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JUNE 1, 2012

H T E F Y O E N AR A M Two Thousand Twelve

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Aspirin bottle, 1900

ore than twenty years ago, then-editor of Augusta Magazine, Beth Siciliano, gave me an assignment to write an article about once-a-day aspirin therapy. At the time, I thought taking aspirin was supposed to be a reactive event, something you did when you had a headache, a toothache, fever. The concept of taking an aspirin on general principles was new to me back then, but it seemed like a fitting commentary on modern life: something is bound to hurt before this day is over, so you might as well accept that fact and just take the aspirin as soon as you get up. It’s going to happen soon enough, so get it over with.

I remember jokingly asking Beth, “Is this daily aspirin in addition to the ten or more most of us are already taking in the course of a typical day?”

Well, as we all know by now, an aspirin a day has replaced an apple a day as the cornerstone of preventive medicine. Aspirin is at the same time the most mundane of drugs and the most amazing.

Quick: name a drug you take if you have a headache — or a stroke. Name an inexpensive, overthe-counter drug that can help prevent heart attacks, blood clots, strokes, cancer — and pain and swelling

from stubbing your toe. The answer for all these situations and more is aspirin, a modern-day miracle drug if ever there was one. New benefits from aspirin continue to be discovered.

But an aspirin a day isn’t for everyone. Who should take pains to avoid aspirin? How did this amazing drug come to be, and how does it work?

A drug with an ancient history Most histories of aspirin begin with Hippocrates in the fifth century B.C. writing about a bitter powder made from willow bark that helped ease aches and pains and reduce fevers.

Actually, aspirin’s origins date much farther back, into earliest Biblical times: remember God telling Moses, “take these two tablets”?

Fast forward many centuries to the late 1890s and we meet Felix Hoffman, the German chemist pictured above (and that’s aspirin’s molecular structure on the left), an employee of a company you may have heard of: Bayer. For several decades prior to his appearance in the story, salicin or salicylic acid had been given in high doses to treat pain, Please see ASPIRIN page 2

THE SKINNY ON BAYER’S WAR HEADACHES Aspirin emerged from the labs of Bayer, a German company, in 1899. Business was good and growing until Germany went to war in 1914. German assets in Britain were frozen, and Allied nations like the US were not inclined to buy products from enemy nations.

This had a negative effect on the aspirin supply at a time when it was desperately needed.

Beginning in 1915, Bayer set up a number of shell corporations and subsidiaries in the US to guard against the possibility that, if America entered the war, Bayer’s sales and assets in the US would be lost. A US war office called the Alien Property Custodian was established

by Woodrow Wilson, chaired

by A. Mitchell Palmer, whose job was to seize, administer, and in some cases sell “enemy property” in the US. Palmer soon uncovered the Bayer subsidiaries that were nominally American-owned but actually controlled by Bayer’s German headquarters.

He seized Bayer’s US assets and by the authority of the Trading with the Enemy Act, sold all of Bayer’s US patents, factories and trademarks, including the Bayer cross logo, bought by patent medicine company Sterling Products. The rights to “Aspirin” and the US rights to the Bayer name and trademarks were bought back

by Bayer in 1994 for $1 billion. +

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ASPIRIN… from page 1 swelling and fever caused by conditions like arthritis and influenza. Hoffman’s own father suffered from arthritis, and also suffered from stomach trouble caused by salicylic acid. The younger Hoffman zeroed in on the word acid, reasoning (correctly, in part) that it was the source of digestive troubles for those taking salicylic acid. He subjected the material to a few chemical reactions which resulted in a less acidic, yet more effective product, acetyl-salicylate.

Although that development occurred in 1897, it wasn’t until 1899 that Hoffman’s work was given the final stamp of approval and the newly christened product — aspirin was its name — went on sale to the general public. (Aspirin was coined from A for acetyl, the SPIR from the meadowsweet plant they extracted the salicylic acid from, Spirae ulmaria, and the IN came from the fact that ending drug names with IN was the in thing to do at the time.)

Is aspirin a success? Today, 80 billion aspirin tablets are taken each and every year, nearly 220 million pills a day, for everything from inflammation to chronic pain.

The history of aspirin is a living history: new benefits seem to emerge regularly, and as recently as the early 1980s, a British scientist and his colleagues won the Nobel Prize in Medicine for discovering, after all this time, how aspirin works. And that’s a really complicated subject.

The mechanics of pain Pain is a strange phenomenon. Its official definition is vague enough and complicated enough that some doctors subscribe to a simplified explanation of pain: “it’s whatever the patient says it is.”

After all, what one person thinks is overwhelming pain may hardly bother the next person. And another patient may experience excruciating pain in his left big toe every day, even though his left leg was amputated twenty years ago.

That’s the kind of pain aspirin can go to town on: unwanted pain, chronic, nagging, unrelenting pain. Bad pain.

As opposed to good pain, which is desirable, and in fact, lifesaving. A life devoid of pain would be dangerous, if not lethal. You would pick up a hot pan

and be unaware until you began to smell burning flesh; you would step on a nail and not realize it for hours, perhaps until infection set in; you would injure yourself and continue to experience setbacks because pain wouldn’t constantly remind you to protect the injury.

Good or bad, pain — no matter where it originates — is a sensation felt in the brain. That’s why a person can experience phantom pains from a limb severed long ago.

That discovery — that the pain of a finger smashed by a hammer is actually felt in the brain — is fundamental to understanding how aspirin works.

Simply speaking, nerve endings at the tip of your smashed finger send a message to the brain using “redalert!” chemicals called prostaglandins.

Prostaglandins intensify the message to the brain that pain is being experienced, helping the brain to take appropriate actions (jerking your hand away from a fire, for example). Inhibiting the production of prostaglandins, as aspirin does, turns down the volume on the “you’ve got pain” messages reaching the brain.

Unexpected benefits Some prostaglandins are also instrumental in the formation of blood clots. Inhibiting blood clots can be a good thing, since their formation in the wrong places they can cause heart attacks. Many people take a daily lowdose aspirin to decrease their chance of suffering a heart attack. Popping an aspirin is also a great first line of defense for someone who has just had a heart attack, and an aspirin-a-day can help prevent second heart attacks.

In the 1980s, a study using only doctors as participants — 22,000 of them — found that the 11,000 doctors who took an aspirin every other day had half as many heart attacks as the other half, who took a placebo.

A 1997 American Heart Association study estimated that thousands of heart attack victims would survive if they chewed an aspirin at the first sign of chest pain.

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ASPIRIN… from page 2 research reports have emerged showing aspirin’s effectiveness in reducing the risk of cancer and slowing its spread through the body.

British scientists undertook a large-scale review of 51 earlier studies and found several items of good news: • People who took 300 mg or less of aspirin daily had after three years a 25 percent lower risk of developing any type of cancer, and a 15 percent lower risk of dying from cancer if they were diagnosed. That benefit was more than doubled (from 15 percent to 37 percent) after five years of taking aspirin.

• Aspirin cut by 36 percent the risk of metastatic cancer compared with non-aspirin users, a benefit provided by taking at least 75 mg of aspirin per day.

• One type of cancer, metastatic adenocarcinoma, which can affect the lungs, colon, and prostate gland, was cut almost in half (46 percent) in people who take daily aspirin.

• A further study looking at both randomized and observational trials confirmed aspirin’s beneficial effects on metastasis, specifically against esophageal, throat, breast, biliary, and colon cancers.

Warnings and side effects It would seem that everybody should be on some kind of daily aspirin regimen, but that’s not the case.

Some people are allergic to aspirin. It’s off limits for them. Since we’ve established aspirin’s ability to reduce blood’s clotting ability, aspirin is not a good idea for people with bleeding disorders like hemophilia. Since its earliest days, aspirin has been known to cause unpleasant stomach and gastrointestinal side effects for some takers, so people with ulcers or sensitive stomachs should

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AUGUSTA MEDiCAL EXAMINER

avoid aspirin.

People with kidney problems are not prime candidates for using aspirin liberally, and excessive use of aspirin over the long term can damage healthy kidneys.

The CDC, the FDA, the American Academy of Pediatrics and others recommend that no one under 19 should be given aspirin “during episodes of fever-causing illnesses” due to the risk of Reye’s Syndrome.

The American Academy of Ophthalmology said earlier this year that research indicates people aged 65 and older who take aspirin daily have double the risk of developing AMD, age-related macular degeneration.

If you are in one of the groups above and should avoid aspirin, keep in mind that many over-thecounter products, from Alka-Seltzer to Maalox, contain aspirin, as do a number of prescription medicines. A list of aspirin-containing products is available at reyessyndrome.org.

In the end...

