By Jill Kruse, D.O.

I was sitting in my beach chair on vacation soaking up the sun when I overheard the couple next to me sounding concerned. They were throwing out lots of big medical terms but were very confused and said that they did not understand anything that they read on this MRI report. I turned to them, apologized for eavesdropping, and introduced myself as a physician. I offered to “translate” what the radiologist report said, and they gladly accepted. 

Their problem was not a lack of information. They had access to the patient portal and were able to download the MRI report and the physician’s notes. All this information was written in medical terms, acronyms, and shorthand with a few words in Latin and Greek sprinkled in. What they lacked was clarity and understanding.

So, I sat there on the beach and translated the report into layman’s terms. The family was grateful, and I was happy to help ease their minds. This was not what I had planned to do on this beautiful day at the beach, but it was rewarding to be able to use my knowledge and skills to help them get some clarity. However, it was disheartening that they had to rely on help from a stranger who happened to overhear their discussion about arteriovenous fistula.   

The medical record is written by doctors to communicate to other doctors and is full of terms and jargon that are not used by most people. Having access to this information is good, but when taken out of context or the relationship of a visit with a physician, information can cause more confusion and unnecessary anxiety.

To quote Takeda Shingen, “Knowledge is not power, it is only potential. Applying that knowledge is power. Understanding why and when to apply that knowledge is wisdom!” Years of medical school, residency, and continuing medical education help doctors gain knowledge, understanding, and hopefully, the wisdom to communicate effectively with our patients.

A worthy health care team welcomes and encourages questions, eager to give you the best information possible. We want you to know what is going on with your health, and to fully understand what all the labs and tests mean.
If you ever feel like this family on the beach, my recommendation is to contact your physician or health care provider and ask for more time to discuss your health status. Doctors on the beach everywhere will thank you, as we relax and enjoy our time with our family knowing that your family is well taken care of.
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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.  

By Andrew Ellsworth, M.D.
 
My last conversation with Grandpa was over the phone. He was sick and dying. I was 1,200 miles away in residency, learning how to be a family physician. I was not going to make it home in time to see him one last time.
 
We did not know exactly what was wrong. Sure, he could have had more tests and been admitted into the hospital, but that was not what he wanted. Thankfully, a family friend and physician had talked to my grandparents about their end-of-life goals. This discussion helped Grandpa realize what was important to him, like his faith and being with Grandma, and what was not, like spending time in doctor’s offices and hospitals. 
 
Even though I was a physician in training, I supported his choice. He was in a peaceful place, listening to music, talking with Grandma and other friends and family. 
 
Most people want to die at home. However, only 20 percent do. When it comes to dying, some advance planning may make a world of difference. 
 
It does not require an official document or appointment with a lawyer to make plans for how you would like to spend your final days. It does not even necessitate a visit with your doctor, although all the above may help. The most important thing is talking to your loved ones about your wishes and goals of care.  
 
How do you know when to have this talk, how to bring up the topic, and what to say during the conversation? How and when do you say “enough is enough” when it comes to searching for a cure, a surgery, a treatment, or spending a few more nights in the hospital? Discussing these questions may not be easy, but it is more productive and less stressful to have the conversation now rather than during a crisis.
 
Start with scheduling an appointment with your doctor for the sole purpose of talking about your end-of-life goals, expectations, and values. Then, together, adjust your care plan accordingly. Revisit these discussions periodically with your family and your healthcare providers. 
 
It was tough not being there with Grandpa, but he was at peace, so I was at peace. This past year, many others have had to say goodbye remotely or did not even have the chance. This is a reminder for us all to have meaningful conversations, to tell our loved ones how much they mean to us, and to cherish the time we do have together. 
 
Andrew Ellsworth, 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 Andrew Ellsworth, M.D.
 
We all know the feeling. You ate too much, and now your stomach is letting you know about it. Or maybe you ate some junk food, and now you don’t feel well. How is it that another slice of pizza one moment seems like exactly what we want, but later we realize it was not what we needed?
 
