By Richard P. Holm, MD
 
It was June 10, Old Settler’s Day in De Smet, SD, and the carnival was in town. As a fifth grader, I had been doing odd jobs for a month to save up money for that day. For the price of 25 cents, I filed through a trailer to see a “real alligator woman, half human, half alligator.” Of course, it was fake. Sitting there on a table was a dried-up, stuffed, alligator body connected to a live human woman’s head (who was chatting with us). The table had mirrors to cover the hollow box that held the woman’s body underneath. It was an amusing ruse, a trick, an intentional untruth that benefited the marketer exactly 25 cents per viewer. That was, by definition, disinformation.
 
By contrast, misinformation happens when people believe some ineffective treatment helps or some effective treatment harms, and they spread that misinformation. For example, in the 1980s, we noted that people, who were having heart attacks, had more premature ventricular contractions (PVCs) and these people were more likely to die. Researches found drugs that suppressed those PVCs thinking to save lives. It took us about ten years to discover that those drugs increased deaths rather than lessened them. We thought we were doing right but were, by mistake, harming people instead. That is misinformation.
 
Another example of misinformation occurred in the 1980s when I encouraged parents to place their babies on their bellies to sleep, thinking to protect babies from inhaling drool. We later found that babies sleeping on their bellies had more sudden infant death than those sleeping on their backs. We were misinformed.
 
Another example would be in trying to help others by telling them to avoid vaccinating babies with the mistaken thought that this would prevent autism. This is spreading misinformation and is harming people by allowing the spread of a killing virus, especially to immune compromised younger children and older adults.
 
Bottom line:

1. There will always be people and corporations who will tell intentional untruths (disinformation) in order to profit themselves and take “easy money” from trusting souls. We can protect ourselves by being informed consumers, watchful of those who promote “alligator women.” Also, we should know that marketing and corporate profit does not justify the right to tell untruths.
2. We must be humble enough to listen to evidence-based science and to change our minds. There will always be myths that seem true but, when held under the scrutiny of science, are wrong.
3. Seeking and telling the truth is always the right thing to do.

 
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By Richard P. Holm, MD
 
My first experience with cardiopulmonary resuscitation was during the summer of 1969. I was an orderly in a Minneapolis intensive care unit (ICU) when my patient stopped breathing. I called for help and provided mouth-to-mouth breathing and chest massage until the team arrived. Later the doctor told me I saved the patient’s life, further convincing me that medicine was my life’s purpose.
 
Cardiopulmonary resuscitation (CPR) is the act of rhythmically pushing on the chest and breathing into the mouth of a person whose heart beat and breathing has ceased. CPR can result in enough circulation to keep the victim alive until spontaneous circulation and breathing resumes.
 
In 1740, the French described how mouth-to-mouth breathing sometimes saved drowned people, and, through the early 1900s, mouth-to-mouth breaths were given to bring lifeless newborns around. In the mid-1950s, two anesthesiologists, Dr. Elam and Dr. Safar, with help from the Red Cross, began promoting mouth-to-mouth resuscitation for adults discovered in cardiac arrest. In 1960, chest compressions were proven valuable in preserving circulation, especially to the brain, and even more important for survival than artificial respiration. In fact, rapid (100-120/minute), constant, three to four-inch chest compressions (without artificial breathing) are now recommended for patients having out-of-hospital cardiac arrest.
 
In 1947, a Cleveland surgeon used an internal (open chest) defibrillator to save a 14-year-old boy, and in 1955, Boston cardiologist, Paul Zoll, developed the now popular external (on skin) defibrillator. Studies show that the defibrillator is even more important than chest compression. With available automated external defibrillators (AEDs) and education on how to perform CPR and use AED devices, we have even better outcomes.
 
For those having a cardiac arrest, the sooner they get defibrillation, effective CPR, and a 911 call for help, the greater the chance of functional recovery. Out-of-hospital successful survival after CPR is about ten percent but increases to 35 percent when the arrest is witnessed and the victim is provided early defibrillation. The sad news is that more than 50 percent of those who could benefit will not have CPR because bystanders fear they might do something wrong. The big mistake is NOT TO TRY.
 
