Tue, 07 Apr 2026 18:04:18 -0500WeeblyTue, 07 Apr 2026 14:18:31 GMThttps://www.prairiedoc.org/blog/theres-no-place-like-home-home-safety-evaluations​Prairie Doc Perspective Week of April 5th, 2026
There’s No Place Like Home – Home Safety Evaluations
By Jill Kruse, DO
In my role as a hospitalist, I am always happy when a patient is healthy enough to be discharged.  A resounding majority of people want to go back to their home after they leave the hospital.  What we do not want is an unsafe environment leading to repeat injuries resulting in a hospital readmission.  
At discharge we can have members of the Home Health team perform a “Home Safety Evaluation”. Physical Therapists, Occupational Therapists and sometimes Speech Therapists will evaluate a person’s home for safety concerns and ensure it is set up optimally for best function.  The team looks at areas where injuries typically occur.  This could include the instillation of grab bars in the bathroom or having a shower chair.  Paying attention to slipping or falling hazards – such as throw rugs or loose stair railings.  Good lighting, especially on stairs and in hallways, can help prevent tripping and falling.  
Before hospital discharge Physical Therapists will evaluate how well a person can walk including their balance.  If there are steps in the home, they will ensure the ability to navigate stairs is evaluated.  They perform tests which can help predict who is at a higher risk for falling.  The proverb may be, pride goeth before a fall, but a walker or cane could help prevent that.  Unfortunately, too often pride is the reason that the walker or cane is not used in the first place.  Using someone else’s old walker may be a bargain, but proper walker and cane height is important. A used device may be more dangerous if not adjusted properly and therapists can help confirm they are at the correct height. 
Occupational Therapists evaluate a person’s ability to perform “Activities of Daily Living”. These include being able to feed, dress or bathe themselves, and using the bathroom.  They have lots of assistive devices, tricks and tips to assist people if arthritis, injuries, or recent surgery prevents the person from moving like normal.  
Speech Therapists are asked at times to assess a person’s cognition and “safety awareness”.  They evaluate and determine if this person can the person recognize an emergency and get to safety or call for help.  With dementia, the part of the brain responsible for logic and good decision making is no longer working.  Dementia patients often make impulsive mistakes such as walking into traffic or forgetting to turn the stove off after cooking.  
There is no place like home, but it needs to be a safe home.  With a few tips and modifications, your home can be a safer place to live thereby keeping you there longer.  We want you to “Stay healthy in there.”
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).]]>Mon, 30 Mar 2026 14:32:29 GMThttps://www.prairiedoc.org/blog/anatomical-variations-breaking-down-the-basic-details-of-tumors-and-cancerPrairie Doc Perspective Week of March 29th, 2026
Anatomical Variations: Breaking Down the Basic Details of Tumors and Cancer
By Ethan L. Snow, PhD, MA


Cells are the basic building blocks of all living organisms. In a healthy body, cells follow an orderly life cycle: they develop from a systematic process called mitosis, perform important physiological functions to maintain body homeostasis (i.e., a stable internal environment), and die via apoptosis when they become dysfunctional, old, or no longer needed. This cycle is tightly regulated by DNA – the body’s genetic code that controls when and how each cell functions.


With about 30 trillion cells in each human body, some cells naturally develop mutations in their genetic code that disrupt their life cycle. Mutations can be caused by genetic issues, environmental exposures (e.g., tobacco smoke, radiation), infections, lifestyle, and other etiologies. Cells with mutated genetic codes are usually detected and removed by the body’s immune system, or they stop working and die on their own. However, sometimes these altered cells survive and gain a competitive growth advantage, causing them to replicate more rapidly than normal. Over time, this uncontrolled growth can create a mass of cells known as a tumor.


Tumors can develop anywhere cells are present (i.e., essentially anywhere in the body), and they are classified as benign or malignant. Benign tumors are non-cancerous, and they typically grow slowly and exhibit clear boundaries. Contrariwise, malignant tumors are invasive to nearby tissues – a hallmark of cancer – and are characteristically more aggressive. A biopsy is often necessary to confirm whether a tumor is benign or malignant. Notably, not all tumors are cancer (e.g., a benign tumor is not cancer), and not all cancers produce tumors (e.g., leukemia is a cancer of the blood).


A serious feature of malignant cancers is their ability to spread to other locations in the body – a process known as metastasis. Metastasis occurs when malignant cells break away from the original tumor, travel through the bloodstream or lymphatic system (or other pathway), and seed new tumors in other areas of the body. This makes cancer more difficult to treat and can provoke additional sequelae.


Clinical jargon associated with tumors and cancer can be daunting, but breaking down the terminology can be helpful. For example, the root words “hem-” means blood, “angio-” means vessel, and “-oma” means tumor, so a “hemangioma” is quite literally a “blood vessel tumor”. Additional terminology can be descriptive; for example, a “giant intramuscular lipoma” describes a fatty (“lyp-”) tumor (“-oma”) that is located within (“intra-”) a muscle (“-muscular”) and is at least five centimeters in any one dimension (the criteria for “giant” classification).


While loss of control is the foundational concept for tumor and cancer development, routine screening, avoiding carcinogens, and other controllable actions are important for preventing cancer, detecting it in early stages, and performing early interventional treatment. A lump, bump, or lesion might be just that, or it might be something serious. Tumors and cancer are complex, and they command respect and proper attention. It’s important to consult a physician about such concerns so they can execute a proper workup and assemble a multi-disciplinary healthcare team as warranted.