In the simplest of terms, it comes down to hunger and cravings. The message for hunger is initiated by the body. When our stomach is empty, and our blood sugar and insulin levels begin to drop, our bodies release the hormone ghrelin and send it to the hypothalamus in our brains resulting in a desire to eat. Cravings, however, are entirely controlled by our brain. Fatty and sugary foods help release feel-good opioids and dopamine in our brains. The message in this case is a misapplied sense of reward.  
 
Our bodies, especially the gastrointestinal system, respond directly to what we put into them. Many common problems like abdominal pain, heartburn or reflux, constipation, and diarrhea are often directly caused by our diet. Other conditions like irritable bowel syndrome and Celiac disease can also be treated by a change in diet. Cutting down on processed meats and processed carbohydrates may help decrease your risk of colon cancer. 
 
Thus, when it comes to filling our hungry stomachs with healthy options, there are ways to overpower the feel-good cravings from our brains. First, turn off the TV. Plenty of studies have shown we eat more than we ought to with the TV on. That goes for your phone, too. Second, slow down. Savor your food. Give your body time to send the signals from your digestive tract to your brain that you’ve had enough. Third, drink water while you eat. Room temperature water is best for digestion. Also, we often misinterpret being thirsty for being hungry. Having a glass of water before you eat can help satisfy your thirst and help you eat less. Fourth, eat with someone in person, via Zoom or phone call. When you eat with someone you are more likely to make healthier choices and eat slower.
 
Our bodies know what is good for us. We just need to understand the messages. Next time you have a craving, or think you feel hungry, rather than automatically eating more, take time to assess your situation. If you discover you are tired, stressed, sad, angry, or lonely, appreciate your new self-awareness and explore behaviors other than eating that could better satisfy your needs. If what you are feeling truly is hunger, give your body what it really wants: a healthy diet.
 
Andrew Ellsworth, 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 Tyler A. Ptacek, M.D.
 
Back pain can be disabling, not only in terms of employment but also in terms of social connections. This point was never more clear to me than when I saw Maria, a 56-year-old experiencing severe low back pain for nearly five years. The pain prevented her from standing or walking for more than five minutes at a time and had cost her the job she loved. Maria shared with me her one heart-wrenching goal; she wanted to hold her first grandchild, a six-month-old baby boy. Doing so had caused pain so intense it put her in bed for a full day afterwards.
 
At our first visit, we discussed the treatments she had exhausted with no relief. Pain pills had severe side effects. She tried numerous steroid injections which seemed to help for several weeks, but the pain returned as did her disability. These "quick fixes" were not only failing to relieve her pain but were causing other health issues. She was diagnosed with osteopenia and pre-diabetes; both are known risks of prolonged steroid use. She had been told there were no other options for her. I reviewed her medical history and immediately noticed a glaring treatment deficit; she had never been to physical therapy. 
 
After six weeks of physical therapy and a trial of some basic non-opioid medications, she was able to lose weight and developed a home routine to decrease the pain significantly, but one problem remained. She still could not pick up her grandchild without severe pain. 
 
We ordered new imaging and found arthritis in the small, paired joints in the back of the lumbar spine, plus inflammatory disc/bone problems in the front of the low back structure. This is a well-known phenomenon called “Modic endplate changes.” For perhaps the first time, Maria received a full explanation of her imaging and learned what was causing her pain.  
 
We treated her L4 and L5 Modic changes with an outpatient, minimally invasive procedure which targets the basivertebral nerve. This treatment has the potential to provide a permanent cure for pain related to this specific problem. Maria’s recovery process was mostly anesthesia-related, and she had 80 percent relief of the pain within two weeks. At her three-month follow-up appointment, she had tears of joy as she told me how wonderful it was to hold her now one-year-old grandson!  
 
This is why I am a pain doctor, not only to relieve pain, but to restore function and help patients achieve their basic life goals. Life is about the little things that most of us take for granted, whether it is standing, walking or holding our grandkids. 
 
