by Andrew Ellsworth, M.D.
 
One late summer day, fresh out of residency and seeing patients for the first time as a full-fledged family physician, I examined a young man who had a fever, fatigue, and a bad headache. Considering the time of year, influenza was low on the list of possibilities, and COVID-19 did not yet exist. After a physical exam and listening to his story, I ordered some tests, which resulted in a diagnosis of West Nile virus.
 
Now that we are entering the later half of the summer, the weather and environment are prime for West Nile virus. When the weather becomes hotter and drier, the mosquito species Culex thrives and has the potential to harbor West Nile virus in its saliva.
 
The first reported case of West Nile virus in the United States was in 1999. Now, it's here to stay. There is no vaccine for West Nile virus for humans. The treatment is largely supportive, rest, fluids, and time.
 
Thankfully, most people who become infected with West Nile virus have mild or no symptoms. About one in five of those infected develop a fever, headache, rash, muscle aches, joint pains, vomiting, or diarrhea. About one in 150 may develop a severe case that affects the central nervous system, resulting in encephalitis which is inflammation of the brain, or meningitis known to cause inflammation of the membranes around the brain and spinal cord. Some of those cases can be fatal, which equates to an average of 130 deaths in the United States from West Nile virus each year. 
 
You cannot get West Nile virus from another person. The key to prevention is to avoid getting bitten by a mosquito. This late summer and early fall, remember the mosquito repellent, avoid going outside at dawn or dusk, consider wearing pants and long-sleeved shirts, and consider treating your clothes with permethrin which can kill or repel mosquitos.  Avoid having areas or containers outside that can collect water and create spaces for mosquitoes to lay eggs. 
 
It took a couple of weeks, but thankfully my patient fully recovered. Nowadays, if it is late summer or early fall, and someone has a fever, headache, and fatigue, there is a good chance it is COVID-19. However, one must remember other causes, and West Nile virus is certainly a possibility. 

Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. 

By Kenneth A. Bartholomew, M.D.
 
As a physician with 45 years of practice, I’ve seen my share of diseases. I have usually been on the physician side of the diagnosis-treatment paradigm. However, knowing the rationale for diagnostic screening tests, I fortunately did not shirk my own.
 
Testing too much or too frequently leads to insignificant findings that may have no long-term consequences yet create worry and further testing. Too often, this can lead to surgery that does not save lives but carries pain, disability, unnecessary expense, and sometimes post-op infection that occasionally is fatal. Knowing what and when to test is a crucial conversation to have with your doctor.
 
Although annual prostate-specific antigen, or PSA testing is no longer recommended, periodic testing may raise suspicion if a rising pattern is seen. As luck would have it, this turned out to be my dilemma, so I retested six months later, and when my PSA continued to climb, I went in for a biopsy. The biopsy showed a very aggressive type of cancer, the type that metastasizes very quickly to bone. Surgery was scheduled and computed tomography or CT scans ordered to help with staging my surgery.
 
Even though I had had three colonoscopies in the preceding 25 years, the CT scan showed a tumor inside my colon that was only about one millimeter from breaking through the wall and spreading to other organs. An extra year of procrastinating would almost certainly have found me with two cancers that would have already spread. Catching them early, surgery was curative, and I was one of the lucky ones who did not have to undergo months of radiation or chemotherapy.
 
So, please, have this discussion with your doctor, and review the American Cancer Society’s screening guidelines, as these vary with age, family history, and your unique set of risk factors. Go to www.cancer.org and be proactive. Catch it early and you too can go on enjoying life with your family for years to come.
 
Kenneth A. Bartholomew, M.D. is a contributing Prairie Doc® columnist. He lives in Fort Pierre, South Dakota and serves on the Healing Words Foundation Board of Directors, a 501c3 which provides funding for Prairie Doc® programs. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                   

By Kelly Evans-Hullinger, M.D.
 
As a clinical professor at my state’s medical school, I frequently have medical students seeing patients with me in clinic. While the majority of patients are happy to allow student involvement, some decline. This makes me wonder what misconceptions lead patients to be averse to trainees participating at their clinic visits or hospital bedsides. In my experience, the presence of learners has a positive influence on our work in the clinic and hospital.

