By Andrew Ellsworth, MD
 
When I come home from a day at the clinic and hospital, there is no better feeling than my children running up to give me a big hug. For the past couple of weeks, I have had to remind them to stop, and just do an air hug until I have had a chance to change clothes and shower. The idea is to wash away any germs and decrease the risk of getting my family sick after working with several patients and sick people during the day. Maybe these efforts are too much, or maybe they are not enough. 
 
The Covid-19 virus spreads through respiratory droplets, from talking, coughing, or sneezing, and appears to also spread via a fecal-oral route. The fecal-oral route is how the stomach flu often spreads, and many of us know how easily that circulates through families and daycares. Someone who has been to the bathroom may touch a doorknob or a serving spoon, which someone else touches before eating, and they may become infected. That’s why we need to wash our hands well and avoid touching our face and our food.  
 
Unfortunately, the virus can spread from people that do not have symptoms, or before they have symptoms which is why, I worry, I may not be doing enough to protect my family from the one person who puts them at the biggest risk: me. Some doctors and nurses are deciding to avoid their families altogether and live in the garage or the basement when they come home. I haven’t decided to do that yet, but maybe I should, or maybe I will. 
 
Pandemics and disease have separated families for longer than the history books can tell us. Before they knew the cause, our ancestors knew that if someone had smallpox, quarantine and fire were the only ways to help prevent the spread. People, houses, and entire cities were quarantined. Disease has arguably decided more wars than the battles themselves. During the 1918 influenza pandemic, soldiers from Fort Riley carried the disease to other American military bases and from there, to the battlefront in Europe.  
 
These lessons of history helped us learn about how to control disease. Advancements in infection control, medicines, and vaccinations have turned the tide and made many diseases a distant memory. For Covid-19, we do not yet have proven medications or a vaccine. However, we are learning more every day how to help those who are sick and how to better prevent the spread. In the meantime, my family and I will continue to practice social distancing and similar efforts to do our part to flatten the curve and slow the spread, to give us time to find treatments to combat this current scourge on humanity.  
 
Andrew Ellsworth, MD 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, DO
 
History has its eyes on you. That is a quote from the popular musical Hamilton, but as we are dealing with a global pandemic it also applies to all of us.  The year 2020 is going to be remembered someday in history books.  How it will be remembered is in part, up to us.  Will this year go down in history as a time of great selfishness – with people hoarding masses of toilet paper and masks?  Will this year go down as a time when we all came together to help our neighbors through this scary and uncertain time? 
 
There are heartwarming stories of people in Italy singing from their windows at night.  All these voices raised up together to bring hope and a small spark of joy.  Even though they are separated physically by the quarantine, they unite in spirit and in song.  In the United States there have been reports of neighborhoods that are connecting on social media to see who on their block needs resources.  They assign “team leads” to check in with each family to see if they need anything.  The “team lead” arranges for someone in the neighborhood to deliver groceries and medications to the doorsteps of the elderly or those quarantined. 
 
Families are home eating together each night.  Activities have been cancelled and the normal day to day busyness has gone away.  At my own home, board games are being pulled out of the closet, books are being read more, and family movie night is a regular occurrence.  There is no rushing to get out the door to this activity or that event.  In the midst of the fear and the uncertainty, I am trying to savor the quiet moments at home with those I love most. 
 
Now is the time to re-connect with family and friends that you “didn’t have time” to talk with.  Now is the time to send that text or email.  Don’t hesitate to make that phone call or Facetime someone who is important, but previously was not high on your list of things “to do”.  This past week I have had more phone calls and text messages from friends and family than I can ever recall before.  That has been a gift. 
 
Every day we write history.  Today we get to decide what people will remember about this year.  Let’s do everything we can to show how we can come together to save lives and overcome this disease.   
 
Jill Kruse, DO 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, MD
 
With the coronavirus causing school to be cancelled, my son brought his schoolwork home. He shared with us a Greek mythology worksheet about Pandora’s Box. If you aren’t familiar, the Greek god Zeus gave a wedding present to beautiful Pandora but instructed her not to open it. Like many of us, impatience and curiosity got the best of her and she opened it anyway which caused a lot of new problems.
 
