Prairie Doc Perspective Week of May 26th, 2024
“Early intervention”
By Joanie Holm, R.N., C.N.P.


It has been a few years since my children were babies! Having spent my youth as a babysitter and a career in pediatrics, I was pretty comfortable in watching the developmental of babies, toddlers and young children. ( Teenagers are another story for another day!!) That isn’t always the case for young parents who may not have experience with this age group.


Babies develop in a somewhat predictable fashion. As you think of a newborn, you might think of the poor neck control which changes drastically over the next few weeks to months. Perhaps you think about the cooing, babbling and words that may start in the 8-10 month time frame. 


As the parent, grandparent or care provider It is important to know the basic milestones so that you will be aware of a child who may have developmental delays and may need assistance. Early intervention is a system of services that helps babies and toddlers with developmental delays or disabilities. Early intervention focuses on helping eligible babies and toddlers learn the basic and brand-new skills that typically develop during the first three years of life, such as:

• physical (reaching, rolling, crawling, and walking);
• cognitive (thinking, learning, solving problems);
• communication (talking, listening, understanding);
• social/emotional (playing, feeling secure and happy); and
• self-help (eating, dressing).

The Grants for Infants and Families program (Part C) awards formula grants to the 50 states, District of Columbia, Puerto Rico, the Department of the Interior, and Outlying Areas to assist them in implementing statewide systems of coordinated, comprehensive, multidisciplinary, interagency programs and making early intervention services available to children with disabilities, aged birth through two, and their families. Under the program, states are responsible for ensuring that appropriate early intervention services are made available to all eligible birth-through-two-year-olds with disabilities and their families, including Indian children and families who reside on reservations geographically located in the state.
(Center for Disease Control- CDC- Early Intervention website)


To help monitor a child’s developmental milestones, the CDC has put out a free development tracker app. The app offers photos and videos to guide you. This is an excellent way to follow your child’s progress and intervene if needed. The earlier the intervention, the better for the child.


If you have concerns about your child’s development, speak to your primary care provider who will help you with a referral for services.


Joanie S. Holm, R.N., C.N.P. is co-founder and president of Healing Words Foundation that supports Prairie Doc® programming. 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 21 Seasons, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.

Prairie Doc Perspective Week of May 19th, 2024
Grief: There is No Prescription
By Amanda Kriens, CCHW
As unique is our loss is as unique is our grief. What do we do when one day we can smile, laugh, and look back at memories with fondness and thankfulness for the life we shared with our loved one; the next day we feel paralyzed by our pain and sadness? We feel broken and feel as though we may never be our “old self” again? We may not like the answer…we feel what we feel. There is no twelve steps, timeline or prescription for our grief. New research supports that as unique as we are as humans, as unique as our relationships are, as unique as our brains, is as unique as how we will process our grief. 
    By allowing ourselves to feel what we feel and becoming curious about those feelings we can, with time, heal. We may not ever be our “old self” again but we can become a new self. A new self that has become more resilient, more self-aware and has more compassion for ourselves and likely for others. We do not have to become bitter but we can feel angry. Anger is a common feeling to have when we are experiencing grief but so is laughter and sadness. By allowing ourselves to release our anger through healthy means such as exercising, journaling, writing a letter we can move through this feeling. By laughing when we feel like it we can release endorphins and increase our serotonin which in turn helps us feel good. By crying when we feel sad we can release stress through the actual tears coming from our eyes. Those tears chemical makeup are different than the tears our eyes naturally produce for moisture. By allowing our sad tears to flow we can help release that sadness out of our body. We may feel exhausted after this release but then while listening to our bodies, we rest.
    Suppressing our feelings is not only not good for our mental health it is also not good for our physical health. We are more likely to suffer from chronic illness if we are not processing our thoughts and feelings in a healthy manner. Some tips for caring for yourself while experiencing grief are:

• Get adequate rest: 7-9 hours of sleep per night 
• Drink water: Half your body weight in ounces
• Eat healthy meals and snacks: Eat the rainbow fruit, vegetables, protein and healthy carbs
• Talk to someone: Find a therapist and/or a grief support group
• Build a support system: It is okay to need others during this time and allow them to support you
• Say no when needed: Do not overwhelm yourself with too many stressful tasks or events
• Don’t isolate: Do things you enjoy and with others who bring you joy
• Move your body: Go on walks or to the gym
• Get in touch with nature: Spend time outside and in the sunshine
• Journal: Write down how you feel 
• Give yourself time: Don’t shame yourself when you have a hard time
• Plan things ahead: Put things on the calendar that you can look forward to 
• Honor their memory: Think of how you would like to me memorialize your loved one
• Read a book on grief: Understanding your Grief by Alan D. Wolfelt, Ph.D.

Amanda Kriens, CCHW is a community health worker at Avera Behavioral Health in Brookings, SD. Amanda provides outpatient community health worker services to children, adolescents, families and adults. Her services are personalized to help those dealing with anxiety, depression, abuse, stress, cultural diversity, interpersonal issues and trauma related to sexual violence. Her practice includes cognitive behavioral therapy, mindfulness and solution-focused therapy, and helping patients find additional community resources. 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 providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central.  

