By Richard P. Holm, MD
 
We have all had to deal with bullies throughout our lives, and I have had my share. One fall day, coming home from school, I saw two guys from my third-grade class beating up on a smaller kid and was moved to step in to help. I was chagrined but not surprised when the victim ran home, and I became the new target. The beating I took that day was minimal, however, the sense that I did the right thing by standing up against bullies has propped up my self-worth my whole lifetime.
 
Bullies and abuse are everywhere. While in medical school, I was in an Atlanta emergency room when a woman came in with a broken nose and other broken bones and bruises that were explained away as the result of a fall, when we knew full well the injuries were inflicted by her spouse. Since coming to this prairie town 38 years ago, I have seen several cases of parents who physically and emotionally abused their children, and of adult children who physically and emotionally abused their parents. I remember numerous cases where women came into my office, explained their husbands were physically beating them, and despite my recommendations to escape and seek shelter, they stayed married to the scoundrels.
 
The American Psychiatric Association defines domestic violence and abuse as control by one person over another in any relationship. Control is the operative word. The means of this control can result from physical, sexual, emotional and economic abuse, including threats of isolation.
 
The number of American troops killed in Afghanistan and Iraq from 2001 through 2012 was greater than 6,000, and the number of American women murdered by male partners during that time was about 12,000. The Center for Disease Control estimates that in the U.S., one out of every four women and one out of every seven men will have experienced severe physical violence from a bully in their lifetimes.
 
The National Coalition for the Homeless estimates ten million children are exposed to domestic violence every year, and that people exposed to such hostility as children are three to four times more likely to become abusive or be abused than people raised in families without it.
 
Sometimes it’s right to stand up to a bully, and when there is danger, it’s right to escape and get help. And it’s always right to save your children from a lifetime of abuse by not allowing it in your family.
 
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By Richard P. Holm, MD

It is miraculous to consider how much access and exposure we have to information through our computers, televisions, radios and newspapers. Unfortunately, we need to be on guard because too much of this buzz can be false information.

In an October 2017 article, the Pew Research Center found 43 percent of people in 2016 received their news from Facebook listening for information that aligned with their world view (not necessarily with facts). Pew also found 23 percent had shared, by intention or accident, untrue political messages on social media. We need to be more critical of all sources of information around us. Almost as malignant as fake news are advertisements that pretend to be factually based.

Of course, marketing (sales) can be good and important as it moves commerce, and I’m not saying industry doesn’t sponsor credible scientific research. However, marketing can be harmful when selling a weight-loss program that gives false hope, when peddling virility pills that are ineffective or when pushing an outrageously expensive drug that should be used only after first-line medicines are tried. Advertisements can and should be based on truth, but my cynical side sees the words “truth in advertising” as an oxymoron, like “seriously funny,” “awfully good” or “found missing.” Indeed, marketing motives can be as different from evidence-based science as corn syrup is to leafy green vegetables.

It has been our desire and goal at Healing Words Foundation to find and help spread health information that is not influenced by marketing or sales. What is known today as Prairie Doc® media started in the 1980s with newspaper articles, expanding in the 1990s with a local talk AM-radio show, in 2003 with a television show and in 2010 with social media. Prairie Doc® has been made possible with the help of volunteer physicians and experts, South Dakota State University and its students, our paid and voluntary Prairie Doc® production staff, our Foundation Board of Directors and, most importantly, the unrestricted underwriting of organizations and individuals like you. We feel blessed to have such wonderful talents and gifts allowing us to bring our unbiased and credible public health information to the people.

The mission statement of the Healing Words Foundation and all Prairie Doc® programming is enhancing health and diminishing suffering by communicating useful information, based on honest science, provided in a respectful and compassionate manner.

This is a call for all of us to be careful and critical. We don't have to be influenced by fake news but rather need to choose our sources of information carefully. Let this be a time of truth.
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By Richard P. Holm, MD

We take a lot of things for granted. With the advent of antibiotics in the 1930s and 40s, we saw a true change in longevity and a reduction in premature death from infectious diseases. Now we are seeing deaths from bacteria which are resistant to every antibiotic and it’s not just the sick and decrepit who are affected. Recent studies show many more people are dying in the U.S. from antibiotic resistant bacteria than from AIDS. It’s a real crisis resulting from too much of a good thing.

