Friday, August 5, 2011

Stay regular with “Colon Blow”

By Richard P. Holm MD

Several years ago a comedy TV show on Saturday night parodied high fiber breakfast cereal calling their fake brand “Colon Blow.” At our house, that’s what we call our fiber breakfast cereal mix topped off with ground flax seed and dried or fresh fruit.

There is good reason I promote high fiber, but the story is a bit complicated. Many of my patients, especially the elderly, struggle with constipation problems. Very often these people have been taking one stimulant laxative or another such as senna or casanthralol, and have been doing so for many years.

Specialists have known for a long time that stimulating the bowels with an irritant only works for a short while, and then a higher dose is required, and then a higher dose… and so on. What’s worse, following the use of bowel stimulants, commonly there is diarrhea and then rebound constipation when these drugs are stopped. Thus, many people have had a roller-coaster bowel problem for a very long time as a result of using stimulant laxatives.

But in a controlled environment like a nursing home, I’ve noted that when you stop the stimulant laxatives, and use instead fiber with as-needed osmotic non-stimulating laxatives, the problem goes away in about two weeks.

Here’s the formula:

1. Start with enough fiber. I generally recommend food fiber, not the packaged type, such as bran-type breakfast cereal or oatmeal. Another good source is ground golden flax seed, which has an additional fish oil-type benefit. Start slow, and increase gradually;

2. If needed add plain stool softener, one to three capsules once or even twice a day if necessary. Adjust dose to daily balance bowels. Avoid softeners when in combination with a stimulant laxative. I repeat: don’t use stimulant laxatives;

3. If still no success by the above, add one of the following: milk of magnesia, polyethylene glycol (Miralax,) or sorbitol “but only when needed.” All three work by drawing fluid into the bowel rather than by irritating it.

Fiber is the most important part of the formula, and new science shows significantly reduced over-all death rates in those who eat enough fiber. So as the TV comedy skit goes: “I stay regular with colon blow. You can too.”

Early to bed?

By Richard P. Holm M.D.

I must admit I am not one for getting enough sleep. Like many others, I have an internal drive and clock, which I presume comes from the combination of disparate genetic threads of many and varied ancient ancestor. Somewhere from back in the recesses of my heredity appears the desire to stay up late, revel, and dance around a campfire. Yet within this same combination of chromosomes appears also a separate and compelling force to get up early and get work done.

The result of the coming together of just such ancestral drives is a guy who cuts short his daily requirement of sleep. I’m always pushing it, and short naps are my only saving grace.

Having watched the scientific literature about sleep through the years, until now I have noted that the data has been relatively inconclusive about the value of getting more sleep. Of course grandmothers have always scolded those who wanted to stay up late, and Ben Franklin joined in with, “Early to bed and early to rise makes you healthy wealthy and wise.” But where is the proof that people would benefit from getting more sleep?

A recent small study seems to clarify that question. It followed 11 male basketball players and monitored their sleep, finding the actual sleep obtained in this group was between six to nine hours. The researchers then required players to get at least 10 hours of sleep per night, including naps, for about seven weeks.

Measurement of player abilities before and after the sleep intervention found that with increased sleep the players ran faster sprints by five percent, free throw percentages increased by nine percent, three-point field goal percentages increased by 9.2 percent, and the players reported feeling and doing better during games.

Of course there is also scientific data to say that individual needs vary, and as a person ages sleep needs lessen. We also know that too much sleep can result from depression, and we don’t exactly know what the ideal hours of sleep would be for what age and what individual.

That said, perhaps it is time to heed what Grandmothers have told us for years, we would do better if we got more sleep.

Tuesday, June 21, 2011

Respecting kidneys

By Richard P. Holm MD

Your two bean-shaped fist-sized filtering organs called the kidneys, as the comedian says, “just don’t get no respect.” We take them for granted until they stop working.

But there is more to these inglorious and obscure organs than you would think. Each day something like 200 quarts of blood are pushed through the kidneys to remove about 2 quarts of urine loaded with toxins and waste products. But these guys aren’t just filtering out waste.

Kidneys know when to remove excess water when over-loaded or to conserve water when dehydrated; they know how to and when to balance electrolytes and body chemicals; they stimulate the bone marrow to make blood when red cells are low; they stimulate bones to grow and to strengthen when needed; and along with several other body systems, they measure, manipulate, and balance the blood pressure in order to get oxygenated blood out to all the cells of the body.

