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HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS • HEALTH • MEDICINE • WELLNESS

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JUNE 4, 2021

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who already had a medical or health condition before contracting COVID-19: They are elderly, ugusta’s Dr. Jeremy Hertza was reviewhave vascular or heart problems, are diabetic ing his daily patients at a morning or obese, have kidney or liver disease, suffer staff meeting when the talk turned to from asthma or other pulmonary conditions, COVID-19. That’s not so unusual— are immunocompromised, or have lung issues but what was surprising was when a or are long-time smokers. staff member mentioned their own problems   Brain scans of COVID patients are also unfocusing at work, weeks after recovering from covering small, but significant, signs of changthe disease. es. Hertza points to one international study   It’s been widely reported that patients that highlighted a 27-year-old COVID patient who’ve had COVID-19 can experience lingering whose scans found signs of a mini stroke that symptoms and deficits. Many of those patients was ultimately tied to his lingering symptoms. do nothing about them, believing that, as they   With other reports circulating about sympdid with COVID, they will recover eventually. toms such as loss of taste or smell that still  However, that’s not necessarily the case, have not returned, the big question is what said Hertza, who is a neuropsychologist and patient and families should do if they think director of NeuroBehavioral Associates in they’re having lasting problems post-COVID. Augusta and a staff neuropsychologist at East “My concern,” said Hertza, who has treated Georgia Regional Hospital. He also provides hundreds of post-COVID patients to date, “is comprehensive mental health services for inpathat patients will think, ‘Oh, I’m just having a tients at Augusta’s Doctors Hospital and Select post-COVID problem, it’ll probably go away.’ Specialty Hospital, as well as for a hospital in Then five years from now, we find out we had Miami through Inpatient Psych Solutions. a year to intervene and to make it better.”   “When you look at post-COVID syndrome,   He points to other neurological conditions the most common symptom is fatigue, then such as stroke and traumatic brain injury, Do you have it post-COVID? Get help now, not later. muscle aches, then dysexecutive syndrome, where—with treatment such as physical, ocwhich is the feeling that you can’t keep your cupational or speech therapy—the most rapid by Danielle Wong Moores thoughts organized,” he said. “It’s brain fog— recovery happens within the first few months you can’t quite focus, the words don’t come after an injury. as easily, your thoughts aren’t as organized, your attention wanders.”  “The best thing if someone is having problems is to get some type of treat  Research is discovering that this type of central nervous system issue can ment now, because for all we know, there is a critical window,” said Hertza. happen in as many as 53% of post-COVID patients, with symptoms lasting “As with many other medical conditions, the sooner you intervene, likely the at least six months. But that number is just a shot in the dark. Experts worbetter the outcome.” + ry that it’s possible patients could continue to have problems further down the road, since COVID is still such a new disease. “It’s really not been long EXPERIENCING POST-COVID SYMPTOMS? enough to know long-term outcomes,” said Hertza. • Talk to your doctor   Researchers are, however, taking a look at other neurological disorders to • Consider a referral to a neuropsychologist help provide clues as to how these COVID symptoms might manifest. One • Consider referrals to physical, occupational or speech such condition is concussion. Most patients who get a concussion recover therapy without any problems, but a small percentage, 10% or less, go on to have • Make lifestyle changes, such as exercise, a healthier what Hertza describes as “truly lifelong lasting” problems. “We suspect, aldiet, and quitting smoking to ensure your body is getting though we don’t know for sure, that it’s similar with COVID,” he said. enough oxygen and the right nutrients +   Research is also finding that post-COVID syndrome tends to affect people

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JUNE 4, 2021

THE FIRST 40 YEARS ARE ALWAYS THE HARDEST

SLEEPY PARENTHOOD KIDS by David W. Proefrock, PhD

  Aggressive behavior in children must be addressed, and addressed in the right way, or it will continue and get even worse. Taking responsibility and apologizing may have to be repeated, but in time it will work. Punishing aggression with more aggression is never the right answer. + Dr. Proefrock is a retired clinical and forensic child psychologist.

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by Warren Umansky, Ph.D.   In Part 1 of this series, we explored how much sleep your child probably needs. In Part 2, we talked about the importance of setting up a routine that begins with a fixed bedtime and works backward to include homework, dinner, and playtime. After two weeks of following this plan, your child should be going to sleep at a time that allows her to wake up easily and in a good mood. Not happening quite that well? Let’s look at where things might be going wrong.

cause he is so active in bed. Solution: Put a blanket and pillow on the floor next to your bed. “You can sleep on the floor or go back to your bed.” Those are the only two options. You want to start this on a night when you don’t have to get up early the next day. After a few nights, he is likely to stay in his own bed. On a weekend morning, enjoy having everyone in bed together for good snuggling!