Medical education is a complex, highly intensive program that requires years of education and practice. Most medical students are college graduates who performed well in their undergraduate studies and went above and beyond their peers in volunteering, extracurricular activities, and other achievements. After college, some go directly to medical school, and some have variable years of other experiences.

Traditionally the first two years of medical school take place in the classroom, learning about anatomy, physiology, disease processes, microbiology, and pharmacology. The third and fourth years are spent almost entirely in the clinical setting, seeing patients, and learning how to apply their hard-earned knowledge.

After medical school, new doctors go on to their residencies to receive further training in their chosen specialty; and after that, some continue to fellowship. This postgraduate training is rigorous. After at least three but sometimes many more years, those physicians will be ready to practice independently in their specialty.

Recently a student and I saw a patient with leg pain and swelling. After the student’s evaluation, we discussed in the patient’s presence what features of this patient’s pain concerned me for an urgent condition, how we should proceed with diagnostics, and why. The patient was able to observe how much thought went into our assessment, and hopefully the patient appreciated serving as teacher.

When I as an attending physician have a student or resident in my clinic, I am at my best. Students are caring and thorough with our patients. Teaching often requires me to talk about a new diagnosis or treatment in greater detail, and the patient reaps the benefit of hearing that discussion. It is not uncommon for a student to ask me a question to which I don’t know the answer, and ultimately both of us learn something new.

I would encourage patients, when they encounter trainees in their medical care, to view these compassionate and hardworking people as I do: a true complement to patient care. All physicians are life-long learners and are exceedingly grateful for our patients, who are our greatest teachers.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Veronica Radigan, M.D.
 
Summertime. For most, this signals thoughts of warm weather and good times with family and friends. Sadly, what brings happiness for some can trigger stress and sorrow for others. In the words of a Vietnam War veteran, “The fourth of July was once my favorite holiday with friends and family…but now it is a day I wish never existed.”

Now ask, what could this veteran, a victim of a farming accident, a female sexual abuse victim, a child who lost his mother to domestic violence and a survivor of a tornado all have in common? The answer is post-traumatic stress disorder or PTSD.

As defined by the CDC, PTSD is an intense, uncontrollable emotional and physical reaction to a reminder of a traumatic event or distressing memories. Though most people associate this disorder with service members and war, the reality in our society is that PTSD is diverse and far reaching. It is estimated that 70 percent of the population will experience at least one traumatic event in their lifetime and current research shows that about six percent of American adults will suffer from PTSD.

The privilege of talking with hundreds of patients has opened my eyes to the variation of PTSD symptoms and its commonplace in our society.

Some PTSD symptoms are intrusive such as distressing memories, dreams, or flashbacks. Others experience intense psychological or physiological reactions to triggers. The need for avoidance causes some suffering from PTSD to shut out memories of the event and evade reminders such as people, places, situations, or objects. PTSD can alter mood and thoughts which can lead to feelings of blame, fear, horror, anger, guilt, or shame and inability to experience positive emotions. Common symptoms also include irritability and angry outbursts; reckless or self-destructive behaviors such as substance use; hypervigilance; and problems with concentrating and sleep. 

The reality is that PTSD is complex and affects everybody differently, so a treatment that works for one person may not work for another. Currently, the main treatments for PTSD are medications and/or psychotherapy. Support from family, friends and groups are crucial to recovery.

It can be difficult to take that first step to ask for help but with time and treatment PTSD can be managed and controlled. Research shows that the symptoms of PTSD last much longer for those not receiving treatment versus those that receive treatment. By creating more awareness and discussing the diverse nature of PTSD more people will be inspired to get help or give help to those suffering. If you are unsure where to start, ask your family doctor or search for local mental health providers. 
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Veronica Radigan, M.D., a psychiatrist in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist and a guest this week on the Prairie Doc® Q&A show. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

By Andrew Ellsworth, M.D.
 
Recently our family went on a camping trip. Our kids loved how we canoed our supplies across a lake and set up our campsite. My wife and I were reminded how much work it is. Soon our children were experiencing more mosquitos, flies, caterpillars, and ticks than they had ever seen before.
 