Tyler A. Ptacek, M.D. is a contributing Prairie Doc® columnist and a guest this week on the Prairie Doc® television show. He practices in Rapid City, South Dakota as a board certified and fellowship-trained interventional pain physician. 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.

Artists and medical personnel both know the importance of art. The famous nurse Florence Nightingale once said, “Variety of form and brilliancy of color in the object presented to patients are an actual means to recovery.” Elaine Poggi, Founder of the Foundation for Photo/Art in Hospitals agrees and stated “The mood changes when our beautiful nature photos are placed on the walls, providing color, comfort, and hope to patients, caregivers, and loved ones.”

Before COVID, the walls of my exam rooms featured some of my favorite art. Each room had a different, deliberately chosen theme. One theme was photographs of the Grand Tetons and Canyon De Chelle taken by Ansel Adams. Canyon De Chelle is on the Navajo reservation where I did a rotation as a resident. Another room was filled with an Asian mural and photographs of my time in South Korea when I was a student ambassador for SDSU at their sister school in Taejon, South Korea. My third exam room had circus posters and pictures of Baraboo, Wisconsin, hometown of the Ringling Brothers, and the location where I did my residency training.

The art helped break the ice with patients and allowed me to share a special part of myself and my life with them. It also provided my patients with something to look at while waiting for me to come into the room. It gave us something to talk about other than their illness or why they came to the doctor that day. As part of the discussion, I learned about my patients’ travels, their love of photography, or memories of going to the circus as a child. Each picture was an opportunity to share a common bond. 

COVID forced those pictures off the walls and into storage. The rooms were stripped of anything extraneous that could potentially become contaminated. My exam room walls are now blank and sterile; the rooms seem a little colder and less inviting. There is less color and joy in the rooms. Without art, we tend to jump into the clinic visit topic without first connecting as people. I didn’t realize what a big difference the loss of art on the walls could make until it was gone. 

Dr. Rachel Naomi Remen said “At the deepest level, the creative process and the healing process arise from a single source. When you are an artist, you are a healer: a wordless trust of the same mystery is the foundation of your work and its integrity.” Photographer Prakash Ghai explained it much more succinctly when he stated, “Art heals both the creator and the viewer.” I miss my art and cannot wait until I can once again hang some healing on my exam room walls. 

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. 

By Jill Kruse, D.O.

This has been an exhausting year for moms. Last spring, we had no idea we would still be dealing with this pandemic a year later. It presented difficult decisions, such as in-person school or remote learning, how to work from home while caring for children, or how to pay the bills without work, when to let children visit their grandparents, what to do for birthdays and holidays. Regardless of the decision made, it seemed someone somewhere was judging our choice. But I want you to know, I see you every day doing the best you can. 
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To all the new moms, I see you when the OB floor was empty of friends and family to celebrate the new life you brought into the world. If you were COVID positive, I see you with your beaming smile behind a mask as you hold your new baby. 

Mothers of toddlers, I see you trying to keep little fingers out of mouths as you teach them to wash their hands. I see you attempting to be professional on a Zoom meeting with toddlers giggling and playing in the background.
I see you moms of elementary and middle school children as you took on the role of teacher to keep your kids learning during the shutdown. I see you search for answers to big questions from your children about when things will be “normal” again.

Mothers with high school children, I see you consoling your Juniors and Seniors who missed out on sports seasons, proms and graduation ceremonies that were altered, cut short, or cancelled. I see you advertising prom dresses for sale captioned “only worn once for pictures.” 

I see you moms of college age children, yes, they are still your babies, as they prepare to leave the nest for school or a job. This new world experience will not be the same as you remember, yet I see you helping to make the most of it. 

Grandmothers, I see you, too! You have two sets of babies to think about, your adult children and your grandchildren. I see you longing for their visits and hugs. And I see you when your family could not be with you in the hospital or nursing home.

Moms, I see you for the force of nature you are as you nurture your family through this pandemic. To quote A.A Milne, “You are braver than you believe, stronger than you seem and smarter than you think. But the most important thing is, even if we’re apart…I’ll always be with you.”

