By Andrew Ellsworth, MD
 
Life is about balance. We balance our time, our budgets, our work, and our family. If you concentrate too much in one area, you will soon be wanting in another. Additionally, our bodies are constantly working to keep our blood pressure, blood sugar, and temperature in balance. 
 
Covid-19 disrupted our balance, both in our lives and for some, in our bodies. It overwhelmed some communities with too many people who became sick. Other communities banded together (or rather, apart) to slow the virus and protect the most vulnerable. 
 
Thankfully, many areas have been successful at slowing the spread and flattening the curve, avoiding the tidal wave of sick people filling the hospitals. However, this came with a great cost to the balance in our economy, our social interactions, and our normal way of life. It revealed and magnified numerous problems. It exposed disparities in healthcare, and it provoked supply chain issues, food chain issues, unemployment, poverty, and misinformation. 
 
People have many needs in addition to safety. People often need work not only for money for food and shelter, but also for fulfilment and purpose. People often need other people because we are inherently social creatures that thrive from being there for others, providing words of encouragement, or a caring shoulder to lean on, or an embrace.  
 
Living with Covid-19 around us require a new balance that may change over time. While it would be wonderful, reducing cases to zero is probably not realistic for a while. Meanwhile, our communities need economic activity and we need social interactions. Thus, some people are venturing out more and businesses are reopening. Some places are doing this more cautiously than others. We need to get creative and adjust our expectations of normal for a while. Our elders and those with high risk conditions may not be safe or feel safe, so we should do what we can to help them. Washing hands, wearing masks and being mindful of the distance between us are not perfect but are still the best forms of protection for now.
 
No one knows what the future holds. Perhaps reopening the economy will increase our cases of Covid-19, and perhaps not. Perhaps the virus will dissipate over the summer months. If it re-emerges in the fall, will we be ready? Will we plan and use this time to prepare? Will we again work together to protect our fellow man? Let’s use this time wisely and find our new balance.
 
Andrew Ellsworth, MD 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 Richard P. Holm, MD

One summer during my college years, another premed student and I got a job at the Swedish Hospital in Minneapolis, as nurses’ aides. At that time, the guys were called orderlies, but we were part of the nursing department. We were taught how to clean patients’ private parts without making the patient feel self-conscious, and how to place urinary catheters mostly in old men with prostates that had overgrown and were blocking urinary flow.
 
We all have those private areas, let’s not pretend otherwise. The waste disposal parts are as important to us through our lifetime as our hearts, except not quite as romantic. Try switching metaphors and famous poems simply don’t have the same pizazz. For example, try E.E. Cummings’ “I carry your colon with me,” or William Wordsworth’s “My urinary tract leaps up when I behold a rainbow in the sky,” or Douglass Cross’ “I left my bladder in San Francisco.”
 
Romance aside, we are happy when our urinary tract is working well, draining the urine, removing waste and water. The kidneys collect and concentrate the urine, they deliver this yellow fluid through the ureters, the tubes from the kidneys to the bladder. The bladder is a bag to collect the urine until it is convenient to be emptied.
 
It seems like a simple, straight-forward system. However, trouble could be around the next corner. Conditions like urinary tract infections, kidney stones, bladder control problems, and prostate troubles are not uncommon through the course of a person’s life and can vary from causing short-term discomforts to long-lasting conditions.
 
One of the barriers to treatment for many people is the human problem of stigma and shame. It does not feel good to admit to anyone, even a loved one or a medical professional, that you’re having troubles “down there.” Let me reassure you: this is a common human condition. Shame is an enemy to a healthy, functioning body. I would instead say “join the club!” and remind you that you are not the only one with such a problem.
 
I am no longer the young orderly helping the old men in the Swedish Hospital with their issues. I now find myself amazed at the magnificent function of the human body, identifying more with those old guys than I do with the young staff. All of us have bladders and urinary tracts about which there is nothing to be ashamed.
 
