Prairie Doc Perspective Week of April 26th, 2026
“Anesthesia: Biting the Bullet is No Longer Necessary”
By Andrew Ellsworth, MD


Anesthesiology is the branch of medicine committed to pain relief and patient care before, during, and after surgery and other procedures. It has origins in ancient times but made large advances in the last two centuries.


It is one of medicine’s greatest achievements that someone can comfortably drift off to sleep, have their knee replaced, or their gallbladder removed, and wake up with minimal pain.  


Ancient civilizations used herbal remedies to help numb pain with forms of cannabis, opium, mandrake, or alcohol. Even by the time of the Revolutionary War, these remained the only options, which did little for the pain of an amputation. Survival depended on the speed of the surgeon. Patients would “bite the bullet” and literally clench down on a lead bullet or piece of leather to help endure the pain and protect their teeth. Surgeries were completed in minutes, and most amputees did not survive due to infection or blood loss.  


Major advances in anesthesia came in the mid-1800s with the emergence of ether and chloroform. American dentist William Morton was the first to publicly show ether’s use as an anesthetic, famously demonstrated at Massachusetts General Hospital in 1846.


During the Civil War, anesthesia became widely adopted in the military and used in the vast majority of surgeries. Typically, ether or chloroform was soaked in a cloth and placed over the patient’s face for inhalation. After the war, the physicians with a new understanding of anesthesia were dispersed across the country, and use of anesthesia went from a sporadic, questionable intervention to standard practice.


Epidurals are another major advance in anesthesia, decreasing the pain of childbirth, surgery, and some forms of back pain. Epidurals numb pain by delivering medication near the spinal nerves with an injection in the back. First developed in the early 1900’s, epidurals became widely used in the United States by the 1970’s. The addition of a catheter allowed continuous pain relief throughout labor, replacing a single injection. 


Modern anesthesia has continued to evolve. Propofol, first developed in the 1970s and approved in the United States in 1989, is now commonly used to start and maintain anesthesia. Often called the “milk of amnesia,” it works quickly and allows for a smooth, clear-headed recovery.
Anesthesia techniques continue to improve and become safer and more effective. With the expertise and close monitoring of an anesthesiologist or nurse anesthetist, patients can undergo complex procedures with excellent pain control and minimal risk. 


Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of April 19th, 2026
“Medications for treating substance use disorders”
By Kelly Evans Hullinger, MD
Substance use disorders like alcohol and opioid use disorders can be diverse, and every patient has a different story when it comes to their addiction. Social factors, genetics, history of trauma or mental health disorders, and many other contributors may be at play, which can make treatment of substance use disorders challenging.
Because of these challenges, successful treatment of substance use disorders often requires multiple approaches. Just like a patient with diabetes is best treated with diet, exercise, education, and medication, a patient with a substance use disorder is most effectively treated with a multi-disciplinary plan. For many patients, medication can be an important piece of the approach.
I have had several recent experiences with patients successfully abstaining from alcohol and opiates with the help of medication. The most common example that I see is alcohol use disorder, which can range from alcohol dependence to binge drinking behavior which causes disruption in a person’s social and family life and often leads to other medical problems.
One evidence-based option that I often use for patients with an alcohol use disorder is an oral medication called naltrexone. Recently, a patient who previously struggled with binge drinking described the effect of this medication to me, which was an enlightening explanation. “Doc, I’ve always been someone who, if I had one beer I was going to have 6 or 12 more. But on this med I can have one or two beers with my friends and I just don’t feel like having any more.” As a quite safe and accessible medication, naltrexone is an option I discuss frequently in my primary care clinic.
Another common and sometimes devastating problem is opioid use disorder. We have very good evidence that medications can significantly improve the probability of a patient being able to stay off opioids, and those options are gradually becoming easier to access as well. One of my patients who for many years struggled with opioid use disorder, even as it wreaked havoc on their life from a medical and legal perspective, has done extremely well with medication assisted therapy. They described the effect of medication as, “the first time I can remember that I have gone days without thinking about finding opioids.”
A current area of research is around GLP-1 agonists (commonly used in diabetes and obesity) as potential treatment for substance use disorders. While the verdict is still out on these, we may soon have some data on whether they hold up as effective treatment options for this group of patients as well.
While social support, therapy and counseling, and other facets of treatment will always be important, medications to help patients with some forms of substance use disorder are an essential piece of the puzzle. I have witnessed many of my own patients who have hugely benefited from those treatments. I am hopeful that medications will become easier for patients to access and have more options in the future.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of April 12th, 2026
“Death, Taxes, and Aging Eyes”
By Debra Johnston, MD


Benjamin Franklin famously wrote “in this world nothing can be said to be certain, except death and taxes.”