Resistance is due to excessive and over-use of antibiotics, which are often incorrectly seen as the cure for whatever ails us. The most glaring example is when antibiotics are given for what is obviously the common cold, making absolutely no difference in the course of the illness. Often, I hear from the patient, “Why not start an antibiotic to keep this viral bronchitis from turning into pneumonia?” To that question I usually answer, “You are correct, when bacterial pneumonia occurs, it often follows a common cold, but studies show antibiotics don’t prevent the occurrence of that pneumonia following the cold. Rather, it becomes a pneumonia resistant to treatment.”

So why are we over-using antibiotics? Most experts say it is from patient or parent expectation. One study showed that if the doctor perceives the parents expect antibiotics for their children, 65 percent of the time the doctor will prescribe antibiotics. Conversely, when parents do not indicate an expectation for antibiotics, even when the children are similarly ill, the doctor prescribes them only 12 percent of the time. Ultimately the doctor is responsible but too often yields to pressure to provide unnecessary treatment.

Another reason for growing antibiotic resistance has resulted from use of antibiotics in animal and poultry feed which boosts animal growth and profits. In the U.S. antibiotics are now limited for use only when a veterinarian prescribes them, but similar limits are not in effect in India and other countries. Also, veterinarians are prescribing the newer broader spectrum antibiotics only for the care of sick individual animals, not the entire herd. These new moves are a start, but closer monitoring of usage needs to occur. The good news is that in countries where efforts to use fewer antibiotics are successful, within a few years, antibiotics become effective again.

Based upon current science, rather than expecting an antibiotic from the doctor, it’s in our best interest to discuss options and use antibiotics only when they are necessary. We can also benefit by taking time to read food labels carefully, choosing antibiotic-free products.

Let’s not take antibiotics for granted. By avoiding the overuse of antibiotics, we can save ourselves from a real crisis.
​
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By Richard P. Holm, MD
 
Q: What are some types of skin cancer? 
A: The three major types are basal cell, squamous cell and malignant melanoma. In general, one in five, or 20 percent of people in the U.S. have had or will have some type of skin cancer. In Australia where the sun is intense, two out of three skin cancers are basal cell, one in four are squamous cell, and one in twelve are malignant melanoma.
                                                                                                                                                                   
Q: Should I go to a dermatologist for screening?
A: The dermatologist is the most experienced with skin cancer, but primary care providers can help, too. Realize, however, that the first person to discover skin cancer should be you, along with a partner to look over places you cannot see. Self-screening is especially important for those at high risk for skin cancer.
 
Q: Who is at high risk for skin cancer? 
A: At highest risk would be anyone who has had a bad sunburn or excessive lifetime sun exposure, especially when young, and those with light complexion, freckles, blue eyes, blond or red hair. At higher risk for malignant melanoma are those with many moles, with a prior personal history of skin cancer, and with a family history of malignant melanoma.
 
Q: Does sunscreen help prevent skin cancer?
A: This is widely presumed to be true but not yet scientifically proven. In fact, some speculate that people who use sunscreen may feel emboldened to expose themselves to more hours of damaging sunlight. Also, using sunscreen to shield skin from sunlight may possibly result in vitamin D deficiency. All that said, it is my opinion there is enough evidence to use sunscreen all year long and, if you live in the northern climates, take 2000 IU of vitamin D daily.
 
Q: How do I know when to go to the doctor?
A: The ABCDE mnemonic helps in knowing when a skin lesion might be dangerous. A: asymmetry or irregularly shaped; B: border fuzzy not sharp; C: more than one color in it; D: diameter wider than pencil width; and E: lesion evolving or changing. It is common to mistake a benign and safe look-a-like seborrheic keratosis for a possible malignant melanoma. Seborrheic keratosis is light brown to black, raised, and waxy. If one can partially peel or scratch off waxy material with a fingernail, then it is likely a benign keratosis. Malignant melanomas can be either flat or nodular…but never waxy.
 
No question, if ever you are in doubt, see your doctor.

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By Richard P. Holm, MD
 
Miracles still happen.
 