Simple, first-level, CPR courses are available for anyone interested in every community and through the internet, while AED devices are popping up in almost every community gathering area. Please notice where they are placed. Trust me, if someone has a cardiac arrest, and you try to help, you might just save a life.
 
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By Richard P. Holm, MD
 
For years I cared for a lovely woman with scleroderma. It all started with Raynaud’s phenomenon a condition causing her fingers, after an exposure to cold, to become pale-white then blue or red and painful. Raynaud’s phenomenon occurs in about four percent of the population, is usually not associated with any other condition, but sometimes goes with rheumatoid arthritis, lupus or, in this case, scleroderma. My patient also experienced progressively tight and shiny skin on her hands, then chest, then everywhere. She had tiny red spider vein spots (telangiectasia), heartburn, weight loss, weakness and puffy joints. Over the years her fingers became scarred and quite immobile with always worsening sores on the tips. Through it all, this wonderful lady had a very positive attitude and always seemed to have a smile on her face, although, near the end, the skin of her face became so tight that smiling became a challenge.
 
Yearly, about three in 100,000 middle-aged U.S. adults develop scleroderma (or when full-blown called systemic sclerosis). Normally, after a cut or a sore develops and in order to heal the wound, our bodies trigger both the immune system (to fight off invasion of bacteria, fungi and viruses) and special repair cells (to close off the wound with collagen and scar tissue). Once the damage has been repaired, extra collagen production usually stops, but not with scleroderma. For some unknown reason, scarring continues uncontrolled. At this time, treatment for this very puzzling auto-immune condition is restricted to treatment of symptoms; no cure for scleroderma exists.
 
We think that inheritance, hormones, certain infections and long-term exposure to pesticides, silica dust or polyvinyl chloride all might have something to do with the cause, but we really don’t know. We also don’t know why four times as many women get it as men; why it it can involve just a spot or a sword shape skin area and never progress; why it may or may not occur with Raynaud’s phenomenon, involvement of the esophagus and smaller parts of the skin but doesn’t progress; and why, in some unfortunate cases, it progresses everywhere, like in my patient.
 
Similar to many other autoimmune conditions, scleroderma is one where the immune system, for some undefined reason, runs amok, mistaking normal tissue as a foreign invader. Scientists and physicians are on the hunt to learn first why scleroderma happens and then how to stop the process.
 
If we understood more about scleroderma, we would all find it easier to smile.
 
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By Richard P. Holm, MD
 
Be careful when you mess with Mother Nature. Once we began defining the human genome, we started to realize how many bacteria, fungi, and viruses live in and on our bodies. We believe that each person standing in front of us are made up of equal numbers of human cells to the number of non-human cells. These are not mere hitchhikers, they are essential to our living. Even within each human cell we have components called mitochondria that originally were bacteria. Eons ago they became incorporated and an essential part of the functioning human cell. We couldn’t survive without the outsiders. Simply put, we are like a country made up of natives AND immigrants working together for the good of the whole.
 
The attached non-human organisms, together, make up what has been called the human microbiome or microbiota. Researchers are trying to know better what is a normal or abnormal microbiome, what causes it to be imbalanced, and what can be done to enhance a healthy microscopic environment of organisms that are getting a lift on our bodies.
 
A powerful example of imbalance comes when the use of antibiotics alters the microbiome and results in the emergence of a harmful and even deadly overgrowth infection by a bacterium called Clostridium difficile (C. diff). The result is a very sick large intestine. Think how weeds take over a lawn when the grass is destroyed.
 
Aside from the invasive, severe, gut illness of C. diff, there are other human conditions and illnesses that may be related to an imbalanced microbiome such as: irritable bowel syndrome, psoriasis of the skin, uncomfortable infections of the vagina, obesity and rheumatoid arthritis, as well as neuropsychiatric disorders such as autism, schizophrenia, obsessive-compulsive disorder, attention deficit disorder and chronic fatigue syndrome. Research is ongoing and we have a lot more to know before we have microbiome related treatments.
 
We all know that, when used appropriately, antibiotics help people and save lives, but experts estimate that 20 to 50 percent of the use of these microbiome disturbing antibiotics are inappropriate or unnecessary when used in hospital settings, and that percentage is worse when used in outpatient settings.
 
