July13 18 by Daniel Pearson

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JULY 13, 2018

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From the ashes

oday is a pretty awesome day for me. It marks 2 years clean for me. As I sit here and reflect on how amazing my life is today, I really thought it would be selfish not to share my experience with drug addiction and recovery with anyone who may be struggling out there. Two years ago today I was a desperate, pregnant, absolutely hopeless catastrophe, and I knew both my and my unborn baby girl’s life were in danger if I didn’t make a change. So for the first time in my life, after 10 years of drug addiction, I decided this was going to be the first day of the rest of my life. And it was. That day I had absolutely nothing. My purse had been stolen, I had no ID, phone, clothes, literally nothing but the clothes on my back, the gift of pure desperation and a drive to do something with my life. I hadn’t had a job in over 8 years because I couldn’t pass a drug test and I couldn’t work unless I was high. I had no family relationships because I’d ruined them all, and the friendships I had were solely based on what kind of drugs they had and how accessible they were to me. So I did what was necessary to get what I needed to get into Hope House and by July 26, 2016, I was officially in treatment.

I was a hopeless, desperate catastrophe. I had never done anything like this before because in my head I knew I could quit any time I wanted to. I just didn’t want to. I blamed and fueled my addiction on everything and everyone who had done me wrong and all the bad things that had happened to me in my life. Responsibility and accountability weren’t even words that existed in my vocabulary.

I spent 10 months in treatment, and thanks to a combination of determination, hard work, the amazing staff there, the support network of sober women, the support of my family (which was a BIG deal for me because they had written me off completely because of the monster I had become), and by the grace of God, I learned how to live a healthy, productive life, how to “adult,” and be a good friend, and a daughter, and most importantly, a good mother. On October 12th my daughter will be 2 years old. She was born a healthy, happy baby, with no complications. Fast forward to the present day and I have gotten and maintained a job, I pay taxes, my word means something to people because my actions match my words, I am trustworthy, I am reliable, I am a daughter again, I don’t have to ask my family to help me with money, I can afford to put my daughter in a Christian daycare, I am able to provide my daughter with everything she needs physically, emotionally, and financially, I have a network of women that I know at any given time I could pick up the phone and they would be there for me no questions asked, I was able to afford to take my mother skydiving

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Summer is in full swing, and kids everywhere are outside doing what kids do best -- playing in the fresh air and soaking up the warm sunshine. While this is one of the best times of the year for kids to enjoy life, it’s also one of the best times to get sun burned if not properly protected from the sun’s rays. It’s important to note that children are especially susceptible to getting burned, because they don’t realize the dangers of the sun the way adults do, and can really only detect the fact that they feel hot or burned once damage has already been done. So here’s a handful of tips to help let your kids enjoy everything about summer but also stay safe in the sun: • A helpful trick is to apply sunscreen BEFORE putting on swimsuits or other clothing, to ensure all parts of the body are covered. • One good, harsh sunburn in childhood, especially one with blistering, can mean bigger consequences later in life. • UVA and especially UVB rays from the sun are responsible for the majority of skin cancer-causing rays purchase sun screens and sunglasses that protect against both • Most experts recommend spf 30 or greater for routine use in the sun. SPF higher than that is up to personal preference of mom and dad. • Apply sunscreen 15-20 minutes prior to going outside, and bring a hat or sunglasses, too • Reapply sunscreen every 2 hours (or every 1 hour with heavy sweating or swimming). • Water, sand, and pavement can reflect sunlight, too • Don’t forget about protecting the lips! Chapsticks can contain spf too, which helps! • Babies younger than 6 months of age should not be directly exposed to the sun for very long, and should definitely be kept in protective (but light, breathable) clothing and sunscreen. Be smart about how long and at what time of day babies are brought outside! • Speaking of times of day, 10am-4pm are the most risky times of day for sunburns to occur, as the sun’s rays are strongest and most direct during these hours. (This is also the hottest part of the day, and can leave a child dehydrated as well). So early morning or evening tends to be a safer time to let kids play outside, in general. • If you start to see pink, and even worse red, on a child’s skin, it’s time to come inside! Chances are they are feeling crispy but won’t realize it until later. • Don’t forget how dehydrating it can be to be out in the sun! Drinking plenty of fluids and water (not soda) helps the body do everything better, including maintaining healthy skin! +

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JULY 13, 2018

When a loved one has Alzheimer’s Disease by guest columnist Nancy, V. Karp, Ed.D., M.Ed., P.T.

ASK DR. KARP

Alzheimer’s Disease (AD) has touched the lives of many of us, through a loved one or a friend with the disease. In the US, 5.7 million people have AD. Closer to home, Georgia has approximately 140,000 people living with AD. I have been a physical therapist for over 45 years, and during that time I have traveled with many patients through the stages of their disease. I hope I can give you and your loved one with AD a few ideas for improving the quality of your lives. The most common question I hear is: “What can I do for my loved one?” You can actually do a lot. Since I am a physical therapist, I tend to focus on the physical changes in a person’s muscles, posture and balance. Did you know that subtle changes in a person’s balance and how they walk (their gait), can be seen even before cognitive changes appear? A slower gait and difficulty walking while talking or while being distracted may indicate the beginning of cognitive problems. Walking and balance are significant health markers throughout all stages of AD. Gait speed and balance predict the likelihood of a fall, a major complication of AD. So what can you do? Simply take regular walks with you loved one. This benefits both of you. Keeping leg and foot muscles strong are major preventers of falls. Walking briskly (Or as briskly as possible) is good for the

heart and brain. You can walk together (even indoors) to the beat of music or to the beat of a metronome. It actually can be fun! This helps to improve the smoothness of the gait. Once you both get into the daily routine of going for a walk or moving to music, he or she will look forward to that time each day. Movement is very important for heart and brain health. Recent research has shown that exercise, even in the later stages of the disease, is very beneficial for an AD patient. It is never too late to begin. Keeping good muscle tone and joint range-of-motion is equally important for you and the person with AD, so exercise together. Caregivers who exercise regularly experience less stress and are better able to care for their loved one over time. Supporting a loved one through all stages of AD requires you to be an observant detective and to use your creativity. Communication may require you to observe the emotion and body language behind what is being said, not just the words. If you ask a question, give the person a chance to answer. This may take longer than usual, making it seem like an uncomfortable silence for you, but not for the AD patient. Be reassuring, attentive and supportive, as the person answers. We have a tendency to fill in silence, but silence is a Please see KARP page 6