Every drug has its list of side effects and possible contraindications, and aspirin is no exception, but it stands alone in its ability to cure, prevent, or minimize the risk from a host of medical ills ranging from simple headaches to death-dealing cancers.

Should you begin daily aspirin therapy?

Perhaps. Aspirin may be the most ordinary and commonplace of all medicines and be a lowly OTC drug to boot, but it’s obviously powerful.

Yes, aspirin is a certified wonder drug. + Check the Medical Examiner blog at www.AugustaRx. com/news this week for a selection of vintage Bayer aspirin ads.

What’s your story?

Nearly all of us — even doctors and nurses — are sometimes patients. Perhaps you were recently injured playing your favorite sport, or years ago you somehow got hurt without even leaving your favorite recliner. Maybe you were diagnosed with a dreaded disease, mugged in a dark and lonely parking lot, or you stubbed your toe in the safety of your own bedroom. On the other hand, perhaps you needed medical attention 5,000 miles from home.

Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale. We’ll publish your encounters with the medical profession as often as we receive them. + Send your submissions for Medicine in the First Person to the Augusta Medical Examiner via e-mail: info@AugustaRx.com or to PO Box 397, Augusta, GA 30903-0397. (The Medical Examiner reserves the right to accept, reject, or edit any submission at its sole discretion.)

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Why would anyone pay for a subscription to a free newspaper? That’s certainly a legitimate question.

The answer: as a major regional medical center, patients come to Augusta hospitals and physicians from all over the Southeast. The MCGHealth Medical Center alone sees patients from every single county in Georgia, not to mention South Carolina, Florida, and beyond. Add to that the regional reach of Eisenhower Army Medical Center and both Veterans Administration hospitals, the Joseph M. Still Burn Center at Doctors Hospital, MCGHealth Children’s Medical Center, Walton Rehab and University Hospital, and it’s clear that many people seeking treatment in Augusta are not local residents.

Furthermore, some of our most loyal readers are in town only occasionally. Or their treatments and visits to Augusta are only temporary. Even local residents may find it more convenient to walk to their mailbox than visit one of our many newsstands.

Subscriber copies are mailed the day prior to the issue date so they will be received by most readers no later than the publication date printed on the paper. Copies are sent by First Class mail in a sealed envelope so they’ll arrive promptly and in crisp condition. Rates are $16 for a 6-month subscription (12 issues), $32 for a full year (24 issues). Complete the form below and drop it in the mail with your payment. Thank you! +

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JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER

Hope IS Possible

What about your dreams?

Helen Blocker-Adams ver the past several years the number of reality shows, ranging from Dancing with the Stars to The Voice to The Bachelorette to The Survivor and countless others in between, have taken over the television airwaves. I know many people who watch some or all of these programs religiously. You can read comments on Facebook and see the strong interest and almost obsession about celebrities and regular folks doing things that fascinate and entertain. I

“Waste your money and you’re only out of money, but waste your time and you’ve lost a part of your life.”

- Michael Leboeuf like to live their lives vicariously through others. Think about it.

Sports often affect people the same way. The NBA season is in playoff mode and will soon be over. Baseball season is in full swing. Football season will be here in no time. I know men, and some women, who know the statistics on numerous teams and their players. Now, I’m not trying to bash sports and sports fans. Not at all. I love sports and football is my favorite. But while you’re studying, reading about, memorizing, throwing out stats when you’re talking with your friends and co-workers at the water cooler, think about how many hours you’ve spent amassing that knowledge, even if you’ve done it without really trying. One way or another,

you’ve invested a lot of hours.

Over a period of time those hours can add up. Time that could have been spent working on your own dream, goals and vision. Some people are so out of balance that they will look back at their life and see they have little to nothing to show for it — except a lot of TV watching. Is that you?

Frankly I love to read on my Facebook page, for example, how someone is living their dreams – maybe they’re writing a book, performing in a play, have written a poem, have graduated from college or high school, have started a business or an organization that focuses on young people or the elderly – regular folks living their dreams.

There are only so many hours in a day and if one is spending a larger percentage of their time living through someone else’s dream, then you won’t have time to focus on yours.

So: what about YOUR dream?

Since starting this column, I also started an annual breakfast entitled “Minority Mental Health Awareness Breakfast”.

We’re now in our fifth year, held annually in July, and our next event is scheduled for Thursday, July 19, 2012. For information please contact me at hba@hbagroup-intl.com + Helen Blocker Adams is President/ CEO of The HBA Group, Intl and Executive Director of the Southeast Enterprise Institute, Inc. Visit her website at www.helenblockeradams. com. If you like politics, visit her blog at www.projectlogicga.com.

You can reach her via email at hba@hbagroup-intl.com Helen’s new book, Unlikely Allies: 8 Steps to Bridging Divides that Impact Leadership can be purchased by visiting www.hbagroup-intl.com or www.authorhouse.com

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like being entertained. I like watching television. I do have a preference for some television programming like Law & Order.

I wonder if one can overdose on watching too many reality shows and too often? My point is that if someone is constantly talking about someone else’s dreams, then when do we have time to focus on our own dreams?

Reality television is a genre of television programming that presents purportedly unscripted dramatic or humorous situations, documenting actual events and usually features ordinary people instead of professional actors, sometimes in a contest or other situation where a prize is awarded.

Reality television began in 1948 with Alan Funt’s TV series, Candid Camera. But in 1999-2000, this genre exploded with television series such as Big Brother and Survivor, two programs which, by the way, I have never watched.

So what makes these types of shows so insanely popular? I think it’s because many people

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JUNE 1, 2012

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WHAT EVERYBODY OUGHT TO KNOW ABOUT BAD BILLY’S POTOMAC FEVER CURE

by Bad Billy Laveau I am a likeable guy. I am a loner who functions well in a crowd. I like Carolina, Clemson, Alabama, Auburn and Florida fans … except one day a year when they have the audacity to attack the Bulldogs in Athens and think they can win.

I like medium-rare rib eye steaks. Oysters on the half shell. Raw peanuts right out of the shell. Watermelon sold by old men in overalls sitting on tailgates of roadside pickup trucks. Baby lima bean soup seasoned with ham hocks. Jalapeño cheese dip.

Guacamole. Sourwood honey on sharp cheddar cheese toast.

Eggs over easy on grits with a double side of bacon.

But there are things I hate.

(Herein, I use “hate” loosely as a catch-all that carries only minimal impetus.) Being a Certified Citizen of the South, I have a right to do that. I feel compelled to give you pause for thought.

If you pick up a double handful of garden soil, there will be more microbes in your hands than there are humans on earth. Yeah, that is a big number, but it is accurate. Now you have a decision to make: Do you love those microbes? Or hate them?

Some microbes you ought to love: probiotics, yeast that makes bread edible, mold that produces penicillin.

Some microbes you ought to tolerate: those that have little or no direct effect on human health.

Some microbes you ought to hate: human pathogens that cause necrotizing fasciitis, pneumonia, strep throat,

gonorrhea, AIDS, HIV, polio.

Common human pathogen species number in the hundreds. The total number microbial species number in the hundreds of thousands.

(Most recently, I learned to hate the microbes that live in a termite’s stomach and help them digest the wood they ate from my house. It was a $1500 hate lesson.)

So how do we quickly determine which to hate and which to love? We do politically incorrect things. We profile. We discriminate.

We reward the ones that benefit us. We grow penicillium mold in huge tanks with perfect temperature and nutrition. We coddle them. We multiply their numbers.

We punish the ones that are non-productive or harmful. We attack them with antibodies.

We poison them with specific chemicals and antibiotics. We cut off their food supply. We attack them with surgery, pills, shots, topical ointments, folk medicine, magic spells, and any other method of extermination we can conjure up.

All this makes perfect sense to any sane mind. We are scientific. We do what we need to do for the survival of our species.

But when we venture outside our germ warfare against microbial infection, does our government follow the same logic in attacking the enemies of our wellbeing? Do we reward the good and punish the bad?

Heavens, NO! How misguided can you be? They do just the opposite.

If someone works hard and makes money to provide for himself and his family, does the government reward him for his

E

TH

t s e B hard work? No, the government extracts a tax, taking away part of his earnings. And the more he works, the more they take.

If someone does not work and does not provide for his family, does the government punish him? No, they take money from the hard workers and give it to the non-worker.

If foreigners break our laws and come into the county illegally, do we punish them?

No, our politicians want to give them special privileges, money, the right to vote, and other benefits they did not earn and do not deserve.

What about immigrants who come here legally? The government takes tax money from them and gives it to the illegal immigrants. The legals are punished; the illegals are rewarded.

If a certain ethnic group is determined to wage guerrilla war upon our populace, do we concentrate on that ethnic group whose goal is kill us?

No, that would be profiling, discriminatory, and unfair.

