William Worrall Mayo had a curious and remarkable life, which included influencing the development of the prestigious Mayo Clinic. He was the descendent of famous English chemist John Mayow, who in 1668 first discovered spiritus nitroaereus, a component of air that would later be known as oxygen. W.W. Mayo was born in England in 1819 and before moving westward to the Americas, Mayo would study under John Dalton, the scientist best known for developing modern atomic theory.
Mayo left for New York City to work as a pharmacist but soon moved west to attend medical school. He first trained in Indiana but finished his medical degree in Missouri. There, he was troubled with recurrent bouts of malaria, which he blamed on the southern heat. This brought him to move north to Minnesota for a healthier climate.
He lived in several Minnesota towns including St. Paul, Duluth, and Le Sueur, before finally moving to Rochester. During those times, W. W. supplemented his medical practice by tailoring, farming, operating a ferry service, serving as a justice of the peace, and publishing a newspaper. He was called to serve as a physician during the devastating Dakota Indian War of 1862, which ended near New Ulm, Minnesota and concluded with the hanging of 38 Dakota Sioux Indians.
Dr. Mayo then moved his family to Rochester in 1864, bringing his wife Louise, their three daughters and a young son. He came for a job with the draft board, performing examinations for the Army. After the Civil War, Dr. Mayo, often called “the little doctor,” due to his height of only 5’ 4”, set up a medical practice of his very own and welcomed the addition of a second son to the family. While W. W.’s practice continued to grow, he also found time to serve as an alderman, a school board member, the mayor of Rochester, and a member of the Minnesota State Senate.
In 1883, a destructive tornado came through Rochester and Mayo turned to the Sisters of St. Francis for help, a teaching order with little medical experience. His eldest son, Will, had just returned to Rochester after medical training, and his second son Charlie, still in medical school, both joined W. W. to care for tornado victims. In response to this experience, the Sisters later built St. Mary’s, a twelve-bed hospital with the three Mayo doctors as surgeons and the Sisters of St. Frances as nurses.
The success of the Mayo Clinic is said to have happened because of W. W.’s early concept of a group practice and his appreciation for collaboration. It all started with the dad and two sons working together, along with the Sister-teachers turned nurses and the research and education that follows the shared work of a team.
By Richard P. Holm, MD
Despite the man's caring conversation, I heard very little of it because his large, rosy, bulbous, and bumpy nose had stolen my attention. Years later, when I met him again, he looked like a different man. The rosacea and rhinophyma skin condition, which had made his face so red and nose so massive, was calmed down with medication, and the excessive growth of skin over the nose had been trimmed away by laser scalpel. This time my eyes were no longer drawn to that globular and swollen proboscis and instead were charmed by his kind and wizened eyes.
Acne rosacea, or more commonly called just rosacea, affects 14 million people in the U.S., or five percent of the population, and is sometimes said to be an adult version of acne vulgaris. We see rosacea more often in 30 to 50-year-old women, and it can flair as menopause approaches. When it does affect men, it can be severe, and in a percentage of cases, rosacea can cause an ever-growing piling up of skin over the nose, called rhinophyma.
Rosacea usually targets fair-skinned, freckle-faced, blond or redheaded, blue-eyed people who flush easily. It seems triggered by sun exposure, hot drinks, hot baths and showers, hot spicy foods, stress, exercise, and steroid medications. Of course, one way to prevent rosacea is to try to avoid such triggers.
Acne vulgaris, or more commonly called just acne, is similar to rosacea, and seems also related to hormonal swings. Acne affects about 85% of all U.S. adolescents and, more often than rosacea, causes whiteheads and blackheads. Adolescents living in western modernized civilizations struggle with acne, however it rarely affects anyone living in non-industrialized societies. This has led some experts to believe acne and rosacea might be made worse by soap, excessive cleanliness, antibiotic use, and anything that alters the normal-flora living on our skin, which protects us from invasive bacteria. It’s like how grass on a lawn protects against weeds.
The two conditions of rosacea and acne have common methods of treatment. Over-the-counter lotions like benzoyl peroxide, prescription antibiotics, and Vitamin A, each in lotion and pill form, are still the mainstay of therapy.