Some think that the scourge of smallpox was present around 12,000 years ago, however, we know for sure it was here 3000 years ago as it was found on the face of an Egyptian Pharaoh mummy. We know that it caused many large and devastating epidemics killing about 35 percent of infected adults and 80 percent of infected children. Even during the 20th century, smallpox still resulted in 300-500 million deaths world-wide.
 
Pictures of people suffering from this miserable viral illness show skin of face and body breaking out with dime-sized firm white or red blisters. People also commonly developed fevers, vomiting, spread of blisters into mouth and eyes, and too often came to a wretched and miserable death. If one survived, the common facial pox scars could be extremely disfiguring and sometimes affected the cornea of eyes causing blindness.
 
During the tenth century in China, someone began inoculating the fluid from a smallpox blister onto abraded skin on the arm or leg of a healthy individual, allowing for a single pox to get started in a controlled way. This worked fairly well except that the procedure made them infectious to others for a while and resulted in death to the recipient one percent of the time. Contracting smallpox killed about 35 percent of adults, so reducing the rate to one percent was an improvement. This rather dangerous process of inoculating live smallpox became popular in England during the 16 and 1700s.
 
Smallpox was given the medical term variola from Latin for spotted pimple. It had been commonly known as the red plague until in Britain during the 1600s it was called smallpox to distinguish it from great-pox or syphilis.  
 
Noting that milk maids rarely got smallpox, in 1796 British rural physician Edward Jenner found that inoculating the fluid of the milder disease cowpox provided for substantial immunity from smallpox without significant risk to the recipient and without the danger of spreading smallpox. Jenner called the cowpox inoculate “vaccine” after vacca, the Latin word for cow.
 
With a vaccination campaign lead by the World Health Organization, world-wide deaths reduced from two million per year in 1967 to none in 1977. I find it nothing short of a miracle that in those ten years, human smallpox infections were virtually eliminated from this world.  It was a miracle wrought by human intelligence, the ingenuity of creative and resourceful minds, and the scientific method.
 
It was the miracle of vaccination.
 
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By Richard P. Holm, MD
 
Nothing has touched my soul and spoken to aging with grace quite like the ancient Indian medicine wheel and the traditions that have evolved from it. From the National Library of Medicine, I learned that in the Americas, Indian tribes have multiple interpretations of the four directions, but the following prayer is my own, geriatrician’s interpretation of a version from the book Black Elk Speaks and Oyate (Nakota, Dakota, Lakota) tradition.
 
First, we get down on our knees and feel the soil, the sacred Mother Earth, bringing the world around us, the animals, plants, prairies, lakes, mountains, the environment of our planet from where all food and sustenance comes. Earth is foundation. Then we stand up on our tiptoes, and raise our arms to sacred Father Sky, the sun, stars, clouds, rain, wind, air and breath of life, light and dark; from where all energy flows and ebbs. Sky is infinity. Earth and sky, the beginning and the end.
 
Around the central campfire and within the circle, first we bow east, symbolized by red, rising sun, springtime, birth, blood, the very young; a sense of innocence, youth. May we have hope for a future with an open mind to all things new and true.
 
We bow south, symbolized by yellow, full sun, summer, sexuality, the anticipating young woman and young man; a sense of unconquerable power and invulnerability, early adulthood. May we have the courage and strength to fight for justice.
 
We bow west, symbolized by black, setting sun, an approaching dark thunderstorm, oncoming night, autumn, resignation, the reality filled community leader and medicine woman/midwife; a sense of the horrors of war and reality of loss, mature adulthood. May we have the gravity to protect freedom of choice and face vulnerability with honest eyes.
 
Finally, we bow north, symbolized by white, starry night, winter, old age, wisdom, the sagacious elder and teacher; a sense of beauty, grandchildren and the circle of life, an experienced body and mind, release from the fear of change and death. May we have insight to savor family and friendship, and the good sense to walk in another’s moccasins.
 
Inside the circle is the tree of life, where we become aware of our self, our consciousness, tribe, community, country, world, and our connection to all direction.
 
Dear Mother/Father of Earth and Sky, thank you for your blessings, the sacred hoop of life, and especially the wisdom to find release from fear of death. May our sisters and brothers of all Clans and Nations realize our sacred connection and, in harmony, savor the joy and even the sorrow of our circle of life and aging.
 
