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.