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.
Showing posts with label education. Show all posts
Showing posts with label education. Show all posts
Sunday, April 3, 2011
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.
Thursday, December 17, 2009
I Have A Secret
By Shawn Vuong
There are times when practitioners and patients get caught up in the world of pharmaceuticals. It's human nature to want the 'pill' that solves it all. Truth is that sometimes pills aren't always the right answer.
A good primary care doctor knows this. The good family practice doctor knows when to just suggest that chicken noodle soup for the flu, the relaxation methods for insomnia, or the many many others. In this post Dr. Holm talks about such a technique.
_____________________________________________________________________
By Richard P. Holm MD
I have a secret way to prevent loss of control of bowel and bladder, which costs nothing, is under-used, and works. Let me explain.
The muscles between the pubic bone, in the front of the pelvis, and the tailbone, in the back, are called the pelvic floor muscles. They act like a hammock to keep all the organs of the abdomen from falling out. These muscles also control the release of urine and feces, which most people prefer to do in a private place and in a sanitary way. To accomplish such control, however requires the pelvic floor muscles to work well.
Although this topic is almost verboten in proper public forums, if you think about it, anyone who eats and drinks also has to discharge waste products. There is nothing secret about that.
In 1948 an OB-GYN doctor Arnold Kegel developed exercises to strengthen the pelvic floor muscles in order to help fix urinary incontinence in women after childbirth. Since then his ideas have spread. The exercises have also been recommended for helping with bowel and bladder control for men as well as women; for conditioning muscles to make birthing easier; for rehab following prostate surgery; even for improving sexual enjoyment in women and men.
All that considered, what has been repeatedly proven by scientific study is that men or women with urinary incontinence who actually do the exercises over more than a month experience significant improvement in their symptoms. It works. I believe Kegel exercises must be considered as a solution for incontinence before contemplating drug or surgical solutions.
Kegel exercises are simple to do. Find these pelvic muscles by starting and stopping the flow of urine without using your stomach, leg, or buttock muscles. Simply tighten and relax the pelvic muscles about 200 times a day. There are many variations and even devices to encourage the strengthening of the pelvic floor muscles, but the key to success is to simply do it. To say it again, the benefits come with tightening the muscles 200 times a day, and making that a habit.
Kegels are something you can do quietly, while just sitting there, without anyone else knowing. It’s a secret habit worth having.
There are times when practitioners and patients get caught up in the world of pharmaceuticals. It's human nature to want the 'pill' that solves it all. Truth is that sometimes pills aren't always the right answer.
A good primary care doctor knows this. The good family practice doctor knows when to just suggest that chicken noodle soup for the flu, the relaxation methods for insomnia, or the many many others. In this post Dr. Holm talks about such a technique.
_____________________________________________________________________
By Richard P. Holm MD
I have a secret way to prevent loss of control of bowel and bladder, which costs nothing, is under-used, and works. Let me explain.
The muscles between the pubic bone, in the front of the pelvis, and the tailbone, in the back, are called the pelvic floor muscles. They act like a hammock to keep all the organs of the abdomen from falling out. These muscles also control the release of urine and feces, which most people prefer to do in a private place and in a sanitary way. To accomplish such control, however requires the pelvic floor muscles to work well.
Although this topic is almost verboten in proper public forums, if you think about it, anyone who eats and drinks also has to discharge waste products. There is nothing secret about that.
In 1948 an OB-GYN doctor Arnold Kegel developed exercises to strengthen the pelvic floor muscles in order to help fix urinary incontinence in women after childbirth. Since then his ideas have spread. The exercises have also been recommended for helping with bowel and bladder control for men as well as women; for conditioning muscles to make birthing easier; for rehab following prostate surgery; even for improving sexual enjoyment in women and men.
All that considered, what has been repeatedly proven by scientific study is that men or women with urinary incontinence who actually do the exercises over more than a month experience significant improvement in their symptoms. It works. I believe Kegel exercises must be considered as a solution for incontinence before contemplating drug or surgical solutions.
Kegel exercises are simple to do. Find these pelvic muscles by starting and stopping the flow of urine without using your stomach, leg, or buttock muscles. Simply tighten and relax the pelvic muscles about 200 times a day. There are many variations and even devices to encourage the strengthening of the pelvic floor muscles, but the key to success is to simply do it. To say it again, the benefits come with tightening the muscles 200 times a day, and making that a habit.
Kegels are something you can do quietly, while just sitting there, without anyone else knowing. It’s a secret habit worth having.
Thursday, December 10, 2009
Stress
By Shawn Vuong
The human stress response is a balance of two delicate systems, the sympathetic and the parasympathetic nervous systems. The sympathetic system gives us that boost of energy and anxiousness we get before something big is about to happen or if we are surprised. Our hearts beat quicker, we breathe faster, our pupils dilate, and our muscles prime for action. This is the acute stress response that has helped us through our hunting and gathering years. After that stress our parasympathetic response takes over. It is known as the rest and digest system. Usually after a big meal you'll feel pretty tired, that's your parasympathetic response at work.
The problem becomes when stresses become a long-term issue. Money, work, kids, relationships, and time all can add up and continuously stress us out. This is bad, because this stimulates our sympathetic nervous system for a long period of time. This system was not meant to be chronically simulated, and because of this we see the harmful effects of stress on the body.
___________________________________________________________________________
By Richard P. Holm MD
Whose life is not stressful? The one who says she or he is not stressed has blindfolds on, or hasn’t lived long enough. A definition for stress is needed. What is stress? The dictionary says that it is a state of mental, emotional, or physical strain resulting from adverse or demanding situations.
The other evening I turned and asked my wife what she thought was the most stressful thing. We both agreed that it is to watch our children (and parents, for that matter) individually struggle with their own challenges in life… as we stand helplessly on the sideline, without the ability, or the right, to intervene or fix what’s happening. I know that at some point children should be left to learn from their own mistakes.
Knowing when to or NOT to step in is addressed in the Serenity Prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. The prayer makes it seems so clear but the difficult part of the serenity prayer is the wisdom comment. When do you take the challenge to change something versus when do you leave it alone?
In the same vein, a recent study showed that men who bottle up their anger over unfair treatment at work and who are unable or not allowed to express their resentment over conflicts, are more than twice as likely to have a heart attack and/or die than those who can vent or manage such work-stress. I would never suggest people should let anger and temper rage, but unhappy-at-work people should either try to make appropriate changes there or switch jobs. No job is worth holding emotions in and dying young.
