By Richard P. Holm, MD
 
The phone rang, and I answered it because the call was from a nearby community. No big surprise that the caller was obviously not from anywhere near, and the caller was asking for a donation for some organization in which I had no interest. I said, in a kindly tone, “No thank you,” and hung up. They will never end the call. YOU MUST HANG UP.
 
Financial abuse by telephone or internet has been called “the crime of the 21st century.” People of all ages are at risk, but scammers commonly target the elderly. Those of us past 65 are more often home to answer the phone, are apt to stay on the line longer and are less likely to report a crime. Making all of this worse, telemarketing crime is challenging to prosecute and, therefore, inviting to criminals.
 
There are plenty of bad guys out there. The National Council on Aging has written a compendium of common fraudulent traps that can result from telephone calls or internet messages. Here are some:

• Callers may pose as Medicare representative to obtain your personal numbers for the purpose of billing Medicare for bogus services. Remember, U.S. Government agencies will NEVER initiate a call.
• Because of outrageous prices for drugs, people are lured to purchase less expensive prescriptions from internet and out-of-country pharmacies. Beware that doses of drugs may be different than desired, and sometimes unsafe substances are added.
• Callers may be selling false or dangerous anti-aging products and claim reduced wrinkles or bags under eyes. Don’t trust them. Talk to your doctor.
• Con-artists may promise to split a large sum of money with you, provided you first agree to send a “good faith” donation to help cover shipping costs. Don’t believe it.
• “Hi Grandma, do you know who this is?” Never give out the name of a family member on an unsolicited call. They usually ask you for money for a fake emergency or rescue. Always check by calling family first.
• Especially after a major disaster, callers ask for “rescue money” to help those harmed which, of course, goes to the scammers, not those in need.
• Fake investment plans are everywhere. Strangers calling or emailing you with a great investment opportunity, should not be trusted, especially if it sounds too good to be true.

 
Take home message: Don’t respond to calls or emails from strangers selling or pushing you into something. Don’t donate to causes that you didn’t initiate. Beware of scammers. In a kindly tone, say, “No thank you,” and JUST HANG UP.
 
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By Richard P. Holm, MD
 
People are drawn to sail in the British Virgin Islands (BVI) for different reasons. Some go there to prove to themselves, or to someone else, that they have the moxie, sailing knowledge and finesse to sail on the ocean. Others go to find excitement, beauty, peace, or just to escape the cold of a northern winter. When I started traveling down from South Dakota in the late ‘80s, I did so for a number of those purposes. This year, I went for different reasons.
 
More than two years ago, I was diagnosed with pancreatic cancer, and six months ago the cancer had spread to one spot in the liver. After another four months of chemo, the cancer surgeon cut out that spot with the outside chance he might “get it all.” My 40 years of practicing internal medicine told me I had better do my favorite things while I can. This time, I went sailing for the love of family and friends and for the sense of eternity that the sea provides. I also went to heal. I hoped that the warmth, salty sea, nurturing nature of wind, fun of the islands and spiritual connectedness would provide a mending milieu for me.
 
I was feeling pretty frail in the weeks leading up to the trip but realized anew an oft quoted wisdom: “Motion of the ocean is lotion” for curing what ails you. During the two-week-time on our sailboat, I was always moving: clambering to tighten some line, drop a sail, lower the dinghy, or maneuver the boat to anchor. I was moving even as I sat there. For two weeks every vertebra, joint, ligament and muscle danced with a shifting, rocking, repositioning boat. I didn’t realize the extent of the motion until I sat still for an hour in the airport on the way home. After this short period of immobility, when rising to buy a final island chicken roti, I noticed that I was “old man” stiff again. The rigidity had magically been gone for two weeks! Boat living was a healing potion, a lotion of motion, which provided a potent remedy and recuperation for this guy in need of generous portions of both.
 
I believe embracing motion and change is important as we grow older, keeping us from prematurely aging, from congealing. Author Gail Godwin says a willingness to change helps us from turning into our “final (frozen) selves” too early.
 
Motion is the lotion.
 
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​By Richard P. Holm, MD
 
My mother was nearly 90-years-old when I noticed a change in her speech during our daily phone calls. When we got her to the hospital, the X-ray (CT) study of her brain implied a blood clot had formed within one of the brain arteries during the night. She was having a “stroke” of bad luck.
 
