By Richard P. Holm, M.D.
This month, a scientific journal reported the remarkable case of a 35-year-old man who took an unusual treatment for ulcerative colitis. His colon was so inflamed and sore that he had been advised by doctors to have it surgically removed. After researching experimental therapy for ulcerative colitis, he decided to travel to Thailand where a doctor gave him 1,500 roundworm eggs to swallow.
The idea that worms might have something to do with ulcerative colitis and Crohn’s disease came from the observation that colitis is common in developed countries like America, where worm or parasitic infections are rare. In contrast, colitis is rare in countries where virtually the entire population has worms living inside of them.
This is similar to scientist David Strachan’s “hygiene hypothesis,” that was presented in the British Medical Journal in 1989. He showed data that hay fever and eczema were more common in families with one child than in larger families, and he speculated that the difference was because of an earlier and broader exposure to infections in the larger families. He suggested that more exposure to the dirty world results in less allergies.
Strachan’s idea has expanded and the “hygiene hypothesis” proposes that in developed countries, as a result of a “too-clean” environment, there is an increase in the diseases of the immune system such as inflammatory bowel disease, multiple sclerosis, asthma, and even childhood-onset diabetes mellitus type 1. Remember, however, the “hygiene hypothesis” is still just theory.
Let’s get back to our patient with colitis that traveled to Thailand. To everyone’s delight, after eating worm eggs, the gentleman quickly became symptom free. About three years later, after a relapse, he took more eggs and got better again. Over the six years that scientists studied the patient, they found his immune system was changed by worm therapy and noted that his colon had increased mucous production.
We are not talking night crawlers here, and some worm infections can be very harmful in humans, so people should not eat worms without scientific direction. Studies are now underway using pig whipworms, which are a less-aggressive worm, in treating not only inflammatory bowel disease, but also multiple sclerosis.
“Nobody loves me, everybody hates me, guess I’ll eat some worms.” Maybe some day we’ll be eating worms for colitis, too.
Sunday, December 19, 2010
Monday, December 13, 2010
On suffering
By Richard P. Holm, M.D.
Part of the mantra or sacred prayer of every physician is to reduce suffering, but what is it to suffer? The dictionary explains suffering as more than just experiencing something unpleasant or painful. The origin of the word comes from the Latin word “sufferre” or “to bear,” as if carrying a burden.
It is interesting to note that neuro-imaging maps have found that a certain part of the brain fires up when we feel either physical pain or emotional distress. Two radically different kinds of suffering seem to share a single neurological space in our heads. I also read in researching this topic that some individuals feel suffering leads to the construction of meaning in life and that it helps us to know more about our world.
To better understand the concept of suffering, this week I asked a number of patients and friends what it was that had caused them the most suffering. Surprisingly not one described an experience of physical pain. Rather the answers all turned around emotional loss. I heard about emptiness and anxiety following the death of parents and siblings, about the psychological stress of having kids, and a lot about the depression following divorce. People seem to forget about physical pain, but they remember emotional hurting.
Recently a national survey of hospice directors asked how we treat those dying from various illnesses and I was asked to fill out a form with challenging questions. Two questions were especially difficult for me: “Is pain and suffering a means for spiritual growth?” and “Should physicians seek to relieve patients’ spiritual suffering just as much as patients’ physical pain?”
I have no problem with the idea that people grow from suffering, but I struggle with the subtle implication that to relieve people of life’s emotional and spiritual pain could possibly rob their lives of meaning.
Bottom line, emotional pain is probably more significant than most of us realize, and my hat is off to the psychiatrists and psychologists whose jobs concentrate on just that part of the quest to enhance human health.
May we all find meaning in this crazy and sometimes hurtful life, and may we all find some help when it gets too painful.
Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.
Part of the mantra or sacred prayer of every physician is to reduce suffering, but what is it to suffer? The dictionary explains suffering as more than just experiencing something unpleasant or painful. The origin of the word comes from the Latin word “sufferre” or “to bear,” as if carrying a burden.
