Prairie Doc Perspective Week of March 24, 2024
“Feeling winded?”
By Andrew Ellsworth, MD


“Well, doc,” the patient was telling me, “I get winded so easily now. I can hardly go to the mailbox without stopping to catch my breath. It did not used to be that way. Do you think something is wrong?”


Many of us have experienced shortness of breath. After a period of inactivity, such as winter or a busy month, when we decide to exercise again, it may be easier to feel winded. That experience can be due to deconditioning, feeling out of shape. A good remedy for that is a gradual increase in exercise, helping us to regain our strength and endurance. 


Sometimes we get short of breath for other reasons. A recent infection can be a common cause, giving us a bad cough and leaving us winded for a while. There are several other lung causes like asthma or chronic obstructive pulmonary disease, including emphysema and chronic bronchitis, which can leave us short of breath. 


However, the feeling of shortness of breath does not necessarily mean there is a problem with the lungs. Shortness of breath can be a symptom of heart disease. A partial or total blockage of an artery in the heart may give someone chest pain, but sometimes shortness of breath could be one of the only symptoms. 


One can feel winded from heart failure, when the heart is not pumping as well. As the heart has trouble keeping up, a person can get short of breath from the buildup of fluid, which may cause swelling of the legs and sometimes buildup of fluid in the lungs. 


Or, perhaps the shortness of breath is from anemia. If someone is anemic, the hemoglobin level in their blood is low, which reduces the body’s ability to carry oxygen throughout the body. Anemia can have a variety of causes, such as blood loss, low iron or other nutritional deficiencies, or problems with the production of blood cells. Blood loss can be caused from anything from heavy periods to a stomach ulcer. Everything that can result in anemia, can result in shortness of breath. 


My patient with shortness of breath from walking to the mailbox came in to see me and we did several tests including a chest x-ray, blood tests, and an EKG. Ultimately, we did a stress test and after an angiogram and stent in the heart, he feels much better and is walking a mile or two nearly every day. 


It is important to tell your healthcare provider if you are feeling shortness of breath. While it could be due to anything from your heart, your lungs, being out of shape, or even anxiety, please do not ignore your body if you are feeling winded. 


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 and instagram featuring On Call with the Prairie Doc® a medical Q&A show celebrating its 22nd season of health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. 

Prairie Doc Perspective Week of March 17th, 2024
“True Self-Care”
By Debra Johnston, MD


During our most recent family movie night, we watched one of my favorites: Encanto. At one point in the movie, a character who has been gifted supernatural strength confesses that she fears she will crumble under the weight of all that is expected from her. Although she accomplishes amazing things, it never feels like enough. She never feels like she, herself, is enough. 


Popular culture suggests she should prioritize "self-care," which is usually represented by manicures or massages and long soaks in the tub, or perhaps half an hour of meditation or spin class. 


Now, to be clear, I'm a big fan of massages and getting my nails done, and I spend a lot of my professional time nagging people about exercise, as my patients can certainly attest. But I'd suggest this perspective on self-care is at best incomplete. Protecting your mental well-being goes well beyond little escapes, and even beyond tending to your physical health.


The specifics of true self-care are unique to each individual, because each individual is unique, in their needs, their desires, and their circumstances. You simply can't meditate quality daycare into existence, or a nasty coworker into a team player, or a loved one into sobriety.


Self-care, meaningful self-care, means being able to recognize that you are human, and you have limits and that it’s not just ok, it's critical, to acknowledge and respect those limits. The demands vying for your time and energy are endless. Those resources, however, are not. True self-care means standing up for your right to be the one who decides how you will allocate them.


This means setting boundaries, and that's an incredibly difficult thing to do. With those limits will naturally come guilt, because you simply can't do everything for everyone, or even all the things you yourself want to do. No one else can decide where your lines are, and no one else will hold those lines on your behalf.


In order to hold those boundaries, you must be kind to yourself. Most of us have a perpetual self-commentary of criticism that tells us we could do better, we should do better, we aren't enough. Honest self-reflection is important, but why does that so often mean a laser focus on where we fell short, without recognizing how far we came? We internalize the message that if we can't keep up with demands that escalate until we crack, the fault is ours. It's not. To draw these boundaries, and make that self-compassion meaningful, we each must clarify our own values.


Spending our limited energy in ways that conflict with the ideas we hold most dear is the antithesis of self-care. We need a clear idea of what those values are to hold that line. Massages and meal delivery services can be great tools, but the real key to protecting your mental well-being is a lot harder to define and a lot harder to do.


