By Richard P. Holm, M.D.
This month, a scientific journal reported the remarkable case of a 35-year-old man who took an unusual treatment for ulcerative colitis. His colon was so inflamed and sore that he had been advised by doctors to have it surgically removed. After researching experimental therapy for ulcerative colitis, he decided to travel to Thailand where a doctor gave him 1,500 roundworm eggs to swallow.
The idea that worms might have something to do with ulcerative colitis and Crohn’s disease came from the observation that colitis is common in developed countries like America, where worm or parasitic infections are rare. In contrast, colitis is rare in countries where virtually the entire population has worms living inside of them.
This is similar to scientist David Strachan’s “hygiene hypothesis,” that was presented in the British Medical Journal in 1989. He showed data that hay fever and eczema were more common in families with one child than in larger families, and he speculated that the difference was because of an earlier and broader exposure to infections in the larger families. He suggested that more exposure to the dirty world results in less allergies.
Strachan’s idea has expanded and the “hygiene hypothesis” proposes that in developed countries, as a result of a “too-clean” environment, there is an increase in the diseases of the immune system such as inflammatory bowel disease, multiple sclerosis, asthma, and even childhood-onset diabetes mellitus type 1. Remember, however, the “hygiene hypothesis” is still just theory.
Let’s get back to our patient with colitis that traveled to Thailand. To everyone’s delight, after eating worm eggs, the gentleman quickly became symptom free. About three years later, after a relapse, he took more eggs and got better again. Over the six years that scientists studied the patient, they found his immune system was changed by worm therapy and noted that his colon had increased mucous production.
We are not talking night crawlers here, and some worm infections can be very harmful in humans, so people should not eat worms without scientific direction. Studies are now underway using pig whipworms, which are a less-aggressive worm, in treating not only inflammatory bowel disease, but also multiple sclerosis.
“Nobody loves me, everybody hates me, guess I’ll eat some worms.” Maybe some day we’ll be eating worms for colitis, too.
Sunday, December 19, 2010
Monday, December 13, 2010
On suffering
By Richard P. Holm, M.D.
Part of the mantra or sacred prayer of every physician is to reduce suffering, but what is it to suffer? The dictionary explains suffering as more than just experiencing something unpleasant or painful. The origin of the word comes from the Latin word “sufferre” or “to bear,” as if carrying a burden.
It is interesting to note that neuro-imaging maps have found that a certain part of the brain fires up when we feel either physical pain or emotional distress. Two radically different kinds of suffering seem to share a single neurological space in our heads. I also read in researching this topic that some individuals feel suffering leads to the construction of meaning in life and that it helps us to know more about our world.
To better understand the concept of suffering, this week I asked a number of patients and friends what it was that had caused them the most suffering. Surprisingly not one described an experience of physical pain. Rather the answers all turned around emotional loss. I heard about emptiness and anxiety following the death of parents and siblings, about the psychological stress of having kids, and a lot about the depression following divorce. People seem to forget about physical pain, but they remember emotional hurting.
Recently a national survey of hospice directors asked how we treat those dying from various illnesses and I was asked to fill out a form with challenging questions. Two questions were especially difficult for me: “Is pain and suffering a means for spiritual growth?” and “Should physicians seek to relieve patients’ spiritual suffering just as much as patients’ physical pain?”
I have no problem with the idea that people grow from suffering, but I struggle with the subtle implication that to relieve people of life’s emotional and spiritual pain could possibly rob their lives of meaning.
Bottom line, emotional pain is probably more significant than most of us realize, and my hat is off to the psychiatrists and psychologists whose jobs concentrate on just that part of the quest to enhance human health.
May we all find meaning in this crazy and sometimes hurtful life, and may we all find some help when it gets too painful.
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.
Part of the mantra or sacred prayer of every physician is to reduce suffering, but what is it to suffer? The dictionary explains suffering as more than just experiencing something unpleasant or painful. The origin of the word comes from the Latin word “sufferre” or “to bear,” as if carrying a burden.
It is interesting to note that neuro-imaging maps have found that a certain part of the brain fires up when we feel either physical pain or emotional distress. Two radically different kinds of suffering seem to share a single neurological space in our heads. I also read in researching this topic that some individuals feel suffering leads to the construction of meaning in life and that it helps us to know more about our world.
To better understand the concept of suffering, this week I asked a number of patients and friends what it was that had caused them the most suffering. Surprisingly not one described an experience of physical pain. Rather the answers all turned around emotional loss. I heard about emptiness and anxiety following the death of parents and siblings, about the psychological stress of having kids, and a lot about the depression following divorce. People seem to forget about physical pain, but they remember emotional hurting.
Recently a national survey of hospice directors asked how we treat those dying from various illnesses and I was asked to fill out a form with challenging questions. Two questions were especially difficult for me: “Is pain and suffering a means for spiritual growth?” and “Should physicians seek to relieve patients’ spiritual suffering just as much as patients’ physical pain?”
I have no problem with the idea that people grow from suffering, but I struggle with the subtle implication that to relieve people of life’s emotional and spiritual pain could possibly rob their lives of meaning.
Bottom line, emotional pain is probably more significant than most of us realize, and my hat is off to the psychiatrists and psychologists whose jobs concentrate on just that part of the quest to enhance human health.