Understanding and protecting our normal flora, our microbiome, the community of organisms that live in, on, and around us gives us a whole new way of dealing with many illnesses. We need to be very careful to use antibiotics only when absolutely necessary. Be careful when you mess with Mother Nature.
 
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By Joanie S. Holm, RN CNP
 
The famous American artist, Andrew Wyeth, graced the world with many works of art. One of his most famous, Christina’s World, is at home in the Museum of Modern Art in New York City. This painting portrays a woman in a field of tall grass at the bottom of a hill below a dilapidated farm.  On close inspection, it is noted that the women has rail thin arms and hands that seem to claw the ground.
 
The woman is Christina Olson, a friend and neighbor of Wyeth’s in Maine. Christina was an extremely independent woman who suffered from a progressive neuromuscular disorder thought to be Charcot-Marie-Tooth disease (or CMT). Her ability to walk as a toddler slowly diminished as she aged. She refused to use a wheelchair or walker, preferring to use her arms for crawling.
 
Charcot-Marie-Tooth disease is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886: Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. CMT comprises a group of disorders that affect peripheral nerves, those that lie outside of the brain and spinal cord. CMT is caused by a gene mutation that affects the covering of the nerves. There is no cure and treatment is aimed at symptomatic care.
 
Upon learning of the story behind the famous and beautiful Andrew Wyeth painting, I enjoy it at a different level. Andrew Wyeth got to know the soul inside the women who had physical struggles in this life. I’m grateful to him for giving this to the world.
 
I’m also grateful for Drs. Charcot, Marie, Tooth and all of the other scientist who helped and continue to put the puzzle pieces together for those who suffer with neurodegenerative diseases. Their work may not be lauded as masterpieces and displayed in the museums of the world, but their contribution to society should not be overlooked.
 
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By Richard P. Holm MD
 
It was a Boy Scout canoe trip into the Minnesota Canadian boundary waters in the summer of 1965 when a gangly group of DeSmet Scouts discovered the sun again after two days of chilling and soaking rain. Taking our noon break from canoeing all day, we found a solar exposed, very large, warm, and welcoming rock on an island and stretched out on its warm surface We took off our shirts and dried our soaked socks while reveling in the renewing rays of the sun.
 
At that moment I could feel the wonderful power and force of ol’ sol beaming into me. I remember thinking how the sun’s radiation was the visible energy source for life on this earth, and I wanted more of it. It must be a natural instinct to want exposure to the rays of the sun. Think how people seem to gravitate to the beach for sunbathing, and how sad some get in the days of the winter solstice when there’s not enough of it.
 
Recently, we have become more aware of the importance of enough vitamin D which our bodies manufacture when rays of sun come in contact with our skin. We can also get this important vitamin from the oil of deep-sea fish (such as cod) who live in very dark waters gathering their vitamin D by eating falling phytoplankton who mostly live on the sun-soaked surface water. The fish store their plankton-source vitamin D in their livers, and it is that cod-liver oil source of vitamin D that supplemented children for many years. Now we can take fish oil capsules, flax seed oil (another vitamin D source) and vitamin D3 supplements which all work to do almost the same thing as laying out on a warm rock in the boundary waters. Still, we know that just about 50 percent of people don’t get enough vitamin D.
 
The flip side of all this sun and vitamin D talk is that one can get too much of both. One should not take more than 5,000 international units (IU) of vitamin D per day, and one should avoid too much sun. We know that excessive sun (or tanning booth) exposure causes premature skin aging with wrinkles, sagging, brown spots, rough skin, not to mention skin cancers.  You hear and read everywhere the following words of advice: use sunscreen, wear protective clothing and avoid tanning booths.
 
But after two days of a soaking cold rain, it should be okay to lay out on a warm rock.
 
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​By Richard P. Holm, MD
 
Understanding the story of acute appendicitis brings us to understand other causes for a belly ache or abdominal pain. Like many other causes of abdominal pain, appendicitis is a blockage of a smooth muscle tube (SMT). We have a lot of SMT hollow transport tubes in our bodies including: esophagus, stomach, small and large intestines, kidneys, ureters, bladder and urethra, bile ducts, pancreatic ducts and gallbladder, fallopian tubes, the uterus and even the aorta and blood vessels.
 
When anything blocks the forward-moving squeezing of one of these SMTs, people have cramping spasm-like pain that lets up and comes again later with nausea or vomiting adding to the misery of the situation. Patients usually can’t find a comfortable position and are all over the bed, moving and anxious.
 