On one of our lovely hikes, nearly every time I looked down, I found another tick crawling on my shoe or leg. Ticks love tall grass, wooded areas, and other moist and humid environments often close to the ground. Although you may find them on your head, they don’t normally drop down from above, rather, they start low and crawl up.
 
Ticks are not insects. They are part of the arachnid family, cousins to scorpions, mites, and spiders with two body parts and eight legs. Ticks commonly enjoy sucking the blood of deer, cats, dogs, mice, squirrels…and humans.
 
Blacklegged ticks, sometimes called deer ticks, carry borrelia burgdorferi, the bacteria that can cause Lyme disease. These ticks live in the eastern half of the United States.
 
Symptoms of Lyme disease include fever, headache, fatigue, and the classic target-like rash called erythema migrans. If caught early, this disease is often successfully treated with antibiotics. If not, later stages can affect multiple body systems including the heart, joints, eyes, and nerves. 
 
Other types of ticks can cause Rocky Mountain spotted fever, tularemia, babesiosis, and ehrlichiosis. Rocky Mountain spotted fever also causes fever, headache, nausea, and rash. Treatment within five days decreases the risk of progression to severe disease. 
 
If you find a tick latched onto your body, it is best to use tweezers and pull it off at its head as close to the point of attachment as possible. Pull upwards with steady, even pressure and avoid squeezing the tick’s body. Clean the skin afterwards and dispose of the tick.
 
When outside in the grass, weeds, garden, or woods, consider wearing long pants and tucking the pant legs into your socks to help prevent ticks from accessing your skin. Apply tick repellant on lower clothing and check for ticks at the end of the day. 
 
Despite checking frequently, my son found a tick on him after we got home, and I found one on me two days later. We enjoyed sharing our love and respect for nature with our children, plus they learned how to safely remove a tick. Next time, we hope to bring home lots of great memories, and no ticks.
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                                      

By Jennifer May, M.D.

Many of my patients will say “Doctor, I am so inflamed”. The use of the word inflammation is commonplace as we search the market for anti-inflammatory diets or self-help books on inflammation. The inflammatory response created by the immune system contributes to healing, but when left unchecked can contribute to chronic disease, allergy, and non-specific symptoms such as achy joints, fatigue, and malaise.

The immune system has two main parts. The first of these is the innate immune system which is the body’s first line of defense. The innate immune system acts as a barrier that prevents harmful materials from entering the body and responds quickly when needed. The second part is the adaptive immune system. This system is more specialized and takes over if the innate immune system is unsuccessful. The adaptive immune system responds slower than the innate immune system but more accurately.

So, how can we make our immune system healthier? Here are four areas that one can focus on to improve immune health: quality rest, eating well, exercising, and managing stress.

Lack of sleep weakens the immune system and makes it easier to become ill. This means your colds last longer and you may get them more often. Researchers recommend that adults get 7-8 hours of good sleep each night, while teens need about 10 hours.

Physicians often propose anti-inflammatory diets for people with chronic disease, inflammatory conditions, and food sensitivities. No one diet fits all, but diets that avoid inflammatory foods have proven beneficial. Dietary recommendations include avoiding processed food, meaning, things that come in a box or a bag. Focus on whole foods, such as apples, brown rice, nuts, seeds, and legumes. A good diet for inflammation and cholesterol is the Mediterranean diet. It increases omega-3 fatty acids which help reduce inflammation and hopefully lower those cholesterol numbers.

Exercise also helps our immune system. Getting at least 20-30 minutes of moderate to high level exercise a day boosts antibody response which helps stave off illness. In addition, exercise will also improve your mood. Managing stress is difficult for everyone. However, unplugging and practicing mindfulness are good coping strategies that can help you decompress after a long day.

We are often overwhelmed by stressful, busy lives. Inflammation and immune system issues cannot be fixed with a pill or a bit of advice. It requires a personal commitment to assess your own habits. Then consider what changes are possible for you. Working on one or all the aforementioned areas is worth a try. The power to improve your health and immunity lies within.

Jennifer May, M.D. practices rheumatology in Rapid City, South Dakota. She is a contributing Prairie Doc® columnist and guest host this week on the Prairie Doc® encore television show. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.

By Debra Johnston, M.D.
 