Whether it is children or a job that is making life stressful, may we all discover serenity and find the wisdom to change what we can, and let go when we must.
The human stress response is a balance of two delicate systems, the sympathetic and the parasympathetic nervous systems. The sympathetic system gives us that boost of energy and anxiousness we get before something big is about to happen or if we are surprised. Our hearts beat quicker, we breathe faster, our pupils dilate, and our muscles prime for action. This is the acute stress response that has helped us through our hunting and gathering years. After that stress our parasympathetic response takes over. It is known as the rest and digest system. Usually after a big meal you'll feel pretty tired, that's your parasympathetic response at work.
The problem becomes when stresses become a long-term issue. Money, work, kids, relationships, and time all can add up and continuously stress us out. This is bad, because this stimulates our sympathetic nervous system for a long period of time. This system was not meant to be chronically simulated, and because of this we see the harmful effects of stress on the body.
___________________________________________________________________________
By Richard P. Holm MD
Whose life is not stressful? The one who says she or he is not stressed has blindfolds on, or hasn’t lived long enough. A definition for stress is needed. What is stress? The dictionary says that it is a state of mental, emotional, or physical strain resulting from adverse or demanding situations.
The other evening I turned and asked my wife what she thought was the most stressful thing. We both agreed that it is to watch our children (and parents, for that matter) individually struggle with their own challenges in life… as we stand helplessly on the sideline, without the ability, or the right, to intervene or fix what’s happening. I know that at some point children should be left to learn from their own mistakes.
Knowing when to or NOT to step in is addressed in the Serenity Prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference. The prayer makes it seems so clear but the difficult part of the serenity prayer is the wisdom comment. When do you take the challenge to change something versus when do you leave it alone?
In the same vein, a recent study showed that men who bottle up their anger over unfair treatment at work and who are unable or not allowed to express their resentment over conflicts, are more than twice as likely to have a heart attack and/or die than those who can vent or manage such work-stress. I would never suggest people should let anger and temper rage, but unhappy-at-work people should either try to make appropriate changes there or switch jobs. No job is worth holding emotions in and dying young.
Whether it is children or a job that is making life stressful, may we all discover serenity and find the wisdom to change what we can, and let go when we must.
Tuesday, November 24, 2009
Corrosive Stomach Acid
By Shawn Vuong
A wise pharmacology professor once told me, "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy."
This week Dr. Holm talks about drugs, particularly in the context of heart burn. In our pharmacology class, we are learning about how all types of drugs interact with the body. Prescription drugs, over-the-counter drugs, herbals, and even supplements all effect the body in different ways. The key to prescribing drugs correctly is weighing the risk of toxicity of a drug versus the benefit gained.
Each substance has it's own toxic effect when given at too high of doses. But we must make the dose high enough to see a benefit. In effect, we get a titer-totter like scenario where we are trying to balance the correct dose to see benefit while trying to limit toxic effects (also known as side effects). Some drugs are easy to give, since they have a high benefit but low toxic effects such as statins. Other drugs have medical health professions constantly walking that fine line between lethal effects and benefit to the patient such as chemotherapy agents or anesthetics.
So remember, every substance has toxic effects when given at incorrect doses. Even water can cause lethal effects if you drink too much. So, please work with your doctor to correctly dose your medications, because they can sometimes give you nasty side-effects.
_________________________________________________________________________
By Richard P. Holm MD
It has always amazed me that the stomach can produce large amounts of a very corrosive hydrochloric acid. Of course, we do that in order to breakdown food so our bodies can absorb nutrients.
In response to food stretching the stomach and esophagus, tiny proton-pumps in special cells that line the stomach make acidic stomach juice. The resultant strength of gastric acid during digestions can be not as corrosive as battery acid, but almost.
Fortunately, a special layer of mucus protects the stomach from the acid, and as food moves on into the small intestine, the corrosive juice is neutralized by sodium bicarbonate produced by the pancreas.
When something goes wrong: the stomach-mucus layer fails; the acid rolls up into the unprotected esophagus; or there is not enough sodium bicarbonate to neutralize the acid… then symptoms occur. People can be pretty miserable as digestive juices are eating away at their own tissue, rather than the food they just ate.
Fortunately we have very effective medications to reduce acid production when something goes awry. One group of antacids, which reduce acid quickly are the H2 blockers with ranitidine (Zantac) as an example. Another group, which reduce acid slower but more effectively, are the proton-pump inhibitors, with omeprazole (Prilosec) as an example.
These two types of powerful antacids have been a blessing for many people who truly suffer from excess acid stomach. A major drawback with both types of medicines, however, comes when trying to stop them, which can result in rebound acidity.
A recent study provided two months of omeprazole to people who at start had never been troubled with heartburn. When the medicine was stopped, however, the volunteers had rebound acid symptoms.
People need to be warned when using these stomach acid medicines that short-term use is safe and can be very helpful. However, getting off of them after prolonged use can be a challenge and may require a gradual reduction over two to three months. Certainly some people should never be off of them, but that should be discussed with your doctor.
Take home message: we have good medicines to counter the corrosive battery-like acid made in our stomachs, but they need to be used with caution.
A wise pharmacology professor once told me, "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy."
This week Dr. Holm talks about drugs, particularly in the context of heart burn. In our pharmacology class, we are learning about how all types of drugs interact with the body. Prescription drugs, over-the-counter drugs, herbals, and even supplements all effect the body in different ways. The key to prescribing drugs correctly is weighing the risk of toxicity of a drug versus the benefit gained.
Each substance has it's own toxic effect when given at too high of doses. But we must make the dose high enough to see a benefit. In effect, we get a titer-totter like scenario where we are trying to balance the correct dose to see benefit while trying to limit toxic effects (also known as side effects). Some drugs are easy to give, since they have a high benefit but low toxic effects such as statins. Other drugs have medical health professions constantly walking that fine line between lethal effects and benefit to the patient such as chemotherapy agents or anesthetics.
So remember, every substance has toxic effects when given at incorrect doses. Even water can cause lethal effects if you drink too much. So, please work with your doctor to correctly dose your medications, because they can sometimes give you nasty side-effects.
