Prairie Doc Perspective Week of July 27th, 2025
Feeling Dizzy? How Physical Therapy Can Help You Find Your Balance
By Matt Leedom, PT, DPT, NCS


Have you ever stood up too quickly and felt the room spin? Or rolled over in bed and suddenly felt like you were on a merry go round you didn’t ask to ride? Maybe you’ve started to notice you feel a little unsteady when walking or need to hold onto furniture “just in case.” If that sounds familiar, you are not alone. And more importantly, you are not without options.


Dizziness and balance problems are surprisingly common. These issues can develop after a cold, a minor head injury, or simply as part of the aging process. But despite how common they are, they are often overlooked. Many people chalk them up to aging or learn to “just live with it,” avoiding stairs, skipping favorite outings, or giving up activities they enjoy because they don’t feel steady.


That is where physical therapy can make a real difference. And no, it is not just about stretching or lifting weights. Physical therapists who focus on balance and vestibular care can help identify the source of your symptoms and offer practical, personalized solutions.


Let’s start with one of the most common causes of vertigo: Benign Paroxysmal Positional Vertigo, or BPPV. It sounds complicated, but the fix is often simple. In BPPV, tiny crystals in your inner ear float into the wrong place and start sending confusing signals to your brain. The result? Sudden, brief spinning sensations with head movement or changes in position. A trained physical therapist can perform a series of head and body movements called repositioning maneuvers to guide the crystals back where they belong. Relief is often immediate.


But not all dizziness is BPPV. Sometimes it stems from vestibular system weakness, where the inner ear is not working properly. This can be caused by a virus, changes that come with age or for reasons unknown. Other times, balance problems are linked to neurological conditions like Parkinson’s disease or stroke, or to weakness and reduced movement after illness. Even changes in vision or sensation in your feet can throw off your balance.


That is why careful evaluation is so important. A physical therapist will assess how your eyes, ears, brain and muscles work together to keep you steady. Then they will create a personalized plan to help you feel more confident and stable. This may include exercises to improve gaze control, strengthen your muscles, practice safe walking and retrain your sense of balance.


Most importantly, therapy helps you rebuild your confidence. When you are afraid of falling or feeling dizzy, it is easy to stop moving. But that can make things worse. Physical therapy offers a safe way to stay active and regain control.


You do not have to live in fear of the next dizzy spell or miss out on the things you enjoy. If you are feeling off balance, ask your doctor if a referral to a vestibular trained physical therapist is right for you. The path to steady footing might be closer than you think.


Matt Leedom, PT, DPT, NCS, is a board-certified clinical specialist in neurologic physical therapy and an assistant professor in the Department of Physical Therapy at the University of South Dakota. He earned his B.S. in psychology from USD and his Doctor of Physical Therapy degree from Creighton University. Leedom’s clinical expertise includes the treatment of individual neurological conditions, including vestibular disorders. His research focuses on improving mobility and quality of life for individuals with Parkinson’s disease, with current projects exploring cognitive flexibility training and non-invasive brain stimulation to address gait and postural impairments. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and streaming on the Prairie Doc Facebook page), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 
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Prairie Doc Perspective Week of July 20th, 2025
Spiritual Pain and Grief
By The Rev. Kari Sansgaard, Avera@Home Hospice Chaplain – Sioux Falls, SD

After nearly twenty years of parish ministry, I entered the world of health care, which, I learned, abounds in acronyms. My first clue was in chaplaincy training, known as “CPE” (Clinical Pastoral Education), the required education for most hospital and hospice chaplains. CNA, SoB (Shortness of Breath), PRN, HoH (Hard of Hearing), and a myriad of other acronyms are now part of my own vernacular. QoL (Quality of Life) is the ‘big’ one in hospice, sometimes called “comfort care.” When quantity of life becomes diminished, it’s all about quality.

Dame Cicely Saunders, the founder of hospice as we know it, understood human suffering as a combination of physical, psychological, social and spiritual pain. She famously said the following: YOU MATTER BECAUSE YOU ARE YOU, AND YOU MATTER TO THE END OF YOUR LIFE.

I suggest that all people are spiritual, where spirituality is defined as the source(s) of meaning and purpose that guide and encourage us. Spiritual pain, then, is part and parcel of being human. I describe it simply as anything that breaks your heart. A pet dies; a friend moves away; a family member becomes estranged; a dream is not realized; divorce, death, broken trust, and so on. 