Since we’re twelve now... As the Medical Examiner marks twelve years in print this month, interesting things about the number twelve come to mind. There are usually twelve people on a jury; there were twelve apostles; twelve months make a year; we usually tell time based on a 12-hour base. In human anatomy, part of our digestive system has a connection to twelve. The small intestine connects the stomach and the large intestine. The small intestine is where absorption of food takes place to nourish the body. Depending on a person’s size, the entire small intestine can range from as short as nine feet

long to thirty feet or more. The small intestine has three parts: its shortest segment is the initial portion leaving the stomach (in green above), followed by the middle section (the jejunem), and then the final part, the ileum, which connects

to the cecum, considered to be the start of the large intestine. It’s that first part — the duodenum — that we want to focus on. The word comes from the Latin duodecim, which looks a lot like “two” (duo) and “ten” (decim), which does, in fact, add up to twelve. The Greek equivalent is dodeka-dactylon, literally “twelve fingers long,” so named by the Greek physician Herophilus (335-280 B.C.E) because its length is equal to the breadth of about twelve fingers. But is it pronouned do-WAH-de-num or do-oh-DEE-num? Depends on who you ask. +

Are there more synapses in the brain than stars in the universe? Both the universe and the human brain are full of numbers so immense as to be almost incomprehensible. Can you really wrap your head around this number: 100,000,000,000,000? In words, that’s what 100 trillion looks like. It is also one estimate of the number of synapses in the brain. However, some neuroscientists believe a more accurate estimate adds one more zero, which makes it one quadrillion: 1,000,000,000,000,000. To break those numbers down to more manageable size (haha, not really), a trillion is a thousand billion; a quadrillion is a thousand trillion. We should also define synapse. Simply put, a synapse is a tiny gap or junction between two nerve cells across which messages are passed. Each synapse is like a highway intersection where multiple roads meet. With at least 100 trillion such intersections in the brain, the number of potential connections is staggering. But how do those numbers compare to stars? Here too, the numbers are astronomical. Literally! Our galaxy, the Milky Way, has a mere 100,000,000,000 (100 billion) stars. That is far lower than even the most conservative estimate of the number of brain synapses. But while we’re on the subject of 100 billion, that’s one estimate of the number of galaxies in the known and observable universe, although guesstimates by astronomers and cosmologists run as high as 500 billion galaxies. Stars per galaxy is said to average 300 billion (the Milky Way and our 100 billion stars is relatively small; the Andromeda Galaxy, for example, has an estimated 1 trillion stars). Multiply 100 billion (the number of galaxies, conservatively) times the average number of stars per galaxy (300 billion) and let’s see... carry the zero... and the estimated number of stars is 30,000,000,000,000,000,000,000 (or 30 sextillion). That is said to be many times more than the total number of grains of sand on all the beaches on earth. To get a grasp of what 30,000,000,000,000,000,000,000 of something looks like, grab an eye dropper and put 10 drops of water into a glass. Science writer David Blatner says just 10 drops of water contain 30 sextillion H20 molecules. In closing, here is a number we can definitely all understand: 1. That’s the total number of known stars in our solar system. +

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Who is this? ON THE ROAD TO BETTER HEALTH A PATIENT’S PERSPECTIVE Editor’s note: Augusta writer Marcia Ribble, Ph.D., is a retired English and creative writing professor who offers her unique perspective as a patient. Contact her at marciaribble@hotmail.com

by Marcia Ribble

ost of us will find this man to be a complete unknown, but he is a true giant in medical history and despite his distant birth (1852), he is known to this day as the father of modern neuroscience. Santiago Ramón y Cajal was born in northern Spain, the son of an anatomy teacher. That would prove to be significant in his medical career, but in his youth there was virtually no sign that Ramón y Cajal would ever amount to much of anything, let alone a scientist with an enduring worldwide reputation. As a child he was expelled and banned from numerous schools due to his rebellious, argumentative nature. He found himself living in a jail cell at age 11 after blowing a gaping hole in a neighbor’s door. No one was injured in the blast, but neither was Ramón y Cajal particularly penitent: after three or four days in jail he was released, only to build another cannon with his friends. “We were incorrigible,” he wrote in Memories of My Life. This one exploded, leaving him with a piece of shrapnel imbedded in his eye. His father apprenticed him to a shoemaker and a barber, but neither career materialized. At age 16, his father took him to a cemetery to look for human remains for anatomical study. (Strange? Definitely.) This curious expedition was the most unlikely of turning points in Ramón y Cajal’s life, since he already had demonstrated artistic talent. His illustrations later became a significant part of his medical career. He enrolled in medical school at the University of Zaragoza where his father taught, and graduated at age 21 in 1873. He accepted a post as a medical officer in the Spanish army, but refused to allow his father’s letters of recommendation to influence his career there, and as a result he was sent to a remote outpost in Cuba (in 1874-75) during the Ten Years’ War. There he contracted both malaria and tuberculosis and was forced to return to Spain to convalesce. After recovering and furthering his medical education, he was named professor of anatomy at the University of Valencia in 1883. There he focused his research on the pathology of inflammation, the structure of epithelial cells and tissues, and the microbiology of cholera. Moving to Barcelona in 1887, Ramón y Cajal learned about cell staining as a research tool, allowing him to study the brain’s complex neural network. The prevailing wisdom of the day held that the entire nervous system was a single continuous network. Called reticular theory, Ramón y Cajal discovered the composition of the brain and nervous system to be individual cells. His pioneering research included the discovery of the connective mechanisms of the brain and the cerebrospinal system. (See QA on page 3 for more information) But his research was not limited to such cerebral regions. He also discovered a new type of cell named after him: interstitial cells of Cajal (ICC); “they serve as a pacemaker which creates the bioelectrical slow wave that leads to contraction of smooth muscle” in the intestine. Ramón y Cajal was co-awarded the 1906 Nobel Prize in Medicine for his work on the structure of the nervous system, along with Italian scientist Camillo Golgi, despite Golgi being a proponent of the later disproved reticular theory. Ramón y Cajal died in Madrid at age 82 in 1934. +

For the past month my computer has been messed up. But I am slowly but determinedly fighting to get past the craziness. Even when it’s working now, it’s not doing what I used to be able to do with ease. Reminds me of my body and its refusal to accomplish things that used to be easy for me. I was never very fast, but now I’m close to being a turtle. Fortunately, I am still fairly convinced that I am in control and my body just needs to get its act together. Some days that actually works, and on other days, well, you all know the routine. On top of the computer malfunctioning, I recently pulled my adductor muscle in my thigh, the right leg of course, which makes driving close to impossible since I can’t lift my leg from the accelerator to the brake. So I loaned my car to my granddaughter who is doing the driving these days. That turned out to actually be a benefit, giving me more company. Yeah! Being driven around also means more frequently seeing my little greatgranddaughter who is as precious as a jar full of lightning bugs. We haven’t done much this week due to the heat, the 100 degree plus “feels like” temperatures, and the humidity. So what is left to be done inside? My laundry is already

finished. My dishes are done. The dog has been fed and has a full water bowl. I even have leftovers for supper. I’ll be finished with this article soon, and then I’m hoping for some kind of inspiration. Looking back 50 years ago, none of this would have been a problem. I’d get up in the morning and try to get my laundry done and out and hung on the lines by 6 am. Then two babies to feed and dress and make formula for the littlest one. Dishes, dusting, sewing on buttons, ironing, vacuuming, chasing the kids, reading to them, lunch, outside for playtime, naps (not for me), start fi xing supper. From early morning ’til late at night I can’t recall a moment without a task waiting for me to complete. This makes not having anything I need to do both funny and strange. I need a hobby, or maybe several of them. I’ve thought about some of my former hobbies. Knitting and crocheting and other needlework is pretty much ruled out by arthritis and neuropathy in my hands. This is the time of year for picking fruit and making jam, but arthritic hands and boiling hot sugar don’t work well together. Canning tomatoes? Ditto the hot stuff. I’ve thought about taking up painting and that’s OK if I can accept abstract impressionism as my go-to expression. Suggestions, anyone? +