_________________________________________________________________________
By Richard P. Holm MD
It has always amazed me that the stomach can produce large amounts of a very corrosive hydrochloric acid. Of course, we do that in order to breakdown food so our bodies can absorb nutrients.
In response to food stretching the stomach and esophagus, tiny proton-pumps in special cells that line the stomach make acidic stomach juice. The resultant strength of gastric acid during digestions can be not as corrosive as battery acid, but almost.
Fortunately, a special layer of mucus protects the stomach from the acid, and as food moves on into the small intestine, the corrosive juice is neutralized by sodium bicarbonate produced by the pancreas.
When something goes wrong: the stomach-mucus layer fails; the acid rolls up into the unprotected esophagus; or there is not enough sodium bicarbonate to neutralize the acid… then symptoms occur. People can be pretty miserable as digestive juices are eating away at their own tissue, rather than the food they just ate.
Fortunately we have very effective medications to reduce acid production when something goes awry. One group of antacids, which reduce acid quickly are the H2 blockers with ranitidine (Zantac) as an example. Another group, which reduce acid slower but more effectively, are the proton-pump inhibitors, with omeprazole (Prilosec) as an example.
These two types of powerful antacids have been a blessing for many people who truly suffer from excess acid stomach. A major drawback with both types of medicines, however, comes when trying to stop them, which can result in rebound acidity.
A recent study provided two months of omeprazole to people who at start had never been troubled with heartburn. When the medicine was stopped, however, the volunteers had rebound acid symptoms.
People need to be warned when using these stomach acid medicines that short-term use is safe and can be very helpful. However, getting off of them after prolonged use can be a challenge and may require a gradual reduction over two to three months. Certainly some people should never be off of them, but that should be discussed with your doctor.
Take home message: we have good medicines to counter the corrosive battery-like acid made in our stomachs, but they need to be used with caution.
Sunday, November 1, 2009
Asthma
By Shawn Vuong
This post from Dr. Holm really hits home with me. In my late elementary school/early middle school years I was plagued with exercise-induced asthma. When I would play in PE class or recess, my chest would just feel like it was tightening up. The wheezing, the tightness, and the shortness of breath is very scary.
My parents took me to a pediatric pulmonologist and I was tested for asthma. Right then, the doctor prescribed me an albuterol inhaler, which became my life line. After that, any physical activity that I did was preceded by a couple puffs from my inhaler. I was too scared to have another asthma episode.
Asthma is not just something that is brought on by exercise, but can be induced by allergies, pollutants, smoking, chronic disease, infections, or even stress. Asthma can be deadly. If you think you have some of the signs or symptoms of asthma I encourage you to see your doctor.
____________________________________________________________________
By Richard P. Holm MD
A few years ago, a 40-something woman was walking across the farm yard when something in the air brought on wheezing, like gangbusters. She turned back to the house for her inhaler, but just couldn't make it, and collapsed in the yard.
While her husband was hurriedly driving her to town, she stopped breathing entirely. Her husband gave her mouth-to-mouth until the ambulance met them.
In the ER, we were able to place the breathing tube down, but her brain had been too long without oxygen. And a few days later, I will never forget how she gently escaped from this earth surrounded by her loving family.
This tragic death taught me how asthma kills. So what can we do to prevent a similar calamity?
First, recognize when you are at risk. Have you experienced an asthma attack that comes on fast and out of the blue?
Next: are you using your rescue-immediate-acting inhaler more often lately? I should add here that albuterol or any of the fast acting adrenaline-like asthma inhalers might cover-up or even cause worsening inflammation in the lungs. They only work for the short run-and increased use of these fast acting rescue meds is a big time danger signal.
Finally: know that when your asthma is accelerating you need to turn off the inflammation and our best tool to do that is a steroid. Not a body building type, but and anti-inflammatory which slowly turns off asthma for the long run.
That's the take home message: although fast acting rescue inhalers are good to have-they forecast danger. The real hero in this disease is the anti-inflammatory steroid inhalers.
So if you or your family member with asthma is using the rescue inhalers more than usual do not dally. You need to be talking to your doctor about anti-inflammatory steroids.
This post from Dr. Holm really hits home with me. In my late elementary school/early middle school years I was plagued with exercise-induced asthma. When I would play in PE class or recess, my chest would just feel like it was tightening up. The wheezing, the tightness, and the shortness of breath is very scary.
My parents took me to a pediatric pulmonologist and I was tested for asthma. Right then, the doctor prescribed me an albuterol inhaler, which became my life line. After that, any physical activity that I did was preceded by a couple puffs from my inhaler. I was too scared to have another asthma episode.
Asthma is not just something that is brought on by exercise, but can be induced by allergies, pollutants, smoking, chronic disease, infections, or even stress. Asthma can be deadly. If you think you have some of the signs or symptoms of asthma I encourage you to see your doctor.
____________________________________________________________________
By Richard P. Holm MD
A few years ago, a 40-something woman was walking across the farm yard when something in the air brought on wheezing, like gangbusters. She turned back to the house for her inhaler, but just couldn't make it, and collapsed in the yard.
While her husband was hurriedly driving her to town, she stopped breathing entirely. Her husband gave her mouth-to-mouth until the ambulance met them.
In the ER, we were able to place the breathing tube down, but her brain had been too long without oxygen. And a few days later, I will never forget how she gently escaped from this earth surrounded by her loving family.
This tragic death taught me how asthma kills. So what can we do to prevent a similar calamity?
First, recognize when you are at risk. Have you experienced an asthma attack that comes on fast and out of the blue?
Next: are you using your rescue-immediate-acting inhaler more often lately? I should add here that albuterol or any of the fast acting adrenaline-like asthma inhalers might cover-up or even cause worsening inflammation in the lungs. They only work for the short run-and increased use of these fast acting rescue meds is a big time danger signal.
Finally: know that when your asthma is accelerating you need to turn off the inflammation and our best tool to do that is a steroid. Not a body building type, but and anti-inflammatory which slowly turns off asthma for the long run.
That's the take home message: although fast acting rescue inhalers are good to have-they forecast danger. The real hero in this disease is the anti-inflammatory steroid inhalers.
So if you or your family member with asthma is using the rescue inhalers more than usual do not dally. You need to be talking to your doctor about anti-inflammatory steroids.
