Prairie Doc Perspective Week of June 15th, 2025
“Anatomical Variations: Connecting Physicians and Anatomists”
By Ethan L. Snow, PhD


It’s remarkable how much anatomy education and medical practice overlap, yet anatomist-physician collaborations are often underutilized for improving student learning and patient care outcomes.


Becoming an anatomist or a physician requires commitment to many years of education and practical training. Both generally require four years of comparable, comprehensive baccalaureate coursework followed by four or more years of concentrated graduate/medical education and practical training. Amid both career paths, students work diligently to achieve predefined benchmarks for competency in complex human anatomy, meticulous clinical applications, and interrelated skills. Nevertheless, it is natural for anatomists to lose insight about practical clinical skills and physicians to lose insight about anatomical intricacies – most notably while the other person is keenly maintaining expert-level knowledge and knowhow of that very information. Anatomical variations offer a course of action for efficiently and effectively addressing the “use it or lose it” principle for both experts.


Human anatomy is taught and learned according to its foundational morphologic norm – that is, the typical configuration, form, and function of structures in the body. Understanding typical anatomy allows physicians to draw clinical insights from patients’ chief complaints. For example, knowing the typical arrangement of bones, muscles, nerves, and vessels in the body allows orthopedic physicians to discern differential diagnoses and establish safe and effective surgical and therapeutic treatment plans for patients with musculoskeletal issues. However, anatomical variations – structures that do not present in typical location or form – are common and can complicate both learning and medical practice.


As authorities in the granularity of human anatomy, anatomists develop and maintain expertise about the development, presentation, and impact of anatomical variations, especially as they uncover specific cases during routine cadaveric dissection. As authorities in the minutiae of patient care, physicians develop and maintain expertise about adaptive clinical practices to address anatomical variations, especially as they come across specific cases during patient examinations and surgeries. In these regards, each professional can strategically benefit from the other’s expertise to create better outcomes, and this “bench-to-bedside” collaboration is known to promote translational medical education, high-definition patient care, and exemplary interprofessional behavior.


Despite their inherent benefits, strategic anatomist-physician collaborations appear underutilized. Investigating anatomical variations cases permitted by cadaveric donors and/or living patients offers one way to encourage these collaborations. Common field interest seems to effortlessly reciprocate enthusiasm from both parties. Anatomists can leverage workload designated for research/scholarship and physicians can fulfill contractual service obligations, thus offering a manageable framework for each to strategically contribute expertise and achieve high-quality and high-impact productivity. Simultaneously involving students can further distribute workload while providing them with meaningful research experience and influential mentorship.


As indicated, cadaveric donors and living patients play a critical role in this framework by willfully permitting analysis of their associated tissues and records. Human cadaver dissection offers complete and unrestricted views of anatomical variations, and patient records (diagnostic imaging, physician summaries, etc.) convey the clinical presentation and impact of variations. Anatomists, physicians, and students remain extremely grateful to each for their incredible contributions to advancing medical education and patient care.


Ethan L. Snow, PhD is an Anatomist and currently serves as an Assistant Professor of Innovation in Anatomy at South Dakota State University in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.

Prairie Doc Perspective Week of June 8th, 2026
“Pain Science: Rethinking How We Experience Pain”
By Kory Zimney, PT, DPT, PhD is a professor at the University of South Dakota
Pain is a universal human experience, yet it remains one of the most misunderstood aspects of health. Traditional views often equate pain directly with physical injury, but modern pain science challenges this simplistic understanding. Pain is a multifaceted phenomenon involving sensory, emotional, and cognitive factors. This perspective advocates for a holistic approach to pain management, emphasizing the nervous system's role and empowering individuals to retrain their pain response. 
Pain and Injury Are Not Always the Same
Most of us can think of a time when we had an injury but no pain. Maybe you noticed blood on your body when out gardening, only to see a significant cut on your arm, or waking up and noticing a large bruise on your body, and you don’t recall what caused it. Sometimes, pain may have emerged after you saw the cut or bruise, but not when the injury happened.  The opposite side further exemplifies the disconnect between pain and actual tissue damage: we can use the example of phantom limb pain, where individuals experience pain in a limb that no longer exists. These examples highlight that pain is not always a direct indicator of physical damage. In the first situation, we have injury and no pain; in the second, we have pain with no injury.
Pain as a Complex, Multidimensional Experience
Pain is not a simple signal proportional to the extent of tissue damage. The pathway of sensory information from the body travels to multiple areas of the nervous system, including the somatosensory cortex (for location and sensation) and the limbic system (for emotional processing). This interconnectedness underscores the sensory and emotional components of pain, making it a complex experience.
The Brain's Role in Predicting and Protecting
The brain plays a crucial role in interpreting signals and predicting potential threats, which can influence the experience of pain. For instance, gently stretching your finger backwards can cause discomfort before actual tissue damage occurs – a protective mechanism. Chronic pain often results from an oversensitive or overprotective nervous system, where the brain's predictions sensitize the pain response. People are not faking pain, and the pain is not made up in their head; the nervous system actually changes to make it more sensitive. Think of it like the motion detection lights outside your house, the sensitivity dial has been ramped up, a leaf falls off your neighbor's tree, and your lights go on, it is overprotective. Your brain also uses more than just sensory information to process pain or potential threats. Psychological factors (for example trauma, fear, thoughts, and emotions) and sociological factors (such as environment, stress, and lifestyle) interact with biological factors (immune and endocrine systems) to shape an individual's pain experience. 
Understanding Pain is Crucial for Recovery
Understanding that pain doesn't always mean your body is damaged and that your sensitive nervous system can be retrained empowers individuals to challenge limiting beliefs and actively participate in their pain management. It involves a holistic approach, including improving lifestyle factors (diet, exercise, quitting smoking, etc.), addressing psychological factors (decreasing stress, reframing negative thoughts, and more), and promoting movement and daily activities. 
Understanding the complex nature of pain empowers individuals to actively participate in retraining their nervous system to reduce the impact of chronic pain and improve overall well-being.


