By Richard P. Holm MD

“Every once in a while, my heart seems to be jumping out of my chest, I get a weak feeling and short of breath,” the patient explained. When I listened with my stethoscope, his rhythm was different than the usual lub-dub, foot-tapping, sounds, which are regular as a band marching through town on a summertime parade. Instead his heart had the irregular rhythm of popping corn, chaotic and unpredictable, and I couldn’t tap my foot to it.

As predicted, the EKG showed the rhythm of atrial fibrillation, with the atrial rate running at three to 400 beats per minute, and the ventricular rhythm chaotic, as the experts say, irregularly-irregular at about 150 beats per minute. Atrial fibrillation, or A Fib, is the most common abnormal heart rhythm condition. It afflicts about one percent of the total population, more than two million people in the U.S., and eight percent of all those older than 80 years of age.

There are many causes for A Fib, including long standing high blood pressure, coronary artery blockage, sleep apnea, too tight or leaky heart valves, too much or too little thyroid hormone, blood clots to the lung, an inherited conduction system or wiring condition, excessive amounts of tobacco, coffee, alcohol, or amphetamine, a viral infection involving the heart, stress of any kind, or just an old and weak heart.

There are two main reasons we need to do something about this rhythm abnormality. Most devastating can be the clots that can form in the atria since they are not emptying effectively, resulting in something like 10 to 25 percent of all strokes to the brain. Second, the ventricles are not efficient pumps when atria are fibrillating and even worse so when the ventricles are beating at 150 beats a minute.

So, with A Fib we must slow the heart down, thin the blood to prevent strokes, and sometimes even bring the rhythm back to normal when we can. While we are at it, in each case, physicians need to study why A Fib happened. It is a complex and interesting condition, and there is a lot of debate about what kind of blood thinners to prescribe, what kind of rhythm-control drugs to use, and when to use surgery and pacemaker treatments.

But the bottom line about A Fib is that good treatment by your general or cardiology physician can prevent problems and allow a normal life, even with the heart rhythm as irregular as popping corn.

Richard P. Holm, MD is 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
 
Before my junior year in high school, I returned from a Boy Scout canoeing trip to discover my sister had been killed in a car crash. I will never forget the sadness of the moment when I walked into the house that was filled with what seemed like half the caring and wonderful town of De Smet to find my mom and dad there grieving. It was near the end of that summer, but the beginning of a long period of mourning for my family and me.
 
There were lessons that came to me after my sister’s death. I realized how important support from a community could be. Consolation came from our friends, neighbors, church community, as well as people we barely knew. It seemed more about their presence and not their words. I noticed there were people who had trouble themselves dealing with such loss, and they sort of disappeared.
 
Also, I realized that a funeral is not exactly a time of closure for a family, but really just the beginning of a time to accept reality and forge ahead with the difficult changes that life can and does deal out. It took me years to think about my sister and relish in her memory rather than cringe from the pain of the loss. In that sense, I know I will never have closure and that’s good.
 
Some 14 years after her death, while I was on the faculty of a medical school in Georgia, I found myself having to advise medical students how to talk to patients or family about sad news. I reviewed the medical literature on the subject at the time and concluded that there is no right way to do it except to be 100 percent honest and to say whatever is needed with compassion.
 
Through the years those guidelines have sustained me while I have had the burden of sharing awful news. 
 
Bottom line, it is being there, more than words that consoles. Never worry about what to say, just show up, be honest, and care.
 
Richard P. Holm, MD is 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 the U.S., there are almost five million people with mild to moderate dementia, and studies show that about 70 percent are at home, either alone or with a caregiver, often a spouse. If people with mild to moderate dementia can stay home safely, this would save Medicare and Medicaid a great deal of taxpayer money. More importantly, this would provide those people affected with dementia their preferred environment. Indeed, it is important to allow all people the chance to stay at home whenever possible.
 
A 2013 Johns Hopkins report studied more than 250 people with dementia living at home and found that 99 percent of the demented and 97 percent of their caregivers had at least one unmet need. The foremost unmet need was defined by safety issues such as poor lighting in walkways which increased the risk of falling. Other needs that were not being met in this study included not performing regular exercise, poor follow-up with health care providers, not having prepared legal and estate planning and not receiving help with medications and some activities of daily living. Researchers found that those with lower income, with depression and with borderline rather than severe dysfunction had significantly more unmet needs.
 
When there were at-home caregivers for these folks with early dementia, the caregivers were often not aware of these deficiencies. In addition, the needs of the caregivers were often ignored or unrecognized. Remarkably, at-home caregiver stress and depression were some of the strongest predictors for an earlier move of the person with dementia to the nursing home.
 