Ethan L. Snow, PhD, MA is a clinical anatomist who currently serves as an Associate Professor at South Dakota State University in Brookings, South Dakota. Dr. Snow leads the Snow Lab Research Team – a collaborative and interdisciplinary team of undergraduate students, professional students, faculty, and clinicians who analyze rare and unique clinical cases involving anatomical variations. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, on SDPB YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 23 Mar 2026 14:06:09 GMThttps://www.prairiedoc.org/blog/what-the-heart-wants-is-exercisePrairie Doc Perspective for the Week of March 22nd, 2026
“What the heart wants (is exercise)”
By Kelly Evans Hullinger, MD FACP
Cardiovascular disease remains the most common cause of death in the US as well as a very common cause of chronic illness and disability. Heart attacks, heart failure, and strokes result in about 2500 deaths per day in the US, according to the American Heart Association®. While huge strides continue to be made in treatment of these events, including medications and procedural abilities, as always, prevention is the best medicine.
Many risk factors exist for cardiovascular disease; some, such as genetics or family history, are out of one’s control. However, there are many things we can do to reduce our risk, including quitting smoking and controlling high blood pressure, high cholesterol, or diabetes. One behavior that applies to us all is to get enough exercise.
The American Heart Association® recommends getting at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise per week, preferably spread over several days in the week. Moderate exercise might include brisk walking, gardening, or leisurely biking. Vigorous exercise might include walking on an incline, jogging or running, or heavy yard work. Additionally, they recommend resistance or strength training be included twice per week.
Starting from sedentary? No problem, but don’t expect to go from zero to 150 minutes in the first week. Listen to your body; you can even start with walking or chair exercise for ten minutes per day. You will find that with consistency you will be able to build on that week to week. Most importantly, find a physical activity that you enjoy enough to keep doing. For many people, exercising with a family member or friend really helps.
We know that regular exercise can cut the risk of cardiovascular disease substantially; one large study showed a reduction in mortality by over 20%, with more exercise giving even greater protection. How exercise benefits the heart goes beyond its effect on obvious markers like weight; exercise improves blood flow in the vessels around the heart in a way that reduces future bad outcomes. As I tell my patients when we discuss exercise, its benefits are far greater than its effect on weight. Your heart will thank you for the exercise no matter what the scale says.
So let’s all get moving this week! Any exercise is better than none, and there is something out there for everyone. The heart wants what it wants, and that’s exercise.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 16 Mar 2026 15:40:01 GMThttps://www.prairiedoc.org/blog/old-age-only-10-years-awayPrairie Doc Perspective Week of March 15th, 2026
“Old Age, Only 10 Years Away”
By Dr. Becca Jordre
Every year I ask my students, “How old is old?” The answers vary, but the most honest response I’ve ever received came from a patient who said, “Old is 10 years older than my age.” We all tend to push aging just out of reach, as though it belongs to someone else.
As a physical therapist, professor and researcher in aging, I see the consequences of that distance every day. When we mentally place older adults in a separate category, we give ourselves permission to speak and act in ways that quietly do harm. We call someone an “old lady” without pause. We dismiss a symptom as “expected at your age.” We offer the well-meaning but quietly deflating compliment that someone is doing well “for their age.” Each of these small moments narrows what we believe is possible for that person.
This is ageism. Generally unintentional, ever-present in our society.
The problem is not acknowledging that aging brings real changes. It does. Health conditions, pain, and mobility challenges become more common with age, but not in some uniform pattern that warrants focus on a number. The problem is when age becomes the answer rather than the starting point. When decline is the expectation, we stop asking about goals, we stop noticing strengths and we start designing lives around an assumed limitation.
Consider a common piece of advice: move to a single-story home as you grow older. It sounds reasonable. But research tells a more nuanced story. Studies have found that those living in homes with stairs showed less decline in physical function over time compared to those without. Climbing stairs is demanding, repetitive physical work for the legs and heart. Removing that daily challenge in the name of safety may quietly accelerate the very decline we hope to prevent.
This pattern holds more broadly. Research consistently shows that vigorous exercise, not just gentle stretching or slow walks, produces the greatest health benefits as we age. Higher-intensity activity improves strength, balance, heart health and cognitive function in people well into their 80s and 90s. When we steer older adults toward only the lightest, most cautious forms of movement, we deprive them of the very stimulus their bodies need. In trying to protect, we inadvertently take away opportunity.
Language works the same way. When family members, neighbors and health care providers speak as though decline is inevitable, we coach people toward caution, avoidance and withdrawal. Expectation shapes behavior, and low expectations are their own kind of harm.
The answer is not to ignore age or pretend it doesn’t matter. It is to treat aging as a human experience, seeing a person not as a number but as an individual with unique aspirations, interests and abilities. 
None of us are exempt from aging. We are all just at different points on the same road. The assumptions we make about older adults today are the assumptions that may one day be made about us. That alone is reason enough to think more carefully about what we say, what we recommend, and what we decide is possible with each passing year.
Dr. Jordre is a professor of physical therapy in the School of Health Sciences at the University of South Dakota. She earned her Doctor of Physical Therapy degree from Duke University in 2002 and her Ph.D. in Health Sciences from the University of South Dakota in 2021. She is board certified in Geriatric Physical Therapy and is a Certified Exercise Expert for Aging Adults. Her research centers on healthy aging, with a particular focus on athletes age 50 and older. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 09 Mar 2026 14:09:45 GMThttps://www.prairiedoc.org/blog/meaningful-living-in-rural-communities-pathways-to-productive-agingPrairie Doc Perspective Week of March 8th, 2026
Meaningful Living in Rural Communities: Pathways to Productive Aging
By: Whitney Lucas Molitor, Ph.D., OTD, OTR/L, BCG and Allison Naber, Ph.D., OTD, OTR/L
Living in rural communities offers unique opportunities to promote successful aging. Incorporating a purposeful lifestyle, developing social connections and engaging in daily physical activity is essential to achieving positive health outcomes and quality of life.
Finding purpose includes exploring the activities you already engage in and being open to new possibilities. Engaging in motivating activities provides a framework for a purposeful life. The selected activities can promote health, foster a sense of identity and give a sense of purpose in life while aligning with personal values and interests. While some daily activities are performed without much thought, identifying others may require careful exploration. 
In rural communities, consideration of the physical context is also essential. The American Occupational Therapy Association provides a framework that incorporates reflection on personal values, interests and prior life experiences. This approach, along with establishing priorities and goals, can be a valuable way to explore daily activities and create new opportunities for engagement that enhance purpose in daily life. To align life purpose with a rural context, it is essential to incorporate outdoor activities, find creative ways to connect with family and friends and explore opportunities with local groups. Activities can be modified to support evolving interests, abilities and desires. 
Establishing and maintaining strong social connections is critical to promoting healthy aging in rural communities. Older adults in rural areas may experience social isolation due to limited opportunities for interaction. This can be due to changes in overall health, technology barriers (limited internet access or limited computer or smartphone skills) or physical barriers (limited community mobility or driving restrictions). Social isolation can pose physical, psychological and behavioral health risks. Engaging in meaningful activities with others can help build relationships, find purpose or fulfillment and develop new hobbies or skills. Educational programs or groups are an excellent way to explore new leisure activities or learn strategies to improve health and well-being. Reaching out to family or friends, visiting your local senior center, attending community events, or joining a club can all provide a sense of connection, purpose and well-being.
In addition to staying socially connected, developing a regular physical activity routine is essential for older rural adults. Adults over 65 should set goals to strengthen their muscles and improve their balance by engaging in at least 150 minutes of moderate physical activity per week. Moderate physical activity increases breathing and heart rate, but you should still be able to talk while active. Beneficial activities include brisk walking, dancing, riding a stationary bike or NuStep, using weights or resistive exercise bands, gardening or participating in water aerobics. Consider setting a goal to move your body for 30 minutes each day to reduce sedentary time. Sedentary activities include watching TV, reading, sitting or lying down. Prolonged sedentary behavior increases the risk of poorer health outcomes among older adults. Intentionally participating in meaningful activities throughout the day will reduce time spent sedentary. Reduce sedentary behavior by standing during commercial breaks, walking around your home after a meal or stretching after reading the paper or playing cards. Incorporating the strategies mentioned in this article can promote well-being and enhance quality of life.


