By Richard P. Holm, MD
 
A dear physician friend of mine who practices in Florida developed renal (kidney) failure a few years ago at the age of 60. He was initially treated with peritoneal dialysis which involves repeatedly flushing special fluid into the abdominal cavity, letting it sit for a bit to remove poisons and then draining out the contaminated fluid, usually three times a week at night. Later, he moved to hemodialysis where blood is drained from his arm into a filtering machine where the blood is cleared of the same poisons and then pumped back into his blood stream. This is done usually three times a week taking four hours at a sitting.
 
It must be a burden to be required to do dialysis three days a week or more for something that most of us take for granted. Since a transplanted kidney is much cheaper than dialysis and is better on the body than dialysis, it would be preferable for most people to get a transplant. However, finding a transplant organ can be difficult. In the past year my friend has had at least four scheduled transplant dates, only to be turned down at the last minute. How frustrating that must be!
 
The National Kidney Foundation notes that more than 120,000 people in the U.S. are currently on the waiting list for an organ and 100,000 of these are for kidneys. Six thousand living and 12,000 cadaver kidneys are transplanted each year in this country while 20 people die every day waiting for an available organ.
 
Organs that are commonly transplanted from living or cadaver donors include kidney, liver, heart, lung, pancreas and even small intestine. Tissues include cornea, skin, heart valve, vein, tendon, ligament and bone. A healthy living donor may be related, or not, to the recipient.
 
It is a courageous and altruistic act of loving kindness to donate an organ so another person may live. To explore becoming a living donor go to organdonor.gov. This gift of life has remarkably minimal risk to the donor and, depending on the organ donated, usually means just a few days in the hospital. While you’re thinking about it, TALK TO YOUR FAMILY about your intentions and mark “yes” as a potential donor on your driver’s license.
 
Please consider organ donation, a most precious gift to someone in need, like my friend in Florida. It takes courage but you will save a life.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook 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
 
I appreciate how the old prayer goes, "Bless the food before us, the family beside us, and the
love between us..."
 
A few years back, our youngest son, had a break-in at his home and they took his computer with
all his pictures as well as his original created songs. They also got away with my old film-dependent
camera with a bunch of undeveloped pictures my son had taken. He decried that it wasn't the loss of the computer or the camera, it was the loss of memories and ideas contained within. He was
dismayed that he dreamt he caught the thieves breaking into his house and in his dream, he choked them and hit them with a baseball bat.
 
It brought back the memory of advice one of my patients gave me one day, "If you want to
destroy your enemy, make them hate." I know how self-destructive hate can be. In that sense,
the thieves got my son twice, once for the robbery and once for the deep anger they instilled in
his heart.
 
Maybe once a year I watch a family self-destruct as children of a dying parent return from afar to
criticize the choices that the local family had made, often demanding more aggressive care
when the parent is at the end and it is time to let go.
 
I have seen lawyers at the bedside of a borderline-competent patient working a change in the
will, giving more land to one child than another, resulting in the blackest of disharmony between
kids that had grown up together as family and who will never speak to each other again.
 
I have seen widows and widowers remarry and find joy once again after the sad death of a
spouse, only to have children selfishly scrambling for the spoils of the inheritance, leaving
someone in the equation without their fair share. Truly there is nothing more heart-breaking than to see such destructive behavior among family members.
 
But this does not always happen. In fact, more often than not, the death bed of a parent brings
some great moments of joy. One family I remember in particular, surrounded their dying mother
with harmonious hymns in that hospital room as they had the family reunion that hadn't occurred in many years. Families most often come together around a dying parent or sibling joyously sharing of family memories while supporting and loving the one leaving.
 
Our son found a way to let go of the loss and anger following the robbery and moved on to new
equipment and even better creativity.
 
It isn't the material stuff in front of us, it is the family beside us, and the love between us.
 
Richard P. Holm, MD is author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook 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

“Every once in a while, my heart seems to be jumping out of my chest, I get a weak feeling and short of breath,” the patient explained. When I listened with my stethoscope, his rhythm was different than the usual lub-dub, foot-tapping, sounds, which are regular as a band marching through town on a summertime parade. Instead his heart had the irregular rhythm of popping corn, chaotic and unpredictable, and I couldn’t tap my foot to it.

As predicted, the EKG showed the rhythm of atrial fibrillation, with the atrial rate running at three to 400 beats per minute, and the ventricular rhythm chaotic, as the experts say, irregularly-irregular at about 150 beats per minute. Atrial fibrillation, or A Fib, is the most common abnormal heart rhythm condition. It afflicts about one percent of the total population, more than two million people in the U.S., and eight percent of all those older than 80 years of age.

There are many causes for A Fib, including long standing high blood pressure, coronary artery blockage, sleep apnea, too tight or leaky heart valves, too much or too little thyroid hormone, blood clots to the lung, an inherited conduction system or wiring condition, excessive amounts of tobacco, coffee, alcohol, or amphetamine, a viral infection involving the heart, stress of any kind, or just an old and weak heart.

There are two main reasons we need to do something about this rhythm abnormality. Most devastating can be the clots that can form in the atria since they are not emptying effectively, resulting in something like 10 to 25 percent of all strokes to the brain. Second, the ventricles are not efficient pumps when atria are fibrillating and even worse so when the ventricles are beating at 150 beats a minute.

So, with A Fib we must slow the heart down, thin the blood to prevent strokes, and sometimes even bring the rhythm back to normal when we can. While we are at it, in each case, physicians need to study why A Fib happened. It is a complex and interesting condition, and there is a lot of debate about what kind of blood thinners to prescribe, what kind of rhythm-control drugs to use, and when to use surgery and pacemaker treatments.

But the bottom line about A Fib is that good treatment by your general or cardiology physician can prevent problems and allow a normal life, even with the heart rhythm as irregular as popping corn.

Richard P. Holm, MD is author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook 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
 
Before my junior year in high school, I returned from a Boy Scout canoeing trip to discover my sister had been killed in a car crash. I will never forget the sadness of the moment when I walked into the house that was filled with what seemed like half the caring and wonderful town of De Smet to find my mom and dad there grieving. It was near the end of that summer, but the beginning of a long period of mourning for my family and me.
 
There were lessons that came to me after my sister’s death. I realized how important support from a community could be. Consolation came from our friends, neighbors, church community, as well as people we barely knew. It seemed more about their presence and not their words. I noticed there were people who had trouble themselves dealing with such loss, and they sort of disappeared.
 
Also, I realized that a funeral is not exactly a time of closure for a family, but really just the beginning of a time to accept reality and forge ahead with the difficult changes that life can and does deal out. It took me years to think about my sister and relish in her memory rather than cringe from the pain of the loss. In that sense, I know I will never have closure and that’s good.
 
Some 14 years after her death, while I was on the faculty of a medical school in Georgia, I found myself having to advise medical students how to talk to patients or family about sad news. I reviewed the medical literature on the subject at the time and concluded that there is no right way to do it except to be 100 percent honest and to say whatever is needed with compassion.
 
Through the years those guidelines have sustained me while I have had the burden of sharing awful news. 
 
Bottom line, it is being there, more than words that consoles. Never worry about what to say, just show up, be honest, and care.
 
Richard P. Holm, MD is author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook 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.