While appendicitis is a blockage where the appendix and the large intestine meet, other examples of smooth muscle tube blockage include blocked colon with cancer, blocked kidney or ureter with stones, perforating aortic aneurysm with obstructed flow, infection of the gallbladder with gallstone obstruction and blocked fallopian tube with an ectopic pregnancy.
 
When appendicitis is just beginning, the pain is around the belly button. As appendicitis worsens, pain moves from the belly button to the lower right abdomen and intensifies until either the blockage is resolved (usually with surgery or antibiotics) or the appendix ruptures, spilling fecal material and infection out into the abdominal cavity. This causes severe infection and inflammation especially affecting the smooth lining that surrounds the abdominal cavity. The lining has plenty of nerves and thus, this causes a new and exquisite type of pain.
 
Now we have peritonitis (inflamed peritoneum) which causes the patient to stop moving, to become still, almost frozen to the table or bed, not wanting anyone to touch him. This is a dangerous situation and requires emergency intervention. Other examples of pain from peritonitis include perforated stomach ulcer or ruptured: diverticula, gallbladder or ovarian cyst.
 
Clues as to what is causing either blocked SMT or peritonitis pain come with location of pain, the history of the progression of the illness, and the physical examination. Laboratory and X-ray may also help. People with non-dangerous belly pain, often have recurrent constipation, menstrual symptoms or bladder infections and should seek help at the outpatient clinic. In contrast, some clues to bring one to the emergency room should include progressive, unexplained, severe abdominal pain, shaking chills and blood in the urine or stool.
 
Understanding how a blocked SMT or peritonitis happens with appendicitis, helps, in turn, to explain the many possible causes of a belly ache.
 
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By Richard P. Holm MD
 
Mr. D, a diabetic patient of mine, came into the clinic with exercise induced leg pain. Iniitally the pain would go away if he stopped exercising, but now it was coming on after walking less than a block. He said, “the pain is meaner and lasts longer after I stop.”
 
The diagnosis of Mr. D’s condition is claudication, a condition where arterial flow to the legs is blocked. I immediately called the vascular specialist for an urgent appointment. Two weeks later the patient returned to the office after having had his blocked arteries dilated with a balloon followed by the placement of stents to hold them open. Happily, he told me he could once again walk for miles without pain.
 
His vascular doctor had started artery dilating meds, lipid meds, and daily baby aspirin. I renewed my encouragement for Mr. D to eat fewer calories, exercise daily, keep his blood sugars controlled, and the most important advice, “Stay away from sitting long on that darn couch. It’s like smoking.”
 
The narrowing process, called atherosclerosis, can be the result of genetic tendencies, diabetes, smoking, high blood pressure, high blood lipids, and even normal aging. Arteries usually narrow gradually, but atherosclerosis can sometimes trigger a clot and a sudden complete blockage resulting in a sudden, and devastating event.  It can occur in coronary arteries of the heart, cerebral arteries of the brain, renal arteries of the kidneys, and peripheral arteries of the legs. And, in general, when it’s happening in one, it’s happening in all.
 
Narrowing of blood flow can deprive muscles, skin, ligaments, and nerves downstream of precious blood flow and oxygen, resulting in an aching and agonizing hurt that would bring anyone to their knees. When it happens in the legs, like what happened with Mr. D., the pain symptom is called claudication and the condition is called peripheral artery disease or PAD.
 
PAD affects five percent of all people over 50, but more than 30 percent of all diabetics in the same age group. There can be a curve ball with diabetes or with aging, as these people sometimes lose feeling in their legs and feet due to nerve destruction, setting them up for PAD without pain. The presenting sign then would be painless sores on the feet which won’t heal. This is especially treacherous because, without good blood flow, the healing is very slow and the patient, having no pain, is not as motivated to do the work required to heal ulcers.
 
Leg pain that goes away with rest may not sound so bad, but peripheral arterial disease is one of the most formidable challenges in modern medicine. 

By Richard P. Holm, MD
 
Vaccines protect people from illness with minimal risk.
 