Earwax and Elbows
By Shawn Vuong
In this post, Dr. Holm talks about one topic that doctors have been losing ground on for a long time, the Q Tip. Every physician from the ENT to the family practitioner has seen the damage Q Tips have caused eardrums and ear canals. They warn their patients to not stick anything into their ears, and to let ear wax come out naturally. I remember when I was in grade school, some health professional came in and told us only to use a wash cloth to clean out our ears and to never use a Q Tip. Almost 20 years later, I still use them like a bad habit.
Using Q Tips and Bobby Pins to clean out your ears is a bad habit, although it may seem like you are doing it to keep your ears clean. In this case, the gross wax that a person is trying to clean out of the ear canal is actually the stuff you want in there for protection. Dr. Holm explains more about the Q Tip problem, and gives some better solutions to cleaning out one's ears.
_____________________________________________________________________
By Richard P. Holm MD
It was 1973, and the Professor advised our Sophomore Med School class that the smallest thing that should ever go into the ear canal is your elbow. Through 31 years of practice I have seen many injuries to ears resulting mostly from Q Tips and Bobby Pins. People use these weapons sometimes to scratch an ear itch, but mostly to remove earwax.
Earwax is an oft-maligned material that has an interesting story.
Recently scientists have discovered genetic differences by the character of earwax. East Asians and American Indians are more likely to have a dry grey and flaky type of wax, while Africans and Caucasians are more likely to have the moist honey-brown type. Anthropologists have even used earwax type to track human migratory patterns, and claim the dry type indicates a genetic change, which came as a beneficial reduction in sweating for those living in cold climates.
Also called cerumen, the stuff that comes out of ears is a mixture of oil, sweat, and old sloughed off ear canal skin. As we chew, the jaw movement moves the gooey stuff outward down the canal, dragging with it dirt, dust, and debris. We know it also provides for lubrication and protection against bacteria and fungus.
With aging, dehydration, or metabolic problems, the earwax can sometimes thicken, stop moving, fill the ear canals, and cause trouble. In this case one should apply a couple drops of warm olive oil or baby oil to each ear two or three times a week.
Q-Tips or Bobby Pins should be avoided since they will only pack the wax and potentially perforate the eardrum. If oil fails to drain the wax plug, a few weeks of drops will at least prepare the wax for removal. Then a solution of warm (not hot or cold) vinegar-water irrigated by an inexpensive ear syringe purchased at any drugstore should clear the plug. Failing that, see your doctor.
There’s lots to do besides putting your elbow up there.
In this post, Dr. Holm talks about one topic that doctors have been losing ground on for a long time, the Q Tip. Every physician from the ENT to the family practitioner has seen the damage Q Tips have caused eardrums and ear canals. They warn their patients to not stick anything into their ears, and to let ear wax come out naturally. I remember when I was in grade school, some health professional came in and told us only to use a wash cloth to clean out our ears and to never use a Q Tip. Almost 20 years later, I still use them like a bad habit.
Using Q Tips and Bobby Pins to clean out your ears is a bad habit, although it may seem like you are doing it to keep your ears clean. In this case, the gross wax that a person is trying to clean out of the ear canal is actually the stuff you want in there for protection. Dr. Holm explains more about the Q Tip problem, and gives some better solutions to cleaning out one's ears.
_____________________________________________________________________
By Richard P. Holm MD
It was 1973, and the Professor advised our Sophomore Med School class that the smallest thing that should ever go into the ear canal is your elbow. Through 31 years of practice I have seen many injuries to ears resulting mostly from Q Tips and Bobby Pins. People use these weapons sometimes to scratch an ear itch, but mostly to remove earwax.
Earwax is an oft-maligned material that has an interesting story.
Recently scientists have discovered genetic differences by the character of earwax. East Asians and American Indians are more likely to have a dry grey and flaky type of wax, while Africans and Caucasians are more likely to have the moist honey-brown type. Anthropologists have even used earwax type to track human migratory patterns, and claim the dry type indicates a genetic change, which came as a beneficial reduction in sweating for those living in cold climates.
Also called cerumen, the stuff that comes out of ears is a mixture of oil, sweat, and old sloughed off ear canal skin. As we chew, the jaw movement moves the gooey stuff outward down the canal, dragging with it dirt, dust, and debris. We know it also provides for lubrication and protection against bacteria and fungus.
With aging, dehydration, or metabolic problems, the earwax can sometimes thicken, stop moving, fill the ear canals, and cause trouble. In this case one should apply a couple drops of warm olive oil or baby oil to each ear two or three times a week.
Q-Tips or Bobby Pins should be avoided since they will only pack the wax and potentially perforate the eardrum. If oil fails to drain the wax plug, a few weeks of drops will at least prepare the wax for removal. Then a solution of warm (not hot or cold) vinegar-water irrigated by an inexpensive ear syringe purchased at any drugstore should clear the plug. Failing that, see your doctor.
There’s lots to do besides putting your elbow up there.
Friday, September 25, 2009
An Old Dog’s Computer Quest
By Shawn Vuong
Technology. I love it.
I am a proud member of the millennial generation (aka Generation Y). While we aren't known for our humility or strong work ethic, we are known for our extreme integration with technology. As time goes on and more of the Generation Y hits the workforce, we will be expecting businesses to be updating to fully integrated all digital business schemes. In medicine this means the adoption of the electronic medical record.
While this seems like a huge step for older physicians still in practice (the baby boomer generation), this is hardly what we (as the Generation Y) envision as our ideal digital medical record. As time goes on, and our generation starts becoming the majority of the medical work force I for see the trend digital medical record becoming much more than some doctors could ever imagine. Fully integrated, international, digitally accessible and protected medical records. If I go to vacation in California and get hurt, I expect the ER doctor to be able to read my full history since my birth on his EMR at his/her hospital. If my child gets a test done at Mayo, I want to see the results online as soon as my physician gets them. We may have a long way to go before we get to this kind of integration. But I believe this is the future of medicine.
________________________________________________________________
Technology. I love it.
I am a proud member of the millennial generation (aka Generation Y). While we aren't known for our humility or strong work ethic, we are known for our extreme integration with technology. As time goes on and more of the Generation Y hits the workforce, we will be expecting businesses to be updating to fully integrated all digital business schemes. In medicine this means the adoption of the electronic medical record.