With much compassion and love, Tyler and Allie’s mom (a.k.a. Dr. Kruse).

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.  

By Vance Thompson, M.D.
 
In the old days, country doctors often cared for folks by coming to the patient’s homes. These house calls brought great relief to people and families that needed medical attention.

Nowadays, we are becoming familiar with telemedicine, or health care services provided electronically via the Internet. In rural settings, telemedicine helps provide specialty care to patients without the travel required for in-person visits. Access to medical care via telemedicine can greatly reduce costs and wait times for those in need. And, during the pandemic we saw how telemedicine grew tremendously, regardless of location.

Some aspects of telemedicine are almost like being together in person. For instance, according to Nobel Peace Prize recipient Dr. Bernard Lown, in about 75 percent of patient encounters, listening to the patient describe symptoms and concerns allows doctors to obtain sufficient information to make the diagnosis before performing a physical examination and tests.

Experience has shown that listening and diagnosis can occur via telemedicine, but can empathy occur to the point of the patient feeling deeply cared for? Caring is defined as feeling or showing concern for or kindness to others. I feel caring for one another is one of the most important aspects of our life here on Mother Earth.

There has been significant research about the telemedicine patient experience. In a 2020 landmark study called the Press Ganey Report on Telehealth more than 3.5 million surveys about telemedicine were sent out in the United States and the results were supportive of this new technology.  

Overall, patients considered the telehealth experience a positive. Patients also felt very cared for in their telehealth visit and they were more likely to refer their friends to a doctor who provided choice between an in-person visit or a telehealth visit. What was also interesting is that it did not matter the age of the patient. Millennials and Boomers alike gave similar positive ratings to doctors and health care facilities that provided them the option of telehealth.

Like I tell my fellow physicians and health care providers, whether in private or academic practice, or in training, we are here to serve the public. I believe telehealth is here to stay because the public wants it. Offering both a quality telehealth network visit and the more traditional in-person visits gives patients the choice with regards to which is best for them. It also demonstrates that providers and health systems are listening to the patient.
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Vance Thompson, M.D., an ophthalmologist surgeon in Sioux Falls, South Dakota, is a contributing Prairie Doc® columnist. He will guest host On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB this Thursday at 7 p.m. central. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook. 

By Kelly Evans-Hullinger, M.D.
 
My grandmother was a lively, caring, wonderful woman, who remained very active late in her life. One spring day, after an unusual April blizzard, she stepped out of her apartment on her way to her weekly bridge game. She fell on the ice, in an event that led to an open ankle fracture and changed the course of the remainder of her life.
 
We all know that a fall, especially in an elderly or frail person, can result in disaster. Major fall-related injuries such as hip fractures can sometimes precede abrupt decline in function and death in the worst cases. While many falls don’t result in any injury at all, when I discuss falls with my patients, I consider those events near misses and potentially catastrophic for any elderly or frail person.
 
Falls can have many causes, and often numerous factors contribute. Some factors can be modified by at-risk people, and some cannot. Discussing the mechanism and contributors to falls with one’s health care provider (or even better, a physical or occupational therapist) can help identify those factors. If a person can reduce their risk of fall and injury, by all means we want to help!
 
Modifiable risk factors might include weakness in large muscle groups, need for and proper use of an assistive device such as a walker or cane, and potential hazards in one’s home such as rugs or bathtubs.  Of course, in some patients there may be fall risk factors which cannot be easily modified, which might result in the decision for extra help or a change in living arrangement.
 
After my grandmother’s ankle fracture, she had a rocky course. She endured surgeries, bone infection, hospitalizations, and other medical complications. She never regained the ability to walk independently again and spent much of the last couple years of her life in a nursing home where she could receive the care she required.
 
Last summer, my grandmother contracted COVID-19 at her nursing facility and sadly died a few weeks later. A woman who led a truly remarkable life lost her fierce independence after an accidental fall. I’m sure if she could have gone back in time, she would have just stayed home that icy April day. If you or a loved one is worried about falling, I hope you will talk to your primary care provider about it.
 
