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MARCH 8, 2019
AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006
The straight scoop on the world’s second-most consumed beverage after plain water.
What’s going on with coffee? One day a study says it’s suspected of causing cancer, the next day another study proclaims its salubrious properties. Harvard University’s T.H. Chan School of Public Health recently released a comprehensive overview of coffee, the world’s most popular beverage other than water. They examined coffee’s on-again, offagain connection with health. After all, just last year California made headlines around the world by requiring all coffee shops and sellers in the state to label every cup and bean they sold as a potential carcinogen, a cancer-causing agent. That decision led to an uproar among consumers and scientists alike, and probably had little effect on coffee sales. The decision was based on a collection of technicalities. Four years previously the chemical acrylamide was classified as “reasonably anticipated to be a human carcinogen” based on studies in rats. Acrylamide is present in
coffee, along with more than a thousand other naturally occurring chemical compounds. By definition and by law, the California judge who made the warning label ruling had no choice: an earlier California law mandated that consumers had to be warned about any chemical listed on specified lists of carcinogens. Cancer researchers immediately responded, stating that coffee not only does not need a warning label, it can protect against cancer and other diseases. The Director of Research at the American Institute of Cancer Research (AICR), Dr. Nigel Brockton, pointed out in the wake of the California ruling that “it is unwise, in this case, to extrapolate studies from animals to humans because the metabolism of acrylamide differs considerably, and the doses used for lab studies are not comparable. The beneficial effects of coffee, even for relatively high intakes, have been demonstrated and are linked to improvements in insulin control, antioxidant responses and reduced inflammation — all of which provide protection against cancer.” The AICR also has stated that coffee may reduce risk for endometrial and liver cancers. In the wake of these and hundreds of other reactions from cancer researchers, a proposal
was made in January to exempt coffee from Proposition 65, the California law which mandated the warning labels. The state’s Office of Administrative Law is currently reviewing the proposal. Coffee has other health benefits. A meta-analysis (a review of previously published studies) of more than 45,000 people followed for up to 20 years found that coffee consumption, caffeinated more than decaf, was associated with a lower risk for developing type 2 diabetes. The specific benefit found was 8% for 1 cup per day up to 33% for 6 cups a day. Another meta-analysis found a 30% decrease in the incidence of diabetes for the heaviest coffee drinkers (up to 10 cups a day) compared to the lowest consumers. (The benefit was 20% for drinkers of decaf.) When it comes to heart health, the Harvard overview acknowledged that some people can get the jitters, literal heart palpitations from drinking coffee. Despite that, overall and for most people, regular coffee consumption may lower the risk of heart disease and stroke. The data is well established: one study it cited followed more than 83,000 women; another some 37,500; and still another a meta-analysis of 21 clinical studies. All showed significant heart Please see COFFEE page 3
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PARENTHOOD by David W. Proefrock, PhD Your 7 year-old daughter has become obsessed with the idea that you and your spouse are going to get divorced. She talks about divorce two or three times a week and becomes very upset over even the slightest family disagreement. There is no reason for her to be concerned. Your relationship is strong and none of your friends or relatives have divorced recently. What should you do? A. Let her know that you are really tired of hearing all this divorce talk. Whenever she brings it up, tell her firmly to stop talking about it. B. Reassure her when she brings it up, but don’t make a big deal of it. Move her on to a different topic. C. Don’t do anything. It’s just a phase she’s going through and she will get over it pretty soon. D. Make sure you don’t argue or disagree in front of her and show her that you are getting along well.
If you answered: A. She is feeling insecure and this response does not address that underlying issue. B. This is the best response in this case. She is a young child feeling insecure. This addresses that insecurity without feeding into it. C. This is probably true, but doesn’t address her underlying insecurity. Part of good parenting is fostering a feeling of security even when things are scary. D. Don’t start behaving differently. She will sense both the change and the insincerity and will assume something is wrong in spite of your efforts. The key in this or similar situations is finding the best way to make her feel secure. A brief reassurance without dwelling on it is usually best. You have said your relationship is strong, but if she is picking up on actual problems with the marriage, then her insecurity is no longer unwarranted. Any genuine causes for fearfulness and insecurity should be addressed. + Dr. Proefrock is a local clinical and forensic psychologist
The wet weather over the past few weeks made me think about the alleged association between pneumonia and cold rain. In many tragic stories and movies, a character will have to trudge through the rain, finally find a safe haven and be warmed by a fire, only to die within a short period from an ailment suggestive of pneumonia. They lay in a bed wheezing and coughing before their last agonizing breaths. Charlotte Bronte is said to have died from such, all of those long walks on wet moors. Elvis sang about catching pneumonia from taking cold showers in GI Blues.1 The myth that rain and damp weather causes illness persists in our culture. Modern science has established that cold weather does not cause colds and flu. The same is true with pneumonia. Pneumonia is an infection of the lungs and caused by bacteria, viruses, and fungi. In fact, there are more than 30 causes of pneumonia. The most common bacterial pneumonia is caused by Streptococcus pneumoniae. One third of pneumonia cases are caused by viral infections that includes influenza viruses. The least common cause are fungi.2 Pneumocystis jiroveci is one fungus that affects people with immune systems
compromised by HIV infection or cancer.3 Anyone can get pneumonia, but those with compromised immune systems, people over 65 or younger than 2, and smokers are all at higher risk. Hospital patients experiencing comas, stroke, brain injuries, surgeries, and poor oral motor coordination are at increased risk for aspiration pneumonia. This type of infection occurs when saliva, vomit, or food particles are inhaled into the lungs.4 When the bacteria, virus, or fungi are introduced into the lungs, the alveoli (the tiny air sacs in the lungs) fill with fluid and pus. One or both lungs can be affected. The list of symptoms is long and varies slightly between bacterial and viral pneumonia. Symptoms of bacterial pneumonia include, but are not limited to, coughing up colored mucus, confusion, sweating, loss of appetite, rapid pulse, chest pain, shortness of breath, fever, and blue lips and fingernails. Viral pneumonia may present with headache, muscle pain, weakness, cough, and shortness of breath.2 Pneumonia definitely calls for medical treatment, although treatment options vary depending on the type of pneumonia. A diagnosis may require tests beyond a
physical exam: chest x-rays, blood tests, cultures, testing oxygen saturation of the blood, CT scan, or examination of the bronchi via scope.2 Fortunately, most cases are treated on an outpatient basis. However, if severe enough, pneumonia may need to be treated in the hospital. The CDC reports that flu/pneumonia was the 10th leading cause of death in Georgia in 2016.5 So go wander in the moors and sing in the rain unfettered. However, seek care and advice from a medical professional if you have symptoms of pneumonia. Also, encourage those who may be susceptible to infection to seek care at the first signs. Sometimes the symptoms may be mild. We’ve all heard of someone who had “walking pneumonia” and was not even aware. It is best to err on the side of caution. + References 1. Rijkers, G.T. (2017). Rocking pneumonia. Retrieved from https://pneumonia.biomedcentral.com/articles/10.1186/ s41479-017-0043-0. 2. Johns Hopkins Medicine. Pneumonia. Retrieved from https://www.hopkinsmedicine. org/healthlibrary/conditions/ respiratory_disorders/pneumonia_85,P01321 3. MedlinePlus. Pneumoniaadults (commonly acquired). Retrieved from 4. https://medlineplus.gov/ ency/article/000145.htm MedlinePlus. Aspiration pneumonia. Retrieved from https://medlineplus.gov/ency/ article/000121.htm 5. Center of Disease Control. (2016). Stats of the States of Georgia. Retrieved from https://www.cdc.gov/nchs/ pressroom/states/georgia/georgia.htm
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COFFEE… from page 1
benefits from drinking coffee, and did not find them in drinks like tea and soda, suggesting that components in coffee other than caffeine confer the benefits. Another 10-year study of 46,000 men tracked coffee consumption and the development of gallstones. After adjusting for other factors known to cause gallstones, the study concluded that men who consistently drink coffee are “significantly less likely” to develop gallstones. In the realm of mental health, Harvard reported on various studies involving almost 600,000 individuals, finding that depression is much more common in non-coffee drinkers than coffee drinkers. Specifically, one study found up to a 28% reduced risk of depression for the heaviest coffee consumers compared to the lowest.
