Respect People’s Choices
By Andrew Ellsworth, M.D.
This summer I attended the celebration of life service for Dr. Rick Holm, the original Prairie Doc who founded this newspaper column, a radio show and a television show now entering its twentieth season. He died from pancreatic cancer in March of 2020 during the early days of the Covid-19 pandemic and thus there was no public service at the time.
Many friends and family gathered to celebrate Rick. We sat on lawn chairs, shared tales, and sang songs in a beautiful park on a gorgeous evening. We recalled stories of him being notoriously late, knocking over wine glasses with his large hand gestures, and mistakenly eating potpourri thinking it was trail mix. Themes emerged of Rick’s amazing ability to accomplish so much in a day, his skill for active listening, and his passion for finding the best in people.
His children shared memories of their dad, including their family bedtime prayer “Help us to be kind and honest and respect people’s choices, and help us to be better people tomorrow.” Rick crafted that prayer from the Hippocratic Oath, the promise that doctors make when they complete their training and before they begin their careers. The oath emphasizes the medical ethics principles of beneficence (to do good), and nonmaleficence (to do no harm), and the importance of patient autonomy (to respect people’s choices).
Listening to the Holm bedtime prayer, I realized how the oath had taken on new meaning for me this past year as I observed people choosing to get vaccinated for Covid-19, or not. As a primary care physician, I know Rick would have recommended vaccination for all who are eligible. He was a proponent of preventative care and vaccines help prevent disease. Rick would have listened with kindness to the concerns of each patient. He would have explained with honest science how the vaccine works and how the risk of a severe reaction from the vaccine is greatly outweighed by the benefits of being vaccinated, such as reducing the chance of serious illness and complications from Covid-19.
Just as my colleagues and I promise to do, Rick would have cared with beneficence for his patients that were sick with Covid-19, even if they refused the vaccine. He would have respected their choices and held their hand with no maleficence, no judgement, or condescendence. At the same time, he would have celebrated with a Snoopy dance those who choose to get vaccinated, those who choose to quit smoking, to start exercising, and to eat healthier. As we carry his legacy into another decade, we continue the message of The Prairie Doc, “Stay healthy out there, people!”
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Return to Wellness
By Dr. Luke Mortimer, M.D.
I recently saw a patient I hadn’t seen in more than 18 months. This patient had previously come to me somewhat routinely for arthritic knees. Together, we constructed a conservative treatment plan to help increase activity and prolong the life of those knees. Unfortunately, the Covid-19 pandemic put a dent in our plan. Prior to the pandemic, this patient had been a borderline diabetic with some other medical comorbidities. Upon their return, we found a lot had changed. The patient had gained 30 pounds, decreased activity, and could not move about very well. We had to revise our plan based upon the patient’s current condition. I have observed, over the last few months, this scenario is not unusual.
With the pandemic, many people simply stopped moving and as a result their joint related complaints skyrocketed. This inactivity created a significant increase in pain and discomfort in those with underlying arthritis. As patients continue to return to society and have a difficult time picking up where they left off, what do we do to help them get back to their normal?
First, identifying the significance of their medical and orthopedic issues is key. Those with more combined orthopedic and medical issues may require a multidisciplinary approach amongst physicians. Success is more likely if the patient and orthopedic surgeon work together with the primary care physician to assist in management of weight, diabetes, cardiac and other issues that need specific attention. Great communication amongst providers is essential to maximize the benefit for the patient.
Second, developing a plan that will assist in overcoming these issues is the next goal. This may involve cautious use of anti-inflammatories or corticosteroid injections to help decrease inflammation. It may involve viscosupplementation or “gel” injections to assist with lubrication. Physical therapy to focus on getting specific muscle groups to unload the joint while also allowing increased movement may be a great place to begin. Walking, water walking, water aerobics, elliptical machine, bike riding, or hiking are great examples of low impact activities that promote good joint health. The overall goal is to get patients that stopped moving back to an active lifestyle. As many of my patients and colleagues say, “motion is the lotion”.
We all know the pandemic has been difficult and affected us all in different ways. Getting outside, increasing activity, and developing goals to help people get moving again is paramount for overall health. A good conversation and developing a plan with your local health care team is a great way to begin your return to wellness.
Luke Mortimer, M.D. is a contributing Prairie Doc® columnist. He practices as a board-certified orthopedic surgeon in Rapid City and Spearfish, South Dakota and Gillette, Wyoming. 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 SDPB most Thursdays at 7 p.m. central.
First Day of School
Prairie Doc® Perspectives for week of August 15, 2021
By Debra Johnston, M.D.
“First day of school! Wake up! Come on. First day of school,” the little fish shouts at his dad in the opening scene of Finding Nemo. The first day of school is an important transition for students of all ages, and it is often a challenging one. That is particularly true this fall as we start yet another academic year marked by the pandemic.
Parents have an important role in preparing their children for a successful school year. First, start adjusting the schedule. Many families relax the rules during the summer and may be in the habit of staying up late and sleeping in. Make sure your child has time to adjust to their school year routine before that first day. Second, develop good habits by acting ahead. Having the backpack ready and clothing laid out the night before saves scrambling in the morning and reduces the risk of forgotten items. Invite your children to help decide if they want school lunch or a sack lunch and let them help pack their lunch boxes.
Back to school checkups for your children provide a valuable opportunity to talk to the doctor about physical, developmental, and social changes. Additionally, children may need immunizations: boosters for tetanus and pertussis, or shots to protect them from HPV, meningitis, and Covid.