  “What do I do about late sports practices/ games or when dad doesn’t bring her back early enough after his visitation?” Relative to visits with dad, you can let him know what   “My child won’t stay in bed.” Children time she needs to go to sleep in order to wake often come out of their room up well and have a good day because they want to know you in school. But you don’t have still are there. (They are likely control of this. Get her into bed Answers to say they need to go to the as soon as you can when she bathroom or they are thirsty or gets home. As for healthy afto your they need a hug. Take care of ter-school activities, you want all these things before they get your children to participate. questions into bed.) Here are some opAgain, do the best you can to tions that work: Lay down with get her in bed as soon as posyour child for a few minutes. sible after getting home. You At the end of that time, say might have to do homework in that you will be back to check on her and she the car and eat along the way, but take solace needs to stay in bed. Say, “I love you,” give knowing that the benefits of participation are her a kiss, and leave the room. Return in 30 worth the stress you feel rushing around. seconds and say quietly, “I love you.” Go back again in a minute, then two minutes, then   “My kids don’t want to put down their 3½ minutes, and continue to space out time. phones and tablets to get ready for bed.” Your child should be asleep after several visits They probably also don’t want to go outdoors to the room. If she comes out looking for you to play during the day either, right? The bigger between your visits, tell her that she needs question is, “Who’s in charge?!” Electronics to stay in bed or you will close the door. She should be a privilege earned by respectful and won’t like the door closed, but if she comes responsible behavior, getting school work finout again and you close the door, you will ished, and getting fresh air and exercise. Most go back in 30 seconds and say, “I’ll leave the elementary school-age children have no need door open if you stay in bed. I’ll be back to for a phone. Other electronics should not be check on you.” Be consistent and it will work. a reason for a teen to stay in her room when Within three nights, she will be settling in and she is home, or to keep a family from eating going to sleep easily. dinner together. All electronics for all children should be shut down 30 minutes before   “My child goes to sleep in his own bed bedtime. You set the rules. If you have to shut but winds up in my bed in the middle of the down wifi, do it for a few nights. (You might night.” Some parents wake up and find their have to do without gaming for a few nights, child in bed with them. No problem here, as but the welfare of the kids comes first.) If you long as he went to sleep in his own bed. It is a train your children at young ages, this should problem when your child is an active sleeper, be less of a problem when they get older. which most middle-of-the-night visitors are. He keeps you awake through the night be-

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If you answered:   A. Physical punishment is never the correct response for aggression. It teaches the wrong thing: that aggression is okay when you are the biggest and strongest.   B. Talks with 6 year-olds are okay to have, but they don’t work. They don’t hurt anything, but they don’t help either.   C. This is what is best. It is important that she takes responsibility and apologizes.   D. Brothers and sisters may be mean to each other, but that doesn’t mean aggressive behavior should be tolerated. There should be consequences.

PART 3

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  Your 6 year-old daughter has been treating her 4 year-old brother very badly. She talks mean to him and pushes or hits him when they argue, which is becoming more frequent. They used to get along well and she was even protective of him. What do you do?   A. Don’t let this kind of behavior get started. Give her a swat or punish her severely when you catch her being mean.   B. Have a talk with her and ask her to start treating her brother better.   C. Correct her firmly when she is mean to him. Make her apologize and tell him that she won’t hit or push him anymore.   D. This is just a phase she is going through. All children are mean to their younger brothers and sisters. Don’t worry about it.

Please see SLEEPY KIDS page 10


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Is it a HIPAA violation to be asked if I’ve been vaccinated?   To correctly answer this question we should start at the beginning: what is HIPAA? The acronym stands for the federal Health Insurance Portability and Accountability Act of 1996, a law designed to protect patient health information from being disclosed without the patient’s consent or knowledge.   It is widely misunderstood. For example, you’re as likely to see it written HIPPA as HIPAA, and good luck getting random healthcare professionals to accurately tell you what it stands for.   The key to answering our title question is understanding what HIPPA is and what it isn’t. It’s usually A-okay for your doctor or your doctor’s nurse to have a chat with your pharmacist about the specifics of your prescription, but it isn’t okay for them to be chatting about your medical history or records with someone at a cocktail party. Your medical records are private and confidential and HIPAA decrees they cannot be disclosed to anyone without your knowledge and consent.   But HIPAA is not supposed to be an impenetrable firewall that blocks the flow of necessary information to people who need it to effectively treat you, or to protect themselves in communicable situations. Nor does the law have any jurisdiction in non-medical situations. It is perfectly legal for a business to ask its patrons if they have been vaccinated. The US Equal Employment Opportunity Commission (EEOC) has ruled that employers have the right to ask their employees if they have been vaccinated and require the question be answered. (Although if your employer called your doctor for that information, disclosure would be prohibited by HIPAA.)   To take a very literal interpretation of HIPAA within the context of the title question would give rise to this scenario:   Your doctor: “So what brings you in today?”   You: “I’m sorry, but HIPAA prevents me from answering that question.”   So of course it’s okay to be asked. It is not a HIPAA violation. If the question bothers you, you are under no obligation to answer it. It could result in a store or employer telling you your presence isn’t welcome, however. +

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#140 IN A SERIES

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

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tool gazing, for lack of a better term, probably goes as far back as star gazing, but it took this notable physician, Dr. Kenneth Heaton, to introduce it to everyone on both sides of the stethoscope in more meaningful ways.   Examination of the stool for purposes of medical diagnostics officially dates back to at least Hippocrates (see this space in our previous issue for a brief bio). Analyzing stool samples has come a long way since the 5th century BCE, but in some respects it probably hasn’t changed all that dramatically. When there seems to be some kind of problem we (and our doctors) want to know about frequency, consistency, color and smell. At least that’s true some of the time.   As one gastrointestinal specialist wrote, “The colon is still the dark continent of physiology. The mystery of defaecation [these British doctors and their spelling!] is not a topic that has attracted a lot of research despite the considerable distress that it can cause.”   This is where the genius of the late Dr. Heaton came in (he died of pneumonia in 2013 at age 77). He developed the Bristol Stool Chart you see here, a widely used stool tool for doctors and patients alike. It’s known as the Bristol chart for two reasons. First, he was on faculty at the UK’s University of Bristol at the time it was first published in medical journals (1997); and secondly, no one wants a poop chart, of all things, named in their honor.   The Bristol Chart (or Bristol Scale) has been criticized for its overly generalized and imprecise nature, but it was never intended to be a diagnostic tool. Instead, if offered a simple and non-embarrassing means for patients to communicate with their doctors. The Bristol Chart often eliminated, if you will, the need to bring in a stool sample. (Do you use Tupperware? Zip-loc bags? What?) It allowed patients to simply say, “Uh, maybe number 3?” instead of having to use a thesaurus to describe their bathroom extrusions. (The Bristol Chart uses words and phrases like “fluffy,” “lumpy,” “mushy,” and “sausage-shaped.”) Most of us would rather just point to a chart and let it handle the descriptions. Or the doctor can point and say, “Like this?” From that point, the doctor can get more detailed information from the patient or the lab and be well on the way to providing relief.   As the children’s book title puts it, “Everybody Poops.” And thanks to Dr. Kenneth Heaton, everybody can easily communicate about it with their doctor. And if you really like the chart, it’s available on coffee cups. Google it. +