Why is it that we use perfectly sane judgment in the eradication and extermination of destructive microbes, but fail to use the same good sense in the treatment of destructive

e n i c i d ME

humans?

I think it is because we do not have enough medically trained people in Congress.

Doctors, nurses, lab techs, EMTs. Come to think of it, I had rather have a well-trained hospital custodian in Congress than some of numb brains we have up there right now. A good custodian knows how to keep things clean and orderly.

How to budget supplies so there is no waste. How to delegate duties. How to share responsibilities. How to work as a team. How to get the job done on time.

If they find a miscreant of any kind, they will wage war on his sorry butt, makes no matter if he is small or large or who or what he is.

They know how to profile and discriminate in a useful manner. If they smell dog poo on the floor or on the grounds, they find the dog and expel him from the premises. They will not worry about how the dog feels about being profiled or discriminated against.

If there is an outbreak of infection in the hospital, they scrub everything down with Lysol. They eradicate the disruptive source. They kill without hesitation or regret.

Now, don’t you think we would be better off with a little more medical thought inside the Beltway? Certainly our politicians could stand a dose of Bad Billy’s Potomac Fever Cure.

What if your doctor said, “Martha, you have bacterial pneumonia. I have an antibiotic that would kill your specific bacteria. But to do that would be profiling and that is politically incorrect. Plus it’s very cruel to the bacteria.

Maybe some of them could be rehabilitated. So get right with Jesus, and tell George to call your preacher and lawyer.

You’re going to die, but you can pass on knowing your conscience is clear because we did not profile, discriminate or kill.”

Do I see smirking? Do I hear laughter in the distance? Is that you laughing? Or is it a newly recruited terrorist cell or dope smugglers or the next wave of illegals crossing the Rio Grande? Surely they go to bed each night laughing at how naive and dumb American policies are.

Lord knows they would be in trouble if we elected a good hospital-trained custodian to the White House. + Bad Billy Laveau is a retired MD with a pointed sense of humor.

Bad Billy speaks and entertains at public and private events for audiences not subject to cardiac seizure secondary to overwhelming laughter and glee BadBilly@knology.net or 706306-9397

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AUGUSTA MEDiCAL EXAMINER

Health 101

by Sandy Turner, RN, EdD, Family Nurse Practitioner, and Assistant Dean for Administration in the GHSU College of Nursing HAVE YOU HAD YOUR FLU SHOT YET? hat? Flu shots in June? This is not flu season, which makes it the perfect time to talk about flu season. It will be here before we know it.

People are always wondering when and if they should have a flu shot. The problem is that no one ever really knows when (or even if) the flu is going to hit this area.

Last year, drug stores started advertising them in September and some people started asking for them weeks before that. My best guess is that by mid to late October is a good time to get the shot. It takes about 6 weeks for the shot to become fully effective in most people, and it’s effective for another 6 weeks as it gradually wears off. That should take you through mid February, which is usually peak time here.

But it’s never a sure thing. Last year flu season didn’t start until March.

People who got their shots early, especially people in healthcare, regularly exposed to sick people, needed to get a second shot to be immunized when people started getting sick.

I often hear, “Every time I get a flu shot I get sick.” That is a common belief. The shot

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might make your arm sore but the days of getting sick from a flu shot are the old days. They’re not made with a live virus like they used to be so it doesn’t make you sick.

Maybe you were exposed to something before you got the shot and that made you sick, but the virus itself doesn’t do anything except help you build antibodies to the virus because they aren’t alive. The only real concern is if you have a strong allergy to eggs.

Some people ask how old you need to be to get the flu shot. We used to say that kids could handle the flu and the shots were only needed for adults. But now we try to immunize as many people as possible. The concept is called “herd immunity.” If as many people as possible are immunized then the few that aren’t won’t get sick because

there isn’t any virus in the whole group (or herd, if you are talking about cattle).

There are several kinds of shots out now, one for adults, one for anyone over 3 years old and one just for infants. A child can take an adult shot, but it is best to give them a half dose, then come back a week later to get the rest. The infant one is a smaller dose too.

Last year they had a nasal spray that was effective for a whole year. They were just giving it to children and they liked it because it didn’t hurt.

That version is made with a live virus and that is why the immunity lasts longer.

So it can make you sick (but usually nothing like fullblown flu), so if you have any health problem that affects your immune system you should definitely not take it.

A few years ago we were concerned about swine flu or H1N1. Now that vaccine is included, so the one shot will cover you for that plus the one or two other strains of viruses that they think will be heading our way this year.

Every year the combination changes so we get new formulations every fall.

So, if you’ve been one of those who avoids flu shots, maybe it’s been for the wrong reasons. Take something to make your arm feel better beforehand. Flu shots are for most people a good safety precaution to help keep you and your family healthier and keep you from needing sick days this winter. This fall, roll up your sleeve and get it over with! + HEALTH 101 – Information to help you make positive changes in your life to improve your health by Sandy Turner, RN, EdD, Family Nurse Practitioner, Director of the Good Samaritan House, A Free Community Health Center Open Mondays 15 pm. 213 N Main St., Dearing, GA 706-556-9080.

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Editor’s note: Exceptional Living appears exclusively in the Medical Examiner each month, addressing issues that all of us can benefit from involving people with special — let’s call them exceptional — needs.

Exceptional Living

Good grief

by Naomi D. Williams, MPH, CHES, CIC® Growing up, and even into my adult life, I associated grief only with dying. When my son Noah was born I was introduced to the never before experienced concept of perpetual grief.

After my first couple of visits to see Noah, I talked with Kathy, one of the nurses caring for him. She said, “In order to heal and handle the long road that you will have, you need to grieve for what you thought you were going to have. You have to grieve and release what you envisioned your pregnancy and birth to be like.” When Kathy made that statement I had a hard time grasping what she meant, yet I learned little by little every day, month and year. And nearly three years later I still find myself grieving.

Albert Pujols taught me another lesson in good grief.

Pujols is a first baseman for the Los Angeles Angels of Anaheim, yet his playing in the Major Leagues didn’t start out as he expected. Albert Pujols’ family immigrated to the United States from the Domincan Republic in the 1990’s. Pujols was a great athlete and had superb talent as a baseball player. Based on his batting average and overall ability as a player, he knew he would be drafted into the major leagues, without a doubt in the first round.

Pujols was right; he was drafted, but not until the thirteenth round of the 1999 draft. He was devastated and a bit in shock. In fact, Albert turned down the offer to play in the majors and went to the minor leagues instead. He knew he was better than a 13th round pick and was going to prove it. In an interview he said he never forgot how disappointed he was and how he used that disappointment to propel him to become a better player.

So how does Albert’s story apply to exceptional living and good grief? Pujols experienced what he considered a major setback.

Everything that he worked for, mentally and physically prepared for in life and his career, was shattered despite his best efforts.

Although our life-altering experiences differ, we both still had to process what was lost and work to use our grief to better ourselves.

I’ve met parents who have endured the exceptional living road much longer than I have, and they tell me that they still grieve over their child and the life they initially envisioned for them. These families reinforce, for me, that it’s normal and natural to mourn those unreached milestones, yet it’s important to not stay in a state of mourning. It’s healthy to acknowledge what you have and what you lost instead of being ostrich like and burying your head in the sand. Whether it’s the loss of a child, parent, a limb, a job, a friendship it’s important to work through the loss and various stages of grief, and know you don’t have to go it alone.

I’m still learning the different types of grief and understanding the various phases, yet I can say there is such a thing as good grief.

Through my grieving process I’ve learned to push myself and Noah to be all that we can be. I’m aware that we may never have a typical life, yet that will not stop us from striving for our best and never settling for less. Although we may all grieve in different ways, a healthy goal is to accept our loss and move forward, living with purpose and reaching to obtain our full potential. + Naomi Williams is a health educator by training, an entrepreneur by nature, mom, and advocate of the best kid ever, Noah Samuel.

Why must conversions always come so late? Why do people always apologize to corpses? - David Brin

JUNE 1, 2012

7+

AUGUSTA MEDiCAL EXAMINER

And so it ends...

The Short White Coat

by Hevil Shah, M.D.

B

eing involved with the Augusta Medical Examiner for the past 3-1/2 years, I knew there would come a time when I would write this, my final “Short White Coat.�

These past few months, as I prepared for graduation and my big move to Little Rock to start my pediatric residency training, I have jotted down and thought through a multitude of ways I wanted to end my tenure as the SWC writer.

Maybe I’ll write about my final patient, I thought.

Maybe about my most difficult challenge. Or maybe I can come up with a clever yet inspirational quote that can one day be in the textbooks next to William Osler’s quotes for physicians.

But throughout the justpassed Memorial Day Weekend, every idea I came up with, I threw away. For those who know me and how much I enjoy discussing a variety of topics, I am at a loss today.

