each day in the US from opioid overdoses alone, mostly from fentanyl. Three years ago, the figure was 130 per day.

I can see positive signs that our country is paying more attention to mental health than ever before, but I do not see enough being done to stem the tide of fentanyl poison. I venture to say that if the ever-increasing death numbers s were from heart, kidney, or lung failure, those responsible for treatment would be doing something about it…a big something. I hope that in my lifetime medical professionals can treat substance abuse disorders with the same respect and vigilance that other medical problems get.

I don’t know the solution, but I do know that educa-

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

tion makes a difference. We need to talk, learn, and keep open minds to realize that addiction is an equal opportunity disease. Like cancer, it doesn’t care who it kills. It gets the rich and poor, males and females with the same non-discriminatory attacks.

In the case above, the lives in the family of this young man have been forever changed. Family photos, holiday gatherings, the anniversary of his demise, memories, dreams, ad infinitum.

I’m not sure whether cats have 9 lives. But I am sure that humans only have one. +

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!

“OUCH!”

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

“And that’s when I fell.” nearest hospital “He doesn’t remember a thing.” “The was 30 miles away.”

“I was a battlefield medic.” “He was just two when he died.”

“It was a terrible tragedy.”“She saved “I sure learned my lesson.”

“I retired from medicine my life.” “It seemed like a miracle.” seven years ago.” “We had triplets.”

“It was my first year “I thought, ‘Well, this is it’.” NOTHING SEEMED of medical school.”

“They took me to the hospital by helicopter.” TO HELP, UNTIL. . “It took 48 stitches.”

ambulance crashed.”

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

“This was on my third day in Afghanistan.” in three places.”

“I lost 23 pounds.” “Turned out it was just indigestion.”

“At first I thought it was something I ate.” “The smoke detector woke me up.”

Everybody has a story. Tell us yours.

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

NOVEMBER 17, 2023

9 +

AUGUSTAMEDICALEXAMiNER

SHORTSTORIES

AS A DOCTOR, WHAT IS THE STRANGEST THING YOU HAVE EXTRACTED FROM A PATIENT? Several decades ago, I had a call from the ER in the wee hours of the night about a young male patient who was complaining of continuous bleeding from a cut near his temple around his left eye.

The patient was incoherent, apparently drunk. His friends said that the cut was bleeding on and off. I would say oozing would be more correct. Going on and off.

They were planning to visit a clinic in the morning, but the oozing worried them.

In my humble opinion it was nothing. But nevertheless I did a full checkup, starting with visual acuity. He had poor vision. He wore glasses, but their whereabouts were unknown. Family members with him didn’t know, and the patient remained incoherent, uncooperative, and even hostile at times.

Exasperated, I go on checking. The cut is quite clean, and it has partially sealed off because of blood clotting, but when I palpate

around it, blood oozes out. I thought that was odd. I palpate further, and there’s something hard inside the cut around his temple.

When in doubt, explore. I carefully insert a forceps into the wound and encounter some resistance. Blood suddenly spurts out. Eeeek.

With one hand pressing the patient’s temple, I probe further with the forceps. The patient goes berserk. I tell his family to hold him and go on checking. There’s something inside… I grab it with the forceps, and the thing actually comes out by itself… and presto! A whole damned lens comes out, part of the AWOL eyeglasses. Apparently the patient had a fall, hit his head while wearing his glasses, and one of the lens comes out of its rim, makes a cut and enters the wound. Astonishing.

The bleeding stops and the oozing also stops. I stitch it up, and the job’s finished after a little more probing and examinations to make sure everything was out.

What I realized that day: the most absurd things can happen to anyone. +

SHORTSTORIES DO DOCTORS LIE TO PATIENTS? During the war in Zimbabwe, a 7 year old boy was brought in to the hospital where I was part of the surgical team. He had been attacked 6 hours before with a machete. His spleen and left

Marshall Curtis

kidney were hanging out and his stomach was bloated from paralytic ileus. He asked me if he was going to die. Given the blood loss, the delay in bringing him in from the rural areas, and the extreme nature of the injuries, I had

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little hope for him, but I lied: “You’re going to be fine.” He looked relieved.