They say most elderly people eventually die of a blood clot, either to the brain, the heart, the kidneys, the legs or somewhere. This happens because, as we age, we develop an over-clotting disorder, or our blood vessels close off due to scaring.
 
By definition, a stroke is a vascular problem caused when the blood flow to a part of the brain is blocked. In 80 percent of cases, it’s a blood clot that originates within brain arteries or starts either in a carotid artery or in a chamber within the heart and is carried by blood flow to the brain. If started within three hours of the event, clot-busters can reverse much of the brain injury from this kind of stroke. However, in 20 percent of cases, brain tissue destruction is due to bleeding making clot-busters not helpful and even harmful.
 
Recently, the World Health Organization stated that three-quarters of all vascular problems are connected to poor lifestyle choices such as physical inactivity, use of tobacco and unhealthy dietary habits. The closest we get to a “fountain of youth” comes from living a healthy lifestyle and — aside from controlling high blood pressure — usually not from medicines. There are no short cuts and cholesterol meds are only minimally helpful.
 
In recent years, we’ve learned how blood clots and strokes can result from two medical conditions that require special treatment. An irregular heart rhythm condition called atrial fibrillation (A fib) may result in blood clots forming within the heart bringing a higher risk for stoke. A fib requires long-term anticoagulation by warfarin or a similar drug.
 
The second condition is moderate to severe sleep apnea which often causes both A fib and an increased risk for clotting. Sleep apnea requires nightly use of a continuous positive airway pressure (CPAP) mask and machine. Many people struggle using CPAP but, unfortunately, no good alternative exists. Generally, throat surgery or jaw thrust devices do not effectively treat moderate to severe sleep apnea. Although wearing CPAP can pose a challenge, people with sleep apnea should endeavor to make the mask device to work.
 
Understanding these issues just might prevent a “stroke” of bad luck.
 
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By Richard P. Holm, MD
 
It was June 10, Old Settler’s Day in De Smet, SD, and the carnival was in town. As a fifth grader, I had been doing odd jobs for a month to save up money for that day. For the price of 25 cents, I filed through a trailer to see a “real alligator woman, half human, half alligator.” Of course, it was fake. Sitting there on a table was a dried-up, stuffed, alligator body connected to a live human woman’s head (who was chatting with us). The table had mirrors to cover the hollow box that held the woman’s body underneath. It was an amusing ruse, a trick, an intentional untruth that benefited the marketer exactly 25 cents per viewer. That was, by definition, disinformation.
 
By contrast, misinformation happens when people believe some ineffective treatment helps or some effective treatment harms, and they spread that misinformation. For example, in the 1980s, we noted that people, who were having heart attacks, had more premature ventricular contractions (PVCs) and these people were more likely to die. Researches found drugs that suppressed those PVCs thinking to save lives. It took us about ten years to discover that those drugs increased deaths rather than lessened them. We thought we were doing right but were, by mistake, harming people instead. That is misinformation.
 
Another example of misinformation occurred in the 1980s when I encouraged parents to place their babies on their bellies to sleep, thinking to protect babies from inhaling drool. We later found that babies sleeping on their bellies had more sudden infant death than those sleeping on their backs. We were misinformed.
 
Another example would be in trying to help others by telling them to avoid vaccinating babies with the mistaken thought that this would prevent autism. This is spreading misinformation and is harming people by allowing the spread of a killing virus, especially to immune compromised younger children and older adults.
 
Bottom line:

1. There will always be people and corporations who will tell intentional untruths (disinformation) in order to profit themselves and take “easy money” from trusting souls. We can protect ourselves by being informed consumers, watchful of those who promote “alligator women.” Also, we should know that marketing and corporate profit does not justify the right to tell untruths.
2. We must be humble enough to listen to evidence-based science and to change our minds. There will always be myths that seem true but, when held under the scrutiny of science, are wrong.
3. Seeking and telling the truth is always the right thing to do.

