By Andrew Ellsworth, M.D.
 
The feeling of pressure and pain in the front of the face around the eyes is all too familiar for millions of Americans. Our sinuses include four pairs of air-filled cavities above and below the eyes and behind the nose. They are helpful for humidifying the air we breathe, resonating our voices, and lightening the weight of our heads. However, the sinuses can be prone to inflammation and infection. 
 
The mucous lining of the sinuses serves as an antimicrobial barrier to infection, and little hairs called cilia help to sweep out unwanted bacteria and viruses. Disruptions to this system commonly come from allergies and viruses. If the passageways get blocked, then bacteria can grow and flourish in the moist, warm, mucous.  
 
Sinusitis is inflammation of the sinuses which can cause the full feeling behind the eyes, pressure, and pain. If left untreated, it can cause fevers and a systemic response from the body. Chronic sinusitis, lasting more than three months, can be caused by allergies, nasal polyps, ongoing infection, a deviated nasal septum, pollutants, or other conditions. 
 
One of the keys to treatment and prevention of sinusitis is keeping the sinuses open and draining. Nasal saline, a saltwater mixture, can be used to help rinse out and open the sinuses and can be just as effective as antibiotics. If allergies are at fault, a steroid nasal spray or steroid pills can be used to decrease inflammation and swelling. A nasal steroid spray can also help treat a nasal polyp, helping to shrink the polyp to aid in the circulation of air and mucous. For some people with chronic and recurring sinusitis, surgery is their best option and can provide welcome relief.
 
Try this. Hold one nostril shut as you breathe in and out of the other. Now switch to the other nostril and breathe in and out. Chances are you can breathe more freely on one side compared to the other. Wait a few hours, try it again and chances are the opposite side is more open. Congestion in our nose naturally changes sides every four to six hours. If you find that one side is always blocked, then you may want to see your primary doctor or an ear, nose, and throat specialist. 
 
Our bodies are designed for flow. The flow of air, food, blood, waste, and even mucous keeps us healthy. Next time you blow your nose, remember you are helping the natural movement of mucous, so just “blow with the flow.”
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Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 Kelly Evans-Hullinger, M.D.
 
It was my first month in the hospital as a new internal medicine intern at a large university hospital.  Upper-level residents that I met during orientation asked me, “What is your first rotation?”  When I answered, “hepatology,” the looks I got in response told me I was in for a tough initiation.

The hepatology service included some of the sickest patients in the hospital. Each one had either end stage cirrhosis or a liver transplant, plus some acute condition requiring them to be in the hospital. They were so complicated, making clear to the newly minted Dr. Evans that a healthy liver is critical for the body to function normally.

Cirrhosis (scarring of the liver) is the undesirable result of many types of chronic liver disease. Many causes of liver disease occur at random, related to autoimmune or genetic origins. However, the most common reasons patients develop cirrhosis are alcohol related liver disease, hepatitis C, and non-alcoholic fatty liver disease, all of which might be controlled if we catch them before cirrhosis develops.

Most people know that chronic heavy alcohol use can result in cirrhosis. We don’t fully understand why some heavy drinkers develop cirrhosis and some don’t, but longstanding alcohol abuse does typically result in some degree of liver damage. Though it can be very difficult, stopping alcohol intake can, in turn, stop progression of liver damage in most patients with alcohol related liver disease.

Hepatitis C, a viral infection which in some people becomes chronic and can ultimately lead to cirrhosis, has been the most common reason for liver transplant in the United States in recent years. With major developments in treatment for this disease over the last decade, we now have highly effective and well tolerated antiviral treatments to cure hepatitis C. This virus can reside in the liver and bloodstream without causing symptoms for decades. Current recommendations advise that we screen for hepatitis C in patients who have significant risk, including all Americans born between 1945 and 1965 in addition to other high risk groups. Talk to your doctor if that includes you.

Nonalcoholic fatty liver disease (NAFLD) is increasingly prevalent and now is among the most common reasons for liver failure. NAFLD is thought to be due to metabolic factors resulting in fatty deposition in the liver. It commonly occurs along with other metabolic diseases such as obesity, diabetes, and high cholesterol. Treatment of NAFLD is focused on diet and exercise and controlling those other metabolic diseases.