He was taken to surgery and one week later he was running around the ward, playing with other kids as though nothing had happened. I’m convinced that had I told him what I really was thinking, he would have given up all hope and died. +

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MIDDLE AGE… from page 5 really strong one that I have to take for two weeks solid. My right ear still hurts sometimes and still stays full of fluid, but it has only been a few days since I started these antibiotics, so I will give it time. I did have a very satisfactory experience at the ENT physician I saw just this past Wednesday though.

I had to call back to clarify something and got a prompt response, so that is promising. Here’s hoping this will work because the doctor said the next option would be to cut it open and drain it and I’d rather not do that.

As I mentioned at the outset, as we age, we need to adapt to change. Our abilities, health, stamina and so much more degrade over the years, and although we can do some things to hold it at bay to an extent — like exercise, diet, medications, etc., and we should do that — we also need to remember to not overdo it and to not beat ourselves up for not being able to live up to our old standards. It is a little easier for me because my old standards were never that high to begin with, but your mileage may vary. Nobody expects a classic car to get great gas mileage and have all the latest bells and whistles, but they are still worth something to somebody who appreciates them.

So let’s appreciate ourselves and our other “classic” friends and family. Some of us and/or our friends are antiques, but they are worth even more. Especially if they are the same friends that don’t call you a slob for greeting them in pajamas. Treasure those friends, because they are priceless. Just don’t try to take them to Antiques Roadshow to get them appraised. That might get a little awkward. + 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.co

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AUGUSTAMEDICALEXAMiNER

CRASH

COURSE

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

P

cut them off or refuse to let them merge and it’s game on. We have talked about road rage before in this series, and it’s a growing problem everywhere. You might not have ever thought of anger and rudeness before now as a function of road design and the failure of roads to stay ahead of population growth, but it is a definite factor.

Let’s talk about specific ways drivers can improve traffic flow in ways that tie in with good manners.

Given that our local roads are in many places stretched to their limits, it doesn’t help when we cause other drivers to slam on their brakes, or we needlessly block entire lanes.

Here are two examples we’ve seen just within the past week: 1) a speeding car in the fast lane of eastbound I-20 cut across 3 lanes of traffic at the last second to exit onto Washington Road, causing several other drivers to slam on their brakes and/or veer out of the other driver’s way.

We suspect this was a planned maneuver just to get ahead of other cars - how rude! - but if there really was a last-second emergency need to get onto Washington Road, the driver could have gone to the next exit and come back much more safely (and less rudely). Here’s another example: 2.) An eastbound driver in front of Stanton Optical on Washington Road decided at the last minute that they wanted to turn left onto Old Evans Road instead of going straight. Cars trying to turn left had already stopped for oncoming traffic, so the best the driver could do was nose in a little to claim a spot in front of another left-turning car. How rude! As a result, the inside through lane (adjacent to the left-turn lane) was completely blocked for the entire green, preventing everyone behind that car from proceeding ahead. That is so rude! And of course, drivers in the outside lane of through traffic weren’t letting any of those cars in.

What is the proper way to prevent such situations? The mannerly thing to do would be to involve no one else in your mistake. You don’t slam on your brakes at the last second because you almost missed your turn; you go ahead to the next street and double back. You don’t veer across multiple lanes of traffic to exit; you drive to the next exit and make your way back one way or the other. You don’t block traffic by straddling two lanes because you forgot this was where you wanted to turn; you go straight and fix things down the road. No one else should have a clue that you missed your turn.

In short, show other drivers some manners. +

{

erhaps you missed the first four installments of this series. If so, you’re forgiven. By all means go back and read them all online. You’ll be a better driver and a better human for the experience. To recap, our general premise is that bad driving annoys other drivers, and annoyed drivers become bad drivers. We are not here to excuse the reactionary drivers and lay all of the blame on the triggering drivers.

No, they are both to blame, the first for their initial offense and the second for being too immature to just be an adult and drive on. Even so, the fact remains that doing something that makes other drivers’ blood boil (rightly or wrongly) has to count for something bad. Those actions should be avoided. For instance:

{

TEN THINGS I HATE ABOUT YOU Part 5

9. The lost art of good manners (See the Sept. 15, Oct. 6, Oct. 20, and Nov. 3 Medical Examiners online for nos. 1 through 8) As you may have noticed, traffic congestion is getting worse. More drivers are on the road all the time anyway (see Thomas Malthus), but in communities like ours, congestion seems to be accelerated. We have heard people say more than once that Grovetown traffic is worse than Atlanta’s. New employers like the cyber command, and massive developments like Grovetown’s Gateway complex (the head count of restaurants alone in that development exceeds 40), tax the capacity of roadways (and the patience of drivers on them) to the max.