Similarly, with Covid-19, this new virus is already out of the box. This is a global pandemic and we are being asked to be patient and conform to social distancing to help slow down the spread. This is our current challenge. Every day we hear about sporting events, concerts, schools, and travel plans being cancelled. This is the best-known method to slow the spread of Covid-19. The less we are mixing and mingling, the less the virus is spreading. 
 
When we slow the spread, we give our healthcare systems the best chance at having the resources on hand to keep up with the number of people who need help at any given time. In areas of the world where cases of Covid-19 were allowed to spike, the healthcare systems are overwhelmed. Some hospitals don’t have enough beds, enough ventilators, enough medicine to treat everyone that needs help. They don’t have enough masks and gowns to protect their staff. In these situations, doctors are having to decide who gets treatment, and who doesn’t.  
 
Thankfully, of those who become infected, possibly 80 percent will have only mild symptoms. Some may not have symptoms at all. However, we need to understand that some will become very sick and some will die. Unlike influenza, Covid-19 is a new virus. Therefore, none of us have immunity from the past or from immunizations. There is no herd immunity. 
 
That is why events are cancelled. That is why social distancing is urged. Since most people will only have mild symptoms and some people may not have symptoms at all, the virus can be spread easily without us realizing it. We all need to be patient and follow the instructions from health officials. By doing so, we can hopefully prevent a large spike of a lot of sick people at once and avoid a worst-case scenario.
 
My son’s main impression from his school lesson was that despite the sickness and problems that were released, Pandora closed the lid and held hope inside the box. I have hope that together we will contain this virus and, in the end, this, too, shall pass.  
 
Andrew Ellsworth, MD 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 Richard P. Holm, MD
 
Our nation has a large and growing public health problem called suicide. It is the tenth leading cause of death in the United States and it is preventable. The Centers for Disease Control indicates suicide was responsible for more than 47,000 deaths in 2017, resulting in about one death every 11 minutes and it affects all ages. Suicide is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age.
 
While the causes of suicide vary, depression is often an underlying factor. Most of us periodically have what is called "situational depression," such as the understandable sadness that follows severe loss or death, but what is more typical of harmful depression is when there is no particular situation, no identifiable “reason” for it.
 
The diagnosis of depressive disorder is not easy. We suspect depression when people experience chronic pain, find it hard to concentrate, are without energy, have flares of temper, sleep too much or too little, have a loss of appetite or have over-eating binges, have unexplained crying spells, or become filled with anxiety for minimal reasons. Often people make things worse by covering-up depression with alcohol, sleeping pills, anti-anxiety medications, or substance abuse, and these all make the diagnosis even more difficult.
 
The challenging concern is that with or without a diagnosis of depression, suicide remains extremely hard to predict. We know that “talking about it” is probably our most important means to help someone who is planning suicide. Although two-thirds of the people with depression do not seek or receive help; of the one-third that do get help and follow-through with treatment, 80 percent are better in four to six weeks.
 
Whenever possible, it’s best to guide people for whom we have concern to talk about their feelings with a professional. However, the most important preventer of suicide is, in many cases, the loved one, friend or kindly neighbor who can give that person an ear, offer true compassion and call for help when red flags are flying. You may never know it, but you might save a life by listening and being a friend.
 
If you or someone you know is struggling emotionally, help is available 24/7. Call the National Suicide Prevention Hotline 1-800-273-TALK (8255).
 
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.        

By Richard P. Holm MD
 
He was my neighbor, a guy my age, a man of many talents and interests, and a dear friend. He was one of those fellows who would give the shirt off his back to help you, if needed. When he was diagnosed with cancer of the pancreas spread to liver, he, his daughters, and his friends knew how this was likely going to go. But we didn’t realize how graciously he would handle his dying process until it happened.
 