Is truth serum... true? WHICH WILL IT BE? Of course it is. Don’t you watch TV or go to movies? Oh, you mean in real life. There is some truth to truth serum, but not a lot. It all dates back to about a hundred years ago when an obstetrician named Robert House noted that scopalamine, one of a group of similar drugs that are sometimes used as sedatives and pain killers — including pentobarbital and the famous sodium pentothal — induced his patients to promptly and candidly answer any question posed to them.

Dr. House advanced the use of the drug as a method of interrogating prisoners. It didn’t take long for scopalamine to be rejected for use in court proceedings. The first such ruling was handed down in 1926. The legal issues are fairly obvious: a person “pleading the Fifth” is referencing the Fifth Amendment to the U.S.

Constitution, which protects individuals from being compelled to testify against themselves in criminal cases. Also known as the right to remain silent, it is violated by testimony considered under law

to be unconstitutionally coerced from someone not in possession of all their faculties. Aside from legal considerations, the effect of truth serum drugs, according to studies by organizations like the CIA and OSS, is said to be no different than alcohol. It can offer the advantage of getting reluctant subjects to be more talkative, but offers no guarantee that what they say is true. Their statements may be “contaminated by deception, fantasy, garbled speech, etc.,” according to a 1961 report by the CIA. In 1963, the U.S. Supreme Court ruled that confessions produced with the aid of truth serum were suspect and inadmissible in court. Truth serum is a convenient plot device on the screen, but there’s not much truth in it elsewhere. +

JULY 13, 2018

Musings of a Distractible Mind

by Augusta physician Rob Lamberts, MD, recovering physician, internet blogger extraordinaire, and TEDx Augusta 2018 speaker. Reach him via Twitter: @doc_rob or via his website: moredistractible.org

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JULY 13, 2018

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uring the Dark Ages before the Internet, doctors were often the only source of medical information. People could go to the library and look things up but most didn’t, so there was still an air of awe given to doctors, who should never be questioned. Things have changed. Now all of the information I’ve got and knowledge I gained in my training and during my practice is available to everyone any time. Sure, people lack the context in which to use much of that information, but they can (and usually do) check their medical questions with Dr. Google. This changes the whole dynamic of the relationship between doctor and patient. Many would say this is for the worse, but I disagree. My father has been going through significant problems with his back. While it’s my normal practice to avoid being a meddler in the care my family gets, I’ve worried over that care in respect to my Dad’s back. At my urging, my parents (who grew up in the age of the high priesthood of doctors) have asked far more questions and have gotten better care as a consequence. “Yeah, but you’re a doctor,” some might argue. Does that mean only doctors are able to question care they (or their loved ones) are getting? No, we should all ask, and every doctor should welcome questions from patients. The more engaged I am with my patients, the more I have seen them open up to me about things because they perceive that what they say matters to me. I respect what they have to say about things, so they talk to me and don’t hold back on their fears or concerns.

This means that people are much less scared to talk to me about things, much more likely to confess their alcoholism, their depression, or their concerns about medications they are taking. All of these things allow me to give better care. So what does patientcentered care look like in a world where the patient is a participant? Here are the rules I follow: • The patient always deserves my respect as their

What happens between appointments is far more important than what happens during them. doctor, and should always perceive that respect. It’s not enough to respect them, I’ve got to show that I do. • It’s their body, not mine. I might think it makes sense to have surgery or take a medication, but they are the ones who have to get cut on or put the foreign substance in their body. I have to approach them with this in mind, asking about their fears and concerns, not simply assuming the fact that I prescribe or recommend something means that they will accept it without question. • I may know more about medicine than they do, but they know more about their own bodies. There is an old saying in medicine, “the patient will always tell you what is wrong with them.” In other words, it is a doctor’s job to listen, to ask questions, and to discuss things with them so that we know what is going on. Many docs are far too quick to disbelieve symptoms the patient reports, and so many patients are afraid to report

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symptoms that “don’t make sense.” This can lead to misdiagnosis. • It’s more important to get it right than to be right. If the patient comes up with the diagnosis then hooray. I don’t care how we come up with it. Who cares if they Google it? I look up my non-medical problems on Google. Should plumbers, electricians, or geologists be mad at me when I look up information in their areas? I couldn’t care less. It’s my pipes, my wires... and my rocks. • I want my patients taking responsibility for their health. As I’ve often said, what happens between appointments is far more important than what happens in them. This means that my job is now one of teacher, interpreter, and encourager. If I can’t explain why they need a medication, they shouldn’t take it. If they have questions, fears, or concerns, I want to hear about them. Most of all, I don’t want people worrying about being scolded when they come to my office. I’m not their mom. • In the end, it’s their choice. If after explaining, listening, educating and even warning, people don’t follow my instructions, I’m OK with that. My job is to let them know the risk of their choices. Once I’ve done my part, I don’t lose any sleep about their choices. As it stands, my patients are quite compliant with what I recommend. They comply as long as I’ve done my side of the agreement, and they tell me when they don’t do as I recommend. I wish other docs would lighten up and stop thinking we are in the Marcus Welby world of prescriptive medicine. We aren’t, thank goodness. +

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KARP… from page 3 good thing for people with AD. Communication methods will change throughout AD stages. A person may get to the point of not being able to express himself at all. This means that your detective skills will have to decipher communication through body language, facial expression and tone. Don’t worry; you will not always get it right. Laugh to lighten the mood. Don’t let unimportant things get in the way of enjoying the person you are with. If it’s Thursday, does it really matter if your loved one thinks it’s Tuesday? Sometimes it is important for a person to remember information and sometimes it isn’t. Anything involving their safety is important. For example, “lock your wheel chair before standing.” You may want to use pictures as reminders, to facilitate memory. Other times, it is better not to correct a person. For example, if the person is asking for their spouse who died 5 years ago, it might not be helpful to say, “Mom, you remember Pop died 5 years ago.” That death then becomes brand new for the person with AD and may start the grieving process all over again. You can use cognitive stimulation techniques with your loved one, for example, touching a hand or an arm if you want the person to put an arm in a sleeve of a sweater. This approach works well if your loved one has apraxia, that is, being physically able to perform a task but not the mental capability. You can help by demonstrating the skill, or by physically guiding the person. Be positive. Say, “Let’s go,” with a

