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.
Wednesday, May 19, 2010
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.
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.
Subscribe to:
Posts (Atom)