How do I say good-bye to

something that been an integral part of my medical school training? To be able to discuss the best and worst, the highs and lows, my inspirations and frustrations of being a medical student, in an age where the written form is a dying art, was an opportunity afforded to me for which I am truly grateful.

I still remember my very first article for the Medical Examiner and how difficult it was for me to write it.

With the inauguration of President Obama running in the background, on January 20th, 2009, I was staring blankly at my laptop screen with a severe case of writer’s block. I had never done anything like this before. I had written essays for schools and scholarships, a few blog entries here and there, but never had I written something that was going to be printed, not just once, but every month.

What should I write about?

I was in the middle of my second-year of medical school and the adventures of the wards were still months away.

But as I listened to the swearing

A med student’s notebook in of our President, it occurred to me that I should write my own faux-inaugural address.

Going through my computer files, I fished out that first article and thought I would share with you the beginnings of my oath: “I, Hevil Shah, do solemnly swear that I will faithfully execute the office of author of ‘The Short White Coat’, and will to the best of my ability, provide a unique introspection into the life of a medical student for the Augusta Medical Examiner.

I write here today humbled by the task granted to me and grateful for the trust you have bestowed in me to provide you with insightful articles about

my life as a medical student.

Now be forewarned, I am only a year-and-a-half into medical school and I might not provide the clinical insight like the former author did until later (my third year, to be exact). But be reassured, I will share with you, my highs and lows, the light-hearted and the poignant, the boring and the nail-biting moments that will define my career as a medical student.�

I hope I was able to live up to that promise and show you the important moments that defined my medical student career and molded me into the physician I am today. Everyone I had the chance to encounter as a medical student had made an invaluable impact on me and I just hope I was able to provide even the slightest of glimpses into my life as an MCG student.

Thank you for your support, your emails, your kind words, and your readership. +

Hevil Shah, M.D, recently graduated from GHSU’s Medical College of Georgia. He may be reached at hevil. shah@gmail.com.

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OUR NEWSSTANDS Medical locations: • Department of Veterans Affairs Medical Ctr, 15th St., Main Entrance • Dept. of Veterans Affairs Medical Center, Uptown Div., Wrightsboro Rd., main lobby • Doctors Hospital, 3651 Wheeler Rd, ER Lobby Entrance • Doctors Hospital, 3651 Wheeler Rd, Employee Entrance (near the Joseph M. Still Burn Center entrance) • Eisenhower Hospital, Main Entrance, Fort Gordon • George C. Wilson Drive (by medical center Waffle House and mail boxes) • GHSU Hospital, 1120 15th Street, South & West Entrances • GHSU Medical Office Building, Harper Street, Main Entrance • GHSU Medical Office Building, Harper Street, Parking Deck entrance • GHSU Hospital, Emergency Room, Harper Street, Main Entrance • GHSU Children’s Medical Center, Harper Street, Main Lobby • GHSU, Laney-Walker Boulevard transit stop, Augusta • Select Specialty Hospital, Walton Way, Main entrance lobby • Trinity Hospital, Wrightsboro Road, main lobby by elevators • Trinity Hospital Home Health, Daniel Village, main lobby • University Health Federal Credit Union/ University Hospital Human Resources, 1402 Walton Way, Main Lobby • University Hospital, 1350 Walton Way, Emergency Room lobby area • University Hospital, 1350 Walton Way, Outside Brown & Radiology/Day Surgery • University Hospital - Columbia County, 465 N. Belair Road, Main Lobby • University Hospital Prompt Care, 3121 Peach Orchard Road, Augusta

Around town: • Barney’s Pharmacy, 2604 Peach Orchard Rd. • Birth Control Source, 1944 Walton Way • ASU Student Bookstore • Blue Sky Kitchen, 990 Broad Street • Columbia County Library, main branch lobby, Ronald Reagan Drive, Evans • Enterprise Mill (North Tower), 1450 Greene Street, Augusta • Daniel Village Barber Shop, Wrightsboro Road at Ohio Ave. • Hartley’s Uniforms, 1010 Druid Park Ave, Augusta • International Uniforms, 1216 Broad Street, Augusta • Marshall Family Y, Belair Rd, Evans • Mellow Mushroom, 12th and Broad Streets, Augusta • Southside Family Y, Tobacco Road, Augusta • Surrey Center, Surrey Center Pharmacy, Highland Avenue, Augusta • Top-Notch Car Wash, 512 N. Belair Road, Evans • Wild Wing Cafe, 3035 Washington Road, Augusta

Plus... 500+ doctors offices throughout the area for staff and waiting rooms, as well as nurses stations and waiting rooms of area hospitals.

JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER

EDITOR’S NOTE: Very little if anything about healthcare is inexpensive, and that includes medicine. Tiny pills can command large prices.

Over-the-counter medications may be less expensive, but are they also less effective? Find the answers to lots of your drug store questions in this column written by Augusta pharmacists Chris and Lee Davidson exclusively for the Medical Examiner.

GOT GAS? Gas is a common and sometimes embarrassing ailment. There are many different causes of intestinal gas, including diet, obesity and internal causes that your doctor can diagnose. We will discuss some medications that can help minimize problems from gas, as well as a couple of preventive steps you can do every day.

If you feel that intestinal gas is a severe problem for you, by all means see a doctor to rule out an internal cause that needs medical treatment. If you visit a physician, have information at the ready: do you have stomach pain and cramping sometimes?

How often do these problems surface in an average day? Do you also feel bloated? If so, is that feeling constant or intermittent? Also does this bloating correspond to the gas episodes that you experience each day? Is there any particular food or meal that seems to be a trigger? All this information can help your physician accurately diagnose your underlying problem.

Excessive gas can be produced due to dietary sources, so eliminating the offending food can be instrumental in correcting the problem. A common dietary source of gas is certain sugars, such as lactose, sorbitol or fructose. It is an absorption and digestion abnormality of these sugars that causes the gas. You can eliminate the sugars from your diet, or consume a digestive enzyme whenever you consume food with these sugars to prevent the gas issue. Certain fruits and vegetables can also produce gas, since they contain starches which are poorly digested by humans but well digested by bacteria.

Digestion by bacteria leads to gas. Examples of these foods are cabbage, beans, prunes and whole grain foods. Check with your doctor or pharmacy or do some research on your own for a more complete list of gas-producing foods. Be forewarned: if you try to eliminate all gas-producing foods from your diet, the list is quite long. Remember, you may not have problems with everything on the list, so eliminate one thing at a time and start with those you suspect to be the worst offenders.

Maldigestion issues can be caused by internal problems that your

doctor can help correct. Pancreatic insufficiency can be corrected by a supplementation of pancreatic enzymes. Intestinal problems such as celiac disease can be prevented by a gluten free diet. There are many tests a doctor can run to rule out certain gas-producing conditions and lead to an accurate diagnosis.

So let’s review a few simple over the counter medicines that say they help with gas. These are mainly broken into two categories: those that prevent gas and those that control gas already produced. Beano is an enzyme used to digest normally un-digestible vegetables in your stomach.

This prevents the starches from reaching the bacteria in your colon and stops the production of gas during digestion by these bacteria. Beano is made from a mold, so people with severe mold allergies may want to consult a physician, possibly an allergist, before trying this product.

The second category controls already produced gas and usually contain two medicines: activated charcoal and simethicone. Simethicone is one of those products that people trust and promote to do the job, but there is little clinical evidence to support this. It is known to be ineffective on colon produced gas but may help with gas in the stomach, including gas from swallowing too much air while eating. This could be from eating or drinking too fast, but is a less common source of gas those already mentioned. Activated charcoal absorbs gas from the colon better than simethicone, but comes with its own set of warnings. Aspirating activated charcoal can be fatal, so be careful when taking this. Use a capsule formulation rather than powder. Do not take activated charcoal too close to taking prescription medications, as it can interfere with the absorption of the medicines and can cause unreliable test results or drug reactions.

So as we grill out this summer, remember to eat slowly, chew food well and avoid potential gas triggers in your everyday diet. It will be less embarrassing for you and others will appreciate it. + Questions about this article or suggestions for future columns can be sent to us at cjdlpdrph@bellsouth.net Written for the Medical Examiner by Augusta pharmacists Chris and Lee Davidson (cjdlpdrph@bellsouth.net )

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JUNE 1, 2012

9+

AUGUSTA MEDiCAL EXAMINER

Ask a Diet itian “Hey, what the heck is an antioxidant?�

In today’s turbulent world anything beginning with “anti� may bring about images of war or violent demonstrations and generally has a negative connotation. Actually, that’s pretty accurate considering anti’s definition is to be “against or in opposition to something.�

Why then so much positive excitement about a food or beverage product high in antioxidants? Based on the aforementioned negative connotation, I should think this was something undesirable and unworthy of front label attention, maybe something more befitting of small print at the very bottom of the back label. Have we been duped again into thinking something bad is really good?