 
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By Richard P. Holm, MD
 
My first experience with cardiopulmonary resuscitation was during the summer of 1969. I was an orderly in a Minneapolis intensive care unit (ICU) when my patient stopped breathing. I called for help and provided mouth-to-mouth breathing and chest massage until the team arrived. Later the doctor told me I saved the patient’s life, further convincing me that medicine was my life’s purpose.
 
Cardiopulmonary resuscitation (CPR) is the act of rhythmically pushing on the chest and breathing into the mouth of a person whose heart beat and breathing has ceased. CPR can result in enough circulation to keep the victim alive until spontaneous circulation and breathing resumes.
 
In 1740, the French described how mouth-to-mouth breathing sometimes saved drowned people, and, through the early 1900s, mouth-to-mouth breaths were given to bring lifeless newborns around. In the mid-1950s, two anesthesiologists, Dr. Elam and Dr. Safar, with help from the Red Cross, began promoting mouth-to-mouth resuscitation for adults discovered in cardiac arrest. In 1960, chest compressions were proven valuable in preserving circulation, especially to the brain, and even more important for survival than artificial respiration. In fact, rapid (100-120/minute), constant, three to four-inch chest compressions (without artificial breathing) are now recommended for patients having out-of-hospital cardiac arrest.
 
In 1947, a Cleveland surgeon used an internal (open chest) defibrillator to save a 14-year-old boy, and in 1955, Boston cardiologist, Paul Zoll, developed the now popular external (on skin) defibrillator. Studies show that the defibrillator is even more important than chest compression. With available automated external defibrillators (AEDs) and education on how to perform CPR and use AED devices, we have even better outcomes.
 
For those having a cardiac arrest, the sooner they get defibrillation, effective CPR, and a 911 call for help, the greater the chance of functional recovery. Out-of-hospital successful survival after CPR is about ten percent but increases to 35 percent when the arrest is witnessed and the victim is provided early defibrillation. The sad news is that more than 50 percent of those who could benefit will not have CPR because bystanders fear they might do something wrong. The big mistake is NOT TO TRY.
 
Simple, first-level, CPR courses are available for anyone interested in every community and through the internet, while AED devices are popping up in almost every community gathering area. Please notice where they are placed. Trust me, if someone has a cardiac arrest, and you try to help, you might just save a life.
 
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By Richard P. Holm, MD
 
For years I cared for a lovely woman with scleroderma. It all started with Raynaud’s phenomenon a condition causing her fingers, after an exposure to cold, to become pale-white then blue or red and painful. Raynaud’s phenomenon occurs in about four percent of the population, is usually not associated with any other condition, but sometimes goes with rheumatoid arthritis, lupus or, in this case, scleroderma. My patient also experienced progressively tight and shiny skin on her hands, then chest, then everywhere. She had tiny red spider vein spots (telangiectasia), heartburn, weight loss, weakness and puffy joints. Over the years her fingers became scarred and quite immobile with always worsening sores on the tips. Through it all, this wonderful lady had a very positive attitude and always seemed to have a smile on her face, although, near the end, the skin of her face became so tight that smiling became a challenge.
 
Yearly, about three in 100,000 middle-aged U.S. adults develop scleroderma (or when full-blown called systemic sclerosis). Normally, after a cut or a sore develops and in order to heal the wound, our bodies trigger both the immune system (to fight off invasion of bacteria, fungi and viruses) and special repair cells (to close off the wound with collagen and scar tissue). Once the damage has been repaired, extra collagen production usually stops, but not with scleroderma. For some unknown reason, scarring continues uncontrolled. At this time, treatment for this very puzzling auto-immune condition is restricted to treatment of symptoms; no cure for scleroderma exists.
 
We think that inheritance, hormones, certain infections and long-term exposure to pesticides, silica dust or polyvinyl chloride all might have something to do with the cause, but we really don’t know. We also don’t know why four times as many women get it as men; why it it can involve just a spot or a sword shape skin area and never progress; why it may or may not occur with Raynaud’s phenomenon, involvement of the esophagus and smaller parts of the skin but doesn’t progress; and why, in some unfortunate cases, it progresses everywhere, like in my patient.
 
Similar to many other autoimmune conditions, scleroderma is one where the immune system, for some undefined reason, runs amok, mistaking normal tissue as a foreign invader. Scientists and physicians are on the hunt to learn first why scleroderma happens and then how to stop the process.
 