In contrast, recently there is a trend to move toward supporting one’s normal flora, avoiding antibiotics, cleansing agents, or oil removing methods, and even trying probiotics. This is all in an effort to re-establish a lawn of protection to fight the invasion of weeds. Treatment is effective in most people, but not all. So if you don’t find relief with typical treatments, or your nose starts growing, it’s time to see your doctor and/or the dermatologist.
A friend gave me feedback a few days ago, "Some people say you are arrogant, but I tell them ‘No—he is just self-confident.’" He followed, "We need that in a doctor, but, you know, there is a fine line between those two characteristics."
Uff da! That threw me for a bit. After thinking about it, I took it as an honest comment and a chance for me to improve myself. A physician/philosopher once said: "A true friend will help you grow by pointing out your warts. Instead of getting angry, one should take it as an opportunity to get better."
What is arrogance? The dictionary’s definition is harsh: "An offensive display of superiority or self-importance; overbearing pride." I see it in people who treat others poorly, especially those who are lower on some hierarchal level. Examples would include an employer who expects sexual favors of some kind, a prison guard who harasses a prisoner hatefully, a teacher or parent who supervises a student or child unjustly, or, to make the point, a doctor who treats a nurse or patient poorly. I believe nothing indicates the true color of an individual more than how he/she treats someone who may be lower on the totem pole.
I have seen examples of physicians acting this way: when a surgeon threw a scalpel across the room; when a specialist spoke negatively to the patient about a primary care physician; and when a surgical resident treated a young inner-city woman, infected by gonorrhea, with disdain and contempt. I am not proud that my profession probably deserves some of its reputation for being arrogant. On the other hand, part of the value provided by a physician comes from the sense that she or he is competent and knowledgeable. A humble physician is one thing, but an unsure and uncertain doctor is another.
Perhaps sometimes I have come off as a know-it-all. I need to work on that because I do not know it all. In fact, it seems the more I do know, the more I realize my inadequacies. My folks came from humble backgrounds, and I was drilled on the Golden Rule. The last thing I want to do is to portray myself as a physician who thinks he is more important than anyone else. Rather, I would like to be known as someone who is both competent and cares.
Richard P. Holm, MD
As part of our Prairie Doc volunteer work to spread science-based public health information, we have assembled a group of pre-professional college women and men to help us out. Almost every Thursday night at 7 PM (6 mountain time), these young “Prairie Doc Assistants”, or PDAs, answer telephone call-in questions for our TV show on PBS. This changing group, initiated by our friend and advisor Mr. Judge Kelley, has been helping us for more than four years.
These kids not only help answer phone calls during live shows, but they help research medical topics, and even help others during medical mission trips. In return, we give them the opportunity to meet our medical guests for 30 minutes before the show, and we help them find shadowing experiences with physicians. They need to experience a taste of what it would be like in med school and in the real world after starting practice, before they commit to it.
My first two years of medical school, back in the 70’s, required putting my nose into books, memorizing how the normal human body works, and understanding what can happen when illness strikes. The second two years, and the internship and residency that followed, were spent learning from an older and experienced master who taught by example. This mentor-based teaching style is a lot like the medieval way of learning, like being an apprentice to a silversmith who knows what he’s doing, and who guides you in making your first silver tea service. In medicine, I think the hands-on, one-on-one, mentoring experience is what matters the most, but the book-learning part is still necessary. Now, med schools are mixing together the book-learning and the mentoring throughout the four years of education, which is a better deal in my opinion.
During my life of medical practice, I have mentored many apprentice nurse practitioner students, P.A. students, medical students, and medical residents; all while I was caring for patients. I asked the patient permission first and very rarely had anyone say “no" to having a student in the room. How else are they to learn how to listen, examine, and think in their quest to become a high-quality care giver? Besides, having a student watching can only make a doctor try harder and be better.
Now, I find myself encouraging college students into the glorious and rewarding field of medicine. Indeed, what an honor it has been to have a treasure chest of knowledge that can be used to help others!