To answer this question I set out on a very scientific quest, asking people of different ages and educational backgrounds if they could tell me the meaning of an antioxidant. My actual question was: “Hey, by the way, what the heck is an antioxidant?�

The responses ranged from total silence (meaning they had no idea at all) to a general understanding of which their confidence level was unworthy of a 25¢ bet. I now know what my second scientific quest will be: to try and understand why people will plunk down their hard earned money to consume something they know nothing about based on a promise of good health from someone they don’t know. This harkens to the days of charlatans and snake oil.

Have we not evolved?

If you investigated the claims and have been one of those chasing down antioxidant rich foods ever since, you are, indeed, running the correct race and hopefully will cross the finish line at a ripe old age, looking much younger than your years. However, if you weren’t sure of your status up to this point, I hope you’ve already learned a good lesson: always ask the two simple questions, “why?� and “how?�

Why is it good and how does it work?

Sure, some of the answers might be sciencebased and technical, but there is always one explanation out there which translates the information into common sense. And so, here is my attempt at translating the very technical world of antioxidants into everyday understandable language.

We know that “anti� means against, yet antioxidants are good for us. So they must be against something deemed bad for our health.

We need not look far. What follows the prefix — oxidants — is our villain.

Oxidants, more commonly known as free radicals, are substances which cause cell damage, which may then lead to chronic diseases such as cancer and heart disease. To understand how free radicals cause the damage, we must (and believe me, I wouldn’t if it weren’t absolutely necessary) delve into chemistry once again.

If you studied chemistry and made it out alive, you might recall that atoms have both protons

and electrons, which have positive and negative charges, respectively. The protons and electrons pair off with one another according to the charges of the proton. When they pair off they create what is known as a bond. The stability of the atom, meaning its ability to hold itself together and function properly, is determined by the strength of these bonds. Atoms with weak bonds can easily break apart, creating free radicals which roam about looking for another atom with extra electrons to pair up with.

The problem comes when the free radical steals an electron from another atom. The attacked atom, in turn, breaks down, impairing its ability to function properly. A chain reaction has begun: missing an electron, it now becomes a free radical too. When too many of the atoms in a cell are impaired, the whole organ can fail to function properly, thus leading to disease.

The cure? You guessed it, antioxidants. They neutralize free radicals by providing an electron to pair with, thereby preventing them from attacking other cells.

Hopefully you now understand why a product with antioxidants is so highly prized, and why the manufacturer/producer wants to be sure to make note of this on the label. Usually the label of trendy foods and beverages are screaming about their antioxidants, but you hear little about those in a more natural state. Some of the staple foods in your cupboard and refrigerator have antioxidants. Foods like: • Fresh fruits and vegetables • Beans • Herbs • Whole grains • Nuts and Seeds • Green Tea • Dark chocolate (60+% cacao) Shockingly these are the very foods that appear on the new My Plate (http://www. choosemyplate.gov/) which was issued by credentialed scientists, not charlatans, who have your best interests at heart.

You now know the why and the how of antioxidants and, as a bonus, you even know the who. +

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+ 10

JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER The HBA Group, Intl Presents Hope IS Possible

A message from Pam Tucker, Columbia County EMA Director:

5th Annual Minority Mental Health Awareness Month Breakfast Conceived and Organized by Helen Blocker-Adams, 2012 CSRA Mental Health Advocate of the Year

Debbie is the Columbia County Elections Director. She has been hospitalized since April 6th when was admitted complaining of persistent, severe headaches. She had surgery on April 9th for a brain tumor and remains hospitalized to this day. This “Lunches with Love” fundraiser is being held in support of Debbie, her husband Lee, and their family during this extremely difficult time in their lives. Please keep them all in your prayers.

In conjunction with the Fifth Annual Observance of Bebe Moore Campbell National Minority Mental Health Awareness Month

Theme: Relationships Strengthen Teamwork Thursday, July 19, 2012 7:30 a.m. – 7:45 a.m. – Registration Program/Breakfast: 7:45 a.m. – 10:00 a.m.

Be My Guest Catering & Events 4216 Washington Road (near Academy Sports) - Evans, Ga. KEYNOTE SPEAKER: Doris Clanton, Associate General Counsel for the Division of Aging Services, Georgia Department of Human Services Office of General Counsel SPECIAL INVITED GUESTS: Jessica Morris, Press Secretary, Congressman Paul Broun and Kristie Gregory, Congressman John Barrow For more information or questions, please email Helen Blocker-Adams at

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JUNE 1, 2012

11 +

AUGUSTA MEDiCAL EXAMINER

The blog spot From THE Bookshelf Posted May 27, 2012 at www.medrants.com. The author is an academic general internist at the University of Alabama School of Medicine.

NOTE: an RVU is a “Relative Value Unit,” a measure used by many hospitals to determine the value of a given service based on such factors as the skill level required, the time needed to perform, the sophistication and cost of the equipment necessary to deliver the service, and so on.

RVUs are a common method of determining physician bonus plans based in part on productivity.

A doctor writes: Let’s be less productive When I first joined the faculty in 1980, no one used the term productivity. The concept of RVUs (see above) had not yet arrived. I believe it was a better time.

Productivity does not just plague physicians. Tim Jackson has authored a brilliant piece about productivity: We’ve become so conditioned by the language of efficiency.

But there are sectors of the economy where chasing productivity growth doesn’t make sense at all. Certain kinds of tasks rely inherently on the allocation of people’s time and attention.

The caring professions are a good example: medicine, social work, education. Expanding our economies in these directions has all sorts of disadvantages.

In the first place, the time spent by these professions directly improves the quality of our lives. Making them more and more efficient is not, after a certain point, actually desirable.

What sense does it make to ask our teachers to teach ever bigger classes? Our doctors to treat more and more patients per hour? The Royal College of Nursing in Britain warned recently that front-line staff members in the National Health Service are now being “stretched to breaking point,” in the wake of staffing cuts, while a study earlier this year in the Journal of Professional Nursing revealed a worrying decline in empathy among student nurses coping with time targets and efficiency pressures. Instead of imposing meaningless productivity targets, we should be aiming to enhance and protect not only the value of the care but also the experience of the caregiver.

The care and concern of one human being for another is a peculiar “commodity.” It can’t be stockpiled. It becomes degraded through trade. It isn’t delivered by machines. Its quality rests entirely on the attention paid by one person to another. To even speak of reducing the time involved is to misunderstand its value.

Efficiency is not, after a certain point, desirable.

What unintended consequences have productivity and RVUs wrought? We have encouraged physicians to spend less time with patients, do procedures more quickly, avoid telephone calls and emails (no RVU points here) and generally worry more about volumes than individual patients. I know that I use hyperbole in these statements, but while we rarely are as cold as the previous sentence, the concepts do influence us. Anyone who can remember medical practice prior to these concepts knows how practice has changed because of these phrases.

Patient visits are not widgets. Patients expect and deserve our full attention without concern for the clock. Patients have questions that we need to answer. History and physical examinations take time. Considering multiple diagnoses takes time. Sometimes we need to stop and read while the patient is in the room. We need time to do our job properly.

I hope others will take up the call. We should banish productivity as a descriptor. The concept has diminished our profession and thus we should reject it. +

Money can’t buy happiness, but it can buy you the kind of misery you prefer. ~Author Unknown

For far too many of us, our identity and sense of personal worth is inextricably intertwined with what we do, our jobs, our careers.

That is a slippery slope, indeed. Jobs are temporary things. I know a young doctor here in Augusta, a decade or two younger than me, who suffered a stroke and was forced to leave his practice.

I frequently think about the plight of professional athletes, full-grown kids who can be considered old in their early thirties.

What do you do at age 30 when “old age” forces you into retirement from the job you’ve had since 3rd grade, the only vocation you’ve ever known?

Yes, what happens when the job that is your very identity is taken away from you?

That describes just part of the message of Still Alice, a book suggested for this review by a Medical Examiner reader.

It’s the story of a 50-year old woman, one Alice Howland, who is a celebrated and esteemed Harvard psychology professor, a woman known for her intelligence even in the rarefied air of Harvard.

When she begins forgetting

things a bit too often, she at first blames menopause, but eventually seeks medical help.

She gets a stunning diagnosis: early-stage Alzheimer’s.

Still Alice tells the story of the descent into Alzheimer’s from the viewpoint of just one person: Alice Howland. That’s unusual.

“The lion’s share of everything written about Alzheimer’s is written by clinicians or caregivers,” says author Lisa Genova, who happens to hold a Ph.D. in neuroscience from Harvard herself. “So we rarely get to sit in the seat of someone with Alzheimer’s.”

