Prairie Doc Perspective Week of April 22nd, 2023
“Protecting Your Skin from Pests”
Kelly Evans-Hullinger, MD

Spring is finally here in the Northern Plains and summer feels just around the corner. As all we Northerners know, as soon as the temperatures hit even a mild degree on the thermometer most of us shed the jackets and long pants, and our skin is front-and-center.  

The sunny season is prime season for mosquitoes and ticks, along with the itchy bites and all the unpleasant infections they can carry. Different species of mosquitoes and ticks can transmit different bacteria and viruses, and around the US we have some specific diseases to be concerned about.

West Nile Virus is an endemic seasonal virus spread by mosquitoes through much of the United States. Common symptoms include fever, headache and muscle aches; the most severe cases involve the brain and central nervous system. In these cases, paralysis and even death can occur.

No vaccine or targeted treatment exists for West Nile Virus, so the best thing we can do is minimize mosquito bites. This means wearing loose fitting clothing to cover skin and a good insect repellent. The most commonly used EPA-approved insect repellent, DEET, has an excellent record of being safe and effective.

Ticks come with their own risks. The most commonly known tick-borne disease is Lyme disease, but there are numerous tick-borne diseases endemic in different parts of the U.S., depending on the distribution of the ticks themselves that carry those diseases. Lyme disease is spread by the black legged tick (or deer tick) commonly found in the Northeast and near the Great Lakes. While here in South Dakota we tend to have very few annual cases of Lyme disease, it is much more common just to the east in Minnesota and Wisconsin.

Again, when it comes to ticks, avoidance is best. If you plan to spend time in a grassy or wooded area, dress to make it hard for ticks to get to your skin with long pants. After your outdoor activity, bathe or shower and check your skin for ticks so that they can be removed as soon as possible. The longer a tick is attached, the more likely they are to spread disease.

If you do get a tick bite and are in a place where tick-borne disease is prevalent, it is a good idea to call or see your medical provider and provide them a picture of the tick if you can. Antibiotics are indicated in many tick-borne diseases, so don’t hesitate to go in when you have concerns about this.
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Being outdoors is my favorite part about summer. To enjoy it safely, protect your skin from the pests looking for exposed skin to bite!
For more information on mosquitoes, ticks, and insect-borne diseases, visit cdc.gov/mosquitoes and cdc.gov/ticks

Prairie Doc Perspective Week of April 16th, 2023
“American Indian Healthcare”
By Sophie Two Hawk, MD; Arna Mora, MD; Carol Whitman, MD
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American Indians face some unique challenges when it comes to caring for their health.  Culturally, we view health in a Holistic manner as a balance of our bodies, mind and spirit that allows for good health.  Historically, the women would have knowledge of herbs and men would be spiritual healers.  
Healthcare was one of the items guaranteed under the treaties.  Initially, healthcare was overseen by the Army and the Bureau of Indian Affairs.  Then Indian Health Service was formed in 1955 to oversee healthcare.  Funding for Indian Health Service varies from one year to the next and only provides part of what is needed.  Therefore, patients need to enroll in programs such as Medicare, Medicaid and Private Insurance which allows the facilities to be able to fully function.  Separate limited funding is given to pay for Purchase Referred Care, i.e. those services that cannot be provided at an IHS hospital or clinic.  The referrals are only covered if you meet certain criteria, such as living within the reservation boundaries.  If you live in three other cities in SD then there are Urban Indian Health clinic which are able to provide some limited health care. 
American Indians face unique challenges to attaining healthcare as well.  There are language, knowledge, and trust issues that impact seeking out healthcare. There is an inherent mistrust by American Indians of IHS and other government agencies due to many historical abuses and mistreatment over the years. This in turn has led to decline in overall individual wellbeing. We were not made citizens of this country until 1924.  We were not legally allowed to practice our Native religion until 1978.  Many were taken from their families at young ages and sent to boarding schools. They faced many abuses during their time in these schools.  In addition, there were other issues such as forced sterilization and studies done without consent or knowledge in the past.  These historical traumas continue to affect current generations. 
There are current economic issues such as lack of employment, housing, and transportation which negatively impact health. We see differences in types of diseases, age of onset of diseases, and ways that treatments need to be given as well.  We see higher rates of conditions and deaths due to conditions such as Diabetes, Liver disease, Infectious Diseases, Injuries, and Suicides.  Some of these rates are higher than any other racial or ethnic group in the United States.  
American Indian Healthcare can be improved by increasing funding, increasing the numbers of tribal members who become healthcare providers and improving the education of those who provide healthcare. 


Dr. Sophie Two Hawk practices internal medicine in Sioux Falls, SD and is Lakota. Arna Mora, MD is an enrolled member of the Cheyenne River Sioux Tribe and is currently a 2nd year Family Medicine Resident at the Center for Family Medicine in Sioux Falls and will complete her residence in June of 2024. Carol Whitman, MD is an enrolled member of the Cheyenne River Sioux Tribe and is currently a 3rd year Psychiatry Residence at the USD Psychiatric Residency Program in Sioux Falls, SD.  She will complete her residency in Psychiatry with a Fellowship in Adolescent and Child Psychiatry in 2025. Find 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, streaming live on Facebook most Thursdays at 7 p.m. central. 