May we all find meaning in this crazy and sometimes hurtful life, and may we all find some help when it gets too painful.
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.
Sunday, November 14, 2010
Send the kids outside to play
By Richard P. Holm, M.D.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said that kids throughout the rest of the world need to step away from their computers and TVs, and exercise their glorious freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first- to fifth-grade children. It was a combined effort by staff at the Brookings Boys and Girls Club, researchers from South Dakota State University, South Dakota medical-school students, and the South Dakota Internal Medicine organization, called the American College of Physicians. We found pedometer and activity readings were significantly greater when children were simply allowed to have free-play, as compared to organized activity.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting spring snow gutter-rivers, and summer biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high-caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes, and why adult joints are so stiff and immobile, and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity. This problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play. And remember, what’s good for kids are good for people of all ages.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said that kids throughout the rest of the world need to step away from their computers and TVs, and exercise their glorious freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first- to fifth-grade children. It was a combined effort by staff at the Brookings Boys and Girls Club, researchers from South Dakota State University, South Dakota medical-school students, and the South Dakota Internal Medicine organization, called the American College of Physicians. We found pedometer and activity readings were significantly greater when children were simply allowed to have free-play, as compared to organized activity.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting spring snow gutter-rivers, and summer biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high-caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes, and why adult joints are so stiff and immobile, and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity. This problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play. And remember, what’s good for kids are good for people of all ages.
Thursday, November 4, 2010
Send the kids outside to play
By Richard P. Holm M.D.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said kids throughout the rest of the world need to step away from their computers and TV sets, and exercise their freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first to fifth grade children. It was a combined effort by staff at the Brookings Boys and Girls club, researchers from SDSU, South Dakota med students, and the SD Internal Medicine organization, the ACP. We found pedometer and activity readings were greater when children were simply encouraged to have free-play, as compared to organized activity, or screen time.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting snow gutter-rivers, and biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes; why adult joints are so stiff and immobile; and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity and this problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said kids throughout the rest of the world need to step away from their computers and TV sets, and exercise their freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first to fifth grade children. It was a combined effort by staff at the Brookings Boys and Girls club, researchers from SDSU, South Dakota med students, and the SD Internal Medicine organization, the ACP. We found pedometer and activity readings were greater when children were simply encouraged to have free-play, as compared to organized activity, or screen time.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting snow gutter-rivers, and biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes; why adult joints are so stiff and immobile; and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity and this problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play.
Tuesday, November 2, 2010
Mental health and mortality
By Richard P. Holm, M.D.
Mental and emotional problems are everywhere. More than half of what I do, as a general internist, is to help people deal with emotional problems. It comes with the heartbreak and suffering of loss, pain, or growing old, with debilitating illnesses, and with the burden of mental illness itself. It is truly a challenge to try to help people cope with such trouble.
This September a large, 13-year Canadian study reported a 322-percent higher death rate in people taking minor tranquillizers compared with those not taking such medicines. Use of this type of drug can be taken as an indicator of emotional problems. Looking closer, there were huge socio-demographic and lifestyle differences between groups.
The study implied that if one comes from a tough neighborhood, drops out of school, struggles with addiction, abuses alcohol, smokes, does not exercise, and has mental health problems, then the risk of premature death is more than three times higher than one without such problems. In other words, emotional illness often walks side-by-side with tough social, economic, and health problems. And the combination is associated with premature death.
There was also an inference from the study that the use of minor tranquilizer-type sleeping medicine might alone carry some risk to one’s physical health. My personal interpretation from the data is that sleeping pills and anti-anxiety medicines can cover up or make worse an underlying depression. What’s more, these tranquilizers often put off or prevent appropriate therapy, such as counseling, exercise programs, and very effective antidepressant medicines.
Mental health is truly an important ideal but it comes and goes for each of us as we struggle and meander through our lives. Physicians and care providers have tools to help, including ears to listen, words of advice, and sometimes even good medicine to prescribe. To ignore indicators that there might be a mental health problem could mean the difference between life and death.
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.
Mental and emotional problems are everywhere. More than half of what I do, as a general internist, is to help people deal with emotional problems. It comes with the heartbreak and suffering of loss, pain, or growing old, with debilitating illnesses, and with the burden of mental illness itself. It is truly a challenge to try to help people cope with such trouble.
This September a large, 13-year Canadian study reported a 322-percent higher death rate in people taking minor tranquillizers compared with those not taking such medicines. Use of this type of drug can be taken as an indicator of emotional problems. Looking closer, there were huge socio-demographic and lifestyle differences between groups.
The study implied that if one comes from a tough neighborhood, drops out of school, struggles with addiction, abuses alcohol, smokes, does not exercise, and has mental health problems, then the risk of premature death is more than three times higher than one without such problems. In other words, emotional illness often walks side-by-side with tough social, economic, and health problems. And the combination is associated with premature death.
There was also an inference from the study that the use of minor tranquilizer-type sleeping medicine might alone carry some risk to one’s physical health. My personal interpretation from the data is that sleeping pills and anti-anxiety medicines can cover up or make worse an underlying depression. What’s more, these tranquilizers often put off or prevent appropriate therapy, such as counseling, exercise programs, and very effective antidepressant medicines.
