By Andrew Ellsworth, M.D.
Will the groundhog see his shadow this year? Every year on February 2, people gather in the small town of Punxsutawney in western Pennsylvania to observe the annual Groundhog Day ceremony. If the groundhog does see his shadow, he may retreat to his den and winter will last another six weeks. If he does not see his shadow, spring may arrive early.
This tradition is nearly 140 years old. Organizers claim for the sake of folklore that the original groundhog, Punxsutawney Phil is still alive today, getting his longevity from drinking the “elixir of life.” But obviously, different groundhogs have been used through the years. The average lifespan of groundhog is only two or three years in the wild, and up to fourteen years in captivity. And besides, it’s inevitable that the groundhog’s eyesight would become less dependable as years go by. But I digress.
Like Punxsutawney Phil, some of us humans often see shadows in our vision. Eye floaters can be spots or shadows in our vision from a variety of causes. They often drift about when we move our eyes, and then dart away if we try to look at them, like a groundhog scurrying back to his burrow.
Most floaters are caused by age-related changes that occur as the vitreous, the jelly-like substance inside our eyes, becomes more liquid. Microscopic fibers within the vitreous clump up and cast tiny shadows on our retina, which we see as floaters.
Floaters are most visible when looking at a plain bright background like a white wall. They may appear as dark specks or clear strings. In general, floaters are not harmful and are nothing to worry about. However, a sudden increase in floaters may signal something worrisome, especially if you notice flashes of light or loss of peripheral vision. This may signal a retinal tear, a painless condition that requires prompt treatment to help save your vision.
As we age and the vitreous of the eye liquefies, it may sag and tug on the retina with enough force to tear it. Without treatment, the retinal tear may lead to a retinal detachment, when fluid accumulates behind the retina and separates it from the back of the eye. Untreated, this can result in permanent vision loss.
There are many reasons to go to the eye doctor once or twice per year for routine checkups to help maintain our vision. However, if you see a sudden increase in shadows, floaters, lights, or darkness of any side or sides in your vision, it’s time to leave your den and scurry back to the eye doctor regardless of the season.
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 Kelly Evans-Hullinger, M.D.
Last spring, I was at home washing my hands, and as I glanced up into the mirror, I noticed something unusual. My bathroom light hit my neck just right as I swallowed and there it was: a prominent lump. I diagnosed myself with a thyroid nodule and wondered how I, a physician, had failed to notice this large protuberance before that moment.
Thyroid nodules are quite common. In some cases, they are noticed by the patient (like me) or are found on exam. In many cases they are found on accident when someone has an imaging test like a CT scan, MRI, or ultrasound, done for some other reason. The vast majority of thyroid nodules are benign, only five percent or less representing thyroid cancer.
Typically, if a thyroid nodule is found, thyroid labs and a formal thyroid ultrasound will be recommended. The size and characteristics of the nodule on the ultrasound helps to guide whether a fine needle aspiration (a type of biopsy) should be performed. Many nodules are fluid filled and small, which we know conveys almost no risk of being cancerous, so those can be watched without biopsy.
In my case the nodule was medium sized, two centimeters in diameter, and had slight irregularity such that it was “mildly suspicious” and did warrant biopsy. As a physician-patient awaiting my procedure, I knew that the data said my nodule was still very low risk of being cancerous, but I still had some anxiety about the worst-case scenario.
My colleague, a surgeon, performed my fine needle aspiration expertly the next month. The procedure was easy, done in the office with minimal discomfort. She drained out enough fluid that I no longer had a visible neck lump afterward. My results returned benign, a huge relief.
My thyroid nodule story is a typical one and leaves me with the following advice for others. If a nodule is characterized as benign on ultrasound, rest assured, as these guidelines are sound and based in excellent data. If your doctor recommends a biopsy, try not to lose too much sleep; the procedure is very tolerable, and still most nodules are benign.
I had the good fortune of knowing that even if my mass turned out to be cancer, most thyroid cancers have excellent cure rates. However, I am oddly grateful to have had a small taste of the health stress my patients deal with daily. I hope it improves my doctoring.
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.
The People at your Table
By Debra Johnston, M.D.
One of my favorite parables describes the difference between heaven and hell. In both places, hungry people sit at tables laden with delicious food. In hell, people suffer and starve because they cannot eat with the long utensils provided. In heaven, people are happy and thrive because they use the utensils to feed each other.
Many cultures and religions have some variation of this story. It illustrates a universal truth: we depend on each other. The current pandemic has starkly illustrated this interdependency, and it does not sit comfortably with our American culture of self-reliance and rugged individualism.
As a physician, I depend on nurses, techs, therapists, and pharmacists. I depend on hospitalists to care for patients too sick to stay home. Hospitalists depend on intensivists to care for the sickest. Doctors depend on nurses providing hands-on care at the bedside, respiratory therapists adjusting ventilators, technicians operating machines which substitute for failing organs. And we all rely on those who sterilize equipment, launder sheets, clean rooms, repair machines, and prepare food.
Two years into the Covid 19 pandemic, those of us who remain in healthcare are tired. We have enough beds, and ventilators, and protective equipment, but the human infrastructure is struggling to keep up.