Kory Zimney, PT, DPT, PhD is a professor at the University of South Dakota, School of Health Sciences Physical Therapy Department and director of the PhD in Health Science program. He received his Master of Physical Therapy from the University of North Dakota in 1994. He completed his post-professional Doctorate of Physical Therapy from Des Moines University in 2010 and graduated with a PhD in Physical Therapy from Nova Southeastern University in 2020. Dr. Zimney is part of the Center for Brain and Behavioral Research at the University of South Dakota and the Therapeutic Neuroscience Research Group conducting research specifically in the areas of pain science and therapeutic alliance. Understanding Pain and What to do about it | Kory Zimney | TEDxUSD. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm on SDPB Radio.

Prairie Doc Perspective Week of June 1st, 2025
“Teen Mental Health”
By Curstie Konold MPH, CSW-PIP, QMHP

The start of summer brings a sense of excitement for many teens. Take a moment to reflect back to your teen years. As we reminisce, we can likely all say that our adolescent years were a unique and informative time of our life. Mental wellbeing habits are often formed during this time as teens strengthen their social and emotional skills, laying a foundation of habits for the rest of their life. Consider what habits you perhaps formed during this time and what supports you had or needed when you were a teen.

There are a variety of important skills that can enhance positive mental wellbeing, and by encouraging teens to practice them, it increases the likelihood of them utilizing them throughout their life. Mental health and physical health are interconnected, so when we encourage physical self-care, we also encourage mental self-care. Healthy nutrition, exercise, and staying active help to maintain positive mental wellbeing. Emotional self-care can also impact mental wellbeing, and it can be practiced through staying active in enjoyable hobbies, music, journaling, play, or spending time outdoors. 

Another important factor impacting mental wellbeing that teens face today is the growing use of social media. Having open conversations with teens about their social media use and how it can impact their mental health is crucial to supporting positive mental wellbeing. The Family and Youth Services Bureau guides parents to educate themselves on social media platforms, have an open-minded conversation about the benefits and risks of social media use, establish rules about privacy and boundaries, model healthy social media use to teens, encourage a balance of social media use with other activities, understand critical thinking and media literacy skills, and provide a safe space for teens to come to parents about managing difficult situations like cyberbullying. 

One of the most impactful things adults surrounding teens can do to support positive mental wellbeing is allowing themselves to be vulnerable enough to talk openly about mental health with teens. Mental health stigma is a large influence in deterring individuals from seeking help, and in order to combat this stigma, open and truthful conversations can encourage teens to not fear discussing their own mental health challenges. These conversations can open the door to understanding what is going on in a teen’s life, providing opportunity to practice healthy skills to promote positive mental wellbeing. 

Understanding brain development can also help adults recognize how to support positive mental health for teens. The pre-frontal cortex in the brain allows us to critically think, make sound decisions, and control our impulses; however, this part of the brain is still developing during adolescence and into early adulthood. This helps us understand why impulses and risk-seeking behaviors are common among teens. Having open conversations with teens allows for discussion of harm reduction strategies to reduce risk-seeking behaviors. Harm reduction seeks to meet teens where they are at in a nonjudgmental way. An example of this might be helping a teen access professional support services to manage mental health concerns and learn healthy coping skills. 

As you think of teens in your life and reflect back on yourself as a teen, consider what type of supportive adult would have positively impacted you during that time. You have the ability to provide a sense of connection and hope for a teen. You have the choice to be a caring adult in the life of a teen that guides them to practicing healthy skills to establish positive mental health for years to come. 