Whitney Lucas Molitor, Ph.D., OTD, OTR/L, BCG, is department chair and associate professor in the Department of Occupational Therapy at the University of South Dakota. Lucas Molitor is a licensed occupational therapist in Iowa and South Dakota. Her research interests include health promotion and productive aging. Allison Naber, Ph.D., OTD, OTR/L, is the academic fieldwork coordinator and an associate professor in The Department of Occupational Therapy at the University of South Dakota. Naber is a licensed occupational therapist in Minnesota and South Dakota. Her research interests include occupational performance and life balance, particularly as they relate to healthy aging. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 02 Mar 2026 15:35:15 GMThttps://www.prairiedoc.org/blog/cultivating-trust-a-trauma-informed-approach-to-the-therapeutic-alliancePrairie Doc Perspective Week of March 1st, 2026
Cultivating Trust: A Trauma-Informed Approach to the Therapeutic Alliance
By Patti Berg-Poppe, MPT, Ph.D. and Shana Cerny, OTD, OTR/L, BCP


Health care professionals enter every patient encounter with the goal of helping individuals heal, yet many don’t realize how often past adversity shapes the way a person experiences care. Trauma, whether from childhood experiences, medical procedures, accidents, interpersonal harm or environmental conditions, doesn’t remain a distant memory. It becomes embedded in the body through biobehavioral adaptations that influence posture, muscle tension, breathing patterns, nervous system sensitivity and low body safety. When we understand that trauma lives not only in stories but also in tissues and reflexes, we begin to see why a trauma-informed approach is essential for building trust.


Trauma and adverse experiences are more common than we may realize. More than two-thirds of the patients that health care providers encounter in practice are likely to have experienced trauma in some form. Trauma‑informed care should be a universal precaution, guiding providers to assume that any patient may have a history of adversity, even if it is never disclosed. This mindset shifts the focus from “What’s wrong with you?” to “What’s happened to you, and how is it affecting your health today?” For clinicians who rely on touch, such as physical and occupational therapists, physicians, nurses and primary care professionals, this awareness is especially important. Touch can be grounding and healing, but it can also activate the sympathetic nervous system, triggering a stress response before a patient has words to explain why.


Trust becomes the foundation of the therapeutic alliance, and trust is built through safety, predictability and respect. Trauma‑informed practice encourages providers to slow down, explain what they are doing and invite patients into shared decision‑making. Simple actions, such as asking permission before touching, checking in about comfort, offering choices and being transparent about what comes next, signal to the nervous system that the environment is safe. These small shifts can reduce physiological stress responses and create space for true healing.