  Lately, Ive been delighted to see photos posted online by friends of their travels across the country. Seeing the vistas they have explored allows me to imagine going there myself, knowing that any photo is never able to capture the entire reality.   Years ago my mom wanted to get my dad to agree to go on a trip with her. For years he had argued against a trip. When she suggested Hawaii, he replied that he’d seen Hawaii on TV, so a trip wouldn’t show him anything he hadn’t already seen. Besides, he liked his own bed and her cooking, so a trip would be uncomfortable. And he didn’t know if his sore knees could handle sightseeing.   So for a long time they stayed at home in their same old-same old routines.   For years they lived small lives, going to the store, the mailbox at the post office, church, the senior center, and he went fishing daily in Lake St Helen in Michigan. They were mostly contented, and mom was able to curb her wish to travel, until one day when she finally had had enough of that small life.   She woke up at five am, packed their suitcases, drank her coffee, and read her newspaper. At 9 am she woke him up. “George,” she said, “at 10 o’clock I’m going to get in the car and I’m going to see the fall tree colors in New England. If you want to come, be in the car, because I am going, regardless of whether you come or not.”   At 10 am he was in the car.   The trip was a wonderful adventure they talked about for the rest of their lives. The colors were brilliant. The towns were different from their Midwest locations in Michigan. Because it was peak tourist time, and because they hadn’t made reservations, finding a place to sleep at night was challenging and led to one night when their only choice was to sleep in their car in the town’s police department parking lot, but

that too was an adventure that allowed them to marvel at how hospitable the policemen were to them.   They talked about the restaurants they ate at and the seafood they enjoyed, and the hills and mountains so vastly different than their flatlander experiences. They added enormously to their awareness of how different some areas of the country are, not from seeing pictures, but from smelling the Atlantic Ocean’s mists, waking up in different locations, and seeing the picket fences and cows in pastures on the sides of hills. Amazingly, it was the first time they had ever been out of Michigan.   Even though an ice cream cone in Vermont tasted just as good as one in Michigan, something about that trip stretched their awareness and expanded their understanding. They had never seen homes without front yards before, where only a sidewalk separated homes from the street. They had never seen rowhouses, or other amenities of living, like courthouse squares. This is not to say their lives lacked variety entirely, because they did explore Michigan. They did go to Greenfield Village and the Henry Ford Museum. They did drive over the magnificent Mackinaw Bridge. They did drive to the Blue Water Bridge and look across the river to Canada, but they didn’t drive over the bridge to experience the novelty of road signs in both English and French. They did vacation at Tawas Bay and Crystal Lake, but they never took the ferry to Mackinaw Island.   It was a good life lived in familiar settings, with familiar foods, and they both said nothing else ever felt as good as sleeping in their own beds.   My life has taken me on more adventures, but what I learned was that it’s possible to eat grits for the first time, to eat fried catfish instead of perch caught on the Great Lakes, and to celebrate differences as well as similarities. I wonder where my next adventure will take me? +

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AUGUSTAMEDICALEXAMiNER

ADVENTURES IN

Middle Age BY J.B. COLLUM

still in my thirties. My late grandmother had given my wife and me her store discount card for when we picked up groceries for her. One Wednesday, I went to the store and used the card. I didn’t even remember then that it was hers and I had never gotten one of my own, so I was clueless. My bill was lower than

and slower reflexes. It is annoying sometimes when you are behind them, but at least they are being sensible. This was the case with my grandmother. She considered the minimum speed limit of 45 on the interstate highways to be akin to the Daytona 500. She avoided the interstates for this reason, to the benefit of all other drivers. Her twin sister Merle, however, drove like she was late for a fire wherever she went. Back when most folks didn’t use seatbelts (these were the things that were stuck under the seat and usually were sticky from spilled drinks and lost lollipops) and when child car seats were unheard of, we kids would slide around in the back seat at every turn. It was fun since we didn’t know that our very lives were imperiled. We just felt like we were on a ride at Six Flags or Disneyworld. It’s a wonder that she never had an accident. Well, that we know of. There is no telling how many she caused though as she careened through traffic and changed lanes with impunity. It was an “E ticket” ride for sure. What her insurance company didn’t know, turned out not to hurt them this time.   Well, I am all out of space for this issue. We can take this up again another day. I encourage you to find out what discounts you can get from being in our exclusive club. If you are a member of this club, you might as well take advantage of the perks. Goodness knows, we draw the short straw regarding so many other things, we might as well revel in the few breaks we get, while we still can. If you know of some senior perks or discounts, feel free to share them by emailing me at the email address listed below. +

THE

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  I will hit another milestone in my adventure into middle age this month. Let’s just say that it is divisible by five. (Did you guess that I’m 25? Try again.) Yes, the anniversary of my birth is upon me once again and it seems like the years are going faster on each trip around the sun. When I hit fifty, I was trying to look at the bright side. I saw the perks I could get by joining AARP, so I did. We took advantage of it for a while, but I usually forgot to ask for the discount or forgot to check to see where we could get the best deal. I guess being forgetful and essentially lazy conspired against me being able to take full advantage of the perks, so we didn’t renew.   The good news is that now that I am hitting another milestone, I will get a few more perks without even having to join a club and pay dues. For the most part, you get new discounts and perks at 50, 55, 60, 62, and 65. Think of it like a credit card and 65 is the Titanium level. It is an exclusive club we are in now. The waiting list is fifty years long. Once you are in, you can’t quit the club even if you want to. Much like membership in a motorcycle gang, the only way out is death.   The bulk of the discounts I’ve found are for restaurants. I guess we older folks like to eat. Of course, we have to be careful what we eat; everything has to be low salt, low sugar, less meat, less cholesterol, low fat, etc. It kind of takes away the appetite though, so we end up eating less. Once you reach 65, you are the A-List for restaurant discounts, but some are available at 50 with an AARP card or 55 without one. Some don’t list an age, so if you went gray like I started to in my thirties, you can get seniors drinks earlier than most. It offended me when I got senior coffees for my dad, and they didn’t even ask for an ID. But my cheapness won out and I kept my mouth shut.   Something similar happened at a grocery store when I was

