Prairie Doc® Perspectives for week of October 10, 2021
By Kelly Evans-Hullinger
 
In the last couple years, I have developed a renewed awe and appreciation of our scientists around the world who work for entire careers to advance science and medicine in their laboratories and beyond. One such scientist is Dr. Barry Marshall. 

Marshall is an Australian physician scientist, who in the early 1980’s along with his cohort Dr. Robin Warren, initiated a paradigm shift in the world’s understanding of gastrointestinal disease when they discovered the bacterium Helicobacter pylori. Prior to that, peptic ulcer disease was thought to be due entirely to lifestyle factors and stress. Marshall and Warren were ultimately able to show that H. pylori played a major role in maybe 80 percent of ulcers worldwide at that time.
 
H. pylori is an unusual bacterium in that it can grow and thrive in a highly acidic environment like the stomach, and for that reason it was difficult to grow in culture. It was found to be widespread around the world, partly due to poor water sanitation systems. The bacteria can invade the surface of the stomach and duodenum, causing inflammation of the stomach or gastritis, ulcers, and rarely, stomach cancer. We now know that if H. pylori is a causative factor in a patient’s stomach ulcers, eradication of the bacteria is an essential part of curing the patient’s disease. 

Now here is the greatest piece of this science story. At the time Marshall and Warren made their discovery, the worldwide scientific community was skeptical that H. pylori was an important factor in peptic ulcer disease. H. pylori did not grow in mouse or rat stomachs, so there was not a good way to study it in a traditional lab. Famously, in 1984 Marshall underwent biopsy of his own stomach, proving he did not carry the bacteria nor have any stomach disease. Then, he drank a beaker of H. pylori culture broth. What followed was an acute gastric illness, and after 2 weeks he had another biopsy showing proven H. pylori infection and gastritis. He then cured himself with an antibiotic and bismuth.

After Marshall’s case study was published, much further research ensued. Today, we can detect H. pylori in our patients with several noninvasive testing strategies, and if detected treat them with a combination of antibiotics and acid reducing medication. Surgery to remove a portion of ulcerated stomach, commonplace prior to this discovery, is now incredibly rare in the developed world. In 2005 Marshall and Warren were awarded the Nobel Prize in Physiology for their detective work.

I wonder, had Dr. Marshall not risked his own health for his experiment, would our understanding have shifted so quickly? Maybe, maybe not, but the story sure wouldn’t be as captivating.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

Prairie Doc® Perspectives for week of October 3, 2021
By Andrew Ellsworth, M.D.
 
Imagine yourself in a blizzard so thick and cold and blinding that you could not see your hands right in front of you. Such blizzards were common 150 years ago on the upper great plains. Without much for houses and trees, the wind blew the snow with such force that the little ice crystals were more like little knives making it hard to keep one’s eyes open even if there was something to see. Thus, to get safely from the house to the barn, farmers often hung a rope between the two, to not get lost. It was literally a lifeline. Otherwise, one wrong turn and perhaps nothing would stop you from wandering across the frozen prairie. 
 
As a sixth generation South Dakotan, I cannot imagine some of the hardships my forefathers had to endure to survive. How did they feed themselves when the rains did not come, or when the fires did? How did they heat the house when the wood or coal had run out? How did they fight the boredom of months in a single room, not to mention the isolation?
 
There are many who still face those questions. Farming still carries great risks with drought, floods, or financial stress. There is the chance of failure, of losing the family farm, of choosing the wrong crops or the wrong time to plant in unpredictable markets with trade wars, changing weather patterns, and other factors. One little mistake may ruin a million-dollar piece of equipment or result in a lifetime disabling accident. 
 
Given these pressures, it may not come as any surprise that farming has one of the highest suicide rates in the nation, which has been rising over the last decade. Of course, you do not have to be a farmer to face financial, physical, or mental pressures that may contribute to feelings of helplessness, failure, loss of hope, and depression. You may be easily irritated and feel like sleeping all day, lack energy, and no longer enjoy what you once did.  
 
If you or someone you know needs help, please reach out. Hotlines available for those in crisis or for those looking to help someone else are the National Suicide Prevention Lifeline 1-800-273-TALK (8255) and the Avera Farm and Rural Stress Hotline at 1-800-691-4336.
 