When someone asks if they can help, by all means say yes pleasant voice and put out your hand for the person to follow. Also, try not to give too many directions at once, since this confuses the person. Is it really necessary to give complex directions rather than simple directions anyway? Instead of saying, “Let’s put on our coats, get in the car and drive to the doctor,” concentrate on the immediate task at hand. Then, go on to the next task. Two areas of frustration for many caregivers are “sundowning” and “wandering.” Sundowning is the increased confusion, anxiety, agitation, pacing and disorientation beginning at dusk and continuing throughout the night. Usually this is accelerated by any activity going on in the home, such as family coming home from work or school along with other activities like dinner being prepared. To help minimize sundowning it is important for the AD person to be active during the day. Too much rest and lack of activity interrupts the sleep/wake cycle. Having a regular routine with activities, rest and meals at set times is very helpful. Let the person pace if they want to. You may want to walk with them around the yard. Have some soothing activities

planned: listening to music with headphones, looking at a photo album, petting the dog in a quiet room or folding towels. Be creative and find quiet activities your loved one will enjoy. Try to cut down on noise and visual distractions. Make sure the room is well lit. Shadows can confuse the person with AD. Wandering is when a person becomes disoriented and lost, even in their own home, neighborhood or places that are familiar to them. A classic example of wandering is walking around looking for the bathroom at home. Again, exercise is very important throughout the disease process. Making sure the person gets plenty of physical activity on a regular basis can prevent the complications of wandering, namely falls. Having good muscle strength in the legs will help to prevent loss of balance and gait problems during wandering. This is essential, since 60 percent of AD patients wander, and ironically, 75 percent of AD patients with hip fractures are wanderers. This is when safety becomes all-important. Use of electronic alert devices that signal caregivers when wandering is occurring are helpful. There are many on the market. Your supervision and reassurance are important. As Alzhiemer’s progresses, a person’s depth perception changes. This is why carpeting in many nursing homes has a solid border near the patient’s room, to help decrease a patient’s likelihood of wandering. Dementia residents see that dark

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space as a hole and will be reluctant to cross it. Depth perception changes are the reason why people with AD can have difficulty going down stairs, especially with dark-colored carpeting or flooring. Bright colored or white tape on the steps can help the person see it as a step. I often put colored tape on the handles of walkers so a patient does not see touching the handles as putting his/her hand in a hole. Take advantage of family and friends who are willing to help. When someone asks if they can help, don’t let the opportunity pass by. Have a list already made up to take advantage of the offer. For example, a neighbor can come by, sit with your loved one and look at a family photo album together. If your Dad likes to do woodworking, his brother, one of his children or a friend can come over and they can hand-sand some wood together. Another idea if someone offers help is to suggest bringing over a casserole or other simple meal. In conclusion, remember to enjoy your loved one. Laugh together. No matter the stage, stay flexible and be creative. The Alzheimer’s Association website has a wealth of information to help you on this journey. + Dr. Nancy V. Karp, Ed.D., M.Ed., P.T. is a member of the Section of Geriatrics of The American Physical Therapy Association. She has practiced in the area of Geriatric Physical Therapy for over 45 years and teaches in the Alzheimer’s component of the Doctoral Physical Therapy program at Augusta University.

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Southern Girls Eat Clean Nicoise Salad...My version of a French classic SURG ERY

Here is my “Southern Girl Version” of a Classic French Nicoise Salad. This salad is typically made with Bibb lettuce, tomatoes, French green beans, tuna, hard-boiled eggs, Nicoise olives and anchovies. The dressing is a simple red wine vinaigrette. We had this delicious salad for lunch on Sunday simply because I had some left over green beans that I needed to use up while they were still fresh. I looked around in the pantry to see what else I could find and found one can of my favorite tuna, Planet Wild albacore tuna. I had spinach on hand and pastured eggs. I did not have any of the purplish black Nicoise olives, but I did have Kalamata olives which is a great substitute for most recipes. I added purple onion to my version of this salad because what doesn’t taste great with purple onion? I dressed the Nicoise salad with my favorite red wine vinaigrette. It is my go-to salad dressing and very simple to put together. What an awesome Sunday lunch! This was super quick and I love it when I can throw together a meal with things I have on hand. It was healthy, clean and very fi lling. I could eat this everyday! The French have it going on, right? Enjoy!

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Nicoise Salad

Ingredients: • 4 cups of fresh organic baby spinach • 1 can of wild caught albacore tuna • 2 hard-boiled organic pastured eggs, peeled and quartered • French green beans, (Haricot verts) steamed • 1 organic tomato, quartered • Sliced purple onion, as much as desired • 1/2 cup of sliced or whole pitted Kalamata olives • 1 Tbsp. of chopped fresh flat leaf parsley • For the dressing: • 1/2 cup of extra virgin olive oil • 3 Tbsp. of red wine vinegar • 1-2 cloves of garlic, crushed • 1 tsp. of Dijon mustard • 1/2 Tbsp. of agave nectar • 1 pinch of salt (I used Real

Salt brand) • 1 pinch of cracked black pepper Instructions: Boil the pastured eggs and allow them to cool at least 3045 minutes. Steam the green beans in the microwave for 2 minutes and allow to cool, or you may blanch them in boiling water for 1 minute and then submerge them in ice water to stop the cooking process. In a small bowl or container, whisk together the olive oil, red wine vinegar, garlic, Dijon mustard, agave and salt and pepper. Set aside. Arrange approximately 2 cups of baby spinach onto 2 dinner plates. Place 1/2 can of tuna in the

middle of each plate and on top of the spinach. Add the tomato slices, quartered boiled-egg pieces, green beans, purple onion and Kalamata olives to the plate surrounding the tuna as shown in the photo. Scatter chopped parsley evenly on top of both salads. Drizzle each salad with red wine vinaigrette and serve immediately. NOTE: Double the ingredients for 4 salad servings + Alisa Rhinehart writes the blog www.southerngirlseatclean. com She is a working wife and mother living in Evans. Visit her blog for more recipes and information on clean eating.

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AUGUSTAMEDICALEXAMiNER

JULY 13, 2018

IS THIS ADDICTION?