Coffee even has life & death benefits. In one study that tracked more than 500,000 people for 10 years, a lower risk of death from all causes was found among coffee drinkers. Another study that followed 200,000 participants for up to 30 years found the 3 to 5 cup per day crowd were 15% less likely to have died during the study period than non-drinkers. Does all of this mean that everyone should drink coffee? Not at all. For some people it may cause insomnia, anxiety and problems controlling blood pressure. For others, their additions of sugar, cream, flavored syrups, whipped cream and more can spell lots of calories. But whether you drink coffee or not, rest assured, it isn’t the semi-lethal carcinogenic brew some would have us believe it is. Drink up, if you’re so inclined. +
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WHAT IS INFLAMMATION?
Quite possibly it’s not what you think. Do you think of inflammation as a uniformly bad thing? Count yourself among the many. But there is a side of inflammation we hardly ever hear about: its good side. Yes, there are good things about inflammation. Do you have a friend or relative that you like, but whom you can only tolerate in small doses? Well, they’re a lot like inflammation. Benjamin Franklin said, “Guests, like fish, begin to smell after three days.” He could have been talking about inflammation: initially and for a short time, inflammation is good. It is the body’s reaction to a situation that isn’t normal and needs to be fixed. It’s when it persists and becomes chronic that inflammation becomes an unwelcome guest. At first, during what we could charitably call inflammation’s honeymoon phase, it sees a problem and calls in the cavalry. Inflammation consists of two kinds of cells: macrophages (literally “big eaters”), large cells brought in to clear away the debris caused by whatever the illness or injury is; and lymphocytes, small white blood cells that, as part of the immune system, recognize and destroy foreign cells and substances that have invaded the body. As these troops are called in by the billions to the scene of battle, there is only so much room. Swelling naturally results. It’s part of the price we pay for healing and relief. Soon enough the swelling goes down; the pain subsides. Except when it doesn’t. We aren’t usually happy with any inflammation, but especially not with chronic inflammation. Everything that ends in -itis, and plenty of things do, is an example of chronic inflammation: laryngitis, arthritis, peritonitis, hepatitis, vaginitis, sinusitis, bursitis, tonsillitis, appendicitis, tendonitis, dermatitis and more. Aside from the fake news that inflammation is always bad, another misconception about inflammation is that it signifies an infection. A jammed thumb or sprained ankle will likely be the site of inflammation, but not of an infection. While inflammation can be painful, good medical care focuses more on the underlying cause than the pain. +
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MARCH 8, 2019
#86 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 email@example.com
his gentleman might look kind and mild-mannered, but don’t let his looks fool you. He was an absolute beast in the business world. Consider his résumé: he started a business in his Minneapolis garage with his brother-in-law in 1949 that today is the largest of its kind on the planet. This man, Earl Bakken, got his calling early in life. As a self-professed nerd in school, his first invention was a very mild and rudimentary taser he used to fend off bullies. That was to foreshadow things to come. Bakken went on to earn a degree in electrical engineering from the University of Minnesota in 1948, a time when hospitals were just beginning to use electronic equipment for the first time, but did not have the staff or knowledge to maintain and repair them. And so was born Bakken’s company, coined from a blend of two words, “medical” and “electronic.” He called it Medtronic. Medtronic as a garage-based maintenance and repair shop didn’t last long. As it happened, one of the pioneers of openheart surgery, C. Walton Lillehei (a doctor worthy of his own “Who is this?” installment), was on staff at Bakken’s #1 customer, the hospital at the University of Minnesota Medical School. Lillehei’s ground-breaking procedures often left his patients needing a pacemaker, if only temporarily. In the 1950s, pacemakers were unrecognizable by today’s standards: they were bulky external devices that were wheeled into a patient’s room on a cart, then plugged into the wall. If that wasn’t cumbersome enough, one of Lillehei’s young patients died during a Halloween 1957 power outage that affected large sections of Minnesota and Wisconsin. The next day, Dr. Lillehei asked Bakken if he could develop a battery-powered pacemaker. Using a circuit diagram for a metronome he had seen in Popular Electronics, Bakken developed a batterypowered transistorized pacemaker that was about the size of two paperback books. He left it with Lillehei for his evaluation and returned the next day for more discussions about developing and refining the device, only to find the prototype was already successfully in use on a patient. That was just the beginning of Medtronic’s innovations. The next improvement was a still smaller battery-powered pacemaker that could be strapped to the body, followed by the first versions of the now-familiar implantable pacemaker in the early 1960s. Today the company manufactures devices that help treat or manage more than 30 chronic conditions and diseases, including chronic pain, urinary incontinence, obesity, diabetes, Parkinson’s disease, and heart failure. From its humble beginnings in Minnesota, Medtronic now conducts business in more than 140 countries and has a payroll approaching 90,000 people worldwide. Although the company’s executive headquarters continue to be in Minnesota (the town of Fridley), as of 2015 Medtronic is officially registered in Ireland, a move prompted by that country’s low corporation taxes. From a legal standpoint the US operation is a subsidiary of the Irish-based corporation. As for Earl Bakken, he retired from Medtronic in 1989 and moved to Hawaii. He died at his home there on Oct. 21, 2018 at the age of 94. +
by Marcia Ribble What season is it? It depends on the day and time, because there has been no consistency this “winter.” In any given week the temperatures have ranged from 20 degrees to 70 degrees. The sun may shine brightly, or it may rain buckets. Aging is similar in many ways for those whose health similarly fluctuates from day to day, month to month, and year to year. After many years of relatively stable health it comes as a surprise when that stability disappears. I find myself in a strange yo-yo pattern of improving health preceded and followed by bouts of “crap.” The element of surprise is worthy of a place in one of those huge novels with hundreds of pages with myriad plot twists and turns and comings and goings. The element of surprise is always there with little correlation between what I am doing and what is happening. In other words, there is no logical way to analyze and predict what may happen next. One day I may have perfectly clear skin on my lower legs and the next day that same skin has broken down and is oozing. One day I have severe pain in my shoulder and the next day my shoulder is not bothering me at all, but I am having terrible cramps in my toes. One day I am itching intensely all over my body and the next day nothing is itching. Because the symptoms are so transient, they are difficult to pin down to any specific cause or causes. Back before I hit my seventies it was much simpler. My knees hurt, not in any mysterious coming and going, but in an all-day every-day way. Going to the doctor was easy. I could simply say, “My knees are killing me!” The doctor could take x-rays and confirm, “Your knees are bone-on-bone. No wonder it hurts.” For a time, I could put
