Thursday, April 16, 2009

Breast Cancer

By Richard P. Holm MD

I've heard it said that we should all have a close brush with death about once a year, in order to keep our priorities straight. 

I spoke to a good friend the other day about her breast cancer experience, and the following story unfolded. During her routine monthly self-breast exam she found a nodule; an abnormal mammogram followed; and then she had a biopsy, which showed cancer cells.

Treatment began with a lumpectomy and then followed six weeks of radiation to the site. Finally gene testing showed how she had a very favorable prognosis and wouldn't require chemotherapy. The expression favorable prognosis is a sweet duet of words, which means that the future looks optimistic, with a very good chance that the cancer won't be back. 

Now it's been three years of disease free survival and she tells me the whole experience changed her life dramatically. Considering the possibility of dying and realizing that her life will not go on forever made her live more in the present. She re-thought what was important in her life, and refocused on giving time to her family.

During this difficult time my friend sensed a rising spiritual presence accompanying her, and grew to feel that she was not alone. She told me that this experience would have been ten times harder without a faith in God.

I have observed many people walk this kind of journey through the valley of death. I am a physician, not a religious leader, but I know that people who get through this experience change how they value their family and friends. They seem to listen more, treasure the little things, and savor the tastes and flavors of each day.

Sometimes we don't know what we have until we almost lose it.

Saturday, April 11, 2009

Three Cheers for Government Research

By Richard P. Holm MD

It was 1948, in Framingham, Massachusetts, when more than 5,000 people were first questioned about lifestyle, physically examined and blood tested. It was the beginning of the Framingham Heart Study, a government funded project, which has continued to this day. Every two years these same individuals are very carefully re-studied. In 1971 their children were added to the study, and in 2002 their grandchildren were entered.

Prior to this time little was known about the general causes for heart disease and stroke. In 1948, the rates of these conditions had been increasing steadily since the beginning of the century. How much is related to environmental factors and how much is inherited were the questions? Is it nurture or nature, and what can we do to make things better?

Over the years we have learned a lot from the Framingham data and we continue to discover from this large investigation why people develop heart disease and related conditions.

Now a similar survey called the National Childrens Study (NCS) is about to begin. The scope and diversity of the people in this research program is so much broader than from Framingham, however. It will involve 100,000 children, from representative counties all across the US, including right here in Brookings county. The NCS will follow these children from even before they are conceived until age 21.

It is important to note that, like in Framingham, no special interest group, such as the Pharmaceutical Industry or Medical Testing Industry, financially sponsors the NCS. Our government, specifically the U.S. Department of Health and Human Services along with the U.S. Environmental Protection Agency, is the fiscal supporter for this splendid and colossal effort.

I believe that our government should be much more involved in sponsoring research like the NCS and the Framingham Study; since industry sponsored studies, although important, have an inherent bias.

It is with the gathering of such information that we may finally learn what causes conditions like obesity, asthma, autism; or what influences intellect or mental health. Is it nurture or nature, and what can we do to make things better?

SDSU television show honored

A television show produced by South Dakota State University has won a national excellence award.

The weekly health-focused show "On Call" won the annual Award for Excellence from the National Association of Medical Communicators.


Monday, April 6, 2009

Are Two Heads Better?

By Richard P. Holm MD

Collaboration is a fancy word, which means two heads are better than one. It's the buzzword that always pops up when physicians are talking about Physician Assistants (PAs) and Nurse Practitioners (NPs). I believe that the art of collaboration, or knowing when and who to call for help, is about the most important and difficult challenge any PA, NP, or MD faces everyday. 

Take for example the isolated over-busy practitioner who knows a lot about everything, but not enough about the specific problem troubling that individual patient. Hopefully that care provider has enough experience and depth of knowledge to recognize when to ask for help and collaborate with someone who knows more. Two heads can be better than one.

There is another side to that story. Last month Mr. X had a complicated problem and I sent him to the specialist in another community. Before he returned, three other specialists were consulted by the first, each adding another test, and medicine, and expense. I was faxed copies of all these consults, but basically kept out of the loop until the patient returned to my office. Here's a time when the big picture had been lost while focusing on all the tiny parts. Sometimes one head is better than four.

Many experts say that the cost and access problems we have with our health care in the US are because care is so fragmented. All the parts are not speaking to the whole. 

In this time where it is likely major health care reform will occur, we must be very careful to construct a system that would encourage care that starts with a medical home. This would be when one very well trained primary care MD, PA, or NP would know when to refer, when not to refer, and expect a return of responsibility for the patient.
Collaboration is the name of the game.

Rick's editorial for vaccines & disease prevention

Curiosity and rabies
(on Louis Pasteur)

The sum of all the world's knowledge in medical Science comes from people with open minds who Look with curious eyes at the messy world about Them. Louis Pasteur, born in rural France late in 1822, grew up to become one of those scientists whose curiosity made all the difference.

Starting with a knowledge of chemistry and a new tool called the microscope, Pasteur showed how different kinds of microorganisms were present when beer and wine ferment, when milk turns sour, and when meat decays. 

He helped the French beer and wine industry understand why their beverages sometimes turned bad, how to prevent contamination, and how to culture the right organisms for the best beer and wine. He showed how to heat milk in order to extend time before souring, which is still called pasteurization. 

Not long after that, Pasteur rescued the French silkworm industry from a bacterial worm disease that had been decimating the silk producing worm crop.

Pasteur came to understand a method for vaccination almost by accident. Overworked while studying how chicken cholera can be given from one chicken to another, he took a week off, leaving his vials of infected juice in the window. When he returned he used the old and weakened material to infect more chickens. When this didn't make the chickens very sick, he had to start over with newly infected material, and discovered that the chickens already exposed to weakened material were resistant to infection.

This and another experiment with anthrax in cattle brought Pasteur to refine the process of vaccination, which protects by stimulating the individual immune system.

He is most known for his vaccination rescue from rabies and certain death when in 1886 he first saved a young man and then countless people from the bites of rabid animals.

Louis Pasteur, a great and curious man, indeed.