By Richard P. Holm, M.D.
 
What is inflammation? Inflammation comes from the Latin words "into the flame" like how moths are drawn to sustaining warmth of a springtime campfire and harmful self-destruction if they get too close. Inflammation is a natural phenomenon that can encourage sustaining healing but also harmful destruction, like a moth into the flame.
 
During my first years of medical school, I was honored to spend my summers with multiple doctors practicing in Watertown, South Dakota. There, pediatrician Ebehardt Heinrichs, M.D., taught me about inflammation while we were examining a young child with acute juvenile arthritis. He pointed out how her hands showed four characteristics of inflammation famously described by Celsus, a Roman who lived at the time of Jesus. Dr. Heinrichs explained, "These are the cardinal signs of inflammation: rubor (redness), tumor (swelling), calor (heat) and dolor (pain)."
 
That summer, a red, swollen, hot, and painful joint found with juvenile arthritis was not the only medical condition I saw resulting from inflammation run amok. Other destructive examples included asthma, poison ivy, psoriasis, Lupus, and rheumatoid arthritis. Those years ago, I learned that we had anti-inflammatory medications to help patients with such unfortunate conditions, although side effects were considerable. In contrast, I also saw examples of how inflammation can be beneficial in fighting off invading infections such as skin abscesses, appendicitis, tonsillitis, meningitis and sinusitis.
 
Beyond this older and established knowledge, researchers have recently learned that beneficial muscle growth comes as a response to localized mild inflammation that follows exercise. Other studies show that low-intensity training, like walking, can reduce harmful chronic inflammation. All-in-all not only can our bodies be harmed when self-destructive inflammation turns against our own cells, but our bodies can be protected and even sculpted by the yin and yang of balanced and healthy inflammation.
 
Recently, researchers have learned of another yin and yang. We know that our bodies can recognize and remove, by inflammation, tiny cancers that pop up periodically. On the other hand, certain cancers can grow because of inflammation. This later finding has allowed for even more new therapies.
 
There have been great improvements in medicines relating to inflammation, compared to what we had during those early Watertown days. We can now, more effectively and with fewer side-effects, turn off harmful targets of inflammation, cool crippling arthritis, sooth devastating rashes and even, when used correctly, shrink certain cancers.
 
Rubor, tumor, calor, dolor . . . like a moth attracted to a sustaining or harmful springtime campfire.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming live and broadcast on SDPTV most Thursdays at 7 p.m. central.              

By Richard P. Holm, MD
 
Mr. S had gained some weight. His wife noted his snoring was getting worse and he was having spells when he would stop breathing during sleep. She informed his doctor who prescribed a home overnight oximetry test. This home test showed Mr. S’s oxygen levels were dropping dangerously low during much of night. The subsequent full sleep study indicated he would benefit from a continuous positive airway pressure or CPAP device. Five years later, the patient died from a heart attack, and the doctor found out that the CPAP machine stayed under his bed and was rarely, if ever, used. One study showed, despite its benefits, only 30 percent of those prescribed CPAP will actually use it.
 
An estimated 22 million Americans suffer from sleep apnea and the majority don’t know they have it. Their sleep is interrupted by snoring, choking and prolonged spells of low oxygen levels. Their days are troubled by fatigue, sleepiness, often abnormal heart rhythms and heart failure. Their risk of stroke over five years is two to three times higher than usual and risk of all-cause premature death three to five times higher. One estimate is that 38,000 annual deaths in the U.S. will occur from heart disease due to untreated sleep apnea.
 
Making the diagnosis is challenging. In 2016, we gave a standardized questionnaire to screen for sleep apnea to 67 people who were 70-years-old or older. Following that, we tested all 67 with home overnight oximetry. Of the 67 tested, 42 percent were normal, 31 percent had mild sleep apnea and 26 percent had moderate to severe sleep apnea. Conclusions from my study were that in this older age group, the commonly used screening questionnaires for sleep apnea misses the diagnosis half the time, about one out of four have life-threatening sleep apnea and, in this older population, women and men are equally burdened by this condition.
 
Anyone with heart disease, high blood pressure, obesity, a history of heavy snoring or observed spells of apnea (and maybe anyone reaching 70) would benefit from a home overnight oximetry test and, if this test is abnormal, from a full sleep study. If CPAP is prescribed, it would be wise for that individual to make every effort to use the CPAP device, knowing that this non-medicinal therapy reduces death rate by three to five times.
 