While this seems like a huge step for older physicians still in practice (the baby boomer generation), this is hardly what we (as the Generation Y) envision as our ideal digital medical record. As time goes on, and our generation starts becoming the majority of the medical work force I for see the trend digital medical record becoming much more than some doctors could ever imagine. Fully integrated, international, digitally accessible and protected medical records. If I go to vacation in California and get hurt, I expect the ER doctor to be able to read my full history since my birth on his EMR at his/her hospital. If my child gets a test done at Mayo, I want to see the results online as soon as my physician gets them. We may have a long way to go before we get to this kind of integration. But I believe this is the future of medicine.
________________________________________________________________
By Richard P. Holm MD
They say you can’t teach an old dog new tricks. Yet today I found myself in front of a Brookings Health System computer with a personal nurse tutor trudging through our new test version of an electronic medical record.
Indeed, for about a year we have been gradually getting used to seeing parts of the hospital record on computer screen. Finally this month we are about to take the leap of dropping our paper orders and progress notes, and going entirely paperless in the hospital.
We have to be prepared so that no patient is harmed by this transformation. That is why the physicians and PA/NPs have spent many meetings this spring developing orders sets, which are pre-defined orders for specific illnesses. That is why we have been having two hours a week of educational meetings all summer long on the topic.
It will be difficult for many of us to make this change, especially since we have been doing things on paper for so many years. At first it will take us all a lot more time. But the whole process is not only taking time, it means our hospital has to make a significant commitment both in personnel and money.
So why would we spend this kind of time and effort? Along with many who are so capably helping us through this, are two RN experts. Today I asked them both just what will result from all this effort, and their answers were straightforward. “It’s all about patient safety and accessing information.” Safety, for example means avoiding dangerous medication allergies and interactions. Access, for example means seeing the patient’s Problem List, prior test results, and medication list whenever needed.
Still, the electronic medical record cannot look into the eyes of a frightened person in pain, listen for a clue to solve a problem, provide for relief of suffering, and then find a way to healing and better health. That’s something this old dog better not forget.
They say you can’t teach an old dog new tricks. Yet today I found myself in front of a Brookings Health System computer with a personal nurse tutor trudging through our new test version of an electronic medical record.
Indeed, for about a year we have been gradually getting used to seeing parts of the hospital record on computer screen. Finally this month we are about to take the leap of dropping our paper orders and progress notes, and going entirely paperless in the hospital.
We have to be prepared so that no patient is harmed by this transformation. That is why the physicians and PA/NPs have spent many meetings this spring developing orders sets, which are pre-defined orders for specific illnesses. That is why we have been having two hours a week of educational meetings all summer long on the topic.
It will be difficult for many of us to make this change, especially since we have been doing things on paper for so many years. At first it will take us all a lot more time. But the whole process is not only taking time, it means our hospital has to make a significant commitment both in personnel and money.
So why would we spend this kind of time and effort? Along with many who are so capably helping us through this, are two RN experts. Today I asked them both just what will result from all this effort, and their answers were straightforward. “It’s all about patient safety and accessing information.” Safety, for example means avoiding dangerous medication allergies and interactions. Access, for example means seeing the patient’s Problem List, prior test results, and medication list whenever needed.
Still, the electronic medical record cannot look into the eyes of a frightened person in pain, listen for a clue to solve a problem, provide for relief of suffering, and then find a way to healing and better health. That’s something this old dog better not forget.
Very-Close-Veins
By Shawn Vuong
Failing leg veins are also known as varicose veins. In this post, Dr. Holm describes how people develop varicose veins, why they are a health risk, and how best to treat them.
Some times conservative treatment can fail, but one should not worry. Many other treatment options exists for varicose veins, although they are usually more invasive and expensive. Some of these options include sclerotherapy, laser surgery, vein stripping, ambulatory phlebectomy, and endoscope vein surgery. If you are having problems with varicose veins, it is best to see your physician to discuss the best treatment option for you.
________________________________________________________________
By Richard P. Holm MD
I’ve heard failing leg veins called everything from “spider veins”, or “a bag of worms,” to “very-close-veins.” Affecting more than fifty percent of people over fifty, these gnarled, distended, varicose veins represent a problem that, generally, only gets worse.
Arteries take blood out away from the heart, like a steel pipeline from a powerful pump station. On the other hand, veins bring blood back like a lazy river that works because of locks or valves located to prevent back flow. But there is nothing lazy about the job of returning all that blood up hill, against gravity, all the way back to the heart.
The trouble with leg veins usually starts during pregnancy, or with a job which requires lots of standing in one spot without walking, or with the increased venous pressure associated with obesity. Of course, some people inherit better veins than others.
When a few valves begin to fail, then veins gradually become distended and dilated, which makes more valves fail, and the problem swells. Common signs of failing veins include edema, redness, rash, fever, pain, and even hard to heal sores. What’s worse, when blood movement slows down, clotting can happen, and when clots spread the result can be life-threatening clots to the lung.
What can we do to prevent varicose veins? Muscles surround most veins within the leg, so when we walk or use our legs, the muscles contract and squeeze, acting like pumps. If the one-way valves are still working, walking and leg movement makes blood flow upward and in this way regular walking or rocking back and forth while we stand helps prevent varicose veins. And don’t forget to put the feet up whenever possible.
The next best solution is to wear compression stockings. Although they can be hard to put on and many people are hesitant to use them, the lower, knee-high stockings are easier to use, do the lion’s share of the job, are relatively cheap, and the results are well worth the effort. Some people absolutely swear by them since they prevent so many problems and feel so good.
There is a lot you can do if you stand to inherit those very-close-veins. Left alone, they only get worse.
Failing leg veins are also known as varicose veins. In this post, Dr. Holm describes how people develop varicose veins, why they are a health risk, and how best to treat them.
Some times conservative treatment can fail, but one should not worry. Many other treatment options exists for varicose veins, although they are usually more invasive and expensive. Some of these options include sclerotherapy, laser surgery, vein stripping, ambulatory phlebectomy, and endoscope vein surgery. If you are having problems with varicose veins, it is best to see your physician to discuss the best treatment option for you.
________________________________________________________________
By Richard P. Holm MD
I’ve heard failing leg veins called everything from “spider veins”, or “a bag of worms,” to “very-close-veins.” Affecting more than fifty percent of people over fifty, these gnarled, distended, varicose veins represent a problem that, generally, only gets worse.