it off, but eventually both knees had to be replaced and, after physical therapy and healing, the pain ended. Easy fix applied and issue resolved permanently. When I was younger, it was that way with pregnancy. I wasn’t pregnant. I was pregnant. I had a baby. I was no longer pregnant, but I was nursing a baby. It was an easily predicted succession of events, even when things like specifics about when precisely I got pregnant and when specifically the baby would be born could not be pinpointed outside a fairly narrow range of possibilities. That is no longer the case. My complaints are sporadic without any discernable patterns to them. Because I have been scientifically trained, and because I also have that tendency naturally anyway, I look for patterns that might indicate certain probable reasons, causes, likely outcomes, and when there are none, it flummoxes me. I am not a hypochondriac. The issues I deal with are real and respond to medication, but neither I nor my doctors can come up with the reasons why my body is sometimes going off half-cocked on me. At this point it’s just an unsolved mystery whose resolution may or may not be found. If I were a hypochondriac, I would be like Charlie Brown trying to decide what was wrong with him. Lucy van Pelt advised him about his fears, asking him if he was afraid of staircases, crossing bridges, cats, and other types of phobias before concluding that Charlie Brown had pantaphobia, the fear of everything. I am quite certain that I do not have EVERYTHING! It’s also conceivable that whatever is causing all this may suddenly disappear like an allergy does when the offending cause is removed. Until then I will remain, as always, curious. +
BRAIN-EATING AMOEBA KILLS WOMAN! WHICH WILL IT BE? No, you aren’t reading the National Enquirer. This sensational headline appeared
around the country and the world last December. People may have missed it or dismissed it, especially because another major element of the story was that her Neti-Pot was the culprit. It sounded a bit far-fetched, but it was all certifiably true. A year earlier, the woman had a sinus infection that failed to respond to medication. She decided nasal irrigation using her Neti-Pot would help, and she used it faithfully.
There was just one problem: the 69-year-old Seattle woman at the heart of this sad tale used ordinary tap water from her Brita filter. The Neti-Pot and other products like it specifically state that only sterile and or saline water should be used. The risk of complications from using tap water for nasal irrigation is extremely low, but it can be eliminated altogether by obeying the warnings to use only sterile or saline water. +
MARCH 8, 2019
Musings of a Distractible Mind
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largest risk. Make sure chest pain is not the heart, fever and cough is not pneumonia, and abdominal pain is not appendicitis. This can be done simply by getting a clearer history, or it may require further testing. Then address problems that are common. Common problems presenting in uncommon ways are more common than weird stuff. I look for patterns: episodic abdominal pain suggests gallbladder. Constant chest pain Doctor: “So Mrs. Smith, what brings you in lasting for two days is never ischemic heart today?” pain. Weird chest pain in a 50 year old diabetic smoker is more worrisome than Patient:”I feel like I am dying. I have trouble classic pain in a 20 year old female. catching my breath, I am running The older people get, the less fevers of 108 every day for the likely you will find a single How doctors past two months, my fingers are diagnosis. Pediatrics is usually diagnose turning black, I pass out at least simple, as kids are usually sick in real life. two times every hour, and I’ve with one thing. Adults, on the been vomiting up blood.” other hand, often have multiple problems at once. You will Doctor (puts hand to beard in thoughtful usually be wrong if you assume all symptoms expression): “Hmmm...Are there any other are related in an adult. symptoms you have been having over the past When in doubt, blame medications. I had two months?” a person recently with itching in the ear that would not stop. We tried multiple things to Patient: “Well, yes, now that you mention relieve this, but couldn’t get it better. She was it, I’ve got a strange rash on my feet and taking a blood pressure pill (ACE inhibitor) they’ve really started to smell bad.” which sometimes causes a relentless cough, and I remembered that chronic cough could Doctor (turns to nurse with knowing also be caused by irritation of the ear canal. expression): “Just as I suspected. That last So we stopped the medication and the bit of information was crucial. There is a rare symptom went away. To be certain, I had her foot fungus that causes all of your symptoms. restart it, and her symptoms quickly returned. (Doctor pulls out a vial of oil from his white The more medications a person takes, the coat). “Let me put this oil (which comes more likely they are having side effects. from the moss of a tree that only grows in Be willing to wait for an answer. Stories Tasmania) on your feet.” develop, and sometimes you hear things The rash vanishes and the patient’s color differently when you’ve heard it the 5th time. returns to a healthy pink glow. Be patient. As a clinician, I fantasize about being the Accept little victories. While I like to put heroic detective who notices those obscure oil on a patient and cure their symptoms, facts that others would miss, coming up with I usually don’t hit the home run. It’s often the life-saving diagnosis when all others better to aim for a 10% improvement, or had failed. This, unfortunately, is not how it improvement of a single symptom, than to fix usually works in real life. them all at once. Over time, a bunch of 10% Here’s how I approach diagnostic problems improvements can make a big difference. in the real world (you may call this “Rob’s Remember: some problems go away on Razor” if you want): their own. Some things need Father Time, not Listen to the story. Patients will usually tell Dr. Rob to get better. you what is wrong with them. Pay attention This all gets back to my role as a physician to the entire history, and don’t make theories as a helper, not a healer. I like to be the until you’ve heard everything. medical magician who pulls a diagnostic Don’t assume you’ve heard everything. rabbit out of the hat, but more often I’m Even after you’ve heard everything, you are the hand that helps people up when they inevitably missing important information. are down, making the most out of a tough This may be “chapter 1” of a the patient situation. It’s not glamorous, but it’s the way story, and simply the passage of time will things usually work. Accept this fact and be make a confusing story begin to make sense. pleasantly surprised on the occasion when First focus on the things that pose the Occam is actually right. + don’t like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician. I like to play Sherlock Holmes and figure out what’s going on with people, and I think I’m pretty good at it. Ok, so I lied. I do like to brag...a little. In most people’s mind’s eye, the role of medical diagnostician goes like this:
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
MARCH 8, 2019
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Will he ever get one right? Probably not.
Questions. And answers. On page 13.
IT’SYOURTURN! We’re never too proud to beg. What we’re begging for is Medicine in the First Person stories. With your help, we’d like to make this a feature in every * issue of the Medical Examiner. After all, everybody has a story of something health- or medicine-related, and lots of people have many stories. Send your interesting (or even semi-interesting) stories to the Medical Examiner, PO Box 397, Augusta, GA 30903 or e-mail to Dan@AugustaRx.com. Thanks!
“My leg was broken in three places.”
“This was on my third day in Afghanistan.” “I lost 23 pounds.” “We had triplets.” “He was just two when he died.” “The smoke detector woke me up.” “It took “She saved 48 stitches.” my life.” “I sure learned my lesson.” “The cause was a mystery for a long time.” “The nearest hospital “They took me to the hospital by helicopter. ” “I retired from medicine was 30 miles away.” “I thought, ‘Well, this is it’.” seven years ago.”
