The Astonishing, Life-Sustaining, Sacred Tear
By Richard P. Holm, MD
Washington Irving once said, “There is a sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are the messengers of overwhelming grief, of deep contrition, and of unspeakable love.”
Normal human tears are a biological wonder composed of a watery portion for providing the cornea hydration and nutrition; a mucous lubrication component for making a tear slimy; and a third thin outer layer of oil for slowing evaporation. Put together you have the astonishing, life-sustaining, curative, slippery and slow-to-evaporate human tear. Vision is completely dependent on tears because the cornea, for purposes of transparency, is designed without blood vessels and is kept alive only by the nutrition it receives from tears.
“Dry eye,” is a condition related to issues involving the eye surface, including the loss of the effectiveness of tear film. Symptoms include pain, itching, burning, redness and mucous around the eye with fluctuating vision that interferes with recreation, reading and even driving. Paradoxically, watery eyes usually indicate a dry and inflamed eye with reactive, poor-quality tears.
The most common causes for dry eye are side effects from many medications. These include decongestants, antihistamines and meds used for acne, fluid excess, blood pressure or bladder spasm. Environmental causes include extensive reading, eye surgery, excessive computer use, contact-lenses, low humidity, wind or fans blowing on the face and a diet without enough oil or certain minerals and vitamins. Primary medical causes for dry eyes include immunologic conditions like diabetes, rheumatoid arthritis, lupus, scleroderma, low thyroid, Sjogren’s syndrome, vitamin A deficiency and just plain aging. Dry eye affects twice as many women as men, and in the U.S. alone, we spend $3.8 billion in health care dollars for this condition, with societal costs estimated at $55 billion a year.
For treatment, we focus on situations causing symptoms and then find ways to avoid those situations. We can include in our diet enough fish, flaxseed or flaxseed oil, liver, carrots, broccoli and walnuts. Protective eyewear can help. Doctors treat some cases with surgery by plugging the tear ducts that drain tears away. Eye drops that reduce inflammation can help. Artificial tears are often prescribed, but as helpful as tears from a dropper may be, they are never as good as the real deal.
Nothing will ever compare to the value and the sacredness of a human tear.
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Sometimes Less Is Best with the Elderly Heart
Prairie Doc® Perspectives - Week of February 10, 2019
By Richard P. Holm, MD
A beautiful 90-year-old woman came into the emergency room after another fall. The last year had been tough for her as she had developed diastolic heart failure. Her weakness and breathlessness were helped some by diuretics, but she was troubled by extreme variations in blood pressure, high one moment and dangerously low the next. Also, she had a calcified and somewhat tight aortic valve and was on a blood thinner for atrial fibrillation.
Heart disease in the elderly includes a wide variety of conditions. The following is a partial list:
The risk of falling was simply too high to continue my 90-year-old patient on blood thinners. I stopped them and backed off a little on the diuretic which could have been worsening her blood pressure drops and causing the falls. The age-old ethic came to mind: “First of all, do no harm.” Balancing the advantages and harms of medicines in the elderly requires careful consideration, and sometime less is best.
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Those Dirty Rotten Scoundrels
By Richard P. Holm, MD
The phone rang, and I answered it because the call was from a nearby community. No big surprise that the caller was obviously not from anywhere near, and the caller was asking for a donation for some organization in which I had no interest. I said, in a kindly tone, “No thank you,” and hung up. They will never end the call. YOU MUST HANG UP.
Financial abuse by telephone or internet has been called “the crime of the 21st century.” People of all ages are at risk, but scammers commonly target the elderly. Those of us past 65 are more often home to answer the phone, are apt to stay on the line longer and are less likely to report a crime. Making all of this worse, telemarketing crime is challenging to prosecute and, therefore, inviting to criminals.
There are plenty of bad guys out there. The National Council on Aging has written a compendium of common fraudulent traps that can result from telephone calls or internet messages. Here are some:
Take home message: Don’t respond to calls or emails from strangers selling or pushing you into something. Don’t donate to causes that you didn’t initiate. Beware of scammers. In a kindly tone, say, “No thank you,” and JUST HANG UP.
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