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She drove like she was late for a fire everywhere she went

I expected and when I asked why, they said it was senior discount day. I was hurt. Once I got home and my wife explained that it was tied to the age of the person whose card it was, I felt a little better, but then I remembered that the cashier didn’t even question my age, and the hurt came back again. Darn my premature gray hair!   Now that I think about it, giving a discount to seniors on only one specific day per week is a great way to reduce the discounts the store must give. My retired friends rarely know what day of the week it is. They don’t need to for most things. I get calls from them in the middle of workdays all the time and I tell them I’m at work. They usually reply with something like, “isn’t this Saturday?” Maybe I’m being cynical, but I believe some pure capitalist thought went into these discounts.   Rental car agencies and auto insurance companies offer some pretty good discounts for seniors, and this makes perfect sense, up to a point. On average, seniors are much more likely to drive more safely than young folks, but as we age, we do lose a step, and this results in basically one of two outcomes.   The typical case is that seniors drive slower to account for their impaired vision, hearing,

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

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by Kim Beavers, MS, RDN, CDCES Registered Dietitian Nutritionist, Chef Coach, Author Follow Kim on Facebook: facebook.com/eatingwellwithkimb

GREEK POTATO AND ARTICHOKE SALAD   Steamed potatoes and green beans are tossed with marinated artichokes, red bell pepper, and capers to give a fresh twist to an old favorite Ingredients • 8 oz red potatoes cut into ½-inch cubes • 4 oz fresh green beans, trimmed, cut into ½-inch pieces • 1 jar (6 oz) marinated artichoke hearts, drained and coarsely chopped • ½ medium red bell pepper, finely chopped • 2 tablespoons finely chopped sweet onion • 2 tablespoons cider vinegar • 2 tablespoons capers • ¼ cup snipped fresh parsley • ¾ teaspoons dried oregano, crumbled (or 1½ teaspoons fresh) • ½ medium garlic clove, minced • ½ teaspoons Jane’s Krazy Mixed-Up Salt Instructions   Steam the potatoes and beans for 7 to 8 minutes, or until just tender. Drain in

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a colander and run under cold water to cool. Drain well. Meanwhile, in a medium bowl, stir together the remaining ingredients. Add the potatoes and beans. Toss gently. Let stand for 30 minutes to allow the flavors to blend.

Yield: 4 servings (serving size: ½ cup) Nutrient Breakdown: Calories 82, Fat 3.0g, (0g saturated, 1.5g monounsaturated), Cholesterol 0mg, Sodium 242mg, Carbohydrate 16g, Fiber 3g, Protein 2g Carbohydrate Choices: 1 carbohydrate, ½ fat +

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ASK DR. KARP

NO NONSENSE

NUTRITION Helen from Wrens, Georgia, asks: “Dr. Karp, I am a lifestyles coach. A client trying to lose weight asked me if pre-prepared diet meal plans delivered to your home are effective for weight loss. Are they?”   There has been an explosion in the number and variety of home-delivered meal plans these days due to the pandemic. Some of the

programs are simply for very busy people who do not have the time, interest or ability to shop or cook. Other programs, constantly advertised on TV, are weight-loss meal plans that promise the pounds will come off if you simply eat their food. Who hasn’t been bombarded by TV commercials, usually with celebrities and clients giving their testimonials about how much weight they have lost on this or that meal plan? Besides meals, the plans almost always contain snack items like shakes, cookies, desserts and herbal and food supplements. Many of the popular weight loss plans also try to incorporate the latest dietary fads. You can buy programs which follow keto, low carb, and paleo diets, to mention just a few.   Can you lose weight on these meal plans? Absolutely. As long as you eat their specially-prepared meals and nothing else, you will lose weight. Why is this? It is not a mystery. If you eat fewer calories than you need to live, you will lose weight. This will happen on any diet, whether it is heathy or not. For example, if you only eat one Big Mac or a Whopper with fries each day and nothing else, you will lose weight. That’s because these burgers and fries contain only about 1000 calories; if you are using 1600-1800 calories a day, which

Factory food? Is that really what you want to eat? most people do…bingo!...you lose weight.   What you really need to do is lose weight while eating healthy food. The gold standard for determining whether the food is healthy is recommendations from nutrition scientists, not testimonials from clients or the health claims of the company selling products.   There are pretty significant problems when enrolling in any type of weight loss meal program. Let’s look at a few of the more important issues.   1) Having someone else pre-prepare meals doesn’t teach you anything about living a healthy life and preparing foods on your own. Eventually, you are going to have to stop the service for one reason or another. What are you left with