Smallpox has been around for many millennia. For thousands of years, the virus caused a deadly illness that killed more than 35 percent of adults and 80 percent of children who contracted the disease. That is until the smallpox vaccine was discovered in 1796. Noting that milk maids rarely got smallpox, British rural physician Edward Jenner found that deliberate infection with the milder cowpox disease provided substantial immunity to smallpox. After decades of improvement to the vaccine and a campaign lead by the World Health Organization, global deaths from smallpox were reduced from two million per year in 1967 to zero in 1977. Human smallpox infections were virtually eliminated from this world because of vaccinations.
 
Another example of clever manipulation of the immune system is the story of a pneumonia vaccine. In a 2003 study, researches noted there had been a huge drop in hospitalizations of the elderly for pneumonia, with 12,000 fewer yearly deaths—especially in those older than 85. This is the result of routine childhood pneumonia vaccination. Although we now encourage two different pneumonia vaccines for those older than 65, the authors of the study claim that it was the routine vaccination of children that was responsible for the reduction of pneumonia in the elderly. Thus, herd immunity profoundly protects immune deficient adults by reducing their exposure to sick kids.
 
There have been dangerous and untrue rumors that vaccinations in children are responsible for autism. Despite the natural human wish to find something to blame for this condition, autism appears in similar rates in children who are given and not given vaccinations. Don’t get me wrong, some vaccines carry risks, but it all depends on the specific type of vaccine and what disease it is treating. Most vaccines are incredibly safe.
 
Take for example the vaccine for Dengue fever, where the risk of side effects is significant. With Dengue vaccine, ten children are saved for every one child who is harmed. Compare that with the measles, mumps, rubella (MMR) vaccine series given in the U.S. which has mild temporary side effects including fussiness, mild fever, injection-site soreness, affecting one child in four. There is temporary mild joint pain, rash, mild glandular swelling, and loss of appetite affecting one in 50, and high fever and platelet problems affecting one in 25,000. Much better than Dengue vaccine. The benefits of the MMR vaccine far outweigh the risks. That is why we routinely give people the MMR vaccine and only give people the Dengue vaccine if they have a high chance of exposure.
 
Vaccination, a clever manipulation of our immune system, protects us from the scourges of the future.

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By Richard P. Holm, MD
 
The U.S. is rated as the tenth wealthiest country in the world. The financial Web site 24/7 Wall St. clarifies that there are two reasons we are not considered wealthier: 1. We have the world’s largest gap between the rich and the poor, which continues to grow 2. We are the only developed nation in the world without universally available health care. The second issue of health care goes hand in hand with poverty. Poverty, not ethnicity, is strongly associated with mental health problems, crime, overcrowding, malnutrition and illness. Poverty also affects children more than others. All of us would be better off if poverty was reduced.
 
The U.S. Census defines poverty depending on the number in the family. For a single person, poverty means a yearly income below about $12,500 and, for a family of four, that number is about $24,000. In 2016, the U.S. Census found about 13% of our general population is in poverty. When we break that down by ethnicity, 28% of Native Americans, 27% of single parent families, 26% of African Americans, 23% of Hispanics, and 21% of disabled people live below the poverty line. Again, experts clarify that some of the most major problems in our country are associated with poverty, not ethnicity.
Contrast this with the growing billionaire class. A Forbes Magazine study stated that the rich are getting richer in a way not witnessed since the first gilded age a century ago. Josh Hoxie, co-author of the Forbes report, said “So much money concentrating in so few hands, while so many people struggle, is not just bad economics, it’s a moral crisis.” For example, the wealthiest 400 people in the U.S. now have more money than the total of the lowest 64% of the U.S. population.
Poverty is a U.S. humanitarian shortcoming within our own borders which, I personally believe, is the core issue about which our political leaders should give their greatest attention. I don’t claim to have the answers to poverty, but our country could do better in making available to all: affordable health care, satisfying jobs with living wages, and quality and affordable pre-school and higher-education. I believe political leaders should be intensely studying the issue of poverty and how to support people in need while encouraging opportunities for rewarding work. All of us, rich and poor alike, could personally try to attack this problem, especially locally.
 
Addressing poverty will also address mental health problems, crime, overcrowding, malnutrition and illness; especially the way these issues so severely affect children. Helping all people caught in the trap of poverty will immeasurably raise all boats and make everyone in our society safer and happier.
 
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