By Richard P. Holm, MD
The shoulder is an elegant piece of machinery that can move and rotate in more directions than any other joint in the body. However, with such freedom comes less stability and greater risk of injury. The upper arm bone (humerus) and the shoulder blade (scapula) make a ball-and-socket type of joint. The ball is held into the socket by a network of rotator-cuff of muscles, tendons, ligaments, and a rim of cartilage. This whole shoulder-joint-muscle system is attached to the chest and body by the collar bone (clavicle). Despite its marvelous engineering and design, humans will over-stretch and over-use their shoulders and injuries will happen.
Mr. AB had fallen off a tractor and dislocated his right shoulder when he was in his 30’s. He has been active as a farmer for more than 50 years, but over the last five months he’s noticed a gradually worsening pain in his shoulder and difficulty shoveling grain. Eventually, he told his wife he just couldn’t take it any longer and she made him an appointment to see me.
This patient came to my office like many farmers come to the doctor: reluctantly. I’m glad that he did. A number of medical problems can masquerade as shoulder pain, and some of them are quite dangerous. It was critical that I first take a careful medical history and perform a detailed exam before I went any further. I discovered that the pain was not related to exertion and relieved by rest, like that from heart trouble. It did not radiate below the elbow and did not have associated neck pain, like one would see with neck-spine nerve trouble. It was not made better by eating, like that from peptic ulcer problems. It was not made worse by a big and fatty meal, which would indicate gall bladder stones. Finally, it was not related to breathing and there was no fever, signs that would indicate pneumonia. Mr. AB’s pain was clearly made worse with movement of the shoulder and nothing else.
When his shirt was off, I noted both shoulders were symmetrical. With thumbs down and arms outstretched, it hurt as he raised his right arm. When I bent that arm at the elbow and rotated it downward, he winced with protest. His symptoms were the picture of inflamed, swollen, and tender structures rubbing while trying to pass under a tight arch of bone and ligament.
Mr. AB went to physical therapy, hired someone else to shovel, and rested his shoulder. Over time, his injury healed and the pain went away. We take for granted the elegant engineering and design of the human shoulder.
By Richard P. Holm, MD
The other day, I was on a run with a scientist friend who recently had suffered a small heart attack. During our run, we talked about cardiac rehabilitation and safe running practices that could help his recovery. He was happy to be back running, and as I was recovering from cancer surgery, I was also happy to be back running. If not over-done, we know that those with or without heart disease benefit from regular exercise. I could feel the run was rebuilding my strength and savored the social time with my friend. When we finished, energized and happy, a short cool-down walk brought us to his home.
There, his wife prepared a light morning breakfast of two eggs, nicely spiced with salt and pepper, a small patty of pork sausage, sliced fried bell-peppers, pieces of fresh melon on the side, and coffee. It was delicious and just the right amount. Twenty years ago, having eggs and sausage for breakfast was thought to be a big no-no. Now, new science has discovered it is NOT the fat and protein in a diet that causes atherosclerosis, but rather the excessive calories. What is more treacherous than the type of food is actually the quantity. If this doesn’t shake your world enough, we have also learned that processed carbohydrates are bad, while a balanced diet of proteins, fats, and small amounts of non-processed carbohydrates are good. For example, large helpings of carbohydrates like potatoes, pasta, pancakes, bread, or donuts can be harmful. Smaller amounts of foods like eggs and sausage are safe. That morning, the calorie count for each of us was about 300 and we both felt great.
Every day there seems to be another study that advises the opposite of what we used to think: eat less salt, now salt to taste unless the heart is weak; don’t eat butter, now butter is caloric but safe; don’t exercise too much, now do it every day; don’t drink alcohol, now a daily glass of wine is good; don’t eat fatty meals, now eat fewer calories and avoid processed carbohydrates. That being said, we have always known about the health benefits of friendship, and no one has refuted that.
In summary, researchers have made headway in understanding what is good for us. May we embrace the science that supports eating fewer calories, less processed carbohydrates, and more fruits and vegetables. If we can also find time for 30 minutes of daily exercise and some quality time with friends, then we have the perfect formula for good health.
by Richard P. Holm
The adage “don’t look a gift horse in the mouth” means to not find fault with something you have been gifted. It refers to the fact that a horse’s age can be determined by looking at their teeth. If the gum has receded and the horse is “long in the tooth”, then it is an old horse. Like an old horse, my teeth and I have been around for a while, and I always get a bit nervous when I drive up to the dentist’s office, concerned about what problems they might find.
There are several things that can cause dental troubles. A common, frequently overlooked cause is dry-mouth. Experts in the field of geriatric dentistry say that saliva is an important and complex fluid that is taken for granted when it comes to dental health. Without spit, teeth fall out in short order, the gastro-intestinal tract becomes troubled, and the overall quality of life diminishes significantly. Certain autoimmune conditions can reduce saliva, but a more common cause of dry-mouth are medications. Dry-mouth is a common and unassuming side effect of many prescriptions. Pills that can cause dry mouth include those used to treat bladder and bowel-spasms, nasal congestion, depression, anxiety, psychosis, acne, epilepsy, pain, high blood pressure, diarrhea, asthma, and nausea.
Although dry mouth is a challenge for many, it is fortunately not my problem. My dental hygienist said, after a thorough look, “Good news: your gums look pretty darn good for a 68-year-old. I see no problems.” After reviewing the X-rays, she said, “You must be regularly cleaning the areas between your teeth. Whatever you’re doing, keep it up.”
It is important to care for your teeth throughout your life so that your gums stay healthy and teeth stay strong. Aside from brushing twice-a-day, and a visit to the dentist twice a year, my efforts include removing food particles at the end of the day with a water-jet-washing device, similar yet more effective than flossing. It surprises me, every night, how many pieces of meat, corn, or broccoli can be stuck up in-between my teeth. Also, over the last ten years, I’ve been using those special disposable tooth-pick flossing tools that come in a bag which I place in a spot I notice and can reach into every day.
With daily jet-washing, picking and flossing, and avoiding medicine-induced dry mouth, I have been rewarded with good dental health. I still have my own chompers, and I’m not quite so “long in the tooth” as could be expected. Hopefully this advice can help you be as equally blessed.