JUNE 4, 2021 when this happens? You are left with old food habits because you have learned zero about what foods to buy and how to prepare them. Enrolling in one of these diet meal programs is a very passive way of re-defining your diet. It is not an active method where learning takes place. What science concludes is that the more active you are in shopping and preparing food, the more successful you will be in reaching and maintaining your long-term weight and health goal.   2) How about the expense of these programs? Enrolling in these food plans is a very poor use of your food dollar. Having foods pre-prepared, pre-packaged and shipped, adds tremendously to the cost. By comparison, buying food and preparing it yourself in simple, healthy, and quick ways is relatively inexpensive.   3) There are usually no or very few studies showing that people eating these meals have been successful at long-term weight loss, or are healthier than others not eating the meals. If you check over the websites for most of the diet meal plans, they are filled with non-evidenced-based testimonials, not facts or data. When it comes to nutrition and diets, run, do not walk, away from

testimonial evidence.   4) Another problem with these weight loss meal plans is food boredom. Although it is true that these plans usually include a variety of foods, compared to what you can do on your own, the food selections are limited. Eventually, this will lead you to desire a wider range of meal choices and you ditch the plan.   So what’s the “No-Nonsense Nutrition” advice for today? Keeping a healthy weight and eating foods that encourage a preventive health lifestyle requires much more than simply eating pre-prepared meals delivered to your home. It requires education, learning and integrating healthy ways of shopping and cooking into your life. It requires you to be an active participant in your meal preparations. Buying pre-prepared foods is expensive, teaches you very little and is a very passive way of making someone else responsible for your weight loss.   You know what they say, “You only get out of life, what you put into it.” So make the effort and put the responsibility for your weight and health back where it belongs: squarely on your shoulders. +

Have a question about food, diet or nutrition? Post or private message your question on Facebook (www.Facebook.com/AskDrKarp) or email your question to askdrkarp@gmail.com If your question is chosen for a column, your name will be changed to ensure your privacy. Warren B. Karp, Ph.D., D.M.D., is Professor Emeritus at Augusta University. He has served as Director of the Nutrition Consult Service at the Dental College of Georgia and is past Vice Chair of the Columbia County Board of Health. You can find out more about Dr. Karp and the download site for the public domain eBook, Nutrition for Smarties, at www. wbkarp.com Dr. Karp obtains no funding for writing his columns, articles, or books, and has no financial or other interests in any food, book, nutrition product or company. His interest is only in providing freely available, evidenced-based, scientific nutrition knowledge and education. The information is for educational use only; it is not meant to be used to diagnose, manage or treat any patient or client. Although Dr. Karp is a Professor Emeritus at Augusta University, the views and opinions expressed here are his and his alone and do not reflect the views and opinions of Augusta University or anyone else.

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JUNE 4, 2021

THOSE PANDEMIC POUNDS

by Rachel Johanek MS, RD, CSO, LD Clinical Oncology Dietitian, Certified Specialist in Oncology Nutrition, Georgia Cancer Center   June 6 is Cancer Survican be tough sometimes, vors Day. As our medical particularly for a society that Sunday advancements grow, from loves bacon. But, what you different screenings that can can do is reduce. Brainstorm June 6 detect cancer earlier to the how you can find substituever-growing research and tions at meals. Maybe it is treatment advancements like adding more fish, chicken or immunotherapy, we continue vegetarian/vegan options. to see a growth in the numMaybe instead of grilling out ber of people who can call steaks, have chicken and lots themselves Survivors. of grilled vegetables. You   For so many, it’s a maradon’t have to make these thon to get there – the workchanges overnight, but start every dietitian knows it. up for a final diagnosis and to find ways to adjust your Shoot, we eat them too! But, the treatment – surgery, cheprotein intake for better research does show that the motherapy, radiation treathealth. more of these we eat, the ment, or a combination – and worse our health is. These  • Get Active! The last big the recovery from it all. But tip is finding ways to add foods often result in weight when they finish, it’s often a more activity into your day. gain, diabetes, heart disbit of a mystery…Now what? ease and even cancer. They It could be a walk, it could While your medical team can damage our cells – the very be dancing to a song in your advise you on how often you opposite of what vegetables living room, or it could be need to follow up for testing a full-on intense workout. do. So let’s keep these foods or screenings, there are other to a minimum and save them The more you move – even things that can be done. if it is in small blocks of time for the occasional treat, not   Nutrition is an area that all an everyday occurrence. like just 10 or 15 minutes – of us, whether cancer survithe better shape your whole  • Cut out the meat There vors or not, could improve. body will be. is significant research that However, as a cancer survi  So whether you’re a cancer shows processed meats, vor, our lifestyle changes can like bacon, sausage and survivor (congrats!) or you make a big impact in how want to prevent a cancer cold cuts, increase the risk well we recover and, hopediagnosis, use the tips listed of many cancers. Naturalfully, avoid a recurrence. The ly then, the research also above to improve your best news for everyone is that recommends avoiding these overall health. The healthier the tips recommended to can- as much as possible. There is you eat and feel, the better cer survivors are the same as also abundant research that and longer your post-cancer those for cancer prevention. survival will be. And maybe, shows we should limit red So let’s talk about how every- meat intake to no more than just maybe, you’ll feel better one, including survivors, can too! + 18 ounces per week. This make nutrition changes to improve their health.  • Eat healthfully! Fruits, vegetables, beans, and whole grains are your friends! All 2522 Wrightsboro Road 736-7230 are rich of antioxidants and TUE - FRI: 7:30 - 5:30; SATURDAY: 7:30 - NOON phytochemicals, which are things that help keep cells healthy. They are also full YOU CAN BELIEVE US WHEN WE SAY: of fiber, which keeps your digestive system healthy. So let’s eat them! We would love to see your plates at least two-thirds full of these foods. We know not every meal will, but aim for as many meals as you can to be full of colorful vegetables, delicious whole grains and beans and a little sweet treat on the side Daniel Field 76 Circle K DANIEL VILLAGE with fruit. former BARBER SHOP  • Reduce those Unhealthy Smile Gas Foods To say you’ll never eat all the foods we find Medical District WRIGHTSBORO ROAD Augusta Mall delicious – things like cakes, potato chips, sodas, pizza – would be unrealistic and

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CRASH

COURSE

More Americans have died on US roads since 2000 than in World Wars I & II combined