“Now THAT hurt!” “OUCH!”
“Turned out it was only indigestion.”
“He doesn’t remember a thing.” “I’m not supposed to be alive.” “It was a terrible tragedy.” “And that’s when I fell.” NOTHING SEEMED “The ambulance crashed.” “It was my first year “At first I thought it was something I ate.” TO HELP, UNTIL... “It seemed like a miracle.” of medical school.”
Everybody has a story. Tell us yours.
Here’s our “No Rules Rules.” We’ll publish your name and city, or keep you anonymous. Your choice. Length? Up to you. Subject? It can be a monumental medical event or just a stubbed toe. It can make us laugh or make us cry. One thing we’re not interested in, however: please, no tirades against a certain doctor or hospital. Ain’t nobody got time for that.
MARCH 8, 2019
As a mom with a house full of kids, I found it very difficult to take care of my family when I was feeling nauseous from chemo treatments. I took the medication my oncologist prescribed for nausea, but I needed something more. I discovered a few natural ways that helped complement my medicine to reduce the feeling of being sick. One way was using ginger and lemon to help soothe my stomach. Ginger can be an excellent natural alternative to help combat nausea. Lemons, according to Health Line, are a popular treatment for morning sickness. Lemons contain citric acid, a naturally-occurring compound thought to aid digestion and soothe the stomach. Another bonus for eating these energy balls is the benefits of the freshly grated lemon peel I add. Citrus peel has anticancer properties and contains multiple beneficial nutrients which inhibit carcinogenesis through mechanisms like blocking metastasis by inhibiting cancer mobility in circulatory systems. On my really bad days, I knew I had to eat something even if I didn’t feel like it, so I tried to incorporate ginger and lemon into some food. One idea for doing this was putting freshly Lemon Ginger Energy Balls grated ginger into my Lemon Ginger Energy Balls recipe. These little power processor and process until a fine flour forms. balls pack a punch of protein with the Toss in the raw cashews and pulse until finely cashews and another form of nausea ground. control with the lemon and ginger. Add all remaining ingredients except for half of the lemon zest to the food processor and pulse LEMON GINGER ENERGY BALLS until a thick, uniform dough forms. This will take about a minute or two. Ingredients Use a 2 tbsp scoop to measure out each ball, • 1-1/2 cup of quick cooking oats and roll each ball in between your hands until • 1/2 cup raw cashews it forms an even circle. Roll each ball in the • 3 tablespoons no-sugars-added peanut other half of the lemon zest to coat lightly. Store butter these bites in the fridge for up to 10 days, or in • 2 tablespoons real maple syrup the freezer for up to a month. If you opt for the • 3 scoops of Pyure organic stevia freezer, let each ball thaw for 5-10 minutes before (100% stevia with no fillers) enjoying. + • zest from 2 lemons divided in half by Gina Dickson, Augusta wife, • juice from one lemon mom and grandmother, colon cancer • 2 teaspoons fresh finely grated ginger survivor, passionate about creating • 1 teaspoon vanilla extract a community to help women serve • 1/4 teaspoon pink Himalayan salt healthy meals to their family. Visit my blog at thelifegivingkitchen.com Instructions First, add the oats to your food
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ASK DR. KARP
NUTRITION MaryAnn in Warrenton, Georgia, asks, “What’s all the fuss about salt?” There is no question about it, we Americans eat way too much salt. Way, way too much. The salt comes from very specific things we eat, so it is pretty easy to figure out how to reduce salt in our food…and it’s an extremely important thing for you to do, too. Too much salt contributes to high blood pressure, heart attacks, strokes and kidney disease. We need salt to live, but it is our
over-indulgence in salt that is the problem. Sodium is what is listed on the Nutrition Facts Label because it is actually too much SODIUM that is the health problem. Table salt contains about 40% sodium, which means it is the most significant source of sodium in our food. However, other foods and drinks contribute some sodium, for example, soft drinks and some vegetable drinks. The current advice is for all of us to reduce daily sodium intake to less than 2300 milligrams of sodium (about 1 teaspoon of salt). In addition, for those of us who are African-American or have high blood pressure, diabetes, or chronic kidney disease, the recommendation for sodium is 1500 mg/day, which is about ¾ teaspoons of salt. This 1500 mg/day recommendation applies to about half of all U.S. citizens, including children. Lowering sodium in the foods you eat and drink does not mean you need to go on a low-salt diet. It does mean, however, that you need to be wiser about your use of salt. We need some sodium for muscles to contract, for nerves to work and for your body fluids to be in balance, both inside and outside your cells. However, Americans
MARCH 8, 2019
TOO MUCH SALT CONTRIBUTES TO HIGH BLOOD PRESSURE, HEART ATTACKS, STROKES AND KIDNEY DISEASE.
are presently eating from two to four times the amount of salt that we should be! Where does all this salt come from? It is usually added to our food, not in the original food itself. For example, fruits, veggies, beans, grains and plain meat do not contain a lot of sodium. The salt is added when we preserve meats, we add the salt in our cooking, our sprinkling and when we eat in restaurants. Smoked, cured, salted or canned meat, fish and poultry are high in sodium. This includes bacon, deli meats, ham, hot dogs, sausage, sardines and anchovies. Have you noticed that restaurant and fast food is becoming saltier and saltier? Sodium also comes from store-bought “convenience” foods, pre-prepared foods and canned foods. Don’t forget
that condiments like mustard, ketchup, soy sauce and foods like pretzels, chips and pickles are all high in sodium. It is actually quite easy to cut down on the amount of salt you eat each day. Just follow some simple guidelines: • Don’t salt food without tasting it and then, if you want to add some salt, add less. Take the saltshaker off the table. If you like to sprinkle, sprinkle pepper and spices instead. Herbs and spices can easily substitute for the taste of salt. • Eat more meals at home and start with fresh food, not pre-prepared meals like those frozen entrées and casseroles. The more you eat out, the higher your sodium intake will be. • There is no need to buy more expensive low-sodium
canned food. Instead, when you open a can of veggies or beans, for example, empty the can into a strainer first, and run water over it for a few seconds. This will wash away a lot of the salt (and extra sugar) used in canning. We routinely do this at home and it is amazing how quickly this has become a habit. • When using salt substitutes, check the sodium content on the Nutrition Facts Label. Some salt substitutes are actually high in sodium. Also, some spice mixtures, for example Cajun spices, contain salt along with the spices, so read the nutrition label. • What about all those sea salts? Different sea salts may be fun to use because they have different flavors and colors. These flavors and colors come from the contaminants in the salt. Be aware, however, the different sea salts contain about the same amount of sodium as table salt. In addition, sea salts might not contain iodine, like iodized table salt. Don’t merely switch from table salt to sea salt and think you are taking in less sodium. You are probably not. Although sea salt has the same amount of sodium as table salt, you may be able to add a little Please see ASK DR. KARP page 10
