Don't Miss the Ball
By Richard P. Holm, MD
The first hint that I had glaucoma, came when I was at the eye doctor and it was discovered by machine testing that I had lost vision in the peripheral areas around but not including the center point of vision on my left eye. Loss of peripheral vision is a sign that glaucoma might be occurring, and indeed, when they measured the pressure within my eyes, it was increased on the left. I had no idea something was wrong.
An estimated three million people in the U.S. have glaucoma, one-half have no idea something is wrong, and 120,000 are blind as a result. Glaucoma is the second leading cause of blindness in the world, especially for those coming from African origins. Once discovered, we have treatment, so the best preventive move is to get routine glaucoma testing.
Glaucoma causes peripheral vision loss and preserves central vision until late in the disease. Central vision is that concentrated view we have of the object at which we are staring. It is the eye of the needle into which we are trying to put the thread; the subtle smile of the mysterious woman about which we are painting; the target into which we are aiming our arrow. Say it again, early on, central vision is preserved in glaucoma.
Remember, glaucoma causes progressive loss of peripheral vision. Peripheral vision is important, allowing us to see the shooting star that flashes suddenly from the eastern horizon, while we stare at the big dipper and the northern star; to see the ball and boy that might jet out from behind that car, while we drive down the road; to see the guy across the room who has captured our attention, while we secretly watch him with peripheral vision.
For comparison, macular degeneration, causes the opposite kind of loss to that of glaucoma, specifically, loss of central vision while preserving peripheral vision. Both conditions affect the retina, that blanket of nerves covering the back side of the eye, which, like a camera, captures the image of an autumn moon rising on a South Dakota lake, a wind wave of grass moving on a prairie hill, or the surprised face of discovery on a visiting grandchild.
Take home message: people don’t realize there is peripheral vision loss resulting from glaucoma, until the damage has been done. Get in to have routine eye testing. You may have no idea something is wrong.
A Smoking Gun
By Richard P. Holm, MD
Mr. C, a 56-year-old fellow came into my office because he was experiencing shortness of breath with any exertion and was hoping we could fix it. He admitted that he has been smoking about one-and-a-half-packs a day for 40 years, and lately he’s been trying to cut down. Multiplying 40 times one-and-a-half gives him a 60-pack-year history of smoking, which is a lot. Also he’s inhaled to a lot of hog and hay dust over all these years.
He said his symptoms have been coming on over the last five years and now his heart beats fast with any exertion. His cough is getting worse, and for a year he’s been coughing up some pretty ugly stuff first thing in the morning, but the rest of the day he just can’t get it up. Lately, he’s been wheezing more and his chest gets tight, especially at night when he is trying to sleep.
Breathing tests demonstrated that he can inhale OK, but it takes some pushing and time to exhale. Blood tests showed high levels of hemoglobin, low levels of oxygen, and the chest X-ray showed over-expanded lungs. These are changes indicating the diagnosis of emphysema combined with chronic bronchitis, also called chronic obstructive pulmonary disease or COPD. This is not good news for Mr. C. because COPD is the third leading cause of premature death in the U.S. and a major cause for a miserable disability.
Normally in the lungs, airway tubes branch out, multiply, and become progressively smaller until they reach tiny air sacks called alveoli, which are covered with microscopic blood vessels. It is here where inhaled air touches blood. It’s the place of an almost magical switcheroo. Life giving oxygen is passed from air into blood in an exchange where the waste product carbon dioxide is passed from blood into air. With COPD, the walls of the tiny air sacks first lose their elasticity and then are destroyed leaving larger non-functioning cavities. Also, airways that are supposed to carry air to the alveoli become blocked because of inflammatory swelling and mucous.
Trying to help him, I encouraged Mr. C. to quit smoking, prescribed a medicine to help him quit, and provided an inhaler to turn off inflammation and dilate the bronchial tubes.