It doesn’t help that major two-lane roads like Robinson Avenue and Flowing Wells Road are torn up for years at a time, only to eventually reopen as, yes, two-lane roads.

Ah, but we digress — a little. Addressing traffic congestion, a very real contributor to unsafe driving, is the responsibility of traffic engineers who are supposed to be long-range planners, looking far into the future to anticipate and minimize problems before they occur. They aren’t supposed to wait until thousands of houses have sprung up in dozens of huge subdivisions, and only then start transforming 2-lane roads into newer 2-lane roads. Maybe the new version has a suicide lane or right turn lanes here and there, but for the torrent of through traffic, they’re still only two lanes It doesn’t take a brain surgeon to figure out that with more and more (and more) cars on the same old roads, coupled in some places with construction projects and their attendant congestion belatedly attempting to fix things, something’s got to give. Many drivers are already short-fused (and no wonder) and that’s before any interactions with other drivers. Let someone

Next issue: “10 Things’” final installment

NOVEMBER 17, 2023

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The blog spot — posted by Steven Zhang, MD on March 18, 2019

THE DIFFERENCE BETWEEN LEARNING MEDICINE AND DOING MEDICINE

Back when I was a third-year medical student, I would sometimes bike to the hospital campus early enough to catch the groundskeepers cleaning the promenade in front of the medical school before the foot traffic arrived. Discovery Walk, as it’s called, is a beautiful promenade with stone murals commemorating the significant discoveries made at Stanford. It’s a beautiful scene, especially during sunrise or sunset, which many of my classmates have taken a liking to posting on Instagram.

Some of them have showcased almost their entire lives as a medical student on Instagram and have earned a few thousand followers, making them minor celebrities of sorts.

It’s fun to scroll through those carefully tailored pages and reminisce — they’re highlight reels of our shared times over the past handful of years. There are photos of research conference presentations, selfies in surgical scrubs with shiny stethoscopes draped across their necks, a carefully choreographed display of textbooks and anatomy drawings scattered across a table.

Spend enough time on these social media feeds and you, too, would be ready to apply to medical school. Even the less glamorous photos — the ones accompanied by complaints about the long hours or sleep deprivation or bland hospital food — are glorified and gloss over the reality of the wards.

The glitzy aspects of medicine usually portrayed on shows like Grey’s Anatomy have leaked from television onto cell phone screens.

One of my interviewers on the residency interview trail asked me if I would change anything in medical school. I told him that I’d reverse the whole experience and have students begin with the wards during first year and end with the textbooks and tests before graduation. And I don’t mean just gently immerse first-year medical students into a well-oiled, private clinic fully staffed with happy physician assistants and nurses but to throw them into the trenches of a busy hospital with overworked interns as orientation.

I’d have the first-years follow the surgery or the medicine intern taking call and get their hands dirty with the “scut” work of the hospital — the endless pile of tasks that keep the hospital running but are medically unrelated. They’d help answer the inconsolable pagers beeping constantly to order for more Tylenol or laxatives, examine the incontinent patient who keeps soiling herself and then change her dressings, write the discharge summaries (which sometimes end up being small novellas) for patients who will only return a few days later, and process the maze of paperwork of finding a new home for the patient who has nowhere to go because no one would take him. Then, I’d have them take a stab at typing up the dozens of daily patient notes on the computer, writing the same phrases — “the patient is stable” — over and over until the words lose their meaning.

Only then, when the students know what the inner workings of the hospital is like and know they can stomach them, would they begin to actually learn medicine. There’s an underbelly of this machine that never gets to see the spotlight of Instagram.

I finished my last residency interview mere hours ago before writing this piece, and suddenly the specter of intern year has somehow grown exponentially larger. Though I’m eager to shed my short white coat, I feel as unprepared as ever — a gaudy resume filled with research publications and passable board scores won’t help much next year. And if there’s one lesson that I have learned since starting medical school and could tell my younger self, it would be that learning medicine is the easy (and Instagram-glamorous) part. But actually doing medicine? It’s hard. +

“It’s not like it is on TV.”

Steven Zhang is a medical student

11 +

AUGUSTAMEDICALEXAMiNER AN OLD EXAMINER FAVORITE OF OURS FROM WAY BACK IN 2012

When you quit...

