​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).
​

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).

Prairie Doc Perspective Week of November 16th, 2025
Virtual Reality: A New Frontier in Mental Health Care
By: Carissa Regnerus, RDH, MA, FADHA, Regan Luken, RN, MSN, and Betty Hulse, PA-C, MSPAS
The USD School of Health Sciences Complementary and Alternative Medicine research team, in partnership with the South Dakota Human Services Center (HSC), has introduced virtual reality (VR) as a groundbreaking tool in inpatient mental health care. 
A pilot study, funded by the South Dakota Community Foundation, was implemented by the research team that reviewed the utilization of virtual reality as an additional tool for inpatient mental health care.  Liminal VR software, designed to increase relaxation and reduce stress and anxiety, was selected and viewed through VR headsets for an immersive experience. The participants attended VR sessions three days per week over the course of four weeks. Baseline measurements related to stress, anxiety and mood were taken prior to starting the course and after finishing each day of VR sessions. Quantitative and qualitative data were collected at the end of the four-week course. Data was also collected from staff who were involved with the participants.
One of the most compelling aspects of the study was its impact on engagement. Individuals who had previously disengaged from programming found joy and purpose in VR sessions. Notably, a typically reserved patient experienced emotional insight through immersive therapy, highlighting VR’s ability to foster self-awareness. Offering tailored experiences such as calm, awe and relief, the technology empowered patients to select sessions best suited to their needs.
With overwhelmingly positive feedback from both patients and staff, this initiative has demonstrated VR’s potential to enhance therapeutic outcomes—leading to improved mood and relaxation, and reduction in stress and anxiety.
The success of VR within HSC has inspired life skills staff to explore additional digital interventions, including YouTube-guided visual meditation. Recognizing VR’s potential beyond inpatient care, the research team is considering student-focused mental health applications and seeking funding to expand services into health care and educational settings.
Community Impact and Future Considerations
The study bridged service gaps and sparked discussion on alternative mental health approaches. Observing patients eagerly anticipating their sessions reinforced the power of brief interventions in shaping mood. The study encouraged staff to value every patient interaction, however brief, as a meaningful step toward healing.
South Dakota’s rural landscape can limit access to traditional mental health services. VR can bridge this gap by providing accessible, personalized mental health support in various settings, reaching more South Dakota residents. Mental health challenges are a growing concern in South Dakota. According to NAMI, 112,000 adults in the state live with mental health conditions and 448,334 South Dakotans reside in communities lacking sufficient mental health professionals. With VR's ability to deepen engagement and enhance therapy, could this technology alleviate provider workloads and shorten hospital stays? Additionally, the use of VR may prove beneficial in addressing substance use disorders, offering new insights into patient behaviors and motivations. Further research into community collaboration and stakeholder feedback could provide valuable data on treatment satisfaction, service quality and long-term patient outcomes.
As mental health care evolves, integrating VR offers a path toward innovation, healing and accessibility—helping individuals not just manage their conditions, but actively reclaim joy in their daily lives.
State MH fact sheet https://www.nami.org/wp-content/uploads/2023/07/SouthDakotaStateFactSheet.pdf SD 
https://dss.sd.gov/behavioralhealth/reportsanddata.aspx
Author Bios:
Carissa Regnerus, RDH, MA, FADHA, is a faculty member at the University of South Dakota (USD) Department of Dental Hygiene, where she has been shaping future professionals since 2001. As a member of the USD School of Health Sciences Complementary and Alternative Medicine research team, she actively explores innovative approaches to patient care, including the use of virtual reality (VR) in mental health treatment, and is beginning to investigate VR’s potential to reduce dental anxiety. Carissa teaches public health courses for dental hygiene students and is passionate about fostering community impact through progressive and inclusive healthcare strategies.
Regan Luken, RN, MSN, is a faculty member at the USD Department of Nursing and teaches in the MSN in Nursing Informatics and e-Health program. Leveraging technology in health care improves outcomes by creating a more connected and healthier community.  
Betty Hulse, PA-C, MSPAS, associate professor in the USD Physician Assistant Studies Program, has served as clinical education coordinator since 2008. Betty has experience working with psychiatric patients in the hospital setting as well as patients who have substance use disorders in residential treatment. She is a strong advocate for programs that increase access to treatment for mental health and substance use disorders. She is a proponent of the “Let’s Be Clear” initiative to saturate South Dakota with naloxone (Narcan) and empower anyone to reverse an opioid overdose and save lives. 
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 November 9th, 2025
Understanding Macular Degeneration: The Importance of Early Detection and Specialized Care
By: Jed Assam, MD, Founder and Vitreoretinal Surgeon, VRA Vision 

Age-related macular degeneration (AMD) is one of the leading causes of vision loss among adults over 65. This condition affects the back of the eye where light is processed by macula. The macula is the part of the retina providing sharp, detailed vision needed for reading, driving, and recognizing faces. Two categories of macular degeneration are “dry” and “wet”. This article will focus on dry macular degeneration and therapy options to help slow vision loss from it. 

