by Andrew Ellsworth, M.D.
 
One late summer day, fresh out of residency and seeing patients for the first time as a full-fledged family physician, I examined a young man who had a fever, fatigue, and a bad headache. Considering the time of year, influenza was low on the list of possibilities, and COVID-19 did not yet exist. After a physical exam and listening to his story, I ordered some tests, which resulted in a diagnosis of West Nile virus.
 
Now that we are entering the later half of the summer, the weather and environment are prime for West Nile virus. When the weather becomes hotter and drier, the mosquito species Culex thrives and has the potential to harbor West Nile virus in its saliva.
 
The first reported case of West Nile virus in the United States was in 1999. Now, it's here to stay. There is no vaccine for West Nile virus for humans. The treatment is largely supportive, rest, fluids, and time.
 
Thankfully, most people who become infected with West Nile virus have mild or no symptoms. About one in five of those infected develop a fever, headache, rash, muscle aches, joint pains, vomiting, or diarrhea. About one in 150 may develop a severe case that affects the central nervous system, resulting in encephalitis which is inflammation of the brain, or meningitis known to cause inflammation of the membranes around the brain and spinal cord. Some of those cases can be fatal, which equates to an average of 130 deaths in the United States from West Nile virus each year. 
 
You cannot get West Nile virus from another person. The key to prevention is to avoid getting bitten by a mosquito. This late summer and early fall, remember the mosquito repellent, avoid going outside at dawn or dusk, consider wearing pants and long-sleeved shirts, and consider treating your clothes with permethrin which can kill or repel mosquitos.  Avoid having areas or containers outside that can collect water and create spaces for mosquitoes to lay eggs. 
 
It took a couple of weeks, but thankfully my patient fully recovered. Nowadays, if it is late summer or early fall, and someone has a fever, headache, and fatigue, there is a good chance it is COVID-19. However, one must remember other causes, and West Nile virus is certainly a possibility. 

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 featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. 

By Kenneth A. Bartholomew, M.D.
 
As a physician with 45 years of practice, I’ve seen my share of diseases. I have usually been on the physician side of the diagnosis-treatment paradigm. However, knowing the rationale for diagnostic screening tests, I fortunately did not shirk my own.
 
Testing too much or too frequently leads to insignificant findings that may have no long-term consequences yet create worry and further testing. Too often, this can lead to surgery that does not save lives but carries pain, disability, unnecessary expense, and sometimes post-op infection that occasionally is fatal. Knowing what and when to test is a crucial conversation to have with your doctor.
 
Although annual prostate-specific antigen, or PSA testing is no longer recommended, periodic testing may raise suspicion if a rising pattern is seen. As luck would have it, this turned out to be my dilemma, so I retested six months later, and when my PSA continued to climb, I went in for a biopsy. The biopsy showed a very aggressive type of cancer, the type that metastasizes very quickly to bone. Surgery was scheduled and computed tomography or CT scans ordered to help with staging my surgery.
 
Even though I had had three colonoscopies in the preceding 25 years, the CT scan showed a tumor inside my colon that was only about one millimeter from breaking through the wall and spreading to other organs. An extra year of procrastinating would almost certainly have found me with two cancers that would have already spread. Catching them early, surgery was curative, and I was one of the lucky ones who did not have to undergo months of radiation or chemotherapy.
 
So, please, have this discussion with your doctor, and review the American Cancer Society’s screening guidelines, as these vary with age, family history, and your unique set of risk factors. Go to www.cancer.org and be proactive. Catch it early and you too can go on enjoying life with your family for years to come.
 
Kenneth A. Bartholomew, M.D. is a contributing Prairie Doc® columnist. He lives in Fort Pierre, South Dakota and serves on the Healing Words Foundation Board of Directors, a 501c3 which provides funding for Prairie Doc® programs. Follow 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, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                   

By Kelly Evans-Hullinger, M.D.
 
As a clinical professor at my state’s medical school, I frequently have medical students seeing patients with me in clinic. While the majority of patients are happy to allow student involvement, some decline. This makes me wonder what misconceptions lead patients to be averse to trainees participating at their clinic visits or hospital bedsides. In my experience, the presence of learners has a positive influence on our work in the clinic and hospital.

Medical education is a complex, highly intensive program that requires years of education and practice. Most medical students are college graduates who performed well in their undergraduate studies and went above and beyond their peers in volunteering, extracurricular activities, and other achievements. After college, some go directly to medical school, and some have variable years of other experiences.

Traditionally the first two years of medical school take place in the classroom, learning about anatomy, physiology, disease processes, microbiology, and pharmacology. The third and fourth years are spent almost entirely in the clinical setting, seeing patients, and learning how to apply their hard-earned knowledge.

After medical school, new doctors go on to their residencies to receive further training in their chosen specialty; and after that, some continue to fellowship. This postgraduate training is rigorous. After at least three but sometimes many more years, those physicians will be ready to practice independently in their specialty.

Recently a student and I saw a patient with leg pain and swelling. After the student’s evaluation, we discussed in the patient’s presence what features of this patient’s pain concerned me for an urgent condition, how we should proceed with diagnostics, and why. The patient was able to observe how much thought went into our assessment, and hopefully the patient appreciated serving as teacher.