It is interesting to note that neuro-imaging maps have found that a certain part of the brain fires up when we feel either physical pain or emotional distress. Two radically different kinds of suffering seem to share a single neurological space in our heads. I also read in researching this topic that some individuals feel suffering leads to the construction of meaning in life and that it helps us to know more about our world.
To better understand the concept of suffering, this week I asked a number of patients and friends what it was that had caused them the most suffering. Surprisingly not one described an experience of physical pain. Rather the answers all turned around emotional loss. I heard about emptiness and anxiety following the death of parents and siblings, about the psychological stress of having kids, and a lot about the depression following divorce. People seem to forget about physical pain, but they remember emotional hurting.
Recently a national survey of hospice directors asked how we treat those dying from various illnesses and I was asked to fill out a form with challenging questions. Two questions were especially difficult for me: “Is pain and suffering a means for spiritual growth?” and “Should physicians seek to relieve patients’ spiritual suffering just as much as patients’ physical pain?”
I have no problem with the idea that people grow from suffering, but I struggle with the subtle implication that to relieve people of life’s emotional and spiritual pain could possibly rob their lives of meaning.
Bottom line, emotional pain is probably more significant than most of us realize, and my hat is off to the psychiatrists and psychologists whose jobs concentrate on just that part of the quest to enhance human health.
May we all find meaning in this crazy and sometimes hurtful life, and may we all find some help when it gets too painful.
Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.
Sunday, November 14, 2010
Send the kids outside to play
By Richard P. Holm, M.D.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said that kids throughout the rest of the world need to step away from their computers and TVs, and exercise their glorious freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first- to fifth-grade children. It was a combined effort by staff at the Brookings Boys and Girls Club, researchers from South Dakota State University, South Dakota medical-school students, and the South Dakota Internal Medicine organization, called the American College of Physicians. We found pedometer and activity readings were significantly greater when children were simply allowed to have free-play, as compared to organized activity.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting spring snow gutter-rivers, and summer biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high-caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes, and why adult joints are so stiff and immobile, and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity. This problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play. And remember, what’s good for kids are good for people of all ages.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said that kids throughout the rest of the world need to step away from their computers and TVs, and exercise their glorious freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first- to fifth-grade children. It was a combined effort by staff at the Brookings Boys and Girls Club, researchers from South Dakota State University, South Dakota medical-school students, and the South Dakota Internal Medicine organization, called the American College of Physicians. We found pedometer and activity readings were significantly greater when children were simply allowed to have free-play, as compared to organized activity.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting spring snow gutter-rivers, and summer biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high-caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes, and why adult joints are so stiff and immobile, and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity. This problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play. And remember, what’s good for kids are good for people of all ages.
Thursday, November 4, 2010
Send the kids outside to play
By Richard P. Holm M.D.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said kids throughout the rest of the world need to step away from their computers and TV sets, and exercise their freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first to fifth grade children. It was a combined effort by staff at the Brookings Boys and Girls club, researchers from SDSU, South Dakota med students, and the SD Internal Medicine organization, the ACP. We found pedometer and activity readings were greater when children were simply encouraged to have free-play, as compared to organized activity, or screen time.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting snow gutter-rivers, and biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes; why adult joints are so stiff and immobile; and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity and this problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play.
Last night at a lecture about the value of education in Afghanistan, the speaker told us of kids growing up surrounded by war, without being able to play outside safely. He said kids throughout the rest of the world need to step away from their computers and TV sets, and exercise their freedom by going outside to play. The place erupted in applause.
This simple statement is supported by a recent “Move Muscles” or 2M study we did with first to fifth grade children. It was a combined effort by staff at the Brookings Boys and Girls club, researchers from SDSU, South Dakota med students, and the SD Internal Medicine organization, the ACP. We found pedometer and activity readings were greater when children were simply encouraged to have free-play, as compared to organized activity, or screen time.
