Research tells us that regardless your age, exercising just 30 minutes daily of even mild to moderate walking increases energy levels, improves mood, and actually increases longevity. I submit that doing this outside is even better, weather permitting. Of course, on the northern high plains, sometimes the weather forces us to an indoor gym or to the personal exercise machine in the basement to get activity, but that’s OK too.
However, when we can, we should get out of the igloo and do our exercise outside. When the sun’s rays come pouring through our pupils, they not only give us vitamin D to strengthen our bones, but those rays tell our brains that we are alive. The views we see of the outside clue us into the changing cycle-rhythm of the day and season, prevent that seasonal affective disorder, and provide for a sense of a spiritual light of hope. Going outside, when possible, is very good for us.
Better yet, getting outside in South Dakota every season of the year makes the modern adventurer realize why they call this the “Land of Infinite Variety”. I especially relish my daily one-mile round trip walking trek to my morning café for breakfast and coffee (even in inclement weather when I have to put on boots and get all bundled up in my hooded 40 below winter coat). That said, there are many pleasant days in South Dakota throughout all four seasons.
I have wonderful memories of enjoying the outside in South Dakota. These include Black Hills riding snow-mobiles, down-hill skiing, and steep hill hiking to the summit of Black Elk’s Peak; spring and fall hiking through Oakwood Lakes and Lake Poinsett State Parks; sailing in the yearly Lake Poinsett Sailing Regatta; road biking through and around our community of Brookings; east and west river pheasant and deer hunting with friends; working in my vegetable and pepper garden; and walking or running some distance almost EVERY DAY for the last 40 years.
Take it from an experienced physician who has lived here for 57 out of his 69 years and who thinks he’s seen it all. Nothing comes close to improving one’s emotional and physical health than being an active interested person who gets outside and savors all four seasons on the northern high plains land of infinite variety.
Facing my own pancreatic cancer, I have read a few books recently recommended by friends who are lovingly trying to comfort me. A book written by neurosurgeon Eben Alexander, MD has been one of those stories that talks about a “near death experience” (NDE). Alexander developed bacterial meningitis and, during a seven-day coma experienced a NDE like others. He found himself drawn to a warm light while sensing tremendous reassuring comfort. A former skeptic of these stories, he has become a fervent advocate that these experiences (NDE) are evidence for God and Heaven. His final chapters discuss how inadequate science is in explaining consciousness and suggests that each of us is “more than our physical body.”
Throughout the ages, some of the greatest minds in the universe have addressed the question “what is consciousness?” From what source does our awareness come? Where does God fit into that question? Alexander states that “. . . the greatest clue to the reality of the spiritual realm is the profound mystery of our conscious existence.”
As a physician who has practiced for many years, I have tried my best to use evidence-based science to guide me in choosing the best diagnostic and therapeutic options for my patients. I define medical science as a search for truth using double-blinded studies that avoid the placebo effect and preconceived biases. As science advances, we are continuously improving what we can do for people. For example, we can now cure certain cancers that twenty years ago would have killed those affected. We can now relieve suffering from severe heartburn, from shortness of breath, from a heart that races, and from unrelenting depression. I am forever enthused and amazed by the continuous improvements in medicine that keep unrolling with proper use of the scientific method.
However, with all of our “method”, science has not been able to answer the consciousness question, the spiritual connectedness we can feel toward each other, the question about life after death, and the love and acceptance that many of us sense coming from God or another higher power. I agree with the neurosurgeon: answers to these questions must come, not from science, but from another place.
I love our home in Brookings, SD. When anyone asks me where I am from, instead of saying my home of 37 years, I almost always answer that I grew up in the sweet town of De Smet where I attended twelve years of school. Emotional and physical health starts in the community in which we were raised.
Many people take a lot of pride in being from that little town and much of that is from its history. Back then, within the library and the local Masonic Lodge, there were several original oil paintings by Harvey Dunn the famous painter and illustrator. It’s neat that De Smet has a connection to such a famous artist.
However, it’s most significant notoriety comes from the Laura Ingalls Wilder books because De Smet is the Little Town on the Prairie. Laura’s tales of growing up in the late 1800s in a pioneer town are famous throughout the world. Her clearly written words tell how those of European ancestry first moved and homesteaded onto American Indian land of the Minnesota and Dakota prairie. In particular, her book The Long Winter illustrates how challenging the conditions could be on the winter prairie, and how settlers (and Indians) had to be tough as nails to survive and thrive.