In hospice, when death is impending, spiritual pain can lead us to ponder existential questions, such as the following:

• How has my life been meaningful?
• Is there a God or Higher Power?
• What will be my legacy?
• Have I lived my life to the fullest?
• What do I do about my regrets?
• Will I see my loved ones again?

Chaplains abide with us when we boldly ask these (and other) questions. At our best, we provide both active and reflective listening, safe space, and a supportive presence. In the crying, wrestling, confusion and fear, we remain.

In addition to supporting areas of spiritual pain, chaplains are curious about sources of meaning in our lives (our spiritual resources). In whom or what do you place our ultimate trust? What people, experiences, music, places and/or Higher Power enliven your spirit and ground you? Life review in this realm can lead to laughter, connection and peace.


SPIRITUAL CARE IS NOT AN OPTIONAL EXTRA FOR THE DYING.
-Dame Cicely Saunders

When we are grieving, spiritual pain can be exhausting. We can move through anger, sadness, numbness and peace in the course of thirty minutes. How do we ‘do’ life with the emptiness we feel? We are not made to endure this suffering alone.

Grief groups, clergy, therapists, good friends, music, books, podcasts and nature walks, are among the resources available to us. It is important, in all life chapters, to nurture our spiritual resources. When crises come, our spiritual grounding can buoy us.

As you tend to your body, mind and spirit through in this complex and beautiful life, may your QoL be well.

Pr. Kari Sansgaard, is an ELCA pastor who serves as Avera Hospice Chaplain at Daugherty House Prince of Peace and Touchmark All Saints in Sioux Falls. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective Week of July 13th, 2025
“The Implant and Surgical Approach Choices Every Cataract Patient Should Understand”
By Vance Thompson, MD
Introduction
Few decisions in life are more impactful than the choice to undergo cataract surgery—and how to have it done. Because cataract surgery is so common, many patients don’t realize it involves important decisions that can affect their vision for the rest of their lives. Modern technology has introduced new options for how the surgery is performed and what type of lens implant is used. These choices matter.
Before we explore the available options, it’s important to first understand what a cataract is and the role of the natural lens in our vision.
The Lens of the Eye
Behind the pupil sits the eye’s natural lens. When we’re young (typically under age 40), this lens is flexible and able to shift focus to help us read and see clearly at all distances. It also contributes about 20% of the eye’s focusing power.
As we age, this lens gradually becomes stiffer—often starting in our 40s—leading to difficulty seeing up close. This is why people begin to need reading glasses or bifocals. Over time, the lens also becomes cloudy, reducing the quality of vision even with glasses. When this happens, it’s called a cataract.
Cataract surgery is one of the most successful and common procedures in the world. It involves replacing the cloudy natural lens with a clear artificial lens implant.
Lens Replacement Surgery: More Than Just Cataract Removal
During cataract surgery, we remove the clouded lens and replace it with a new, clear one. Some lens implants restore clarity but still require glasses—often trifocals—to help patients see far away, up close, and at intermediate distances (like a computer screen).
Other advanced lens implants do much more. They restore both clarity and a full range of vision, often giving patients the ability to read, work, and drive without glasses—similar to the visual range they had in their 30s.
It’s important to understand:

• Insurance typically covers the standard lens that restores clarity only.
• Advanced lens implants, which restore clarity and reading range, involve an additional investment by the patient.
• Both options are good—but which is best depends on the patient’s lifestyle, eye health, and visual goals. Your consultation with your eye doctor and surgeon helps with these important decisions. 

Some people choose to have Lens Replacement Surgery even before their cataract fully forms, especially if they’re in their 40s to 60s and want to eliminate their need for reading glasses or bifocals. This is called Refractive Lens Exchange and the patients who do it never need to worry about developing a cataract and they are not dependent on reading glasses or bifocals anymore. 
Surgical Technique: Manual vs. Laser Lens Capsule Opening
The natural lens is housed in a thin, clear membrane called the capsule—imagine a grape inside a grape skin. During surgery, the surgeon must create a round opening in the front of the capsule, about 5.0 mm in diameter, perfectly centered over the lens. This allows the lens to be removed and the new implant to be placed in the capsule.
After surgery, the capsule naturally "shrink-wraps" around the new lens implant. This process, called capsule contraction, helps hold the lens in place for the rest of the patient’s life--and does this the best if the opening overlaps the edge of the implant for 360 degrees.
Achieving this ideal overlap is a key to long-term stability of the implant.
There are two main methods for creating the capsule opening:

1. Manual method – done with handheld forceps and typically quite accurate.
2. Laser method – uses a femtosecond laser guided by advanced imaging (OCT) to precisely place and shape the opening.