That perspective, however, is one that many of us want

to and need to understand.

Countless people who read this paper provide care every day for patients with Alzheimer’s. For others, their family’s matriarch or patriarch has the disease. That can sometimes mean spending the proverbial 36-hour day caring for someone you’ve known as long as you can remember, but who doesn’t remember you or know who you are.

That isn’t easy. But as is the case with almost every subject, the more informed we are, the more capably we can deal with difficult situations.

Alzheimer’s is like death in that none of us know anyone who has fully experienced it and then come back to tell us what it’s like.

Despite that handicap, Lisa Genova has given us a rare understanding from inside the mind of an Alzheimer’s victim.

In the Examiner’s nearly six years of publication, non-fiction books have monopolized this space. Still Alice seems like a great reason to make an exception. + Still Alice by Lisa Genova, 292 pages, published in 2009 by Pocket Books, Simon & Schuster

the

Clipping File Fatal freedom fries?

An article in the health section of the website howstuffworks.com raised an interesting question: What’s more likely: death by an auto accident or death by french fries?

Your thoughts?

It’s a slam dunk win for french fries! The results weren’t even close.

Motor vehicle deaths have dropped every year since 1996, with two small exceptions (in 2002 and 2005, in both cases an increase of less than 1 percent) and have been on an overall downward trend since the mid-1960s. The death toll for 2010, the latest year for which stats are available, was 32,885.

The french fry toll for 2010 was slightly higher: 599,413, according to the CDC. “Hold on. You’re saying almost 600,000 people were killed by french fries — in one year?”

Not exactly. But sort of.

Here’s the logic of the article’s writers: 13 million people in this country have heart disease.

Granted, high-fat foods are only

one contributing factor to heart disease, but the other biggies — genetics, hypertension, smoking, and diabetes — are not quite as avoidable as fries are. And in the world of fast food, french fries are viewed as “exceptionally artery clogging.”

Added to that, howstuffworks. com cites the figure 35. That’s how many pounds of fast food fries the average American eats in a year’s time, they say.

So given the official statistics and their spin on them, the average American is more than 18 times more likely to be killed by french fries than in an auto accident.

Sex vs sleep: the age-old debate Here’s slam dunk winner #2. Just up the road in Atlanta, entrepreneur Danny Rinaldi was thinking about launching an alcoholic Red Bull-type drink with herbal ingredients that promised to enhance libido.

But in market research, one question sent the project off in a new direction. The question:

“Would you rather have better sex, or a better night’s sleep?” In focus groups, 100 percent of women said they’d rather have better sleep.

Mr. Rinaldi, says a recent article in the Wall Street Journal, reflected on his own sleep troubles borne of jet lag from frequent overseas travel. The alcoholic, libido-enhancing energy drink transformed became a sleeppromoting herbal supplement.

Now, Sleep Formula 39 is the top-selling non-prescription sleep aid in its test market, according to a market research firm, reports the WSJ.

PSA test under fire The U.S. Preventive Services Task Force last week gave PSA screening for prostate cancer a “D” rating, meaning “there is a moderate or high certainty that the [test] has no net benefit or that the harms outweigh the benefits.”

They cited a U.S. study which showed no benefit in preventing death from prostate cancer, and a European study that said only 1 in 1,000 screened men would benefit. +

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JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER

THE EXAMiNERS +

“The Garden City” is You have a better too bland. We’re a idea for Augusta’s major medical center. slogan?

by Dan Pearson

“Augusta, where everyone You’re right: knows what No other city necrotizing fasciitis is.” would have that.

I do. It’s medical, it’s timely, and no other city would have it. Ok, let’s hear it.

© 2012 Daniel Pearson All rights reserved.

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. 1951 Masters champion 6. Last name, with 55-A 10. Medicine 14. Throat dangler 15. By mouth 16. Clinton Attorney General 17. Drug runners 18. Exhort 19. Untie 20. Entirely 21. Capital of Western Samoa 23. Emptied (as a bladder) 25. Unnecessary 27. Snake 28. Famed dancer and actor 29. Itinerary shorthand 30. Gamma follower 32. Israeli submachine gun 33. Wrestling acronym 34. Little old Chevy 35. Cleveland nine, casually 38. Java 39. Cowboy show 40. Welt 41. Pledge 42. UGA conf.

43. To be under the weather 44. Doggie doc 45. Famous area road 49. Noted downtown building 51. Unusual 52. Ed Rice or Philip Morsberger 53. NBA team not ending in S 54. Georgia-based news pioneer 55. First name, with 6-A. 56. Ahmadinejad’s country 58. Land grant holder (in Old England) 60. Computer command 61. GHSU’s ____ Lane Parking Deck

BY

The Mystery Word for this issue: LIWGLANK

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

We’ll announce the winner in our next issue!

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— Marshall McLuhan

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above. Once any letter is used, cross it out

by Daniel R. Pearson © 2012 All rights reserved. Built in part with software from www.crauswords.com

Solution p. 14

62. Duck with soft down 63. River in central Europe 64. Comply 65. Prepared

DOWN 1. Doctors (once upon a time) 2. Undeveloped seeds 3. Esophagus 4. Malt beverage 5. Pronounce as a nasal sound 6. Augusta author Shivers 7. Rich tapestry 8. Aiken has-been 9. Raise 10. Augusta Park?

11. Portrayed 12. Not legal 13. Well-behaved 22. Prefix for “around” 24. Room within a harem 26. Meat stew braised in red wine 29. Female sheep

31. NBA’s Ming 33. Exclamation of surprise 34. Pertaining to the voice 35. Major airline of yore 36. Georgia and Bank separator (once upon a time) 37. Inferential; by inference 38. Write down quickly 39. In law, a defendant’s reply 41. Only movie ever named for an inner ear problem?

42. Caribbean calypso music 44. -ectomy beginning 45. Really, really small 46. Noisy insect not heard for years at a time 47. Preserved produce 48. Mean, stubborn 50. Skinflint 51. Facet 52. Too 57. Steal from 59. Hasten

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.

by Daniel R. Pearson © 2012 All rights reserved

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by Daniel R. Pearson © 2012 All rights reserved. Built with software from www.crauswords.com

U D O K U

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

Use the letters provided at bottom to create words to solve the puzzle. All the listed letters following 1 are the 1st letters of each word; the letters following 2 are 2nd letters of each word, and so on. Try solving words with letter clues and entering unique and minimal choice numbers (such as 8 thru 11 in this puzzle). A sample is shown. Solution on page 14.

M 1 2 3 4 5 6 7 8 9 P L 1 2 3 4 5 6 7

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— Dr. Seuss

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1.AAAASSTTCQ 2.HHOONNRRUI 3.DEEEEEMMMS 4.SEWPP 5.LLTTE 6.EIIIR 7.MSOC 8.NEA 9.TSS 10.E 11.D

SAMPLE:

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

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by Daniel R. Pearson © 2012 All rights reserved

WORDS NUMBER

THE MYSTERY WORD

JUNE 1, 2012

13 +

AUGUSTA MEDiCAL EXAMINER

The Patient’s Perspective

TELL US YOUR STORY

by Marcia Ribble

But not like this. Just mail it or e-mail it.

Studies show the fear of public speaking exceeds any other fear, including heights, spiders, snakes, and even death.

Whatever your medical experience, we’d like to hear your story for our Medicine in the First Person feature. It can be frightening or funny, ordinary or extraordinary, just a few paragraphs long or quite a lengthy tale. (We’ll publish your name or keep it to ourselves: your choice) Details, page 3

USE US! +

PLEASE USE OUR ADVERTISERS WHENEVER POSSIBLE.

WITHOUT THEIR SUPPORT THIS PAPER WOULD NOT BE POSSIBLE.

WITHOUT YOUR SUPPORT OF THEM, THEIR SUPPORT WOULD NOT BE POSSIBLE. THANK YOU FOR YOUR SUPPORT OF OUR SPONSORS WHENEVER POSSIBLE.

You could be reading your ad instead of ours.

For advertising information, contact us at 706.860.5455

WHERE+DO YOU GET YOUR +

MEDICAL EXAMINER?

+

Among our many delivery destinations: Burke County Hospital, downtown Aiken, St. John Towers, Brandon Wilde, Washingtom Commons, Wild Wing Cafe, Surrey Pharmacy, Select Specialty Hospital, Augusta Back & Neuroscience, and Barney’s Pharmacy. +

When I was a child, women often were at home, but without transportation, so doctors still made house calls. As I noted in my first column, they learned an awful lot of information that way, not just about their patients, but also about the patients’ families.

They were able to see patients as enmeshed in a large familial dynamic.

All that had ended by the time I was having children, so doctors often lost sight of the fact that their patients were part of families who were also affected by the patient’s medical issues.

