Prairie 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).

Prairie 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).

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Prairie 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).

Prairie 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).

Prairie 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).

Prairie 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).

Prairie 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).

​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).

Prairie 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).

Prairie 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).

Prairie 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).

Prairie Doc Perspective Week of December 14th, 2025
Happy Holidays! Use Occupations to Balance Seasonal Stress
By: Karen Hebert, Ph.D. & Mackenzie Feldhacker, OTD
The holiday season is fast approaching with all its festive occupations like decorating the house, buying and wrapping presents and preparing and serving holiday meals. Between the additional time requirements, costs, travel and interactions with family members, this can be a particularly stressful time of year. Difficulties with getting around the house or community, remembering and managing multiple to-do lists, and feeling comfortable socializing for long periods of time can compound holiday stress.  While some people experience a sense of deep engagement and enjoyment with holiday preparations and celebrations, others find the additional demands tiring and overwhelming. Many of us experience a variety of emotions, from deep joy to stress, during this busy time. No matter how you view the season, faculty in the Department of Occupational Therapy at the University of South Dakota have some advice to help reduce stress and enjoy your festive occupations this year.  
    Take a moment to think about your favorite holiday activities and identify what makes these moments enjoyable for you. This might include visiting friends and family, the smell of peppermint hot chocolate or memories associated with listening to songs from your childhood. Early in the season, map out the preparations that need to occur ahead of various celebrations or events. Using a calendar or planner to proactively schedule activities and tasks reduces the demand on your memory, especially during times of high emotion. This may involve scheduling a time to wrap presents ahead of a gift exchange or planning when to make appetizers ahead of an after-work party. Break larger occupations like decorating the house into smaller tasks that can be spread over time. Try to balance completing stressful tasks and fun activities across a week. If a large holiday gathering is planned for a Friday, consider scheduling quiet activities that you can complete independently the day or two before. Physically demanding occupations like hanging holiday lights or going shopping can be balanced with smaller activities like writing greeting cards. 
    You can also reduce stress during holiday preparations by avoiding multi-tasking.  Evidence from the occupational therapy and cognitive psychology literature suggests that trying to engage in multiple activities at the same time results in worse performance and higher feelings of stress and anxiety.  Use this as an opportunity to fully engage your senses and emotions in the event. Put on holiday music or a favorite movie while decorating the house or wrapping presents. For those who enjoy socializing, seek out small groups for wrapping or cookie decorating parties. Don’t forget to engage your other senses by enjoying the special tastes and smells of the holidays. Finally, be sure to schedule quiet moments for yourself to relax and recharge.  Research has found that scheduling periodic breaks ahead of time provides greater stress reduction than waiting until you feel overwhelmed to take a break. Go for a walk, enjoy a holiday coffee, take a long bath or just take a moment to rest and remind yourself of the joy of the season.  
Karen Hebert, Ph.D., OTR/L, is an assistant professor in the Department of Occupational Therapy at the University of South Dakota. She studies how working memory and cognitive processing influence the experience of positive and negative emotions during the completion of daily occupations, particularly among those with neurological and mental health conditions. Her favorite occupations include reading, swimming and traveling with her husband and two girls. Mackenzie Feldhacker, OTD, OTR/L, CLT-LANA, is an associate professor in the Department of Occupational Therapy at the University of South Dakota. Her interests are the scholarship of teaching and learning and the needs of individuals with neurological conditions, particularly Parkinson’s disease. Her favorite occupations include baking, spending time outdoors and playing games with her family. 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).