The end of this sad story is that he has a condition we can help, but not fix. And if he doesn’t stop smoking, I predict that it won’t be long before he will die, short of breath.
Tomato Christmas and Rural Health
By Richard P. Holm MD
Our eldest son, who now lives in Brooklyn, New York, recently came home to South Dakota on “he loves how he can see the stars and the Milky Way in the night sky, the morning tangerine sun rising in the east, and the space and lack of congestion in shelter-belted houses surrounded by fields of abundant crops, separating the miles between small towns. Home-grown tomatoes here have even prompted him to deem August in South Dakota as “Tomato Christmas.”
“It is so different than life in the city,” he says. The tall buildings, with city lights on all night long wash out the stars; usually the sun is up for hours before it is seen; sidewalks are full of people rushing to and fro at almost every hour; towns have filled and merged such that there are no open spaces between them; and aside from parks, there are too few growing places in the city. He told me, “The beauty and wonder of rural life becomes more apparent only when you have been away from it for a while.”
But rural more remote living can result in increased health risks because, when there is an emergency, extensive travel can be required, even to the closest hospital. Then, that small-town hospital with its limited resources may lack the necessary tools and experience to help you. Even with helicopters flying to the rescue, rural living may still result in delay in care when minutes can matter. And when a medical problem is not so urgent, rural people often still have to travel long distances to obtain outpatient medical, subspecialty, dental, and pharmaceutical care.
The result, as outlined by the National Institutes of Health, is that too often rural residents delay care, problems become more serious, and higher rates of chronic disease occur. In addition, with farmers’ potential exposure to chemicals, excessive dust, and dangerous, motorized farming equipment, farming is rated the fourth most dangerous profession, behind industrial fishing, logging, and piloting.
But technology has helped the rural health condition. With (e) electronic connectivity, like the e-Intensive Care Unit and e-Emergency Room, communicating health information between small rural hospitals and more urban specialty centers, has helped reduce the risks. Additionally, your Prairie Doc television program endeavors to reduce rural risk by bringing science-based health information to the people of this rural region.
Although living in a rural area carries some health disadvantages, the risks have been reduced. This makes living here even more worth it, especially during Tomato Christmas.
Stand up to, or run from bullies
By Richard P. Holm, MD
We have all had to deal with bullies throughout our lives, and I have had my share. One fall day, coming home from school, I saw two guys from my third-grade class beating up on a smaller kid and was moved to step in to help. Well, the victim ran home, and I became the new target. The beating I took that day was minimal, however, the sense that I did the right thing that day by standing up against bullies has propped up my self-worth my whole lifetime.
Bullies and abuse are everywhere. While in medical school, I was in an Atlanta Emergency Room when a woman came in with a broken nose and other broken bones and bruises that were explained away as the result of a fall, when we knew full well they were inflicted by her spouse. Since coming to this prairie town 35 years ago, I have seen several cases of parents who physically and emotionally abused their children, and of adult children who physically and emotionally abused their parents. I remember numerous cases where women came into my office, explained their husbands were physically beating them, and despite my recommendation to escape and seek shelter, they stayed married to the scoundrels.
The American Psychiatric Association defines domestic violence and abuse as control by one person over another in any relationship. Control is the operative word. The means of this control can result from physical, sexual, emotional and economic abuse, including threats of isolation.
The number of American troops killed in Afghanistan and Iraq from 2001 through 2012 was greater than 6,000, and the number of American women murdered by male partners during that time was about 12,000. The Center for Disease Control estimates that in the U.S., one out of every four women and one out of every seven men will have experienced severe physical violence from a bully in their lifetimes.
The National Coalition for the Homeless estimates ten million children are exposed to domestic violence every year, and that people exposed to such hostility as children are three to four times more likely to become abusive or be abused than people raised in families without it.
Sometimes it’s right to stand up to a bully, and when there is danger, it’s right to escape and get help. And it’s always right to save your children from a lifetime of abuse by not allowing it in your family.