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal 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 Debra Johnston, M.D.
 
Bacchus was a member of the Roman pantheon of gods. In ancient times he had a variety of attributes,
but modern culture primarily remembers him as a god of wine and debauchery. Perhaps the image of his followers, or Bacchantes, as individuals who have abandoned society to live in a raucous state of perpetual inebriation has contributed to our perception of alcoholism and addiction.
 
When I talk to my patients about their use of substances, be it alcohol, prescription medications, or street drugs, I find that most believe they don’t have a problem. They tell me they aren’t using every day, or they still make it to work in the morning, or they haven’t been arrested, or, my personal favorite, they only drink beer. 
 
There are many substances that people can misuse, and to which people can become addicted. If one peruses the current handbook that guides diagnosis in psychiatry, it is easy to see the similarities between alcohol use disorder, and opioid use disorder, and cannabis use disorder, and a myriad of other addictions. 
 
Sufferers may use more, or more often, than they intended. They may want to cut back but be unsuccessful when they try. They may spend unusual amounts of time seeking, using, or recovering from the use of their preferred substance. They may have strong cravings. They may give up other activities in favor of using. Their performance at work or school may suffer, or they may fail to meet family commitments. They may find themselves needing a greater quantity to achieve the same effect or having withdrawal symptoms. They may continue to use, despite knowing their use is detrimental to their relationships, or that it is dangerous and damaging their health.
 
It is important to recognize that a person does not need to have all the above-mentioned experiences to have a substance use disorder. Indeed, the diagnosis can be made in the absence of most these criteria. Most who suffer from addiction are not souls lost on skid row. They are our neighbors, our friends, our family.  
 
Genetics is an important predictor of who will develop a substance use disorder, but it is not the only factor. Life experiences, particularly trauma experienced in childhood, personality traits, and the social environment all affect risk. 
 
Addiction is a common disease. Drugs and alcohol kill hundreds of Americans every day. The same is true for heart disease and cancer, and we don’t criticize the patient for these diseases. It’s time we show the same compassion for people diagnosed with addiction and consign the image of the Bacchantes to mythology.
 
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.
 
Eyes are often called the “window to the soul”, but they can also be the “window to your health”. Most people know that it is essential to visit your primary physician for an annual check-up, but an annual eye exam is an important part of staying healthy as well.
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The eye is the only area of the body where doctors can see small blood vessels with such clarity. So, during your annual physical exam, your physician will examine your eyes briefly with a handheld tool called an ophthalmoscope. This device gives your physician a great view of those blood vessels located on the back wall of your eye. 

However, for a much more thorough understanding of your eye health, you need a dedicated eye exam by an optometrist or ophthalmologist. These health care providers have an arsenal of tools and techniques at their disposal for examining the eye and screening for eye disease.

For example, when your optometrist or ophthalmologist looks at the back wall of your eye, they lower the lights in the room and use drops to dilate your eyes. This enhanced exam is more effective in detecting changes in or damage to those blood vessels which can be caused by high blood pressure or diabetes. As a result, eye doctors frequently refer patients to their primary care physicians in the early stages of these diseases.  

When diabetes is diagnosed, medical doctors and eye specialists work hand in hand monitoring patients for complications from the disease. One such complication, diabetic retinopathy, damages the blood vessels of the retina and is the most common cause of blindness in American adults. This too can be detected during a dilated eye exam.  

An eye specialist can also screen for glaucoma, a condition where fluid builds up in the eye causing increased pressure that can damage the optic nerve. If left untreated, it can lead to blindness.   

Macular degeneration is another disease that your optometrist or ophthalmologist is trained to detect. This is an eye disorder associated with aging and results in damage to the central vision which at its worst can result in the permanent impairment of vision needed for reading and close-up sight. 

It takes a team of providers to monitor and maintain your health. When scheduling your annual exams, do not ignore your eyes, as they can be the “window” we need to see what is going on in the rest of your body.  

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.