Research on trauma‑informed health care highlights how past adversity can influence patient engagement, adherence and outcomes. When patients feel overwhelmed, misunderstood or rushed, they may appear “non‑compliant,” when in reality their nervous system is doing its best to protect them. A trauma‑informed lens helps clinicians interpret these reactions not as resistance but as communication. It encourages us to look beyond the symptom in front of us and consider the whole person, including their history, their stress load, their strengths and their goals.


Holistic care means recognizing that physical symptoms rarely exist in isolation. Pain, fatigue, dizziness and muscle tension often have emotional and neurological components. When providers acknowledge this mind‑body connection, patients feel seen rather than dismissed. They’re more likely to share concerns, ask questions and participate actively in their care. This collaboration strengthens the therapeutic alliance, which research consistently links to better health outcomes across disciplines.


Trauma‑informed practice is not a specialty; it’s a skillset. It requires curiosity, humility and a willingness to adapt. It asks clinicians to be mindful of their tone, body language and pace. It reminds us that healing happens in relationships, and that every interaction, every moment of touch, every explanation, and every pause can either reinforce safety or erode it.


When we approach patients with the assumption that their bodies carry stories we cannot see, we create conditions where trust can grow. And when trust grows, so does the capacity for healing.


Patti Berg-Poppe, MPT, Ph.D., is a physical therapist, professor, and Chair of the Department of Physical Therapy at the University of South Dakota. She has published on trauma‑informed care, including work examining how adverse childhood experiences influence patient engagement and how trauma‑aware practices can strengthen therapeutic relationships. Her writing and teaching emphasize the importance of trust, safety and respectful communication in all health care interactions. Shana Cerny, OTD, OTR/L, BCP, is an occupational therapist and associate professor in the Department of Occupational Therapy at the University of South Dakota. Her research, service and teaching interests revolve around trauma-informed care, including publication of practice guidelines for trauma-informed occupational therapy, interventions for individuals after exploitation, and the effectiveness of a trauma-informed care curriculum for multi-disciplinary care providers. She is a Trust-Based Relational Intervention® Educator and co-creator of the Child & Adult Advocacy Studies graduate certificate at the University of South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

​]]>Mon, 23 Feb 2026 14:42:55 GMThttps://www.prairiedoc.org/blog/the-not-so-silent-struggle-of-sleep-apneaPrairie Doc Perspective Week of February 22nd, 2026
“The Not-So Silent Struggle of Sleep Apnea” 
By Andrew Ellsworth, MD


Take a moment to breathe. Close your eyes. Slowly inhale through your nose, pause, and gently exhale through your mouth. After a few steady breaths, you likely feel more relaxed and ready for the day.
Now imagine plugging your nose and trying to breathe with your tongue pressed against the roof of your mouth, blocking the airway. You would quickly feel stressed and uncomfortable. Now imagine that happening over and over again, all night long.
That is what occurs with obstructive sleep apnea.
Obstructive sleep apnea happens when relaxed throat muscles and soft tissues collapse and block the airway during sleep. These temporary pauses in breathing—called apneas—cause lower oxygen levels. The brain senses the drop and briefly arouses the body to reopen the airway. This cycle can repeat dozens, even hundreds, of times per night. The result is fragmented sleep, low oxygen, and a body that never truly rests.
Sleep is when the body resets and restores itself. It supports immune function, heart health, metabolism, memory, mood, and emotional regulation. When sleep suffers, so does overall health. Poor sleep increases the risk of high blood pressure, heart disease, stroke, diabetes, cognitive decline, and even dementia. People who are chronically tired are also less likely to make healthy choices.
The gold standard treatment for sleep apnea is CPAP—continuous positive airway pressure. A bedside machine delivers steady air through a mask, keeping the airway open during sleep. Some patients benefit from BiPAP, which provides different pressures when breathing in and out. When used consistently, these therapies can dramatically improve sleep quality, energy, focus, hormone balance, and cardiovascular health.
Other treatments may help in selected cases. Weight loss, dental appliances, side sleeping, and certain surgeries can reduce airway obstruction. For patients who cannot tolerate CPAP, hypoglossal nerve stimulation (often known by the brand Inspire) is an option. This implanted device stimulates the nerve controlling the tongue, helping maintain an open airway during sleep.
Although sleeping with a mask may not sound appealing at first, some people feel better quickly and do well with it. Others improve once they are used to it. It often takes patience—trying different masks, adjusting pressure settings, or adding humidification. With proper support and follow-up, most people adapt well.
The benefits of treating sleep apnea far outweigh the risks of ignoring it. Restful sleep improves energy, protects the heart and brain, and enhances overall quality of life.
If you or someone you love snores loudly, stops breathing during sleep, or feels tired despite a full night’s rest, consider visiting your medical provider. Restoring healthy breathing at night may be one of the most important steps toward better health.
Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Tue, 17 Feb 2026 14:52:41 GMThttps://www.prairiedoc.org/blog/the-bones-of-the-matterPrairie Doc Perspective Week of February 15th, 2026
“The Bones of the Matter”
By Deb Johnston, MD


When I was in medical school, I learned that a shocking number of people would die or be admitted to a nursing home after a hip fracture. 


