Stress on the Prairie
By Richard P. Holm MD
During the summer after my freshman year of high school, my dad found me a job working on a farm, hoping it would teach me the work ethic. I remember hard physical work, long hours of hauling and stacking bales, and profound loneliness while painting farm buildings.
At the time, it was the most stressful experience of my young life, bringing me out of my lackadaisical youth and a tad closer to the world of a responsible adult. I have often referred to that time as the period in my life when I realized the value of hard work. It was a tough summer brought upon me by my dad and a kindly farmer, and I became the better for it. Of course, this was nothing compared to what some farm-kids experience, but I learned that summer stress and hard work could be a good thing.
There are many things that can cause stress: tension, trauma, aging, money pressure, worry, fear, and anxiety from big or only perceived problems. It is a pull-push force exerted on the body resulting in strain, with or without movement. One famous expert, Hans Selye, defined stress in two ways: there is distress, or bad stress; and eustress, or good stress. He found that bad stress results from being forced to face trouble without tools to cope or solve the problem. It is like being broken-down in the field, and you can't get the part to fix it.
A famous Harvard Study starting in 1938, which followed one class of sophomore men for the duration of their lives, discovered cholesterol, IQ, and childhood temperament had nothing to do with healthy aging; while smoking, alcohol abuse, and depression all had major negative effects. Healthy aging was best accomplished and measured, not by money, but by how these men coped with tough times while finding ways to connect with others.
Good stress is facing adversity and finding ways to either solve problems or accept them as unresolvable. Like exercise, it involves movement, and is something we can learn to accept and even enjoy. As Selye put it, good stress makes you stronger, and the opposite is also true: without stress, our muscles, bones, and hearts become weak. Indeed, the trials of life can become good stress if we can learn to deal with adversity. Stress can give us strength, direction, and even purpose.
Whether it is learning to work hard on a farm, dealing with broken down machinery, facing the inconsistencies of Mother Nature, experiencing long lonely hours in isolation, or tolerating cantankerous humans. Stress is part of this life, and coping with it is a skill we can and need to develop.
by Richard P. Holm MD
Mr. D, a diabetic patient of mine, came into the clinic with exercise induced leg pain. He told me that lately he could only walk about three blocks before the pain would come on, but it would go away if he stopped. He then told me that last week it came on after two blocks, and yesterday he could only go one. He said: “Now the pain is meaner and lasts longer.” With the diagnosis of claudication, a condition of blocked arterial flow to the right leg, I called the vascular specialist and we set up an appointment. Two weeks later the patient came into the office having had his blocked arteries fixed with a balloon and stents and he told me he could walk for miles again.
Narrowing of the arteries that feed the heart, brain, kidneys, and extremities can happen gradually, or can trigger a clot and a sudden complete blockage. This can occur in coronary arteries of the heart, cerebral arteries of the brain, renal arteries of the kidneys, or peripheral arteries of the legs. The narrowing process, called atherosclerosis, can result from things like diabetes, smoking, high blood pressure, abnormally high blood lipids, and even normal aging; In general, when it happens in any one of these organs, it happens to all of them.
Narrowing of blood flow deprives muscles, organs, and all living material downstream, of oxygen. When such tissue, which is networked with nerves, misses some of their blood flow, there follows an aching, anguishing, and agonizing hurt that would bring anyone to their knees. The classic example is heart pain, or “angina pectoris”, a condition that occurs due to narrowed coronary arteries, is triggered by exertion, and is relieved with rest. Another is leg pain, or “claudication”, which occurs when the arteries that feed the muscles and tissues of the legs become narrow and restrict blood flow. This is what was happening with Mr. D and is called peripheral artery disease, or “PAD”.
PAD affects five percent of all people over 50, but affects more than 30 percent of all diabetics in the same age group. Since diabetics often lose feeling in their legs and feet over time due to nerve destruction from elevated sugars, they may have PAD without pain and the presenting symptom can be in the form of painless sores on the feet that are very difficult to heal. This kind of presentation of PAD is treacherous because, without good blood flow, the healing process just doesn’t want to happen. What is more, a patient who is not experiencing pain is often not very motivated to do the work required to protect his or her feet so ulcers can heal.
Mr. D did very well with new blood flow to his legs, especially with his renewed ability to walk further, which allowed for tighter control of his diabetes.
Listening For God
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 young, only child. Even though most marriages don’t survive such an insult, this one did. Between that woman and man, there was love, forgiveness, and the Church. The people of the congregation, like the wings of a mother hen, surrounded the couple with support, comfort, and warmth.
Some critics of organized religion say that we are hard-wired to believe in God. They say that it explains why religion exists but not why God exists. They point out that no society has survived more than three generations without a religious foundation including belief in prayer, the afterlife, and ritual, but just because we need God, doesn’t mean God exists. I contend that the opposite is true and am reassured of God’s presence by this and more observations.
I am reassured of God’s presence when watching a religious based rehabilitation program help men find their way back from drug or alcohol abuse. The leaders, who fill a mentor role, teach “It is not about you. . . it is about loving others and loving God.” I am reassured when studying the complexity of the human heart and the way the muscles, 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 and brings spiritual connection to the hearts and joyful tears to the eyes of those listening and singing. I am reassured when a church, mosque, or synagogue full of people saying the Lord’s Prayer, or any prayer in unison, reverberates within 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 sync 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 try to help resolve the health problems people face. In caring for people, especially at the end of their lives, I have realized that most times science is simply not enough. There is another place to where people need to go for help when the finale is near. The Spiritual realm, in my view, is all around us, if we listen very carefully for it, and this Divine Essence provides, for many, great meaning and help.
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.
Health Care Costs Run Amok
By Richard P. Holm, MD
The Patient Protection and Affordable Care Act, commonly called the ACA or Obamacare, could have been named the ‘Access and Cost’ act. It was successful in ‘protecting patients’ by guaranteeing access. . . making insurance available for more than 20 million people who were not able to get insurance prior to the ACA. The second part of the name, ‘affordable care’, referring to cost, has not been as successful, however.
Politicians have said, and this is correct, “since the ACA was implemented, increases in health spending have slowed.” Personally, I do not find this statement reassuring, when looking at the enormous cost of health care in the United States. We spend $3.2 trillion per year for health care, which is twice the average cost per person than that of the next ten most expensive countries and more than five times the outrageous $600 billion we spend per year on the defense budget.
Individual costs also grew during the last five years. Patient deductibles increased by 63% and premiums by 19% during a time when worker earnings grew only by 11%.
From an October 2015 Commonwealth Fund Report comparing the U.S. with 13 other rich countries, the data indicates higher spending in the U.S. happens in part due to excessive use of medical technology and higher health care prices, while there were LESS doctor visits, hospital admissions or spending on social services.
Despite all the health care spending in this country, we have poorer health outcomes, more chronic conditions, and shorter life expectancy. It’s like paying a high price at a fancy restaurant, expecting a perfect steak, and instead, getting meatloaf.
How should we fix the healthcare cost problem?
The ACA brought access. Now we need to control cost.