History is important, but the continued thriving character of present day De Smet is the result of the myriad of activities occurring in the community. For example, Old Settler’s Day is De Smet’s summer festival, usually taking place on June 10th, has parades, tractor pulling, (and a carnival that used to come to town). I remember, as an eight-year-old, thinking that June 10th was almost better than Christmas. It was a surprise and disappointment to my young self when I found out, one day, that June 10th wasn’t celebrated everywhere as it was in De Smet. I was not quite correct, however; South Dakota is abundant with similar community summer planting or harvest festivals.
Of course, most important are the lifetime friendships that develop in these communities. I remember joining with other families during holiday meals, celebrations and funerals, and even sitting around family campfires. There was sledding, camping, and canoeing with the Boy Scouts; hayrides, roller skating, dances, and rock and roll music; football, basketball games, track meets, talent contests, and many band and choir performances; and there was church.
Innumerable studies show how such social and community connections are related to enhancing the overall health of individuals. How lucky and healthy can a guy be, growing up in a little town on the prairie!
More than 3.5 million people in the U.S. are legally blind or visually impaired. Approximately 21 million Americans have some eye condition that compromises their vision, and many of these problems could have been prevented.
Mrs. E., who lived well into her 90s, would regularly come into my office years before her death, never complaining about her age-related macular degeneration (AMD). However, the diagnosis was obvious to me because, when she stared at my face, she would do so by looking a foot to the left of my nose. Since the AMD had destroyed her central vision, she used her peripheral vision to see. AMD is the most common cause of blindness in the elderly and we know it occurs in certain families, in races with lighter complexions, and in heavy smokers. Mrs. E. was a heavy smoker.
Glaucoma is another blinding eye condition, but unlike AMD, the peripheral vision is lost, and the central vision is spared. This gradual and painless loss of vision is due to injury of the optic nerve and is commonly the result of increased fluid pressure within the eye ball. However, glaucoma can occur in people with normal pressure, and it might not occur in people with increased pressure. About 2.5 million Americans have been diagnosed with glaucoma, and another 2 million don’t know they have it. If diagnosed, treatment helps.
Diabetic retinopathy is more common than AMD or glaucoma, with more than 5.5 million Americans affected. Diabetes causes new, tiny, and unfortunately very fragile, blood vessels to develop on the retina, and when these delicate blood vessels bleed, they cause swelling, scarring, and progressively spotty vision loss. If caught early, treatment helps.
Cataracts, which is the clouding of the lens of the eye, affects more than 22 million Americans and is the leading cause of blindness in the world. This condition is noted more commonly in obese or hypertensive people, in certain families, in diabetics, after excessive exposure to the sun and ultraviolet light, following eye surgery, in heavy smokers and drinkers, and following the use of steroids, estrogen therapy, or statin medications. Preventive methods and cataract surgery help.
For most of these eye conditions, there are methods to treat or prevent the blinding consequences, yet many people do not have regular eye exams. The message is staring you in your face, or perhaps a foot to the left of your nose. Get your eyes checked.
Thinking about bone fractures brings up an old English children’s rhyme. “Sticks and stones may break my bones, but words will never hurt me.” This ancient phrase has supplied many a verbally abused child with clever words in defense from a bully. I wondered if this old saying had an interesting history, but found nothing about its early beginning on the internet. The first written record of the phrase was in an English book authored in 1830 with the words “golden sticks and stones.” Later in 1862 the words, that are used now, popped up in a U.S. magazine printed by the African Methodist Episcopal Church.
Close to 15 million fractures occur yearly in the U.S. from various causes, mostly from falling and more rarely from sticks and stones. It’s intriguing to examine how a fractured bone heals. When a single bone breaks, there becomes two parts with the rough edges of the fracture held loosely together by muscle and soft tissue. Bleeding into the fracture site is a necessary step for healing since the blood clot that forms around the break initiates inflammation (redness, pain, swelling, and heat). Inflammation tells the body to avoid movement, stimulates new blood vessels to increase blood flow to the area, and calls in white blood cells to fight infection and clean up destroyed tissue and cells.
Over the first week or two after the fracture, stem cells are drawn in to help. They turn into cartilage-making cells and replace the blood clot with an early and soft cartilage. This material is sticky and if the bones are not yet reconnected, the gummy and adhesive cartilage helps them re-join and then binds the bones together. This soft callus hardens over the next couple of weeks, stem cells turn into bone making cells, and new bone tissue starts filling in.