Arteries take blood out away from the heart, like a steel pipeline from a powerful pump station. On the other hand, veins bring blood back like a lazy river that works because of locks or valves located to prevent back flow. But there is nothing lazy about the job of returning all that blood up hill, against gravity, all the way back to the heart.
The trouble with leg veins usually starts during pregnancy, or with a job which requires lots of standing in one spot without walking, or with the increased venous pressure associated with obesity. Of course, some people inherit better veins than others.
When a few valves begin to fail, then veins gradually become distended and dilated, which makes more valves fail, and the problem swells. Common signs of failing veins include edema, redness, rash, fever, pain, and even hard to heal sores. What’s worse, when blood movement slows down, clotting can happen, and when clots spread the result can be life-threatening clots to the lung.
What can we do to prevent varicose veins? Muscles surround most veins within the leg, so when we walk or use our legs, the muscles contract and squeeze, acting like pumps. If the one-way valves are still working, walking and leg movement makes blood flow upward and in this way regular walking or rocking back and forth while we stand helps prevent varicose veins. And don’t forget to put the feet up whenever possible.
The next best solution is to wear compression stockings. Although they can be hard to put on and many people are hesitant to use them, the lower, knee-high stockings are easier to use, do the lion’s share of the job, are relatively cheap, and the results are well worth the effort. Some people absolutely swear by them since they prevent so many problems and feel so good.
There is a lot you can do if you stand to inherit those very-close-veins. Left alone, they only get worse.
Saturday, August 8, 2009
Hip Pain
By Shawn Vuong
According to MayoClinic.com, osteoporosis is a condition where bones become weak and brittle due to low calcium levels. Osteomalacia on the other hand is a condition where the bones soften do to low Vitamin D. In children this condition is called rickets.
This week Dr. Holm give a very common medical story about the nice elderly lady who fell and broke a hip, due to these hiding conditions. But what does this have to do with us young people you may ask? Dr. Holm's story is more than just a description of a common clinical picture of osteoporosis or osteomalacia, it's about bone health. These days more and more people are sitting in front of the computer all day at the office, or maybe in the dorm room skipping class and playing WOW (World of Warcraft). We are not getting enough Vitamin D and we are not leading lives conducive to good bone health.
So some suggestions for those of us who do not want to break a hip include:
- 30 minutes a day of weight bearing exercise
- Drink more milk and get a little sun
- Take a multivitamin
By Richard P. Holm MD
Osteoporosis is a condition of thinning and porous bone, while osteomalacia is about soft protein-poor bone. To understand the difference, listen to this common and real story.
The eighty year-old woman arrives in the emergency room by ambulance with a new hip fracture. She would be writhing in pain, but if she moves it hurts even more, so she is lying perfectly still in pain.
After injecting pain reliever, the doctor notes the right leg is shortened, turned outward, and the X-Ray indicates a fracture of the hip. More specifically the break is in the neck between the ball and the body of the thighbone, also called the femur.
The doctor listens carefully to her story and discovers that she is a widow still living in her own home, still doing some gardening, still driving her friends around town to club meetings, still cooking and cleaning for herself. But all of that changed when she lost her balance on the back stoop, couldn’t find a rail to catch herself, and down she came striking hard on the cement sidewalk.
Her daughter-in-law says that it is a miracle she hadn’t tripped before what with the loose rugs scattered through the rooms, the electrical cords running everywhere, and the hand-knitted slippery foot warmers she wears after supper while shuffling around the darkened house.
The diagnosis of osteomalacia is suspected, as she describes generalized fatigue and aching over the last five years, and on exam she has a remarkable arching back and now this fractured hip. Later a very low Vitamin D level confirms the diagnosis, and the doctor suspects it’s been low the last half of her life, resulting from working inside the house most of the day, with little exposure to the sun. Vitamin D supplement becomes part of the patient’s treatment.
It is interesting to point out that there is no real clinical difference between osteoporosis and osteomalacia.
This was a story about home safety and prevention of falls, about bone building and bone maintenance, and how much more important vitamin D is than we used to think.
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.
Monday, April 6, 2009
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.
(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.
Tuesday, December 30, 2008
Farmer's Lung
By Richard P. Holm MD
We call it the "South Dakota syndrome", said the Mayo Clinic kidney specialist to a room full of doctors at a conference on the intensive care patient.
I think I was the only South Dakotan there; it was some 1200 miles away.
"These SD farmers wait until they are next to death from kidney failure and appear at the Mayo Clinic with words like: "I'm feeling a little weak lately but I don't want to complain"" he said.
As I heard this I was both a little proud and yet very dismayed. We don't want to look like whiners around here.
The problem with this denial and cover-up is that not only do we lose the opportunity to diagnose a medical problem early, but often precautions are not taken which could prevent a lot of trouble later.
This goes for all systems of our body: the kidney, the brain, the heart, the colon, the skin and the hearing.
But this is especially true for the farmer's lung. Here's the take home message: Don't cover up symptoms. If your cough lasts longer than 2 weeks, go in and see your doctor.
An ounce of prevention is worth a pound of cure. Don't go into that silo or pit when you shouldn't, avoid unnecessary exposure to toxins and dust, and I can't stress this point enough; wear a mask!
I would rather the South Dakota syndrome mean we are a bunch of hard working but careful people who live long and are able to enjoy a full and easy breathing retirement someday.
I think I was the only South Dakotan there; it was some 1200 miles away.
"These SD farmers wait until they are next to death from kidney failure and appear at the Mayo Clinic with words like: "I'm feeling a little weak lately but I don't want to complain"" he said.
As I heard this I was both a little proud and yet very dismayed. We don't want to look like whiners around here.
The problem with this denial and cover-up is that not only do we lose the opportunity to diagnose a medical problem early, but often precautions are not taken which could prevent a lot of trouble later.
This goes for all systems of our body: the kidney, the brain, the heart, the colon, the skin and the hearing.
But this is especially true for the farmer's lung. Here's the take home message: Don't cover up symptoms. If your cough lasts longer than 2 weeks, go in and see your doctor.
An ounce of prevention is worth a pound of cure. Don't go into that silo or pit when you shouldn't, avoid unnecessary exposure to toxins and dust, and I can't stress this point enough; wear a mask!
I would rather the South Dakota syndrome mean we are a bunch of hard working but careful people who live long and are able to enjoy a full and easy breathing retirement someday.
