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.

Monday, April 18, 2011

How do you get rid of the pain of degenerative arthritis?

By Richard P. Holm, M.D.

Many people deal with the chronic pain of degenerative arthritis, and every day people walk or sometimes wheel into my office asking for relief. Whether it is hip, knee, or shoulder arthritis resulting from an injury that happened years ago, or back and neck arthritis coming from an inherited condition or the aging process, these folks suffer. They have pain during movement, when they are still and trying to sleep, or too often continuous pain. Unfortunately, arthritis prevents movement, which only confounds the problem.

Of course we have medical weaponry to fight against such an enemy. I could prescribe exercise, stretching, hands-on physical therapy, topical ointments, pain medicines, muscle-relaxing pills, anti-inflammation solutions, injections, and finally call for a surgeon to repair or replace bad joints. My preference of these is to do whatever it takes to keep people moving and strengthening. Unfortunately, although these options can be very helpful, too often they are inadequate and some people still hurt.

In response to continued pain and dysfunction, individuals will sometimes turn to complimentary and alternative therapies such as massage, spinal manipulation, progressive relaxation, acupuncture, yoga, and tai chi. Also there are herbal remedies such as glucosamine, chondroitin, gamma linolenic acid, and many more. I should say here that there is a growing body of scientific evidence to support some of these options when used appropriately. 

In spite of all these standard or legitimate complimentary therapies, however, there are those who still hurt and can fall prey to scam artists trying to profit from someone’s misfortune and desperation. I would warn people about advertisements that promise too much, yet it is difficult for me to attack such claims, since our standard therapies for arthritis can also be expensive and inadequate.

When all is said and done, people will still hurt. It is simply the human condition and most often the consequence of staying alive a long time. But I believe the best plan to deal with the chronic pain of degenerative arthritis should be to do whatever you can to keep moving.
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, April 3, 2011

Brain injury in a football hero

By Richard P. Holm M.D

If you ask any of us who were on the DeSmet High School football team of 1966, we will tell you about how hard we played, the joy of our teamwork, our lasting friendships, and, of course, about our winning record. But I have come to realize now how foolish I was to repeatedly lower my head and use it as a battering ram hitting my opponents with everything I had.

Although contact sports are so much an enjoyable part of our modern life, we are finally coming to realize the danger such games can cause to the heads of the players. Nearly one and a half million head injuries occur in the United States each year and 20% or more of these are sports related. Researchers show that in football, soccer, and ice hockey, every season around 50% of the athletes experience some kind of concussion symptoms following a hit to the head.

What is worse news, research has revealed that once a concussion happens, that individual is very susceptible to permanent brain injury after a second-impact. Like playing on a twisted ankle, it’s the second hit that does the real damage.

It is a scientific fact that head trauma can result in subtle neuro-cognitive loss and later even chronic progressive brain disease and mental illness. One well-known example is the boxer Mohammed Ali who struggles with Parkinson’s disease, the likely consequence of repeated head trauma.

So how do we protect the brains of our youth? We should start by teaching players, couches, and parents to recognize the symptoms of concussion. If head trauma results in a headache, dizziness or imbalance, nausea or vomiting, any confusion, double vision, memory loss, sleep disturbance, emotional change, intolerance to loud noise or bright lights, or especially any hint of loss of consciousness, then there has been, by definition, a concussion. More on this at

Any athlete with such an experience should immediately stop playing, especially in order to prevent the second impact syndrome. Medical professionals should direct any athlete, who experiences concussion not to return to contact play until they experience one completely symptom-free week.

It is better to miss one game than be brain injured for a lifetime.

The miracle of the tube

By Richard P. Holm, M.D.

By the 16th day after conception, the human embryo has grown into a hollow ball of cells. Then a fold develops on the underside of the sphere, and it pushes inward until the sides wrap around the bend and become a cylinder that starts at a primitive head and extends down to what looks like a tail.

The resulting pipe is called the primitive gut, and it is evolving into what later will become the mouth, esophagus, stomach, and both the small and large intestines. Eventually this tube will extend about 26 feet from lips to anus. During development, pouches budding out from this food tube will also form the lungs, liver, gallbladder, and pancreas.

Once the embryo fully develops and is born, the gastrointestinal (or GI) tract begins performing the marvelous act of digestion. When food is shoved into the mouth, it is gummed or chewed until the tongue pushes it down. Food is swallowed as a small ball – doctors call it a bolus – and it passes the entrance to the lungs where a fleshy a trapdoor called the epiglottis protects the lungs and helps move the food into the esophagus.

The esophagus is a toothpaste-tube-type apparatus that moves the bolus into the stomach. There, acid not only helps break down the food, but it also kills most of the microorganisms that enter with food. Now liquefied, food then moves into the small intestine where tiny, shag-carpet-like fingers provide a surface area that’s about the same size as a football field. All that space is needed, and those tiny fingers work together to absorb nutrients.

The leftover liquid material finally moves to the large intestine, or colon, and this organ works mainly to reclaim water. The colon also harbors colonies of good bacteria that work on the leftover material and produce an important vitamin. That vitamin subsequently is absorbed and the body uses it to prevent bleeding.

The tube from lips to anus may not receive the respect it deserves, but it is an engineering masterpiece that humbly nourishes our lives.