Given proper nutrition, immobilization of the fracture, and enough time, bones will completely heal, even in very old persons. I believe it is a slow and constant miracle how our bodies are always and everywhere healing, repairing, and even replacing themselves from birth unto death.
Back to the children’s rhyme, “sticks and stones . . .” Isn’t it true that sometimes hurtful words cause broken hearts that never mend? Perhaps we should learn from the grace and speed of healing bones and let go of those hurtful words, forgive, reconcile, and heal.
Economists often explain high health care costs by comparing the selection of food at the grocery store when someone else is paying. The analogy still works but with a twist. Reported in a recent medical journal, Harvard researchers looked at health care spending here in the U.S. compared to the 10 next highest income countries of the world. They found that, in 2016, we spent almost 18% of our gross domestic product (GDP) on health care. Spending was much less for other countries, ranging from about 9.5% in Switzerland to 12.5% in Australia. That’s a significant difference!
Most surprising was that the problem in the U.S. did NOT appear to be from overutilization (getting too much care) as many have previously thought. Overall, people in the U.S. saw the doctor and were sent to the hospital about as frequently as people from other nations. The quality of the care received was also comparable. The study group also noted that our ratio of primary care doctors to specialists was similar, as were the number of specialist referral rates. The study found that, in the U.S., there was an overuse of expensive image testing and many more specific surgical procedures (60% more CT scans performed than the average of the other countries; 45% more MRIs; 38% more total knee replacements; and 32% more C-sections). Still, these accounted for only a small part of the large difference in spending. This was partly because, in the U.S., we sent people home from the hospital a little sooner than in other countries.
The rate of poverty was found to be higher in the U.S. than in other wealthy nations, and only 90% of our people were insured compared to 99-100% in all the other 10 countries. Those are big problems and could partially explain the high cost of health care here. However, the research suggested that higher U.S. health care spending stems mostly from the complexity of our payment system. This has resulted in high U.S. administrative costs (8% GDP vs. 3%), the higher price of hospitalizations, procedures, doctor visits, as well as the price of drugs. For every U.S. dollar equivalent Europeans spent on drugs, we spent $2.50 for the same drugs. For every dollar equivalent Europeans spent on angiograms, we spent $5.25 for the same procedure. Going after overutilization will likely not help much. It’s the price of things that matters the most.
It would be like going to your grocery store and finding the cost of milk is more than twice as high as the store on the other side of town, because payment for milk here comes NOT from you, the consumer, but rather after bargaining between your employer, their chosen insurance company, the government, the dairy, and the grocery store. It’s time to simplify!
By Richard P. Holm MD
My Grandmother, Axie Jackson Powell, died at 99 having lived a blessed yet tragic life. As a young girl she lost her father and two step-fathers to illness. Her mother, struggling to raise four children alone and out of desperation, put Axie and two of her siblings into an orphanage. Axie grew up separated from her mother.
The history of adoption is as old as humankind, with family members commonly raising children orphaned by death, war, or economic destruction. The middle ages introduced the concept of the orphanage when babies were left at the door of monasteries and were then raised within the institution of the church. But much of what the world knows about adoption, and how to protect orphans, actually stems from the orphan trains of the U.S. in the late 1800s. The American Civil War and increased immigration brought about orphanage over-crowding and resulted in huge numbers of homeless children roaming the streets of urban cities on the east coast. A group of religious leaders spearheaded a solution by shipping orphaned children on trains to the rural west.
Over the next 70 years, as many as 250,000 orphaned, abandoned, or homeless children were placed on trains and sent to the farms of rural foster families in the west. It was the largest mass relocation of children to ever occur and helped establish the foster care system in America. While many lost children were introduced into families where discipline and love gave them a chance for a reasonable life, some of these children were indentured and exploited, rather than adopted, and were made to become farm laborers and household servants.
Because of the orphan train social experiment, laws to protect children from abuse were developed. The best example was the Minnesota adoption law of 1917 which required background checks for families who wished to adopt and careful follow-up after placement. This effort, to ensure the best interest of the child by encouraging and monitoring foster homes and adoption, spread throughout the country and parentless children went to orphanages only when other options failed.