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By Richard P. Holm MD
 
I bet I hear it once a week, “It’s hell to grow old!” Of course, growing old is something we all will do, unless we die first. Alas, the future can look quite sad and depressing, especially if you think about the flab, falls, pain, blues, anxiety, thin bones, loss of libido, weakness, and memory loss that can come with aging.
 
But wait! Listen to the exciting news. Just out, there is a powerful potion that can prevent the aging process. That’s right…guaranteed to slow aging.
 
Researchers have observed how shortly after starting this terrific tonic: flab turns to muscle; falls are reduced; chronic pain and fibromyalgia seem magically lessened; depression and anxiety disappears; bones are actually strengthened; sexual function is enhanced and recharged; people experience new strength, energy, and power; and most important memory is clearly improved. What’s more, this special medication has also been shown to reduce diabetes, heart attack, stroke, and breast or colon cancer.
 
That’s not all. If you take advantage of this fabulous offer today, it will improve your appearance within weeks. Sounds too good to be true. It is scientifically proven, beyond a shadow of a doubt. And no other treatment plan comes even close. Nothing!
 
You would expect the price for this magnificent medication that brings about all these benefits to be more than the sum of one third of your income, or at least many thousands if not millions of dollars. But no! This medicine is equally available to the rich and poor alike, requiring only an extra effort on your part.
 
You could expect to work lots of extra hours each day to achieve these wonderful benefits. But no! You don’t have to work an extra two hours at the beginning or end of your workday, you don’t have to work even one extra hour.
 
Starting today we have a special opportunity. For spending only a half hour every day walking twelve blocks, yes that’s right, just twelve blocks, or whatever distance you can make in 30 minutes, you will receive most of the benefits I mentioned earlier. That’s right, only a half hour!
 
But wait, this offer only lasts for a short time. The longer you delay, the less you will get. If you start today, the benefits begin sooner and last longer.
 
That’s right…guaranteed to slow aging. Exercise is the bargain of a lifetime.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.               

By Richard P. Holm, MD
 
How do any of us cope with the catastrophes of life? Years ago, a couple faced the tragedy of an accidental death of their only young child. Even though most marriages don’t survive such an insult, this one did. Between the woman and man, there was love, forgiveness, and plenty of help from the people of their church. The people of the congregation, like the wings of a mother hen, surrounded the couple with support, comfort, and warmth.
  
Researchers found that no society has survived more than three generations without a religious foundation including belief in prayer, afterlife, and ritual. One interpretation of this data argues that religion serves the function of helping a society continue, thus implying religion endures due to survival advantage. Some critics of organized religion argue just because we have the need for a spiritual connection doesn’t mean that God exists. I contend that the opposite is true. Even though atrocities have been done in the name of religion, I am reassured of God’s presence by the fact that societies do better with a faith-based underpinning. However, I think there are other more convincing reasons than this to believe in God.
 
I am reassured of God’s presence when watching a religious based rehabilitation program successfully help men find their way back from drug or alcohol abuse. The leaders, who fill a mentor role, teach “It’s not just about you. . . it’s about loving others and loving God.” I am reassured when studying the complexity of the human heart and the way the heart muscle, valves, and arteries interact while sending blood with oxygen and nutrition to every cell in the body. I am reassured when our Hopeful Spirit Chorale sings, bringing spiritual connection to the hearts, and tears to the eyes of those listening and singing. I am reassured when a church, mosque, or synagogue full of people saying a wisdom prayer such as the Lord’s Prayer in unison, vibrates the souls of the congregation. I am reassured when watching a flock of birds or a school of fish move together and change direction as if one organism, in synchrony by some ancient and holy spirit.
 
As a medical doctor caring for people through the years, I have had to rely on science with which to help resolve health problems people face. Observing people, especially as they reach the end of their lives, I realized that often science is simply not enough. There is a deeper place where people need to go for help when the end is near. In my view, if we listen very carefully, the spiritual realm is all around. For many, this Divine Essence provides great help and meaning. We need to open our spiritual ears for that Holy Something that resides outside our scientific understanding. 
 
In one famous interview of Mother Theresa the interviewer asked her how she prays. “I listen,” was her response. “What does God say in return?” was the next question. “He listens,” was the answer.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.  