Mental health is truly an important ideal but it comes and goes for each of us as we struggle and meander through our lives. Physicians and care providers have tools to help, including ears to listen, words of advice, and sometimes even good medicine to prescribe. To ignore indicators that there might be a mental health problem could mean the difference between life and death.
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.
Thursday, October 28, 2010
The medicine wheel, the Great Spirit, and John Wesley
By Richard P. Holm M.D.
The American Indian medicine wheel is thought to have existed for more than 5,000 years and has been the basis for not only medicinal but also religious approaches to problems of living.
Although there are significant differences between regions and tribes, the medicine wheel reflects not only certain botanicals but also the circle of life and the Great Spirit surrounding all of us. East is spring, sunrise, childhood, physical, and yellow; south is summer, noon, adolescence, social, and red; west is autumn, sunset, adult, intellectual, and black; north is winter, night, elder, spiritual, and white. Up is sky and Father; down is earth and Mother; and center is fire.
The history of modern medicine in the Americas starts with the spiritual and herbal knowledge of the Indian. As the Europeans made their great western migration into this new land with Mediterranean medical concepts, there was a great mixing of ideas with the American Indian’s spiritual and herbal way. This resulted in the evolution of a uniquely American way of caring for the ill, especially helped by Indian knowledge of the medicinal nature of flora and fauna, and their respect for the spiritual element needed for healing. This in turn, influenced health care throughout the world and reflections of it remain with us today.
In 1735, when young John Wesley the famous English Methodist came to a new American colony at Savannah, Georgia, he was impressed by the rugged health and the medical practices of the American Indian. Later back in England he even composed a book, which described many Indian secrets to the art of healing.
Wesley wrote that Indian illnesses, during this era, were exceedingly few because of their continual exercise and lack of excessive alcohol. The great epidemics brought from Europe followed, however, and the physically rigorous life was no longer required. It resulted in decimation of about 80% of the Indian population with severe injury to their spiritual focus and culture.
We should learn and never forget the lessons from American Indian heritage: the proper use of medicinal ingredients, the value of a physically active life, and the spiritual power of the circle of life and the Great Spirit surrounding us all.
The American Indian medicine wheel is thought to have existed for more than 5,000 years and has been the basis for not only medicinal but also religious approaches to problems of living.
Although there are significant differences between regions and tribes, the medicine wheel reflects not only certain botanicals but also the circle of life and the Great Spirit surrounding all of us. East is spring, sunrise, childhood, physical, and yellow; south is summer, noon, adolescence, social, and red; west is autumn, sunset, adult, intellectual, and black; north is winter, night, elder, spiritual, and white. Up is sky and Father; down is earth and Mother; and center is fire.
The history of modern medicine in the Americas starts with the spiritual and herbal knowledge of the Indian. As the Europeans made their great western migration into this new land with Mediterranean medical concepts, there was a great mixing of ideas with the American Indian’s spiritual and herbal way. This resulted in the evolution of a uniquely American way of caring for the ill, especially helped by Indian knowledge of the medicinal nature of flora and fauna, and their respect for the spiritual element needed for healing. This in turn, influenced health care throughout the world and reflections of it remain with us today.
In 1735, when young John Wesley the famous English Methodist came to a new American colony at Savannah, Georgia, he was impressed by the rugged health and the medical practices of the American Indian. Later back in England he even composed a book, which described many Indian secrets to the art of healing.
Wesley wrote that Indian illnesses, during this era, were exceedingly few because of their continual exercise and lack of excessive alcohol. The great epidemics brought from Europe followed, however, and the physically rigorous life was no longer required. It resulted in decimation of about 80% of the Indian population with severe injury to their spiritual focus and culture.
We should learn and never forget the lessons from American Indian heritage: the proper use of medicinal ingredients, the value of a physically active life, and the spiritual power of the circle of life and the Great Spirit surrounding us all.
Friday, October 1, 2010
A lousy essay about cooties
By Richard P. Holm M.D.
Remember a cruel playground game about cooties or “you’re it?” Also called pediculosis capitis, cooties, or a head louse infestation truly is something from which to run. Head lice are small wingless insects that get into the hair and scalp. Except for the common cold, this infestation is the most common communicable condition of childhood, affecting something like 10-20 million people per year.
They do not jump or fly, or live on any other animal but humans, but these little blood-sucking invaders are extremely easy to spread by head-to-head contact. This happens especially in pre-school, kindergarten, grade-school spaces, where kids will be kids, and personal hygiene has nothing to do with it.
The diagnosis is confirmed by finding the louse, which is clear to tan and the size of a sesame seed, crawling around the ears and at the nape of the neck, or discovering tiny white to grey eggs, also called nits, attached to hair shafts.
It is nice to know that head lice generally do not crawl outside the scalp, and other than causing severe itching, the condition does not cause any other important problem or carry any illness.
This is in contrast to their cousin “body lice,” who reside below the scalp, after feeding set up in the creases of clothes, and can carry infectious diseases such as typhus, trench fever, and relapsing fever. Head lice are also different from bed bugs who are brown and larger, can live away from the human body, and can feed off warm-blooded mammals other than humans. It is a relief to know that bed bugs carry no disease, which is similar to head lice but unlike body lice.