By Richard P. Holm, MD
In 1966, a ten-year-old boy from Hamlin County, South Dakota was sleeping out with his buddies when a skunk crawled into his sleeping bag and bit the boy aggressively near the face. Despite providing the child with old-style vaccinations, the boy succumbed to rabies within a month. Even with present day technology, once rabies gets to the nerves it is at least 96% fatal in humans. rabies is believed to kill more than 55,000 people every year in Africa and Asia alone—most of them after a bite from a rabid dog. By comparison, in the U.S., rabies kills only about two or three people per year.
Over the last 50 years, effective vaccination programs for domestic dogs and cats, along with improved rabies post-exposure prevention (PEP) treatment, has significantly reduced the number of rabies-related deaths in the United States. Domestic animal vaccination has been quite successful in containing rabies exposure to humans, but minimally affects the risk of rabies in wild animals and thus they remain a reservoir for the disease. This and the newer PEP, which is easier to take and more effective, has also helped radically reduce human rabies.
We still have plenty of animal rabies, however. In SD, over the last ten years, we tested 6,500 animals suspected of rabies, since they were seen in unnatural hours acting sluggish or aggressive. They found five percent tested positive. Specifically, 195 skunks, 48 bats, 47 cows, 22 cats, 16 dogs, eight horses, three goats, and two raccoons were rabid. Please take note that none of the 16 infected dogs had been vaccinated, giving credibility to the value of vaccination. Of all the bats tested, only three percent were positive, while 48% of the skunks tested were rabid. These were selected due to bizarre behavior and thus the percentage affected is artificially high. Still, this gives another reason, besides bad odor, to avoid skunks.
Just last week a Sioux Falls man was walking his dog late in the evening near many evergreens, when he noted something was crawling on his forearm. When home in the light, he noted tiny double bite marks, highly suspicious for bat bites. Since SD bats are usually bug eaters, not arm chewers, this incident was worrisome. The doctor recommended rabies PEP.
Bottom line: Vaccinate your pets, avoid messing with wild animal, and seek immediate medical care whenever bitten by any animal.
By Richard P. Holm, MD
In the U.S. there are almost five million people with mild to moderate dementia. Studies show that about 70% of these people are at home, either alone or with a caregiver (often a spouse). If more people with mild to moderate dementia could stay home safely, this would save Medicare and Medicaid a great deal of taxpayer money. More importantly, this would provide those affected by dementia with their preferred environment. Indeed, it is important to allow all people the chance to stay at home whenever possible.
Recent Johns Hopkins research studied more than 250 people with dementia and found that 99% of the demented and 97% of their care givers had at least one unmet need. The foremost unmet need was safety issues which increased risk of falling, such as poor lighting in walkways. Other unmet needs included not performing regular exercise, poor follow-up with health care providers, not having prepared legal and estate planning, and not receiving needed help with medications and daily living activities. Researchers found that individuals with lower income, with depression, and/or with borderline—rather than severe—dysfunction, had significantly more unmet needs.
When there were at-home caregivers for these folks with early dementia, the caregivers were often not aware of these deficiencies. Add to all of this, the needs of the caregivers were often ignored or unrecognized. Remarkably, at-home caregiver stress and depression was one of the strongest predictors for an earlier move of the person, with dementia, to the nursing home.
Methods to enhance a person’s chance of staying at home are not difficult. Preparation for legal issues and estate planning should be done early and BEFORE memory loss. Other methods include providing raised toilet seats, grab bars in the bath and bedroom, properly tacked down carpets, adequate night-time lighting, and proper day and night time footwear. Researchers also strongly advise providing enhanced support for caregivers, such as educating them about support services available, like social services, occupational therapy, and caregiver support groups. In addition, screening for and treatment of any caregivers’ depression should be provided. This would go a long way in helping people stay at home as they age.
Bottom line: most of us (and our families) are not prepared for the possibility of dementia as we age. If we prepare, we greatly improve our chances for staying at home.
In 1735, the young religious leader John Wesley visited the city of Savannah, located in the province of Georgia in what was then the American Colonies. He was particularly impressed by the Native American peoples he encountered, describing them as the perfect example of health, correctly believing this to be due to their lean diet and rigorous physical lifestyle.