What is happening physically, including subconscious, internal effects

What you might feel like or experience, including conscious, external effects

Within 20 minutes Your bp drops to the level it was before you smoked your last cigarette. The temperature of your extremities, with blood flow no longer constricted by the effects of nicotine, begins to return to normal

With your blood pressure back down to where it was before that last cigarette — a comfortable 240/160 — you no longer feel your circulatory system constricted by nicotine. Instead, your hands are constricted on the arms of your chair, your grip cutting into the armrest fabric and actually leaving deep impressions in the wooden accents — made of oak. Your vision is blurred and you’re beginning to drool slightly — tiny concessions for gaining freedom from cigarettes.

Within the first 8 hours The level of the deadly carbon monoxide in your bloodstream drops to normal

Feeling the acute effects of dropping carbon monoxide levels, you have a strong urge to revert to old habits. But you’re determined.

You fight the urge to suck the tailpipe of an idling car and instead chase cars through the neighborhood on foot, inhaling deeply.

Within 24 hours Your chance of a heart attack decreases

While your risk of a heart attack from smoking drops, the risk of a heart attack caused by not smoking skyrockets. Fortunately, you’re able to let off steam by screaming at your children, parents, marriage mate, store clerks, pets, neighbors, the TV, trees, rocks — and marriage counselors.

From 2 weeks to 3 months Circulation improves; lung function increases up to 30 percent

Circulation improves, but so does perspiration. Every time you even think about cigarettes, or pass within 3 miles of a convenience store, you break out in a cold sweat. You notice your improved lung function as you sob hysterically two to three times a day. Vomiting caused by withdrawal symptoms is now down to just twice a week.

From 1 to 9 months Shortness of breath, coughing, lung and sinus congestion, and fatigue all decrease. Tiny cilia in breathing passages regain their ability to eliminate mucus, dust and inhaled germs, reducing the chance for respiratory infections

Even though fatigue caused by smoking has decreased, you still experience a little fatigue due to waking up fifteen to twenty times a night from nightmares that you broke down and took a puff.

Your lungs no longer feel choked, but for some reason you have a constant urge to choke the cat.

At the 1 year mark Coronary disease risk is cut by half

To celebrate your successful one-year anniversary and your reduced coronary risk, you celebrate at your favorite all-you-caneat restaurant with a huge steak dinner, loaded baked potatoes, and three trips to the dessert bar.

5 years after your last puff Your risk of stroke is now that of a non-smoker

You finally feel like you’ve turned the corner and mastered the art of non-smoking. Although you kicked the habit, you rarely kick the dog these days, and you hardly ever pick up cigarette butts off the sidewalk and fondle them anymore, savoring their aroma.

10-15 years after you quit Your risk of lung cancer is half that of those who continue to smoke. The risk of cancers of the mouth, throat, esophagus, bladder, kidney and pancreas all drop. At 15 years your risk of coronary heart disease is as low as a non-smoker’s.

As a confirmed and successful quitter, you adopt a smug and condescending attitude toward smokers and those struggling to quit, knowing you’re a superior being. Finally, at the fifteen-year mark you conquer every character and personality flaw associated with quitting and at long last regain your emotional equilibrium.

You’re kind and considerate to one and all, and you unfailingly and uncritically do everything you can to support others who are trying to quit, doing so with loving encouragement and without critical judgement. After all, you tell people, it was easy. +

— by Dan Pearson

+ 12

AUGUSTAMEDICALEXAMiNER

The Examiners

NOVEMBER 17, 2023

THE MYSTERY WORD

+

by Dan Pearson

Definitely. We have Modoc? I thought you You sure have a to run up to Modoc have a colonoscopy first thing tomorrow. busy day tomorrow. first thing.

My doctor still works from home.

So why are we going to Modoc?

I do.

The Mystery Word for this issue: NCLCISI

© 2023 Daniel Pearson All rights reserved.

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

EXAMINER CROSSWORD

PUZZLE

1

2

3

4

5

6

7

10

15

16

17

18

19

11

12

13

31

32

33

57

58

We’ll announce the winner in our next issue!

9 4 7 5 3 E S 9 4 X 9 3 1 U A 6 2 4 5 D M I 8 5 7 O 9 N6 3 7 K E 8 7 U R 4 3 7 6 5

22 24

25

30

39 43

44

46

47

49

50 56 61

by Daniel R. Pearson © 2023 All rights reserved.