Although this societal responsibility to children spread globally, families in the U.S. presently adopt more children than the rest of the world combined. That said, right now there are 110,000 foster children in the U.S. eligible and waiting to be adopted, and every year 23,000 children age out of foster care without having found a permanent family.
There are plenty of Axies out there. The gift of “family” by fostering or adopting is a win-win proposition.
Prairie Doc Perspectives can be found in the following newspapers. If your local paper doesn't carry Dr. Holm's column, please suggest that they contact us at email@example.com and we'll add them to our distribution list.
Mrs. B. started having a leaky bladder after her third child, notably whenever she laughed heartily. The problem worsened as she aged, and by the time she was in her 60’s, she was wearing a pad purchased at the local pharmacy. Mrs. B. finally came in to the doctor for help and asked about medicines she had seen advertised on TV and in magazines that promised to help prevent incontinence. The doctor first referred her to physical therapy to help her learn pelvic muscle exercises and, after a second patient plea, also prescribed the medication requested. The patient didn’t do the exercises but took the medicine which was quite expensive. Over the next three months she noted some minimal improvement with leaky bladder, but she still needed pads, and she began experiencing other problems. They were side effects of her incontinence medication and included constipation, dry eyes and mouth, blurry vision, insomnia, headaches, and depression. She had also recently fallen several times.
This is not an uncommon story. About one third of all women over 60 experience some level of urinary incontinence; this is twice as often as in men. Incontinence in women is generally the result of previous pelvic surgery, childbirth, and/or menopause. In men, it is generally the result of benign or malignant prostate growth blocking the urethra and bladder exit, which can cause an over-expansion of the bladder. If the dilation persists for too long, this, in turn, can cause loss of bladder contracting strength and worsen the incontinence problem.
In men, it is important to remove the blockage by either shrinking the prostate with medication or surgically opening the pathway before the bladder is over-expanded for too long. In women, the medications are much less helpful and have safety issues, especially in older women. The best thing women can do is to start with pelvic floor muscle strengthening exercises and the sooner the better. Also, there are bladder training techniques, pelvic surgeries, and even bladder stimulation devices that can help. Experts advise slow tightening and relaxing the pelvic floor muscles 200 times a day . . . whenever you think of it. An excellent reminder is to make it a habit of tightening the pelvis whenever you smile, and smile often. That would help women and men alike.
Bottom line: especially in women, medications for incontinence are often only marginally helpful and carry with them hefty side effects and cost. Pelvic floor muscle strengthening exercises are more effective than meds, without side effects, inexpensive, and underutilized. Do it with a smile so you can laugh without worry.
by Richard P. Holm
The first indication of my having glaucoma came when I was at the eye doctor for a regular checkup. It was discovered by machine-testing that I had lost peripheral vision in my left eye. Loss of peripheral vision is a sign that glaucoma might be occurring, and indeed, when they measured the pressure within my eyes, it was increased on the left. Before that, I had no idea something was wrong.
An estimated three million people in the U.S. have glaucoma; half of which have no idea something is wrong, and 120,000 become blind as a result. Glaucoma is the second leading cause of blindness in the world, especially for those coming from African origins. Treatment is available once the condition is discovered, so the best preventive move is to get routine glaucoma testing.
Glaucoma causes peripheral vision loss and preserves central vision until late in the disease. Central vision is that concentrated view we have of the object at which we are staring. It is the eye-of-the-needle into which we are trying to put the thread; the subtle smile of the mysterious woman about which we are painting; the target at which we are aiming our arrow. Say it again, early on, central vision is preserved in glaucoma.
Just because our central vision is retained until late-stage glaucoma, that doesn’t mean it isn’t causing problems. Peripheral vision is important, allowing us to see the shooting star that flashes suddenly from the eastern horizon while we’re staring at the big dipper; to see the boy that might jet out from behind a car in pursuit of his ball while we drive down the road; to see the guy across the room who has captured our attention, secretly watching him without letting him know.
For comparison, macular degeneration causes the opposite kind of vision loss. More specifically, it results in a loss of central vision while preserving peripheral vision. Both conditions affect the retina, the blanket of nerves covering the back side of the eye, which, like a camera, captures the image of an autumn moon rising above a South Dakota lake, a wind-wave of grass moving on a prairie hill, or the surprised face of discovery on a visiting grandchild.
Take home message: people don’t realize there is peripheral vision loss resulting from glaucoma until the damage has been done. Get in to have routine eye testing. You may have no idea something is wrong.