Many premature deaths, especially from heart disease, could be prevented by first discovering the diagnosis of sleep apnea and then, when apropos, by taking the CPAP cure.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming live and broadcast on SDPTV most Thursdays at 7 p.m. central.               

By Richard P. Holm, MD
​
After 40 years as a doctor interacting with patients, in the last two and a half years the tables turned, and I’ve become the patient. Although most are good, I’ve found some doctors are detached, some are too quick, some would rather be somewhere else, some are even angry; but, when a physician who cares walks into the room, and I’m not exaggerating, the day becomes better, the pain becomes less, and hope fills my heart. Scientific knowledge is important, but the ability to convey honest concern, human thoughtfulness and compassion is equal in importance in this healing profession. So, how do we select pre-med students for that, or teach compassion in medical school?

There are studies that show those interested in humanities or taught disciplines that explore how people tick, do better in the compassion department. These disciplines include history, literature, religion, ethics, anthropology, psychology, cultural studies and the arts of theater, film, painting and poetry. Some explain that the humanities give us the very reason to learn science and mathematics.

Several studies support the value of humanities in medicine. Seven hundred medical students were surveyed about their lifetime exposure to the humanities and the results indicated that those who had more humanities knowledge had more empathy, tolerance to ambiguity, resourcefulness, emotional intelligence and less burnout. Another study found that a med student’s ability to recognize diagnostic clues increased by more than 35 percent after taking a visual arts class. Another study found practicing improv theater helped med students learn to prepare for unexpected questions and conversations. A fourth study showed how writing exercises helped med students have foresight into what a patient may be experiencing. Clearly, an exposure to the humanities makes a better doctor.

I believe that care providers who have had a well-rounded humanities education have a better chance of understanding about how it feels to face pain, nausea, loss of bodily functions or even a cancer diagnosis. Those steeped in good literature or art have a better opportunity to tap creative juices to problem solve and tolerate a life that can be ambiguous and unpredictable. Those who are knowledgeable of history, ethics, cultural ways will find it easier to know when it is time to stop aggressive care and move toward comfort.
This is a call for all students to become readers, to find time to enjoy the humanities, to exercise your caring and compassion muscles; so, when you come into the room of a person suffering, it makes their pain less and day better.

​For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming live and broadcast on SDPTV most Thursdays at 7 p.m. central.          

By Richard P. Holm, MD

The world of radiology began in 1895 when a European physicist Wilhelm Röntgen noticed fluorescence behind heavy cardboard when a cathode tube was activated nearby. Röntgen used his wife’s hand to demonstrate for the first time how these unknown rays, or X-rays, could penetrate the soft tissue of her hand and illustrate the bones that lay within. Röntgen generously refused to patent his discovery which allowed the explosive growth and development of a new industry.

Unfortunately, researchers were unaware of the dangers of too much X-ray exposure and during the early years harm was done, even causing death of some experimenters before safeguards were established. Over time, as technology advanced and more X-rays were utilized, interpreting the images became an increasing challenge and the field of radiology developed. Physicians trained in interpretation helped care providers make better clinical decisions.

I was a first-year resident at Emory University Hospital in Atlanta in the fall of 1975 when the hospital purchased one of the earliest computerized tomography (CT) scanners. It was called an EMI scanner named after the British company that took a huge financial risk in order to develop the technology. Electric and Music Industries (EMI) had signed with the Beatles as their recording company in 1962 and having amassed a fortune from the exponential rise of Beatles popularity, EMI was able to fund the theoretical work of Godfrey Hounsfield which took X-rays of the head from all directions while a computer compiled the results. When all other funding resources said “no,” Hounsfield’s brainchild happened, “with a little help from his friends.”

I was rotating through neurology when the results of the EMI scans started making an impact. We were amazed how they showed tumors, blood clots and lesions inside the skull. We thought it was going to change everything, and indeed it did!

Jump to the present and see how interpretive radiologists have expanded into intervention. Now, instead of simply identifying a tumor or abscess with ultrasound, X-ray, CT, or MRI, radiologists, under the guidance of an imaging modality, can pass a needle into a deep tumor and take a biopsy, drain an abscess, open-up a blocked tube and much more. Procedures that, in the past, would have required open abdominal or chest surgery, now can be done with minimal trauma and pain with quick recovery.

As a patient who has benefited under the expert image-guided hands of an interventional radiologist, I too can sing loud and clear, “I get by with a lot of help from my friends.”

For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc®, featuring On Call with the Prairie Doc® a medical Q&A show streaming live on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.