Early Signs and Symptoms
Macular degeneration begins silently. Early symptoms may include mild blurring, difficulty seeing in low light, or the appearance of wavy or distorted lines. Later on, a dark or empty spot near the center of the vision can develop. In advanced stages, central vision may be lost entirely. Regular eye exams are crucial because early AMD can be detected during a dilated retinal examination or with specialized imaging. 

Impact and Risk Factors
A few major risk factors include age, family history, current smoking, and genetics.  Individuals with a family history of AMD should be especially vigilant about screening.

The Importance of Eye Exams and Specialist Care
Routine eye exams with an optometrist or general ophthalmologist are the first line of defense in identifying AMD. However, once AMD is suspected or diagnosed, referral to a retina specialist is essential. Retina specialists undergo additional years of fellowship training specifically in identifying and treating diseases of the retina and macula. This specialized expertise allows for detailed diagnostic imaging, tailored treatment plans, and access to the latest clinical advances in emerging therapies for AMD.

Current Treatments and New Technologies for Dry AMD
For patients with intermediate dry AMD, one of the most promising new therapies involves photobiomodulation (PBM) using the Valeda Light Delivery System, an FDA-authorized device. PBM works by exposing the retina to specific wavelengths of light that stimulate the mitochondria—the “powerhouses” of our cells. By energizing these tiny structures, PBM helps improve cellular metabolism and reduce oxidative stress thought to have a role in slowing AMD.

Clinical trials, including the LIGHTSITE III and LIGHTSITE IIIB, have shown that PBM can lead to improved visual function and contrast sensitivity in patients with intermediate AMD. These studies support PBM as a safe, non-invasive treatment option for eligible patients.

In addition, there are FDA-approved injections for geographic atrophy, a more advanced stage of dry AMD. These treatments aim to slow progression and preserve remaining vision, marking a major milestone for patients who previously had limited options.
For AMD that has advanced beyond the ability to benefit from the therapies mentioned there are still options. Many vision aids and tools are available today that can help optimize remaining vision. Getting a referral to a Low Vision specialist is another step available to help individuals affected by advanced AMD.

Treating Early to Protect Vision
Early identification and intervention is key. Just like controlling blood pressure or diabetes early to prevent complications later on, addressing macular degeneration before it becomes advanced can make a significant difference in the long run. Current therapy slows down AMD to keep vision better for longer, but does not completely stop or reverse dry AMD. Regular follow-ups and referral to a retina specialist can ensure timely diagnosis, access to cutting-edge treatments, and personalized care to preserve sight for as long as possible.
Dr. Jed Assam is a board-certified, fellowship-trained retina specialist dedicated to the diagnosis and treatment of AMD along with other macular and retinal disorders. He is the founder of VRA Vision in Sioux Falls, a Center for Excellence in Macular Degeneration, and is passionate about patient education and early intervention to prevent vision loss. 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 November 2nd, 2025
“Listen to your gut”
By Jill Kruse, DO
   People often talk about having a “gut feeling” or are told to “listen to their gut” when making a decision.  Do you know what your gut is trying to tell you?  There are multiple things that your digestive system can do to get your attention.  Do you know what your body is trying to tell you?  Here are some of the things your gut could be trying to say.
   Pain just below the breastbone that occurs soon after eating could be a sign of a stomach ulcer.  Pain that improves with eating, but then comes back 2-3 hours after eating could be a sign of an ulcer in the small intestine right past the stomach.  The pain from ulcers is often described as a burning pain.  This pain improves with acid blocking medication like a PPI (Proton Pump Inhibitor) or antacids. 
   The gallbladder can also cause significant pain in the right upper part of the abdomen, especially after eating fatty foods.  Often this pain will radiate to the right shoulder or between the shoulder blades.  It can lead to significant nausea and diarrhea.  This pain usually will come and go.  It can become very severe if a small gallstone gets stuck in the bile duct between the gallbladder and the small intestine.  Infections of the gallbladder can cause fevers and chills as well.
    Issues with the small intestine can also cause serious pain.  The condition of Irritable Bowel Syndrome (IBS) causes abdominal pain, bloating and changes in bowel movements.  IBS can cause severe diarrhea, severe constipation or both.  IBS is considered a diagnosis of exclusion since these symptoms can be caused by many other conditions like Microscopic Colitis, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, Small Intestine Bacterial Overgrowth, and even Colon Cancer.
     However, it is important to note that not all pain in the stomach area is from the digestive system.  Heart attacks can also give symptoms of indigestion, nausea, vomiting, and stomach pain.  These subtle signs happen more frequently in women and can lead to delay in diagnosis.  Aortic dissections or ruptured aortic aneurisms can also cause severe, tearing pain in the abdomen that can radiate to the back or shoulders.
     If you notice your gut trying to tell you something, listen and get it checked out by a doctor.  Many of these issues have similar or overlapping symptoms. Finding a physician who can order and interpret the right tests to find the answer is key. Your gut knows when something is wrong, and you should trust it.   Listen to your gut and stay healthy out there.
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 October 26th, 2025
“The key to boosting immunity”
By Kelly Evans Hullinger, MD FACP