When I as an attending physician have a student or resident in my clinic, I am at my best. Students are caring and thorough with our patients. Teaching often requires me to talk about a new diagnosis or treatment in greater detail, and the patient reaps the benefit of hearing that discussion. It is not uncommon for a student to ask me a question to which I don’t know the answer, and ultimately both of us learn something new.

I would encourage patients, when they encounter trainees in their medical care, to view these compassionate and hardworking people as I do: a true complement to patient care. All physicians are life-long learners and are exceedingly grateful for our patients, who are our greatest teachers.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal 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 celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Veronica Radigan, M.D.
 
Summertime. For most, this signals thoughts of warm weather and good times with family and friends. Sadly, what brings happiness for some can trigger stress and sorrow for others. In the words of a Vietnam War veteran, “The fourth of July was once my favorite holiday with friends and family…but now it is a day I wish never existed.”

Now ask, what could this veteran, a victim of a farming accident, a female sexual abuse victim, a child who lost his mother to domestic violence and a survivor of a tornado all have in common? The answer is post-traumatic stress disorder or PTSD.

As defined by the CDC, PTSD is an intense, uncontrollable emotional and physical reaction to a reminder of a traumatic event or distressing memories. Though most people associate this disorder with service members and war, the reality in our society is that PTSD is diverse and far reaching. It is estimated that 70 percent of the population will experience at least one traumatic event in their lifetime and current research shows that about six percent of American adults will suffer from PTSD.

The privilege of talking with hundreds of patients has opened my eyes to the variation of PTSD symptoms and its commonplace in our society.

Some PTSD symptoms are intrusive such as distressing memories, dreams, or flashbacks. Others experience intense psychological or physiological reactions to triggers. The need for avoidance causes some suffering from PTSD to shut out memories of the event and evade reminders such as people, places, situations, or objects. PTSD can alter mood and thoughts which can lead to feelings of blame, fear, horror, anger, guilt, or shame and inability to experience positive emotions. Common symptoms also include irritability and angry outbursts; reckless or self-destructive behaviors such as substance use; hypervigilance; and problems with concentrating and sleep. 

The reality is that PTSD is complex and affects everybody differently, so a treatment that works for one person may not work for another. Currently, the main treatments for PTSD are medications and/or psychotherapy. Support from family, friends and groups are crucial to recovery.

It can be difficult to take that first step to ask for help but with time and treatment PTSD can be managed and controlled. Research shows that the symptoms of PTSD last much longer for those not receiving treatment versus those that receive treatment. By creating more awareness and discussing the diverse nature of PTSD more people will be inspired to get help or give help to those suffering. If you are unsure where to start, ask your family doctor or search for local mental health providers. 
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Veronica Radigan, M.D., a psychiatrist in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist and a guest this week on the Prairie Doc® Q&A show. Follow 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, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

By Andrew Ellsworth, M.D.
 
Recently our family went on a camping trip. Our kids loved how we canoed our supplies across a lake and set up our campsite. My wife and I were reminded how much work it is. Soon our children were experiencing more mosquitos, flies, caterpillars, and ticks than they had ever seen before.
 
On one of our lovely hikes, nearly every time I looked down, I found another tick crawling on my shoe or leg. Ticks love tall grass, wooded areas, and other moist and humid environments often close to the ground. Although you may find them on your head, they don’t normally drop down from above, rather, they start low and crawl up.
 
Ticks are not insects. They are part of the arachnid family, cousins to scorpions, mites, and spiders with two body parts and eight legs. Ticks commonly enjoy sucking the blood of deer, cats, dogs, mice, squirrels…and humans.
 
Blacklegged ticks, sometimes called deer ticks, carry borrelia burgdorferi, the bacteria that can cause Lyme disease. These ticks live in the eastern half of the United States.
 
Symptoms of Lyme disease include fever, headache, fatigue, and the classic target-like rash called erythema migrans. If caught early, this disease is often successfully treated with antibiotics. If not, later stages can affect multiple body systems including the heart, joints, eyes, and nerves. 
 
Other types of ticks can cause Rocky Mountain spotted fever, tularemia, babesiosis, and ehrlichiosis. Rocky Mountain spotted fever also causes fever, headache, nausea, and rash. Treatment within five days decreases the risk of progression to severe disease. 
 
If you find a tick latched onto your body, it is best to use tweezers and pull it off at its head as close to the point of attachment as possible. Pull upwards with steady, even pressure and avoid squeezing the tick’s body. Clean the skin afterwards and dispose of the tick.
 
When outside in the grass, weeds, garden, or woods, consider wearing long pants and tucking the pant legs into your socks to help prevent ticks from accessing your skin. Apply tick repellant on lower clothing and check for ticks at the end of the day. 
 
Despite checking frequently, my son found a tick on him after we got home, and I found one on me two days later. We enjoyed sharing our love and respect for nature with our children, plus they learned how to safely remove a tick. Next time, we hope to bring home lots of great memories, and no ticks.
 
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 featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.