If we understood more about scleroderma, we would all find it easier to smile.
 
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By Richard P. Holm, MD
 
Be careful when you mess with Mother Nature. Once we began defining the human genome, we started to realize how many bacteria, fungi, and viruses live in and on our bodies. We believe that each person standing in front of us are made up of equal numbers of human cells to the number of non-human cells. These are not mere hitchhikers, they are essential to our living. Even within each human cell we have components called mitochondria that originally were bacteria. Eons ago they became incorporated and an essential part of the functioning human cell. We couldn’t survive without the outsiders. Simply put, we are like a country made up of natives AND immigrants working together for the good of the whole.
 
The attached non-human organisms, together, make up what has been called the human microbiome or microbiota. Researchers are trying to know better what is a normal or abnormal microbiome, what causes it to be imbalanced, and what can be done to enhance a healthy microscopic environment of organisms that are getting a lift on our bodies.
 
A powerful example of imbalance comes when the use of antibiotics alters the microbiome and results in the emergence of a harmful and even deadly overgrowth infection by a bacterium called Clostridium difficile (C. diff). The result is a very sick large intestine. Think how weeds take over a lawn when the grass is destroyed.
 
Aside from the invasive, severe, gut illness of C. diff, there are other human conditions and illnesses that may be related to an imbalanced microbiome such as: irritable bowel syndrome, psoriasis of the skin, uncomfortable infections of the vagina, obesity and rheumatoid arthritis, as well as neuropsychiatric disorders such as autism, schizophrenia, obsessive-compulsive disorder, attention deficit disorder and chronic fatigue syndrome. Research is ongoing and we have a lot more to know before we have microbiome related treatments.
 
We all know that, when used appropriately, antibiotics help people and save lives, but experts estimate that 20 to 50 percent of the use of these microbiome disturbing antibiotics are inappropriate or unnecessary when used in hospital settings, and that percentage is worse when used in outpatient settings.
 
Understanding and protecting our normal flora, our microbiome, the community of organisms that live in, on, and around us gives us a whole new way of dealing with many illnesses. We need to be very careful to use antibiotics only when absolutely necessary. Be careful when you mess with Mother Nature.
 
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By Joanie S. Holm, RN CNP
 
The famous American artist, Andrew Wyeth, graced the world with many works of art. One of his most famous, Christina’s World, is at home in the Museum of Modern Art in New York City. This painting portrays a woman in a field of tall grass at the bottom of a hill below a dilapidated farm.  On close inspection, it is noted that the women has rail thin arms and hands that seem to claw the ground.
 
The woman is Christina Olson, a friend and neighbor of Wyeth’s in Maine. Christina was an extremely independent woman who suffered from a progressive neuromuscular disorder thought to be Charcot-Marie-Tooth disease (or CMT). Her ability to walk as a toddler slowly diminished as she aged. She refused to use a wheelchair or walker, preferring to use her arms for crawling.
 
Charcot-Marie-Tooth disease is one of the most common inherited neurological disorders, affecting approximately 1 in 2,500 people in the United States. The disease is named for the three physicians who first identified it in 1886: Jean-Martin Charcot and Pierre Marie in Paris, France, and Howard Henry Tooth in Cambridge, England. CMT comprises a group of disorders that affect peripheral nerves, those that lie outside of the brain and spinal cord. CMT is caused by a gene mutation that affects the covering of the nerves. There is no cure and treatment is aimed at symptomatic care.
 
Upon learning of the story behind the famous and beautiful Andrew Wyeth painting, I enjoy it at a different level. Andrew Wyeth got to know the soul inside the women who had physical struggles in this life. I’m grateful to him for giving this to the world.
 
I’m also grateful for Drs. Charcot, Marie, Tooth and all of the other scientist who helped and continue to put the puzzle pieces together for those who suffer with neurodegenerative diseases. Their work may not be lauded as masterpieces and displayed in the museums of the world, but their contribution to society should not be overlooked.
 