L

ing statistics. Another factor may be that fabled teenager sense of invincibility, and the evidence may best be shown in seat belt usage (or the lack thereof). Compared to other age groups, teens and young adults often have the lowest seat belt use rates in various studies. In 2019, surveys revealed that about 43% of U.S. high school students did not always wear a seat belt when riding in a car driven by someone else. (Adult seat belt compliance is usually in the 90% range.) Among teen drivers and passengers 16–19 years of age who died in car crashes in 2019, almost half were unrestrained at the time of the crash (when restraint use was known).   Another factor is distracted driving. It’s a bad idea for any driver, but especially for drivers with only weeks or months of lifetime driving experience. The 2019 national Youth Risk Behavior Survey revealed that, among U.S. high school students who drove, nearly 40% had texted or e-mailed while driving at least once during the 30 days before the survey.   Teens are more likely to speed than older drivers, and studies have shown teen drivers typically are more prone to tailgate. 2018 fatal accident statistics discovered that among drivers aged 15-20, 30% of male drivers and 18% of female drivers who were involved in fatal crashes were speeding. These were the highest percentages of any age group.   Of course, drinking alcohol is illegal for people less than 21 years of age, as is driving after drinking any amount of alcohol at any age. Even so, drinking and driving is semi-legendary among teenagers. In fact, 24% of drivers aged 15–20 who were killed in fatal motor vehicle crashes in 2018 had been drinking. Teen drivers have a much higher risk for being involved in a crash than older drivers at the same blood alcohol concentration (BAC), even at BAC levels below the legal limit for adults.   We’ll conclude Kids & Cars next issue with some additional safety factors for teen drivers (and their parents). +

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et’s wrap up our Kids & Cars series in this issue and the next one with a look at how to keep old kids — sometimes known as teenagers — safe and sound when it comes to driving.   Of course, when you’re old enough to start driving you don’t feel like you’re a kid anymore; you’re starting the transition into “young adult.”   But in the same way that the big dogs in elementary school (6th graders) turn into the babies of junior high, and then the seniors of junior high (8th graders) are the following year back at the bottom of the high school totem pole as freshmen, so it is with driving. You may be nearing the doorstep of young adulthood, but you’re a baby behind the wheel.   Something that is significant about most endeavors is that there is a massive difference between when things are running smoothly versus when something goes wrong.   Knowing how to drive around a deserted parking lot with dad on a Sunday morning, or sailing down a straight, lonely country road is completely different from driving in heavy traffic while someone is tailgating you; it’s completely different from skidding on wet pavement or knowing what to do when being blinded by the high beam headlights of an oncoming car. Over years of driving, certain reactions are learned and become automatic. New drivers have to think about their emergency reactions at moments when there is no time to think.   That is lesson #1 for teenage drivers: don’t be overconfident. Don’t drive beyond your skill level, and don’t overestimate your skill level.   The importance of safe driving for new, teen drivers is underscored by accident statistics. According to 2019 statistics, seven teenagers died every day in motor vehicle crashes in the U.S., some 2,400 over that entire year. Per mile driven, teen drivers aged 16–19 are nearly three times as likely as drivers aged 20 or older to be in a fatal crash, says the CDC.   Why are the rates so high? As mentioned, inexperience is the starting point for teen driv-

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SLEEPY KIDS… from page 2

  “Is it okay to use melatonin to help my child fall asleep?” Melatonin is a hormone produced by the pineal gland in our brain which prepares us to fall asleep in the evening. It is available at most pharmacies as a sleep aid without a prescription in the United States. Melatonin also plays a role controlling body temperature, stress response, blood pressure, and immune response. So it should not be used casually. It has been beneficial to children with known sleep problems who have ADHD, autism, and some other neurological problems. But behavioral approaches like those described in this series of articles should be tried before resorting to medication and you always should talk with your physician before trying melatonin or any supplement.   “Can I be more lenient about bed time on weekends or during the summer?” You can be more lenient during these times depending on the weekend and summer schedule. If your child has to wake up early on the weekend for synagogue, temple or church, earlier bedtime is needed. If your child has a job or is attending camp or summer school during the summer, stick with the earlier bedtime based on the same guidelines described previously: easy time getting up in the morning equals maintaining the current bedtime; hard time getting up spells earlier bedtime.   Family, education, spirituality, good nutrition, exercise, good role models — and sleep — all are part of the formula of success for children. It’s your job to make sure all of these are in place. Find your inner strength or seek the help of family, friends, and professionals. It is worth it for your children. Dr. Proefrock’s excellent column on page 2 and other articles in this publication can also offer you guidance to be the very best parent/caregiver you want to and can be.   We would love to respond to your questions and comments about this 3-part series. Feel free to email Medical Examiner at the address on page 3. Put “Sleep” in the subject line. You will get a response by email. + Dr. Umansky has a behavioral health practice for children and adolescents in Augusta.

MYMOSTMEMORABLEPATIENT Ladies and gentlemen, we want to hear your stories. And we know you have them. But how can you tell them without violating HIPAA? It’s not difficult. A: Get the patient’s permission, or B: Change and/or disguise enough details to ensure anonymity and protect patient privacy There are many doctors who regularly blog about their patients and even write best-selling books about them. Names like Oliver Sacks and Atul Gawande spring to mind. Friends, this is eminently doable. We’d like this to be an occasional (or even better, a regular) feature in the Examiner. We’ll be happy to run your story anonymously and vigorously guard your privacy, or give you a byline (or use your pen name). Our mail and email addresses are on page 3 of every issue.

THANK YOU IN ADVANCE!