If you regularly read the Medical Examiner (first, two words: thank you!) you know that over the years we have often blasted, sometimes gently, other times not so gently, the obsession people have with their screens. But we wondered about the recent declaration by the World Health Organization that the nasty habit is a true addiction known as “gaming disorder.” We did a little digging, and also asked occasional guest columnist Justin White (full disclosure: he’s a gamer) to offer his pros and cons. Here’s what we have to show for our efforts. Justin first:

he first generation of video games is largely considered to have started in 1972 with Pong. It was simple in its concept: two paddles bouncing a ball back and forth. But this was not the first video game. That honor goes to a creation by a nuclear physicist way back in 1958. Games have changed exponentially from first-generation games like Pong and Super Mario Bros to the amazing detail and photo-realism of games like Grand Theft Auto and Skyrim. And the differences aren’t just a fresh coat of paint. With these new advancements come new ways of affecting not just how people have a good time but sometimes even how they think. According to the latest research, playing video games can change the regions of the brain responsible for attention and visuospatial skills and make them more efficient. More than 116 scientific studies have concluded that playing video games changes how the brain performs and even its very structure. Some studies noted improvements in several types of attention, such as sustained concentration and attention, and selective attention.

The regions of the brain involved in attention, say the studies, are also more efficient among gamers and require less activation to sustain attention on demanding tasks. The evidence showed that the right hippocampus area of the brain was enlarged in both long-term gamers and in study volunteers following a game training program. Video games can be put to educational and therapeutic uses and can improve reaction times and hand-eye coordination. A study in the Proceedings of the National Academy of Sciences by Vikranth Bejjanki and colleagues showed that playing video games, in particular fast-paced shooting games, (think Call of Duty or PUBG) showed improved performance in perception, attention, and cognition. A set of experiments were done on small groups of people (10 to 14 each) which found that gamers with previous experience playing such action video games were better at perceptual tasks such as pattern discrimination than gamers with less experience. In another study they trained people with little to no

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experience with playing action games giving them 50 hours of practice. What was found was that these people performed much better on perceptual tasks than they had prior to their training. In the educational field games have made advancements. Video games can be fun and stimulating, which means it’s easier to maintain a student’s undivided attention longer. Because of the excitement they offer, video games can be a more appealing way of learning than traditional methods for some. Their ability to engage can encourage learning, allowing students to grow their curiosity and meet challenges that stimulate learning. However, video games do have some potential negatives. While they do have some educational advantages, academic achievement may be hindered. Studies have shown that the more time a youth spends playing video games, the poorer is his performance in school. A study by Argosy University’s Minnesota School of Professional Psychology found that the more time

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JULY 13, 2018

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AUGUSTAMEDICALEXAMiNER

DON’T LICK THE BEATERS Useful food facts from dietetic interns with the Augusta University MS-Dietetic Internship Program

STAY HEALTHY & HYDRATED by Lauren Kirby, MS-Dietetic Intern Summer is definitely here, time to partake in outdoor barbecues, play in the park, hike, and achieve that summer glow by hanging out at the pool. While you are enjoying these activities and the hot weather, it is easy to become dehydrated. It is important to pay close attention to your health this summer to prevent adverse health effects that can be caused from dehydration such as low blood pressure, irritability and confusion, rapid heartbeat/breathing, fever, and delirium. Our bodies are more than half water, so good hydration is essential for our overall health. Fluids that we consume improve blood pressure, lubricate joints, regulate body temperature, aid in digestion, and move waste out of our bodies. With the increased temperatures and outdoor activities, we tend to sweat more, losing large amounts of fluid through sweat and evaporation as the body works to stay cool. Dehydration occurs when more fluid is moving out of our body than we are taking in. Most of us associate dehydration with excessive thirst, muscle cramps, and fatigue. Did you know that

dehydration may also affect your brain function? The brain is about 70% water, so being dehydrated may decrease your cognitive function. In a study looking at hydration and heat, adolescents who exercised for 1.5 hours and developed a state of dehydration experienced significant shrinkage in brain tissue. Even a 2% reduction in body water weight (just 3 lbs in a person who weighs 150 lbs) could result in shorter attention span, short-term memory loss, and visualmotor tracking issues. Clearly it is extremely important for you to stay properly hydrated throughout the hot summer months. Water is an excellent choice to drink to stay hydrated: it’s readily available, cheap, safe, and calorie-free. Here are a few tips for staying hydrated this summer: • Add some flavor. Try infusing your water with fresh fruit or vegetables such as lemons, limes, oranges, berries, cucumber, or mint. Adding these fresh ingredients can enhance your water by creating a refreshing, spa-like beverage without any added sugars, artificial sweeteners or preservatives. • Carry a reusable water

bottle. Having water in sight at all times will remind you to drink more water throughout the day. • Drink before you eat. Sometimes “hunger” pangs are really telling us to drink more water; our brain confuses thirst with hunger at times. So before you reach for that afternoon snack, grab your water bottle before eating and you may be surprised that your hunger pangs have disappeared. • Choose water over other beverages. Even though milk, juice, tea, and sodas are fluids and can help hydrate, caffeine-containing drinks can also increase your need for water. Choosing water over other drinks, will also help you eliminate the unnecessary sugar, additives, calories, and caffeine that the other drinks contain. • Eat your water! All whole fruits and vegetables contain water. The following foods have a high water content and they are a go-to snack during the summer to stay hydrated. 96% water: cucumber, lettuce 95% water: zucchini, radishes, celery 94% water: tomato 92% water: cauliflower, eggplant, red cabbage, bell peppers, spinach, watermelon, strawberries 91% water: broccoli, grapefruit 90% water cantaloupe 88% water: peaches 87% water: pineapple, cranberries, orange, raspberries • Chia seeds. Chia seeds are chock-full of nutrients and other bio-active compounds that are necessary for good health. They are an ancient superfood that sustained the Aztec and Mayan people for many generations. The seeds are very small in size and Please see WATER page 10

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Eric H. Augusta, GA

H H H H H 7/9/2018 I don’t understand how lungs work. I’m 6’5”. So how can I be short of breath all the time? +

Cecil C. Augusta, GA

H H H H H 7/9/2018 I was supposed to get a pulmonary function test next week, but I was stopped and breathalyzed Saturday night. I passed, so I guess I can cancel the pulmonary function test, right? + H H H H H 7/10/2018 We’re taking a family trip to California this summer. Everyone is going to Yosemite except me; I’ll stay by myself at the hotel that day. I have COPD which is bad enough already, and we’ve heard the scenery at Yosemite is breathtaking. +

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H H H H H 7/10/2018 One star! My boss is always breathing down my neck. You can’t do that without lungs. Guilty! + H H H H H 7/10/2018 I’m moving from a dinky little apartment to a spacious house with a big yard. I think this move will give me more breathing room. I hope so, anyway. + H H H H H 7/10/2018 If you have an iron lung, how do you prevent rust? +

MEDICAL

INER

JULY 13, 2018

they can absorb water. Soaking chia seeds in water will increase its water content. Consider consuming them before going out in the heat will help to keep you hydrated as they slowly release the water as your body digests the seeds. • Coconut water. The liquid from coconut is very mineral-rich and packed with potassium, magnesium, calcium, and sodium. Coconut water can replenish lost fluids and electrolytes from excessive sweating during the hot summer months. • Make sure you are drinking enough water. Many people are unsure how much water they should drink daily. Recommendations may differ depending on your age, weight, and physical activity level. To figure out the amount of fluid you need daily based on your height and weight, consult with a registered dietitian nutritionist (RDN) since they are specialized and trained in this area. Visit the Academy of Nutrition and Dietetics’ website for a list of RDNs in your area. +