By Richard P. Holm, MD
 
Remember the Greek myth of Narcissus, a vain and handsome young man who was punished by a goddess for rejecting the innocent love of another. Narcissus was made to fall in love with his own reflection in a pool and he wasted the rest of his life staring at his own image.
It's easy to criticize our society's obsession with beauty. We all know “beauty is only skin-deep” and people’s outward appearance sometimes does not reflect their inner goodness (or lack of it). We also know that the cover-up of the wrinkles of aging, with faces pulled tight from surgery or injections of tissue expanders into lips usually make movie stars appear even more artificial and unreal.
 
Naturally, we all want to make a good first impression. In the wild, it’s the bird with the most colorful feathers that successfully woos the most healthy and finest specimen of the opposite sex in order to advance the species. Looking good is important for getting a job, selling a product or even making a convincing argument. To dress and appear well groomed, and to look clean and healthy, provides the appearance that someone has their act together. It is human nature and practical to want to look nice.
 
Our epidemic of obesity, alongside society’s definition that thin is desirable, is a disheartening paradox. More troubling is that, short of radical and dangerous surgery, weight loss programs do not last. After five years, most programs and efforts show only one in 100 are able to keep weight off. We would be healthier if we emphasized eating right rather than weight loss.
 
Besides, what is true beauty? Does it really matter the measure of the waist, the turn of the nose, or the color of the hair? Are we most charmed by the impression of youth or that of experience; the look of innocence, or that of confidence; the appearance of cool, or that of compassion? Certainly, what seems beautiful today will be different tomorrow.
 
Looking nice can be important, but, In my opinion, it’s valuable to recognize that it is a golden heart and a healthy lifestyle which makes one beautiful. Exercising well, eating a balanced reasonable diet, connecting with and caring for friends and family and, finally, loving ourselves are the elements which bring on real and lasting beauty. Narcissus wasted his life above a calm pool looking at himself. We can do better.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.              

By Richard P. Holm, MD
 
Just about 4000 years ago, Chinese writings explained the medicinal powers of what is now called cannabis or marijuana, describing its properties to help arthritis, gout, malaria, nausea and psychological stress. In the 1500 and 1600s the Spanish and English brought cannabis to the new world for medical purposes and it became a huge commercial crop for making rope. In the 1920s cannabis emerged in jazz clubs as a recreational drug. At the time, it was thought of as a better alternative to alcohol since cannabis users didn’t seem as disruptive to the community.
 
During the prohibition era of the 1930s, the U.S. Bureau of Narcotics considered cannabis as addictive and they made it illegal along with alcohol. Further, the U.S. Controlled Substance Act of 1970 defined cannabis as a ‘Schedule 1’ drug putting it in the same category as heroin and LSD, claiming there was a high abuse potential and no medicinal use. Although these claims have changed, the U.S. law remains on the books. During the Obama administration, the Department of Justice was directed to relax prosecution of cannabis rule-breakers while allowing state rules to supersede the U.S. law. The Trump administration has made very little change since.
 
Questions about cannabis remain since scientific experimentation for medicinal use has been limited due to legal restrictions. However, strong evidence points to legitimate medical uses for cannabis. Cannabidiol or CBD, one of the chemicals derived from hemp, helps those with chronic pain syndrome, children with uncontrolled seizures, those with glaucoma and finally enhances appetite stimulation and reduces nausea and malaise in cancer patients.
 
We know there is abuse potential with cannabis, just like with alcohol. Driving intoxicated with cannabis increases crashes, even if only half as much as alcohol. Also, we know excess cannabis has potential to dull and injure young and undeveloped minds. Some suggest that legalizing cannabis would allow better laws and enhanced regulation, lessening underage use.
 
Consider the tragedy of 70,000 deaths per year (and rising) from the overdose of legal and illegal opioids while there are almost no reported deaths from cannabis use, despite quite extensive consumption in the U.S. Most opioid abuse seems to stem initially from efforts to reduce chronic pain syndrome, and this condition seems to be potentially helped with medicinal doses of cannabis.
 
It is time to allow medicinal use of cannabis. It might help us reduce the deaths from opioids.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.