Prairie Doc Perspective Week of December 7th, 2025
Silent but Serious: How to Spot and Manage Gum Disease
By Katie Pudwill, RDH, PhD
Gum disease is one of the most common chronic health conditions in adults. For those 40 and older, it’s also the leading cause of premature tooth loss. Unlike cavities, which often cause sensitivity or pain, gum disease is silent. Because the infection starts under the gums, you may not notice symptoms right away.
There are two types of gum disease: gingivitis and periodontitis. Gingivitis is an early, reversible infection of the gums caused by bacteria and hardened plaque (calculus). Once the bacteria and calculus are removed, the gums can return to their healthy state. Think of it like a sliver in your skin: once it’s out, the redness and swelling go away.
Periodontitis is irreversible and develops when the infection reaches deeper structures: the gum tissue, the ligament holding the tooth, and the bone beneath. Over time, this leads to gum recession, loose teeth, and tooth loss if untreated. Signs include gum recession, teeth appearing longer, shifting teeth, or changes in your bite. These symptoms reflect permanent damage to the tooth’s support system.
Because gum infections are deeper in the gingival pocket, they can go unnoticed. Signs of both gingivitis and periodontitis include red, swollen gums and bleeding when brushing or flossing. This is often called “pink in the sink.” Other symptoms may include bad breath, a bad taste in the mouth, or irritated or “itchy” gums. If you notice these, it may be time to get your gums professionally evaluated. Most dental hygienists recommend a cleaning every six months, as that’s when gingivitis commonly returns.
When periodontitis is diagnosed in a dental office, the first step is usually nonsurgical periodontal therapy. This involves scaling and root planing; a thorough cleaning to remove bacteria, plaque, and calculus. Dental hygienists will use special instruments, including ultrasonic scalers, to clean the roots of the teeth and allow the gums to heal. For advanced cases, they may even recommend laser treatment, localized antibiotics, and other adjuncts individualized for your needs. Patients with advanced disease may be referred to a specialist called a periodontist for surgical options to repair the damage that the infection has caused. This might include flap surgeries or bone grafting. 
Home care is an essential part of managing both forms of gum diseases. Brushing twice a day with a soft-bristled toothbrush and cleaning between teeth is not just about preventing cavities, it’s about the gums too. The infection starts in the gum pocket, so cleaning under the gumline is key. Interdental brushes and water flossers often outperform traditional floss at removing bacteria from the gingival pocket around the tooth.
Gum disease may be silent, but its effects are not. Periodontitis has lasting consequences not only for your smile but for your overall health. Fortunately, with early recognition and consistent care it can be managed effectively. If your gums bleed, your breath smells bad, or it’s been more than a year since your last dental visit, now is the time to act. A healthy mouth is a vital part of a healthy body.
Sources: National Institutes of Health. Oral Health in America: Advances and Challenges. U.S. Dept of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research; 2021. 
Katie Pudwill, RDH, PhD, is a registered dental hygienist and educator in South Dakota. She teaches periodontics, ethics and jurisprudence, and dental anatomy at the University of South Dakota Department of Dental Hygiene. Katie is passionate about improving oral health through education, prevention, and advocacy. 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).

Prairie Doc Perspective Week of November 30th, 2025
“Oral Caries Prevention in South Dakota: Challenges and Opportunities”
By Carissa Regnerus, RDH, MA, FADHA
Dental caries (decay) remains the most common chronic disease in the U.S. and globally, despite decades of research and proven preventive strategies. In South Dakota, 60–65% of adults and over half of children have experienced tooth decay, with higher rates among low-income, rural and tribal populations. These disparities reflect longstanding challenges in accessing preventive care, especially in underserved areas.
Two of the most effective, evidence-based strategies to prevent dental caries are fluoride use and dental sealants. Community water fluoridation (CWF) and topical fluoride treatments help strengthen enamel and repair early damage, while sealants protect the deep grooves of molars, where 90% of cavities occur. Sealants can prevent up to 80% of decay within two years and remain partially effective for several more years. Yet only 49% of South Dakota third graders have sealants on at least one permanent molar, falling far short of the CDC’s Healthy People 2030 goal of 60%. Studies show that children from low-income or rural areas are at higher risk for decay- yet they are less likely to receive sealants.
Although South Dakota Medicaid covers sealants for eligible children, many dental practices do not accept Medicaid primarily due to low reimbursement rates, further limiting access. Meanwhile, over 94% of South Dakotans benefit from systemic fluoride through CWF, thanks to state regulations requiring optimal fluoride levels in public water systems. However, this cornerstone of public health is under threat.
In April 2025, the U.S. Secretary of Health and Human Services proposed ending CDC recommendations for CWF, citing alleged health risks. Despite continued support from the ADA, CDC and WHO, this shift has fueled a wave of anti-fluoride legislation across the country. Utah and Florida have already enacted statewide bans on water fluoridation, and several other states have introduced bills to restrict or eliminate it. In South Dakota, Senate Bill 133 sought to remove the mandate for maintaining optimal fluoride levels in public water systems. Although the bill was ultimately defeated, it reflects growing skepticism among some lawmakers and constituents. Similar legislation is likely to resurface in 2026, especially as national debates around fluoridation intensify.
The consequences of reduced access to fluoride and sealants are significant. Untreated caries can lead to emergency visits, costly restorative procedures and general anesthesia for children. Dental pain and infection also contribute to missed school and work, financial hardship and diminished quality of life--impacting nutrition, sleep, emotional well-being and social participation.
Sealants and fluoride are complementary, affordable and preventive, costing far less than treating decay. Their combined use is endorsed by the ADA and exemplifies the adage: An ounce of prevention is worth a pound of cure. Sustained protection depends on consistent access to both, especially for those most vulnerable.