It’s been a long time since I’ve worked in the ER, but some stories stay with me. One such story belongs to a woman in her early 30s. After a year of trying to conceive, she was finally pregnant. Then she started spotting. When she developed severe pain, and almost fainted while putting their toddler to bed, her husband brought her to the emergency room.
 
It didn’t take long for us to identify an ectopic pregnancy. The fertilized egg had implanted in her fallopian tube. Our obstetrician took her to the operating room, where we found large amounts of blood in her abdomen. The surgeon removed the pregnancy and the damaged tube, stopping the bleeding.
 
The uterus is a highly specialized organ. It is usually a bit smaller than a pear but stretches with pregnancy to accommodate six plus pounds of baby and another three plus pounds of placenta and amniotic fluid. The muscle is invaded by the developing placenta but remains strong enough to push a baby out months later.
 
In a normal pregnancy, the fertilized egg divides as it travels down the fallopian tube, entering the uterus approximately four days after fertilization. By seven days after fertilization, or the third week of pregnancy, as many as 300 cells have developed from that fertilized egg. These cells have started to differentiate. Some will form the embryo, and some will go on to form the placenta and other organs that protect and support the pregnancy. It is around this time that the blastocyst, which is the technical term for these cells, will attach to the lining of the uterus. For this attachment to happen, both the uterus and the blastocyst must be in exactly the right stage. The window of opportunity is only a few days which pass by even before a woman misses her period.
 
Unfortunately, not all pregnancies land in the uterus. Pregnancies that attach elsewhere are called ectopic pregnancies. Most ectopic pregnancies are found in the fallopian tubes, although they can be located on the ovary, the cervix, or somewhere in the abdomen.
 
Many ectopic pregnancies will resolve on their own: the cells will stop dividing and the mother’s body will reabsorb the tissue. However, some will continue to grow, causing tearing and bleeding. Untreated, continuing ectopic pregnancies are almost always fatal for the pregnant person. Even with modern imaging and surgical techniques, ectopic pregnancies are the leading cause of pregnancy-related death in early pregnancy. 
 
My patient’s story had a happy ending. Thanks to early diagnosis and treatment, she survived her ectopic pregnancy, and she now dotes on her grandchildren. Too many women around the world don’t get that chance.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Debra Johnston, M.D.
 
For the past few months, I’ve been fielding questions about the baby formula crisis. Make no mistake, the shortage of baby formula is indeed a crisis.
 
Babies are delicate. Their immature bodies rely on having just the right intake of water and salts, and just the right composition of proteins, fats, and carbohydrates. Their organs can’t keep that balance independently, the way healthy older children and adults can. Formula is carefully designed for this.
 
Breastmilk is the ideal food for baby, providing nearly complete nutrition for the first year of life. But not every baby or mother can breast feed. For example, infants with galactosemia are unable to metabolize milk sugar, and mothers with certain infections risk passing them to their babies through breastmilk. There are a variety of social and physical factors that can make breast feeding, or pumping breast milk, untenable.
 
Sometimes we can induce the production of breast milk, but this is a usually difficult and always time-consuming process. It isn’t an option for the mother staring at an empty formula shelf while her two-month-old cries in hunger. And solid foods are not a safe option for babies under four to six months of age as they aren’t physically ready to swallow or digest them.
 
Historically, the most common alternative to a breastfeeding mother was a wet nurse, a woman hired or enslaved to breastfeed another’s infant. The milk of domestic animals, usually cows, was also used as a substitute. But this milk was often contaminated, and animal milk does not have the same nutritional composition as human milk, so babies fed this way were vulnerable to malnutrition and infection. Many died as a result.
 
As science progressed, we learned more about food preservation and sanitation. We learned to pasteurize milk. We learned to produce sweetened condensed and evaporated milk. We learned about the nutritional gaps between human and animal milk, and we began to understand why the latter was not good for babies.
 
By the mid-20th century, most formula fed babies drank a homemade concoction based on evaporated milk, water, and sugar. These home formulas were susceptible to contamination, and difficult to get balanced just right. Many babies still died in infancy because of these issues, although far fewer than in previous centuries. Eventually, commercial formulas were refined to closely mimic the nutritional composition of breastmilk. Manufacturers developed specialty products for infants with issues like prematurity, food allergies and metabolic diseases. These formulas were easy to mix, and far less likely to be contaminated.
 