That one month as a new physician on the hepatology service was enlightening. I learned so much about the importance of a healthy liver, and I continue to use those lessons regularly in primary care.
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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. 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.
 
America is grappling a difficult legacy. Our society was built by the blood and sweat of slaves, on land previously occupied by Native Americans. When we won independence, only white male property owners were fully enfranchised. Enslaved peoples were not fully counted under the constitution. Married women had no legal identity.
 
Immigrants, particularly from Ireland, southern Europe, and Asia faced open hostility. Catholic Churches were vandalized. Nearly 1000 Jewish refugees fleeing Nazi Germany were turned away in Miami harbor. Japanese Americans were forced from their homes and into internment camps.
 
We have a proud heritage of noble ideals, but we have often failed to live up to them. We have emphasized our differences, not to celebrate the rich tapestry of life they create, but to divide ourselves into “us” and “them.”
 
In the last 250 years, our society has moved in meaningful ways toward equal participation. Slavery is illegal. Women can own property. People of different races can marry. We still face the consequences of generations of discrimination, but most of us find we have opportunities our grandparents did not.
 
The LGBTQ+ community is the most recent to demand an end to discrimination. Awareness is increasing, but many people still have little information, or have misinformation, about the diversity of human sexuality and sexual identity.
 
Three years ago, a high school friend shocked me when she revealed that she was, in fact, a trans woman. I wonder how many other people I’ve met and cherished have felt compelled to hide something so important. We know that suicide attempts in the LGBTQ+ community are higher than in the general population, particularly for young people who are bullied in their communities or rejected at home. LGBTQ+ individuals are more likely to be victimized by violent crimes.
 
I often think of the saying “a rising tide lifts all boats.” It reminds me that working to improve my neighbor’s wellbeing makes my own more secure. This is especially true for the neighbors who don’t look like me, who don’t pray like me, who don’t vote like me, who don’t love like me. If their rights are threatened, it is only a matter of time before mine are, as well.
 
We can all look back in our family trees and find someone who faced discrimination for their race, religion, or class. And of course, we all have mothers and grandmothers! Let’s remember those struggles and extend compassion. We are more alike than we are different.
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Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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 Jill Kruse, D.O.
 
One definition of the word murmur is “to express one's discontent in a subdued manner.” So, it makes sense that a heart murmur is often a soft-spoken signal that something may be going on in the heart. The heart does not always shout to get our attention like it does with a heart attack. Sometimes it quietly whispers to those who will listen that there might be an issue. The murmur itself is not the problem, rather, the murmur is telling us to look for one. 
 
Some murmurs are called innocent or benign. These are murmurs when the heart is normal, but the blood is flowing over the valves rapidly which causes a sound. About forty to forty-five percent of children will have a murmur at some point in their life. No treatment is needed for these murmurs and children will often outgrow them, but up to ten percent of them do persist into adulthood. 
 
Murmurs that indicate more serious issues are often associated with valve disorders in the heart. The valves are the areas that open when the chamber of the heart beats and close when the heart is between beats, to allow the chambers to relax and refill with blood. Sometimes a valve does not fully close, or it will balloon backwards and allow blood to backflow across the valve. This back flow causes a murmur. This is called valve prolapse that leads to blood regurgitation or “regurg” which requires medical attention.
 
A different type of murmur is caused by mitral or aortic valve stenosis. Stenosis is when the valve does not fully open, so the same amount of blood is forcing itself through a narrower opening in the same amount of time as it does in a normal valve. That extra pressure causes the murmur because the heart must work harder to push the blood through the valve. Over time if this is untreated it can lead to damage of the heart muscles.  
 
The most common murmur is aortic sclerosis, which happens when the aortic valve develops scarring, stiffening, or thickening. This can occur with age or after infections such as rheumatic fever or endocarditis.  This is not dangerous by itself, but if it progresses to stenosis, it can be cause for concern.
 
Often when a doctor hears a murmur, we may want to get a better look with a special ultrasound called an echocardiogram to see if we can find the cause of the noise. Once the cause is found, a follow up plan can be made.
 
When the heart whispers, we must always listen. By doing so, we may avoid further discontent, forcing the heart to raise its voice over a larger problem.  
 
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.