Curstie is a private independent practice licensed social worker and holds a Master of Public Health degree. She is the Associate Director at the Center for Rural Health Improvement (CRHI) at the University of South Dakota. Curstie owns Mindful Matters, LLC where she provides mental health services and promotes trauma-informed care to her clients. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

Prairie Doc Perspective Week of May 25th, 2025
“Living with Parkinson’s Disease”
By Dr. Kelly Evans-Hullinger
“I am concerned your symptoms are due to Parkinson’s disease,” is something I have said to numerous patients over the years. This is a degenerative neurologic disease which is common enough that most patients have heard of it or even know someone living with it.
Most commonly, the patient or their family might have noticed classic symptoms: a tremor, difficulty with movement like walking, or balance problems. Importantly, not all tremor is Parkinson’s, though that is typically the biggest concern my patients have. 
Parkinson’s disease is typically a diagnosis made by findings on history and physical exam; it is uncommon that further testing is used. Often, we will refer to our experts in neurology to confirm a suspected diagnosis. As a progressive neurological disease, we don’t currently have any tools to stop or slow the progression of Parkinson’s, but we have many tools to improve symptoms and quality of life.
First and foremost, regular exercise is paramount for patients with Parkinson’s. Quality of life and functional status is better in patients exercising with moderate intensity 150 minutes per week. The type of exercise doesn’t necessarily matter, so find something that is enjoyable enough to stick with.
Beyond independent exercise, specialized therapies administered by a qualified physical therapist and speech therapist can reduce symptoms. Physical therapists will help with walking, movement, and balance; speech therapists can improve patients’ speech and communication and, if needed, help with swallowing problems.
Medications are commonly used to help with tremor and rigidity in Parkinson’s disease. Most often, the first line treatment is a medication called carbidopa-levodopa, and most patients see immediate gratification with the effect of the medication on their movement symptoms. If needed, other medication options can be added.
Finally, options such as deep brain stimulation (DBS) can be used in more severe disease in which medications are not adequate to control motor symptoms. This involves insertion of a device into the affected area of the brain; electrical stimulation there alleviates those symptoms. Other interventions are sometimes used as well with the help of a specialty-trained neurologist.
In summary, Parkinson’s disease is fairly common as people age, and most patients live for many years with the disease. It is important to be educated on the disease and all the options that might improve symptoms and quality of life while one lives with Parkinson’s disease, and a qualified physician can help tailor those treatments to each individual patient.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm on SDPB Radio.

Prairie Doc Perspective Week of May 11th, 2025
“Have you pre-habilitated today?”
By Joanie Holm, RN


On a recent morning, the first story I heard on the radio was about Pre-habilitation prior to surgery.  We have all heard of rehabilitation, but have you considered pre-habilitation, or increasing your exercise before surgery?  


Recent studies by Durrand, Singh and Danjoux of the National Institutes of Health (NIH) have documented what was inherently known- that building up a reserve of strength before surgery pays off. Makes sense, right!


The physiological challenge of a major surgery has been linked to running a marathon. In both cases, preparation is critical. Surgery involving a major body cavity has an estimated mortality of 4%. Post- operative complications of a major surgery affect 15-40% and may increase the hospital length 2-4 fold as well as increasing readmissions.


The NIH study demonstrated that increasing preoperative functional capacity promotes recovery, reduces complications and reduces healthcare cost.


Later in the day, as I walked the track, my brain took a leap. Isn’t life our chance to pre-habilitate? Wouldn’t pre-habilitation help us if we caught COVID or Influenza? What if you or I suddenly need to have our appendix or gallbladder removed? What if we are in a car crash and have broken bones? What if we have a stroke or heart attack? Pre-habilitation through daily exercise, eating a balanced diet and moderate intake of harmful substances would increase our chances of survival and recovery without complications.


Today and all of the tomorrows are our chance to prepare for the possibility of poor health. We are the key member of the prehab team. Take advantage of your health today to prepare for unexpected complications. Get up and get moving!