The laser method can:

• Provide a near-perfectly round and centered opening.
• Improve the chances of 360° overlap, which enhances lens stability.
• Use imaging to determine the exact center of the natural lens—something that can be more difficult to judge manually.

Both manual and laser methods are highly respected and can lead to excellent outcomes. However, the laser approach involves an additional cost and is generally considered more precise. Patients should weigh these benefits with their doctor when deciding which approach is right for them.
Conclusion
When considering cataract surgery—or elective lens replacement—patients should be informed about:

• Implant choices: standard (clarity only) vs. advanced (clarity and range of vision).
• Surgical techniques: manual vs. laser-guided lens capsule opening.

Understanding these options empowers you to have meaningful conversations with your eye surgeon and make the best decision for your vision and lifestyle.


Vance Thompson, MD is an internationally recognized specialist in refractive cornea, phakic IOL and lens replacement surgery. He is the Founder of Vance Thompson Vision Sioux Falls, SD and the Director of Refractive Surgery.  Vance Thompson Vision has grown to serve the mid and mountain west with nine locations.  Dr. Thompson also serves as a Professor of Ophthalmology at the Sanford USD School of Medicine. As a leading international researcher, he has played a key role in the development of the most advanced technologies and techniques for both laser and implant vision correction. He has a passion for research and development of new technologies and has served as the medical monitor or principal investigator in over 130 FDA monitored clinical trials studying laser and implant surgery.  Dr. Thompson is the immediate Past President of the American Society of Cataract and Refractive Surgery (ASCRS) a                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  nd is also on the Executive Committee as Vice President of the International Intraocular Implant Club (IIIC) that was founded in 1966 by Sir Harold Ridley, the inventor of the Lens Implant that revolutionized cataract surgery and refractive lens exchange.  In addition, Dr. Thompson has published numerous papers and book chapters and is co-author of the textbook Refractive Surgery. He has lectured and taught advanced laser and implant surgery to thousands of surgeons all around the world. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective Week of July 6th, 2025
“Motion is Lotion; the Importance of Movement”
By Anthony P. Fiegen, MD




Orthopedic medicine is truly a team sport; we have the opportunity to collaborate with nonsurgical professionals, including physical therapists, occupational therapists, athletic trainers, among others, to deliver comprehensive musculoskeletal care. While there are proven surgical options to help our patients where indicated, in many cases, patients are able to achieve pain relief and improved function with nonsurgical treatment options. Much of orthopedic surgical training is appropriately dedicated to the planning and execution of surgery, but it is also important to understand and recognize patients who present with conditions readily addressed without surgery and the accompanying risks of invasive procedures. It is also important to advocate the idea of prevention.


A phrase that is often loosely spoken within our clinic is, “Motion is Lotion.” What does this mean? This is a simple phrase to express the importance of movement and activity, whether that be independent exercise, supervised or specialized therapy, or simply taking a walk outside. With inactivity, we naturally are at risk for muscle loss, obesity, and the many adverse health conditions associated with obesity. It is important to consider exercise and its many health benefits. More specifically, resistance training and cardiovascular exercise have been shown to have robust benefits to our overall physical and mental health and function. 


The National Institute of Health has been studying the effect of strength training for more than 40 years, demonstrating beneficial results in adults including maintained muscle mass, maintenance and improvement of mobility, and increasing healthy years lived. Not all resistance training is the same, however, the effects on improved function largely are the same. Resistance training promotes muscle strength and growth, simultaneously improving our overall cardiovascular health. Studies have demonstrated that our muscle mass peaks around the age of 35. Naturally, muscle volume and performance decline slowly until we reach the age of approximately 65 where muscle volume loss proceeds faster. However, this decline in muscle volume and strength is substantially slowed by resistance training. Dr. Fielding with Tufts University, an NIH-supported scientist, has studied resistance training at a molecular level. His research has suggested that the best recipe for improving physical function and avoiding disability is a combination of walking and resistance training, whether resistance be against gravity or moving weight. The list of research-proven benefits of resistance training is quite impressive. In addition to improved muscle mass and cardiovascular health, resistance training offers improved metabolism and promotes weight loss of adipose tissue, increased bone density potentially preventing fractures associated with aging and fragility, improved balance and coordination, and natural release of anti-inflammatory mediators. Outside of bone and muscle anatomy, being active and exercising has been proven to reduce stress, improve our mood and cognitive performance, boost our energy and libido, as well as provide a mean of self-confidence.


