This Science-Based Guy Believes in SpiritsBy Richard P. Holm, MD
I am a physician who believes in evidence-based science. I am also old, approaching my own “last chapter” from pancreatic cancer. I share this, not to engender pity . . . none. Rather, I share this in order to give you a sense of my potential bias as I write about the question; do we have a spirit or soul that is more than a brain-chemical reaction that will go away at death? Of course, the ultimate answer to that question is, nobody knows. Some archeologists believe that religion first began when someone wondered what happened to the life force or spirit of a young boy after he died. Where did it go? Archeologists speculate that “job one” for the early church (and, for that matter, churches of today) was to reassure and comfort the family after the death of a dear one. However, just because it reassures us, doesn’t prove the soul exists, but there are other experiences that do. I remember my mother explaining to me one night before prayers that there is so much more going on than we know, so much that cannot be explained by physics and chemistry. She described waking up in the middle of the night in Minneapolis during WWII, filled with dread at the same moment that my dad was landing on some Pacific Island in full combat. That was something about which she could not have known due to radio and mail silence. How DID she know? Do we have spiritual connections we simply don’t understand? During my career, at least three patients described a near-death-experience with all its typical raiment including an out-of-body experience, a warm and comforting light, a life-review (like a movie) and reassurance that there is nothing to fear about dying. A recent meta-survey indicated that this happens in 17 percent of people who are resuscitated and in equal percentages throughout all cultures and religions. It is also amazing to learn that the warm light is seen even by people blind from birth. Even as a stubborn science-based guy, together with years of experience as a geriatric internist and hospice director, I truly find a community faith with a loving and inclusionary church very reassuring. I have reason to believe that there is a spirit within us that connects us all and that doesn’t die with our bodies. I have been at the bedsides of many dying people, while their spirits lift from the body and pass through the porthole of eternity. Being there has brought me to believe that the soul is more than a brain-chemical reaction that goes away after death. 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. Suicide, a Permanent Answer to a Temporary ProblemBy Richard P. Holm, MD
Years ago, a family brought a 25-year-old farmer into the emergency room with a gunshot hole over his heart and with no pulse or breathing for more than ten minutes. It was a self-inflicted wound and this young farmer would farm no more. The family was besides themselves with loud and sorrowful wailing that wrenched my soul. They told me that the impending harvest looked poor, the loan was coming due, and he had been isolating himself, drinking more and getting angry at every little thing. They had no clue he was at risk of suicide. Sure, he was a little down, but not this! He picked a permanent answer to a temporary problem. Significant thoughts of suicide occur in one of four women and one of eight men. Although there are more attempts by women, more deaths occur by men. In 2017 there were 1.4 million attempts and 47,000 deaths due to suicide, and despite these high numbers, the money invested in depression and suicide research is sadly low. Risk factors for suicide include family history or prior experience of depression or manic depression, a history of being abused or being an abuser, excessive use of alcohol, sleeping pills or substance dependence, a recent emotional loss or a significant medical illness. Also, there is higher risk during local epidemics of suicide in youth especially on reservations. Sometimes depression and suicide have no reason whatsoever. How can any of us help ourselves or a person at risk? First, remember it never hurts to ask, “Are you thinking about suicide?” Those words will NOT bring it on but could encourage the person to find someone to give lifesaving assistance. If you sense there is an emotional downward change happening, encourage that person to get help. If depression is milder and NOT at the suicide level, nonmedicinal treatment can give relief. Examples abound such as daily 30-minute walks, regular interaction with friends and family and the regular opening of one’s heart to spiritual connectedness. If more help is needed, talk with your physician or care provider and consider medicines that effectively work for depression. Although two thirds of people with depression do not seek or receive help; when the one third who do get help are treated, four out of five of those folks are better in a month. Get help if needed. Finally, if you are in crisis, call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) which is available 24/7. Please don’t chose a permanent answer to a temporary problem. 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. Imaging With a Little Help From My FriendsBy Richard P. Holm, MD