So what can hurt these magnificent unappreciated organs and then what should we do to protect them?

Inherited and genetically caused problems, autoimmune illnesses, birth defects, aging blood vessels, infections, blocking kidney stones, certain medicines, and even environmental toxins all can cause kidney trouble.

Of course if blood pressures are too high then kidneys can be harmed, but the opposite is true, too. That is, sometimes sick kidneys may be the cause of high blood pressure, making it hard to know which one is the egg and which one is the chicken.

By far the most common destroyer of kidneys, however, is a prolonged exposure to high sugar levels. Indeed, diabetes mellitus is responsible for about 40% of all kidney failure, and with the epidemic of obesity and diabetes in this country, we are facing a future where there will be more people suffering with kidney failure than ever before.

The formula for each individual to best avoid such a fate has to do mostly with living a healthy life-style, that is to get regular exercise and eat a balanced smaller portioned diet.

Your kidneys deserve a little respect.

Wednesday, June 8, 2011

To straighten the bones of children

By Richard P. Holm M.D.

The history of medicine is filled with stories of bonesetters, and in the middle ages they even had a guild. These people splinted broken bones with sticks, leather, and clay casts, and were separate from physicians and barber surgeons.

Then in the 1700s, Nicholas Andre’ a professor of medicine at the University of Paris, formally described methods to treat boney deformities in newborn children such as clubbed feet with splinting. He described similar methods used for the straightening of young tree saplings. Andre’ wrote a textbook on the subject titled L’Orthopedie. The ancient Greek word orthos means free from deformity, to straighten, to make right; and the Greek word paideia refers to the art of raising a child. Literally orthopedics means to straighten the bent bones of children. Together they provide for the name of a present day surgical specialty, but other things needed to happen first.

In the mid-1800s ether and then chloroform were discovered. Available and popularized during the Civil War, anesthesia made amputations a way to save lives after limbs were shattered from dirty gunshot wounds. It wasn’t until after the war that we learned of bacteria and discovered how antiseptic methods could prevent the need for amputation, and avoid infection after surgery. Just about at the same time, X-rays were discovered by Wilhelm Roentgen, which allowed for the marvelous and revealing image of our internal boney structure.

This all set the stage for expanding the orthopedic focus from just casting deformities of children. In the 1890s a well-known bonesetter from Liverpool, England, Evan Thomas encouraged his son Hugh to go to Medical School, and afterward taught Hugh bone setting and casting methods, which at the time were not being taught in Medical School. Hugh and his nephew Robert Jones worked together to develop orthopedic surgical methods in treating not just deformed children, but also bone injuries to construction workers, and then war injuries to military men during World War I.

And thus we have come from bonesetters, and straightening the bones of children, to the marvelous field of orthopedic surgery.

Wednesday, June 1, 2011

Tornado Alley

By Richard P. Holm M.D.

Did you know that three out of four tornadoes in the world happen in the U.S. and that many of them occur in this neck of the woods? They call it tornado alley starting early in Texas, and progressively later in the season through the spring and summer up through Oklahoma, Missouri, Kansas, Nebraska, and the Dakotas. That said tornadoes can happen anywhere and at any time of the year.

A tornado typically forms when a cold front with wind going one way bumps up against warm moist air with wind going the other way. The theory goes that updrafts on one side, and falling rain on the other can start these opposing winds spinning. When one end of the twisting wind is sucked into the updraft of a tall thundercloud, the speed of the whirling is enhanced and becomes concentrated as it tightens down into a funnel, much like a skater spins faster as the arms and legs come in.

About two percent of tornadoes reach speeds of up to 300 mph causing 70% of the damage, and 70% are minimally destructive, with winds of less than 110 mph.

The major rule to protect oneself from tornadoes is to avoid flying debris. Experts advise avoiding windows, (and not wasting time opening them.) If you are in a sturdy permanent home, go to a lower central windowless room, maybe under a stairwell, or in a bathtub. Get low and cover with a mattress or sleeping bag if possible. If in a mall or church, avoid large spaces; find a hallway, bathroom, or smaller windowless room and crouch.