The treatment of head lice involves attacking from several directions. Start with over-the-counter Permethrin lotion (Nix), or Pyrethrin (Rid, A200, or Pronto shampoo). These need repeating in one week to get the next egg hatch. (Suffocating with mayonnaise, herbals, olive oil, or butter does not work.) What is most effective and yet underutilized is to thoroughly comb wet hair every two days for two weeks with a special fine-tooth comb. Finally wash all bed linens and clothing that came in contact with those infested, drying in a hot dryer for 40 minutes. Bagging stuffed animals and clothing for two weeks also works.
So when your little one comes home with cooties, don’t panic and don’t run. Get out a fine-tooth comb, special lotion, and get to work.
Remember a cruel playground game about cooties or “you’re it?” Also called pediculosis capitis, cooties, or a head louse infestation truly is something from which to run. Head lice are small wingless insects that get into the hair and scalp. Except for the common cold, this infestation is the most common communicable condition of childhood, affecting something like 10-20 million people per year.
They do not jump or fly, or live on any other animal but humans, but these little blood-sucking invaders are extremely easy to spread by head-to-head contact. This happens especially in pre-school, kindergarten, grade-school spaces, where kids will be kids, and personal hygiene has nothing to do with it.
The diagnosis is confirmed by finding the louse, which is clear to tan and the size of a sesame seed, crawling around the ears and at the nape of the neck, or discovering tiny white to grey eggs, also called nits, attached to hair shafts.
It is nice to know that head lice generally do not crawl outside the scalp, and other than causing severe itching, the condition does not cause any other important problem or carry any illness.
This is in contrast to their cousin “body lice,” who reside below the scalp, after feeding set up in the creases of clothes, and can carry infectious diseases such as typhus, trench fever, and relapsing fever. Head lice are also different from bed bugs who are brown and larger, can live away from the human body, and can feed off warm-blooded mammals other than humans. It is a relief to know that bed bugs carry no disease, which is similar to head lice but unlike body lice.
The treatment of head lice involves attacking from several directions. Start with over-the-counter Permethrin lotion (Nix), or Pyrethrin (Rid, A200, or Pronto shampoo). These need repeating in one week to get the next egg hatch. (Suffocating with mayonnaise, herbals, olive oil, or butter does not work.) What is most effective and yet underutilized is to thoroughly comb wet hair every two days for two weeks with a special fine-tooth comb. Finally wash all bed linens and clothing that came in contact with those infested, drying in a hot dryer for 40 minutes. Bagging stuffed animals and clothing for two weeks also works.
So when your little one comes home with cooties, don’t panic and don’t run. Get out a fine-tooth comb, special lotion, and get to work.
Sunday, September 19, 2010
Sharing of Cultures and The Art of Healing
By Richard P. Holm MD
The earliest records of medical teaching came from very ancient Egypt, Babylonia, India, and China. Accounts of experimental and scientific thought, however, first began in Greece and expanded into the medical teaching of Hippocrates and his students. Medical learning then spread to ancient Rome where the word medicine was derived from the Latin “ars medicina,” meaning the art of healing, and this knowledge spread throughout the Roman Empire.
Alas, the ancient knowledge of the Mediterranean would have been lost with the burning of the Library of Alexander and the sacking of Rome except for the collections saved in the Arab world.
Probably the first medical school developed one thousand years ago in the southern Italian coastal city of Salerno. It happened because of a monk named Constantine the African, who understood Arabic and other languages of the time. He could translate, back into Latin, the surviving ancient Grecian and Roman medical texts, which were then written in Arabic and had been invigorated by more than a hundred years of medical practice in Arabia. So it was that in a small library in a Salerno monastery, ancient medical knowledge became accessible once again to the Western world.
Reinvigorated with these translations, the medical practitioners of Salerno became the best care providers of the medieval world, and, in turn, drew the sick in hope of discovering a cure and students seeking to learn the art of medicine. Over time, the sharing and learning accelerated. Salerno thus became known as the “Town of Hippocrates,” where Greek and Latin medical traditions merged with Arab and also Jewish wisdom.
The coming-together of different cultures and information led to a wonderful augmentation and synergy of medical knowledge, where men and women of mixed backgrounds reveled in learning how to care for the sick in a medieval world. Of course this golden time ended by forces of political and cultural hatred, but the knowledge that almost had been lost still survived. Some of it is taught in medical schools today.
May we always remember the lessons of the past, the value of recording knowledge, and the wisdom of sharing cultures.
The earliest records of medical teaching came from very ancient Egypt, Babylonia, India, and China. Accounts of experimental and scientific thought, however, first began in Greece and expanded into the medical teaching of Hippocrates and his students. Medical learning then spread to ancient Rome where the word medicine was derived from the Latin “ars medicina,” meaning the art of healing, and this knowledge spread throughout the Roman Empire.
Alas, the ancient knowledge of the Mediterranean would have been lost with the burning of the Library of Alexander and the sacking of Rome except for the collections saved in the Arab world.
Probably the first medical school developed one thousand years ago in the southern Italian coastal city of Salerno. It happened because of a monk named Constantine the African, who understood Arabic and other languages of the time. He could translate, back into Latin, the surviving ancient Grecian and Roman medical texts, which were then written in Arabic and had been invigorated by more than a hundred years of medical practice in Arabia. So it was that in a small library in a Salerno monastery, ancient medical knowledge became accessible once again to the Western world.