Debra Johnson, 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 providing health information based on science, built on trust for 22 Seasons, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central

Prairie Doc Perspective Week of March 10th, 2024
“This Isn’t the Baby Blues”
By Elizabeth A. Milton, LPCC, LPC-MH, MS
Transitioning to become a parent can be one of the most pivotal changes in a person’s life. Rarely are the hard moments of this change talked about enough. For example, did you know 1 in 5 women and 1 in 10 men suffer from postpartum depression? Parents of any culture, race, age, or income level can be affected. We commonly hear and get confused about postpartum depression being the “baby blues”. This is a common misconception. The baby blues are very common and happen to 80% of women in postpartum. This occurs within the first few days and lasts a few weeks. The baby blues will usually go away with rest and time.
 Postpartum depression and postpartum anxiety are much more serious and will not get better without some sort of treatment. Postpartum depression and postpartum anxiety usually last weeks to months or sometimes years after childbirth, if not treated. Some of the red flags or symptoms one can look out for include: frequent shame, guilt, and sadness; feelings of rage, irritability; scary unwanted thoughts; lack of interest in caring for baby; difficulty in bonding with baby; loss of interest, joy, or pleasure in things you used to enjoy; disturbances in sleep and appetite; constant worry; racing thoughts; feelings of dread; physical symptoms like nausea, dizziness, and hot flashes; and possible thoughts of harming yourself or your baby. If you identify with any of these symptoms, please reach out to your doctor or mental health professional in your area. You know you best and if you don’t feel like yourself, there is no shame in asking for help. 
Becoming well and mentally healthy again are possible with treatment. Some of the common treatments for a person struggling with postpartum depression or anxiety can be seeing a counselor, medication management, bright light therapy, cognitive behavioral therapy, couples therapy, support from others, exercise, adequate sleep, healthy diet, yoga, and relaxation strategies. A healthy support network of friends/family can be so helpful for new moms and/or parents. Here are some tips on supporting your loved ones throughout this transition: Reassure her, this is not her fault, she will get better; Encourage her to talk about feelings; Help with housework without being asked; Encourage her to take some time for herself; Be realistic about what time you will be home, and come home at that time; Help her reach out to others for support; Schedule some dates with her and work together to find a babysitter; Offer simple affection and physical comfort. 
There are so many resources available especially at postpartum.net or by dialing 988. Please know this is a transition and transitions are temporary. With help, you can be well. Take care of yourself. 


Elizabeth provides counseling for individuals and families — primarily adolescents and adults in an outpatient setting at Avera Behavioral Health in Brookings, SD. She is a certified perinatal mental health therapist and works with depression, anxiety, stress management, trauma, interpersonal conflict, adolescent issues and women’s issues. She is also certified to teach Bringing Baby Home workshops through the Gottman Institute. Her practice includes trauma-informed counseling, individual dialectical behavior therapy, cognitive behavioral therapy, emotion freedom technique, and solution-focused and mindfulness strategies. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.  

​

Prairie Doc Perspectives Week March 3rd, 2024
“Sexual function and aging”
By Dr. Lauren Wood Thum and Dr. Dennis Joseph Thum


As husband and wife urologists, we talk a lot about sex (mainly at work). There are several issues that commonly arise in our patients that can lead to a less than satisfactory sex life. The great news is many treatment options exist.


There are many factors affecting men and women as they age that can interfere with sexual relations. In women, vaginal dryness, prolapse and incontinence are most common. A decrease in circulating estrogen in peri and post-menopausal women leads to atrophy, or dryness, of the vagina that can result in pain. Symptomatic pelvic organ prolapse can create physical barriers to intercourse. Embarrassing urinary incontinence is another reason some shy away from intimacy.


Nearly all women who are experiencing painful vaginal dryness or dyspareunia (pain with intercourse) can be safely treated with a vaginal estrogen cream. Unlike hormone replacement therapy (HRT), vaginal estrogen poses few risks and can safely be administered without fear of cancer, stroke or clotting problems. The cream is placed in the vagina several times weekly at night, helping to improve tissue quality and relieve symptoms of pain and dryness.


For women who struggle with a vaginal bulge, many options exist to maintain sexual function. A pessary can be fitted in some women who are able to remove it themselves. More often, outpatient surgery is used to restore normal anatomy and maintain sexual function if desired.


Incontinence, the involuntary leakage of urine, has many causes and several treatment options exist depending on the type.


Diagnosing and treating male urologic factors are also key to maintaining intimacy. Erectile dysfunction (ED) is common in aging men for a variety of reasons including but not limited to vascular, hormonal and psychologic issues. Certain treatments for an enlarged prostate or prostate cancer can also lead to ED. The backbone of therapy for erectile dysfunction includes pills like Viagra or Cialis.  For some men who do not respond well to these medications or have side effects that are intolerable, penile injections provide a simple and effective solution.  As a last resort, surgical options are also available.


Peyronies disease is another issue we frequently see in men that affects sexual quality of life.  This is caused by deposits of scar tissue in the penis.  This scar tissue can frequently cause curvature with erection, which makes sex difficult or painful.  Excellent non-operative and operative treatments exist which can restore a couple’s sexual quality of life.


Whether sexual intercourse remains a priority in your relationship as you age is a very personal decision and is ultimately up to you. If you are suffering from conditions interfering with your ability to be sexually active, many treatment options exist and we encourage you to speak with your doctor about these issues.  


-D. Joseph Thum and Lauren Wood Thum are both board certified Urologists at Urology Specialists in Sioux Falls, SD. Dr. Joseph Thum also sees patients in Worthington. In their free time, they enjoy the outdoors and spending time with their sons and German Shepherds. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. ​