Prairie Doc Perspective Week of February 23rd, 2025
“Abnormal Electrical Signals”
By Kelly Evans-Hullinger, MD
Atrial fibrillation is probably a diagnosis you have heard of, if not because a friend or family member has it, because it has been mentioned in a public advertisement or pharmaceutical commercial. Atrial fibrillation (or “A-fib”) is the most common cardiac arrhythmia, a condition estimated by the American Heart Association to be present in more than five million Americans.
A-fib happens when abnormal electrical signals occurring throughout the cardiac atria (upper chambers of the heart) override the normal intrinsic electrical pacemaker. Sometimes this causes symptoms such as heart palpitations, dizziness, poor exercise tolerance, or heart failure. In many cases, however, patients have no symptoms at all. I can recall numerous instances of finding A-fib in a patient simply by listening to their heart on a routine exam and finding the heart rhythm to be irregular. The widespread use of smartwatches and other monitoring devices is alerting people to the possibility of A-fib with greater frequency.
Atrial fibrillation is diagnosed by an electrocardiogram (ECG) or a longer term heart rhythm monitor. When we find A-fib, we should look for any underlying causes such as heart valve problems, heart failure, and even thyroid disease. More frequently, A-fib does not have any single cause; it can occur for no particular reason, but a person’s risk of it increases with numerous factors including obesity, heavy alcohol use, high blood pressure, sleep apnea, and of course advancing age.
Treatment of atrial fibrillation has various options, which include medication to keep the heart from going too fast, medication to keep the heart in a normal rhythm, shocking the heart back into normal rhythm, or a catheter procedure to ablate the abnormally-firing portions of the cardiac tissue.
Of utmost importance, because in A-fib the atrial chambers do not effectively pump and empty blood into the lower chambers with each heartbeat, blood pools in some areas and has the risk of forming clots. This is why patients with atrial fibrillation are at elevated risk of a stroke and why for many of those patients we recommend taking a blood thinner long-term. We have tools to estimate stroke risk in an individual patient, so the discussion of blood thinners is one you should have with your primary care provider or cardiologist.
In summary, atrial fibrillation is a very common diagnosis, especially as patients get older. Our individualized approach to treatment focuses on control of symptoms and quality of life as well as reducing the risk of stroke. 
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM on streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

Prairie Doc Perspective Week of February 16th, 2025
“There are more than ample reasons to be concerned about your vision ”
By Debra Johnston, MD


Recently, I had a gentleman come for an annual wellness visit. He hadn’t had one for quite some time, and I could tell he was a little uncertain about what to expect. He was patient while we reviewed his family history, and tolerant while we talked about diet and exercise, but he’d had enough when I asked about the last time he’d been to the dentist and the eye doctor. “What is this about?” he asked me, somewhat exasperated. I suppose people don’t usually expect to go to their primary care doctor and have her nag them about their teeth or their eyes! 


But both teeth and eyes are really important to your overall well being. There is ample evidence linking poor dental health to other issues, like heart disease and preterm births. The eyes provide clues to many systemic diseases, such as autoimmune diseases like rheumatoid arthritis, cancers, various infections, genetic conditions like Marfan’s syndrome, and of course more mundane issues like high blood pressure and high cholesterol. Naturally, I harp on people with diabetes to get to the eye doctor almost every time I see them! Diabetes can damage small blood vessels, and in the eye this damage may lead to blindness. 


Even if you don’t notice any problems with your vision, it’s important to see your eye doctor periodically. Diseases like glaucoma can be silent, and the visual loss so gradual that you don’t notice it until it is advanced. Glaucoma can be successfully treated, but only if it is detected! Macular degeneration is also silent in the early stages, but can be detected by a careful eye exam by an ophthalmologist or optometrist. 


Most of us understand instinctively that we would face additional challenges if we had poor vision. There would be no hopping in the car to drive to the store. There would be no picking up a magazine to leaf through in the waiting room. There would be no recognizing an old friend from across the street. We might not consider that these circumstances contribute to increased social isolation and depression, or increased risk of injuries. Some research links vision loss, like hearing loss, with dementia, although the nature of that relationship isn’t clear. Nevertheless, there are more than ample reasons to be concerned about your vision! 


In addition to those regular trips to the eye doctor, there are some steps you can take to protect your eyes. Keep your chronic medical conditions, like diabetes and high blood pressure, under control. Don’t smoke or vape. Wear sun glasses with UVB protection. Eat lots of fruits and vegetables. Don’t drink much alcohol. And of course, protect your eyes from injury: over a million Americans live with significant vision loss in at least one eye because of eye trauma. 


My answer to my patient’s very reasonable question was simple: anything that impacts your well being deserves consideration from your doctor. And that most definitely includes your eyes!


Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. 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 on SDPB or 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 February 9th, 2025
Popeye and Testosterone Replacement
By Andrew Ellsworth, MD


A few (or more) years ago, Popeye the Sailor Man was an inspirational cartoon character. When needed, the superhero would quickly swallow some spinach and become strong, able to pack a punch that would defeat any evil villain. 


Nowadays, TV and internet commercials are encouraging men to consider testosterone replacement as the way to become stronger. While they are quick to tout the benefits, the risks are important and should not be ignored. 


Testosterone is the hormone in men that is produced from the testicles. It helps in sexual development in men, libido, erections, sperm production, muscle mass, and bone growth. It counteracts fat mass, stimulates red blood cell production, and plays a role in cognition and mood. 


If a man has low testosterone (hypogonadism), determined by at least two early morning fasting blood draws, and they have symptoms of low testosterone, then it is reasonable to consider testosterone replacement therapy. Signs and symptoms of hypogonadism include low libido, decreased erections, loss of body hair, low bone mineral density, gynecomastia (breast development), and small testes. 


Symptoms such as fatigue, depression, reduced muscle strength, increased fat mass, and low blood counts can be caused by a wide variety of factors, and should not be reasons alone to consider testosterone replacement. 


The best way to increase one’s testosterone is through good old diet and exercise. Studies have shown exercise, strength training, and weight loss all help to increase testosterone levels, oftentimes more than testosterone replacement does. Fat produces a hormone called leptin, which counteracts testosterone. Thus, losing fat and gaining muscle naturally increase one’s testosterone. Meanwhile, a healthy diet and exercise often boost energy, mood, and overall health.


The most effective method for testosterone replacement is by injection. There are also topical gels and patches. Any over the counter supplement that claims to boost testosterone is misleading and unlikely to have any significant effect on testosterone levels. 


Risks of testosterone replacement include prostate cancer, heart attacks, strokes, blood clots, acne, breast enlargement, sleep apnea, aggression, and can contribute to an enlarged prostate, which can cause urinary frequency or even urinary obstruction. While natural testosterone stimulates sperm production, testosterone replacement decreases sperm counts, decreases fertility, decreases testicular size, and decreases natural testosterone production. 


Testosterone levels naturally decrease as men get older. While some may advertise testosterone as a “fountain of youth,” the benefits are limited in this scenario and the risks increase as men get older. Popeye had the right idea. Putting in the work, and eating some spinach, is likely the better long-term plan. 


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine at Avera Medical Group in Brookings, South Dakota. 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 (on SDPB most Thursdays at 7pm and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective for the week of February 2, 2025
“Teen Mental Health” 
By Jill Kruse, DO
The most recent survey of teen mental health by the Centers for Disease Control in 2023 revealed that 20.3% of adolescents in the United States have been diagnosed with a mental health condition. This reflects a 35% increase since 2016. The survey also found that 40% of teens reported persistent feelings of sadness or hopelessness, 20% seriously considered suicide, and, tragically, 9% attempted suicide.
These statistics should alarm any parent or grandparent of a teenager. As the mother of a 12-year-old and a 14-year-old, I often think about my children’s mental health and how to best support them. They are growing up in a world far different from the one I knew. Today’s teens face the challenges of social media, cyber bullying, academic pressure, and the struggle to fit in with their peers, all while navigating the changes of puberty.
Like every parent, I want my children to be happy, resilient, and safe. The first step is creating a space where they feel safe sharing their thoughts and feelings. Listening to them without immediately jumping in to solve their problems or dismiss their emotions is a crucial skill for parents to practice. Taking the time to talk and ask open-ended questions about how they feel can make a significant difference. What might seem minor to an adult with years of experience and perspective can feel overwhelming to a teenager. It is essential for our kids to know we are here to support them, no matter the size of the problem.
Another key parenting strategy is modeling good self-care and emotional regulation. That can mean working on improving our own mental health.  Showing teens how to be kind to themselves and handle life’s setbacks teaches them invaluable lessons. Mental health is not a one-time fix; it is a lifelong process. Adolescence is the ideal time to equip teens with healthy coping strategies. Teaching them how to handle stress and overcome failures prepares them to become thriving, well-adjusted adults.  
Parents should also trust their instincts when something feels off. If your teen shows a sudden drop in grades, stops enjoying activities they once loved, or seems persistently sad or angry, it’s time to seek help. If teens become more withdrawn or secretive, having a discussion about your concerns is warranted.  Resources like pediatricians, school counselors, and therapists can provide support and guidance.    
As a mother, I am committed to walking this journey alongside my children, every step of the way. Together, we can navigate the challenges, celebrate the victories, and build the tools they need for a happy, healthy future. 
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, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show, 2 podcasts, and a Radio program, providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found.