Even today, a hip fracture can be a devastating event for an older American. Up to 30% will die within the next year. Many more will loose independence and require admission to assisted living or a nursing home. Estimates vary, but it may approach 50%. As hard as it is to believe, these statistics are improved from my long ago medical school days.


As a doctor in training, the solution seemed obvious. If osteoporosis caused hip fractures, and hip fractures caused premature death and disability, then my mission as a primary care physician would be to prevent osteoporosis. I’ve been nagging my patients about their calcium and vitamin D intake and their weight bearing exercise ever since.


To be fair, the reality is a bit more nuanced. It’s true that osteoporosis is a major factor in hip fractures, but it is often accompanied by other issues: poor nutrition, poor balance, low muscle mass, and more obvious serious health conditions like dementia, heart disease, kidney disease, and diabetes. 


Similarly, preventing osteoporosis isn’t as simple as urging everyone to drink enough milk. Generally we can build stronger bones up until about age 30. After that, the goal is to maintain bone mass. Those critical years are often decades before a person starts thinking about their bones, and sometimes well before they start thinking about their health at all! 


Other habits also influence how strong your bones are at their best. Smoking and alcohol reduce bone mass. Weight bearing exercise increases it; while being sedentary has the opposite effect. Your body needs vitamin D to make bone, too, and deficiencies are surprisingly common. 


Other health conditions, and their treatments, can have significant influences on your bone health. The list is long: eating disorders, premature menopause, inflammatory bowel disease, seizure disorders, asthma, rheumatoid arthritis, chronic kidney disease, thyroid disease, cancer.


While preventing osteoporosis starts in childhood, hope is not lost just because you are well into middle age, or older. Talk with your doctor about what you should be doing to keep your bones healthy. Do you need help getting rid of nicotine, or cutting back on alcohol? Are you having trouble getting enough calcium or vitamin D? Are there medications you are taking that could be changed? Is it time to start screening?