Methods to enhance a person’s chance of staying at home are not difficult. Preparation for legal issues and estate planning should be done early and BEFORE the loss of memory. Other methods include providing raised toilet seats, grab bars in the bath and bedroom, properly tacked down carpets, good nighttime lighting in walkways and proper day and nighttime footwear. Researchers also advise providing enhanced support for caregivers with education about community support available such as social services, occupational therapy and caregiver support groups. In addition, screening and treatment of any caregivers’ depression, should be provided. This would go a long way in helping people stay at home as they age.
 
Bottom line: Most of us, and our families, are not prepared for the possibility of dementia as we age. If we prepare, we greatly improve our chances for staying at home.
 
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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. I was chagrined but not surprised when 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 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 the injuries were inflicted by her spouse. Since coming to this prairie town 38 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 recommendations 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.
 
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By Richard P. Holm, MD

It is miraculous to consider how much access and exposure we have to information through our computers, televisions, radios and newspapers. Unfortunately, we need to be on guard because too much of this buzz can be false information.

In an October 2017 article, the Pew Research Center found 43 percent of people in 2016 received their news from Facebook listening for information that aligned with their world view (not necessarily with facts). Pew also found 23 percent had shared, by intention or accident, untrue political messages on social media. We need to be more critical of all sources of information around us. Almost as malignant as fake news are advertisements that pretend to be factually based.

Of course, marketing (sales) can be good and important as it moves commerce, and I’m not saying industry doesn’t sponsor credible scientific research. However, marketing can be harmful when selling a weight-loss program that gives false hope, when peddling virility pills that are ineffective or when pushing an outrageously expensive drug that should be used only after first-line medicines are tried. Advertisements can and should be based on truth, but my cynical side sees the words “truth in advertising” as an oxymoron, like “seriously funny,” “awfully good” or “found missing.” Indeed, marketing motives can be as different from evidence-based science as corn syrup is to leafy green vegetables.

It has been our desire and goal at Healing Words Foundation to find and help spread health information that is not influenced by marketing or sales. What is known today as Prairie Doc® media started in the 1980s with newspaper articles, expanding in the 1990s with a local talk AM-radio show, in 2003 with a television show and in 2010 with social media. Prairie Doc® has been made possible with the help of volunteer physicians and experts, South Dakota State University and its students, our paid and voluntary Prairie Doc® production staff, our Foundation Board of Directors and, most importantly, the unrestricted underwriting of organizations and individuals like you. We feel blessed to have such wonderful talents and gifts allowing us to bring our unbiased and credible public health information to the people.

The mission statement of the Healing Words Foundation and all Prairie Doc® programming is enhancing health and diminishing suffering by communicating useful information, based on honest science, provided in a respectful and compassionate manner.

This is a call for all of us to be careful and critical. We don't have to be influenced by fake news but rather need to choose our sources of information carefully. Let this be a time of truth.
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow
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By Richard P. Holm, MD

We take a lot of things for granted. With the advent of antibiotics in the 1930s and 40s, we saw a true change in longevity and a reduction in premature death from infectious diseases. Now we are seeing deaths from bacteria which are resistant to every antibiotic and it’s not just the sick and decrepit who are affected. Recent studies show many more people are dying in the U.S. from antibiotic resistant bacteria than from AIDS. It’s a real crisis resulting from too much of a good thing.

Resistance is due to excessive and over-use of antibiotics, which are often incorrectly seen as the cure for whatever ails us. The most glaring example is when antibiotics are given for what is obviously the common cold, making absolutely no difference in the course of the illness. Often, I hear from the patient, “Why not start an antibiotic to keep this viral bronchitis from turning into pneumonia?” To that question I usually answer, “You are correct, when bacterial pneumonia occurs, it often follows a common cold, but studies show antibiotics don’t prevent the occurrence of that pneumonia following the cold. Rather, it becomes a pneumonia resistant to treatment.”

So why are we over-using antibiotics? Most experts say it is from patient or parent expectation. One study showed that if the doctor perceives the parents expect antibiotics for their children, 65 percent of the time the doctor will prescribe antibiotics. Conversely, when parents do not indicate an expectation for antibiotics, even when the children are similarly ill, the doctor prescribes them only 12 percent of the time. Ultimately the doctor is responsible but too often yields to pressure to provide unnecessary treatment.