FROM THE ASHES… from page 1

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WATER… from page 9

AIKEN-AUGUSTAʼS MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006

for Mother’s Day this year, I have a drivers license and pay car insurance, I mean I could keep this list going for daaaays! For those of you who knew me in active addiction, you knew that sobriety wasn’t even in the cards for me, especially after the death of my son in 2015. I mean, it was just unheard of. My point is this: was it easy to get to where I am today? Hell no. It was painful, it was stressful, it was emotionally draining, it physically sucked the life out of me....but God doesn’t take you through things you can’t handle and he will restore everything you’ve lost. To anyone out there struggling, I’m here to tell you man, if I can do this, you can too. It ain’t easy, and you can’t do it alone, but you alone must do it. There is always hope. Reach out. #wedorecover + — by Ellen Barfield Evans, Georgia What’s your story? We would love to read your tale of health, medicine or wellness. Please send it to either email address or the PO box shown on page 3. Remember, we honor every writer’s wishes whether to use their name or to remain anonymous.

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Craig Bowron and Peter Melchert M.Ds. on Nov. 16, 2017

DOCS, DO YOURSELF A FAVOR: LEAVE THE COUNTRY Here’s some advice for your career in health care: Leave the country as soon as possible. This has nothing to do with the president’s attempts to euthanize the Affordable Care Act. Or with EMRs, Medicare reimbursements, or the burnout surveys you get from your employer, who also sends emails aimed at getting you to work faster and more efficiently. It’s none of that. You need to leave the country, just for a week or two, and provide medical care to someone who would have a hard time getting it without you. Go somewhere where the waiting room is a line at the clinic door: no 500-gallon aquariums, or tapestry-sized TVs dangling from the wall. You need to go someplace where your patient took a 10-hour bus ride out of the Agrarian Age just to see if you can help them. You need to see how the other half lives, the much larger “half” of the world that doesn’t enjoy anything near our standard of living. This isn’t a do-gooder diatribe. No pictures of the kids with the flies in their eyes. Do this for yourself. When you get there you will undoubtedly see how overwhelming the needs are, and how seemingly inconsequential your efforts would appear. Like standing next to a sequoia, or staring up at the eclipsing sun, the experience will make you feel very small. It will take your mind off whether your kid has chosen exactly the right college major, whether your current set of kitchen knives will make it through the holidays, or whether you’re paying too much for your current cable package. What a relief. This is something an antidepressant cannot do for you. It’d be nice if your particular medical talents include cleft palate repair or tropical medicine, but bring whatever skills you have. You can do something. It’s OK to start small and safe: you don’t have to be choppered into a sub-Saharan civil war. Don’t go with the self-aggrandizing attitude that you’ll be reaching out to the poor, ignorant, masses. They can smell haughtiness a mile away, and besides, it makes you look fat and bloated. Try humility. Remember, you didn’t hit a triple; you were born on third base. And being uneducated doesn’t make one unintelligent. Don’t go to hone or resurrect your skills on “the natives,” thinking they’ll be too unsophisticated to notice, or that something is better than nothing. They deserve more than that. You’ll almost certainly learn how to do more with less, but it’s not always the case that something is better than nothing. Particularly when you and your team aren’t in it for the long run. And don’t wait till the kids are settled or the 401k has hit some subjective threshold or you’re retired. Now is the right time, while you have the energy for it. Do it. Go. +

Don’t wait. Go now.

Craig Bowron is an internal medicine physician and Peter Melchert is an internal medicine-pediatrics physician.

READ EVERY ISSUE ONLINE! WWW.ISSUU.COM/ MEDICALEXAMINER

This is not a book I’ll be reading: I have exactly zero plans to die, and I have to admit in all modesty, so far it’s going rather well. But for the rest of you people, this book might come in handy. Except, that is, for that small problem of denial. Oh, you have it too? Yes, we all know that we are future corpses. We all know that we could be ice cold by this exact moment tomorrow. But we don’t really believe it, at least not the tomorrow scenario. Even Ms. Tisdale, our author, candidly admits on page one of this book, “I have never died.” Ask any nurse or doctor and they will tell you of patients in their 80s and 90s who had no intention of dying, and who wanted every heroic effort made on their behalf. We say good for them. But at some point we all have the face the transformation of death from a distant and hazy conceptual theory to an immense (albeit possibly

movable) granite fact. Hopefully this realization will come gradually, and with the impending death of someone else. That’s the usual order of things: we have to face the deaths of others before our own. Not that it makes the process any easier. As natural as death is, it is very, very unnatural when we come face-to-face with it. Hence the need for books like this (although this one is unlike any other). Tisdale includes such practical sections as

“Caretaker Dos and Don’ts,” “Advance Directives,” and “Preparing a Death Plan.” Even though Sallie Tisdale by her own admission has — just like you and me — never died herself, she offers some unique credentials to deal with such a sensitive subject: she has years of experience as a palliative care nurse, still more years as an endof-life educator, and a shelf full of literary awards for her writing. That’s a good combination. Good writing along with first hand experience offers clarity when it comes to the basic, sound, practical advice promised in the book’s title. After all, death happens all day every day all over the world, so the best advice on how to cope with it and the difficult periods before and after it can’t be a mystery, even if death itself might be. +

Advice for Future Corpses (And Those Who Love Them); A Practical Perspective on Death and Dying by Sallie Tisdale, 256 pages, published in June 2018 by Touchstone Books

Research News Beware tattoo side effects The British medical journal BMJ Case Reports in June contained an interesting article about a patient with an unusual case history who experienced chronic pain after getting a tattoo. Her experience has implications for a much broader patient base, however. The patient had a double lung transplant in 2009 and had been taking immunesuppressing drugs ever since to fight rejection. She had gotten tattoos prior to the transplant with no ill effects, but after getting another several years posttransplant, she went from the usual skin irritation to severe pain in the knee and thigh of the leg that had been recently inked. The pain was so severe she required painkillers, was still raging 10 months later. After being referred to a rheumatologist and undergoing a battery of tests (all of which were negative), a biopsy of leg

tissue revealed inflammatory myopathy — chronic muscle inflammation. Physiotherapy to strengthen her leg muscle eventually (after 3 years) eliminated the pain, whose cause doctors still don’t definitively know. However, the timing leads them to conclude it is related to the tattoo and the patient’s compromised immune system. With the ever-increasing popularity of tattoos, the BMJ authors say patients with known less than perfect immune systems should be aware of the potential risks. Getting jiggled to sleep Just in time for the season of epic summer road trips (if they even happen anymore) comes news of why it can be hard to stay awake behind the wheel. Researchers at Australia’s RMIT University (officially the Royal Melbourne Institute of Technology) have discovered that natural vibrations of cars make people sleepier, affecting

alertness and concentration within as little as 15 minutes of hitting the road. In simulator testing, drowsiness became more pronounced as the 60-minute test progressed. The finding is significant, since as many as 20 percent of fatal road crashes involve driver fatigue. The study may contribute to better seat design, and lead to further exploration of the finding that some levels of vibration help keep drivers awake. Unexpected bad news Smokers who grew up in the 40s, 50s and 60s could be forgiven for ignorance about smoking: the known dangers were deliberately suppressed. Today’s generation knows all the risks, which is why University of Texas research published earlier this week is surprising: young adults are starting to smoke and use e-cigarettes in numbers more than triple the rate of adolescents. +

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AUGUSTAMEDICALEXAMiNER

THE EXAMiNERS

JULY 13, 2018

by Dan Pearson

Have you ever heard the advice “never take Tell me you a sleeping pill and a did not do that! laxative the same night”?