Monday, December 15, 2008
Medical Education
By Shawn Vuong
The decision to go to medical school is a big one. Dr. Holm brings up a good point, why do people chose to go to medical school? I think there are many reasons why a person would want to pursue medicine, but Dr. Holm hit the big one, "to help people."
If you're interested or have a child who is interested in pursuing medicine that's great. But remember doctors are not the only ones who work in the health care field. Physician assistants do similar work to that of a physician and have a lot of autonomy, schooling is also much shorter. Nursing is a great career choice for those who want to work directly with patients. Nurses are more involved in direct patient care than physicians, and if that's what gets you up in the morning consider nursing school. Also, with nursing school there is a lot of room for growth with nurse anesthetist programs, LPN programs, and many others. And there are much more than nurses and PA's, consider social workers, psychologists, dentistry, physical therapy, occupational therapy, and many others.
If you are interested in helping people, there is a wide variety of options out there not just medical school.
Why Go To Medical School?
By Richard P. Holm MD
Why do we choose the paths that we take in life? Certainly some of it is just happenstance, a chance occurrence that came about for no particularly reason. I believe, however, that often we are influenced to take on challenges by seeing other people fulfilled by doing good things.
I remember, as a kid, watching on black and white television, a Hallmark-Hall-of-Fame version of Arrowsmith, by Sinclair Lewis. This was a 1920's story about a Midwest boy who goes to the East coast to med school, comes back to practice medicine in a small town, and there develops a special interest in infectious diseases.
The hero goes on a quest to halt an epidemic on a tropical island, has a tragic love with great heartbreak along the way, and then, of course, saves the day in the end. There was something about the compassion this physician had for using science to help people that intrigued me.
Growing up in a small community I experienced the typical cuts and colds, bumps and bruises of a kid. There the good doctor, who was also a respected community leader, cared for me. One day during my high school freshman biology class while dissecting a frog, it came to me, "Maybe I should be a doctor!"
It was at that moment I started pointing in this direction, and here I am 45 years later, still thrilled by the challenge.
What is it that triggers a person to apply to medical school? Is it an idealistic wish to make a difference in the world; the intellectual challenge to use science to discover something new; or the model of someone who provides one-on-one caring and healing to the sick or dying?
I would say almost 34 years after graduating from medical school, that practicing medicine is a little bit of all those things, but mostly it is about trying to do what you can to help people, and the reward in knowing that sometimes you are able to help.
Whatever the experience, or example, or dream that moves a kid down the road toward a health care profession, I would call it a very good thing.
Why do we choose the paths that we take in life? Certainly some of it is just happenstance, a chance occurrence that came about for no particularly reason. I believe, however, that often we are influenced to take on challenges by seeing other people fulfilled by doing good things.
I remember, as a kid, watching on black and white television, a Hallmark-Hall-of-Fame version of Arrowsmith, by Sinclair Lewis. This was a 1920's story about a Midwest boy who goes to the East coast to med school, comes back to practice medicine in a small town, and there develops a special interest in infectious diseases.
The hero goes on a quest to halt an epidemic on a tropical island, has a tragic love with great heartbreak along the way, and then, of course, saves the day in the end. There was something about the compassion this physician had for using science to help people that intrigued me.
Growing up in a small community I experienced the typical cuts and colds, bumps and bruises of a kid. There the good doctor, who was also a respected community leader, cared for me. One day during my high school freshman biology class while dissecting a frog, it came to me, "Maybe I should be a doctor!"
It was at that moment I started pointing in this direction, and here I am 45 years later, still thrilled by the challenge.
What is it that triggers a person to apply to medical school? Is it an idealistic wish to make a difference in the world; the intellectual challenge to use science to discover something new; or the model of someone who provides one-on-one caring and healing to the sick or dying?
I would say almost 34 years after graduating from medical school, that practicing medicine is a little bit of all those things, but mostly it is about trying to do what you can to help people, and the reward in knowing that sometimes you are able to help.
Whatever the experience, or example, or dream that moves a kid down the road toward a health care profession, I would call it a very good thing.
Monday, November 17, 2008
Med School to Doctor Transition
By Shawn Vuong
These last two posts highlighting some of the medical education we would like to give through this blog to the general public, has had me look back on my extremely short medical career (currently in week 17).
Healhcare reform is in the air, and from what I've read and heard about the morale of health care professionals, it is at an "all time low." Many professors and physicians come in to teach us different topics, and many say, "It looks bleak out there, I hope you know what your in for."
What worries me is the transition. What happens to the altruistic medical student who wants to save the world? What beats him/her into submission and makes them into bitter doctors? Is it the troubles we deal with during our residency training?
A recent article by Dr. Edwin Leap makes me think so. He calls out to all residents and interns as medicine's last hope. It is inspiring and really heartwarming, makes me want to go out and save a life. Hopefully I can keep this in the back of my mind for the rest of my hopefully long and fulfilling career.
Be our hope, my friends! Be the hope of medicine, the hope of the wounded parents and febrile children, the gasping elderly and the poisoned teens. And learn to see all you do through the eyes of a higher calling. That perspective, if you can develop it and hold tightly to it, will keep you happier than any political reform or paycheck ever could.
The Hot Toe
By Richard P. Holm MD
It was 1972 and I was a green sophomore med student spending my summer shadowing a doctor in Watertown. As soon as we walked into the patients room, my hero-teacher told me the patient was suffering from an acute attack of gout.
The crusty old German doctor explained we were seeing the classic signs of inflammation. He said that the great Celsius, a physician living in the first century, described inflammation with four cardinal signs and the definition still applies.
"In Latin it's rubor, calor, tumor, dolor," is what he said. "Commonly inflammation means infection, but in this case there is no infection. Rubor is redness, calor is heat, tumor is swelling, dolor is pain, and add to that loss of function." There it was, a red, hot, swollen, painful toe. And the patient said, "It hurts so bad I can't stand for my wife to look at it."
The patient was a 45 year-old man with a tendency to drink too much, a prior experience of similar bouts of severe single joint inflammation, and he came from a family many of whom also experienced this same condition. He was moderately over-weight, quite sedentary, and was taking a water-pill for high blood pressure.