Reinvigorated with these translations, the medical practitioners of Salerno became the best care providers of the medieval world, and, in turn, drew the sick in hope of discovering a cure and students seeking to learn the art of medicine. Over time, the sharing and learning accelerated. Salerno thus became known as the “Town of Hippocrates,” where Greek and Latin medical traditions merged with Arab and also Jewish wisdom.
The coming-together of different cultures and information led to a wonderful augmentation and synergy of medical knowledge, where men and women of mixed backgrounds reveled in learning how to care for the sick in a medieval world. Of course this golden time ended by forces of political and cultural hatred, but the knowledge that almost had been lost still survived. Some of it is taught in medical schools today.
May we always remember the lessons of the past, the value of recording knowledge, and the wisdom of sharing cultures.
Thursday, July 29, 2010
The Hippocratic Promise
Richard P. Holm MD
Through ancient and modern history, there is a tradition in the medical profession that the graduating medical student publicly and formally takes an oath and promises to uphold high ethical standards. It is a med student rite of passage, which has been handed down from our ancestors.
Historically it has been the Hippocratic oath, which is to swear by Apollo the Physician, and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, to preserve life and to care for all regardless of rank, age or intellect. This apparently represented a shift in attitude in ancient Greece, as earlier many had used the knowledge of medicines and herbs to poison. Also it asked that the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a child with a disability should all be valued as equal in importance.
But this traditional oath is replete with modern controversy. For example if the old oath is followed, the children of physicians would have preferential admission into medical school; we could not cut out kidney or bladder stones, or do any surgery for that matter; physicians could not take payment for providing care to patients (except maybe room and board); and there would be conflict with how we presently give suffering terminal patients enough pain medicine. Indeed, the old oath was meant for another time.
At the Sanford USD School of Medicine as in every medical school graduating medical students still give a contemporary version of the Hippocratic oath. Although there is some variation between schools, every version promises to diminish suffering and enhance health; to do no harm; to search for truth through science; and to respect the freedom and right of self direction for every patient. Modern versions also speak to just distribution of care when resources are limited, avoiding over and under-treatment, asking for help when necessary, and the art of a warm, sympathetic, and caring bedside manner.
Every physician upon entering the medical profession has made an oath and covenant to uphold a worthy ethical standard. This is more than tradition. It is a promise.
Through ancient and modern history, there is a tradition in the medical profession that the graduating medical student publicly and formally takes an oath and promises to uphold high ethical standards. It is a med student rite of passage, which has been handed down from our ancestors.
Historically it has been the Hippocratic oath, which is to swear by Apollo the Physician, and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, to preserve life and to care for all regardless of rank, age or intellect. This apparently represented a shift in attitude in ancient Greece, as earlier many had used the knowledge of medicines and herbs to poison. Also it asked that the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a child with a disability should all be valued as equal in importance.
But this traditional oath is replete with modern controversy. For example if the old oath is followed, the children of physicians would have preferential admission into medical school; we could not cut out kidney or bladder stones, or do any surgery for that matter; physicians could not take payment for providing care to patients (except maybe room and board); and there would be conflict with how we presently give suffering terminal patients enough pain medicine. Indeed, the old oath was meant for another time.
At the Sanford USD School of Medicine as in every medical school graduating medical students still give a contemporary version of the Hippocratic oath. Although there is some variation between schools, every version promises to diminish suffering and enhance health; to do no harm; to search for truth through science; and to respect the freedom and right of self direction for every patient. Modern versions also speak to just distribution of care when resources are limited, avoiding over and under-treatment, asking for help when necessary, and the art of a warm, sympathetic, and caring bedside manner.
Every physician upon entering the medical profession has made an oath and covenant to uphold a worthy ethical standard. This is more than tradition. It is a promise.
Tuesday, July 13, 2010
Valuing Others
By Richard P. Holm MD
This week, in our little town in South Dakota, a young man in his twenties came into my office weeping and scratching his arms and legs. I was expecting a rash-type problem, when he blurted out that he was injecting methamphetamine two to four times a day. “It has destroyed my life,” he said. “I used to have a job, insurance, a house, and a life. Now I have nothing. Please help me,” he cried. I did my best for him.
By definition addiction is the state of physical or psychological dependence on a drug, which is liable to have a damaging effect. It’s a habit, a compulsion, or an obsession, which turns around and bites the user and everyone nearby. Alcoholism is the most pervasive and obvious addiction in our society. If it doesn’t directly affect you, most certainly it affects someone dear to you.
The potential for addiction is part of our collective human nature. I dare say that every one of us given just the right situation would be addicted to one drug or another, whether it be cigarettes, pain medicines, sleeping pills, marijuana, methamphetamine or a fine red wine.
What is it that separates the addict from normal happy people who are able to function in society? Some experts define addiction and, specifically, alcoholism with the four features of craving, loss of control, physical dependence, and tolerance. Others add that addiction means losing perspective about what has value in life. Vision of the surrounding world dims, and instead the addict obsesses on self and how to get another shot, pill, snort, drag, or drink. Addiction accelerates like a maelstrom into such selfness until nothing else exists.