Modern baby formula is the result of centuries of science. With it, millions of babies grow and thrive. Not having access threatens lives.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Jill Kruse, D.O.
 
Summer is just around the corner and warm days outside in the sunshine will soon be here. This is the perfect time to remember the importance of sunscreen. The number of sunscreens has increased over the years and the plethora of options can make it confusing when shopping for one that works best for you and your family.

There are two main categories of sunscreen: chemical and physical. Each type has its own list of pros and cons. Where you are going, how long you are going to be outside, and what you are doing may factor into which type is right for you.

Chemical sunscreens are probably more common to most consumers. They absorb UV rays and convert them into heat energy before they can damage the skin. These sunscreens are easy to find and relatively inexpensive in the form of lotion, gel sticks, and spray. Main ingredients include avobenzone, octinoxate, and oxybenzone.

Chemical sunscreens must absorb into your skin to work properly. They work best when applied 20-30 minutes before you go outside in the sun. They spread on easily and last long. You want to apply generously, but in general, less of this product is needed to get good coverage when compared to physical sunscreens.

Due to absorption into the skin, chemical sunscreens are not recommended for infants under six months. This type of sunscreen can also run the risk of causing allergic reactions, especially those with sensitive skin or conditions such as eczema or atopic dermatitis. Some ingredients in chemical sunscreens can cause damage to coral reefs and are banned in many places such as Hawaii, Key West, parts of Mexico, several Caribbean islands. 

The other type of sunscreens available are physical sunscreens. These sit on top of the skin and provide a physical barrier to the UV rays, reflecting them away from the body. The main ingredients are titanium dioxide and zinc dioxide. Physical sunscreens are usually sold in the form of a white, thick paste. Some are available in fine powders than can be brushed on like makeup. Paste is more difficult to rub onto the skin compared to lotion and must be reapplied more frequently as it can be easily rubbed off especially when the skin is sweating. It may leave a film, and if you miss a spot, that area is not protected.

Whichever type of sunscreen you use, look for one that blocks both UVA and UVB rays. Remember to reapply often, even on cloudy days and limit exposure to the sun between 10 a.m. and 2 p.m. when the UV rays are at their peak. Enjoy the sun and summer but do so safely. Your skin will thank you. 
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Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                  

By Andrew Ellsworth, M.D.
 
With the storm approaching, my wife texted me after work to come home right away. Within minutes, after I left the clinic, she called me again to tell me NOT to come home and to seek shelter immediately. At first, I thought I could make it home, but then the wall of wind hit, and a tree fell onto the road in front of me. I turned around and another tree blocked the way. Then it got so dark. It was disorienting and I turned on my windshield wipers using the fluid to try to clear the dust and mud off my windshield. That did not help. Thankfully, I made it safely to a friend’s house. 
 
Recently many communities in our region suffered from storms with strong winds that blasted through rural and urban areas in numerous states. Thousands of trees were uprooted, communities went without power, some lost their homes, and unfortunately lives were also lost. While some people were visibly injured, others hurt psychologically. 
 
In my community there were warnings of a storm coming, but it came sooner than expected and most people were surprised at its power. Because of timing of the storm, many people were still on the roads coming home from work. I saw them on the roads with me. Others were trying to secure possessions outside their homes. Many were hit by flying debris and fallen trees. I saw them in the emergency department after the storm. This was a reminder for me to be prepared ahead of time, heed warnings, and seek shelter before the storm comes, not when it comes. 
 
For the last few weeks following the event, I heard people share their experiences during the storm. Some had conversations with me, but I also witnessed many other conversations going on at work, outside with neighbors, and at the grocery store. 
 
If you have been through something difficult or traumatic, there are benefits of sharing your story. It does not help to hold it inside. Talk to someone who can listen, whether it is a friend, family member, counselor, your doctor, or an anonymous person on a helpline. Consider writing or drawing. Find ways to process what you have been through. 
 
Many communities are healing through neighbors helping neighbors and people sharing their stories. This is what our grandparents did when they experienced terrible blizzards, drought, and war, and this is what their ancestors did before them. They helped each other through hardships, and they shared their stories. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.