 Joanie Holm, RN is a one of the original founders of Healing Words Foundation/Prairie Doc Programming and is the current Board President. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm
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Prairie Doc Perspective Week of May 4th, 2025
SD BAND: Bridging Rural Behavioral Healthcare Needs in South Dakota 
By Ryan Groeneweg, Ed.S., BCBA
As a school psychologist working for a small public school, I remember a teacher asking me to observe a student in her classroom. She expressed concerns about an elementary student’s unusual behavior, lack of playing with classmates, lack of communication and even some unusual motor movements, including flapping her hands. This was in 2001, and I was experiencing my first referral for a student who would eventually receive an educational diagnosis of autism. 
 At that time, autism was considered rare, and providing educational support to meet their needs was challenging. I began to see a growing number of referrals, increasing communication and behavioral challenges, and came to realize that my training and experience as a school psychologist weren’t enough. In 2010, after completing the required coursework and supervision, and passing the National Behavior Analyst Certification Board examination, I began a career as a Board-Certified Behavior Analyst (BCBA) in South Dakota. At that time, fewer than 10 BCBA professionals were in South Dakota. 
Today, there are 88 active BCBAs registered in South Dakota, far below Minnesota (517), Iowa (282), and Nebraska (300). Even when compared to states with similar rural and frontier characteristics, South Dakota lags behind North Dakota (97), Montana (92), and Alaska (89). Currently, nationwide demand for behavior analysts is higher than ever. Annual nationwide demand for individuals holding BCBA certification has increased each year since 2010, with a striking 58% increase from 2023 to 2024. 
One major reason South Dakota has fallen behind was the absence of an in-state training program until 2021. Recognizing this critical gap, a partnership between the Public Health and Health Sciences programs in the University of South Dakota’s School of Health Sciences, the University of South Dakota’s Center for Disabilities, and LifeScape -a Sioux Falls-based non-profit organization- launched the Applied Behavior Analyst (ABA) two-year graduate program. This program aims to expand South Dakota’s behavioral health workforce and contribute essential public health services across the state.
Students who complete the USD ABA graduate program must independently complete 2,000 hours of ABA supervised fieldwork experience. When you consider that most BCBAs in South Dakota live near the state’s larger population centers, Sioux Falls and Rapid City, it’s apparent that those supervised fieldwork experience hours are mostly completed where supervision is available. This barrier creates limited access to BCBAs in rural communities but highlights a great opportunity: addressing disparities in access to specialists in rural areas. South Dakota continues to experience critical shortages of professionals trained to support individuals with autism and other developmental disabilities. 
The South Dakota Behavior Analyst Network Development (SD BAND) was formed to address the critical need for enhanced behavioral health services and the greater integration of BCBAs throughout the state, especially in underserved rural communities. This network of state partners includes the University of South Dakota (USD), Community Healthcare Association of the Dakotas (CHAD), South Dakota Department of Social Services (SD DSS), South Dakota Department of Human Services (SD DHS), and the Community Support Providers of South Dakota (CSPSD). SD BAND is tasked with expanding the presence and collaboration of BCBAs within community health centers and other health care settings across South Dakota, to raise awareness among health care providers, adult service providers, and the broader community about the crucial role of BCBAs, and to facilitate their integration into existing service delivery options. 
Ryan Groeneweg, Ed.S., BCBA, Mr. Groeneweg has been the Director of Community Education at the USD Center for Disabilities since January 2019. In this role, he is the principal investigator (PI) for the South Dakota Department of Education Training and Technical Assistance Grant (2019 to present), and the South Dakota State Autism Grant (2019 to present). He is also an assistant professor at the USD School of Medicine and the program director for the USD School of Health Science Master in Health Science, with a Specialization in Applied Behavior Analysis (ABA) and the USD ABA Certificate Graduate program. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

Prairie Doc Perspective Week of April 27th, 2025 
“The Golden Rules of Dementia”
By Jill Kruse, DO
Dementia is a progressive condition that results in decline in cognitive function.  People with dementia have increasing difficulties with short term memory, thinking, and reasoning.  For family members it can be hard to watch the decline in a loved one who is struggling with dementia.  Interacting when someone has dementia can be difficult.  Following these three Golden Rules can help.  
Rule number 1: Do not ask direct questions.  Asking someone with dementia if they remember your name or remember what they had for breakfast can be distressing.  Someone with dementia may not be able to find the answer you are looking for and can feel put on the spot to come up with an answer.  
Rule number 2: Listen to the person with dementia and learn from them.  When someone is suffering from dementia, their feelings are more important than facts.  My grandmother had dementia for the last 20 years of her life.  She was very upset that my aunt had not come to visit her.  My aunt had passed away a few years prior.  At first, we thought the best thing was to tell her the truth, that my aunt had died.  We saw that this was new information each time we told her.  She grieved deeply each time she heard that news.  It was kinder to tell her that my aunt was away at school and would be home at the next holiday to visit.  There was no reason to keep inflicting that trauma on her.  We were able to ease her mind.  She was worried she had done something wrong to cause my aunt to not visit.   
Rule number 3: Do not contradict.  The part of the brain that is able to reason is no longer functioning in dementia.  Trying to win an argument with logic is not beneficial. Another time visiting my grandmother, she was very anxious that she had not taken lunch out to her husband.  She believed he was out working in the field on the family farm.  My grandfather had died the year I was born.  Rather than contradicting her, I said that I would make sure that he got lunch and would take it out for her.  This made her feel better.   
These three golden rules can help give the family member with dementia a sense of security and safety.  It can also be helpful for family members to interact with the person they love in a new and meaningful way.  Meet the person with dementia where they are, instead of trying to force them to be where you are.  If you allow them to take the lead, you may learn some beautiful stories from the past and have fond memories for your future.    
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show, 2 podcasts, and a Radio program, providing health information based on science, built on trust, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found.