He was treated and truly helped by chemotherapy for a while, but gradually the tumor cells developed resistance to the drugs and the oncologist suggested no more chemo. He was ready to have only pain meds and hospice. In the end, per his direction, with the help of hospice and the caring people at the small-town nursing home, he shuffled off this mortal coil comfortably, surrounded by his family and friends.
 
Fortunately, he had a compassionate and grounded primary care doctor and oncologist team who were realistic and knew when to stop intervention; loving daughters and friends to surround him with support; plenty of ready-to-heat-and-eat tater-tot-like hot-dishes; an advanced directive that said he was not to have medical intervention if pointless; and plenty of pain medicine for comfort. When I visited him two days before his death, despite an expanding belly full of cancer, he told me he was getting enough meds and was comfortable. Most important, he was absolutely not fearful but courageously accepting of the dying process.
 
In comparison, I find it tragic and too common that patients and families are overwhelmed with a fear of death. Some suggest this disabling dread comes from our cultural practice of covering up death with the intent to make life easier. Thus, a lifelong apprehension and running from death has become the norm.
 
Bottom line, too many people choose to be dragged through unnecessary suffering at their end of life, and too often doctors and nurses comply. We could do a better job stopping unnecessary medicines, touching our patients more and providing comfort to not only the patient, but to the patient’s family as well.
 
Dying people have the right to ask for and be reassured that enough comfort medicine will be provided and that it’s going to be alright. Our profession has been improving in this regard, but certainly could do better. When it’s time, it’s important that we all have the opportunity for a comfortable death, just like my neighbor.
 
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook, featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.        

By Richard P. Holm, MD
 
As I was researching the history of Native American health care, I took note of the various terms used early on by indigenous people to describe European immigrants. Initially, the references had to do with skin color. Several tribes labeled Europeans as “white skinned,” or “yellow-hided.” Some tribes still use the term “umsewah,” meaning “bleached wood.” 
 
Other tribes described Europeans as “hairy mouthed,” “hair faces” and “dog faces,” referencing facial hair on European men. Ears were also important in naming. One tribe characterized the immigrants as “ears sticking out” because they did not have long hair covering their ears as did Native Americans. Some say that the ear label referred to that tribe’s word-meaning for donkey or mule.
 
As time went on, Native Americans began to describe Europeans based not only on how they looked, but on how they behaved. A Lakota word for Europeans is “wasichu,” which means, “taker of the fat, or a greedy individual.” Recognizing the transgression over the last two centuries, I can’t blame the Lakota for choosing the label, “wasichu.”

These Native American words reflect the impact of two cultural world’s colliding and reveal a disharmony resulting from the loss of access to traditional hunting and farming lands, the loss of family and language as children were shipped to boarding schools, the loss of self-respect with isolation on the reservation and much more.  The result of all this has been decades of health disparities. For example, American Indians are 50 percent more likely than white people, to have a substance abuse disorder, 60 percent more likely to commit suicide, twice as likely to smoke cigarettes or to die of childbirth, three times more likely to die from diabetes and five times more likely to die of tuberculosis.
 
But change is coming. Revered Oglala Lakota medicine man, Black Elk, prophesized that with the seventh generation following the tragic Wounded Knee massacre of 1890, Native American people would begin to recover from the historical trauma experienced since the collision of these cultures in the mid-19th century.
 
From 1890 to 2020, that’s one hundred and thirty years. Divide that by seven and, right now, you have 19-year-olds who constitute that seventh generation. It’s time for those of us with ears sticking out and those without, people of all skin colors and cultures, to create an environment that allows all people to come out of poverty and help make positive changes in Native American health care.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.     

 By Richard P. Holm, MD
 
Standing in front of a group of De Smet Parent Teacher Association® (PTA®) members, I was to play a trumpet solo. My teacher thought I was prepared, but unfortunately, I was not. My fears brought my heart up into my throat, I became short of breath, my heart pounded and, indeed, I stumbled and had to start over again. Although my failings were likely amusing to some in the audience, they were certainly not indicating any musical skills. It was a devastating experience for me.  
 