The world of radiology began in 1895 when a European physicist Wilhelm Röntgen noticed fluorescence behind heavy cardboard when a cathode tube was activated nearby. Röntgen used his wife’s hand to demonstrate for the first time how these unknown rays, or X-rays, could penetrate the soft tissue of a hand and illustrate the bones that lay within. Röntgen generously refused to patent his discovery which allowed the explosive growth and development of a new industry. Unfortunately, the first researchers were unaware of the dangers of too much X-ray exposure and, during the early years, harm was done even causing death to some experimenters before safeguards were established. Over time, as technology advanced and more X-rays were being utilized in medicine, interpreting the images became a more difficult challenge and the field of radiology developed. Physicians trained in X-ray INTERPRETATION helped other physicians make better clinical decisions. I was a first-year resident at Emory University Hospital in Atlanta in the fall of 1975 when the hospital purchased one of the earliest computerized tomography (CT) scanners. It was called an EMI scanner named after the British company, Electric and Music Industries, that took the financial risk for developing the technology. Years earlier, EMI had signed with the Beatles as their recording company. Having amassed a fortune from the exponential rise of Beatles popularity, EMI was able to fund the theoretical work of Godfrey Hounsfield. His invention took X-rays of the head from all directions while a computer compiled the results. “With a little help from his friends” at EMI, Hounsfield’s brainchild happened. I was rotating through neurology when the results of the EMI scans started making an impact. We were amazed how they showed tumors, blood clots and lesions inside the skull. We thought it was going to change everything, and indeed it did! Jump to the present and see how INTERPRETIVE radiologists have expanded into INTERVENTION. Now, instead of simply identifying a tumor or abscess with ultrasound, X-ray, CT or MRI, radiologists, under the guidance of an imaging modality, can pass a needle into a deep tumor and take a biopsy, drain an abscess, open-up a blocked tube and much more. Procedures that, in the past, would have required open abdominal or chest surgery, now can be done with minimal trauma, with minimal pain and with quick recovery. As a patient who has benefited under the expert image-guided hands of an INTERVENTIONAL radiologist, I too can sing loud and clear, “I get by with a lot of help from my friends.” 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. The Cost of Health CareBy Tom Dean, MD
Health care costs too much. The U.S. spends twice as much as other wealthy nations and yet we have poorer outcomes. Patients in this country visit physicians less frequently and spend less time in hospitals than residents of other wealthy countries. So, why such high costs? It's a complex issue with no simple answer. Experts have identified three major factors contributing to this situation. The most significant is higher prices, followed by costly administrative complexity and finally, the use of ineffective or overly aggressive medical interventions that provide little benefit to patients. What about prices? The average U.S. hospital discharge costs over $29,000 compared to $18,000 in the Netherlands and $16,000 in Canada. The average MRI price in Australia is $350 compared to $1145 in the U.S. Prices, especially drug prices keep going higher. Lantus insulin introduced nearly 20 years ago at about $35 per vial now sells for $260. The U.K. price is $26. Gleevec, a remarkably effective drug for leukemia, introduced in 2001 at $26,000 per year, more recently sells for $120,000. The generic form sells for $96,000. Trying to control costs in the U.S., both the government and insurance companies have applied complex regulations resulting in the addition of administrative staff and steadily increasing expenditures. Studies show that 20 to 30 percent of health care expenditures now go to cover admin costs, a much higher rate than other countries. What to do? As a society we have depended on market forces to control prices. This is effective when selling groceries and gasoline but in health care it has failed. The simple explanation is that health care providers do not compete based on price. Even when patients have comparative cost information, they all too often do not select the most cost-effective approach. Too little incentive exists for providers, especially physicians, to seek out the most efficient approach to care. In fact, existing financial incentives often push physicians and other providers in the opposite direction – the more you do the more you are paid. Bottom line: As a society we in the U.S. have never figured out where health care fits in the spectrum of economic activity. Is it a commercial product like automobiles and blue jeans where those with more resources can purchase more elaborate products, or is it a basic human service like public education or fire protection to be made available to everyone? In the words of the late Professor Uwe Reinhardt, one of the giants of health policy analysis, what we have is a philosophical and ethical challenge not an economic one. Tom Dean, MD of Wessington Springs, South Dakota is a contributing Prairie Doc® columnist who has practiced family medicine for more than 38 years. He served as a member of the Medicare Payment Advisory Commission. 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. |
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