Franklin was a legendary intellect, and it’s hard to overstate the impact he had. But I’d suggest an addition to that particular quote, one with which I suspect he’d agree.


Most of us know him as one of the Founding Fathers, as the author of Poor Richard's Almanack, as the guy who flew kites during lightening storms. Perhaps less famously, Franklin was also an inventor. He is credited with the creation of the bifocal lens, reportedly inspired by his frustration with switching between pairs of glasses.


As a woman of a certain age, who has needed corrective lenses since childhood, I can well appreciate that frustration, and in turn, that invention! Our eyes are complex organs. In the very front, there is the clear dome of the cornea. Then we have the iris, the colored part of the eye. This is a muscle, and it controls the size of the pupil, the black central hole through which light is allowed entry. From there, light strikes the lens, which is pulled into different shapes by small muscles around its edge, and focused onto the retina in the very back of the eye. Specialized cells in the retina convert light to electricity, and the optic nerve transmits these messages to the brain. 


When I talk to my middle aged patients about symptoms they may be having, they frequently volunteer that they now need glasses for the first time, or that they have “upgraded” to those bifocals. They are usually surprised when I reassure them that this is not only normal, but frankly expected! The cells that create the lens loose the ability to repair or replace themselves over time. The lens becomes less flexible. It doesn’t change shape as easily, and as that happens the eye has a harder time focusing up close. Eventually, a person develops presbyopia: age related far-sightedness. 


This same process leads to a condition quite familiar to most people: cataracts. As those cells in the lens deteriorate, they become increasingly cloudy. Light has a harder time penetrating, and it may be scattered on the way through, instead of sharply focused. People may notice blurry vision, muted colors, glare around lights. They may need brighter light to read, and find it very difficult see at night. By 80, approximately 50% of people either have cataracts, or have had cataract surgery. 


Presbyopia and cataracts may be a normal, readily treated part of aging, but you shouldn’t neglect those eye exams. As we get older, other eye conditions become more common. Diseases like macular degeneration and glaucoma can be detected by the eye doctor well before they cause symptoms. Since those symptoms include irreversible vision loss, we should all be motivated to make that appointment!


Medicine is ever changing. Research avenues that seem promising turn into dead ends. Dead ends become detours to unexpected and exciting places. Maybe in the future, we will have drops or supplements or some other way to keep our eyes young. But for now, nothing can be said to be certain, except death, taxes. . .  and presbyopia.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

​Prairie Doc Perspective Week of April 5th, 2026
There’s No Place Like Home – Home Safety Evaluations
By Jill Kruse, DO
In my role as a hospitalist, I am always happy when a patient is healthy enough to be discharged.  A resounding majority of people want to go back to their home after they leave the hospital.  What we do not want is an unsafe environment leading to repeat injuries resulting in a hospital readmission.  
At discharge we can have members of the Home Health team perform a “Home Safety Evaluation”. Physical Therapists, Occupational Therapists and sometimes Speech Therapists will evaluate a person’s home for safety concerns and ensure it is set up optimally for best function.  The team looks at areas where injuries typically occur.  This could include the instillation of grab bars in the bathroom or having a shower chair.  Paying attention to slipping or falling hazards – such as throw rugs or loose stair railings.  Good lighting, especially on stairs and in hallways, can help prevent tripping and falling.  
Before hospital discharge Physical Therapists will evaluate how well a person can walk including their balance.  If there are steps in the home, they will ensure the ability to navigate stairs is evaluated.  They perform tests which can help predict who is at a higher risk for falling.  The proverb may be, pride goeth before a fall, but a walker or cane could help prevent that.  Unfortunately, too often pride is the reason that the walker or cane is not used in the first place.  Using someone else’s old walker may be a bargain, but proper walker and cane height is important. A used device may be more dangerous if not adjusted properly and therapists can help confirm they are at the correct height. 
Occupational Therapists evaluate a person’s ability to perform “Activities of Daily Living”. These include being able to feed, dress or bathe themselves, and using the bathroom.  They have lots of assistive devices, tricks and tips to assist people if arthritis, injuries, or recent surgery prevents the person from moving like normal.  
Speech Therapists are asked at times to assess a person’s cognition and “safety awareness”.  They evaluate and determine if this person can the person recognize an emergency and get to safety or call for help.  With dementia, the part of the brain responsible for logic and good decision making is no longer working.  Dementia patients often make impulsive mistakes such as walking into traffic or forgetting to turn the stove off after cooking.  
There is no place like home, but it needs to be a safe home.  With a few tips and modifications, your home can be a safer place to live thereby keeping you there longer.  We want you to “Stay healthy in there.”
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).