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.

What do you say?

By Richard P. Holm M.D.

Before my junior year in high school, I returned from a Boy Scout canoeing trip to discover my sister had been killed in a car crash. I will never forget the sadness of the moment when I walked into the house, which was filled with what seemed like half the caring and wonderful town of DeSmet, to find my Mom and Dad there grieving. It was near the end of that summer, but the beginning of a long period of mourning for my family and me.

There were lessons that came to me after my sister’s death. I realized how important support from a community could be. Consolation came from our friends, neighbors, church community, as well as people who we barely knew. It seemed more about their presence, and not their words. I noticed there were people who had trouble themselves dealing with such loss, and they sort of disappeared.

Also I realized that a funeral is not exactly a time of closure for a family, but really just the beginning of a time to accept reality and forge ahead with the difficult changes that life can and does deal out. It took me years to think about my sister and relish in her memory rather than cringe from the pain of the loss. In that sense, I know I will never have closure and that’s good.

Some 14 years after her death, while I was on the faculty of a medical school in Georgia, I found myself having to advise medical students how to talk to patients or family about sad news. I reviewed the medical literature on the subject at the time, and concluded that there is no right way to do it except to be 100% honest, and to say whatever is needed with compassion. Through the years those guidelines have sustained me while I have had the burden of sharing awful news.

Bottom line, it is being there, more than words, that consoles. Never worry about what to say, just show up, be honest, and care.

A triple-degree burn

By Richard P. Holm, M.D.


She was removing the pan of hot grease from the stove when she spilled the stuff all over her right hand. One area of skin was just red like sunburn, which is defined as a first-degree burn. Another spot blistered making that burn second-degree. But in the center there was a third-degree burn where the grease had injured both the outer and inner layer of skin so severely it caused, eventually, a small open ulcer. Fortunately there was no fourth-degree burn, which is when the muscle and connective tissue below the skin is also injured.

She ran cool water on it for 10 minutes, and then came to see me in the clinic. I removed the dead skin gently where blisters had broken, applied antibiotic ointment with silver and sulfa, and a cotton gauze dressing to the injured skin, and prescribed pain medicine. She was instructed to protect the wound, gently wash and redress it twice daily, cut away dead skin but not break the intact blisters, just let them break by themselves, and watch carefully for infection. I set an appointment for her to see me in a few days.

I have had the experience of treating burns that were so severe that the nerve endings were destroyed and there was little pain. More common however, is the unrelenting pain associated with less-severe burns, and that was the case with our hot grease injury. The wound looked good and healed nicely over time, but she and I were challenged dealing with her pain until thankfully it resolved after a several weeks.

The skin is the largest organ of the body and it weighs six to nine pounds. It spreads a thin-but-important layer over the outside of our body, protecting us from invading bacteria and viruses, managing fluid balance, controlling body temperature, and allowing for sensations that include touch, pressure, heat, cold, and especially pain.

It shouldn’t take a burn to realize the value of our skin.

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

Ovarian cancer

By Richard P. Holm, M.D.

When this story begins, Mrs. Z. was 70ish and a special patient to me because years earlier, I had discovered her need for heart-valve surgery and later had helped direct her breast cancer care after she had discovered a lump. Now she had pelvic pressure pain and fullness, vaginal bleeding, and some urinary symptoms. She knew something was wrong, and apologized for delaying this visit because she was afraid of what I might find.

It is one of those moments I will never forget. On exam I was surprised to find a grapefruit-sized mass in her pelvis and when I looked up to her worried eyes it must have been written on my face. She knew before anything was said.

The very next day she went to surgery, and I was asked to assist. Indeed the tumor was a malignancy coming from her ovary, and although 85-90 percent of ovarian cancers come from the cells that cover the surface of the ovaries, I think my patient had what is called a germ-cell tumor. This kind of tumor comes from inside the ovary, is usually found in younger women, and starts from egg-producing cells. There is a third kind of ovarian cancer that starts from hormone-producing tissue or stromal cells, but we had to wait for the microscopic exam to tell.

She had several ovarian-cancer risk factors that included a family history of colon cancer, a late menopause, and her previous breast cancer history. Even when we understand risk factors, ovarian cancer is called a silent killer because, like in Mrs. Z’s case, the symptoms usually appear late, often after the tumor has spread. But in her case the cancer hadn’t spread.

Mrs. Z eventually died of heart failure in her late 80s, had many wonderful retirement years with her kind husband, and our friendship grew through those years. It’s the kind of thing that makes my job such a joy.

Jumping on the Vitamin D bandwagon

By Richard P. Holm M.D.



“Jump on the bandwagon” is a political phrase started in the mid 1800s when a circus clown turned politician and used his musical bandwagon for political rallies. As he passed through different towns it happened that local politicians found seats on the bandwagon, wishing to share in his popularity. As the political use of bandwagons spread, the phrase “jump on the bandwagon” came to refer to opportunists who support popular ideas without proof of value.



What proof do we have of the value of taking calcium and vitamin D, or have we all jumped on a bandwagon? Recently a committee of scientists and experts were gathered by the Institute of Medicine (IOM) to define what is scientifically proven about calcium and vitamin D.



After extensive hearings and study they said that there is solid proof that low levels of vitamin D are associated with poor bone health. We don’t have enough evidence yet to say conclusively vitamin D deficiency effects cardiovascular health, or causes hypertension, diabetes, falls, colon cancer, and psychiatric illness. They didn’t deny it they just said more studies are needed.



With regards to dietary calcium, the IOM concluded that most people in the US and Canada daily get enough Calcium, except for girls aged 9-18. They also discovered that significant numbers of postmenopausal women are taking too much calcium.



Vitamin D is more complicated, because levels are quite unpredictable, although commonly low in the elderly, those with dark skin, the obese, and people living in institutions. Even though multiple experts have advised that levels are too low when under 30 to 50 nanograms per milliliter, the conservative IOM declared that levels below 20 are deficient. The IOM did advise supplementation for all over one year of age, stating that for adults taking up to 4,000 units is safe, and advised not to take more than 10,000 daily.



Take home message: I encourage calcium supplements for 9-18 year old girls but not for adults. I also like to measure vitamin D levels, especially in people with dark pigment, obesity, osteoporosis risk, those institutionalized, or in persons older than 60. And for bone health I strongly recommend, along with an exercise program, all adults should daily take 2 to 4,000 units of vitamin D. That’s not just jumping on a bandwagon.