By Andrew Ellsworth, M.D.
 
Do you know anyone who had influenza this past year? Chances are you do not. Sure, plenty of people had the “stomach flu” with vomiting and diarrhea, otherwise known as gastroenteritis. Some people had colds and others had COVID-19. But cases of influenza this season have been exceptionally low.
 
Starting a year ago, when someone came to my clinic with symptoms of influenza, including fevers, chills, muscle aches, or respiratory symptoms, we tested for both COVID-19 and for influenza. At first, every COVID-19 test was negative while many influenza tests were positive. However, with social distancing, mask wearing, washing hands, and people staying home when they were sick, influenza cases in South Dakota plummeted faster than I have ever seen. 
 
The charts put out by the South Dakota Department of Health speak for themselves. Every week they send out the latest influenza statistics and compare them to past years. The number of influenza cases forms something like a bell curve or mountain which peaks in South Dakota typically during the third week of February and then tapers down again. This year that line of cases for 2020-2021 is essentially flat, and this week we saw a slight increase in cases which will hopefully only form a small bump on the chart as opposed to a mountain.
 
Usually there are well over 2,000 confirmed cases of influenza in South Dakota each year, with almost 15,000 confirmed in last year’s season. In a normal year, many more people have influenza but go unrecorded because they are not tested. For this current influenza season, many people are being tested for COVID-19 and influenza at the same time. Despite thousands of tests, there have been only 55 confirmed cases of influenza in the state through the third week of February.
 
Over the last decade, influenza claimed an average of 32 lives each year in South Dakota. The worst season was 2017-2018 when 73 people died, and the fewest deaths occurred in 2015-2016 when 9 people died. We know that this past year, COVID-19 claimed the lives of more than 1,850 people in South Dakota. COVID-19 still managed to thrive even while influenza withered. The biggest reason is because COVID-19 is more contagious than influenza. Vaccinations and past immunity to influenza also help reduce its occurrence. 
 
We cannot stress how important and helpful everyone’s efforts over this last year have been toward keeping the numbers of COVID-19 down as much as we could to “flatten the curve” and avoid a catastrophe with everyone getting sick at once. We are not out of the woods yet, but we are getting closer. As far as influenza goes, it would appear that washing our hands, staying home when sick, social distancing, and wearing masks have drastically helped to minimize the spread.
 
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.
 
Last summer we heard the prediction that by the end of 2020, we would have a safe, effective vaccine to the SARS-CoV-2 virus, which had only been discovered, of course, in December 2019, before causing countless deaths and mayhem in the world as we knew it. I must admit, I was skeptical.
 
Early in the pandemic, I learned that the fastest a vaccine had ever been developed was for the mumps virus, an effort which took four years. Even with all possible resources devoted to a COVID-19 vaccine, how could we ever do this in one year? Before I could even ponder this, however, my curiosity took me down the rabbit hole of the mumps vaccine.
 
Maurice Hilleman, to whom the mumps vaccine is credited, is something of a superhero in the world of virology and vaccine development. Over the course of his career, he was involved in the development of 40 vaccines, including an influenza vaccine in 1957 estimated to have prevented hundreds of thousands of deaths.
 
One night in 1963, Hilleman’s young daughter Jeryl Lynn awoke him from sleep. She was feeling sick.  Hilleman saw the telltale swelling of her salivary glands and knew she had the mumps. Mumps was a common childhood ailment, and while most children got mild illness including the classic swollen cheeks, it also caused aseptic meningitis, deafness, and infertility in males. Hilleman put Jeryl Lynn back to bed, then drove to his lab to retrieve a swab and culture media. He returned and awoke young Jeryl from her slumber to swab her mouth.
 
Over the next four years Hilleman cultured and tested the Jeryl Lynn strain of the mumps virus until it was safe enough to administer without the risk of illness but still effective in generating an immune response against a normal mumps virus. Jeryl Lynn was present when her younger sister Kirsten was publicly immunized with the new mumps vaccine as a small child. As a result of Hilleman’s vaccine, the United States now has only about 200 cases of mumps per year, compared to 200,000 per year before the vaccine.
 