I learned about that first hand when I had a missed abortion at five months of pregnancy.

A missed abortion is not an abortion. It occurs when a baby dies inside the womb and a miscarriage does not take place.

The doctor explained to me that my body would gradually disintegrate the baby and get rid of it in tiny bits and pieces. Talk about trauma! I was alone at the doctor’s office without anyone familiar to hold on to, so I had to absorb the shock of that news without any support. Then I had to go home and tell my extended family, none of whom had ever heard of a missed abortion before.

My husband didn’t understand, so he just told me that it was OK and I could have another baby. My mother was furious and wanted something, anything, except that awful emptiness of no miscarriage, no dilation and curettage (D & C), and no baby. My mother-in-law thought I’d had an abortion, and she was angry too. I was in shock and mourning and hated myself for destroying a baby I wanted.

Then I started to get morning sickness and thought I might be having a psychological pregnancy, inventing what I wanted and was grieving for.

The doctor had told me to come back in two months. I struggled to hold on and was grateful when my kindergartner would arrive home for lunch and I was forced to think about something beside what my body was doing to my baby. I was convinced that I was going crazy, and hit a point just before the two months were up that I started

Talk is cheap.

Not talking can be deadly.

to cry and couldn’t stop crying.

Looking back with today’s knowledge, I can only imagine how crazily my hormones were behaving, because at that two month check-up the doctor told me that I was pregnant again, and that I’d lost one baby and gotten another at the same time. I was dealing with ending-a-pregnancy-hormones and preparing-for-anotherpregnancy hormones all at the same time.

It turned out that the doctor suspected that I might already be pregnant again when he told me the first baby was dead, which is why he didn’t do a D & C. Explaining that development to the relatives was weirder than telling them the first baby was dead. Another problem was linked to establishing exactly when the second pregnancy had begun because I had been more or less continuously pregnant for about fifteen months by the time the baby arrived, and the fact that he weighed 12 pounds 10 ounces, further complicated the issue.

Today, even with the tools doctors have, like more sophisticated heart monitors for babies in vitro and ultrasound, many medical issues affect entire extended families. Doctors need to be sensitive to that and patients need to be forthcoming with their doctors and tell them about how their medical concerns are impacting the whole family so they can get the support I needed and didn’t have. + Marcia Ribble received her PhD in English at Michigan State and recently retired from the University of Cincinnati where she taught composition. She taught writing at the college level and loves giving voice to people who have been silenced. She can be reached with comments, suggestions, etc., at marciaribble@hotmail.com.

“If you can’t explain it to a six year old, you don’t understand it yourself.”

— Albert Einstein

+ 14

JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER

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

...carefully hidden in the page 2 ad for GEORGIA DERMATOLOGY & SKIN CANCER CTR Congratulations to Betty Bryant, who scores a $20 Wild Wing Cafe gift certificate, two free movie passes courtesy of Health Center Credit Union, a free Top Notch Car Wash gift card, and anything else we may be able to scrape together on short notice. Win this stuff!

The new Mystery Word is on p. 12. Start looking!

The Celebrated MYSTERY WORD CONTEST ...wherein we hide (with fiendish cleverness) a simple word. All you have to do is unscramble the word (found on page 12), then be the first to 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: gift certificates from Wild Wing Cafe, Top Notch Car Wash, Cheddar’s, and movie passes from Health Center Credit Union!

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. 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.

The new scrambled Mystery Word is found on page 12

EXAMINER CLASSIFIEDS HOMES, APARTMENTS, ROOMMATES, LAND, ETC.

Hosp. $445 a month includes utilities and Internet service. Please contact 706589-0238 ask for May.

FOR SALE Brand new contemporary townhome/end unit in The Vista on Hwy 1, minutes from MCG. 1450 sqft. Two bdrm, two baths, office. Walk-in closets, lots of upgrades. Hardwood throughout, custom tiled kitchen/bathrooms. Floor to ceiling windows, pristine condition.

Ready today. $125K - OBO. 803-5078991.

TOWNHOME Great location, everything new, 2 master suites, sunroom, all appliances. $98,000 (706) 504-4023

LOFT APT. Above commercial building on Walton Way; newly renovated, updated and private; nice 1-BR 900sqft layout; convenient to MCG, VA & ASU. $675/mo, references; 706-589-3548.

7612

GETAWAY 14 acres natural wooded with beautiful rocky creek flowing through. Available immediately to enjoy while planning future devel. Hiking trails cleared, hunting, fishing, golf near outstanding Glascock school system. Call owner: 706-798-4359 81712

HOUSE FOR SALE 3 bedroom, 2 full bath, 2-car garage. Off Dyess Pkwy near Ft. Gordon. $99,900. Call 706-3395548 or 706-210-4334 TOWNHOME large furnished room (dresser, bed, night stand, linens) for rent with private bathroom in convenient and very nice neighborhood near Doctors

HOMESBYOWNER.COM Sell • Buy • Rentals • 706.564.5885 WEST AUGUSTA Luxury 3 BR / 2 BA Townhouse, 1-car attached garage located off Pleasant Home Road $725 /mo 706-228-4655 TOWNHOME 3 bedroom, 3 full bath townhome. 2 master suites, like new, end unit with extra parking, single garage, covered patio, $125,000. 706-799-0394

SERVICES HOME HEALTH CHECK-UP Biological and chemical contamination will make you sick. Help your doctor! We Cure Sick Homes. 706-772-9898 www.commandonow.com LYNN’S CLEANING SERVICE over 20 years experience in the CSRA with an eye for detail. Call 706.833.2658 or email lynn_dubose@hotmail.com 1612

BIBLE BY PHONE - Free daily Bible readings; for Spiritual Encouragement and

NOTICE! ATTENTION! If any current or past employer has failed to pay you min. wage or time and a half overtime pay, you may be entitled to an order from US Federal Court awarding you twice the amount of your unpaid wages plus atty. fees. For info, call Arthur H. Shealy, Attorney at Law, 803-278-5149, 1010 Plantation Rd, North Augusta SC 29841. You may be entitled to a similar award for unpaid wages if your employer required you to perform duties during your lunch hour, before clocking in, or after clocking out.

PERSONAL TRAINER Certified by United States Sports Academy in Science of Bodybuilding and Strength Training for Athletes. Significant improvements for all sports at all ages. Natural techniques for relief of all common sports-related injuries employing positioning and myofascial release. Rapid recovery and strength gains.

One free session to 1st 10 applicants.

E-mail Hme3065805@aol.com or call 803-257-5421

THE PUZZLE SOLVED

USE THE FORM BELOW AND MAIL IT IN, OR GO TO WWW.AUGUSTARX.COM AND PLACE & PAY CONVENIENTLY AND SAFELY ONLINE. THANKS!

(OURS IS COFFEE)

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CLASSIFIED ADVERTISING FORM Name Address Work number (if applicable) ( ) Home phone ( ) Category of ad (leave blank if unsure):

SPARKLING CLEAN Looking for offices to clean. No contract req. Husband & wife team have years experience and give FREE on-request estimates. Call 706.831.8552 or 706.831.8553

LAWN SERVICE Commercial, residential.

Call Vince: (704) 490-1005

SENDING US A CLASSIFIED? WHAT’S YOUR DRUG OF CHOICE? Augusta Medical Examiner Classifieds

Growth. Call 706-855-WORD (9673)

QUOTATION

In case we need to contact you. These numbers will not appear in the ad.

QUOTATION PUZZLE SOLUTION: Page 12: “Whereas convictions depend on speed justice requires delay.”

— Marshall McLuhan

AD COPY (one word per line; phone numbers MUST include the area code): .25

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(Copy this form or continue on additional sheet if more space needed.)

Send this form with payment to:

AUGUSTA MEDICAL EXAMINER, PO BOX 397, AUGUSTA, GA 30903-0397 Total ad cost by number of words as shown above: $

The Sudoku Solution

COFFEE IS GOOD MEDICINE VISIT DRUGOFCHOICECOFFEE.COM FOR YOUR REFILLS TODAY

WORDS BY NUMBER “Sometimes the questions are complicated and the answers are simple.”

— Dr. Seuss

Multiply by number of times ad to run: x Total submitted: $

The Augusta Medical Examiner publishes on the 1st and 3rd Friday of every month.

Your ad should reach us no later than 5 days prior to our publication date.

Thanks for reading!

www.AugustaRx.com

JUNE 1, 2012

15 +

AUGUSTA MEDiCAL EXAMINER

Hospitals add $38 billion to Georgia’s economy University generates ATLANTA – During a time when Georgia’s economy continued to suffer, a new report shows that in 2010, Georgia hospitals provided the state a muchneeded $38 billion economic boost. The report, commissioned by the Georgia Hospital Association (GHA), the state’s largest hospital trade association, also showed that with the state’s unemployment rate hovering around 10 percent at that time, hospitals accounted for more than 337,000 full-time jobs.