64

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

67

QUOTATIONPUZZLE

33. Curt 35. Uncontrolled dependency 36. Arab mandolin or lute 38. Serfdom 41. New Age singer 42. ___ Pack of the 50s 43. Educational speech 44. Earthen pot 46. Outlaw 50. Sound starter?

51. Affectedly quaint (British) 52. Prefix for ship 53. Brink 55. Not pro 56. Type of fist 57. Gusto 58. Manages, just barely 60. Possesses

1 2 3 7 5 9 O N O 7C 6 Y U O 2I 4 8 1 T H W 6 5 T 9 8 4 3 — Author unknown

G D D O T R O G N R N A O E I I A E T N U C U E N H Y E Y C W V T

A R N A

by Daniel R. Pearson © 2023 All rights reserved

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.

Solution p. 14

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

1 2 3 4 5 6 7

8 9 10 11

E 1 2 3 4 5 6

1

2

3

1 2 1 2

1

1

2

P 3 4 5

2

3

4

5

6

.

— Author unknown

6

1.FIASCOE 2.RISTOOC 3.TRUMT 4.HPPG 5.EELI 6.DART 7.I 8.N 9.I 10.N 11.G

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

by Daniel R. Pearson © 2023 All rights reserved

BY

9

14

20 21 ACROSS 1. Initials on p. 3 23 5. Once the world’s 26 27 28 29 most wanted man 10. 1st, 2nd, or 3rd, etc 34 35 36 14. Authentic 37 38 15. Speeder’s nemesis 16. Country backroad 40 41 42 17. Mild oath 45 18. Office person 19. Sea eagle 48 20. Grabbing 51 52 53 54 55 22. Augusta __________ 23. Georgia Chateau 59 60 24. Former president Dan 62 63 of MCG 26. Coffee holder 65 66 29. “Where The Wild Things...”

by Daniel R. Pearson © 2023 All rights reserved.

30. At odds with 34. Beech follower DOWN 36. Insincerely sweet 1. HPV, herpes, etc.

37. Country south of Libya 2. Nation south of the 38. Tint Caspian Sea 39. Growl; snarl 3. ___ mater 40. Portrayed or depicted 4. Monetary unit of Lesotho 43. One of Trump’s favorite 5. Peach follower insults 6. Common solution 45. Like the numbers in 10-A 7. Capital of Yemen 46. ____ canto (operatic 8. Hereditary title of the Holy singing style) Roman Empire 47. “Through” lead-in, at times 9. Noah’s boat 48. Prefix meaning “of a cell” 10. Field scavengings 49. Rights grp.

11. Take in 51. 8th Greek letter 12. Tina Turner’s real first name 54. Tease; tempt 13. Spool 59. Dry watercourse 21. Family 60. Worshipper of Vishnu 22. Blacken 61. Arduous journey 25. Epoch 62. Therefore 26. Brewery beginning?

63. Up and about 27. Seating assistant 64. Moved up 28. Chemical secreting organ 65. Paradise 31. Rule of _____ (in burns) 66. Hit, back in the day 32. Certain tactic 67. Formicary residents

WORDS NUMBER

8

Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, NOV. 26, 2023

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NOVEMBER 17, 2023

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

The

Advice Doctor

why she was yelling into her mailbox, she told me she was sending a voice mail.

©

Moe: What did the artist do when he spilled paint all over himself?

Joe: He brushed himself off.

Moe: Nope. He drew a bath.

A

hound dog is lying in the yard of an old farmhouse. An old man is sitting in a rocking chair on the porch when a traveling salesman walks up and pauses at the yard’s rickety wooden gate.

“Excuse me, sir,” calls the salesman. “Does you dog bite?”

“Nope,” replies the old man.

The instant the salesman pushes open the gate and walks into the yard, the dog launches itself at the salesman and bites his leg.

Holding his leg in pain and trying to fend off the dog, the salesman angrily yells, “I thought you said your dog doesn’t bite.”

“I did,” replies the old man. “But that ain’t my dog.”

Moe: Yo mama...

Joe: What? We’re doing “Yo mama” jokes now? Seriously?

Moe: Yes. Civilization is unraveling. We need to do our part.

Joe: Oh good grief. Get on with it then.

Moe: Yo mama is so dumb...