Just as that rope was a lifeline from the barn back to the farmhouse years ago, a simple phone call can be a lifeline for those in need of help today. No matter your occupation or stage of life, please reach out if you need help. Even if it feels like you are in a blinding blizzard with nowhere to go, reach out and take hold of that rope, that lifeline, and make that phone call. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

​Prairie Doc® Perspectives for week of September 26, 2021
By Matthew Stanley, D.O.
 
Alcoholism, and addiction overall, isn’t a character flaw, or a weakness of self-control. It’s a disease. And, if you are like most of us, you’ve probably been affected by it. Maybe you struggle with alcohol consumption yourself or have a friend or family member who does. I rarely talk with anyone who doesn’t have a personal story about how addiction has affected their life.
 
In fact, about 14 million adults have an alcohol use disorder and there are about 95,000 alcohol related deaths every year in this country.
 
Unfortunately, we don’t think of it like any other medical illness, so we don’t usually talk to our primary care doctor about it. But that is one of the best places to start the conversation, during your yearly checkup, when you’re talking about health goals it is okay to say, “I think I have a drinking problem.” 
 
Some of the warning signs to look for in yourself or a loved one include sacrificing family bonds for your addiction such as missing a child’s ball game, concert, or graduation. Things that you were once passionate about fall by the wayside. You’re fatigued and foggy; barely able to get up in the morning. You have cravings for the substance. You’re counting down the time until you can get off work and have a drink. You are in danger of losing your job or important relationships, or you’ve gotten in trouble with the law. You tell yourself and others that you could easily quit and will; but you never do.
 
By starting the conversation, you will have a clearer path toward the help you need. Your doctor can guide you to outpatient counseling or support groups, or perhaps treatment at a facility.
 
There is overlap between behavioral health and addiction in terms of risk factors. Much like behavioral health, addiction has an approximate 60 percent genetic hereditability. Mental health conditions and a history of trauma put you at greater risk of addiction. And like so many health conditions the earlier you start the worse the disease. Those who begin drinking before age 15 have a five times greater risk of developing an alcohol use disorder.
 
I’ve spent my career talking about and treating addiction. I see that the conversation is changing, and I’m heartened by it. There is a rising social consciousness about addiction. More and more we’re willing to have candid and productive conversations about it.
 
The next time your doctor asks you about alcohol consumption, take that as a prompt to have an honest conversation.
 
Matthew Stanley, D.O., a psychiatrist in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist and guest host this week on the Prairie Doc® television show. 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 SDPB most Thursdays at 7 p.m. central. 

​Prairie Doc® Perspectives for week of September 19, 2021

By Kelly Evans-Hullinger, M.D.
 
It is September, fall is in the air, and what we might call “respiratory season” is nearly upon us. Respiratory season refers to the colder months in which we spend much of our time indoors, maybe October through March. Normally, this season correlates with when we see high rates of typically seasonal respiratory infections such as influenza and respiratory syncytial virus or RSV.

Living through the COVID-19 pandemic has given us knowledge we can use to greatly decrease the spread of all respiratory infections. During the 2020-2021 respiratory season, rates of influenza were at historic lows in South Dakota and across the country due to the measures we took to decrease the spread of COVID-19. So, what are the lessons learned?

First and foremost, we should learn that when we are sick with respiratory symptoms, we should avoid spreading our illness to others. It remains essential that anyone experiencing symptoms of cough, fever, or cold symptoms be evaluated and consider testing for COVID-19, influenza, and possibly other infections to ensure avoidance of spread.

Second, if you are sick, even if you have tested negative for COVID-19, try to avoid spreading germs to others. We should especially avoid contact with those most vulnerable to respiratory illnesses – this includes the very young and the very old and those who have suppressed immune systems or chronic lung disease. If you must be around others, keep distance when possible, cover your mouth and nose when coughing or sneezing, and at best, wear a mask to keep those respiratory droplets out of the air. I now cringe to think of years past, when I would power through my common colds and see patients without a mask. I know I can do better in the future.

Finally, vaccines remain one of our best tools for infection prevention. Of course, vaccination against COVID-19 is crucial and has proven to be highly safe and effective. But let’s not forget other respiratory vaccines. It is time to think about getting your annual influenza vaccine. And if you are 65 years old or more, or if you have any medical problems increasing your risk for bacterial pneumonia, you should ask your healthcare provider about a pneumococcal vaccine.

We have the tools to keep ourselves and others healthy during the respiratory season. I, for one, hope that lessons learned during a respiratory viral pandemic might help us all do better in the future.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

​By Debra Johnston, M.D.
 