Another reason for growing antibiotic resistance has resulted from use of antibiotics in animal and poultry feed which boosts animal growth and profits. In the U.S. antibiotics are now limited for use only when a veterinarian prescribes them, but similar limits are not in effect in India and other countries. Also, veterinarians are prescribing the newer broader spectrum antibiotics only for the care of sick individual animals, not the entire herd. These new moves are a start, but closer monitoring of usage needs to occur. The good news is that in countries where efforts to use fewer antibiotics are successful, within a few years, antibiotics become effective again.

Based upon current science, rather than expecting an antibiotic from the doctor, it’s in our best interest to discuss options and use antibiotics only when they are necessary. We can also benefit by taking time to read food labels carefully, choosing antibiotic-free products.

Let’s not take antibiotics for granted. By avoiding the overuse of antibiotics, we can save ourselves from a real crisis.
​
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter 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
 
Q: What are some types of skin cancer? 
A: The three major types are basal cell, squamous cell and malignant melanoma. In general, one in five, or 20 percent of people in the U.S. have had or will have some type of skin cancer. In Australia where the sun is intense, two out of three skin cancers are basal cell, one in four are squamous cell, and one in twelve are malignant melanoma.
                                                                                                                                                                   
Q: Should I go to a dermatologist for screening?
A: The dermatologist is the most experienced with skin cancer, but primary care providers can help, too. Realize, however, that the first person to discover skin cancer should be you, along with a partner to look over places you cannot see. Self-screening is especially important for those at high risk for skin cancer.
 
Q: Who is at high risk for skin cancer? 
A: At highest risk would be anyone who has had a bad sunburn or excessive lifetime sun exposure, especially when young, and those with light complexion, freckles, blue eyes, blond or red hair. At higher risk for malignant melanoma are those with many moles, with a prior personal history of skin cancer, and with a family history of malignant melanoma.
 
Q: Does sunscreen help prevent skin cancer?
A: This is widely presumed to be true but not yet scientifically proven. In fact, some speculate that people who use sunscreen may feel emboldened to expose themselves to more hours of damaging sunlight. Also, using sunscreen to shield skin from sunlight may possibly result in vitamin D deficiency. All that said, it is my opinion there is enough evidence to use sunscreen all year long and, if you live in the northern climates, take 2000 IU of vitamin D daily.
 
Q: How do I know when to go to the doctor?
A: The ABCDE mnemonic helps in knowing when a skin lesion might be dangerous. A: asymmetry or irregularly shaped; B: border fuzzy not sharp; C: more than one color in it; D: diameter wider than pencil width; and E: lesion evolving or changing. It is common to mistake a benign and safe look-a-like seborrheic keratosis for a possible malignant melanoma. Seborrheic keratosis is light brown to black, raised, and waxy. If one can partially peel or scratch off waxy material with a fingernail, then it is likely a benign keratosis. Malignant melanomas can be either flat or nodular…but never waxy.
 
No question, if ever you are in doubt, see your doctor.

For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter 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
 
Miracles still happen.
 
Some think that the scourge of smallpox was present around 12,000 years ago, however, we know for sure it was here 3000 years ago as it was found on the face of an Egyptian Pharaoh mummy. We know that it caused many large and devastating epidemics killing about 35 percent of infected adults and 80 percent of infected children. Even during the 20th century, smallpox still resulted in 300-500 million deaths world-wide.
 
Pictures of people suffering from this miserable viral illness show skin of face and body breaking out with dime-sized firm white or red blisters. People also commonly developed fevers, vomiting, spread of blisters into mouth and eyes, and too often came to a wretched and miserable death. If one survived, the common facial pox scars could be extremely disfiguring and sometimes affected the cornea of eyes causing blindness.
 
During the tenth century in China, someone began inoculating the fluid from a smallpox blister onto abraded skin on the arm or leg of a healthy individual, allowing for a single pox to get started in a controlled way. This worked fairly well except that the procedure made them infectious to others for a while and resulted in death to the recipient one percent of the time. Contracting smallpox killed about 35 percent of adults, so reducing the rate to one percent was an improvement. This rather dangerous process of inoculating live smallpox became popular in England during the 16 and 1700s.
 
Smallpox was given the medical term variola from Latin for spotted pimple. It had been commonly known as the red plague until in Britain during the 1600s it was called smallpox to distinguish it from great-pox or syphilis.  
 
Noting that milk maids rarely got smallpox, in 1796 British rural physician Edward Jenner found that inoculating the fluid of the milder disease cowpox provided for substantial immunity from smallpox without significant risk to the recipient and without the danger of spreading smallpox. Jenner called the cowpox inoculate “vaccine” after vacca, the Latin word for cow.
 