“Georgia hospitals are known as the guardians of health care in our communities but they are also essential in helping protect the economic health of our communities,” said GHA President Joseph Parker. “We’re proud of the fact that even in the worst economic times, the Georgia hospital community has stood tall and continued to serve as a key economic engine and resource for jobs.”

Contrary to popular belief, hospitals, however, are not immune to the economic downturn. The report shows that in 2010, Georgia hospitals provided more than $1.5 billion in uncompensated care, an increase of nearly $46 million from 2009 and a massive $162 million jump from 2007. This was primarily due to the state’s unemployment rate climbing into double digits, leaving hundreds of thousands of Georgia families without any health care insurance and forcing them out of primary care settings and into hospital emergency rooms.

“It’s a huge concern because these numbers are growing exponentially every year with no relief in sight,” said Parker. “There aren’t many businesses and industries that can absorb those kinds of losses and still keep their doors open. Hospitals have become experts in doing more with less.”

In 2010, more than half of Georgia

in 2010, an increase of 12,000 jobs from 2009. When an economic multiplier is applied to this number, it reveals that hospitals sustained over 337,000 full-time jobs in Georgia. The output multiplier considers the “ripple” effect of direct hospital expenditures on other sectors of the economy, such as medical supplies, durable medical equipment and pharmaceuticals. Economic multipliers are used to model the resulting impact of a change in one industry on the “circular flow” of spending within an economy as a whole.

“When you take a hospital out of a community, you not only lose those valuable jobs and the ability to attract other industries to your area, you create a negative ripple effect that is so destructive to so many other existing businesses in the community and region,” Parker added.

The hospital economic impact report also measures hospitals’ direct economic contributions to Georgia’s working families. Using a household earnings multiplier, the study determines that hospitals generate more than $15 billion in household earnings in the state. The household earnings multiplier measures the increased economic contributions from households employed directly or indirectly by hospitals through daily living expenditures. +

hospitals lost money from the patient care they provided while more than a third of hospitals — exactly 34 percent — operated with a negative total margin.

The growing uncompensated care burden, coupled with years of federal and state cuts to Medicare and Medicaid, has many hospital executives throughout the state concerned about the future.

President Obama’s 2013 budget proposal called for cuts in Medicare of $268 billion and Medicaid by $52 billion over 10 years while the U.S. House, a couple of weeks ago, approved a budget reconciliation package that calls for Medicare spending reductions of $6 billion over 10 years.

On average, services to Medicare and Medicaid recipients account for 55 percent of hospital revenues. In the 2010 national health care reform legislation, Medicare payments to hospitals were reduced $155 billion over 10 years with the promise that 32 million currently uninsured Americans would be provided health care coverage under the new law.

“During a time when the nation’s Baby Boomers are beginning to flood the nation’s Medicare rolls, the federal government must not back away from its commitment to provide adequate health care coverage for this vulnerable population,” said Parker. “When you cut payments to Medicare and Medicaid, you not only threaten the ability of hospitals to meet the health care needs of their communities, you also threaten thousands of good-paying jobs in our communities.”

The report shows that the mere presence of a hospital is a major source of jobs in any given community. As the state’s unemployment rate continued to exceed the national average, the Georgia hospital workforce accounted for nearly 157,000 full and part-time jobs

About GHA Established in 1929, GHA is the state’s largest trade organization of hospitals and health systems providing education, research and risk management services to its 174 hospital and health system members.

Additionally, it represents and advocates health policy issues benefiting Georgia’s citizens before the state legislature and U.S. Congress as well as before regulatory bodies.

$850M for local and state economy

ATLANTA – University Health Care System in Augusta, Ga., generated more than $849,777,853 in revenue for the local and state economy in 2010, according to a recent report by the Georgia Hospital Association. The report also found that, during the same time period, University Health Care System provided approximately $27,344,503 in uncompensated care while sustaining nearly 6,800 full-time jobs throughout Augusta and the rest of the state.

The report revealed that University Health Care System had direct expenditures of more than $367,360,303 in 2010. When combined with the an economic multiplier developed by the U.S. Dept. of Commerce’s Bureau of Economic Analysis, the total economic impact of those expenditures was more $849,777,853. The multiplier considers the “ripple” effect of direct hospital expenditures on other sectors of the economy, such as medical supplies, durable medical equipment and pharmaceuticals. Economic multipliers are used to model the resulting impact of a change in one industry on the “circular flow” of spending within an economy as a whole.

“In these challenging economic times, it is wonderful to see the very positive impact University Health Care Sytem has on our local economy,” said James R. Davis, CEO of University Health Care System. “The CSRA has supported this health system for nearly 200 years, and we will continue to support our community with quality, affordable health care.” +

M E D I C A L S E RV I C E S D I R E C T O RY WALKING

Knob

Hill

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Spinal Cord Injury Care • Traumatic Brain Injuries Respite Care • Specialized Rehabilitation Care Specialized Dietary Requirements Adult Day Care • Alzheimer’s Care

Approved for VA and Medicaid and private pay Knob Hill Assisted Living Center is just off Washington Rd. near Windmill Plantation, approx. 3 miles from Evans WalMart

For more information or to make a referral, please contact us: KNOB HILL ASSISTED LIVING CENTER Ryan Hunt • huntglobalinc@gmail.com 2822 Knob Hill Farm Road • Evans, GA 30809

706-860-0541

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410 HITCHCOCK PARKWAY NEW CPC OFFICE AS OF AUG. 1

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Evans, South, Crossroads, Central and North Augusta offices open 8:30 am-8:00 pm Monday thru Thursday and 8:30 am-5:00 pm Friday Aiken office hours: 8:30 am-8:00 pm Mon & Tue and 8:30 am-5:00 pm Wed thru Fri CPC-Crossroads open weekends for CPC patients with acute care needs. Please call ahead.

26 PHYSICIANS • EVENING HOURS • 6 CONVENIENT LOCATIONS •

TO ADVERTISE HERE CALL 706.860.5455

+ 16

JUNE 1, 2012

AUGUSTA MEDiCAL EXAMINER

Future scientists explore sickle cell research at GHSU camp

OPEN HOUSE 2-4 PM SUNDAY, JUNE 3rd

4 BR/3.5 BA Lovely, Well-Cared for, One Own Georgia Health Sciences University will host two science and Home built in 2006 on Private Cul-de-Sac! leadership camps this summer for teenagers age 14-18 with sickle Walking Trails, Masters Rental, cell disease.

Double Garage, Custom Built Workshop Participants in the GHSU Future Scientists Camps receive with electricity! 5 mins. from Medical Complex hands-on laboratory experience in sickle cell research, develop selfadvocacy and leadership skills, and learn about health sciences career opportunities.

The free overnight camps run June 11-15 and July 9-13 and include meals and accommodations on the GHSU campus in Augusta. A limited number of spaces are still available for the June session.

The program is endorsed by the GHSU Sickle Cell Center and funded by the National Institutes of Health and the National Institute on Minority Health and Health Disparities. +

Ann Marie McManus 706-481-3800 706-736-3375 www.GoodLifeAugusta.com

For more information, contact Leah Taylor at letaylor@georgiaheatlh.edu or Robert Gibson at rgibson@georgiahealth.edu or call 706-721-3641.

®

+

Walton Foundation hosts 2nd Annual Wheelchair Tennis Championship

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Donald Shapiro considers himself a tennis player first. It just happens that he plays on wheels.

Shapiro, along with other players from the Augusta area and the Southeast, will participate in the Walton 2012 Foundation for Independence’s 2nd Annual JUNE Wheelchair Tennis Championship on June 16 and 17 at Newman Tennis Center, 3103 Wrightsboro Rd. The event is part of the Georgia Wheelchair Tennis Grand Prix, which also includes events in Atlanta and McDonough, Ga., and will culminate in a Georgia State Wheelchair Grand Prix Championship in Peachtree City in October.

Shapiro has been playing wheelchair tennis for the past 30-plus years and last year ranked No. 3 in the U.S. in Wheelchair Tennis A rankings. He is also an advocate of the sport, coaching the Walton Foundation’s wheelchair tennis clinics on most Monday evenings at The Club at Rae’s Creek, where wheelchair users play against one another as well as able-bodied players. “It’s a great opportunity to see that people in wheelchairs can not only play sports like tennis, but play competitively,” said Shapiro.

Those wishing to enter the tournament must be wheelchair users and current USTA members. Cost is $54 for one event and $56 for two; the deadline to register is June 9.

Spectators are encouraged to attend. + For more information, contact Alice Salley at 706-826-5809.

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