While many people think about osteoporosis as a woman’s disease, it affects men too, albeit at lower rates. In fact, men may have a higher risk of death after a hip fracture. We all need to be thinking about our bones. It’s never too early. Or too late.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 09 Feb 2026 15:46:17 GMThttps://www.prairiedoc.org/blog/spring-into-seasonal-allergiesPrairie Doc Perspective Week of February 8th, 2026
“Spring into Seasonal Allergies”
By Jill Kruse, DO
The groundhog may have seen his shadow, but Spring will be here soon.  While many of us look forward to warmer days and blooming flowers, those who suffer from seasonal allergies know that the return of grass, budding trees, and blooming flowers can lead to more sneezing than smiles.  Welcome to the Spring allergy season.  
If your seasonal allergies seem to be getting worse each year, it is not in your head.  A Study from the National Academy of Sciences in 2021 found that over the last 30 years the North American pollen allergy season has increased by approximately 20 days.  Pollen concentrations have also risen 21%.  The Spring tree pollen season has been starting earlier and the Fall ragweed season has been ending later.  
Seasonal allergies can develop at any time in one’s life.  The most common risk factor for developing seasonal allergies is family history.  If have family members with allergies, you have an increased risk of developing them as well.  Seasonal allergies are the sign of an overactive immune system that has mistakenly identified harmless substances, like pollen, as dangerous threats to the body.  This triggers an inappropriate defense response that leads to the common symptoms of allergies like runny nose, congestion, watery eyes, itching, and sneezing.  The immune system is trying to fight pollen like it would fight a cold. This is why it can be difficult to differentiate between allergies and illness.  
There are a few ways to help decrease the risk of children developing allergies.  Several studies have shown that children who visit a farm in their first year of their life or have furry pets have a lower risk of allergies.  In that first year of life, the immune system is busy trying to figure out what things the body needs to defend against and what things are safe to ignore.  The environment on the farm has so different allergens, that it allows the immune system to become tolerant of the harmless pollen and animal dander. However, once someone has allergies, and the immune system is sensitive to these substances, further exposure to allergens that are on a farm will not help.  It will just make the allergy sufferer more miserable.  
The first line over-the-counter treatment for seasonal allergies is intranasal corticosteroids such as Fluticasone (Flonase), Mometasone (Nasonex), and Budesoninde (Rhinocort).  These nasal sprays have been shown to be more effective than over-the-counter oral antihistamines such as Loratidine (Claritin), Fexofenadine (Allegra), and Cetirizine (Zyrtec).   If the spray does not give adequate control, then adding an oral antihistamine can help. 
If these medications are not effective, then seeing an Allergist is the next step to enjoying everything that comes with April showers and May flowers.  The groundhog says we have six more weeks to prepare for Spring.  Regardless of when it comes, everyone can enjoy Spring if they understand seasonal allergies and how to treat them.  
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on  YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 02 Feb 2026 16:11:41 GMThttps://www.prairiedoc.org/blog/insomniaPrairie Doc Perspective Week of February 1st, 2026
“Insomnia”
By Kelly Evans Hullinger, MD, FACP
Difficulty sleeping is an common concern we hear about in primary care. Many of us will have trouble sleeping on occasion, but when that is a persistent pattern causing distress or functional impairment, we call it insomnia. Insomnia can mean difficulty falling asleep, difficulty maintaining sleep, or waking early unable to fall back asleep. 
First and foremost, is the difficulty sleeping causing problems? If it is not resulting in problems with daily functioning, we may need to manage expectations around sleep. Not every person needs 8 hours per night, and if your imperfect sleep is perfectly tolerable, it is probably best to leave it alone. As we age, we need less hours of nighttime sleep; again, as long as you feel well during the day, that is just fine.
For those whose poor sleep is resulting in intolerable drowsiness or difficulty functioning at work or home, I have more questions. Is an acute illness or stressor contributing? Might there be another sleep disorder like sleep apnea or restless leg syndrome? Is pain, an urge to urinate, or some other physical symptom causing your awakenings? Is there underlying depression, anxiety, or other mental health concerns? Are you taking any medications or substances that might cause sleep disruption? Addressing any of these may significantly improve sleep. Alcohol is a common culprit; often assumed to help people fall asleep, alcohol actually yields poor quality rest.
Most patients with insomnia can be helped with behavior changes alone, or “sleep hygiene.” There are a few basic tenets, some more intuitive than others. First, optimize the sleep environment; ideally this means a dark, cool, quiet bedroom. Second, a consistent bedtime and wake time are very important, even on the weekends. This is particularly difficult for our patients who have jobs requiring rotating shifts. Next, find a bedtime routine which helps your brain wind down; think less screen time, and more reading, meditating, or listening to calming music. 
Finally, and less intuitive to most, if you do find yourself lying in bed for 20 minutes without falling asleep, get out of bed, try a calming routine over again, then get back into bed. More time spent not sleeping in your bed is more time your brain spends learning the bed is a place to be awake. Furthermore, it fuels anxiousness when we lie awake yearning for sleep, so it is best to break that cycle.
I see a lot of people tracking sleep with their smartwatch or other wearable device, and my advice is to be aware of potential pitfalls. We don’t have good evidence that the information all devices provide on sleep is accurate, and for most people tracking those statistics actually tends to increase anxiety around sleep which may worsen the problem.
Have you followed all the above advice but still suffer from insomnia? The gold standard treatment is cognitive behavioral therapy for insomnia (CBT-I) provided by a mental health professional. Beyond that we do have pharmacologic options, but medications for sleep can be fraught with potential problems, especially for our patients over age 65. Even some over-the-counter sleep medications can have significant risks in older patients, so please use caution and talk you your primary care provider.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 26 Jan 2026 15:21:09 GMThttps://www.prairiedoc.org/blog/for-the-health-of-it-be-selfish-invest-in-education-your-own-and-the-kids-down-the-streetPrairie Doc Perspective Week of January 25th, 2026
“For the health of it. Be Selfish: Invest in education. Your own and the kids down the street.”
By Greg Heiberger, PhD & Ashley McConnell, MS
When we asked ChatGPT if it was a good idea to invest in education it responded with the wisdom and confidence of a sentient being who believes they are on the cusp of knowing everything. It told me the reason to invest in education and yourself is primarily financial, using examples like increased lifetime earnings, career stability, etc. And yes, although these things are true and GPT was not hallucinating, it missed the mark. 
Education abroad programs through universities are one of the many vetted, safe, hands on, transformative experiences educational institutions provide to students and a great way for students to invest in their learning. This past May we co-led our fifth education abroad program with nearly 30 future healthcare professionals to Ghana. We spent 2 weeks in west Africa shadowing and learning, providing support as needed, developing empathy, and building communication, diagnostic, & clinical skills. This experience was transformational, for me as an educator, and for every student who is so fortunate to invest in themselves in this way.
Over the span of 2 weeks students spent half of each day shadowing in the KNUST Hospital in Kumasi, Ghana. We then engaged deeply in the community and culture each afternoon. Students visited a local elementary school, the largest market in west Africa, learned local history, and toured a slave trade castle where 30,000 slaves made their way through the door of no return each year. We were fortunate enough to participate in a safari with close-up experiences with monkeys, baboons, elephants and more. Finally, we spent a few days learning about the history and current healthcare system in the U.K. with our boots on the ground in London. We rode big red busses and saw Big Ben, and hosted a guest lecture with a professor from Cambridge Medical School. In just 17 days, students had powerful opportunities to learn about healthcare systems in hands-on ways across the world.
These experiences built empathy, opened students’ eyes to the developing world, and transformed their lives and their future work as healthcare providers. As students reflected on their experiences in the hospital, they started to see how culture influences a person’s experience with healthcare and then started to see those same values reflected in our afternoon excursions. One quote from a student highlighted family and how that extends to the community: “After seeing how these patients rely on their family and how family-orientated their culture is, I was challenged to see the importance and role of family in the US.”
To learn more, tune in to Prairie Doc Programming to see and hear directly from students about their life-changing experiences. We guarantee you’ll leave inspired and hopeful. Then use that inspiration to invest in yourself, set a goal to read more, attend a webinar, recommit to your health and wellness goals, and if you find yourself so inclined to invest in the education of others check out https://www.sdstatealumnifoundation.org.
We want to interject one final observation. We want to assure you the kids are alright. There are many negative hot takes about the younger generation and overall they are wrong. Keep investing in these amazing youth and our future is bright – the kids are alright!
Dr. Greg Heiberger serves as the interim dean of the Van D. & Barbara B. Fishback Honors College. He previously served as associate dean of academics and student success in the College of Natural Sciences at South Dakota State University and is a tenured associate professor in the Biology & Microbiology Department. He helped to create and implement the SDSU - KNUST relationship, has led numerous study abroad experiences including 4 courses to Ghana.
Ashley is the Coordinator for Student Success with the College of Natural Sciences. She has been advising pre-medical students since 2022 and has led several study abroad programs, including 3 programs to Ghana. She also teaches First Year Seminar and Career Seminar courses, and MCAT prep every spring. 
Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Tue, 20 Jan 2026 16:30:37 GMThttps://www.prairiedoc.org/blog/sole-survivors-how-to-give-your-feet-the-support-they-need​Prairie Doc Perspective Week of January 18th, 2026
“Sole Survivors: How to give your feet the support they need”
By Jill Kruse, DO