What I remember most is the silence.
 
She was 19 years old, just starting her first semester of college. She had been transferred to our level 1 trauma center, intubated and in a medically induced coma. I was a third-year medical student, being introduced to the realities of medicine. Our team was clustered around her in the procedure room adjacent to the ICU while my senior resident inserted the central line we would use to quickly administer large volumes of medicine and fluids. 
 
ICUs can be busy, noisy places. This ICU was a large open room, with rows of beds surrounded by all the equipment needed to care for critically ill and injured patients. The sounds of machines whirring and beeping, of doctors and nurses and all the support staff, accompanied us in that little windowless procedure room.
 
The neurosurgery team solemnly filed through the door, eyes grim. They’d reviewed her CT scan. The pressure of the blood accumulating inside her skull had forced the base of her brain downward, into the space usually occupied only by the top of the spinal cord. We stared at each other in silence. We’d already lost the battle.
 
During the next few days, I watched her 20-year-old sister support their parents as we walked through the process of declaring brain death and deciding on organ donation. Other than the silence, the sister’s grief, and her courage, are my most potent memories.
 
Over the years, I’ve seen many lives irrevocably altered by brain injuries. Children thrown from their bicycles. Soldiers caught in blasts. Women battered by their partners. Seniors who slip and fall. Some patients fight to regain skills that were once effortless. Some succumb to their injuries or the consequences. The lucky ones sometimes don’t even realize how close they came to having their lives upended.
 
Our ability to help has improved significantly in the nearly 30 years since I stood at that young woman’s bedside. People survive injuries that would have previously been fatal. People recover enough to rejoin the community, instead of finishing their days in nursing homes. Nevertheless, too many still die, over 50,000 Americans every year. Nevertheless, survivors spend months relearning basic skills with the help of skilled therapists. Nevertheless, millions live with varying degrees of disability, despite aggressive rehabilitation.  
 
As with so many things, the best treatment is prevention. Buckle your children into their car seats. Use your seatbelt. Wear your helmet. Keep the guns locked up. Learn how to reduce the risk of falls, especially for the young, and the old. It’s much better to protect that fragile brain, than to try to put it back to rights.   
 
Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Jill Kruse, D.O.
 
The kidneys may be called the Rodney Dangerfield of the body, as they often “don’t get no respect.” The National Kidney Foundation estimates that one in three adult Americans are at risk for kidney disease, yet these organs are mostly ignored unless they develop stones or stop working.

When healthy, kidneys work continuously at their main job of filtering blood to remove unwanted products and help produce urine. Kidneys clean approximately 200 liters of blood each day removing up to two liters of toxins, waste, and water in the process. Perhaps less well known is the fact that the kidneys are essential for many other functions in the body as well, including managing blood pressure and preventing anemia.

Kidneys release the hormone renin which is part of the complex renin-angiotensin-aldosterone system, or RAAS, instrumental in helping regulate blood pressure. RAAS regulates sodium and potassium absorption in the kidneys and balances fluid and electrolyte levels in the body, all of which have a direct impact on blood pressure.

When treating patients whose blood pressure does not respond to medications, heart doctors will examine RAAS function. They may also order an ultrasound of the kidneys. Sometimes this reveals a narrowing of the artery going into the kidneys which may be responsible for treatment-resistant high blood pressure.

Kidneys also secrete a hormone called erythropoietin which acts on bone marrow to help the body produce red blood cells. Without this hormone, people can develop anemia.

Vitamin D is converted to its active form by the kidneys allowing the body to use the vitamin to its advantage. Thanks to the kidneys, vitamin D helps balance calcium and phosphorus absorbed from the foods we eat. Without enough calcium, people can develop weakening of the bones and muscles.

Kidneys complete these and many other functions so efficiently that a healthy person can donate one and the remaining kidney will do the work of two. They work hard to help us, so let’s do our fair share to help them. If you have diabetes, work to control it as best you can because high blood sugars can damage your kidneys. And one thing all of us can do for our kidneys is to stay hydrated.

There is no doubt that kidneys deserve more respect. Talk to your doctor about blood tests or urine tests to check your kidney’s health and functionality. Kidneys…let’s show them some respect!

Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

​By Andrew Ellsworth, M.D.
 