During our lifetimes, all of us experience physical and psychological ailments. People will admit to physical trouble but don’t like to admit to psychological problems, and most of us are reluctant to ask for help. Many of these feelings increase adrenaline levels which, in turn, cause fast heart rate, shaking, shortness of breath, dizziness, diarrhea, urinary frequency, sleeplessness, headache, sweating and generalized discomfort. Sometimes these feelings of anxiety are normal, and sometimes not.
 
A reasonable level of anxiety can keep us driven to hunt for food, fix something, discover another frontier and improve what we can improve. Without stressors and the anxiety that follows, some experts believe we would become lazy, stop dealing with troubles and civilization would end. On the other hand, when feelings of anxiety expand out of proportion to the trouble we are facing, or come on easily and frequently, anxiety can sometimes interfere with a normal functioning life. Too much anxiety can be harmful to an individual.
 
We are all thrown off-balance by one kind of psychological challenge or another as we struggle through the typical encounters of daily living. Who hasn’t experienced periods of anxious moodiness that follow the reduced sunlight of winter, or anxiety following the loss of a job or facing the demands of a new job? How does anyone handle a severe illness in a child or a spouse? Who can deal with divorce without anger, disappointment and, you guessed it, anxiety? Life is often very difficult; every individual will confront stressors in different ways and sometimes we just need help.
 
Bottom line: Each of us must deal with our own physical and mental illnesses throughout our lifetime, sometimes minor, like forgetting a trumpet solo, sometimes major, like a prolonged sense of anguish after a death in the family. When our ability to live a normal life is being interrupted by anxiety, it’s time to see the doctor.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.          

​By Deb Johnston, M.D.
 
Primary care doctors do a lot of different things. We diagnose illnesses from the trivial, to the catastrophic. We treat maladies both chronic and acute. We confront, and we console.
 
Of course, these are common roles in medicine, filled by many different providers. One role the primary care physician is more uniquely suited to fill, however, and one of my personal favorites, is that of guide. I’m talking specifically about the art of prevention, of maintaining wellness over the long term, and reducing the risk of diseases that might make it harder to do what you need to do, what you want to do, what you love to do.
 
Prevention is truly underutilized. We’re a lot better at looking for a problem, and a pill or a procedure to fix it, than we are at fixing what might lead to a problem in the first place. In fairness, human beings are inclined to wait for the crisis to hit before we believe it is really and truly ahead. Changing habits is hard and eating takeout pizza while watching must-see TV is a lot less work than hitting the gym and making a salad.
 
On the other hand, some parts of prevention are easy. It’s easy to get a flu shot, or a shingles shot. It’s easy to get a mammogram, or a colonoscopy. It’s easy to get blood drawn, and get checked for diabetes or hepatitis C.  
 
Of course, it’s only easy to do these things if you are aware of the benefits of doing so. This is the value of the annual checkup. From birth, to your last birthday, wellness visits have an important role. 
 
For infants and children, we monitor growth and development. For adults, we screen for diseases, and give advice on reducing risk factors that might lead to disease. Even the oldest of our old can benefit from simple tests for things such as hearing and memory. At every age, we think about safety: is that infant sleeping on her back? Is that teen wearing his seatbelt? Is that adult drinking and driving? Is that elderly person at risk for falls? Has that patient received their flu shot? 
 
Under the Affordable Care Act, most insurance programs cover prevention visits with no copay. This even includes Medicare. Everyone can benefit from these opportunities to focus on staying well, rather than treating problems. 
 
Prevention is an important part of being a primary care doctor, and an important reason to HAVE a primary care doctor. So, take your preventative action today, make a call and set up an appointment, just for that checkup. 
 
Deb Johnston, M.D. is a contributing Prairie Doc® author who has practiced family medicine for more than 20 years. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.      

By Kelly Evans-Hullinger, M.D.
 