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 firstname.lastname@example.org If your question is chosen for a column, your name will be changed to insure 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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MARCH 8, 2019
Ask a Dietitian
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by Sarah Coleman, RD, LD Pediatric Dietitian at Augusta University Health
See recipe on page 15 bacon, and higher fat cuts. When eating other meats besides fish, choose leaner meats like chicken and turkey and limit red meat to no more than once per week. • Try more beans. Aside from seafood and lean meats, beans are the main protein source found in the Mediterranean diet. Beans and lentils are loaded with fiber and plant protein. They also supply essential micronutrients like potassium, magnesium, and iron. Try adding black beans to your salsa or chickpeas to your salad to increase your intake of these foods. • Love your fats! Unsaturated fats like olive oil, nuts, nut butters, and seeds are great ways to add heart-
healthy fats to your diet. These are also an important part of the Mediterranean diet. Use olive or canola oil in place of butter when cooking or add nut butters to your morning oatmeal to increase your healthy fat intake. • Experiment with herbs. The Mediterranean diet emphasizes using herbs, pepper, garlic, onions, and citrus to season your foods instead of using salt. This will help you decrease your sodium intake and make your heart happy! Try experimenting with different herbs and salt-free seasonings in the kitchen. • Get plenty of exercise. Another critical part of the Mediterranean diet is lots of exercise! Be sure to get at least 150 minutes per week of moderate exercise or 75 minutes per week of vigorous exercise each week. Ask your friends and family to join you with this to promote a healthy lifestyle. Working with a Registered Dietitian can also be extremely helpful when following this diet. Dietitians are the nutrition experts who can help you personalize this diet to make it work for you and increase your success! +
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ranean diet. Fatty fish are a great source of omega-3 essential fatty acids that are important for the heart and brain. Additionally, fish is a great source of protein and is usually easy to prepare. Try adding shrimp to your vegetable pasta dish or salmon with your vegetables and brown rice. This diet avoids high-fat meats like sausage,
March is National Nutrition Month and you may be looking for ways to improve your health. If so, you’ve probably heard of the Mediterranean diet and its super powers including the ability to make your heart healthier, protect against cancer, and help you live longer. The Mediterranean diet is based on foods and recipes found in typical Mediterranean cooking. This includes a variety of fruits, vegetables, whole grains, beans, fish, and healthy fats. Research shows that this diet can help lower LDL cholesterol, which can decrease your risk for heart disease. This diet provides more than 50% of fat calories from healthy unsaturated fats that are commonly found in olive oil, fatty fish, and nuts. Additionally, the Mediterranean diet emphasizes a plant-based and low-sodium diet with wine in moderation and plenty of exercise. All of these components help prevent chronic illnesses. Here are some tips for starting the Mediterranean diet: • Build a strong foundation. The foundation of the Mediterranean diet is centered on fruits, vegetables, beans, and whole grains. These foods provide an abundance of vitamins and minerals that the body needs. Additionally, the whole grains and beans provide fiber for smoother digestion. Use plant-based foods as the base of your recipes like whole-grain pasta with vegetables or stir-fried vegetables with brown rice. • Choose seafood or lean meats. Fish is the main meat consumed in the Mediter-
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The digit(s) of the hand Working now? Probably Take-Out Available? No, they’re essential Good for: Piano playing, pointing at people, eating.
Robert D. Aiken, SC
H H H H H 2/27/2019 I was born with only eight fingers, something I’ve had to deal with all my life. Of course, I’ve got a couple of thumbs too. +
Jason J. Evans, GA
H H H H H 2/28/2019 I work at a bakery, and the owner works the counter, makes deliveries, orders supplies and helps with baking too. He’s got a finger in every pie. My question: isn’t that a health dept. violation? +
Jeraldine A. Augusta, GA
H H H H H 2/28/2019 Please join me in my campaign to restore table manners to this country. Search online for my digital petition to KFC to change their slogan to “Finger-Napkining Good.” I wrote that myself! Let’s make America polite again. This is MAPA country! +
Bradley M. N Augusta, SC
H H H H H 2/28/2019 My wife and I went to a restaurant the other night, and our waitress had the most beautiful fingers I have ever seen. She should be a hand model! As a waitress she was kinda mediocre, but I went ahead and gave her a pretty generous finger tip. +
Marla Q. Aiken, SC
H H H H H 3/1/2019 Is it just me, or does the English language need to be completely overhauled from the ground up? Like the term “finger-pointing.” That’s so redundant! What else could it be??? Knee-pointing? Ear-pointing? If all the energy used in those unnecessary uses of finger could be channeled in positive directions, we could probably wipe out hunger or global warming by next week. +
Fred B. Martinez, GA
H H H H H 3/1/2019 I got an invitation to an event next weekend that promised live entertainment and “finger food.” I am shocked and disgusted. Cannibalism, right here in America? Seriously? +
Janet S. Wrens, GA
H H H H H 3/2/2019 I was brought up home schooled, so I never had the chance to do some of the activities other kids in the neighborhood did at public schools. Like I always heard about finger painting but I never got the chance to try it - until last week. It was fun! I chose bright orange. People stare at me when I’m shopping, but I don’t care. When this wears off I’m going to try purple. +
Jack T. Hephzibah, GA
Anonymous Augusta, GA
H H H H H 3/4/2019 My wife is always on my back for not helping around the house. Always said I wouldn’t lift a finger to help. Well now I’ve cut all the tendons in my hands at work, so I guess it was a self-fulfilling prophecy. + H H H H H 3/5/2019 I’m a physician, and I recently saw a patient who some years ago lost both of his arms in an industrial accident. He came into my office because he was having some vague pains he couldn’t quite identify. I asked him to be more specific, but he said he couldn’t put his finger on it. I thought, well that’s the understatement of the year. +
MEDICALEXAMINER 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
MARCH 8, 2019
AIKEN-AUGUSTA’S MOST SALUBRIOUS NEWSPAPER • FOUNDED IN 2006
IF ANY ISSUE OF THIS NEWSPAPER EVER FAILS TO MEET YOUR EXPECTATIONS AS A READER FOR ANY REASON, YOU MAY OBTAIN A FREE REPLACEMENT COPY AT ANY MEDICAL EXAMINER NEWSSTAND AT NO CHARGE, NO QUESTIONS ASKED.