Our feet support us all day, but often get overlooked until they start hurting.  When every step hurts, it becomes clear how important our feet are.  There can be many causes of foot pain.  There are many things that can cause foot pain. A common cause is problems with the arches in the feet.
There are three arches in the foot.  They are created by ligaments and tendons in the foot along the metatarsal and tarsal bones.  The transverse arch is just behind the toes and goes across the front of the foot. The lateral longitudinal arch is on the foot's outside. It helps keep your foot stable while walking.  The medial longitudinal arch is the one that we are most familiar with. It is what most people refer to when they describe having high arches or flat feet. 
These three arches form a triangle in your foot from the heel to the base of the toes. The foot's arches are key for balance and shock absorption while walking.  Problems with the arches can cause issues with the ankles, knees, and even cause issues in the back.  It is important to address issues with the arches to prevent problems elsewhere.
“Flat feet” is when the medial transverse arch falls. This makes the ankle roll inward. We call this condition “pronation.”   Some people do not have any pain with this condition. In some people, this pronation can lead to pain. You might feel it in the arch of your foot, your ankle, or your knees. This happens because ligaments and tendons get stretched too much. 
High arches are the opposite of flat feet. This is where the arch of the foot rises higher than normal.  Due to this, the foot does not absorb shock as well when walking and can lead to increased pain in the feet.  It can also lead to hammertoes, bunions, and plantar fasciitis. This also affects how weight distributes across the foot, which can impact balance.  
While both of these conditions sound like opposites, it is possible to have both at the same time. A person may have a high arch while sitting. However, when they stand and put weight on their feet, the arch can flatten to flat feet.  The answer to both of these problems is the correct support for the foot and arch.  Flat feet need help to maintain the normal arch. High arches need extra cushioning and support. This helps spread weight and absorb impact while walking. 
No one wants their feet to merely survive the day. If you’re worried about your arches or have foot pain, seeing a podiatrist is a great first step.  They can help get you back on track to walking pain-free so you can not just survive, but thrive. 
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).]]>Mon, 12 Jan 2026 15:24:06 GMThttps://www.prairiedoc.org/blog/accidents-happen-but-being-prepared-saves-livesPrairie Doc Perspective Week of January 11th, 2025
“Accidents Happen, but Being Prepared Saves Lives”
By Andrew Ellsworth, MD


Many of us have been there before—near the top of a ladder, stretching just a little farther to finish the job. Maybe we are cleaning a gutter, hanging Christmas lights, or rescuing a cat from a tree. There is always the temptation to climb one rung higher to reach that final spot.


According to CDC data from 2022, accidents are the third leading cause of death in the United States, behind heart disease and cancer. For those ages 1–44, accidents are the leading cause of death. These unintentional injuries include poisonings and overdoses, falls, and motor vehicle crashes. The leading causes vary by age.  Motor vehicle crashes have historically been the most common cause for teenagers and young adults, though firearms became the leading cause of death for children and teens ages 1–19 in 2020. Poisonings are a major cause of death in both very young children and middle-aged adults.
For adults over age 65, falls are the leading cause of fatal injury. A common and devastating scenario occurs when an older adult falls and breaks a hip, setting off a cascade of complications that can lead to hospitalization, loss of independence, nursing home placement, and even death.


So what can we do to reduce the risk of accidents? Some of the advice may sound like common sense—or like something a responsible parent would say—but it matters. To prevent motor vehicle crashes, avoid driving while impaired, overly tired, or distracted by your phone. Always wear a seatbelt. Drive defensively, obey traffic laws, and adjust your speed for weather and road conditions. If conditions are poor, the safest choice may be to stay home.


Firearms should be locked securely, stored separately from ammunition, and kept out of reach of children and individuals at risk of harming themselves. Education, proper training, and safety courses are essential.


To reduce poisonings, store medications, cleaning products, and chemicals in their original containers and out of sight and reach. Dispose of expired medications properly, and always read and follow labels carefully. Avoid illegal substances altogether.


Finally, falls can sometimes be prevented. Avoid ladders if you have balance issues, and never stand on the top steps. Make sure ladders are secure and have someone assist when possible. To prevent ground-level falls, especially in older adults, remove clutter, improve lighting, install grab bars and handrails, use non-slip mats, wear proper footwear, and address vision, hearing, and balance issues.


