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).

Prairie Doc Perspective Week of September 28th, 2025
Beyond the Baseline: Understanding Tennis Elbow
By. Andrew Ellsworth, MD


A few years ago, I was helping with my son’s baseball team. One day, for a routine practice, my role was to hit fly balls for the boys to catch. While I was confident at hitting fly balls, to make things easier for me, I was handed a racquet that, with a fairly easy swing, would launch the baseballs out to the boys. However, after 20 minutes, my elbow was getting sore. More groups of boys needed to rotate through and catch fly balls, so I kept at it. I swung the racquet and the baseballs flew to the outfield over and over. In the end, after less than an hour, my elbow was shot.  


I was experiencing lateral epicondylitis, or tennis elbow.  It hurt on the lateral, or outside, part of my elbow, and while it did not hurt that bad, it was almost debilitating for certain movements. I took some ibuprofen, avoided certain activities, and needed to give it time to heal. 


Lateral epicondylitis, which now could also be called “pickleball elbow” with the big increase in pickleball players, is an over-use injury of the tendons at the elbow. Caused by any repetitive use of the forearm muscles, microscopic tears can form which cause pain at the insertion where the tendons attach to the bone at the elbow, known as the lateral epicondyle. The cause is not just limited to sporting activities. Manual laborers, painters, gardeners pulling weeds, musicians, and anyone doing an activity repetitively and more than their body is used to doing, can be susceptible to this injury.  Golfers can experience a similar injury, but one that affects the inside part of the elbow, causing medial epicondylitis. 


One of the keys to recovery is paying attention to your body and avoiding activities that cause the pain. Pushing through may make it worse and make recovery last longer. Non-steroidal anti-inflammatories such as ibuprofen may help with the pain, as well as icing, stretches, and physical therapy. Some people may find benefit from using a brace wrapped around the forearm muscles, taking pressure off of the tendons. Rarely, steroid injections or an injection of plasma-rich protein may be used, although these are not without some risk. Other treatments can also include ultrasound and shock wave therapy. 


Thankfully, most cases will subside on their own with time. However, it can take a lot of time, oftentimes several months and possibly up to two years. In very rare cases, surgery to remove damaged tissue may be an option.  


In my case, the pesky elbow pain lingered for at least six months. This was all because of less than an hour of using a racquet that I refuse to ever use again. I am happy to hit fly balls and I still do, but give me the baseball bat, please. 


Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of September 21st, 2025
Exercise and Arthritis: What Really Works
By Becca Jordre, Ph.D., DPT
If your joints ache after sitting too long or make crackling sounds when you get up, you’re not alone. More than half of older adults in the U.S. report having at least one arthritic joint, and while our understanding has improved over the past two decades, old myths still create confusion about how best to manage it.
Is Exercise Safe?
Many people fear that too much movement or vigorous exercise will wear out their joints and make arthritis worse. The surprising truth is that exercise is one of the most powerful ways to protect and even improve the health of cartilage. 
How it Works
Cartilage, the smooth tissue that cushions our joints, doesn’t have a blood supply of its own. Instead, it depends on the surrounding fluid in the joint space. Movement acts like a pump: when cartilage is compressed and released, it pushes out waste and pulls in fresh fluid and nutrients. This happens each time you take a step, bend or jump. Think of it as CPR for your joints, compression and decompression pump fluid in and out, keeping cartilage alive and well.
When Exercise Hurts
For many, pain with certain movements is common, and pushing through pain can make things worse. “No pain, no gain” is not the answer. The key is to find activities that don’t hurt. Even small pain-free movements make a difference. Anything is better than nothing, and over time, those movements can pay off by allowing greater mobility with less pain. 
The Power of Water
For many people with significant arthritis, water-based exercise is a game-changer. Water supports body weight, reducing pressure on joints, easing swelling and providing natural resistance for strength training. Great options include water aerobics or simply walking, running and jumping while in chest-deep water. 
Strength is Key
Another key to managing joint health and improving function with arthritis is strength training. When muscles around the joint are strengthened, they act like shock absorbers and reduce joint stress. Resistance training can start with simple tools like exercise bands or body weight. Small resistance movements can gradually progress to larger, more challenging exercises as strength improves and pain decreases. 
Yes, arthritis is a pain - but avoiding movement only makes it worse. Find pain-free ways to move and build strength. Start small, stay consistent and your joints will thank you.






Becca Jordre, Ph.D., DPT, is a professor of physical therapy at the University of South Dakota, board certified in geriatric physical therapy, and a certified exercise expert for aging adults. Her research centers on healthy aging, with a particular focus on athletes age 50 and older. She collaborates regularly with the National Senior Games Association and developed the Sustained Athlete Fitness Exam (SAFE), a tool designed to assess physical fitness in older athletes. 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 September 14th, 2025
“On the Spectrum”
By Debra Johnston, MD


I had a friend in high school who was generally considered a bit odd. He didn’t dress quite right, never knew how to “read the room,” and often talked far too long and in far to much detail about computers— at a time when very few households even had one. 