For as long as humans have lived, until now, kids have been encouraged to go outside and play. As a kid growing up in DeSmet, I was outside for all four seasons. I remember jumping into piles of leaves, building snow forts for ferocious snowball fights, floating stick rafts down melting snow gutter-rivers, and biking everywhere.
But things have changed. Now we drive our kids to school to sit and listen all day to people talking, they watch while a few athletes compete in a game of some kind, and then they come home to play video games of action heroes, while they sit on a couch eating high caloric snacks. Unless something changes, this generation of kids will grow up to be adults who drive to work while they earn money sitting in an office, and who have labor-saving devices do the work while they continue to sit and watch other people play.
It is easy to understand why there is an epidemic of obesity and diabetes; why adult joints are so stiff and immobile; and why life expectancy in this country is dropping. Simply put, people will die and are dying young from diseases of inactivity and this problem is only getting worse.
We could do something to change this deadly trend if we would simply send our kids outside to play.
Tuesday, November 2, 2010
Mental health and mortality
By Richard P. Holm, M.D.
Mental and emotional problems are everywhere. More than half of what I do, as a general internist, is to help people deal with emotional problems. It comes with the heartbreak and suffering of loss, pain, or growing old, with debilitating illnesses, and with the burden of mental illness itself. It is truly a challenge to try to help people cope with such trouble.
This September a large, 13-year Canadian study reported a 322-percent higher death rate in people taking minor tranquillizers compared with those not taking such medicines. Use of this type of drug can be taken as an indicator of emotional problems. Looking closer, there were huge socio-demographic and lifestyle differences between groups.
The study implied that if one comes from a tough neighborhood, drops out of school, struggles with addiction, abuses alcohol, smokes, does not exercise, and has mental health problems, then the risk of premature death is more than three times higher than one without such problems. In other words, emotional illness often walks side-by-side with tough social, economic, and health problems. And the combination is associated with premature death.
There was also an inference from the study that the use of minor tranquilizer-type sleeping medicine might alone carry some risk to one’s physical health. My personal interpretation from the data is that sleeping pills and anti-anxiety medicines can cover up or make worse an underlying depression. What’s more, these tranquilizers often put off or prevent appropriate therapy, such as counseling, exercise programs, and very effective antidepressant medicines.
Mental health is truly an important ideal but it comes and goes for each of us as we struggle and meander through our lives. Physicians and care providers have tools to help, including ears to listen, words of advice, and sometimes even good medicine to prescribe. To ignore indicators that there might be a mental health problem could mean the difference between life and death.
Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.
Mental and emotional problems are everywhere. More than half of what I do, as a general internist, is to help people deal with emotional problems. It comes with the heartbreak and suffering of loss, pain, or growing old, with debilitating illnesses, and with the burden of mental illness itself. It is truly a challenge to try to help people cope with such trouble.
This September a large, 13-year Canadian study reported a 322-percent higher death rate in people taking minor tranquillizers compared with those not taking such medicines. Use of this type of drug can be taken as an indicator of emotional problems. Looking closer, there were huge socio-demographic and lifestyle differences between groups.
The study implied that if one comes from a tough neighborhood, drops out of school, struggles with addiction, abuses alcohol, smokes, does not exercise, and has mental health problems, then the risk of premature death is more than three times higher than one without such problems. In other words, emotional illness often walks side-by-side with tough social, economic, and health problems. And the combination is associated with premature death.
There was also an inference from the study that the use of minor tranquilizer-type sleeping medicine might alone carry some risk to one’s physical health. My personal interpretation from the data is that sleeping pills and anti-anxiety medicines can cover up or make worse an underlying depression. What’s more, these tranquilizers often put off or prevent appropriate therapy, such as counseling, exercise programs, and very effective antidepressant medicines.
Mental health is truly an important ideal but it comes and goes for each of us as we struggle and meander through our lives. Physicians and care providers have tools to help, including ears to listen, words of advice, and sometimes even good medicine to prescribe. To ignore indicators that there might be a mental health problem could mean the difference between life and death.