With a vaccination campaign lead by the World Health Organization, world-wide deaths reduced from two million per year in 1967 to none in 1977. I find it nothing short of a miracle that in those ten years, human smallpox infections were virtually eliminated from this world.  It was a miracle wrought by human intelligence, the ingenuity of creative and resourceful minds, and the scientific method.
 
It was the miracle of vaccination.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter 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
 
Nothing has touched my soul and spoken to aging with grace quite like the ancient Indian medicine wheel and the traditions that have evolved from it. From the National Library of Medicine, I learned that in the Americas, Indian tribes have multiple interpretations of the four directions, but the following prayer is my own, geriatrician’s interpretation of a version from the book Black Elk Speaks and Oyate (Nakota, Dakota, Lakota) tradition.
 
First, we get down on our knees and feel the soil, the sacred Mother Earth, bringing the world around us, the animals, plants, prairies, lakes, mountains, the environment of our planet from where all food and sustenance comes. Earth is foundation. Then we stand up on our tiptoes, and raise our arms to sacred Father Sky, the sun, stars, clouds, rain, wind, air and breath of life, light and dark; from where all energy flows and ebbs. Sky is infinity. Earth and sky, the beginning and the end.
 
Around the central campfire and within the circle, first we bow east, symbolized by red, rising sun, springtime, birth, blood, the very young; a sense of innocence, youth. May we have hope for a future with an open mind to all things new and true.
 
We bow south, symbolized by yellow, full sun, summer, sexuality, the anticipating young woman and young man; a sense of unconquerable power and invulnerability, early adulthood. May we have the courage and strength to fight for justice.
 
We bow west, symbolized by black, setting sun, an approaching dark thunderstorm, oncoming night, autumn, resignation, the reality filled community leader and medicine woman/midwife; a sense of the horrors of war and reality of loss, mature adulthood. May we have the gravity to protect freedom of choice and face vulnerability with honest eyes.
 
Finally, we bow north, symbolized by white, starry night, winter, old age, wisdom, the sagacious elder and teacher; a sense of beauty, grandchildren and the circle of life, an experienced body and mind, release from the fear of change and death. May we have insight to savor family and friendship, and the good sense to walk in another’s moccasins.
 
Inside the circle is the tree of life, where we become aware of our self, our consciousness, tribe, community, country, world, and our connection to all direction.
 
Dear Mother/Father of Earth and Sky, thank you for your blessings, the sacred hoop of life, and especially the wisdom to find release from fear of death. May our sisters and brothers of all Clans and Nations realize our sacred connection and, in harmony, savor the joy and even the sorrow of our circle of life and aging.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter 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
 
I bet I hear it once a week, “It’s hell to grow old!” Of course, growing old is something we all will do, unless we die first. Alas, the future can look quite sad and depressing, especially if you think about the flab, falls, pain, blues, anxiety, thin bones, loss of libido, weakness, and memory loss that can come with aging.
 
But wait! Listen to the exciting news. Just out, there is a powerful potion that can prevent the aging process. That’s right…guaranteed to slow aging.
 
Researchers have observed how shortly after starting this terrific tonic: flab turns to muscle; falls are reduced; chronic pain and fibromyalgia seem magically lessened; depression and anxiety disappears; bones are actually strengthened; sexual function is enhanced and recharged; people experience new strength, energy, and power; and most important memory is clearly improved. What’s more, this special medication has also been shown to reduce diabetes, heart attack, stroke, and breast or colon cancer.
 
That’s not all. If you take advantage of this fabulous offer today, it will improve your appearance within weeks. Sounds too good to be true. It is scientifically proven, beyond a shadow of a doubt. And no other treatment plan comes even close. Nothing!
 
You would expect the price for this magnificent medication that brings about all these benefits to be more than the sum of one third of your income, or at least many thousands if not millions of dollars. But no! This medicine is equally available to the rich and poor alike, requiring only an extra effort on your part.
 
You could expect to work lots of extra hours each day to achieve these wonderful benefits. But no! You don’t have to work an extra two hours at the beginning or end of your workday, you don’t have to work even one extra hour.
 
Starting today we have a special opportunity. For spending only a half hour every day walking twelve blocks, yes that’s right, just twelve blocks, or whatever distance you can make in 30 minutes, you will receive most of the benefits I mentioned earlier. That’s right, only a half hour!
 
But wait, this offer only lasts for a short time. The longer you delay, the less you will get. If you start today, the benefits begin sooner and last longer.
 
That’s right…guaranteed to slow aging. Exercise is the bargain of a lifetime.
 
For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow The Prairie Doc® on Facebook, Instagram and Twitter 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.