​By Andrew Ellsworth, MD
 
What if there was something you could drink that could help you live longer and was free? Would you drink it? What if I offered something else to drink that could shorten your life and would cost you one dollar? Would you want to buy it?
 
As you might have guessed, the initial question refers to water, which is healthy and free, for the most part. Meanwhile, the latter question refers to a less desirable alternative, soda pop.  
 
A recent study involving half a million people in Europe found that drinking soda pop was associated with a greater risk of death from any cause. What’s even more interesting is how this study found that both regular and diet soft drinks were bad for your health. Drinking sugar sweetened beverages, such as regular sodas, increases your risk of digestive disease deaths. Meanwhile, drinking artificially sweetened beverages, like diet sodas, increases your risk of dying from cardiovascular diseases. 
 
I’m sorry to say, but that diet soda may increase your risk of a heart attack or stroke. These findings were most significant when people drank two or more sugar or artificially sweetened beverages per day, compared to less than one per month.  
 
This study was published in September 2019 in the Journal of the American Medical Association Internal Medicine. It showed associations, which means it saw connections, but it doesn’t necessarily prove a cause and effect relationship. However, this was an impressive study involving half a million people followed for over 16 years. It excluded people if they already had cancer, diabetes, stroke, or heart disease and it tried to account for body weight and smoking as well. Furthermore, other studies have found similar results. 
 
If you really want a soda pop, it’s not going to kill you to have one, but you probably don’t need several every day. If you do, why not try cutting down? If you don’t feel like drinking a glass of water, consider trying a sparkling water, or maybe take a glass of water and put a slice of lemon in it. Maybe try a natural sweetener like honey. Or, have a glass of milk.  
 
In the last several years, people are drinking less soda pop, and the large soda corporations are listening to consumer demands. You may notice some alternatives the next time you walk down the beverage aisle at the grocery store. However, pay close attention to what’s in them. Many are still loaded with sugar, and others have artificial sweeteners. Be wary of sports drinks, juice, supplement drinks and other alternatives.  
 
My recommendation is to enjoy a tall glass of water. It’s good for your health, good for your pocketbook, and you just might feel the satisfaction of self-care. 
 
Andrew Ellsworth, MD of Brookings, SD is a contributing Prairie Doc® columnist who has practiced family medicine for more than seven years. He is immediate past president of South Dakota Academy of Family Physicians. 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
 
Starting in 1805 through 1858 the Dakota Indian people living in Minnesota were, by U.S. government treaties, gradually cut out of their traditional hunting areas. In 1861, crops failed, winter was severe, meager federal payments were late and Dakota children were starving. By August of 1862, desperation moved some of the Dakota Indians to attack white homestead farmers and families and the state militia responded. War was on.
 
After six weeks of fighting the Dakota warriors surrendered and 303 men were sentenced to death by hanging. President Abraham Lincoln commuted many but left 38 Dakota men to hang in Mankato, Minnesota just after Christmas 1862. Those commuted were shipped to prison in Iowa where more than a third died as conditions were so poor.
 
Although many Indian people did not go to war, white hatred of all Indians grew like a prairie fire. Within a year, a $25 bounty was paid for the scalp of any Dakota Indian found free within the state. Lives were lost on both sides of that war, but the Dakota Oyate (Oyate means people) lost their lands and their culture. Pride and family traditions were severely compromised affecting many generations to come.
 
First introduced by mental health expert Maria Yellow Horse Brave Heart, Historical Trauma Response is a societal diagnosis now used by psychologists and historians. It refers to the cumulative, transgenerational, traumatic experience which causes long-lasting injury to communities, cultures and descendants, like that of the American Indian. Another example of HTR is the African American slave experience.
 
Experts state that HTR may cause smoldering animosity between groups as well as poverty, alcohol abuse, violence, depression and suicide behaviors. How can this be treated without compromising a culture’s traditions? Do ancestors of immigrant Europeans have a societal responsibility to right a wrong? Does smoldering animosity block the path to healing?
 
I believe prejudice hurts all of us. Hate poisons the well, even if it is “inherited hate” that came from more than 200 years of conflict and violence. It is time for European descendants to free ourselves from the bonds of historical bigotry and better understand the perspective of the Indian people. It is time for people of all races to stop hating and find ways for cultural healing through spiritual kindness to each other.
 