JUNE 4, 2021

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AUGUSTAMEDICALEXAMiNER

The blog spot From the Bookshelf — posted by Suneel Dhand, MD, on May 25, 2021 (edited for space)

3 REASONS WHY PATIENTS ARE UNHAPPY   When I’m working in the hospital, I always find it interesting talking to patients about their medical history and experiences with outpatient physicians. The state of our primary care system is reflected in the comments I receive from patients. Despite the best efforts of an amazingly dedicated number of doctors, it’s often an impossible job in today’s health care system. Interestingly, I rarely hear patients complain to me about costs or that a certain test or procedure may not be covered by insurance. It’s always about their experiences with the health care system on a human level.   Here are the top 3 reasons I hear for why people are unhappy:

It’s rarely about cost

1. My appointments are either impossible to get or too rushed. Faced with enormous demand on outpatient clinics and ever-increasing bureaucratic requirements, doctors everywhere are finding it extremely difficult to spend adequate time with patients. Sadly, this becomes an even bigger problem when dealing with aging and more medically complex patients. There’s no easy answer if there’s simply not enough supply of doctors or incentives for graduates to go into said specialty. But the doctors that are left to see patients have to find a way to make the most out of the time available. We always need to utilize good communication skills such as ensuring adequate eye contact (assuming in-person visits, which patients overwhelmingly prefer post-COVID) and empathetic active listening techniques. No staring at the screen when we should be looking at our patient! 2. I keep seeing a different clinician. This is one of the saddest things I keep hearing, especially from patients with a long list of medical problems. They are “officially” assigned to one doctor, but each visit will see a different doctor, nurse practitioner, or physician assistant. They desperately need one go-to clinician to be the captain of the ship. But resources are scarce, and this isn’t possible. Hence what I call a merry-go-round of new doctor encounters with the same patient. This is very easy for me to spot on the electronic medical record and is suboptimal to good clinical care. 3. My doctor doesn’t seem to care, and the office rarely returns my calls. Whenever I hear this, it always hits me hard. To be clear, it’s a very small number of people who say something like this—but it’s one of the worst things any patient can think. Of course, I don’t know the backgrounds, but I do see people who seem like very reasonable folks give this feedback. If that truly is what any patient thinks, I only have one piece of advice for them: Find another doctor ASAP! In fact, I often go further than that, and even I hand them contact information for other doctors in the area. Your health is simply too important for you to feel like your doctor is not on your side.   I believe that all the problems we face within our health care system are all right there beneath the surface. They are a simmering volcano waiting to erupt as soon as we come out of the pandemic. There is a shortage of physicians, a lack of focus on primary care and prevention, mind-numbing bureaucracy, and the pain of dealing with 3rd parties.   The nation’s overall health continues to decline while the costs of the system continue to escalate. It doesn’t take an Einstein to work out that those two things are incompatible, and the system will reach a complete breaking point in the not too distant future. + Suneel Dhand is an internal medicine physician

  There is a lot of middleclass suburbia in the Augusta area. But there are also entire neighborhoods in the Garden City where the houses look like sharecropper shacks from some tiny poverty-stricken town in the 1930s.   In other words, in some ways we aren’t too far removed from Brick City, the nickname for Newark, New Jersey, a city we might automatically (and perhaps unfairly) associate with rust belt inner city poverty and crime. If you grew up there and care about yourself and your family and your future, you want to better yourself. In short, you want to get out.   That’s what’s kind of amazing about the journey of Dr. Sampson Davis, the author of Living and Dying in Brick City.   It’s not much of a journey: he was born and raised in Newark, then grew up to live and work there.   On the other hand, it’s an incredible journey: he was born and raised in Newark, was arrested for armed robbery as a teenager there; saw his sister become a drug

addict there and subsequently die of AIDS there; saw his alcoholic older brother become paralyzed as the result of injuries in a bar fight there; and then after all that, he grew up to live and work in that very city.   And not just at any job, either. As you’ve probably already noted, he’s a physician. This book is his chronicle of working in the ER at Newark’s Beth Israel Medical Center, often treating patients he grew up with.   Variously described as “riveting,” “informative,” “heartfelt,” “dramatic,” and “powerful,” Living and

Dying in Brick City looks at medicine through both micro and macro lenses. He tells tales of treating gunshot wounds in patients he has known since childhood, and also takes a big picture approach and makes some pointed observations about the overall state of healthcare delivery in the United States.   Along the way, topics like gang and gun violence, drug dependence, domestic abuse, sexually transmitted diseases, mental illness, unwanted pregnancy and obesity inescapably arise. Unfortunately, they are problems to which no city, including Augusta, is immune.   As one New Jersey newspaper noted in its review of this important book, it should be required reading “for the kids in suburbia who have no idea what life is like in the inner cities, and for the kids in the inner cities to know that there is a way out.” + Living and Dying in Brick City, by Sampson Davis, M.D., 256 pages, published in February 2014 by Siegel & Grau

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The Examiners

JUNE 4, 2021

+

I’m stumped on this Examiner crossword.

by Dan Pearson

“Mealtime synonym Wow, that’s a tough one. for arm” How many letters?

What’s the clue?

Eight.

The Mystery Word for this issue: LARIBEL

Try forklift. © 2021 Daniel Pearson All rights reserved.

EXAMINER CROSSWORD

PUZZLE ACROSS 1. Type of pitch 5. Peak 9. Synagogue scholar 14. Code start 15. IV 16. Older brother of 74-A 17. In Cairo, for instance 19. Laminated rock 20. Where you’d find Mumbai 21. ______ Market 23. Tea serving 24. Thrill; delight 26. Consume 28. Shakespearean prince 31. Anne of Green Gables setting (abbrev.) 32. Bush Field abbrev. 33. Type of doc 37. _____ in (or _______ on it) 41. Nearby SC town, pop. 242 (in 2019) 44. It can be kept in a safe 45. _______ driver 46. Musical drama 47. Apple product 49. Tractor-trailer 50. Height for short 52. Abilities 55. Defer 58. More recent 60. Abbrev. for inflammation of the female genital tract 61. Support for art 63. Pertaining to a node 67. Newborn score 69. _________ artery 71. Kind of wheat 72. Highlight of 46-A 73. Colored portion of the eye 74. Younger brother of 16-A 75. Prying 76. Yield

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We’ll announce the winner in our next issue!

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Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, JUNE 14, 2021

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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

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by Daniel R. Pearson © 2021 All rights reserved.