This summer I attended the celebration of life service for Dr. Rick Holm, the original Prairie Doc who founded this newspaper column, a radio show and a television show now entering its twentieth season. He died from pancreatic cancer in March of 2020 during the early days of the Covid-19 pandemic and thus there was no public service at the time.
 
Many friends and family gathered to celebrate Rick. We sat on lawn chairs, shared tales, and sang songs in a beautiful park on a gorgeous evening. We recalled stories of him being notoriously late, knocking over wine glasses with his large hand gestures, and mistakenly eating potpourri thinking it was trail mix. Themes emerged of Rick’s amazing ability to accomplish so much in a day, his skill for active listening, and his passion for finding the best in people. 
 
His children shared memories of their dad, including their family bedtime prayer “Help us to be kind and honest and respect people’s choices, and help us to be better people tomorrow.” Rick crafted that prayer from the Hippocratic Oath, the promise that doctors make when they complete their training and before they begin their careers. The oath emphasizes the medical ethics principles of beneficence (to do good), and nonmaleficence (to do no harm), and the importance of patient autonomy (to respect people’s choices). 
 
Listening to the Holm bedtime prayer, I realized how the oath had taken on new meaning for me this past year as I observed people choosing to get vaccinated for Covid-19, or not. As a primary care physician, I know Rick would have recommended vaccination for all who are eligible. He was a proponent of preventative care and vaccines help prevent disease. Rick would have listened with kindness to the concerns of each patient. He would have explained with honest science how the vaccine works and how the risk of a severe reaction from the vaccine is greatly outweighed by the benefits of being vaccinated, such as reducing the chance of serious illness and complications from Covid-19. 
 
Just as my colleagues and I promise to do, Rick would have cared with beneficence for his patients that were sick with Covid-19, even if they refused the vaccine. He would have respected their choices and held their hand with no maleficence, no judgement, or condescendence. At the same time, he would have celebrated with a Snoopy dance those who choose to get vaccinated, those who choose to quit smoking, to start exercising, and to eat healthier. As we carry his legacy into another decade, we continue the message of The Prairie Doc, “Stay healthy out there, people!”
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

By Dr. Luke Mortimer, M.D.
 
I recently saw a patient I hadn’t seen in more than 18 months. This patient had previously come to me somewhat routinely for arthritic knees. Together, we constructed a conservative treatment plan to help increase activity and prolong the life of those knees. Unfortunately, the Covid-19 pandemic put a dent in our plan. Prior to the pandemic, this patient had been a borderline diabetic with some other medical comorbidities. Upon their return, we found a lot had changed. The patient had gained 30 pounds, decreased activity, and could not move about very well. We had to revise our plan based upon the patient’s current condition. I have observed, over the last few months, this scenario is not unusual.

With the pandemic, many people simply stopped moving and as a result their joint related complaints skyrocketed. This inactivity created a significant increase in pain and discomfort in those with underlying arthritis. As patients continue to return to society and have a difficult time picking up where they left off, what do we do to help them get back to their normal?

First, identifying the significance of their medical and orthopedic issues is key. Those with more combined orthopedic and medical issues may require a multidisciplinary approach amongst physicians. Success is more likely if the patient and orthopedic surgeon work together with the primary care physician to assist in management of weight, diabetes, cardiac and other issues that need specific attention. Great communication amongst providers is essential to maximize the benefit for the patient.

Second, developing a plan that will assist in overcoming these issues is the next goal. This may involve cautious use of anti-inflammatories or corticosteroid injections to help decrease inflammation. It may involve viscosupplementation or “gel” injections to assist with lubrication. Physical therapy to focus on getting specific muscle groups to unload the joint while also allowing increased movement may be a great place to begin. Walking, water walking, water aerobics, elliptical machine, bike riding, or hiking are great examples of low impact activities that promote good joint health. The overall goal is to get patients that stopped moving back to an active lifestyle. As many of my patients and colleagues say, “motion is the lotion”.

We all know the pandemic has been difficult and affected us all in different ways. Getting outside, increasing activity, and developing goals to help people get moving again is paramount for overall health. A good conversation and developing a plan with your local health care team is a great way to begin your return to wellness.
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Luke Mortimer, M.D. is a contributing Prairie Doc® columnist. He practices as a board-certified orthopedic surgeon in Rapid City and Spearfish, South Dakota and Gillette, Wyoming. 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 SDPB most Thursdays at 7 p.m. central.    

​Prairie Doc® Perspectives for week of August 15, 2021

By Debra Johnston, M.D.
 