Prairie Doc Perspective Week of April 20th, 2025
“Spring is finally here”
Kelly Evans-Hullinger, MD
Spring is finally here, and for many of us that brings the joy of returning to outdoor activities, planning summer vacations, and… well, allergies. Depending on the allergen, people can suffer from allergies any time of year, but spring is a particularly common time in our part of the world to hear my patients complain of seasonal allergies.
Allergic rhinitis most commonly manifests as runny nose, congestion, and sneezing. Other symptoms can include cough from postnasal drip or worsening asthma, hives, and itchy or watery eyes. Sometimes these symptoms can be hard to differentiate from a viral cold, but typically the symptoms are fairly classic and don’t require any testing.
I often have patients inquire about allergy testing. We might refer to an allergy specialist for testing in patients with severe symptoms that aren’t adequately improved with usual care. Testing might include blood or skin patch testing depending on the situation or allergen in question. However, the vast majority of patients can be treated without specialized testing.
Initial recommended treatments for allergic rhinitis are available over-the-counter. Antihistamine medications can reduce many of the symptoms. I recommend using second generation medications such as loratadine, cetirizine, or fexofenadine, which act more specifically for the targeted symptoms. First generation antihistamines such as diphenhydramine or doxylamine are less specific and thus have more problems with adverse effects. Common side effects include dry mouth and drowsiness, but we can see those first generation antihistamines cause more severe adverse effects such as confusion.
Another very effective option is an over-the-counter nasal steroid spray, such as fluticasone or various others. Taken daily these will reduce congestion, mucous, and post nasal drip. They are quite safe for long term use and should not have systemic side effects. Additionally, these can be used along with an antihistamine. 
Take care in the nasal spray aisle, however. Some other nasal sprays are vasoconstrictors, such as oxymetazoline, and while they will alleviate congestion, they should not be used more than three days consecutively. If so they can cause worsening congestion when the medication wears off, or a rebound effect.
In summary, allergies can be a real annoyance and truly make people feel rotten. Basic over-the-counter measures can be very helpful and are worth trying. If those aren’t working, though, time to talk to your primary care provider about other options or the need for further testing.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

​“Zip Code Matter”
Debra Johnston, MD


Those of us who make our homes in the rural midwest understand that we face medical challenges our countrymen in more populated areas don’t. For example, there are two pediatric rheumatologists in the whole state of South Dakota. . . and they are both based in Fargo. In contrast, there are 10 in the Twin Cities with the University of Minnesota alone. In Winner South Dakota, you are nearly 150 miles away from emergency access to a neurosurgeon, assuming you can go by air. No matter where you are in Connecticut, that help is no more than 50 miles away. 


These ideas are probably obvious to anyone reading this. If we haven’t had to travel for medical care ourselves, we know someone who did. But other factors, things that have an even bigger impact on our well being, may be less familiar. 


Economics plays a role, of course. Can you afford your medicine, or to go to the doctor? Do you have time off for that appointment? Are you choosing between keeping food on the table and a roof over your family’s head? Are you filling up on cheap empty calories, or are you able to buy fruits, vegetables and eggs? 


Where you live matters in other ways. Can you buy those healthy groceries nearby? Are there safe places to walk, and for your children to play? How clean is the air in your community? Does your home have lead paint or asbestos insulation? Is the water that comes out of your tap safe to drink, or is it contaminated with chemicals or lead? Does the noise in your neighborhood keep you awake at night? 


Zip codes can impact the infrastructure around you in ways that affect residents unequally. How accessible is the environment? Are people with mobility challenges able to easily enter retail spaces? Do they have housing options? Are the schools able to support children who face learning challenges? Can you find childcare while you work? Can you practice your faith in your community? Social engagement protects your well-being. 


Even our genes are affected by our environment. This is a fascinating new concept that many of us never study in school. Scientists have learned that external factors influence how our genes are expressed, without changing our DNA. These factors start working before birth: nutrition and stress experienced by a pregnant woman influences the development of her child, and has an impact not only throughout that child’s life but into subsequent generations. 


As we think about health, let’s not forget that we aren’t all starting in the same place. It’s worth thinking about how we can address some of those disadvantages.


Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

“My Journey to Becoming a Hospitalist”
By Jill Kruse, DO


When I first moved to Brookings, the primary care physicians took care of their own patients in the hospital.  We would round on patients in the morning before clinic or try to sneak over during lunch or after clinic.  While I loved taking care of patients in the hospital, it was hard to juggle the responsibilities of both giving my attention to the patients in the hospital while seeing people in the clinic.  Any time the hospital nurse had a question; my clinic nurse would have to interrupt a clinic visit or wait for me to between patients.  This could lead to some less-than-ideal times where I was being pulled in multiple directions at once.  
Then about six years ago, the Brookings Health System decided to start a new program where there would be Hospitalist hired.  These would be doctors who would just take care of patients in the hospital.  Primary Care Physicians in the clinic would follow up after the hospital stay and resume care.  This had already been done for several years in Sioux Falls at the Sanford and Avera McKennan.  Despite the fact that I was familiar with what a hospitalist was, it was still hard to give up caring for my patients when they were in the hospital.  However, I learned to see these Hospitalists as valued colleagues who were giving my patients the time and attention that they deserved.  They could give better care and more attention as hospital medicine continues to evolve and advance.
During COVID, I started taking extras shifts to help out in the hospital on weekends.  This was a good way for me to keep up my skills for taking care of patients who were sicker than in the clinic.  In the clinic, we mainly focus on taking care of minor illnesses and injuries as well as managing chronic medical conditions and health maintenance visits.  I realized that I missed taking care of hospitalized patients and caring for people when they were at their sickest. 
 When one of the hospitalists left for a new job, I was asked if I wanted to take their place as a hospitalist.  After careful consideration of all the pros and cons, I decided to answer the call to this new challenge of being a hospitalist.  I am happy to see my former clinic patients, but now it is usually in the grocery store and at the post office.  However, it is extra special when I can care for them when they are admitted to the hospital.  I embrace this current chapter in my medical career and wonder how it will continue to evolve as medicine changes with time.  
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show, 2 podcasts, and a Radio program, providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found.

​“Colon Cancer Screening is Important”
By Andrew Ellsworth, MD


Colon cancer is the second leading cause of cancer-related deaths in men and women. The lifetime risk of developing colon cancer is 1 in 24 for men and 1 in 26 for women. Early detection and treatment are instrumental at improving survival rates, and regular screening decreases the risk of colon cancer in the first place.  


Colonoscopy remains the gold standard for colon cancer screening. While detecting cancer early on is important for survival from any cancer, detecting and removing precancerous polyps during a colonoscopy before they develop into cancer is the main reason regular screenings with colonoscopy have been found to reduce colon cancer rates. 


During a colonoscopy, with a patient asleep or sedated under anesthesia, a long flexible scope with a light and a camera is used to look throughout the large intestine, the colon, for any polyps or abnormalities. Those polyps can be removed with a forceps or a loop at the time they are detected. Afterwards, patients are monitored, wake up, have something to eat, and are ready to proceed about their day.  


Thankfully, a large majority of patients do not have any complications from colonoscopy. The complication rate depends on age and risk factors and the reason for the procedure. The overall rate is approximately 0.5%. The most serious complication risk, a perforation or tear in the colon, is about 1 in 1,000. 


Of course, oftentimes the worst part of undergoing a colonoscopy is the preparation beforehand; getting cleaned out. This is important so the physician performing the procedure has a good, thorough look everywhere in the colon. While cumbersome, with new strategies for doing the prep, many people find this process less awful than they used to.


Stool tests have been an easier, cheap, non-invasive method for colon cancer screening for many years. Often these tests look for blood in your stool. The latest, more expensive option, Cologuard, checks for blood and DNA abnormalities, and is the most successful of the stool tests at detecting colon cancer, at 94%. However, it is only about 43% effective at detecting advanced adenomas, those precancerous polyps that are already getting larger and closer to becoming cancer. This limits the test’s potential at preventing cancer.  


The Cologuard test should not be used for people with risk factors such as a history of colon polyps or a family history of colon cancer. A positive test result should be followed up by a colonoscopy.


The FDA recently approved a new blood test for colon cancer screening. However, it only detected 83% of colon cancers, and only 13% of precancerous advanced adenomas. With this poor detection rate, out of 100 people with cancer, the blood test would falsely tell 17 people that they did not have cancer, and it would miss most precancerous polyps. 


Ever since the Affordable Care Act in 2010, insurance companies have been required to cover colon cancer screening tests. This is because early detection not only saves lives but also saves money. 


Each method has its own pros and cons, so please talk with your doctor regarding which screening method makes the most sense for you. In the end,  “the best colon cancer screening method is the one that gets done.”

“Pneumonia Vaccine Saves Lives”
By Andrew Ellsworth, MD


Over one hundred years ago, the gold mining industry of South Africa had a problem: too many workers were dying from pneumonia. They turned to Dr. Almorth Wright, a British physician who had successfully created a vaccine against typhoid fever that saved countless lives of British soldiers in World War I and other wars. Wright and his colleagues developed an inoculation of killed pneumococci bacteria which resulted in a substantial reduction of cases of pneumonia and death in the miners.  


Pneumonia is an infection in the lungs that causes inflammation and accumulation of fluid or pus, making it difficult to breathe. Pneumonia can be caused by viruses, bacteria, and fungi. Risk factors for pneumonia include old age, young children, smoking, lung diseases such as chronic obstructive pulmonary disease and asthma, other chronic medical conditions, poor air quality, and more. 