Numerous cultural and economic shifts have occurred since Wesley’s initial visit that have greatly affected the health of not only the American Indian, but also that of the white and multi-ethnic settlers that came to populate the country. As advancements in technology have taken away the need for hard daily physical activity, the American public has been taking it easy, letting the wheels and motors do the walking. We have become a country of couch-potatoes and TV watchers. It is a dangerous cycle: as we do less, we become less able to be physically active, which encourages us to do even less. This sedentary lifestyle has an enormous negative impact on our health.
At the same time, diets have changed with the availability of government-subsidized and inexpensive oil, flour, corn-syrup and cheese. This has made highly marketed, high-calorie, high carbohydrate fast-food a dietary staple, rather than the lean meat, fruits, eggs, and vegetables, which had been the traditional American Indian diet. Not only did they eat better, but they worked harder for it as well.
The consequence of eating more and moving less is an obesity epidemic. Two out of three Americans are over-weight and half of these are obese. It is no surprise that an epidemic of diabetes has followed. Right now, 29 million Americans know they have diabetes, and about one in four people with diabetes have it but don't know it. Although this epidemic is affecting non-Indian immigrants that have come to live in the U.S., diabetes is about twice as bad for the American Indian population.
The obesity and diabetes epidemics are a growing problem. The question is, how do we address it? It should certainly start with something more than developing and prescribing diabetic medicine. The most common form of diabetes is type 2, the incidence of which is greatly affected by lifestyle choices. People who eat too much and exercise too little are at a much higher risk. A recent study showed that educating children and parents about eating less and moving more makes the biggest difference in preventing and treating diabetes. Our job as medical care providers and as a society should be to spread this knowledge, encouraging everyone to eat a leaner diet and live a more physically-active lifestyle.
We all could learn from the habits of the early American Indians.
If you ask any of the members of my family to describe us, each would likely include our dog in that description. Our current dog Sasha was discovered at the Humane Society by our daughter, Julia. I asked Julia, “Why do you think our dog is good for us?” She quickly came back, “Sasha is playful and joyful, yet calming, soothing, relaxing, and comforting.” She said, “Sasha is sad when you’re sad and happy when you’re happy; a companion that loves you unconditionally; and on top of all that, SHE IS SO CUTE!”
Our son Preston points out how the dog protects our home by bark-warning us of intruders and cleaning the floor of bug-alluring food spilled from the dinner table. Our son Carter referenced how the dog says to us in dog-speak, “Car ride? I wanna go.” or, “Family is home, HOORAY!” Carter said, “It has something to do with her innocence, blind faith, and pure enthusiasm.”
The four dogs I have loved in my lifetime could each be described by those same descriptors. It doesn’t matter whether a person is emotionally devastated or filled with confidence, everyone can use a little companionship and unconditional love, especially during the lonely episodes that we all face, from time to time.
Different than a loving pet is a specially trained service dog. Service dogs are specially trained dogs who help individuals with mental or physical disabilities. Dogs can pull a person in a wheelchair, protect a person having a seizure, remind a person with mental illness to take their medicine, and calm a person with Post Traumatic Stress Disorder (PTSD) during an anxiety attack. Service animals are not restricted to just canines. Recently, miniature horses have been helpful for some disabled, and after special training, are being accepted as service animals as well.
Service dogs (and sometimes miniature horses) are allowed in places which serve the public, like restaurants or libraries. To allow this, however, the dogs or horses must be specially trained to perform specific tasks for their handler and be well behaved in public. Separate from these service animals are animals providing emotional support. Along with service animals, emotional support animals are allowed to live in housing that has a ‘no pets policy’ when a medical professional certifies that the individual has a verifiable disability and that the animal in question provides a benefit. Different from service dogs and miniature horses, comfort and emotional support pets do not need special training, but are often expected to be disciplined and well trained.
No question, our dog Sasha provides plenty of comfort and emotional support.
By Richard P. Holm, MD
Stories of curiosity, mystery, and murder—invented or real—have fascinated people for many years. The first in this genre, the tale of Frankenstein’s monster, was published in 1818. During the author Mary Shelley’s life, the study of anatomy was gaining considerable interest. But there was a problem: aspiring anatomists were short on bodies to dissect. The grim solution to that problem came in the form of grave robbing.