Prairie Doc Perspective Week of May 12th, 2024
Telegraph, Telephone, Telemedicine
By Jill Kruse, DO


Technology has come a long way in the past 200 years.  The telegraph was invented in 1837 and made rapid long range communication possible.  Messages could be sent around the world through a series of connected wires.  The telegraph had medical applications in the Civil War. It was used to order medical supplies and report information about injuries and casualties to medical teams.  This was cutting edge technology at the time, but it now is considered an obsolete method of communication.  
Alexander Graham Bell patented the telephone in 1876.  By 1900 there were nearly 600,000 telephones in use.  At the end of 1910 there were over 5.8 million active telephones.  The telephone was seen as a tool to connect doctors and patients together over a distance.  A report in The Lancet Journal from 1879 described how a doctor could use the telephone to listen to a baby’s cough and diagnose croup.    
In 1924 The Radio News Magazine predicted a two way video encounter with a “radio doctor” using a television-like device.  In 1959 the University of Nebraska became the first place to use two-way video communications for telemedicine applications.  This was done using closed circuit television to connect medical students at the main campus in Omaha with patients at the Norfolk State Hospital 112 miles away.  However, Telemedicine as we know it today did not get its start until the 1970’s.
Telemedicine can also be used to send radiology images remotely to radiologists who can be in a different state or even a different country.  With the improvement of cellular technology, EKGs can be sent from the back of an ambulance to the hospital.  So before a patient even sets foot inside the door of the hospital, the Emergency Room doctors and Cardiologists can be prepared.  This can not only save time, but can save lives when someone is having a heart attack.  
With the COVID 19 pandemic, there was an increased push to use telemedicine for virtual visits in the clinic setting.  Telemedicine has also been used when patient transfer from smaller hospitals to larger tertiary care centers is not possible or when dangerous winter driving conditions make transfers unsafe.  This technology helps bridge the gap in medical care between rural areas without specialists and urban medical centers.  
The jump from telegraphs to telemedicine with virtual visits is a big one.  I can only imagine what the next 200 years of technological advancements will bring to how we deliver health care.  No matter how we interact, there will always be a doctor ready to connect and help you, stay healthy out there.   
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 and Instagram featuring On Call with the Prairie Doc®, a medical Q&A show providing health information based on science, built on trust, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  
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Prairie Doc Perspective Week of May 5th, 2024
“Learning to Adapt after a stroke”
By Carter Holm, RN


Working as an RN in inpatient rehab, I am often called upon to care for patients who have had a cerebrovascular accident, or more commonly called a stroke. I have observed that every stroke patient experiences a unique combination of symptoms but the one of the most important tasks they accomplish in rehab is learning how to be adaptable. 


According to the American Stroke Association, left sided strokes (which affect the right side of the body) cause patients to experience more difficulty with language, both in speech and understanding. Right sided strokes, can cause more behavioral changes that may lead to uncharacteristic impulsivity, and may affect the patient’s vision. Based upon the type of stroke, each patient's experience is different and they will have their own set of challenges to overcome as they work towards recovery.


Identifying the challenges is a crucial aspect of stroke rehabilitation. A main focus of the rehab team, for example, is balance and gait. Physical therapy is crucial in recovering strength and coordination in the affected side. If a patient is experiencing weakness to the left or right side of their body, they may require the use of a walker to allow for safe ambulation. Some patients may instead require the use of a cane, quad cane, or hemi-walker. Finding the correct assistive devices is one way stroke patients work to return to some normalcy.


Stroke patients may regain their freedom of movement with the help of an adaptive foot brace, or the use of a specialized cane. They may adapt to using their non-dominant hand for eating or writing. They may learn tools to adapt their speech patterns, or use electrical stimulation of the facial muscles to increase strength, and improve oral function. What all of these things have in common is learning how to change, how to adapt. And while each stroke is different, and symptoms vary from patient to patient, one common thread is that all stroke patients, their families, and friends must learn to adapt. And it isn’t just the physical recovery, people must adapt to the emotional and psychological changes as well.
Depression, anxiety, altered moods or sudden mood changes are all common symptoms following a stroke. Often, I have had patients who are so frustrated that they feel like giving up on therapy, even giving up on life. Patients and family members may experience grief: mourning the loss of the person that they were, or that they once knew. Author Delanie Stephenson wrote of her stroke, “While my body and mind were healing, I was learning to be a new person”. Just as the body needs time and practice to adapt to the physical changes, the brain also needs time and practice. 


Neuroplasticity does not return overnight, and may take months to return to normal. Regaining function requires setting goals, hard work, patience, and most important an acceptance of the need to adapt! 


Carter Holm, RN is a Registered Nurse at Avera McKennan in Sioux Falls Specializing in inpatient rehabilitation. Holm is a Certified Rehabilitation Registered Nurse and works with patients through their rehabilitation from strokes, brain injuries, spinal cord injuries, and trauma. 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, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.