Now understanding the many benefits of physical activity, where do we start? If you are looking for some help, reach out to your physician, a personal trainer, or other trained professionals such as a physical therapist or athletic trainer for guidance. The health benefits will not be immediately realized, but you will eventually notice an improvement in your mood, and perhaps many years from now, also an improvement in your overall physical health. “Motion is lotion.” Let’s get out and move!


Anthony P. Fiegen, MD is a fellowship-trained orthopedic sports medicine physician specialized in treating conditions of the shoulder, hip, and knee at the Orthopedic Institute. In addition to a comprehensive sports medicine practice and joint preservation, he also performs joint replacement of the shoulder, hip, and knee. Dr. Fiegen grew up in Madison, SD. He attended South Dakota State University competing for the Jackrabbits’ men’s basketball team from 2009-2013. Prior to joining Orthopedic Institute in 2024, Dr. Fiegen completed orthopedic surgery residency at Mayo Clinic in Rochester, MN. He then went on to complete a sports medicine fellowship at Wake Forest University in Winston-Salem, NC, where he served as a team physician for the ACC Wake Forest football, men’s basketball, and baseball teams.  Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 
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Prairie Doc Perspective Week of June 29th, 2025
“Know your Family Health History”
Roberta K. Olson, PhD, RN


Foundational education as an RN with a BSN from South Dakota State University provided a broad understanding of how our bodies function.  One of the lessons that was high    lighted over the years was the need to pay attention to changes, e.g., my two sisters needed total knee replacement and so did I; my paternal grandfather had a massive stoke and died at the age of 61 years in 1948 from what? It was never diagnosed. My father thought that his dad, who was a farmer, was too stubborn to get regular check-ups from a physician and probably had heart problems in addition to his high blood pressure.


When I was diagnosed with elevated blood pressure in 2015. My only symptom was ocular migraines; I started taking blood pressure medication.  Both of my parents had low (normal) blood pressure and when I was pregnant with our two sons, my blood pressure was consistently in the low normal range. At first, I thought that perhaps the blood pressure machine wrong but with further tests, I was diagnosed with hypertension.


My blood pressure stayed elevated even with the daily medications that I took to keep the hypertension in check. In June 2024 my pulse slowly dropped to 34 (normal is 70-80/minute). On Thursday my primary care physician ordered an  echocardiogram for the following Monday because my pulse was 40 bpm in the office. On Sunday night at midnight, I was awake, got up and measured my pulse.  It was 34 bpm. I debated whether to wait 10 hours for the scheduled echocardiogram or call 911.  I called 911.


The ambulance came at 12:30 a.m. and I was taken for an assessment to the Brookings Emergency Department. Further assessment indicated that I was in  a 3rd degree heart block and would need a pacemaker.  A cardiac surgeon had accepted the request from the Brookings ED Physician. By 4:00 a.m. I arrived at the Avera Heart Hospital in Sioux Falls via ambulance. I was monitored the entire time by the EMT. Further assessment was done by the technicians and at 8:30 a.m. I was on the operating table with the cardiac surgeon ready to insert a pacemaker. I stayed one night in the hospital for observation and was discharged on Tuesday morning.


We are fortunate in South Dakota to have responsive EMTs, competent MDs at all times in the Emergency Department, and Cardiac Surgeons ready to assist as needed at the Avera Heart Hospital.


Following the “organ recital” discussion with my sisters, I learned that a third cousin who lived in Illinois and is four years younger than I am also had a pacemaker inserted a few years ago.  Our grandfathers were brothers. Genetics in your family history is important to know and understand. Dwelling on every ache and pain is not necessary but know your body and changes in the usual patterns of wellness. Post pacemaker my blood pressure is consistently within the low normal range.


Roberta K. Olson, PhD, RN earned her MSN in Nursing of Children at Washington University, St. Louis, MO and her PhD in Higher Education at Saint Louis University. She served in four academic institutions prior to returning to her alma mater and serving the last 20 years of her career as the Dean of Nursing at South Dakota State University. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.