Shelley’s story evolves with the scientist Victor Frankenstein searching for body parts, although his purpose was more sinister than studying anatomy. He pondered: “The moon gazed on my midnight labours . . . who shall conceive the horrors of my secret toil as I dabbled among the unhallowed damps of the grave . . . I collected bones . . . with profane fingers . . . where death had apparently devoted the body to corruption.”
Ten years later, a true story also highlighted the difficulty of finding human bodies for dissection. Dr. Robert Knox, a Scottish anatomist at Edinburgh University, was desperate for bodies to dissect. A lodge keeper, William Hare, had a tenant pass away who owed Hare money. Understandably, Mr. Hare sought to clear the tenant’s debt by selling the body to Knox’s anatomy lab. He received the surprisingly large payment of about $800 in today’s money. After that, Mr. Hare, with his friend Thomas Burke, began murdering the working-class people living in or near Hare’s boardinghouse. Over the next ten months, the bodies of 15 others were sold to the unsuspecting Knox.
The jig was up when Mrs. Gray, another tenant, noted Burke acting suspiciously, and her curiosity prompted her to investigate after Burke had left the hotel. Mrs. Gray found a dead body and called the police. After careful investigation, Burke’s ties to several murders became evident. Dr. Knox convinced a jury he didn’t know of the murders but lost his job; Hare was granted immunity for spilling the beans but had to escape the country; Burke became the fall guy, was hung, and, ironically, his body was dissected in front of a crowd. His skeleton is still on display in the Anatomical Museum of Edinburgh. Wow! A true and intriguing story demonstrating greed, murder, and gruesome justice.
Twelve years later, the American writer Edgar Allan Poe wrote the first detective story The Murders in the Rue Morgue, and some 46 years after that, British author Sir Arthur Conan Doyle began writing about the brilliant detective Sherlock Holmes. Both authors frightened their readers with inventive and gruesome tales.
Stories of curiosity, mystery, and murder—invented or real—have and will continue to fascinate and captivate audiences for years to come.
By Richard P. Holm, MD
Mr. AB was a perfect specimen of health. A mid-fifties-aged man, he was physically fit because of rigorous farm work, and lots of physical activity involved with hunting, and fishing. This morning, he awoke with an uncomfortable chest pressure going into his neck and jaw. He arose to find no relief with stretching, drinking a glass of milk, taking a deep breath, or even laying down again. Finally, after rousing his wife, they made their way to an emergency room (ER) where he was given merciful pain relief and was immediately tested to define if it was his heart that was causing the pain.
Not long after arriving to the ER, while talking with his wife, he suddenly slipped into unconsciousness. The ER crew immediately ran into his room and started resuscitation efforts, but it was there in that cold, mid-winter, South Dakota, pre-dawn-hour that he died, despite their doing all the right things. Likely due to arterial blockage and irritable heart muscle, the symmetry of his heart rhythm had changed into one of pure chaos that wasn't effectively pumping blood. He just couldn't be converted back to a normal rhythm again. The value of rhythm is never more evident than during a cardiac arrest.
The definition of rhythm comes the from Greek roots of rhuthmos (to flow) and rhyme; meaning any regular, recurring, pulsing; a succession of contrasting beats occurring over various periods of time. Think of the rhythmic experience from speech and verse, rhyme and song, or drum and dance. There is something about rhythm that calls for symmetry, and when it is out of sync, there is a part of us that becomes uncomfortable, and we want to make it right again.
The rhythm of life is regular, recurring, pulsing; a succession of surges over time, like the flow of seawater and fish meeting the shore on an estuarial tide; the seasonal swim of salmon up a freshwater river looking for a place to spawn; the birth of lambs and calves, bursting forth on an early springtime prairie pasture; or even the 70 to 90-year life-cycle of humans, moving with joy, sorrow, and grace, from birth to natural death.
When humans die too early, the symmetry is out of sync, the rhythm is disturbed, and we are left wanting to make it right again.