MARCH 8, 2019
ASK DR. KARP… from page 8
less because of the other flavors in different sea salts. • Be moderate when you eat chips, pretzels, and pickles and don’t use so much ketchup, soy sauce, marinades, and mustard. Be prudent with bacon, deli meats, ham, hot dogs, sausage, sardines and those meat “jerkies.” It is true that salting meats was a way of preserving meat before refrigeration, but, hey, it’s the 21st century. Have you noticed that really big thing in your kitchen called a refrigerator/freezer? There is no need to preserve by salting anymore. • Check out The DASH DIET. It is a great way of reducing your blood pressure and reducing sodium in what you eat. Just put NIH DASH DIET in your search engine* and stick to the medical science websites, like the one at NIH. What is the “No-Nonsense Nutrition Advice” for today? Pay attention to all the sources of salt (sodium) you are eating. Read the Nutrition Facts Label. Take the salt shaker off the table, use less salt during cooking and eat out less. Replace the taste of salt in your food with the wonderful flavors of herbs, spices and pepper. Your blood pressure and your risk of heart attacks and strokes will be lower and your wallet will be happier. + * Editor’s note: Also see pages 9 and 15
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MARCH 8, 2019
The blog spot — posted by Justin Millan, R.N., on Feb. 25, 2019 (edited for space)
TURNING PATIENTS: AN ACT OF DUTY & COMPASSION I met a fellow nurse at a wedding recently who, upon hearing that I worked at a long-term acute care hospital (LTAC), shrugged his shoulders and said, “Oh, sure. A lot of turns.” I shrugged, too. He had belittled my work, but in a way he was right. We do execute a lot of turns at my hospital. We complete at least one turn every 2 hours per patient. With an average of 25 patients on the unit, my team will potentially dole out 300 turns per day. Turns — as well as other evidencebased interventions — are fundamental to the survival of bed-bound patients. Perhaps I didn’t bother defending my work because I run into reactions like his all the time. I’m used to it. Among health care workers, the reputation of LTACs is lousy. I find that this disfavor has little to do with the quality of services provided and more with a gut reaction to the nature of these facilities. LTACs are often a repository for bed-bound patients who are on indefinite life support. They can’t move. They are incontinent. They need a lot of turns. And in a health care culture that venerates emergency surgeries and dazzling cardiac innovations, the grim, hopeless long haul of the LTAC is a hard thing to admire. I get it. Having to roll another human being in bed to keep them from developing wounds is sad, especially when the prognosis is poor and there is no end in sight. It’s inglorious. What is an act of duty and compassion on part of the nurse becomes something vaguely sinister — as if we are torturing the patient and defying natural order for personal gain. Perhaps I could have told this nurse how the ethical side is a frequent discussion point at our multidisciplinary conferences. At my hospital, no patient is bullied into staying on life support, just as no patient is unlawfully deprived of it; the decision is made by the patient or by his proxy after many conversations involving physicians, nurses, case managers, and therapists. Our performance as providers should not be measured by the patient’s choice of code status but rather by our efforts to communicate, listen, and inform. The ones who choose to discontinue life support and let the disease run its terminal course are often praised as brave and gracious; likewise, it is tempting to criticize the ones who continue with full treatment as being stubborn or in denial. But that we have legal dominion over our healthcare fates is a privilege with the potential to provoke. We cannot have it both ways: always free to choose and always in agreement with one another’s choices. But regardless of code status, we continue to provide our patients with a lot of turns. Not all of my patients require a lot of turns forever. Sometimes we enter a room to reposition a patient only to discover that he has, for the first time in months, turned himself in bed. This milestone is the result of a long and bitter fight against infection and atrophy. If all goes well, other milestones will follow: weaning off artificial ventilation; learning to eat and speak again; restoration of continence; and discharge to a skilled nursing facility (or even sometimes to home). Perhaps what I should have said to the nurse at the wedding was, I hope you never find yourself in a bed at my hospital. But if you do, be grateful for the turns. And be grateful for the choice. +
What I should have said was...
Justin Millan is a nurse.
From the Bookshelf This is a book that reminds us before we even open the cover that cold case crimes can be solved, that silent victims can still testify, even from the grave. People have a curious fascination with the often gruesome science of forensics. After all, the number of CSI-type shows on television is practically without counting. There are even entire networks, like ID (Investigation Discovery) that are devoted to crime and punishment 24/7/365 (not counting commercials). As you might surmise if you are a bit of a detective, having an author whose name is Nigel indicates the book might have a bit of a British slant. True, not that that’s a bad thing. Actually, pretty much the whole world of forensics is examined in all its fascinating detail in this book, including Britain, France, and even right here in the US of A. Nigel McCrery takes us to the scene whenever and wherever there was a fascinating case or a
breakthrough in forensic methods. He breaks it down into a handful of categories, areas like ballistics, blood, trace evidence, poisons, DNA, and so on. Looking back on the history of the science and its present state, it’s a wonder they managed to catch and convict the right perp even half the time back in the day. And it’s equally amazing that anybody gets away with anything these days with the forensic tools available today.
The sad truth when it comes to forensic science is that the cost of each and every advancement was paid over the centuries with rivers of shed blood and untold lives cut short by acts of violence and mayhem. Blood spatter experts, for instance, unknown to detective work in the not too distant past, hone their craft when blood is spattered and splattered. But thankfully, people have been willing to work in and gradually refine, expand and improve the art and craft of forensic science to the point where, today, it provides the basis for many, many TV shows. Plus it helps solve (and no doubt prevent) countless crimes. If the often gruesome but always fascinating history of forensic science appeals to you, this is a book you’ll definitely enjoy. + Silent Witnesses: A History of Forensic Science by Nigel McCrery; 288 pages, published in September 2014 by Chicago Review Press
Research News A blood test for pain One of the problems with pain is that no one really knows the extent and nature of the pain except the person experiencing it. That means that doctors’ hands are sometimes tied as they prescribe pain meds in good faith for people who are just looking for a buzz. Or they prescribe dosages that are too strong or too weak for the exact pain the patient is really experiencing. That may all change thanks to studies underway at Indiana University. Researchers there have identified markers for pain circulating in the bloodstream, and are now in the process of differentiating the various pain markers for men and women, for migraines, fibromyalgia, and other sources of pain. The test may not be in use next week or even next year, but the prospects are promising.
Targeting tobacco sellers The Commissioner of the FDA has this week called for a meeting with executives of Walgreens to find out why the chain ranks #1 among pharmacies in the dubious category of selling tobacco to minors. It is curious enough that a pharmacy would even carry tobacco products in 2019, but a whopping 22 percent of Walgreens sales since 2010 in more than 6,350 stores inspected were illegal. Walgreens was previously notified about the issue in a letter from the FDA last year. Other major offenders in selling tobacco to minors were Walmart, Kroger, 7-Eleven, Family Dollar, BP and Citgo. A deadly trend Pedestrian fatalities are up. Way up. Statistically, swimming is more dangerous than being a pedestrian. Even so, deaths among pedestrians in 2018 were at a level not seen in nearly 30 years.
The last time pedestrian deaths were anywhere near 2018 levels (which were an estimated 6,227) was in 1990. That year, 6,482 people died on foot, a deadly year that launched a nearly 20-year decline. By 2009, “only” 4,109 pedestrians died. But the trend has been steadily upward ever since. There are many theories about the reasons, but there are two clear sources of heightened pedestrian safety. The theories include the ever-growing popularity of walking; the growing size of vehicles; the proliferation of cell phones, dashboard navigation systems and other causes of distracted driving. The dual solution to the problem clearly lies among two groups: drivers and pedestrians. Or to put it another way: you and me. Incidentally, South Carolina’s pedestrian fatalities rose 7% between 2017 and 2018; Georgia’s rose 32%. +
MARCH 8, 2019
THE MYSTERY WORD
I was in a vegetative state for more than ten years.
I find that hard to believe.
by Dan Pearson
But it’s true. Fact: I lived in California for more than ten years.
So California raises more Fact: maybe you should go back to vegetables than any your vegetative state. other state. Fact.
The Mystery Word for this issue: RAMBLU
© 2019 Daniel Pearson All rights reserved.