Joe: How dumb is she?

Moe: She’s so dumb that when I asked her

Moe: What do you call a bad flood at a convent?

Joe: An inundation.

Moe: I spilled stain remover on my shirt.

Joe: How are you got to get that off?

Moe: Why did the house go to the doctor?

Joe: Haha. Because it had shingles.

Moe: Probably not.

Joe: Oh. Well then, because it had the flue?

Moe: Wrong. A house wouldn’t do that.

Joe: I got it! Because it was homesick!

Moe: Seriously?

Joe: Because it wanted to meet Dr. House?

Moe: That show is so over.

Joe: I know it’s not lupus. It’s never lupus.

Moe: Correct.

Joe: Was it shopping for pain meds?

Moe: Possibly.

Joe: Ok then! Because it had window pains!

Moe: Hmm. Maybe.

Joe: What do you mean “maybe”? It’s your joke!

Moe: Joke? I asked you a serious question.

Moe: What was the drug-dealing duck’s specialty?

Joe: Quack. +

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.

SUBSCRIBE TO THE MEDICALEXAMINER +

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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!

Dear Advice Doctor, I don’t have a question; I just want to share something that happened to me the other day. I went to a walk-up ATM and stood there forever behind an old lady who didn’t know how to use the machine. I finally asked her if she needed help. She said all she was trying to do was check her balance. I was happy to help her, but here’s the thing: she handed me her bank card and then gave me her PIN so I could access her info for her. I did help her, but I told her don’t EVER do what she just did. The next person might not be as honest as me.

— Old People: Be Careful Out There!

Dear Old People, Thank you for sharing your story. You make an important point for us all: many older adults struggle with balance issues. It is not at all uncommon, so your encounter at the ATM is no surprise.

What are the causes? There are many possibilities. The National Institute on Aging lists medications as potential culprit #1. Anyone who suspects that’s a problem in their case should check with their doctor or pharmacist. Is there an alternate drug that won’t result in this side effect, or can the dose of the current medication be reduced safely?

The NIA also suggest that inner ear infections can often be to blame, and alcohol can specifically affect how the inner ear works. That’s important since our sense of balance is maintained in a part of the inner ear called the labyrinth.

Other medical issues can affect balance: diabetes, high blood pressure, stroke and heart disease, vision problems and thyroid disease, to name a few.

It’s vital to let your doctor know you’re having balance issues. Falls can result in permanent disability and vertigo can cause traffic mishaps, so it’s extremely important to intervene to the extent possible.

Among the options: as mentioned, adjusting medication; getting physical therapy, which can even target the inner ear, believe it or not; working to lower blood pressure; adjusting diet; and getting exercise. Your doctor will have more options.

Behavioral therapy can also help. For instance, not standing up too quickly; avoiding heels or walking on slippery floors in socks; using a cane or a walker; removing tripping hazards from your floors and sidewalks.

Help is available. Don’t face this issue lying down.

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.

Why read the Medical Examiner: Reason #8

NAME ADDRESS CITY STATE ZIP Choose six months for $22 ____ or one year for $40 ____. Mail this completed form with payment to Augusta Medical Examiner, PO Box 397, Augusta GA 30903-0397

BEFORE READING

AFTER READING

8 7 + 14 4 3 7 6 5

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

...cleverly hidden on the arm of the nurse in the p. 1 ad for SCRUBS OF EVANS

THE WINNER: C. NEWMAN! 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!

NOVEMBER 17, 2023

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

SEE PAGE 12

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

...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then find it concealed within one of our ads. Click in to the contest link at www.AugustaRx.com and enter. If we pick you in our random drawing of correct entries, you’ll score our goodie package!

SEVEN SIMPLE RULES: 1. Unscramble and find the designated word hidden within one of the ads in this issue. 2. Visit the Reader Contests page at www.AugustaRx.com. 3. Tell us what you found and where you found it. 4. If you’re right and you’re the one we pick at random, you win. (Winners within the past six months are ineligible.) 5. Prizes awarded to winners may vary from issue to issue. Limited sizes are available for shirt prize. 6. A photo ID may be required to claim some prizes. 7. Other entrants may win a lesser prize at the sole discretion of the publisher. 8. Deadline to enter is shown on page 12.

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QuotatioN QUOTATION PUZZLE SOLUTION Reduce everything you want to an action you can do right now.