“First day of school! Wake up! Come on. First day of school,” the little fish shouts at his dad in the opening scene of Finding Nemo. The first day of school is an important transition for students of all ages, and it is often a challenging one. That is particularly true this fall as we start yet another academic year marked by the pandemic.
 
Parents have an important role in preparing their children for a successful school year. First, start adjusting the schedule. Many families relax the rules during the summer and may be in the habit of staying up late and sleeping in. Make sure your child has time to adjust to their school year routine before that first day. Second, develop good habits by acting ahead. Having the backpack ready and clothing laid out the night before saves scrambling in the morning and reduces the risk of forgotten items. Invite your children to help decide if they want school lunch or a sack lunch and let them help pack their lunch boxes. 
 
Back to school checkups for your children provide a valuable opportunity to talk to the doctor about physical, developmental, and social changes. Additionally, children may need immunizations: boosters for tetanus and pertussis, or shots to protect them from HPV, meningitis, and Covid. 
 
The Covid vaccine is available to those age 12 and over, and I urge parents to schedule those shots if your child is eligible! Although in general children are less likely than adults to end up in the hospital with Covid, we do see previously healthy children become seriously ill and suffer complications. The jury is still out on whether the Delta variant is more dangerous to children than previous variants, but we do know this variant is more contagious, which means more people fall ill. Infected children can spread the virus to other people who may be more likely to develop serious illness. There are still many people who are not eligible for the vaccine, who have chosen not to get the vaccine, or whose vaccine may not be as effective as hoped due to underlying health conditions.
 
Many children feel nervous about the start of school and those jitters may be worse this year due to the pandemic. Talk to your children about their concerns. Help them work through “what ifs”: What if I forget to wash my hands? What if I start coughing during school? What if I forget my homework? Most adults have had practice dealing with these experiences in the moment, but we, too, can benefit from mental rehearsals. Become familiar with your school district’s plan for controlling and responding to the pandemic so you can help your child with changing conditions. 
 
With a little preparation, we can reduce stress, set our kids up for a successful year and help them be as excited as Nemo to start school!
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 SDPB most Thursdays at 7 p.m. central.        

By Jill Kruse, D.O.
 
It is often said that laughter is the best medicine, yet I have never written a prescription for a funny movie, or a television comedy show, and I have no clowns or rubber chickens in my office. On the contrary, doctors are often expected to be serious and professional. Perhaps we are missing a great opportunity to help heal. What if more doctors were like Dr. Patch Adams, who is known by the medical community for his quest to inject humor and laughter into the treatment of patients? 

In medicine we work to cure disease. To cure means “to eliminate all evidence of disease.” However, there is a second goal that we also have and that is to heal. To heal means “to become whole by strengthening the mind and spirit to improve the quality of life, even if, or when, no physical cure is possible.” Laughter helps us heal. There have been multiple studies on what happens to the human body when we laugh. Research has been done on the importance of laughter from children to the elderly and no matter the age, laughter is the best medicine. 

Due to the mind-body connection, laughing can aid your brain in producing chemicals that help your heart work better and pump more evenly. Laughing can assist in reducing pain by causing the body to produce its own natural painkillers. A deep belly laugh benefits and enhances your intake of air, which stimulates the lungs and muscles. Laughter helps boost your body’s immune system to help you prevent and fight off infections. It can also lower your stress level and give you more energy. 

According to the American Heart Association, research has shown that laughing can decrease stress hormones, reduce artery inflammation, and increase your HDL (good cholesterol). Who knew that a laugh could do so much good? A study on adults age 65 and older in Japan showed that even after adjustment for high cholesterol, high blood pressure, depression, weight, and other risk factors, the frequency of heart diseases among those who never or almost never laughed was 1.21 times higher than those who reported laughing every day. In the same study, the risk of having a stroke was 1.60 times higher for those who almost never laughed compared to those who were full of mirth.

So, I will leave you with a few “treatments” to help improve your health today. Why did the pillow go to the doctor? Because he was feeling all stuffed up. Why did the cookie go to the hospital? He was feeling really crumby. Does an apple a day keep the doctor away? Only if you aim it well enough. Did you hear the one about the germ? Never mind; I don’t want to spread it around. Laughter is one medicine for which there is no maximum dose. Laugh often and well for a happy and healthy life. 
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Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 SDPB most Thursdays at 7 p.m. central.