Accidents are not always random. Many are preventable with awareness, preparation, and a willingness to slow down. The lesson is simple: don’t take the extra step on the ladder, but do take the extra step to prepare and protect yourself and others from injury


Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 05 Jan 2026 17:26:32 GMThttps://www.prairiedoc.org/blog/beyond-memory-loss-the-human-side-of-dementiaPrairie Doc Perspective Week of January 4th, 2026
“Beyond Memory Loss: The Human Side of Dementia”
By Ranelle Nissen, Ph.D., OTR/L and Allison Naber, Ph.D., OTD, OTR/L
First, you notice the small changes. It may be challenging to find the right word or remember the name of someone you just met. You may forget where you placed your keys when you came home from the grocery store. Overall, you feel healthy, and these instances are easily brushed off as a normal part of aging or the result of poor sleep the night before. However, over time, these instances become more frequent, and you start to miss appointments or struggle to organize your shopping list. If this sounds like you or someone you know, it is time to seek medical help to get screened for dementia.
Dementia is an umbrella term for diseases, such as Alzheimer’s, that cause abnormal brain changes. Over six million adults in the U.S. are living with dementia. There is no clearly identified cause for dementia, but risk factors include age, genetics, family history and lifestyle choices. The cognitive decline associated with dementia may impact a person's memory, thinking, mood, behavior and functioning. As the disease progresses, the person will need greater assistance with everyday tasks, such as balancing their checkbook, driving, preparing meals and grocery shopping, and eventually with personal care, such as dressing, bathing and toileting. Though new research has identified promising medications to treat the symptoms and slow the disease progression, there is no cure for dementia.
As the disease progresses, its effects reach beyond the individual who has received the diagnosis. The person living with dementia will require increasing levels of support, which is frequently provided by unpaid family members or friends, referred to as care partners or caregivers. These care partners dedicate significant time and financial resources to assist the person with dementia as their needs intensify. Often, they assume responsibilities around the clock and may feel isolated.
If you or someone you love is in this situation, the first step is to seek a diagnosis. Schedule an appointment with your primary care doctor to discuss your concerns. They might refer you to a specialist for further evaluation. Once diagnosed, reach out to the support services available in your community and online. Resources are available through organizations such as the Alzheimer’s Association and the Veterans Affairs, as well as state agencies such as the Department of Human Services. No one needs to face this journey alone. These organizations provide education, respite care, meal preparation, light housekeeping, personal care and support groups. Check with your state to see what resources may be available to you. 
In addition to seeking support, it is important to remember that maintaining a sense of purpose and connection can make a meaningful difference for both the person living with dementia and their care partners. Engaging in familiar routines, enjoying favorite activities, and nurturing relationships with family and friends provide comfort and help preserve quality of life. Simple adaptations—like labeling cabinets, organizing daily schedules or using reminder notes—can promote independence and reduce frustration in the early stages. Open communication among loved ones, health professionals and support networks is key to adapting to changing needs. While the journey with dementia brings many challenges, focusing on strengths, celebrating small victories and accessing available resources can help foster resilience and hope for everyone involved.
Ranelle Nissen, Ph.D., OTR/L, serves as an associate dean and associate professor in the School of Health Sciences at the University of South Dakota. Dr. Nissen is a licensed occupational therapist in South Dakota and has helped families and individuals affected by dementia through both her professional work and her volunteer work with the South Dakota Alzheimer’s Association. Allison Naber, Ph.D., OTD, OTR/L, is the academic fieldwork coordinator and an associate professor in occupational therapy at the University of South Dakota. Dr. Naber is a licensed occupational therapist in Minnesota and South Dakota. She volunteers for the South Dakota Alzheimer’s Association as a support group facilitator and community educator. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
]]>Mon, 29 Dec 2025 16:19:23 GMThttps://www.prairiedoc.org/blog/keeping-us-in-balance-the-work-of-the-kidneysPrairie Doc perspective Week of December 28th, 2025
“Keeping Us in Balance: The Work of the Kidneys”
By Andrew Ellsworth, MD


Picture a man crawling through the desert in tattered clothing, whispering “water” as he nears an oasis. He isn’t thinking about his kidneys, yet they may be the main organ still keeping him alive.


The human body does an amazing job at maintaining the balance of our internal environment, known as homeostasis. The kidneys, those two bean-shaped organs at our sides, are vital for maintaining that balance. Through filtration, reabsorption, and the secretion of hormones, the kidneys are one (or two) of our most important organs. 


Each day, the kidneys filter roughly 50 gallons of blood, enough to fill a bathtub. In doing so, they remove waste products and toxins that would otherwise build up and cause harm. They also regulate electrolytes such as sodium, potassium, calcium, and phosphate, which are essential for proper muscle, nerve, and heart function.


The kidneys regulate our fluid balance. If we are dehydrated, they will reabsorb more fluid back into the bloodstream.  Meanwhile, if there is excess, they will increase urine production.  On a normal day, a healthy person usually only needs to drink when feeling thirsty.  Anti-diuretic hormone is secreted by the brain when you start to get dehydrated, telling the kidneys to retain more fluid, and giving yourself the sensation of thirst.


The kidneys help regulate blood pressure through their control of salt and water retention or excretion. They maintain acid-base balance, keeping the body’s pH within a narrow, safe range. In addition, the kidneys secrete hormones involved in bone health and stimulate the bone marrow to produce red blood cells.


With all these responsibilities, preserving kidney health is essential. You can support your kidneys by preventing imbalance where possible. Eat a healthy diet low in salt and added sugar. See your healthcare provider regularly to screen for diabetes and monitor blood pressure, the two leading causes of chronic kidney disease. Avoid taking excessive amounts of medications such as ibuprofen or naproxen. Other prescription and over-the-counter drugs, supplements, and herbal preparations can strain the kidneys as well—so use them carefully and follow directions.


With the kidneys, balance is key. Avoid excess, protect your health, and your kidneys will likely manage the rest. Whether you are sleeping soundly at home or desperately seeking water under a desert sun, your kidneys continue their quiet work—filtering, regulating, protecting, and keeping your body in balance.


Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
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