The Covid vaccine is available to those age 12 and over, and I urge parents to schedule those shots if your child is eligible! Although in general children are less likely than adults to end up in the hospital with Covid, we do see previously healthy children become seriously ill and suffer complications. The jury is still out on whether the Delta variant is more dangerous to children than previous variants, but we do know this variant is more contagious, which means more people fall ill. Infected children can spread the virus to other people who may be more likely to develop serious illness. There are still many people who are not eligible for the vaccine, who have chosen not to get the vaccine, or whose vaccine may not be as effective as hoped due to underlying health conditions.
Many children feel nervous about the start of school and those jitters may be worse this year due to the pandemic. Talk to your children about their concerns. Help them work through “what ifs”: What if I forget to wash my hands? What if I start coughing during school? What if I forget my homework? Most adults have had practice dealing with these experiences in the moment, but we, too, can benefit from mental rehearsals. Become familiar with your school district’s plan for controlling and responding to the pandemic so you can help your child with changing conditions.
With a little preparation, we can reduce stress, set our kids up for a successful year and help them be as excited as Nemo to start school!
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 SDPB most Thursdays at 7 p.m. central.
Laughter is the Best Medicine
By Jill Kruse, D.O.
It is often said that laughter is the best medicine, yet I have never written a prescription for a funny movie, or a television comedy show, and I have no clowns or rubber chickens in my office. On the contrary, doctors are often expected to be serious and professional. Perhaps we are missing a great opportunity to help heal. What if more doctors were like Dr. Patch Adams, who is known by the medical community for his quest to inject humor and laughter into the treatment of patients?
In medicine we work to cure disease. To cure means “to eliminate all evidence of disease.” However, there is a second goal that we also have and that is to heal. To heal means “to become whole by strengthening the mind and spirit to improve the quality of life, even if, or when, no physical cure is possible.” Laughter helps us heal. There have been multiple studies on what happens to the human body when we laugh. Research has been done on the importance of laughter from children to the elderly and no matter the age, laughter is the best medicine.
Due to the mind-body connection, laughing can aid your brain in producing chemicals that help your heart work better and pump more evenly. Laughing can assist in reducing pain by causing the body to produce its own natural painkillers. A deep belly laugh benefits and enhances your intake of air, which stimulates the lungs and muscles. Laughter helps boost your body’s immune system to help you prevent and fight off infections. It can also lower your stress level and give you more energy.
According to the American Heart Association, research has shown that laughing can decrease stress hormones, reduce artery inflammation, and increase your HDL (good cholesterol). Who knew that a laugh could do so much good? A study on adults age 65 and older in Japan showed that even after adjustment for high cholesterol, high blood pressure, depression, weight, and other risk factors, the frequency of heart diseases among those who never or almost never laughed was 1.21 times higher than those who reported laughing every day. In the same study, the risk of having a stroke was 1.60 times higher for those who almost never laughed compared to those who were full of mirth.
So, I will leave you with a few “treatments” to help improve your health today. Why did the pillow go to the doctor? Because he was feeling all stuffed up. Why did the cookie go to the hospital? He was feeling really crumby. Does an apple a day keep the doctor away? Only if you aim it well enough. Did you hear the one about the germ? Never mind; I don’t want to spread it around. Laughter is one medicine for which there is no maximum dose. Laugh often and well for a happy and healthy life.
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 SDPB most Thursdays at 7 p.m. central.
Living Well with Serious Illness
By Francine Arneson, M.D. and Kyle Arneson, M.D., Ph.D.
When patients and their families are asked to meet with palliative care specialists, it commonly triggers a wide range of emotions. Some may feel uncertainty about having an additional care team involved when they already have multiple appointments, and many fear what the referral may mean in regards to their current treatment plan and ultimately to their life trajectory.
Along with these complicated emotions, patients and their families often admit to being unsure why their doctors feel the need to involve palliative care. By contrast, when a patient is referred to a cardiologist, oncologist, or surgeon they tend to understand why. The concept of palliative care has been utilized for decades by many clinicians but has only recently evolved into its own specialty. Recognized through research and clinical trials, palliative care has shown to help patients live well with serious illness by enhancing quality of life, extending prognosis, and ensuring patient centric care and comfort.
Palliative care is delivered alongside best standard medical care by an interdisciplinary team, consisting of doctors, nurses, social workers, chaplains, pharmacists, and others to meet the multidimensional needs of individuals. Ensuring that medical decisions align with the patient’s personal values and enhancing the patient’s quality of life remain the focus of specialty palliative care. Palliative care also aims at minimizing suffering.
Suffering is a scary word, but most people facing a difficult diagnosis will experience some element of suffering. Many first think of suffering as physical distress such as pain or shortness of breath. However, in palliative care, a much broader view of suffering is taken. It includes not only physical symptoms but also the emotional, spiritual, and practical toll illness places on our sense of self and our loved ones.
Palliative care commonly addresses suffering in those who are not having physical symptoms, but have anxiety or depression, overwhelming feelings of guilt, remorse, fear, or discord regarding faith. Palliative care will discuss how illness impacts a person’s independence and appearance and focuses on how illness impacts relationships with loved ones. Palliative care provides that extra layer of support to ensure that all medical care is based upon individual choices and values.
As we attempt to maintain a sense of self through complicated illness, these topics are vitally important but are rarely addressed in normal health care settings. Specialty palliative care strives to ensure that the medical plan of care is based on diagnosis but is also optimized to incorporate the patient’s personal values and beliefs, based on goals and life experiences.
So, although many people are initially hesitant when a palliative care referral has been made, ultimately most people deeply appreciate the benefit of excellent symptom management and the patient centric support that is provided throughout a relationship with the palliative care team.
Francine Arneson, M.D. and Kyle Arneson, M.D., Ph.D. are contributing Prairie Doc® columnists. They practice palliative medicine and radiation oncology, respectively, in Sioux Falls, South Dakota. Francine is the featured guest on the show this week. 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 SDPB most Thursdays at 7 p.m. central.