PUZZLE ACROSS 1. Plane field 5. Ma’s partners 8. Municipal funding ltrs. 14. On the briny 15. Lyric poem 16. Capital of Taiwan 17. Wound leftover 18. Clippers (as abbreviated on scoreboards) 19. Fervent 20. Hebrew liturgical prayer 22. Steal from 24. By mouth 25. What 21-D did 27. Consumed 28. Famous Arnold role 32. Employs 33. Part of verb to be 34. Lofty 36. Auto music players 38. Tantalizes 42. Having three feet 46. What bi means 47. Benedict beginning 50. Humorless person 52. Former coin of France 53. Famous Jack 54. Adam and Eve’s firstborn 56. Big ___ 57. Deer horn 61. Capital of Canada 63. Partridge, for one 65. Money of Ireland 66. Reaping machine 67. A Kennedy or Williams 68. Sudden assault 69. Cylindrical (in botany) 70. Self-esteem 71. Sisters
24 27 31
Click on “MYSTERY WORD” • DEADLINE TO ENTER: NOON, MARCH 18, 2019
We’ll announce the winner in our next issue!
E X A2 M I 6 N E R 4
1 4 6
3 1 7
by Daniel R. Pearson © 2019 All rights reserved.
S U 5 D 3 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.
by Daniel R. Pearson © 2019 All rights reserved.
DOWN 1. Criticize severely 2. Pacers’ school (abbrev.) 3. Close, as a deal 4. Columbia County town 5. Five-dollar word for hay fever 6. Dentist’s org. 7. Discharge (by an organ or gland) 8. Thrust with a knife 9. National standard 10. Public swimming pool 11. Musical dramas 12. Part of the U.S. Congress 13. Names 21. Key publication staffer 23. Scent 26. Large marble 28. Glue for feathers? 29. Period of history 30. Delicious color 31. Becoming gradually slower (in music)
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
32. Athens univ. 35. Byron of note in Augusta 37. Abbreviated it is 39. Abbrev. for HIV, et al. 40. Female sheep 41. Distress signal 43. Word with telephone and South 44. Vulcanized rubber 45. Lair 47. Accompany 48. Small beard 49. Stringed musical instrument 51. Apprentice 55. The back of a person’s neck 56. Uncover 58. Hawaiian feast 59. Head of The Family Fold 60. Staffs 62. Rainy 64. Pos. opp. Solution p. 14
QUOTATIONPUZZLE D E C M N L I O E O I E Y W E N ’ H S R ’
T L T A K
P T R A A T A R N L E U H P T U T
7 6 3 8 1 5 2 4 5E 9 6T 1 8 7 N 9 2 4 3
— Cartoonist Bill Watterson
by Daniel R. Pearson © 2019 All rights reserved
DIRECTIONS: Recreate a timeless nugget of wisdom by using the letters in each vertical column to fill the boxes above them. Once any letter is used, cross it out in the lower half of the puzzle. Letters may be used only once. Black squares indicate spaces between words, and words may extend onto a second line. Solution on page 14.
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.
O 1 2
5 6 7 8 P 1 2 3 4 5 6 7
9 1 2
4 U 2 3
1.GENBAAWWMY 2.IREOOOXSA 3.PANFTUY 4.EDTP 5.PCE 6.RTE 7.DF
1. ILB 2. SLO 3. VI 4. NE 5. D =
9 2 4 3 8 7 5 6 1
3 4 2 7 1 9 6 5 8
1 6 9 8 4 5 2 3 7
8 5 7 6 3 2 4 1 9
MARCH 8, 2019
THEBESTMEDICINE ha... ha...
he world’s leading expert on a rare type of South American hornets visits the last record store left in New York City, a store that specializes in rare recordings of all kinds, including nature sounds. “I understand you have the new recordings of the South American Horned Hornet?” “Yes we do, sir,” says the store clerk. “Would you like to listen before you buy?” “That would be splendid,” replies the entomologist. The clerk cues up the record and the scientist puts on a pair of headphones. But after listening for less than a minute, he tells the clerk, “This recording is not the South American Horned Hornet.” The clerk checks the label on the record and verifies that it is indeed the South American Horned Hornet. “Let’s try the next track. I’m sure it will make an appearance.” But after listening to selections from several tracks, the sound of the South American Horned Hornet is never heard. The hornet expert is not just disappointed; he’s angry. The commotion he stirs up attracts the attention of the store manager. “Is there a problem here?” he asks. “Yes there is!” says the entomologist. “This
man is trying to sell me a recording of South American Horned Hornet sounds, and there is no such thing on this record!” The manager glances down at the black disc on the turntable and immediately sees the problem. “I’m terribly sorry, sir. It appears my associate has been playing the bee side.”
Advice Doctor ©
Moe: I think this wall Trump is talking about is a good idea. I think it will work. Joe: What makes you say that? Moe: Think about it: China built one and you don’t see any Mexicans over there. Moe: Wow, a truck crashed in Atlanta and burst into flames, cooking its entire load of chicken, 40,000 pounds. Joe: I bet the cops suspect fowl play. Moe: I can’t stand tailgaters, so I just decided to break off my rearview mirror. Joe: How is that working for you? Moe: I haven’t looked back since. Moe: I don’t really understand cloning. Joe: That makes two of us. Moe: I’d like to have my dog trained, but who’s got ten years to invest in that? Joe: What on earth are you talking about? Moe: All the good schools are K-9. Moe: Well, after 40 years of marriage, my grandmother finally got my grandfather to quit biting his nails. Joe: How did she manage that? Moe: She hides his teeth. +
Why subscribe to theMEDICALEXAMINER? What do you mean? Staring at my phone all day has had no Effect on ME!
Because try as they might, no one can stare at their phone all day.
SUBSCRIBE TO THE MEDICALEXAMINER +
Dear Advice Doctor, I recently flew from San Francisco to Atlanta to Augusta, and by chance the same person was on both flights, an obese, unwashed (I was close enough to smell him, so believe what I’m saying) and impolite man. I’m sure everyone in the gate area was hoping they wouldn’t be sitting in his row. I dodged that bullet; I was across the aisle in the row right behind him. I thought I could tolerate that until he took his shoes and socks off five minutes into the flight. I nearly lost my lunch. The flight stewards did nothing, but neither did I. Do you think I should have confronted him? — I Flew Up Dear Flew, You may not realize what a common misconception you have raised. Sometimes it seems like everyone in the entire country is on a diet, and many of them think they will succeed if they regularly skip a meal (or “lose their lunch” as you put it). This might seem logical, but in a counterintuitive twist, skipping meals or eating fewer times throughout the day actually leads to weight gain, not weight loss. Do not adjust your Medical Examiner. Yes, someone who eats six or eight times a day (and eats the right things) could have a better chance of losing weight than someone who eats only two meals a day. Why is that true? There are several reasons. Skipping a meal can make you more hungry when the next meal finally rolls around, and that can lead to eating more than you otherwise would have. Also, fasting - even for just the extra few hours involved in skipping one meal - slows down the body’s metabolism. So all things being equal, the skipper is burning fewer calories than someone who recently ate as scheduled. The worst meal to skip is breakfast - not that any meal is good to skip. But studies have established that skipping breakfast is a great way to gain weight. For someone determined to practice fasting, consult your doctor or a registered dietitian for advice on how to do it right. I hope this answers your question. + 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 be provided only in the Examiner.