Prairie Doc Perspective for the Week of April 9th, 2023
“I Can See Clearly Now”
By Jill Kruse, DO
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Johnny Nash may have started his song with “I can see clearly now, the rain has gone,” but what about someone with cataracts.  They cannot easily see “all the obstacles in their way”, and there are not “dark clouds that make you blind” like in the song, but cataracts do cause vision clouding.  
    Cataracts is the name given to the clouding of the lenses in the eyes.  These lenses allow light to pass through the eye to the retina, where the signal is sent to the brain so we can perceive the world around us.  Common symptoms of cataracts include blurred, clouded, or dimmed vision.  They can also make it more difficult to see at night or cause “halos” around lights.  
    While anyone can develop cataracts, it is most common as people age, with over 50% of people over the age of 80 having cataracts.  However, there are some infants who are born with cataracts due to genetic issues, trauma or infection prior to birth.  Most commonly cataracts develop due to age related changes as the proteins and fibers that create the lenses of the eye break down or clump together causing clouding of the lenses.  
    Because cataracts typically develop slowly over time, the effects may not be obvious until the progression is advanced.  While it is common for cataracts to affect both eyes, often one eye progresses faster or is worse than the other.  Cataracts can also affect different areas of the eyes.  The area affected will result in different problems with vision.  Cataracts affecting the center of the lenses may cause issues with reading or yellowing of vision.   While cataracts at the edges of the lenses causes issues with judging distance, difficulty differentiating colors, and can cause double vision in the affected eye. The last type of cataracts is when the back of the lenses are affected reducing vision in bright light and making reading difficult.  This type also tends to be faster growing than other types of cataracts. 
    Factors that can increase the risk of developing cataracts include modifiable and unmodifiable things. Factors that you can change include excessive exposure to bright sunlight, excessive alcohol use, smoking, obesity, and prolonged use of corticosteroid medications. While age is the only truly unmodifiable factor; diabetes, previous eye injuries or surgeries, and high blood pressure can be controlled.
    The most common treatment for cataracts is surgery.  This surgery involves removing the clouded lens and replacing it with a clear, artificial lens.  Once placed, these lenses are permanently left in the eye.  This is generally an outpatient surgery, meaning you do not need to spend the night in the hospital.  The procedure is relatively quick with low risk of complications.  Most people heal within a few weeks.  Afterwards you can enjoy “that rainbow that you’ve been praying for” and enjoy every “bright, bright, sunshiny day!” 

Prairie Doc Perspective for the week of April 2nd, 2023
“Hindered by pain in your heel?”
By Andrew Ellsworth, MD
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If you have pain on the bottom of your foot at the heel, especially when you take your first steps of the day, you likely have plantar fasciitis. One of the most common causes of foot pain, plantar fasciitis pain can subside with time, but sometimes the pain keeps people from doing what they love, whether that be running, walking, or other pleasures of life.  I once saw a young woman suffering from plantar fasciitis who got some relief from an injection.  A few years later she returned wanting another injection so she could dance pain-free at her own wedding. 

The bottom of the foot has thick, white fibers called the plantar fascia. On one end it connects to the heel bone, and on the other the fibers connect to each of the toes. This helps support the foot, tightening as we walk and keeping the arch of the foot elevated like the bowstring maintaining the curve of the bow. 
Pain can arise from stress on the plantar fascia where it connects to the heel bone, the tuberosity of the calcaneus.  This spot, right by the heel on the underside of the foot, can be quite tender to touch when plantar fasciitis is active.  It often is most painful when first walking in the morning or after periods of rest. The pain can linger for months or years. 

Sometimes referred to as heel spurs, on x-ray this spot may show calcifications in the fascia that have formed from years of stress or inflammation. The presence of these heel spurs does not necessarily mean someone will have pain.  Some have pain from plantar fasciitis without heel spurs, and some with heel spurs do not have pain. 
Causes of plantar fasciitis include poor fitting shoes, starting a new exercise routine such as running, obesity, prolonged running or standing, flat feet, and more. The exact cause remains unclear. 

Initial treatments include avoiding activities that make it worse, stretching exercises that may include pointing the toes upward and stretching the calf muscles, avoiding the use of flat shoes, avoiding walking barefoot, heel shoe inserts, a short term trial of NSAIDs like ibuprofen, or possibly a steroid injection. Later, if needed, molded inserts, night splints, immobilization in a boot or cast, or even surgery may be considered.  Thankfully, even without treatment, plantar fasciitis may often go away on its own within a year. 
Plantar fasciitis may only be a spot on the bottom of the foot, but I do not envy those who are reminded of it with every step.