It’s the dead of winter, and who among us isn’t craving the feeling of warm sunshine on our skin? I, for one, am dreaming of summer days spent outdoors, not a care in the world, basking in that delicious ultraviolet light. But alas, I must be my own physician buzzkill (maybe in this case, sun-kill), and remind myself that there is more to those rays than the pure delight I am romanticizing.

The truth is, there is technically no “safe” amount of UV exposure when it comes to our skin and the risk of skin cancer. One in five of us will have a skin cancer diagnosed in our lifetimes, and while many types of skin cancer are not life-threatening, some are. Melanoma, in particular, is a skin cancer with great potential to metastasize and ultimately take lives. Like other skin cancers, ultraviolet exposure is a major risk factor for melanoma.
I can recall one summer day when I was 13, I fell asleep on a July day watching a cousin’s baseball game. My fair-skinned back was exposed to the sun, unprotected, leaving me horrendously sunburned in the days that followed. I will never forget those next few days, one of which I spent carrying my golf bag on a hot, humid tournament day, my back covered in blisters. The thought of it now is enough to make me cringe.

And let’s not forget it doesn’t have to be a hot summer day to incur skin damage. Many of us have been surprised with a sunburn sustained while skiing or ice fishing – sun is sun, whether the temperature is hot or cold – and even on a cloudy day those UV rays make it down to Earth. And don’t get me (or your friendly dermatologist) started on the risks posed by tanning beds.

Protecting one’s skin from the sun is something we can all do to stay healthier. There are a variety of ways to do this: Avoiding sun entirely or staying in the shade, wearing protective clothing like long sleeves, pants, and a wide brimmed hat, physical sunscreen like zinc oxide, or chemical sunscreen – the experts recommend at least SPF 30 applied every 2 hours.
​
I still love summer. I love being outside for hours, sweating in the sun. But these days you’ll find me with SPF 50 applied before I leave the house and carried along at all times for reapplication. 

Kelly Evans-Hullinger, M.D. is a contributing Prairie Doc® columnist who has practiced internal medicine for the past four years in Brookings, S.D. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPTV most Thursdays at 7 p.m. central.        

By Richard P. Holm, MD
 
It’s a holy place when a patient is taking their last breath. For the most part, I’ve tried my best to give comfort at that time. There are many who have stated, “There are worse things than death.” One study in 2016, asked end-stage patients about dying and found that more than 67 percent stated that “needing a breathing machine” was a condition worse than death.
 
Mr. B was an 84-year-old retired farmer who had been struggling with chronic obstructive pulmonary disease (COPD). This condition is related to the loss of ability to exhale normally, which, in turn, is due to the destruction of tiny alveoli which are oxygen and carbon dioxide exchange units. This results in large unfunctional pockets of air which block the flow of air going out.
 
He had smoked and had extensive exposure to toxic farm dust throughout his life, and now he was on continuous oxygen therapy and couldn’t do anything without running out of breath. He had been on pulmonary rehabilitation (exercises to stay in shape), a low carbohydrate diet, metered dose inhaler (MDI) bronchodilators and repeated antibiotics for a few years. This was the third time he was hospitalized in the last two months for “exacerbation of COPD.”
 
He was suffering from a worsening of his lung disease with the added challenge of bacterial pneumonia. His oxygen levels were dropping, and survival was going to require a breathing machine (intubation). He had been intubated over several days during his previous hospitalization and this time, he did not want it.
 
His wife had died a year earlier, all siblings had passed away, but his only child, a son, lived nearby. I will never forget the conversation the three of us had that day. We talked about Mr. B’s poor quality of life. His options were either to be intubated again or to go with comfort care using an opioid. Mr. B realized death was likely, as did the son. Mr. B said, “Let’s try the comfort method.” His anxiety and shortness of breath were reduced immediately after making that choice, and over the next two hours, as the pain medicine kicked in, Mr. B slipped away with his son at his side.
 
This is very serious business, and I usually encourage people who are aware of their situation to fight on, but Mr. B was very tired of fighting for breath. He was ready to let go. In his case, “needing a breathing machine” was a condition worse than death. After his last breath, he finally found relief.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.