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

by Daniel R. Pearson © 2021 All rights reserved.

DOWN 1. Dry watercourse 2. Anemia preventer 3. Obscene 4. Village namesake 5. Letters in many a front yard 6. Vine intro? 7. Bishop’s headdress 8. Fencing sword 9. Haste; recklessness 10. Massage comment? 11. Support 12. Large single dose 13. Maladroit; clumsy 18. Discount event 22. Little drink 25. Consumed 27. Bass organ 28. Blood prefix 29. Upon 30. Built 34. Pen prefix? 35. Pinch 36. Type of towel

38. British nobleman 39. Wicked 40. Tent holders 42. Standard thermometer 43. Surrey Center restaurant 48. Bonefish neighbor (abbrev.) 51. It’s often iced 53. Lottery game 54. The opposite of what was expected (adj.) 55. Involuntary muscle contraction 56. “River horse,” in brief 57. Borders 58. Logical prefix? 59. Downtown Augusta street 62. Extent of time or space 64. Virginia _____ 65. Parched 66. Undergo lysis 68. Beer variety 70. Might

QUOTATIONPUZZLE H L O F E V L O O O B L T H E F Y Y F U U E I F E I I V A A I U by Daniel R. Pearson © 2021 All rights reserved

2 9 W C V L4 L O K T6 N I L E8 5 A D 1 7 — Arthur Rubenstein 3

8 1 5 3 7 4 6 9 2

DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.

Solution p. 14

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

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L 1

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1.CHITTTWWUGLI 2.RHHOOSAIMAE 3.PAVEEETURE 4.THREADO 5.TISN 6.OSEE 7.SIND 8.TB 9.L 10.E

SAMPLE:

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

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by Daniel R. Pearson © 2021 All rights reserved

WORDS NUMBER

1

THE MYSTERY WORD

3 7 6 1 9 2 5 4 8

9 5 3 7 2 6 4 8 1

1 4 2 8 5 9 3 6 7


JUNE 4, 2021

AUGUSTAMEDICALEXAMiNER

THEBESTMEDICINE ha... ha...

A

poodle and a beagle are walking down the sidewalk together when the poodle unloads all his troubles on his friend.   “My life is a mess,” he says. “My owner is a jerk, I hate Alpo, my girlfriend ran away with a Pomeranian, and I’m as jittery as a cat.”   “Why don’t you see a psychiatrist?” the beagle suggests.   “I can’t. I’m not allowed on the couch.”

 Satan opens the gates to hell to welcome the newest loser resident.   “Congratulations,” he says to the doomed soul. “You’ve wasted your entire pitiful life, and now look where you are.”   “Well,” the condemned man says after a quick glance around, “At least I’m not a grown-up living in my dad’s basement.”  Moe: Acceptable manners and conduct between men and women sure have changed over the years.  Joe: So true. Like these days some women get mad when you hold a car door open.  Moe: Especially the ones riding bikes.  Moe: They say you should never scream into a colander.  Joe: And why do “they” say that?  Moe: Because you could strain your voice.

 Moe: How many stars are in the sky?  Joe: All of them.

 Moe: If you would go to Tire Warehouse to buy a tire, what would you go to Men’s Wearhouse for?  Joe: Same thing.

  A teacher noticed that one of her students, an active young girl, was wearing a Fitbit watch.

Advice Doctor

  “Are you tracking your steps?” the teacher asked.   “No,” said the little girl. “I wear this all day for my mom so she can show my dad when he gets home.”

 Dad: I saw a deer on the way to work this morning.  Son: How could you tell it was on its way to work?

 Moe: What’s the difference between a really strong weightlifter and a really, really, really, really strong weightlifter?   Joe: Repetitions.

The

A half Indian-half Irish man married a woman who was half Chinese and half Italian.   In due time they were ready to welcome their first child. After much deliberation, they named their son Ravi O’Lee. +  

Why subscribe to theMEDICALEXAMINER? What do you mean?

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Dear Advice Doctor,   My co-worker brings lunch to work every morning and puts it in the refrigerator in the breakroom. AT LEAST three days a week, someone steals it, or major portions of it, along with her drink. She has tried to catch the person without success, so now her plan is to booby-trap the food with poison, laxatives, hot peppers...whatever. I keep telling her to just let it go, to be the bigger person, but so far she’s determined to exact vengeance. What’s your advice? — Peace Keeper Dear Peace,   I hope I don’t offend you, but I think your advice is 100% wrong, inappropriate, and unhealthy. I totally disagree with it.   You think she should just let it go. Okay. Fine. But do you realize that roughly 70% of Americans are overweight? And despite that you are actively encouraging her to be the bigger person?   Just for the sake of argument, what if her lunch thief is caught and is discovered to weigh 300 lbs? Would you still advise her to be the bigger person?   Not including your friend (assuming she takes your bad advice), 36.5 percent of adults are already obese, and another 32.5 percent of American adults are overweight. Do we need even one more? Being overweight or obese is linked to more than 60 chronic diseases including type 2 diabetes, heart disease, stroke, cancer, and many others.   Being overweight and obese comes with huge economic burdens too. Medical costs for people with obesity are nearly $1,500 per person higher each year than those of people with normal weight. That adds up to billions of dollars. And people who are overweight or obese miss about 56 percent more work than people of normal weight. Still more economic costs!   And this trend is heading in the wrong direction. The average American diet is steadily adding calories over time, 23 percent more than we ate in 1970. As of 2017, all 50 states have an obesity rate over 20 percent. Twenty years ago, not even one state had a rate above 15 percent.   So please, do not encourage your friend to be the bigger person. Urge her to be the smaller person.   Thanks for writing, and I hope I answered your question. + Do you have a question for The Advice Doctor about health, life, love, personal relationships, career, raising children, or any other important topic? Send it to News@AugustaRx.com. Replies will be provided only in the Examiner.

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