Antibiotics have been revolutionary in treating bacterial pneumonia, decreasing the rates of death substantially. Unfortunately, antibiotics do not treat viruses, and early use of antibiotics in the course of a virus will not decrease the risk of pneumonia. If someone has cold symptoms, rest, fluids, time, and an expectorant like guaifenesin can be helpful. If symptoms get worse with the return or persistence of fevers, worsening cough, shortness of breath, or chest pain, please seek medical attention. 


Vaccines for pneumonia, influenza, haemophilus influenzae (Hib), and respiratory syncytial virus (RSV) have significantly decreased the rates of pneumonia. The pneumonia vaccine is now recommended for infants and young children, all adults over 50 years of age and those with certain chronic medical conditions.  The Centers for Disease Control and Prevention (CDC) lowered the age recommendation from 65 to 50 in October 2024 since adults aged 50+ are 6.4x more likely than younger adults to get pneumococcal pneumonia. 


The pneumonia vaccine has changed and updated through the years with the types of bacteria that are targeted. If you have already received a pneumonia vaccine, depending on what you have received and if it has been several years or if you have chronic medical conditions, you may want to talk to your healthcare provider about getting a new pneumonia vaccine.  


Prevention is the best way to fight disease. To prevent pneumonia, it is helpful to wash your hands, do not smoke, consider vaccination, and help keep your immune system strong by getting good sleep, exercising, and eating healthy.


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective Week of March 16th, 2025
“Learning to Perceive: Visual Thinking Strategies in Medical Education”
By Donna Merkt, director of the South Dakota Art Museum at South Dakota State University
Effective medical diagnosis depends not just on looking, but on truly perceiving. Recognizing this, many medical training programs have adopted Visual Thinking Strategies (VTS) discussions about art to enhance students’ skills in nuanced observation, inference, and communication.  In 2004, Harvard Medical School pioneered use of VTS within medical education to refine the diagnostic and interpersonal skills of future healthcare professionals. Now, VTS is embraced in over 30 medical schools. 
Through inquiry-based, participant-centered VTS discussions about art, medical students learn to slow down, look carefully, analyze details, and refine their diagnostic reasoning. During the exercise, participants focus on an artwork while discussing their observations.  The facilitator begins with: “What’s going on here?” Seeks evidence by asking: “What do you see that makes you say that?” Then, spurs the participants with: “What more can we find?” The facilitator remains neutral, paraphrases comments, and points to the artwork to guide discussion. Without authoritative guidance, participants explore multiple interpretations freely. The conversation often lasts 20 minutes per artwork. (Conversely, most museum visitors spend 30 seconds or less with a piece.)  
A 2020 study at the University of Miami Miller School of Medicine, along with others, found that students who participated in VTS showed significantly improved observational abilities compared to peers who had not engaged with the program. By examining and discussing artwork through VTS, participants sharpen their ability to notice small but significant details and interpret ambiguous visual information, a process that mirrors patient assessments, where attentiveness and contextual understanding are key. For example, learning to analyze visual cues that might indicate emotions may enhance healthcare professionals’ abilities to interpret patients’ nonverbal cues, leading to more compassionate and attentive interactions.
VTS discussions engage participants in collaborative analysis, fostering both clear articulation of observations and active listening to others’ perspectives. A systematic review of studies regarding VTS in medical education, published in BMC Medical Education (2023), found that engaging in VTS improved medical students’ observation skills and enhanced their abilities to express their findings concisely and confidently. Further, VTS participants also support their interpretations with evidence—a critical skill in patient care, where diagnoses must be explained with clarity and justification. The structured discussion format of VTS also encourages strong communication, as well as cooperative analytical skills, which are essential for collaborative work within healthcare teams.
Attuning to a patient’s needs requires careful observation, but diagnosing complex cases also demands the ability to navigate uncertainty. Patients may present with overlapping or unclear symptoms, and medical professionals must carefully weigh multiple possibilities. VTS trains students to tolerate ambiguity by prompting them to analyze complex images without immediate resolution. Further, the process fosters active listening to alternative interpretations offered by others, often leading participants to refine their own thoughts. This practice fosters adaptability, allowing future medical professionals to confidently refine their assessments rather than defaulting to initial impressions.
By engaging with works of art in VTS discussions, medical students and practitioners develop sharper attention to detail, improved communications, and increased empathy.  Ideally, this reflective approach extends into clinical practice, allowing healthcare providers to take a more holistic view of their patients, ask insightful questions, thoroughly evaluate symptoms before reaching a diagnosis, and communicate thoughtfully with patients and families.
If you would like to learn more about Visual Thinking Strategies and potential partnerships, contact your local art museum. 
Select Sources: 
Agarwal, G.G., McNulty, M., Santiago, K.M. et al. Impact of Visual Thinking Strategies (VTS) on the Analysis of Clinical Images: A Pre-Post Study of VTS in First-Year Medical Students. J Med Humanit 41, 561–572 (2020). https://doi.org/10.1007/s10912-020-09652-4
Cerqueira, A.R., Alves, A.S., Monteiro-Soares, M. et al. Visual Thinking Strategies in medical education: a systematic review. BMC Med Educ 23, 536 (2023). https://doi.org/10.1186/s12909-023-04470-3 
Rezaei S, Childress A, Kaul B, Rosales KM, Newell A, Rose S. Using Visual Arts Education and Reflective Practice to Increase Empathy and Perspective Taking in Medical Students. MedEdPORTAL. 2023;19:11346. https://doi.org/10.15766/mep_2374-8265.11346
Donna Merkt is a certified VTS facilitator and has practiced VTS for more than 15 years, during which she’s led VTS conversations with thousands of students and adults, and trained numerous educators and medical professionals to use the method.  She currently serves as director of the South Dakota Art Museum at South Dakota State University. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.