— Author unknown

WORDS BY NUMBER Complaining is stupid.

Either act or forget.

— Author unknown

8 1 5 7 2 4 6 9

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IN-HOME CARE

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

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

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

DRUG REHAB Steppingstones to Recovery 2610 Commons Blvd.

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YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo.

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NOVEMBER 17, 2023

SHORTSTORIES

AS A DOCTOR OR NURSE, HAVE YOU EVER BEEN IN DISBELIEF WHEN YOU SAW HOW BAD A PATIENT HAD LET THEIR TREATABLE CONDITION GET BEFORE SEEKING TREATMENT? Absolutely, but I never blame the patient.

There are always reasons why they didn’t take care of their problem sooner (financial, embarrassment, ignorance of their condition, etc.). I can think of two examples right off the top of my head. The first was last month. I was volunteering at a foot care clinic for the homeless. A diabetic, obese, wheelchair-bound homeless vet came to the clinic with badly infected wounds. He had obvious long-term neuropathy on both legs and feet that left left him unable to feel the pain at all.

His legs were weeping copious amounts of edema and oozing infection that soaked his socks and shoes daily. He couldn’t do his own wound care, and clearly his wife didn’t know how to either, or was unable or unwilling to do it at least once a day as was needed. I think being in a wheelchair and not having extra socks also complicated his ability to appropriately care for himself. It took a specialist wound care RN an hour to carefully remove his socks and old dressings without pulling his skin off with them. The man had a doctor’s appointment a few weeks away, but knowing the VA system like I do, I’m sure there just was no appointment available sooner. He was so grateful to receive the care and new socks and shoes at the clinic. It broke my heart to see a vet so poorly cared for. I’m sure he ended up in the hospital due to leg infection, but he didn’t go that day.

The second case cost me a reprimand at the hospital where I worked at the time. A patient was admitted from a nursing home. Before she came, we got a report from the home which mentioned nothing about the terrible condition in which she arrived. I’m sure the nursing staff didn’t even know, but if they did they didn’t provide even the most basic appropriate care for her. When we undressed her, she was in a diaper that obviously had been on her all day or longer. On top of that, she had pressure ulcer on her tailbone so deep you could put your fist in it. The saturated, soiled diaper led me to believe the nursing home staff didn’t keep her clean and dry, and so likely didn’t turn her every 2 hrs (which is the minimum standard.) The “dressing” (using the term loosely) on the pressure ulcer was just a 4x4 dry gauze taped over the wound as if to conceal it. I believe the nursing home didn’t find it until they were getting ready to transfer her. The elder abuse in the form of neglect made me sick, and I was furious. I stormed into my supervisor’s office telling her the horrible condition this poor woman was in, and asked her to call someone in charge at the nursing home. I ended up getting a “talking to” about not staying calm and professional. But this woman’s condition was avoidable (lack of basic bedsore prevention methods), uncomfortable (due to prolonged sitting in a dirty diaper), and very painful. She was at the mercy of these “caregivers” who offered no such thing for her. I had to just suck it up and make sure that at least I and the other nurses would now take care of her properly. I don’t believe family was involved, so despite my indignant protests, she was sent back to the terrible nursing home. Sadly and probably mercifully for her, she no doubt died from infection within weeks. +

to every one of our advertisers, our columnists, and each and every reader.

THANK YOU ALL FOR YOUR SUPPORT We are profoundly grateful for each one of you.

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NOVEMBER 17, 2023

YOU’RE SO VEIN THERE ARE 60,000 MILES OF VEINS IN THE HUMAN BODY When even a few inches aren’t working properly the result can be misery.

SYMPTOMS THAT CAN INDICATE VENOUS DISEASE AND VARICOSE VEINS: Bulging bluish or purple veins visible under the surface of your skin Painful or achy legs that feel heavy Muscle cramping in your legs, particularly at night Itchy legs, especially on your lower leg and ankles Burning or throbbing sensations in your legs Swollen feet and ankles at the end of the day

CL

IN

IC

S

WE CAN HELP

CALL FOR AN APPOINTMENT TODAY

AUGUSTA VASCULAR CENTER 630 13th St., Suite #250 • Augusta 30901

PHONE 706-724-2500

AUGUSTA VASCULAR CENTER WEST 3623 J. Dewey Gray Circle, Suite #100 • Augusta 30909

PHONE 706-854-9932

AugustaVascularCenter.com