If you are in a mobile home or a vehicle of any kind, get out, as these are all extremely dangerous in a tornado. In a vehicle, if you can safely drive away, do so. Otherwise get off the road, get out and away from anything that can roll over or fall on you. If you cannot find a permanent sturdy building, you are safer in a lower spot or ditch away from cars or trees. Lie flat or crouch; face down, with your arms covering your head. Avoid bridges as they offer little protection against flying debris.

It is wise to make a plan and be prepared since we live in tornado alley.

Wednesday, May 11, 2011

Dreaming of poison ivy

By Richard P. Holm M.D.

Every spring through summer I expect a call from a patient of mine after he’s had an exposure to poison ivy. Like 80% of the population, when he touches the plant he breaks out with a miserable blistery and itchy skin reaction. But my friend is so allergic to poison ivy that he gets a rash if he even dreams he’s gone camping.

In this area of the country poison ivy is a very common weed, as it crops up around lakes and streams and on the edge of wooded areas. Normally there are three green or red almond shaped leaves, the side leaflets sometimes have a notch, the middle leaf has a longer stem, stems are hairy without thorns, and there can be small clusters of green or white berries. This might be a freestanding shrub, a trailing ground plant, or come from a rope-like woody and hairy vine, which climbs trees. Remember: leaves of three, let it be; berries white, run in fright; and hairy vine, no friend of mine.

The rash is an allergic reaction humans have from the oil or sap that comes off the fine hairs on the stems, the leaves, and the woody vines, the later of which remain a threat even through the winter.

Once exposed to the oil, there is less than 15 minutes to remove it, and antiseptic rubbing alcohol towelettes are effective, readily available, and cheap. Then rinse this with cold water, followed with a dish detergent cleansing in lukewarm water as hot water too early can spread the toxin. Finally wipe down shoes with rubbing alcohol; wash clothes, and someone not so allergic should wash the dog.

Usually 12 to 48 hours after exposure the allergic skin reaction is a linear, very itchy, blistery rash, which may worsen over days or weeks if not treated. Know that the fluid from blisters is not toxic.

Treatment includes laying on of cool moist washcloths, followed by topical calamine lotion or over-the-counter cortisone cream, and if bad enough, see your doctor for a prednisone prescription.

So if you are dreaming of a camping trip, know what plant to avoid, bring alcohol towelettes, and call the doctor if you get that darn rash.

Saturday, April 23, 2011

When the sugar gets too low

By Richard P. Holm M.D.

“What would it feel like if my blood sugar gets too low?” the patient asked. I had advised her to watch out for hypoglycemia, or low sugar, since it might happen as a side effect of the new diabetic medicine I was prescribing.

I explained to her when sugars are low the body releases two rescue hormones in order to the sugar up. However these life-saving hormones cause symptoms.  Adrenalin brings cold sweats, a light-headed nervousness, butterflies, tremors, and a pounding heart. Glucagon causes a hungry-weak-uneasiness, nausea, and headache. Also the brain doesn’t work right when the sugar is too low and this causes irritability, blurry vision and confusion.  If severely low, loss of consciousness, seizures, and finally permanent brain injury can result.

I remember having a similar feeling as a high school student, when I wasn’t well prepared was standing in front of a crowd trying to play a trumpet solo by memory. My sugar wasn’t low. Rather, I was filled with adrenalin because I was so worried that I would forget the notes. But the feeling was the same: my heart was in my throat, sweat was pouring off my brow, and I was shaking like a leaf.

This same “fight or flight” feeling from an adrenalin surge is the first warning sign that happens when sugar gets too low, and should tell a savvy person to take some action to bring sugar levels up. Probably the fastest absorbed carbohydrate to raise sugar would be crackers, a piece of white bread, a baked potato, or a glass of fruit juice. Of course if the sugar is too low and the patient is having trouble swallowing, then an injection of glucagon or an IV with sugar water would be needed.

There are many and varied causes for low blood sugar, such as tumors of the pancreas, alcohol abuse, complications from gastric bypass surgery, and adrenal insufficiency to name a few. There is even a mild low sugar feeling that commonly occurs when one over-exercises on an empty stomach, but any such symptoms should be discussed with your doctor.

By far the most common cause for hypoglycemia is from certain diabetic medicine, however, and every diabetic should understand the symptoms.

Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.