Prairie Doc Perspective Week of March 2nd, 2025
“Businesses for Babies”
By Christina Young, Director for the Center for the Prevention of Child Maltreatment
When businesses support working parents, they're not just boosting their bottom line – they're helping prevent child abuse and neglect. In South Dakota, 72.5% of all children under age six have all available parents in the workforce, making family-friendly workplace policies crucial for our state's families. 
Research shows that workplace policies like flexible scheduling, paid family leave, and childcare assistance significantly reduce major risk factors for child maltreatment by decreasing parental stress and providing essential economic stability. When parents have the flexibility to attend school events, care for sick children, or work from home when appropriate, it strengthens family bonds and creates more nurturing environments. Access to quality childcare and living wages helps ensure families can meet basic needs without the overwhelming stress that can lead to crisis.
Prevention is far better – and far less costly – than intervention after abuse occurs. Studies show that every dollar invested in prevention can save up to seven dollars in future costs related to child welfare services, healthcare, and criminal justice. By creating supportive work environments, businesses play a crucial role in building the safe, stable, nurturing relationships children need to thrive. These investments in families today help develop healthier communities and a stronger workforce for tomorrow.
The Center for the Prevention of Child Maltreatment's "Businesses for Babies" campaign highlights South Dakota companies that have adopted family-friendly policies. By showcasing businesses that prioritize family well-being through flexible schedules, parental leave, and childcare support, the campaign aims to inspire more companies to implement similar policies. Together, we can create a business culture that strengthens families and protects our most vulnerable citizens – our children.
Christina Young has been an influential figure in the child welfare field for over a decade, dedicating her career to the well-being of children and families. She directed an in-home family services program covering 30 western counties in Iowa, demonstrating her commitment to community-based support. Christina has a bachelor’s degree in psychology and a master’s in human services administration. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.

Prairie Doc Perspective Week of February 23rd, 2025
“Abnormal Electrical Signals”
By Kelly Evans-Hullinger, MD
Atrial fibrillation is probably a diagnosis you have heard of, if not because a friend or family member has it, because it has been mentioned in a public advertisement or pharmaceutical commercial. Atrial fibrillation (or “A-fib”) is the most common cardiac arrhythmia, a condition estimated by the American Heart Association to be present in more than five million Americans.
A-fib happens when abnormal electrical signals occurring throughout the cardiac atria (upper chambers of the heart) override the normal intrinsic electrical pacemaker. Sometimes this causes symptoms such as heart palpitations, dizziness, poor exercise tolerance, or heart failure. In many cases, however, patients have no symptoms at all. I can recall numerous instances of finding A-fib in a patient simply by listening to their heart on a routine exam and finding the heart rhythm to be irregular. The widespread use of smartwatches and other monitoring devices is alerting people to the possibility of A-fib with greater frequency.
Atrial fibrillation is diagnosed by an electrocardiogram (ECG) or a longer term heart rhythm monitor. When we find A-fib, we should look for any underlying causes such as heart valve problems, heart failure, and even thyroid disease. More frequently, A-fib does not have any single cause; it can occur for no particular reason, but a person’s risk of it increases with numerous factors including obesity, heavy alcohol use, high blood pressure, sleep apnea, and of course advancing age.
Treatment of atrial fibrillation has various options, which include medication to keep the heart from going too fast, medication to keep the heart in a normal rhythm, shocking the heart back into normal rhythm, or a catheter procedure to ablate the abnormally-firing portions of the cardiac tissue.
Of utmost importance, because in A-fib the atrial chambers do not effectively pump and empty blood into the lower chambers with each heartbeat, blood pools in some areas and has the risk of forming clots. This is why patients with atrial fibrillation are at elevated risk of a stroke and why for many of those patients we recommend taking a blood thinner long-term. We have tools to estimate stroke risk in an individual patient, so the discussion of blood thinners is one you should have with your primary care provider or cardiologist.
In summary, atrial fibrillation is a very common diagnosis, especially as patients get older. Our individualized approach to treatment focuses on control of symptoms and quality of life as well as reducing the risk of stroke. 
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.