It makes sense then that the opportunity for recovery comes with the sacred message of the Golden Rule: treating others with compassion and fairness. Valuing others is the key ingredient in order to sober- up the self-absorbed addicted individual. It is no wonder spiritual based programs for sobriety are the most successful.
No question, we are all at risk for the selfish cycle of addiction, and our best help comes by relearning how to care for others.
This week, in our little town in South Dakota, a young man in his twenties came into my office weeping and scratching his arms and legs. I was expecting a rash-type problem, when he blurted out that he was injecting methamphetamine two to four times a day. “It has destroyed my life,” he said. “I used to have a job, insurance, a house, and a life. Now I have nothing. Please help me,” he cried. I did my best for him.
By definition addiction is the state of physical or psychological dependence on a drug, which is liable to have a damaging effect. It’s a habit, a compulsion, or an obsession, which turns around and bites the user and everyone nearby. Alcoholism is the most pervasive and obvious addiction in our society. If it doesn’t directly affect you, most certainly it affects someone dear to you.
The potential for addiction is part of our collective human nature. I dare say that every one of us given just the right situation would be addicted to one drug or another, whether it be cigarettes, pain medicines, sleeping pills, marijuana, methamphetamine or a fine red wine.
What is it that separates the addict from normal happy people who are able to function in society? Some experts define addiction and, specifically, alcoholism with the four features of craving, loss of control, physical dependence, and tolerance. Others add that addiction means losing perspective about what has value in life. Vision of the surrounding world dims, and instead the addict obsesses on self and how to get another shot, pill, snort, drag, or drink. Addiction accelerates like a maelstrom into such selfness until nothing else exists.
It makes sense then that the opportunity for recovery comes with the sacred message of the Golden Rule: treating others with compassion and fairness. Valuing others is the key ingredient in order to sober- up the self-absorbed addicted individual. It is no wonder spiritual based programs for sobriety are the most successful.
No question, we are all at risk for the selfish cycle of addiction, and our best help comes by relearning how to care for others.
Friday, June 18, 2010
Protecting Little Girls
By Richard P. Holm MD
Lying on the rolling cot in the emergency room, the beautiful six-year-old little girl was unconscious with bruises on her head, face, and scattered over her body. “Please help her,” pleaded the woman with a baby in her arms. She told me the little girl had been trying to learn how to ride the bike her Daddy had just purchased for her, and I believed what the woman told me.
After the bleed into the brain was diagnosed the story unfolded, and I learned that the woman was not the mother of the injured girl, rather the girlfriend of the father and that the overwhelming evidence showed the physical abuse came from the girlfriend. No one had been there to protect that little girl, and she died a day later from severe head trauma.
Child abuse is only one kind of violence, which can occur between members of any group of people living together. The American Psychiatric Association defines domestic violence as control by one family member over another with some kind of physical, sexual, emotional and/or economic abuse. It comes down to an issue of power, where someone with the upper hand takes advantage of another.
The Centers for Disease Control states that we know about only one third of the cases, and estimates that domestic violence affects more than 32 million Americans, or over ten percent of the U.S. population.
Why does this happen? Is it because our human nature wants to put someone else down when feeling inadequate or angry with our self? Is it because children who are raised in a home where it is not safe learn to threaten and bully rather than to protect people close to them, and this kind of activity perpetuates itself?
No one should have to live in a home where someone with an upper hand abuses another person, a spouse, a partner, a child, or even an elderly parent. Our job in this family of humanity is to find ways to protect little girls and everyone else from those who are threatening abuse.
Lying on the rolling cot in the emergency room, the beautiful six-year-old little girl was unconscious with bruises on her head, face, and scattered over her body. “Please help her,” pleaded the woman with a baby in her arms. She told me the little girl had been trying to learn how to ride the bike her Daddy had just purchased for her, and I believed what the woman told me.
After the bleed into the brain was diagnosed the story unfolded, and I learned that the woman was not the mother of the injured girl, rather the girlfriend of the father and that the overwhelming evidence showed the physical abuse came from the girlfriend. No one had been there to protect that little girl, and she died a day later from severe head trauma.
Child abuse is only one kind of violence, which can occur between members of any group of people living together. The American Psychiatric Association defines domestic violence as control by one family member over another with some kind of physical, sexual, emotional and/or economic abuse. It comes down to an issue of power, where someone with the upper hand takes advantage of another.
The Centers for Disease Control states that we know about only one third of the cases, and estimates that domestic violence affects more than 32 million Americans, or over ten percent of the U.S. population.
Why does this happen? Is it because our human nature wants to put someone else down when feeling inadequate or angry with our self? Is it because children who are raised in a home where it is not safe learn to threaten and bully rather than to protect people close to them, and this kind of activity perpetuates itself?
No one should have to live in a home where someone with an upper hand abuses another person, a spouse, a partner, a child, or even an elderly parent. Our job in this family of humanity is to find ways to protect little girls and everyone else from those who are threatening abuse.
Wednesday, May 19, 2010
Slow Food
By Richard P. Holm
Why does food satisfy the appetite? If we could understand what tells us when to stop eating, then maybe we could understand the cause for obesity.
We know that a hormone called ghrelin delivers feelings of hunger to the brain and that two hormones called cholecystokinin and leptin bring feelings of satiation. So far, however, scientists, and especially those of the pharmaceutical industry, have failed in efforts to safely manipulate these natural signals to stimulate or suppress hunger.