Dr. Rick Holm wrote this editorial for “On Call®,” a weekly program about health on South Dakota Public Broadcasting-Television that is produced by the South Dakota Cooperative Extension Service. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain.
Thursday, October 28, 2010
The medicine wheel, the Great Spirit, and John Wesley
By Richard P. Holm M.D.
The American Indian medicine wheel is thought to have existed for more than 5,000 years and has been the basis for not only medicinal but also religious approaches to problems of living.
Although there are significant differences between regions and tribes, the medicine wheel reflects not only certain botanicals but also the circle of life and the Great Spirit surrounding all of us. East is spring, sunrise, childhood, physical, and yellow; south is summer, noon, adolescence, social, and red; west is autumn, sunset, adult, intellectual, and black; north is winter, night, elder, spiritual, and white. Up is sky and Father; down is earth and Mother; and center is fire.
The history of modern medicine in the Americas starts with the spiritual and herbal knowledge of the Indian. As the Europeans made their great western migration into this new land with Mediterranean medical concepts, there was a great mixing of ideas with the American Indian’s spiritual and herbal way. This resulted in the evolution of a uniquely American way of caring for the ill, especially helped by Indian knowledge of the medicinal nature of flora and fauna, and their respect for the spiritual element needed for healing. This in turn, influenced health care throughout the world and reflections of it remain with us today.
In 1735, when young John Wesley the famous English Methodist came to a new American colony at Savannah, Georgia, he was impressed by the rugged health and the medical practices of the American Indian. Later back in England he even composed a book, which described many Indian secrets to the art of healing.
Wesley wrote that Indian illnesses, during this era, were exceedingly few because of their continual exercise and lack of excessive alcohol. The great epidemics brought from Europe followed, however, and the physically rigorous life was no longer required. It resulted in decimation of about 80% of the Indian population with severe injury to their spiritual focus and culture.
We should learn and never forget the lessons from American Indian heritage: the proper use of medicinal ingredients, the value of a physically active life, and the spiritual power of the circle of life and the Great Spirit surrounding us all.
The American Indian medicine wheel is thought to have existed for more than 5,000 years and has been the basis for not only medicinal but also religious approaches to problems of living.
Although there are significant differences between regions and tribes, the medicine wheel reflects not only certain botanicals but also the circle of life and the Great Spirit surrounding all of us. East is spring, sunrise, childhood, physical, and yellow; south is summer, noon, adolescence, social, and red; west is autumn, sunset, adult, intellectual, and black; north is winter, night, elder, spiritual, and white. Up is sky and Father; down is earth and Mother; and center is fire.
The history of modern medicine in the Americas starts with the spiritual and herbal knowledge of the Indian. As the Europeans made their great western migration into this new land with Mediterranean medical concepts, there was a great mixing of ideas with the American Indian’s spiritual and herbal way. This resulted in the evolution of a uniquely American way of caring for the ill, especially helped by Indian knowledge of the medicinal nature of flora and fauna, and their respect for the spiritual element needed for healing. This in turn, influenced health care throughout the world and reflections of it remain with us today.
In 1735, when young John Wesley the famous English Methodist came to a new American colony at Savannah, Georgia, he was impressed by the rugged health and the medical practices of the American Indian. Later back in England he even composed a book, which described many Indian secrets to the art of healing.
Wesley wrote that Indian illnesses, during this era, were exceedingly few because of their continual exercise and lack of excessive alcohol. The great epidemics brought from Europe followed, however, and the physically rigorous life was no longer required. It resulted in decimation of about 80% of the Indian population with severe injury to their spiritual focus and culture.
We should learn and never forget the lessons from American Indian heritage: the proper use of medicinal ingredients, the value of a physically active life, and the spiritual power of the circle of life and the Great Spirit surrounding us all.
Friday, October 1, 2010
A lousy essay about cooties
By Richard P. Holm M.D.