Lakota leader and mystic Black Elk said, “The bison were the gift of a good spirit . . . and from the same good spirit we must find another strength.”
 
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
 
For years I cared for a young gentleman with recurrent leg swelling associated with redness, fever, pain and open sores between his toes and lower legs and the rash of athlete’s foot. Once again, the emergency room doctor admitted the patient, and started him on intravenous antibiotics while the nurses put on support hose and encouraged him to elevate his legs.
 
There are two types of blood vessels making up “the vascular system.” Going away from the heart, blood is pumped through arteries providing oxygen and nutrients to almost every cell in the body. Coming back to the heart, blood travels through veins, oxygen depleted and loaded with waste. When venous blood passes through the kidneys, liver and lungs, waste is removed.
 
When arterial flow is blocked, pain, loss of muscle strength and open sores develop. In contrast, when venous flow is blocked, swelling and congestion occur which can also reduce arterial flow. Most dangerous, poor venous flow can result in blood clots.
 
Reversible causes for arterial blockage include regularly eating too many calories, not getting enough exercise, smoking and failing to connect enough with people and nature (which is entirely under-rated). Others may talk about pills and supplements, but the plain truth is that nothing comes close to these healthy lifestyle habits in preventing premature obstruction of arteries.
 
A list of preventable or treatable causes for vein and venous obstruction with swelling in the legs is long. It includes congestive heart failure, inherited varicose veins, jobs that require prolonged sitting or standing in one place and leg trauma, all of which injure vein valves, make edema worse and increase the risk for clots. Clots developing in veins are dangerous. They can move to the lungs, threaten life and worsen swelling.
 
My young patient had a combination of foot fungus (athlete’s foot) and bacterial infection growing in toe cracks and leg sores. He also had venous insufficiency (the valves in the veins were destroyed) and new blood clots, possibly triggered by the fungal and bacterial infections. His condition was complicated, indeed! We elevated his feet even higher, increased the pressure of his support hose and added medicines including a low dose diuretic, an anti-fungus medication and an anticoagulant. His leg swelling resolved and stayed that way, especially because he wore 20 pound below-the-knee compression hose.
 
Bottom line: The vascular system makes up an incredibly complex organ system. Please take measures to protect blood vessels by understanding the values of a healthy lifestyle and, when needed, wearing firm below-the-knee support hose.
 
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
 
In 40 years of practice, I have seen how the final moments of one’s life can be inspiring or agonizing, no matter the manner of death. As I see it, the fear of death is a greater enemy than death itself. This has brought me to make the following recommendations for approaching our final moments.
 
Be prepared
Scientific advances, along with health care providers’ driven desire to save lives, have wrought lifesaving techniques that sometimes cause suffering (an unintended consequence). To correct this, making an advanced directive (living will) can help prevent great suffering. Going without is like arriving at the airport with no plans as to where you are going. Remember, a written advance directive is a tool to encourage discussions about end-of-life expectations. When you reach your end-of-life situation, do you want antibiotics, intravenous (IV) fluids, feeding tubes, resuscitation? (I don’t.) Speak to your family members about your wishes now in case you later lose your memory and ability to speak for yourself.
 
Also, there has been a growing emphasis and payment for hospice and palliative (comfort) care. Why not welcome these added financial benefits from Medicare and insurance if you or your family member qualifies? (These you control and can be stopped at any time.) When death is imminent, comfort care can be a blessing as it brings less emphasis on intervention which might cause suffering. Talk to your doctor and family about your choices.
 
Dehydration can be our friend
When a person has a terminal condition, is no longer wanting or able to take oral feedings or fluid, I see it as cruel to force artificial fluids through IV or feeding tube means. Without fluids, the patient’s internal pain relievers (endorphins) turn on while setting the stage for living only about ten more days. Dehydration does NOT cause suffering. Considering the prolonged suffering that can result from artificial fluids, dehydration can be our friend.
 
Reconciliation brings harmony
As we get closer to our own time of death, it is prudent to say to those who matter, this wisdom phrase, originating from Hawaii, called “Ho’oponopono,” and made popular by Dr. Ira Byock. “I am thankful for you, forgive me, I forgive you and I love you.” This can help restore harmony with others and with oneself.
 
Bottom line: The fear of death can keep us from making important plans for an advanced directive and hospice, can trap us on a feeding tube and can keep us from finding harmony with the ones we love. A good death requires the courage to be prepared.
 
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.