To straighten the bones of children

By Richard P. Holm M.D.



The history of medicine is filled with stories of bonesetters, and in the middle ages they even had a guild. These people splinted broken bones with sticks, leather, and clay casts, and were separate from physicians and barber surgeons.



Then in the 1700s, Nicholas Andre’ a professor of medicine at the University of Paris, formally described methods to treat boney deformities in newborn children such as clubbed feet with splinting. He described similar methods used for the straightening of young tree saplings. Andre’ wrote a textbook on the subject titled L’Orthopedie. The ancient Greek word orthos means free from deformity, to straighten, to make right; and the Greek word paideia refers to the art of raising a child. Literally orthopedics means to straighten the bent bones of children. Together they provide for the name of a present day surgical specialty, but other things needed to happen first.



In the mid-1800s ether and then chloroform were discovered. Available and popularized during the Civil War, anesthesia made amputations a way to save lives after limbs were shattered from dirty gunshot wounds. It wasn’t until after the war that we learned of bacteria and discovered how antiseptic methods could prevent the need for amputation, and avoid infection after surgery. Just about at the same time, X-rays were discovered by Wilhelm Roentgen, which allowed for the marvelous and revealing image of our internal boney structure.



This all set the stage for expanding the orthopedic focus from just casting deformities of children. In the 1890s a well-known bonesetter from Liverpool, England, Evan Thomas encouraged his son Hugh to go to Medical School, and afterward taught Hugh bone setting and casting methods, which at the time were not being taught in Medical School. Hugh and his nephew Robert Jones worked together to develop orthopedic surgical methods in treating not just deformed children, but also bone injuries to construction workers, and then war injuries to military men during World War I.



And thus we have come from bonesetters, and straightening the bones of children, to the marvelous field of orthopedic surgery.

Tornado Alley

By Richard P. Holm M.D.



Did you know that three out of four tornadoes in the world happen in the U.S. and that many of them occur in this neck of the woods? They call it tornado alley starting early in Texas, and progressively later in the season through the spring and summer up through Oklahoma, Missouri, Kansas, Nebraska, and the Dakotas. That said tornadoes can happen anywhere and at any time of the year.



A tornado typically forms when a cold front with wind going one way bumps up against warm moist air with wind going the other way. The theory goes that updrafts on one side, and falling rain on the other can start these opposing winds spinning. When one end of the twisting wind is sucked into the updraft of a tall thundercloud, the speed of the whirling is enhanced and becomes concentrated as it tightens down into a funnel, much like a skater spins faster as the arms and legs come in.



About two percent of tornadoes reach speeds of up to 300 mph causing 70% of the damage, and 70% are minimally destructive, with winds of less than 110 mph.



The major rule to protect oneself from tornadoes is to avoid flying debris. Experts advise avoiding windows, (and not wasting time opening them.) If you are in a sturdy permanent home, go to a lower central windowless room, maybe under a stairwell, or in a bathtub. Get low and cover with a mattress or sleeping bag if possible. If in a mall or church, avoid large spaces; find a hallway, bathroom, or smaller windowless room and crouch.



If you are in a mobile home or a vehicle of any kind, get out, as these are all extremely dangerous in a tornado. In a vehicle, if you can safely drive away, do so. Otherwise get off the road, get out and away from anything that can roll over or fall on you. If you cannot find a permanent sturdy building, you are safer in a lower spot or ditch away from cars or trees. Lie flat or crouch; face down, with your arms covering your head. Avoid bridges as they offer little protection against flying debris.



It is wise to make a plan and be prepared since we live in tornado alley.

Dreaming of poison ivy

By Richard P. Holm M.D.



Every spring through summer I expect a call from a patient of mine after he’s had an exposure to poison ivy. Like 80% of the population, when he touches the plant he breaks out with a miserable blistery and itchy skin reaction. But my friend is so allergic to poison ivy that he gets a rash if he even dreams he’s gone camping.



In this area of the country poison ivy is a very common weed, as it crops up around lakes and streams and on the edge of wooded areas. Normally there are three green or red almond shaped leaves, the side leaflets sometimes have a notch, the middle leaf has a longer stem, stems are hairy without thorns, and there can be small clusters of green or white berries. This might be a freestanding shrub, a trailing ground plant, or come from a rope-like woody and hairy vine, which climbs trees. Remember: leaves of three, let it be; berries white, run in fright; and hairy vine, no friend of mine.



The rash is an allergic reaction humans have from the oil or sap that comes off the fine hairs on the stems, the leaves, and the woody vines, the later of which remain a threat even through the winter.



Once exposed to the oil, there is less than 15 minutes to remove it, and antiseptic rubbing alcohol towelettes are effective, readily available, and cheap. Then rinse this with cold water, followed with a dish detergent cleansing in lukewarm water as hot water too early can spread the toxin. Finally wipe down shoes with rubbing alcohol; wash clothes, and someone not so allergic should wash the dog.



Usually 12 to 48 hours after exposure the allergic skin reaction is a linear, very itchy, blistery rash, which may worsen over days or weeks if not treated. Know that the fluid from blisters is not toxic.



Treatment includes laying on of cool moist washcloths, followed by topical calamine lotion or over-the-counter cortisone cream, and if bad enough, see your doctor for a prednisone prescription.



So if you are dreaming of a camping trip, know what plant to avoid, bring alcohol towelettes, and call the doctor if you get that darn rash.

When the sugar gets too low

By Richard P. Holm M.D.

“What would it feel like if my blood sugar gets too low?” the patient asked. I had advised her to watch out for hypoglycemia, or low sugar, since it might happen as a side effect of the new diabetic medicine I was prescribing.

I explained to her when sugars are low the body releases two rescue hormones in order to the sugar up. However these life-saving hormones cause symptoms.  Adrenalin brings cold sweats, a light-headed nervousness, butterflies, tremors, and a pounding heart. Glucagon causes a hungry-weak-uneasiness, nausea, and headache. Also the brain doesn’t work right when the sugar is too low and this causes irritability, blurry vision and confusion.  If severely low, loss of consciousness, seizures, and finally permanent brain injury can result.

I remember having a similar feeling as a high school student, when I wasn’t well prepared was standing in front of a crowd trying to play a trumpet solo by memory. My sugar wasn’t low. Rather, I was filled with adrenalin because I was so worried that I would forget the notes. But the feeling was the same: my heart was in my throat, sweat was pouring off my brow, and I was shaking like a leaf.

This same “fight or flight” feeling from an adrenalin surge is the first warning sign that happens when sugar gets too low, and should tell a savvy person to take some action to bring sugar levels up. Probably the fastest absorbed carbohydrate to raise sugar would be crackers, a piece of white bread, a baked potato, or a glass of fruit juice. Of course if the sugar is too low and the patient is having trouble swallowing, then an injection of glucagon or an IV with sugar water would be needed.

There are many and varied causes for low blood sugar, such as tumors of the pancreas, alcohol abuse, complications from gastric bypass surgery, and adrenal insufficiency to name a few. There is even a mild low sugar feeling that commonly occurs when one over-exercises on an empty stomach, but any such symptoms should be discussed with your doctor.

By far the most common cause for hypoglycemia is from certain diabetic medicine, however, and every diabetic should understand the symptoms.

Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.

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

By Richard P. Holm, M.D.

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

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

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

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

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

Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.

Brain injury in a football hero

By Richard P. Holm M.D

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

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

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

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

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

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

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

The miracle of the tube

By Richard P. Holm, M.D.

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

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

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

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

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

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