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Mediterranean Mahi Mahi The sauce is delicious and the recipe would work equally well with chicken Ingredients • Vegetable oil cooking spray • 2 teaspoons olive oil • 1 cup chopped onion • 2 cloves garlic, minced • ¼ cup dry white wine • 1 (14.5 oz) can stewed tomatoes (chopped, liquid reserved) • ½ teaspoon oregano • 1 (14 ounce) can quartered artichoke hearts (packed in water, drained) • ½ teaspoon Jane’s Krazy Mixed up Salt • ¼ teaspoon pepper • 16 ounces cod or other firm white fish (halibut, mahi mahi) • ¼ cup black olives; chopped (optional garnish) Directions 1. Preheat oven to 400 degrees. 2. Coat non-stick pan with cooking spray, add olive oil and place over medium high heat. Once hot, add onion and garlic, and cook until soft and translucent (3-5 minutes.). 3. Add wine, stir in tomatoes, reserved juice, oregano, and artichokes. Mix well and simmer for about 5 minutes. 4. Pat fish dry and arrange in baking pan that has been coated with cooking spray. Sprinkle the fish with salt and pepper and top evenly with pan sauce. Bake 12-15 minutes until fish flakes with a fork. Sprinkle with olives before serving. Tips: Thaw fish fillets in milk. Submerge the frozen fish in a wide, shallow bowl of milk (or zip-top plastic bag with milk) then place in the refrigerator for 24 hours. The milk bath helps eliminate any fishy or frost-bitten taste. To use simply drain off the milk and pat dry with a paper towel. Even thawed fish from the fish counter can use a quick dip in a milk bath (10-20 minutes is all that is needed). Yield: 4 servings Nutrient Breakdown: Calories 190, Fat 2.5g (0g saturated, 140mg Omega-3); Cholesterol 50mg; Sodium 570mg Carbohydrate 13g; Fiber 1g; Protein 23g, Potassium 553mg, Phosphorus 261mg Percent Daily Value: 10% Vitamin A, 20% Vitamin C, 10% Iron, 8% Calcium Carbohydrate Choices: 1 Carbohydrate Diabetes Exchanges: 3 Vegetable, 3 Very lean meats Recipe provided with permission from Eating Well with Kim. For additional recipes see: www.universityhealth.org/eww Kim’s note: To easily cut the stewed tomatoes pour the can into a medium bowl and cut them with your kitchen sheer right in the bowl. That way the only mess to clean up is one bowl. + See related article, page 9
IT’S A QUESTION OF CARE Caring for The Greatest Generation There are differing opinions about when The Greatest Generation began. 1901 is the
year many say this generation started. Let’s say the Greatest Generation refers to those born between 1901 and 1928. So anyone still living who is of The Greatest Generation is at a minimum 90 years of age. Those of The Greatest Generation lived through both The Great Depression and World War II. The events they experienced and observed, both at home or abroad, are almost unimaginable to the rest of us. Yet, those still living provide us with an amazing example of what it means to have strength, perseverance, and to truly live an honorable life. These admirable qualities are the same ones that require caregivers to work a
little harder to provide them with the quality care they deserve. Most likely when you ask someone of The Greatest Generation how they are, they will answer, “good” or “okay.” They aren’t going to complain about anything that is not literally killing them. They have always “pulled themselves up by their bootstraps,” so why change that now that they are in their 90s? Caregivers must look past their direct answers, stoic gestures, and avoidance of complaining to truly know how they feel or how they are. There are a few simple details to consider when caring for someone of this great generation. First, keep tabs on their appetite. A steady
MARCH 8, 2019 decrease in appetite can be a sign that something isn’t quite right. Loss of interest in things that they have always loved can indicate physical or mental decline. An increase in the amount of sleep they require or how often they fall asleep during the day can also give you important clues. All of these things are simple yet profound indicators of something major going on in their bodies OR it could just be the body’s normal aging process. Either way, it is our responsibility as caregivers to present our findings to their physician and let them determine the cause, ensuring they receive the best care possible. It is also our responsibility to
understand there are different types of care and not all of them are life sustaining, but they are all life honoring. We must be diligent in providing The Greatest Generation with compassionate and quality care while honoring their will to remain strong, stoic, and polite until the end. + by Lori Beth Charlton, MSW, LMSW, C-ASWCM, an Aging Life Care Manager who assists her clients and their families in choosing the best care options for their needs. She is committed to ensuring that her clients receive exceptional care by managing all of the details that create a positive environment for care.
PROFESSIONAL DIRECTORY +
Tesneem K. Chaudhary, MD Allergy & Asthma Center 3685 Wheeler Road, Suite 101 Augusta 30909 706-868-8555
AMBULANCE SERVICE AMBULANCE • STRETCHER • WHEELCHAIR
CHIROPRACTIC Evans Chiropractic Health Center Dr. William M. Rice 108 SRP Drive, Suite A 706-860-4001 www.evanschiro.net
COUNSELING Resolution Counseling Professionals 3633 Wheeler Rd, Suite 365 Augusta 30909 706-432-6866 www.visitrcp.com
YOUR LISTING HERE Your Practice And up to four additional lines of your choosing and, if desired, your logo. Keep your contact information in this convenient place seen by tens of thousands of patients every month. Literally! Call (706) 860-5455 for all the details
Dr. Judson S. Hickey 2315-B Central Ave Augusta 30904 PRACTICE CLOSED 706-739-0071
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Jason H. Lee, DMD 116 Davis Road Augusta 30907 706-860-4048 Steven L. Wilson, DMD Family Dentistry 4059 Columbia Road Martinez 30907 706-863-9445
Zena Home Care Personal Care|Skilled Nursing|Companion 706-426-5967 www.zenahomecare.com
LONG TERM CARE WOODY MERRY www.woodymerry.com Long-Term Care Planning I CAN HELP! (706) 733-3190 • 733-5525 (fax)
Karen L. Carter, MD 1303 D’Antignac St, Suite 2100 Augusta 30901 706-396-0600 www.augustadevelopmentalspecialists.com
DRUG REHAB Steppingstones to Recovery 2610 Commons Blvd. Augusta 30909 706-733-1935
Sleep Institute of Augusta Bashir Chaudhary, MD 3685 Wheeler Rd, Suite 101 Augusta 30909 706-868-8555
TRANSPORTATION Caring Man in a Van Wheelchair-Stretcher Transports • Serving Augusta Metro 855-342-1566 www.CaringManinaVan.com
Medical Center West Pharmacy 465 North Belair Road Evans 30809 Georgia Dermatology & 706-854-2424 Skin Cancer Center 2283 Wrightsboro Rd. (at Johns Road) www.medicalcenterwestpharmacy.com Augusta 30904 Parks Pharmacy 706-733-3373 SKIN CANCER CENTER 437 Georgia Ave. ARKS www.GaDerm.com HARMACY N. Augusta 29841 803-279-7450 www.parkspharmacy.com
Vein Specialists of Augusta G. Lionel Zumbro, Jr., MD, FACS, RVT, RPVI 501 Blackburn Dr, Martinez 30907 706-854-8340 www.VeinsAugusta.com
YOUR LISTING HERE Augusta Area Healthcare Provider Prices from less than $100 for six months CALL 706.860.5455 TODAY!
If you would like your medical practice listed in the Professional Directory, call the Medical Examiner at 706.860.5455
COFFEE IS LIFE. Ok, maybe that's bit too strong, but an overview of numerous research studies by Harvard University's T.C. Chan School of Pu...