Back to that COVID-19 vaccine. Well, my timeline skepticism was unwarranted. In December 2020, data published on two separate vaccines using mRNA technology showed without ambiguity that we did have safe, effective vaccines just one year from the start of this pandemic. How so quickly? We can give credit to a modern technology being ready for this problem and the intellectual weight of thousands of scientists around the world. I think even Maurice Hilleman, the father of modern vaccines himself, would be impressed.
 
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.

I’ve learned a lot from my patients over the years. Sometimes, the lessons are learned as I walk beside them through struggles, both medical and non-medical. Sometimes, the lessons are explicitly stated, words of wisdom that stick with me through the years, and change the way I understand illness, or life in general.

The first such lesson I remember was from a middle-aged woman who had been diagnosed with type 1 diabetes only a few years prior. She came to me with blood sugars that ran critically low in the middle of the night, but sky high during the day. The situation only worsened when she tried to adjust her insulin. Back in those days, our tools for managing diabetes were far more limited, and our insulin regimens far more rigid.

After we adjusted her dosing so that the peaks and valleys of her insulin effect were a better fit for her life, we started fine tuning the control of her blood sugar. We needed to balance her insulin, with her activity, with her food. This is when she said to me, “Diabetes is the original do-it-yourself disease.”

The truth of this statement resonated with me then, and I still hear her words almost every time I see a person with diabetes 20 years later.

The stakes are high. Control of blood sugar is directly correlated with the odds of developing one of the terrible complications of diabetes, such as blindness, strokes, heart attacks, kidney failure, amputations, and nerve damage.

That control rests in part with our medicines, but the real challenge of diabetes lies in the fact that success depends on changing habits, and that is difficult indeed. People with diabetes are asked to change the way they eat, the way they move, the very way they live. They are often asked to monitor their blood sugars, which to date has meant pricking their fingers to take blood, and to make decisions based on those results, sometimes multiple times a day. Then, do it again tomorrow, and the next day, and the next day. Additionally, diabetes medications and supplies are awfully expensive!

There is some hope: new technologies are making it easier to handle the mechanics of managing diabetes, and new medicines are allowing more flexibility in lifestyle. But the burden of success still rests very much on the shoulders of the patient, to balance medicines, with activity, with food, in all the decisions he or she makes every day.  

Diabetes is no doubt, the do-it-yourself disease.
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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.
 
Many people are familiar with the classic Abbott and Costello comedy skit “Who’s on First?” For those who are not familiar, the routine is a hilarious interaction between the two comedians as they discuss players on a baseball team while using confusing references such as “who’s on first” and “what’s on second.” The audience can see that Abbott believes he is clearly communicating the player names to Costello, but it digresses into a laughable experience of misunderstanding and frustration for both parties. The men become increasingly angry as the conversation goes on and each feel that the other is not listening. 

This situation may be funny in the world of entertainment, but it can be disastrous when it happens between doctor and patient. At times, conversation in the exam room can inadvertently go down a similar path of confusion. I recall one such experience when I was showing an x-ray to a patient. I pointed out, “Here is the fracture.”  The patient looked at me, gave a sigh of relief and said, “Thank goodness doc, I was afraid you were going to tell me that it was broken.” At that moment I realized my choice of words had not provided the clarity I intended. Thankfully, this patient spoke out which alerted me to the misunderstanding allowing me to rectify it immediately. 

Those of us in the medical field must be always mindful to ensure that we explain things in clear, everyday language. I apologize for our failures, which do happen. I also ask for your help. Doctors are human and we may incorrectly assume that our patients understand what we are saying, especially if our patients do not tell us otherwise.

Healthcare is a partnership which requires communication from both patient and doctor. It is important to recognize that not all cultures and generations feel empowered to question a doctor. Other patients hesitate to ask what they feel might be perceived as a “silly” question. In addition, patients have varying levels of education and experience when it comes to participating in medical conversations. Sometimes it helps the patient to have a family member or friend in the room to help the patient feel at ease and convey information.

Doctors strive to be sensitive to these situations, to welcome and encourage questions, then listen closely when the patient speaks. No doctor I know will intentionally or maliciously confuse a patient. We welcome your participation so both patient and doctor can best understand what care is needed. Let’s work together and keep the conversation going to make sure we both know “who’s on first” and “what’s on second” when it comes to your health.”
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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.