Another direction of research comes with understanding how certain foods like oatmeal, boiled potatoes, or fresh fruit fill you up, and others like donuts, French fries, or even dried fruit do not. It is interesting to note that drinks of any kind seem very poor in providing feelings of fullness or satiety. It makes perfect sense then that if one is struggling with obesity, foods that do not satisfy hunger, especially those that are highly caloric, should be avoided.
And what about eating too fast? We know it takes time for the food we eat to stimulate our satiety hormones. We all know it is not very satisfying when we shove fast food into our mouths and swallow it down with a big gulp. No one can argue that the obesity epidemic could be related to oh-so-convenient fast food, which seems to match the fast-paced, unsatisfying rush of modern life.
In contrast, there is the Slow Food movement founded in Italy in the 1980s. Slow Food asks us to preserve regional cuisine and local flavors, and to promote local gardens and local family farmers. Slow Food asks us to shop the farmer’s markets, raise our own gardens, teach our children to cook, take time around the supper table to eat slowly, savor the food, and enjoy the company of family.
Bottom line, and the pun is intended: all the rush, with our busy frenetic modern lives, and especially with all that fast-fast food, has left us weighing more and satisfied less. It is time to slow down and savor our food and our lives. to slow down.
Why does food satisfy the appetite? If we could understand what tells us when to stop eating, then maybe we could understand the cause for obesity.
We know that a hormone called ghrelin delivers feelings of hunger to the brain and that two hormones called cholecystokinin and leptin bring feelings of satiation. So far, however, scientists, and especially those of the pharmaceutical industry, have failed in efforts to safely manipulate these natural signals to stimulate or suppress hunger.
Another direction of research comes with understanding how certain foods like oatmeal, boiled potatoes, or fresh fruit fill you up, and others like donuts, French fries, or even dried fruit do not. It is interesting to note that drinks of any kind seem very poor in providing feelings of fullness or satiety. It makes perfect sense then that if one is struggling with obesity, foods that do not satisfy hunger, especially those that are highly caloric, should be avoided.
And what about eating too fast? We know it takes time for the food we eat to stimulate our satiety hormones. We all know it is not very satisfying when we shove fast food into our mouths and swallow it down with a big gulp. No one can argue that the obesity epidemic could be related to oh-so-convenient fast food, which seems to match the fast-paced, unsatisfying rush of modern life.
In contrast, there is the Slow Food movement founded in Italy in the 1980s. Slow Food asks us to preserve regional cuisine and local flavors, and to promote local gardens and local family farmers. Slow Food asks us to shop the farmer’s markets, raise our own gardens, teach our children to cook, take time around the supper table to eat slowly, savor the food, and enjoy the company of family.
Bottom line, and the pun is intended: all the rush, with our busy frenetic modern lives, and especially with all that fast-fast food, has left us weighing more and satisfied less. It is time to slow down and savor our food and our lives. to slow down.
When Grandma Wants to Pull the Plug
By Richard P. Holm MD
“We will all be dead one day, we should not pretend that it won’t happen, and we should all prepare for the experience rather than ignore it.” Recently I was asked to give a talk about the value of the Living Will, and I remember that it became very quiet after those words.
I spoke to a room full of mostly retired people, some of them quite elderly, and I explained that, too often, I have watched helplessly while desperate, fruitless, excessive, and painful health care was provided to a person certainly dying. Put it down as one more paradox in medicine. The fear of death and not facing the reality of dying can be responsible for much of the suffering that can occur at the end of life.
A Living Will, also called an Advanced Directive, is simply a tool to communicate about how you would like to die. It is not about a legal document, it is all about talking to your family. We know there is a time to intervene with fancy medical care and there is a time to let go. My final talking point: the Living Will makes it easier for families to allow a natural and comfortable death when the time is right.
After the presentation one guy told me his wife purposefully avoided coming because she didn’t want to think about such gloomy things. He said wryly, “We are all going to die. Why shouldn’t we talk about it?”
Another asked, “I still don’t know the definition of a Living Will. Does it have anything to do with death squads pulling the plug on Grandma?” I responded, “No, just the opposite. It is all about Grandma telling us when not to put tubes in, so no one has to pull a plug.”
I can’t say it was my happiest audience, and I’m afraid I may have offended some of them by being so blunt. But in this age of external chest massage, shocking paddles, breathing machines, feeding tubes, and the potential for years of vegetative bedridden life, there is hardly a more important message.
“We will all be dead one day, we should not pretend that it won’t happen, and we should all prepare for the experience rather than ignore it.” Recently I was asked to give a talk about the value of the Living Will, and I remember that it became very quiet after those words.
I spoke to a room full of mostly retired people, some of them quite elderly, and I explained that, too often, I have watched helplessly while desperate, fruitless, excessive, and painful health care was provided to a person certainly dying. Put it down as one more paradox in medicine. The fear of death and not facing the reality of dying can be responsible for much of the suffering that can occur at the end of life.
A Living Will, also called an Advanced Directive, is simply a tool to communicate about how you would like to die. It is not about a legal document, it is all about talking to your family. We know there is a time to intervene with fancy medical care and there is a time to let go. My final talking point: the Living Will makes it easier for families to allow a natural and comfortable death when the time is right.