Carissa Regnerus, RDH, MA, FADHA, has been a licensed dental hygienist for over 25 years and a faculty member in the University of South Dakota’s Department of Dental Hygiene since 2001. She has taught courses in dental public health and sealants, and has served on several medical mission trips, reflecting her commitment to prevention and global service. For more information, contact her at [email protected]. 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).
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Prairie Doc Perspective Week of November 23rd, 2025
“Strengthening Paths to Safety: Supporting Domestic Violence Survivors”
By Bridget Diamond-Welch, Ph.D
When someone escapes domestic violence, their journey to healing has only just begun. As physicians, you are often the first professionals to recognize signs of abuse and can play a pivotal role in connecting survivors to lifesaving resources. 
This is especially crucial in rural communities where you may be the only health care provider for miles and where stigma around domestic violence can be particularly strong. Recent research conducted across South Dakota and Iowa shelters with 47 survivors—focusing primarily on rural and Native American survivors—reveals crucial insights about the supports needed to rebuild lives after abuse.
Research in health care settings suggests that many abuse victims may disclose their situation to a health care provider before seeking specialized services, making physicians crucial gatekeepers to support resources. Below we discuss several of the key needs identified by survivors that would help them on their pathway to healing. 
Housing emerged as the most fundamental need. "I have a place to live. I'm not afraid that I don't have a place to sleep at night," explained one Native survivor. Rural survivors faced even greater housing challenges, with one Native participant sharing: "I got assistance for the deposit, but I'm kind of struggling with the utilities." Without stable housing, survivors often face impossible choices between houselessness or returning to abusive relationships.
Transportation barriers create profound isolation, particularly for rural Native survivors. "If they had a bus or something to bring us here, then more people would be willing to come," noted one rural Native survivor. Another rural Native participant explained: "I think we mostly just need help with gas cards" to get to services that may be located far away. 
Mental health support is essential, with many survivors defining healing in terms of emotional well-being. "I guess being able to talk without breaking down emotionally," explained one Native urban survivor. 
Physical health needs intertwine with trauma recovery. "I was really in bad shape. I had to stay in bed for a while and then go back to the hospital," shared a rural Native survivor. 
As medical providers, being aware of how abuse manifests in medical complaints, chronic pain, unexplained injuries, anxiety, depression and missed appointments can help identify patients in need of intervention. Pediatric screening is equally important, as children's health often reflects the safety of their home environment. Documenting findings thoroughly and creating a safe, private space for disclosure increases the likelihood that survivors will seek help when ready.
The consistent support of trauma-informed advocates proves transformative. "It's been a lifesaver. You're around people who know what you're going through," expressed a Native urban survivor. The role of physicians can be to support these survivors in connecting with local advocacy services. Reaching out to your local agency and requesting information on their services, brochures to share with patients, and a greater understanding of local support opportunities provides an essential way to support your patients’ health.
Prevention remains far more effective than intervention after trauma occurs. As trusted figures in rural communities, your advocacy can be particularly powerful in breaking cycles of violence where resources are scarce, but community connections run deep.
What can you do today to make a difference? Connect with your local domestic violence organization and invite them to come tell you about their services and leave fliers in your office. Have this as a resource to share with clients who you identify may be in need. If you do not know who your local provider is, you can find them at: https://www.thehotline.org/get-help/directory-of-local-providers/ 


Bridget Diamond-Welch, Ph.D., is an associate professor and the Director of the Office of Research & Innovation in the School of Health Sciences at the University of South Dakota. Her research specializes in improving system response to interpersonal violence, specifically domestic violence, sexual assault and sex trafficking. Her work examines what survivors need to heal and seek justice, and how systems can improve to meet these needs. Recent publications include Journal of Forensic Nursing, Public Health Reports, Child Abuse & Neglect, and Journal of Interpersonal Violence. Her work has been funded by NIJ and OVW. 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).