It’s hard to look at your television or social media and not see a headline about some “superfood,” supplement, or other product promising to “boost immunity.” And who doesn’t want to boost immunity, especially in a year in which measles outbreaks are becoming routine? Genuinely, there is one entity available to us that, more than any other fad, will help our immunity and protect us against infection: vaccines.
Vaccines are one of the great miracles in the history of science serving humanity. Whereas in centuries before, seeing children and young people die of infectious diseases was a universal experience, vaccines have truly changed the world in that regard. Diseases like smallpox and polio have been wiped out after being something parents feared throughout human existence.
With the huge successes of vaccines, in some ways we as a society have forgotten their wonderful impact. Measles, up until the 1960’s a disease that was commonplace and resulted in unfortunate deaths of infants and children, was rarely seen after widespread vaccination in the late 20th century and early 2000’s. Unfortunately, because of declining rates of childhood vaccination, that is no longer true. Various misinformation campaigns and, probably, a general sense of insignificance (no new parents remember anyone having measles), are to blame.
Measles is a highly contagious disease that statistically requires about 95% vaccination rate in a population to achieve herd immunity. Herd immunity status gives protection to vulnerable individuals including those too young to vaccinate (infants under one year of age). We have seen large outbreaks of measles in numerous states this year, generally in communities where that herd immunity is not being achieved. And because measles is so highly contagious, kids who have not been vaccinated may have to miss school for weeks to stay safe. Most sadly, we have seen deaths this year in the US from a disease which was considered eliminated as recently as 2020. Let’s hope this isn’t a sign of other preventable infectious diseases making a comeback.
So, if you’re looking to boost your immunity this season, of course I recommend a healthy diet, regular exercise, and adequate sleep. But if you want to make the biggest impact, talk to your doctor about vaccines and get caught up with evidence-based recommendations. Your immune system will thank you.
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 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 October 19th, 2025
“Midnight Muscle Cramps? Here’s What Your Body is Telling You”
By Patti Berg-Poppe

You’re asleep when suddenly your calf tightens into a painful knot. You swing your legs over the side of the bed and stand up, trying to stretch the muscle and waiting for the cramp to release. It passes after a minute or two, but the soreness often lingers. These types of nighttime leg cramps are common and often harmless, but disruptive.

Studies suggest that up to 60% of adults experience leg cramps at night at some point in their lives. They become more common with age and can occur more frequently in people with certain medical conditions or those taking specific medications. 

The cause isn’t always clear, but several theories exist. One involves the gradual loss of motor neurons that occurs with aging. As nerve cells die off, the ones that remain may attempt to compensate by branching out to control more muscle fibers. This reorganization may make the system more prone to overexcitation, triggering cramps.

There is also a strong association between inactivity and muscle cramping. Many people spend long hours sitting or standing in place without moving through the full range of motion needed to keep leg muscles and tendons flexible. Over time, this can lead to muscle shortening, weakness, and poor circulation, all of which may increase the risk of cramping.

Daily activities that used to keep our muscles stretched and strong, such as squatting, kneeling, or walking on uneven terrain, are also less common in modern life. Without these movements, muscles like the hamstrings and those in our calves become less adaptable. The typical sleeping posture, with feet pointed down and ankles in plantarflexion, keeps the calf muscles in a shortened position for hours at a time. This posture may increase the likelihood of spontaneous nerve firing, especially during lighter stages of sleep.

Dehydration, electrolyte imbalances, and certain medications (such as diuretics) may also contribute to cramping. In some cases, leg cramps can be linked to medical conditions such as peripheral artery disease, diabetes or kidney disease.

Although painful, most nighttime leg cramps are not dangerous, and they can often be managed with simple changes. Stretching the calf muscles and hamstrings daily, especially before bed, may reduce the frequency and intensity of cramps. Staying physically active, including activities that strengthen the legs and promote circulation, can help maintain muscle function and flexibility. Walking, bicycling, heel raises and chair squats are practical options for many adults.

People who experience frequent cramps may benefit from adjusting their sleep posture. Using a pillow to keep the feet in a more neutral position, or avoiding heavy bedding that pushes the feet downward, can be helpful.