After the presentation one guy told me his wife purposefully avoided coming because she didn’t want to think about such gloomy things. He said wryly, “We are all going to die. Why shouldn’t we talk about it?”
Another asked, “I still don’t know the definition of a Living Will. Does it have anything to do with death squads pulling the plug on Grandma?” I responded, “No, just the opposite. It is all about Grandma telling us when not to put tubes in, so no one has to pull a plug.”
I can’t say it was my happiest audience, and I’m afraid I may have offended some of them by being so blunt. But in this age of external chest massage, shocking paddles, breathing machines, feeding tubes, and the potential for years of vegetative bedridden life, there is hardly a more important message.
Monday, April 19, 2010
Blueprint for Repair
By Richard P. Holm MD
We don’t always appreciate the wonderful healing capacity of our bones.
A few years back I was on call, and the ambulance brought in a young college gentleman who had fallen three stories off a roof onto the cement below. Apparently he landed first on his feet and fell forward. As he landed, he sequentially, like a row of falling dominoes, broke parts of his feet, legs, knees, hands, wrists, elbows, jaw, and nose. The orthopedist who came in to help when I called, counted something like 26 fractures, and my ENT specialist who also came in estimated the patient was going about 35 miles per hour when he hit the concrete.
We ended up sending the young man to the trauma center in Sioux Falls, but what was amazing was how his brain and vital organs had been protected. He had not lost consciousness, remained perfectly awake, and his heart, lungs, gut. and spine were just fine. But the best news came with how eventually, after a lot of rehabilitation, his bones repaired themselves. A year later he walked into my office, without a limp I should add, and shook my hand firmly to thank me for helping him that fateful night.
Most people have the concept that our bones and joints are continuously wearing out and deteriorating over time. It is common thinking that if we simply live long enough, we will end up as a slumped over pile of soft bones and frozen joints. This doesn’t have to be..
Instead, our bodies are constantly remodeling and repairing bones and joints; taking apart, breaking down, and then rebuilding anew. Small injuries are always happening along the way, and maybe it happens more so as we get older, but there is a continuous remodel-and-repair process always going on, throughout your whole life..
The key point to remember is that the blue print for the remodel comes from the daily motion and activity we ask our bodies to perform. Rehab is always going on, especially as we get older.
We shouldn’t have to fall three stories to realize the value of movement.
We don’t always appreciate the wonderful healing capacity of our bones.
A few years back I was on call, and the ambulance brought in a young college gentleman who had fallen three stories off a roof onto the cement below. Apparently he landed first on his feet and fell forward. As he landed, he sequentially, like a row of falling dominoes, broke parts of his feet, legs, knees, hands, wrists, elbows, jaw, and nose. The orthopedist who came in to help when I called, counted something like 26 fractures, and my ENT specialist who also came in estimated the patient was going about 35 miles per hour when he hit the concrete.
We ended up sending the young man to the trauma center in Sioux Falls, but what was amazing was how his brain and vital organs had been protected. He had not lost consciousness, remained perfectly awake, and his heart, lungs, gut. and spine were just fine. But the best news came with how eventually, after a lot of rehabilitation, his bones repaired themselves. A year later he walked into my office, without a limp I should add, and shook my hand firmly to thank me for helping him that fateful night.
Most people have the concept that our bones and joints are continuously wearing out and deteriorating over time. It is common thinking that if we simply live long enough, we will end up as a slumped over pile of soft bones and frozen joints. This doesn’t have to be..
Instead, our bodies are constantly remodeling and repairing bones and joints; taking apart, breaking down, and then rebuilding anew. Small injuries are always happening along the way, and maybe it happens more so as we get older, but there is a continuous remodel-and-repair process always going on, throughout your whole life..
The key point to remember is that the blue print for the remodel comes from the daily motion and activity we ask our bodies to perform. Rehab is always going on, especially as we get older.
We shouldn’t have to fall three stories to realize the value of movement.
Sunday, March 21, 2010
Saturday, March 20, 2010
The New Orleans Flooding Disaster
By Richard P. Holm MD
Some say that the measure of a society is how it learns from its mistakes.What did we learn from the flooding of Hurricane Katrina, which affected New Orleans and a wide swath of southeastern Louisiana in late August of 2005? Eighty percent of New Orleans was flooded in up to 15 feet of very dirty water.
After Katrina for many weeks southeast Louisiana lost most forms of communication with downed towers and lines, although text messaging was left, as it requires little signal power.
Most area hospitals were flooded and lost electricity while looters and drug seekers attacked in boats. One hospital indicated that many people died due to lack of supplies and simply the overwhelming need to provide care without enough help.
Civil disobedience also involved extensive looting and even sniper fire, while one third of the New Orleans Police Department had deserted the city in the days before the storm. Major health problems that followed in the hours and days after the flooding mostly involved not having a safe water supply.
Be prepared is the lesson. Structures for flood prevention should be in top shape; a chain of command for rescuers and maintenance of law and order should be ready; a failsafe method of communicating to include text messaging needs to be available; and effective evacuation plans should be available. Each family should store a safe water supply, non-perishable food, and a portable crank radio and flashlight. Finally we should all learn to text message.Our local, state, and national society can and should learn from past mistakes.
Subscribe to:
Posts (Atom)
