Friday, July 31, 2009

Good Medicine

By Shawn Vuong

This week Dr. Holm talks about the over-use of medications. Sometimes, patients are on too many medications and there are many factors (or maybe the combination of these factors) that could be the culprit. As medicine continues onward so does drug and pharmaceutical research. This will only aggravate the over dependence on drugs we see today. Every day researchers and scientists discover more genes, cell markers, and biochemical pathways to target with new drugs.

As medicine becomes more and more advanced, we may see a decrease in pharmaceuticals. But I predict patients may actually be on more as research shows that therapies which include a combination of old and new drugs work best. What can we do about this over abundance of drugs? The patients can question their physician on why they need certain medications. Doctors can also help battle this by practicing good medicine.


By Richard P. Holm MD

The other day an 80 plus year old woman came into my office visiting from another state and asked if she could get off some of her pills. “I take too many,” she said, and I agreed with her. We stopped ten of the fourteen she was taking.

We live in a pill-taking society. Some of this probably comes from the human tendency to find an easier way to do things. If we have a choice whether to walk or ride to work, we will likely ride. If we have a choice whether to exercise or take a pill to lower blood pressure for example, we will likely take the pill. A pill is easier than a lifestyle change. And there are other forces also encouraging too many pills.

Some significant medical conditions just call for it. Sometimes it takes two to five drugs to get blood pressure down, or control a diabetic’s blood sugar or help a weak heart pump better. If you happen to struggle with a combination of these or other conditions, you can end up taking a smorgasbord of pills.

Clearly drug companies work very hard to convince doctors and patients that drugs work for almost every ailment. And think about how providers are asked by patients to solve a new problem each time, and how simple and pleasing to give a pill to satisfy their needs.

We have a culture with an inclination to over-rely on drugs and over-play their benefits, but what is worse, we under-play their risks. This is a fact: the more drugs, the higher the likelihood for a significant side effect or a dangerous interaction between medicines.

I am not saying that all medicines are bad, and I’m not encouraging you to stop taking your medicines without careful direction by your doctor. The next time you see your provider, however, ask her or him to review the pills you take and try to get the number down. That would be good medicine.

Friday, July 10, 2009

The Power of the Sun

By Shawn Vuong

The sun provides the body a vitamin. It is weird to think about right? We are not plants, yet we need sunlight. The sun is a great source of vitamin D, and also provides cues for your body to keep hormones in balance which is important for a person's sleep cycle and his/her psyche. In the same token, the sun is not something to be enjoyed too much, a person could have a so called "sun over-dose." UV rays from the sun are known to cause many skin conditions that Dr. Holm touches on in this following article. So, enjoy the sun in moderation. If you aren't getting enough sun, consider drinking more milk, eating more fish, or maybe even a short time in a tanning bed. While we don't need the sun for photosynthesis, humans health is affected by the great power of the sun.


By Richard P. Holm MD

There is something about the power of the sun. I was a sixteen-year-old Boy Scout on a canoe trip in Northern Minnesota one summer and we had been soaked with rain and chilled to the bone for two days straight. And then the sun came out, and I stretched out on a rock to gather some of its warmth.

At that moment I could feel the force of ol’ sol beaming into me, and I remember thinking how the sun’s radiation was the visible energy source for life on this earth, and I wanted more of it.

It must be a natural instinct to want exposure to the rays of the sun. Think how people gravitate to the beach, and how sad some get in the days of the winter solstice when they don’t get enough of it. But can you get too much?

The answer is yes. We know that excessive sun exposure causes premature aging with wrinkles, sagging, brown spots, rough skin, not to mention skin cancers, some of which are terrifically malignant. You hear and read everywhere the following words of advice: stay out of the sun; use sunscreen; wear protective clothing; and avoid tanning.

Recently, however, we have become more aware of the importance of enough vitamin D, which comes to us from the rays of the sun. We know that just about 50 percent don’t have enough of it when measured by blood. It is also interesting to note that the other natural source of that vitamin comes from the oil of deep-sea fish.

Scientists have linked low levels of vitamin D with not only increased bone fractures and pain but also heart disease, diabetes, and cancer of the breast, prostate, and colon. Therefore I encourage people to daily take 2000 units of vitamin D. We don’t, however, know yet if giving vitamin D supplements will help.

Maybe we all need to get outside and gather in more of that sun… just not too much of it.

The On Going Project

By Shawn Vuong

Dr. Holm and I continue in our pursuit to make this blog more informative, more educational for patients, and reach a broader range of people. We are currently working on a project to post whole segments of On Call, the famous South Dakota PBS medical broadcast. We hope to be able to post short segments on to YouTube and use them to augment this current text-based blog. After all, streaming video is the wave of the future.

Keep on the look-out for updates!

Forbidden Abdominal Surgery

By Shawn Vuong

In this editorial Dr. Holm brings up a little history of a group of operations so common now, we actually take it for granted. Back in a time before anesthesia and sterile technique, abdominal surgery led to almost certain death. Today, great advances in anesthesia and surgical technique make this type of surgery routine. As we look into the future of surgery with advances in robotic and minimally invasive techniques surgeons and patients are seeing better outcomes and shorter hospital stays than any other point in history. By looking at the history of surgery we can really appreciate the modern miracle of abdominal surgery.


By Richard P. Holm MD

Abdominal surgery was absolutely fatal until the time of Ephraim McDowell.

In the early 1800s medical school professors from every country in the world taught that cutting into the abdominal cavity would always result in infection and death. It was forbidden territory for surgeons.

People settling this new American country were less bound by rules and regulations however, and there was rumor of a West Virginia surgeon who had, a few years earlier, saved his wife and baby with what we now call a cesarean section. But, it could have been just rumor.

Ephraim McDowell was a young doctor from Danville, Kentucky, who had been educated mostly by following and assisting another doctor. Although he had one year of med-school training in the late 1700s, McDowell had never received a formal degree. Despite this, he earned a superb reputation as a neat and meticulous surgeon.

It was in 1809 that Jane Crawford’s lower abdomen began to swell. Her local doctors had made the mistaken diagnosis that she was over-due with twin babies, and called McDowell for guidance. After examining her he knew this was not a pregnancy. He explained to the desperate patient that it was an ovarian tumor, and the only possible cure could be surgery – which had never been done before.

Anesthesia was not to be discovered until the 1840s, and aseptic or sterile technique not to be popularized until the1870s. Despite all convention against doing abdominal surgery in 1809, McDowell knew the woman was doomed without it.

Mrs. Crawford pleaded for him to try, and so he had her come to his office some 60 miles away. While she sang hymns, Ephraim McDowell surgically removed the twenty-two pound tumor. Twenty-five days later Mrs. Crawford returned home in good health and lived for thirty-two more years.

It was quite a while later before the medical profession would admit that a small-town physician from Kentucky had opened the door to the life-saving possibilities of abdominal surgery.