"This is the classic picture of gout," my teacher told me. "His body suffers from too much uric acid, partly because of dehydration from the water pill, partly because of his weight and lack of exercise, maybe a little from eating too much protein, but mostly because he inherited the tendency. Too much uric acid causes the formation of needle shaped crystals in the joint fluid, and then comes inflammation."
"We need to treat the inflammation first, and then later get at reducing the uric acid level, or he may destroy his joints, develop kidney stones and destroy his kidneys," he instructed.
The complex treatment of gout made our patient better. It was the perfect lesson from a great teacher.
Take home lesson:
1. Inflammation is characterized by redness, heat, swelling, pain, loss of function, and can be due to reasons other than infection.
2. Gout most often presents as recurrent episodes of a severely inflamed single joint, most often involving the big toe but it can effect other joints as well;
3. This condition results from the formation of uric acid crystals in joint fluid;
4. Gout can progress to destruction of joints and kidneys, so it needs proper treatment.
It was 1972 and I was a green sophomore med student spending my summer shadowing a doctor in Watertown. As soon as we walked into the patients room, my hero-teacher told me the patient was suffering from an acute attack of gout.
The crusty old German doctor explained we were seeing the classic signs of inflammation. He said that the great Celsius, a physician living in the first century, described inflammation with four cardinal signs and the definition still applies.
"In Latin it's rubor, calor, tumor, dolor," is what he said. "Commonly inflammation means infection, but in this case there is no infection. Rubor is redness, calor is heat, tumor is swelling, dolor is pain, and add to that loss of function." There it was, a red, hot, swollen, painful toe. And the patient said, "It hurts so bad I can't stand for my wife to look at it."
The patient was a 45 year-old man with a tendency to drink too much, a prior experience of similar bouts of severe single joint inflammation, and he came from a family many of whom also experienced this same condition. He was moderately over-weight, quite sedentary, and was taking a water-pill for high blood pressure.
"This is the classic picture of gout," my teacher told me. "His body suffers from too much uric acid, partly because of dehydration from the water pill, partly because of his weight and lack of exercise, maybe a little from eating too much protein, but mostly because he inherited the tendency. Too much uric acid causes the formation of needle shaped crystals in the joint fluid, and then comes inflammation."
"We need to treat the inflammation first, and then later get at reducing the uric acid level, or he may destroy his joints, develop kidney stones and destroy his kidneys," he instructed.
The complex treatment of gout made our patient better. It was the perfect lesson from a great teacher.
Take home lesson:
1. Inflammation is characterized by redness, heat, swelling, pain, loss of function, and can be due to reasons other than infection.
2. Gout most often presents as recurrent episodes of a severely inflamed single joint, most often involving the big toe but it can effect other joints as well;
3. This condition results from the formation of uric acid crystals in joint fluid;
4. Gout can progress to destruction of joints and kidneys, so it needs proper treatment.
That All Important Shoulder
By Richard P. Holm MD
One moment I was jetting down the ski slope unbelievably free, on the edge of control. The next moment I saw a bare spot under a bunch of trees right where I was headed, but I thought too late and was going too fast.
When my skis hit the dirt, I went for one of those head-over-heels flips, struck my right shoulder on an icy hard spot and, finally, came to a stop, a heap of body parts just like Beetle Bailey in an old comic strip.
When accidents happen like that, I find myself wishing in vain to go back five seconds and do that one differently. But of course there was no re-doing it. I felt a burning pain coming from somewhere near my right shoulder, and it was not subsiding.
The doctor in the emergency room examined my shoulder for rotator cuff injury by testing, with resistance, three movements: 1) bring bent arm with imaginary mug of coffee to the chest, 2) rotate the arm out again, and 3) with straightened arm to the side, empty the mug away from the body. Luckily my rotator cuff was fine.
He also reviewed the X-Rays with me and pointed out a separated shoulder blade-collarbone, or AC joint, which ties the arm and shoulder to the chest.
Days later, my orthopedic partner reassured me that although I had torn the AC joint, it wasn't unstable. The only real problem was that I should expect it to hurt for maybe six months, which it did.
The whole experience helped me appreciate the sudden and long lasting consequences of a reckless choice, helped me empathize with others in pain from any cause, and helped me learn about the value of the shoulder and all its parts.
And it helped me to avoid those bare dirt spots too.
Take home message:
1. Accidents can happen in a flash, and can result in long lasting suffering. Therefore it is wise to make good choices to avoid accidents when possible;
2. The shoulder has many important parts, and because it is so very mobile, is also more at risk for becoming unstable if injured;
3. The three movements mentioned above test the Subscapularis, the Infraspinatus with the Teres Minor, and the Supraspinatus muscles.
One moment I was jetting down the ski slope unbelievably free, on the edge of control. The next moment I saw a bare spot under a bunch of trees right where I was headed, but I thought too late and was going too fast.
When my skis hit the dirt, I went for one of those head-over-heels flips, struck my right shoulder on an icy hard spot and, finally, came to a stop, a heap of body parts just like Beetle Bailey in an old comic strip.
When accidents happen like that, I find myself wishing in vain to go back five seconds and do that one differently. But of course there was no re-doing it. I felt a burning pain coming from somewhere near my right shoulder, and it was not subsiding.
The doctor in the emergency room examined my shoulder for rotator cuff injury by testing, with resistance, three movements: 1) bring bent arm with imaginary mug of coffee to the chest, 2) rotate the arm out again, and 3) with straightened arm to the side, empty the mug away from the body. Luckily my rotator cuff was fine.
He also reviewed the X-Rays with me and pointed out a separated shoulder blade-collarbone, or AC joint, which ties the arm and shoulder to the chest.
Days later, my orthopedic partner reassured me that although I had torn the AC joint, it wasn't unstable. The only real problem was that I should expect it to hurt for maybe six months, which it did.
The whole experience helped me appreciate the sudden and long lasting consequences of a reckless choice, helped me empathize with others in pain from any cause, and helped me learn about the value of the shoulder and all its parts.
And it helped me to avoid those bare dirt spots too.
Take home message:
1. Accidents can happen in a flash, and can result in long lasting suffering. Therefore it is wise to make good choices to avoid accidents when possible;
2. The shoulder has many important parts, and because it is so very mobile, is also more at risk for becoming unstable if injured;
3. The three movements mentioned above test the Subscapularis, the Infraspinatus with the Teres Minor, and the Supraspinatus muscles.
Subscribe to:
Posts (Atom)