Unfortunately, we cannot simply hire more people. Becoming a physician requires 11-plus years of higher education. Most care team members have at least two years of specialized schooling which is only the beginning; learning is an ongoing process. Health systems may accelerate some of the administrative hurdles to get more people to the bedside, but we cannot accelerate the time it takes to know what to do there.
The upcoming tsunami of Omicron Covid patients threatens to swamp our health care systems. Not only are more people in need, but their needs are far more intense. In addition to Covid patients, people with other illnesses and victims of accidents still need health care services. As my colleagues and I anticipate the coming surge, we wonder how we will meet it. Who will die that with more support, might have lived?
Like the people in the parable, we need each other. Those who are eligible, please get your Covid shots and boosters. Vaccinated people are less likely to need a hospital bed, and less likely to carry the virus to someone more vulnerable. Get your flu shot. Influenza infections are skyrocketing, too. Wear a high-quality mask in public, to protect yourself and others and avoid spending long periods of time in crowds.
We all depend on each other to stay safe. Like those diners in heaven, please use the available tools and do your part for the person across the table.
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.
A Wolf in Sheep’s Clothing
By Jill Kruse, D.O.
Imagine a condition with symptoms that present differently in each person who has it and no currently approved lab test can definitively confirm the diagnosis. Imagine that the symptoms can flare up and then mysteriously disappear, including fatigue, low grade fevers, joint pain, and mouth sores. All these symptoms overlap with multiple other conditions further complicating a diagnosis. Imagine that the best available method for diagnosing this ailment is a manual checklist of eleven criteria and if the patient suffers from at least four, they receive a diagnosis on a scale of definite, probable, or possible.
What if I told you this condition is caused by an attack on the body by its own immune system and the main way to treat this is by suppressing the immune system we each depend upon to help protect our bodies from infection. The course of this illness can range from mild to rapidly progressing to organ failure and death. This condition is real and has a most appropriate name which means “the wolf” in Latin. The condition is systemic lupus erythematosus (SLE), a condition which evades diagnosis and is difficult to treat.
Lupus mainly affects women between the ages of 15 and 40, particularly women of color. For many busy young women with lupus, symptoms are often brushed off by family, friends, and unfortunately sometimes by health care providers who may view the patient as being “tired” or “over worked.” Routine wellness lab tests, which serve as an alert system for other illnesses, provide no indication of lupus. Patients who persist and find someone to further investigate their symptoms may be misdiagnosed with a myriad of other conditions sometimes resulting in unnecessary medications, treatments, and further suffering.
Work is underway to better understand lupus. The trigger that causes the immune system to start attacking itself is not known, but scientists suspect it involves a combination of genetic and environmental factors.
Research and awareness are making a difference. In the 1950s, the 5-year and 10-year survival of SLE patients was less than 50 percent. Since then, that number has improved to over 90 percent. This increase in survival rate stems from improvements in our ability to diagnosis lupus earlier and to provide better treatments once diagnosed. But we must do better. Early diagnosis of lupus requires patients and health care providers working together to persist in finding this “wolf in sheep’s clothing.”
If you or a loved one has a concern about lupus or other autoimmune conditions, talk with your doctor and see if a consultation with a rheumatologist would be beneficial.
Jill Kruse, D.O. 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.
Humanity in Medicine
By Joy Falkenburg, M.D.
What does it mean to practice humanity in medicine? The phrase is used as a tagline and in book titles. Humanity and compassion in medicine is touted as something to aspire to, a noble accomplishment. But in reality, the biomedical model of health, the business model for healthcare, is not set up to support it. Algorithms and best practices set forth by insurance companies and Centers for Medicare and Medicaid do not account for the time required to establish meaningful human interaction between patient and caregiver.
This conundrum can be frustrating. Understanding the nuances of each individual patient and each situation cannot be rushed. Yet opting to practice ‘slow medicine’ can have negative ramifications; constantly running behind schedule, having more work than you can handle and knowing that there are more critical and needy patients waiting to be seen.
Thankfully, the benefits far outweigh the frustrations. Medical professionals who choose to share in the human condition with patients are better able to care for the whole person in a way that is nurturing and fulfilling to both parties. When we are successful in this effort to see our own fear and our own death and our own vulnerability in our patients, we will meet them and treat them with an open mind and open heart. We will listen actively, without bias or judgement and we will do what is best for them in this moment in their life.
Regardless of our profession, experiencing a sense of powerlessness can creep into us and lead to isolation and avoidance. We can lose connectedness with our own emotions and our own self. Striving to have an awareness and acceptance of grief, pain and knowing when to accept our inability to change circumstances can help us avoid feelings of helplessness.
Being a doctor helped create who I am as a person. I am grateful for all the patients who have enriched my life and taught me lessons of humility, joy, interconnectedness, and impermanence.
My patients and my experiences have indeed opened my mind and my heart. In my exam rooms, my patients and I collaborate in a communion of sorts. We share and connect as we learn about and better understand each other. That is what it means to practice humanity in medicine.
Perhaps these words by one of my favorite authors David Whyte say it best, “Put down the weight of your aloneness and ease into the conversation. Pay attention to everything in the world as if it is alive. Realize everything has its own discrete existence outside your story. By doing this, you open to the gifts and lessons the world has to give you.”
Joy Falkenburg, M.D., a family medicine physician in Custer, South Dakota, is a contributing Prairie Doc® columnist and guest host this week on the Prairie Doc® 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.