The movie Rain Man, in which an autistic character is abducted from an institution by his greedy younger brother, had yet to be released, and certainly no one in my circle was familiar with autism. Once we were, it was Dustin Hoffman’s portrayal of Raymond Babbitt that defined our understanding. For decades, this was the dominant image, even while the diagnostic criteria expanded to include people with less dramatic challenges. Today, I suspect my friend would have been recognized as being “on the spectrum.”


Autism is an ancient condition. Some researchers suspect it explains stories about changelings, fey creatures swapped for humans. While most individuals with classic autism have disappeared from the historical record, and certainly, given that it wasn’t until the DSMIII was published in 1980 that autism was defined as a distinct condition, we can only speculate about historical figures. Nevertheless, many of our greatest thinkers and innovators may have been “on the spectrum.” Michelangelo, DaVinci, Newton, Einstein, Orwell, Twain. . . the list goes on. Sia, Bella Ramsey, Dan Ackroyd, Anthony Hopkins, and of course Elon Musk have all publicly disclosed their diagnoses.


People with autism spectrum disorders are unique human beings, in the same way we are all unique. The condition may present very differently between one person and another. That can make it challenging, for families, schools, clinicians, and of course for the individual themselves! The support that is critical for one person may be utterly useless for another, but research consistently shows that the right support at the right time can help someone succeed, academically, and socially. Of course this is true for us all, but since the challenges faced by people with autism are by definition greater, the need is greater. 


Autism is often accompanied by other conditions, such as ADHD, OCD, epilepsy, and allergies, and well recognized genetic disorders such as Down syndrome. This merely adds to the diversity of the autism experience, and further demonstrates why there isn’t a single “box” into which people with autism can be sorted.


My high school friend? Well, we’ve lost touch over the years, but I know he followed his passion for computers and is very successful in his field. 


I hope he is surrounded by people who appreciate him for who he is.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of September 7th, 2025
“What Questions Do You Have?”
By Dr. Jill Kruse
              We have all heard it before.  Before the end of the visit, the doctor will usually ask, “Do you have any questions?”  That is usually the precise moment that my mind goes completely blank. Every question I can think of seems silly or embarrassing.  I know the doctor is busy so I don’t want to “bother” him/her by taking up too much of their time.  I really do not want to look stupid or ignorant.  So, I say nothing, smile and the doctor leaves the room shortly afterwards.  As soon as that door closes, the flood gates open and all the questions I should have asked bubble to the surface. Now it feels too late to ask them.  Sound familiar?
As we begin our next season of On Call with the Prairie Doc, I encourage all our viewers to come to us with those questions.  This show is unique because we ask our audience to engage with the show.  We do not want you to just be passive consumers of the knowledge.  We want you to be co-creators of the show with us.  While we will never replace your primary care physician, we want to answer the questions that you did ask during your last clinic visit.  Since you can submit questions anonymously, ask that question you were too embarrassed to ask.  Use this show to fact check that health information you saw on social media or heard someone talk about at the local café. 
              We work hard to find the local experts for each show who can share with us their expertise.  At the end of each season, we review our shows and look at what questions were asked.  We see how many questions were answered for each show and what topics resonated the most with our viewers.  We try to determine what topics you want to hear more about. We also look for emerging topics so you have up to date health information that is based in science and built on trust.  
              The hardest part of planning this show is narrowing down all the topics we want to discuss with you to fit within our season.  This is why we will have several “Ask Anything” shows each season.  These shows ensure that you, our viewers, will always have a show where any question not only welcomed, but encouraged.  The beautiful part of our show is that each show is fluid and we can pivot our focus based on the information you want most.  The more you interact with this show, the better it will become.  After twenty-four seasons we have yet to run out of questions to answer.  This week and every week to follow, please ask anything.  We will be here to answer. 
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 August 31st, 2025
Nurturing Active Childhoods in a High-Tech World
By Dr. Patti Berg-Poppe and Dr. Hsin-yi “Tanya” Liu


Long before children say their first words or pick up a pencil, they’re learning through their bodies. They kick, reach, roll, crawl and explore - hardwired to interact with the world through movement. From the very beginning, motor and sensory experiences are how babies discover their environment and how their brains begin to grow and organize.


Simply put, our bodies in motion are the vehicles through which we learn. When children move, their brains light up. Their senses, muscles, emotions and attention systems all come online and begin working together. Through active exploration, children build the foundations of their sensory, perceptual and cognitive systems.


Movement and imaginative play stimulate both brain and body, supporting not only strength and coordination but also emotional regulation, adaptive behaviors and social connection. A child building a tower of blocks isn’t just learning fine motor skills; they’re developing attention, problem-solving and perseverance. Free play fosters communication, cooperation and confidence. Movement is how learning begins … and how it continues to unfold.


Yet despite all we know about the power of movement, children today grow up in an environment where active play is often displaced by screen time. Screens are nearly unavoidable and are often used to entertain, educate or soothe. For many families, technology helps manage the demands of modern life. But when screen use regularly replaces hands-on, movement-rich experiences, opportunities for growth are lost.


A child passively watching a screen misses the sensory variety, trial-and-error learning and face-to-face interaction that come from real-world play. Over time, this shift can influence motor skills, attention, emotional regulation, sleep and readiness to learn, which are essential for thriving in school, relationships and everyday routines.