If cramps are severe, occur often or are associated with other symptoms, it’s worth talking with a health care provider to rule out underlying causes. In many cases, however, consistent movement, hydration and attention to daily habits can make a meaningful difference.

Patti Berg-Poppe is a physical therapist and professor at the University of South Dakota. Her work centers on helping people understand the connection between movement, health and maintaining independence and engagement throughout life. 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 on SDPB 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 October 12th, 2025
“The What If’s”
By Debra Johnston, MD

Let’s call her Sarah, although that wasn’t her name. I’d had the privilege of delivering her, and the fun of watching her grow into a precocious toddler, with an impish smile and a joyous laugh. Then I had the responsibility of explaining her autopsy report to her devastated parents. 

She’d died from an infection that her young, previously healthy body just couldn’t fight. It hadn’t taken long; she’d started running a fever the night before, and her parents brought her to the clinic the next afternoon. The flight crew hadn’t even gotten to our ER before she lost the battle.

Of course we all had “what ifs” to torment ourselves with. What if mom had breast fed for longer? What if dad hadn’t taken her to that play date, with the little friend who had a runny nose? What if the doctor (me) been more detailed in the “how to tell when she’s really sick” discussion? What if her parents had brought her to the ER that morning, instead of to the clinic that afternoon?

The “what if” that has tormented me the most, though, is what if she’d been born just a year or two later?

The infection that killed my little patient was caused by streptococcus pneumoniae. The original version of the Prevnar vaccine, which taught a child’s immune system to fight 7 strains of that bacteria, was introduced in 2000. Shortly after, the rates of serious infections from these bacteria dropped precipitously, and not just in the children who got the shots. Adults also benefited, to varying degrees. 

One modernized version of the Hippocratic oath contains the phrase “I will prevent disease whenever I can, for prevention is preferable to cure.” I don’t remember if my classmates and I said those particular words on graduation day, but it’s a philosophy I wholeheartedly endorse, and one I try to live by. I nag my patients to eat more fruits and vegetables, and to get their calcium. I nag them to exercise more. I nag them to quit smoking. I urge them to get to the eye doctor, and to the dentist. I remind them that seatbelts save lives, that helmets save lives, that smoke detectors save lives. That vaccines save lives. 

I don’t know that the Prevnar vaccine would have saved little Sarah. No vaccine is perfectly protective. She might still have gotten seriously ill. She might still have died. 

But I do know it would have shifted the odds in her favor.  

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, YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of October 5th, 2025
“From Maiden to Mother to Matriarch: Understanding the Transition of Perimenopause”
By Jill Kruse, DO
Women experience distinct stages throughout their lives.  In literature, these are often described as the maiden, the mother, and the matriarch phases.  The transitions between these phases can be challenging times for a woman.  Perimenopause is the transition between mother to matriarch.  
The prefix peri- means around, about or near, and menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months.  The average age of menopause is 51 years old.  Perimenopause typically starts for women in their 40s and lasts between four to ten years. In some cases, it can start as early as 30s or as late as 50s.  
During perimenopause, the ovaries start producing fewer hormones. Estrogen and progesterone levels can vary significantly week to week leading to the symptoms associated with perimenopause. Because of these hormonal shifts, lab tests for hormone levels can be unreliable for diagnosis. Elevated Follicle Stimulating Hormone (FSH) and low Estradiol levels in a woman over the age of 45 can suggest menopause, although repeated testing is usually needed to confirm a diagnosis.  Thyroid Stimulating Hormone (TSH) is often checked in women, since low TSH can mimic perimenopause or menopause symptoms.  
One of the first perimenopause symptoms many women experience is menstrual cycle changes.  Menstrual cycles may become more irregular, longer, shorter, heavier or lighter. Hormonal changes can also lead to hot flashes, night sweats, vaginal dryness, sleep problems, mood changes, and ‘brain fog’. Slower metabolism during perimenopause can also lead to weight gain in some women.  
While perimenopause is a natural part of aging, there are lifestyle changes and medications that can help minimize its symptoms.  Limiting alcohol and caffeine, improving sleep quality, and reducing stress can all help diminish hot flashes.  Doing more weight bearing exercises and taking a Calcium with Vitamin D supplement can help reduce the increased risk of osteoporosis and heart disease, which is caused by the decrease in estrogen.  Quitting smoking is also an important step to help minimize symptoms of perimenopause and menopause.  Discussing with your physician can help you find one of the multiple prescription medications that are available to help reduce symptoms.  
Although this transition from mother to matriarch is not always smooth or easy, knowing what to expect can help alleviate anxiety and fear.  Making healthy lifestyle choices and maintaining regular doctor visits are key. If you are experiencing symptoms, speak with your doctor about possible treatments and how to best support your well-being through this important life phase. 
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).