Oh no. What happened?

I wish I could.

The Mystery Word for this issue: GYRRUSE

Gross!

I slept like a baby.

EXAMINER CROSSWORD

PUZZLE

ACROSS 1. Third son of Adam & Eve 5. White of the eye 11. Or’s partner 14. Hip bones 15. Voyeur 16. No in Glasgow 17. Republic in W Africa 19. Bush Field abbrev. 20. Avengers’ fictional spy 21. VP under George (the first) 22. Prefix with day and week 23. Pelvic exercise 26. Not absolute; proportional 28. Variety of sour cherry 31. City in NW France 32. Nickname for The Jungle Book’s author? 33. Abnormal growth; tumor 37. Word that sounds like a letter of the alphabet 38. Vacuum tube with four electrodes 39. “Star Wars” defense ltrs. 42. Feminine hormone 43. Canoe propulsion system 44. Hope in soccer 47. Large vessel conducting blood into heart 49. Flood 53. Memento 54. NC QB (in brief) 55. Place for extra care (abbrev) 56. Coffin stand 58. Soviet secret police 59. Street child (derogatory) 64. Meadow 65. Latin for “as a whole” 66. Month of Jewish calendar 67. It’s human to do this 68. Formosa’s current name 69. Jungfrau range

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!

VISIT WWW.AUGUSTARX.COM 1

Click on “READER CONTESTS”

QUOTATIONPUZZLE

S T A Y

S O H W

E N B E L Y W T H E I ’ T A E S R W N I E R H H L I H R U G A D G

DOWN 1. Bro’s sib 2. He beat Tom in two Super Bowls (XLII and XLVI) 3. Breaker intro 4. Medical District main street 5. Foretell (Scottish) 6. Another word for phone 7. The 1960 Pulitzer Prize winner 8. Lyric poem written in couplets 9. Kidney-related 10. Philips ________ (in Atlanta) 11. Deficiency in red blood cells 12. Indigenous 13. Make less sensitive (or noisy) 18. Gives in 23. New Zealand parrot 24. Islamic chieftain 25. Stare with open mouth 26. Reprimand 27. Global Atl-based TV station

O N C I E G R W N

29. English court of yore 30. Hobbit series (in brief) 34. Private theater box 35. Capital of Yemen 36. Governing bodies 39. Saturate; immerse 40. Jay’s former competitor 41. Its residents speak Persian 42. Long period of time 44. Cell prefix 45. Roman military catapult 46. Lower back (adj.) 48. Iris and pupil cover 50. Finger or toe 51. “Baby Brave” left fielder 52. All (in music; Italian) 56. Carotene prefix 57. 11-D preventer 60. Type of truck 61. Sick 62. Young dog 63. “The Big Easy” of the PGA

Solution p. 14

— Duke Snider

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.

E X A M I N E R

3 7

8 3

1 6 4

2 9

1 4 1

6 5

4 8

S 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 keypad letters to convert numbers into words suggested by the definitions provided. Sample: 742 (body part) = RIB. Solution on page 14. 1. 674 (diagnostic procedure) ___

6. 297277 (medical procedure) ______

2. 327 (body part) ___

7. 277 (medical procedure) ___

3. 6673 (body part) ____

8. 3323 (sensory condition) ____

4. 4247 (body part) ____

9. 68279 (body part) _____

5. 7546 (body part) ____

10. 527969 (body part) ______

TEXT

THE MYSTERY WORD

JULY 13, 2018

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AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE

The

Advice Doctor

Joe: What did she say? Moe: She said I don’t even have a psychiatrist.

ha... ha...

Moe: How was your doctor appointment? Joe: I was diagnosed with very low blood pressure. Moe: Did they give you a prescription? Joe: Yeah, and a pretty expensive one too: I have to get two Ikea self-assembly bookcases.

world famous professor of journalism who was also an award-winning journalist visited Augusta and happened to meet the publisher of the Medical Examiner. “Would you like to know my opinion of your little newspaper?” asked the journalist. “Absolutely,” said the publisher. “It’s worthless,” said the journalist. “I know,” said the publisher, “but tell me anyway.”

Moe: I just read a study that says lice are becoming resistant to the drugs that once effectively treated them. Joe: I bet that has researchers scratching their heads. A group of Boy Scouts were on a hike when one of the boys spotted a snake. Pointing it out to the scout leader he asked, “Is that snake poisonous?” “No it isn’t,” said the scout leader. The boy picked up the snake, which promptly bit him. The boy started to jerk and spasm and foam at the mouth, and as the other scouts looked on in horror he fell to the ground. “However,” said the scout leader, looking down at the boy, “it is venomous. Poison is ingested or absorbed; venom is injected. Get it right next time, son.”

Moe: I just killed a huge spider crawling along the floor with my shoe. Joe: Good job. Moe: I don’t care how big a spider is, no one is going to steal one of my shoes. Moe: Did you hear some of my friends and I started a band? Joe: No, what’s it called? Moe: We call ourselves Duvet. Joe: What do you play? Moe: We’re a cover band.

A man in an interrogation room with the suspect and an investigator says, “I’m not saying a word without my lawyer present!” “But you are the lawyer,” says the detective. “Right!” says the man. “So where’s my present?” +

Moe: I told my psychiatrist I’ve been hearing voices in my head and seeing imaginary people.

Why subscribe to the MEDICAL EXAMINER? What do you mean? Staring at my phone all day has had no affect on ME!