Remember a cruel playground game about cooties or “you’re it?” Also called pediculosis capitis, cooties, or a head louse infestation truly is something from which to run. Head lice are small wingless insects that get into the hair and scalp. Except for the common cold, this infestation is the most common communicable condition of childhood, affecting something like 10-20 million people per year.
They do not jump or fly, or live on any other animal but humans, but these little blood-sucking invaders are extremely easy to spread by head-to-head contact. This happens especially in pre-school, kindergarten, grade-school spaces, where kids will be kids, and personal hygiene has nothing to do with it.
The diagnosis is confirmed by finding the louse, which is clear to tan and the size of a sesame seed, crawling around the ears and at the nape of the neck, or discovering tiny white to grey eggs, also called nits, attached to hair shafts.
It is nice to know that head lice generally do not crawl outside the scalp, and other than causing severe itching, the condition does not cause any other important problem or carry any illness.
This is in contrast to their cousin “body lice,” who reside below the scalp, after feeding set up in the creases of clothes, and can carry infectious diseases such as typhus, trench fever, and relapsing fever. Head lice are also different from bed bugs who are brown and larger, can live away from the human body, and can feed off warm-blooded mammals other than humans. It is a relief to know that bed bugs carry no disease, which is similar to head lice but unlike body lice.
The treatment of head lice involves attacking from several directions. Start with over-the-counter Permethrin lotion (Nix), or Pyrethrin (Rid, A200, or Pronto shampoo). These need repeating in one week to get the next egg hatch. (Suffocating with mayonnaise, herbals, olive oil, or butter does not work.) What is most effective and yet underutilized is to thoroughly comb wet hair every two days for two weeks with a special fine-tooth comb. Finally wash all bed linens and clothing that came in contact with those infested, drying in a hot dryer for 40 minutes. Bagging stuffed animals and clothing for two weeks also works.
So when your little one comes home with cooties, don’t panic and don’t run. Get out a fine-tooth comb, special lotion, and get to work.
Remember a cruel playground game about cooties or “you’re it?” Also called pediculosis capitis, cooties, or a head louse infestation truly is something from which to run. Head lice are small wingless insects that get into the hair and scalp. Except for the common cold, this infestation is the most common communicable condition of childhood, affecting something like 10-20 million people per year.
They do not jump or fly, or live on any other animal but humans, but these little blood-sucking invaders are extremely easy to spread by head-to-head contact. This happens especially in pre-school, kindergarten, grade-school spaces, where kids will be kids, and personal hygiene has nothing to do with it.
The diagnosis is confirmed by finding the louse, which is clear to tan and the size of a sesame seed, crawling around the ears and at the nape of the neck, or discovering tiny white to grey eggs, also called nits, attached to hair shafts.
It is nice to know that head lice generally do not crawl outside the scalp, and other than causing severe itching, the condition does not cause any other important problem or carry any illness.
This is in contrast to their cousin “body lice,” who reside below the scalp, after feeding set up in the creases of clothes, and can carry infectious diseases such as typhus, trench fever, and relapsing fever. Head lice are also different from bed bugs who are brown and larger, can live away from the human body, and can feed off warm-blooded mammals other than humans. It is a relief to know that bed bugs carry no disease, which is similar to head lice but unlike body lice.
The treatment of head lice involves attacking from several directions. Start with over-the-counter Permethrin lotion (Nix), or Pyrethrin (Rid, A200, or Pronto shampoo). These need repeating in one week to get the next egg hatch. (Suffocating with mayonnaise, herbals, olive oil, or butter does not work.) What is most effective and yet underutilized is to thoroughly comb wet hair every two days for two weeks with a special fine-tooth comb. Finally wash all bed linens and clothing that came in contact with those infested, drying in a hot dryer for 40 minutes. Bagging stuffed animals and clothing for two weeks also works.
So when your little one comes home with cooties, don’t panic and don’t run. Get out a fine-tooth comb, special lotion, and get to work.
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