The American Academy of Pediatrics recommends that children under 18 months avoid screen use altogether, and that children ages 2–5 be limited to no more than one hour of high-quality content per day. These guidelines aren't about restriction for its own sake; they reflect what we know about how children learn best - through movement, play and real-world interaction.


Movement is also one of the most reliable indicators of healthy development. Nearly 9 out of 10 young children in the U.S. meet national physical activity guidelines. This number drops sharply with age. By 6 to 17 years, only about a quarter of children meet these standards. As screen time increases and free time shrinks, children’s need for movement can quietly go unmet.


This steady trend of rising screen use and declining physical activity doesn’t mean we need to eliminate technology. Rather, we need to be more intentional about preserving time for play. Supporting active childhoods means prioritizing daily opportunities for whole-body movement, open-ended exploration and connection. That might look like a walk after dinner, dancing in the kitchen, building a blanket fort or inviting your child to help prepare a meal.


As pediatric physical therapists, educators and parents, we see the impact of movement every day. Children don’t need expensive equipment or curated experiences. They need time, space and encouragement to move through their world and learn as they go. Fostering imagination, exploration and meaningful interactions with peers and caring adults helps children grow into strong, curious and resilient individuals.


For guidance on creating a balanced media plan, visit:
https://www.healthychildren.org/English/media/Pages/hhh.aspx 




Patti Berg-Poppe is a physical therapist and professor and chair of USD’s Department of Physical Therapy, where she also directs the Program for Advancing Early Childhood Intervention (PACE-i). She has extensive experience in pediatric physical therapy and early intervention, with a focus on preparing future professionals to support development through play, movement and family-centered care.


Hsin-yi “Tanya” Liu is a pediatric physical therapist and researcher with expertise in early childhood development, mobility and assistive technology. She has practiced in both Taiwan and the United States and currently serves as assistant professor within USD’s Department of Physical Therapy. Her work focuses on how play, movement and adaptive tools support motor and social development in children.


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 August 24th, 2025
Peripheral Artery Screening: A Lifesaving Check-Up for Your Circulation
By Adam Ladwig, Ph.D., DPT and Jed Droge, DPT
While you’ve likely had your blood pressure checked in your arm countless times, you may have never had it measured in your leg. Yet this simple and often overlooked screening can be critical for detecting restricted blood flow. If left untreated, inadequate blood flow could lead to serious complications including limb loss, disability or even death.
Many people are unaware of a common and serious condition known as peripheral artery disease (PAD). PAD occurs when the arteries in your legs become narrowed or blocked due to plaque buildup, reducing blood flow to your lower limbs. This condition affects over 8 million Americans and is especially common in those over 60 or with a history of smoking, diabetes or heart disease.
PAD doesn’t always come with obvious symptoms, but when it does, they may include leg pain or cramping during walking (called claudication), numbness, cold feet or wounds on the legs or feet that are slow to heal. Unfortunately, because these symptoms can be subtle or mistaken for other issues like arthritis or aging, PAD is often overlooked, until it leads to serious complications like infections, non-healing wounds or even amputation.
PAD can be detected easily and painlessly with a simple screening called the ankle-brachial index (ABI). Although traditionally completed with a Doppler ultrasound, screening can be completed with an automatic blood pressure cuff. The ABI test compares the systolic blood pressure (the first number) in your ankle to the blood pressure in your arm. The whole process takes only a few minutes and can help identify if blood is not flowing properly to your legs.
Health care providers, including physical therapists, are trained to help identify conditions like PAD early. If we detect signs of reduced circulation through an ABI screening, we’ll refer you to a medical provider for further evaluation. If PAD is diagnosed, treatment often begins with lifestyle changes like quitting smoking, increasing physical activity (especially walking) and managing other health conditions such as high blood pressure or diabetes. Physical therapy can play a key role in treatment. One of the most effective approaches is supervised exercise therapy, which has been shown to improve walking distance, reduce symptoms and enhance overall cardiovascular health. In a supervised setting, physical therapists guide patients through structured walking programs, gradually improving circulation and tolerance to activity in a safe, monitored environment. In some cases, medications or procedures may be needed to improve blood flow.
Screening for PAD is especially important because many people don’t know they have it until it's advanced. Early detection can prevent serious outcomes and allow you to keep moving and living independently.
If you're over 60, have diabetes, smoke or have a family history of cardiovascular disease, consider asking your health care provider or physical therapist about ABI screening. It's quick, non-invasive and could make a life-saving difference.
Your legs have something important to tell you. Make sure you're listening.

Adam Ladwig, Ph.D., DPT, is an associate professor at the University of South Dakota where he teaches cardiovascular and pulmonary physical therapy as well as differential diagnosis. He has 13 years’ experience as a clinician and maintains practice in rural South Dakota.
Jed Droge, DPT, is an assistant professor at the University of South Dakota, where he teaches a variety of subjects, including differential diagnosis, to entry-level physical therapy students. He has 15 years’ experience as a clinician, primarily in rural Nebraska. 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