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

Dear Advice Doctor, I recently told one of my coworkers something personal — and made it very clear that this was definitely not for public consumption — only to have it all over the three floors of the hospital within 24 hours. I practically need to quit, it’s so embarrassing, but I can’t afford that. What should I do? — Red-Faced

Dear Red-Faced, It’s rare to hear about this subject these days, but unfortunately that doesn’t mean the problem has gone away (as you are painfully aware). Only the name has changed. Yes, consumption — known today as tuberculosis (TB) — is still a massive threat to public health all over the world. The World Health Organization (WHO) says about one-third of the world’s population is currently infected with TB, although most cases (up to 95 percent) are latent and asymptomatic. While the current name for this disease is more medically accurate, consumption was more descriptive of the condition of patients: it appeared to literally consume its victims. Weight loss progressed until people looked skeletal; they became too weak to work, and soon too feeble to leave their sickbeds. Strong men who loved to work would become breathless upon taking a few short steps; fever would alternate with chills; appetite disappeared. It has been said that tuberculosis — aka consumption — has killed more people than any disease in human history. Frank Ryan, author of the tuberculosis history The Forgotten Plague, puts worldwide TB deaths at some 700 million in the 19th century and 300 million during the 20th century. Robert Koch, who received the 1905 Nobel Prize for his discovery of the bacillus that causes tuberculosis, stated that the disease was responsible for the deaths of one out of every seven people who had ever lived. And it isn’t going away, either. In 2012, WHO estimated that some 8.6 million chronic cases were active, and infectious disease experts say it is the second-leading killer among infectious diseases worldwide, after HIV/AIDS. As of 2010, tuberculosis is still killing almost one and a half million people every year. Transmission takes place via the uncovered coughs and sneezes of those infected. Effective treatment is accomplished through long-term administration of antibiotics, although antibiotic resistance is a growing problem. + Do you have a question for The Advice Doctor about life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will only be provided in the Examiner.

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ADDICTION… from page 8 gamers spend playing video games, the more they argue with their teachers and have lower grades than those who play video games less often. Although there have been studies suggesting video games enhance a child’s concentration (such as a 2012 paper published in Psychology of Popular Media Culture), others say games can both hurt and help children’s attention issues — improving the ability to concentrate in short bursts but damaging long-term concentration. In Annals of General Psychiatry, Dr Philip A. Chan and Professor Terry Rabinowitz wrote “Adolescents who play more than one hour of console or Internet video games may have more — or more intense — symptoms of ADHD or inattention than those who do not.” Video games can also have a negative effect on the physical health of the gamer, including such things as obesity, postural, muscular and skeletal disorders such as tendonitis, nerve compression, and carpal tunnel syndrome. Then there are the psychological problems of game addiction. While not every child will experience this, those who do most often see an increase in depression and anxiety levels. Addicted kids often exhibit social phobias and will see their school performance suffer. As with most things, video games in moderation are not usually harmful. They can be great tools for learning or for just spending a few hours with friends. +

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Video violence: rhetoric versus data As mentioned in the preface to this topic on page 8, the Medical Examiner has long been critical of the obsession people have with their screens. People, please! It certainly looks like addiction in countless ways, but the recent WHO decision to make it official has not been met with anything close to broad acceptance in the public health community. More than two dozen scholars from such diverse groups around the world as the UK’s Oxford University, UNICEF, Johns Hopkins’ Bloomberg School of Public Health and the American Psychological Association jointly protested the classification of gaming as an addiction, arguing that the scientific foundation for such a conclusion is weak at best. Of course, screen addiction is just one half of the screen-time debate. Violence is the other. One study conducted by researchers from Rutgers and Villanova Universities concluded that linking violent video games to real world violent crime is analogous to linking violent crime to wearing socks. After all, mass killers at Sandy Hook, Columbine, Aurora, Parkland and elsewhere all wore socks while perpetrating their atrocities. That may sound like trivializing a very serious social issue, but the researchers carefully compared national crime data from the FBI with sales of three of the most violent video games (Grand Theft Auto: San Andreas; Grand Theft Auto IV; and Call of Duty: Black Ops), all of which have been implicated as contributing to mass casualty attacks (among them: the 2011 Norway shooting; the 2013 Washington Navy Yard attack; Sandy Hook Elementary, and others). They utilized a number of complex tracking methods

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over long periods of time and found no long-term or shortterm correlation between on-screen violence and real world crime. In fact, just one violent first-person shooter game, Call of Duty: Black Ops, racked up $1 billion in sales within days of its release. It would logically follow, say game critics, that real world violence would follow. In reality, both homicide and aggravated assault rates actually fell over the year following the game’s release. Overall, violent crimes have been steadily dropping during the very same time decades-long period in which video games have come to the fore as mass entertainment. Violent video games make a very convenient target* when something terrible happens (in other words, all the time), but in truth the triggers for various tragedies are usually complex and difficult to easily identify. Everyone from parents to news pundits and public health researchers should be careful to avoid stating as fact what is merely an opinion. Does that mean excessive screen time is exonerated as a societal ill? Not in this newspaper it doesn’t. Even if violent video games are not addictive and have never caused a single violent real world crime, most of us would benefit from a major reduction in screen time and a corresponding increase in savoring the spectacular 3D world around us. + * Following the Virginia Tech shootings, the gunman was noted in news reports to be a fan of the shooter game Counterstrike. The Virgina Tech Review Panel found no evidence that he ever owned or even played the game. Similarly, the Sandy Hook gunman was widely reported as being a regular player of Call of Duty, but investigators found he spent most of his video time playing DanceDance Revolution and Super Mario Brothers.

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IT’S A QUESTION OF CARE What should I do if I notice my loved one is having memory problems?

This can be a very difficult topic to address, because usually the person who is experiencing memory problems or confusion is either completely unaware of the problem, or is working hard to cover it up and compensate – particularly, when it’s fi rst beginning. You can be helpful in these ways: • Checking behind him or her. This means looking at the mail and the bills when you visit to ensure that you don’t notice anything unopened that looks important. You might also ask if you can see a bank statement to look at the state of your loved one’s bank account. If you have online access to the bank or credit cards, you might watch activity to be sure it’s in line with how your loved one has historically spent in the past. You can also look at their medication bottles, making sure they’ve been refi lled and that they are taking their medications correctly. • You can go with your loved one to the doctor, or if he or she is reluctant to let you join them, you can alert the doctor in advance that you think there may be problems. You can

JULY 13, 2018

ask the doctor to do a dementia screening test by using one of the typical tests: the MMSE, the MOCA or the SLUMS. These are all reliable screening tools for dementia and help to give a baseline for tracking any decline. • You can offer direct support or help to your loved one in the form of assisting with bills, making lists and helping to keep them organized, driving them to appointments (if you think that is a problem), and helping to set up systems with a calendar. You might even put a tracking system on his or her cell phone if you’re afraid they might get lost when they are driving. You can put a tracking tool on their key ring or in their car as well. • Ask others to watch for you. You might ask neighbors, friends or church members to let you know if they see areas of concern and then you can compare notes and figure out what needs to be addressed most diligently. + by Amy Hane, a licensed Master Social Worker in South Carolina and Georgia, an Advanced Professional Aging Life Care Manager and also a Certified Advanced Social Work Case Manager.

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If you would like your medical practice listed in the Professional Directory, call the Medical Examiner at 706.860.5455