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By Richard P. Holm MD
 
It was a Boy Scout canoe trip into the Minnesota Canadian boundary waters in the summer of 1965 when a gangly group of DeSmet Scouts discovered the sun again after two days of chilling and soaking rain. Taking our noon break from canoeing all day, we found a solar exposed, very large, warm, and welcoming rock on an island and stretched out on its warm surface We took off our shirts and dried our soaked socks while reveling in the renewing rays of the sun.
 
At that moment I could feel the wonderful power and force of ol’ sol beaming into me. I remember thinking how the sun’s radiation was the visible energy source for life on this earth, and I wanted more of it. It must be a natural instinct to want exposure to the rays of the sun. Think how people seem to gravitate to the beach for sunbathing, and how sad some get in the days of the winter solstice when there’s not enough of it.
 
Recently, we have become more aware of the importance of enough vitamin D which our bodies manufacture when rays of sun come in contact with our skin. We can also get this important vitamin from the oil of deep-sea fish (such as cod) who live in very dark waters gathering their vitamin D by eating falling phytoplankton who mostly live on the sun-soaked surface water. The fish store their plankton-source vitamin D in their livers, and it is that cod-liver oil source of vitamin D that supplemented children for many years. Now we can take fish oil capsules, flax seed oil (another vitamin D source) and vitamin D3 supplements which all work to do almost the same thing as laying out on a warm rock in the boundary waters. Still, we know that just about 50 percent of people don’t get enough vitamin D.
 
The flip side of all this sun and vitamin D talk is that one can get too much of both. One should not take more than 5,000 international units (IU) of vitamin D per day, and one should avoid too much sun. We know that excessive sun (or tanning booth) exposure causes premature skin aging with wrinkles, sagging, brown spots, rough skin, not to mention skin cancers.  You hear and read everywhere the following words of advice: use sunscreen, wear protective clothing and avoid tanning booths.
 
But after two days of a soaking cold rain, it should be okay to lay out on a warm rock.
 
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​By Richard P. Holm, MD
 
Understanding the story of acute appendicitis brings us to understand other causes for a belly ache or abdominal pain. Like many other causes of abdominal pain, appendicitis is a blockage of a smooth muscle tube (SMT). We have a lot of SMT hollow transport tubes in our bodies including: esophagus, stomach, small and large intestines, kidneys, ureters, bladder and urethra, bile ducts, pancreatic ducts and gallbladder, fallopian tubes, the uterus and even the aorta and blood vessels.
 
When anything blocks the forward-moving squeezing of one of these SMTs, people have cramping spasm-like pain that lets up and comes again later with nausea or vomiting adding to the misery of the situation. Patients usually can’t find a comfortable position and are all over the bed, moving and anxious.
 
While appendicitis is a blockage where the appendix and the large intestine meet, other examples of smooth muscle tube blockage include blocked colon with cancer, blocked kidney or ureter with stones, perforating aortic aneurysm with obstructed flow, infection of the gallbladder with gallstone obstruction and blocked fallopian tube with an ectopic pregnancy.
 
When appendicitis is just beginning, the pain is around the belly button. As appendicitis worsens, pain moves from the belly button to the lower right abdomen and intensifies until either the blockage is resolved (usually with surgery or antibiotics) or the appendix ruptures, spilling fecal material and infection out into the abdominal cavity. This causes severe infection and inflammation especially affecting the smooth lining that surrounds the abdominal cavity. The lining has plenty of nerves and thus, this causes a new and exquisite type of pain.
 
Now we have peritonitis (inflamed peritoneum) which causes the patient to stop moving, to become still, almost frozen to the table or bed, not wanting anyone to touch him. This is a dangerous situation and requires emergency intervention. Other examples of pain from peritonitis include perforated stomach ulcer or ruptured: diverticula, gallbladder or ovarian cyst.
 
Clues as to what is causing either blocked SMT or peritonitis pain come with location of pain, the history of the progression of the illness, and the physical examination. Laboratory and X-ray may also help. People with non-dangerous belly pain, often have recurrent constipation, menstrual symptoms or bladder infections and should seek help at the outpatient clinic. In contrast, some clues to bring one to the emergency room should include progressive, unexplained, severe abdominal pain, shaking chills and blood in the urine or stool.
 
Understanding how a blocked SMT or peritonitis happens with appendicitis, helps, in turn, to explain the many possible causes of a belly ache.
 
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