Richard P. Holm, MD wrote this essay in February 2020. He passed away in March after a battle with pancreatic cancer. He was founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. Dr. Holm’s legacy lives on through his Prairie Doc® organization. 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 Mark E. Bubak, MD
 
Growing up decades ago, we all knew kids and adults who were held back by their asthma. They sat out gym classes and sporting events, missed school or work over and over again, were up in the wee hours of the night fighting to breath, or seemed to make their own chest noises all the time. They got nicknames like Wheezy.
 
Jump ahead now to 2020. Although we still continue with our traditional allergy avoidance and immunotherapy programs, inhaled corticosteroid inhalers, and long and short acting airway muscle relaxing agents to treat asthma, we now have entered what is being called “The Biologic Era” of asthma treatments.
 
Biologic treatments are not the traditional chemical drugs we have been using for decades. Rather, biologics are antibodies similar to those we use to recognize and fight off germs. When designing biologics for asthma patients, scientists replace the recognition portion with a component that targets “problem signals” from our immune system. One family of signals or targets, known as interleukin proteins, come from T cells and tell other cells what to do. The allergy antibody IgE is another target. When the particular biologic is given, it circulates through the patient until it finds its target, and then binds to that target. The result is to change the way our body works, decreasing parts of the allergy or immune reaction that causes us to have the asthma.
 
All these therapy choices can be overwhelming. We now want to personalize each asthmatic’s program with the goal of “control,” meaning hopefully, no asthma. It all starts with talking to your doctor to establish an understanding of your history followed by a physical examination. You and your doctor might then decide on several options including, allergy testing, blood counts, IgE levels, nitric oxide breath measurement, x-rays, CT scans, and pulmonary function tests as indicated to determine what type of asthma you have. Armed with the knowledge obtained, your allergy doctor can prescribe the best combination of treatments to achieve control.
 
And as an added benefit of control, we can hopefully eliminate the use of that old nickname, Wheezy.
 
Mark E. Bubak, MD practicing in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist. He is certified by the American Board of Allergy and Immunology to care for adults and children with asthma and allergies. 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 SDPTV most Thursdays at 7 p.m. central.        

By Richard P. Holm, MD
 
Mrs. R was a character. Her natural red hair had changed to gray years earlier, but thanks to the magic of her hairdresser, her hair was again flashy red, and she had a personality to match. She was a feisty, fun and full-blooded woman full of zest and pizzazz. She made me smile whenever I made rounds at the nursing home.
 
Through the years, Alzheimer’s disease took its toll on her memory, but her spirit, brightness and spark didn’t seem to fade much. Even near the end, as the family stopped the hair coloring, she gave me a charge of energy and vitality whenever we met. However, the neurodegenerative (ND) Alzheimer’s condition didn’t let up and eventually she slipped off this earthly existence gently while family surrounded her with love.
 
The image of my redheaded friend repeatedly came to me through the years as I cared for people with ND diseases. Neurodegenerative brain loss conditions include Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), Alzheimer’s, Parkinson’s and Huntington’s disease. These heartbreaking conditions happen because of brain cell death but we don’t know what kills the brain cells. We do know that in 2016, 5.4 million Americans were living with Alzheimer’s and we estimate 930,000 people will be living with Parkinson’s in 2020.
 
Presently a lot of research is being done to look for exposure to certain toxins as cause for ND diseases to include pesticides, fungicides, insecticides, metals like arsenic, lead and manganese, polychlorinated biphenyls (PCBs) and other human-made and natural toxins in the environment including tobacco and some antioxidants. We simply do not know the cause or causes, but we’re looking hard.
 
When a person has one of these largely untreatable conditions, we utilize tools called “Activities of Daily Living (ADLs)” to define when that person might need more help. The five ADLs include 1. personal hygiene (being able to bath, groom, brush hair and teeth), 2. continence management (being able to independently use the toilet), 3. dressing (selecting and wearing appropriate clothes), 4. feeding oneself, and 5. ambulating (being able to change position and to get around by oneself with or without an assistance device or wheel chair). Losing ability to do one or more ADLs certainly means that help is needed, if not now, around the corner.
 
Mrs. R had a great life, and although she struggled with an ND brain condition, she didn’t lose her spirit and color until the very end. Miss you, Mrs. R.
 
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He was founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. Dr. Holm’s legacy lives on through his Prairie Doc® organization. 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.