​Prairie Doc® Perspectives for week of September 26, 2021
By Matthew Stanley, D.O.
 
Alcoholism, and addiction overall, isn’t a character flaw, or a weakness of self-control. It’s a disease. And, if you are like most of us, you’ve probably been affected by it. Maybe you struggle with alcohol consumption yourself or have a friend or family member who does. I rarely talk with anyone who doesn’t have a personal story about how addiction has affected their life.
 
In fact, about 14 million adults have an alcohol use disorder and there are about 95,000 alcohol related deaths every year in this country.
 
Unfortunately, we don’t think of it like any other medical illness, so we don’t usually talk to our primary care doctor about it. But that is one of the best places to start the conversation, during your yearly checkup, when you’re talking about health goals it is okay to say, “I think I have a drinking problem.” 
 
Some of the warning signs to look for in yourself or a loved one include sacrificing family bonds for your addiction such as missing a child’s ball game, concert, or graduation. Things that you were once passionate about fall by the wayside. You’re fatigued and foggy; barely able to get up in the morning. You have cravings for the substance. You’re counting down the time until you can get off work and have a drink. You are in danger of losing your job or important relationships, or you’ve gotten in trouble with the law. You tell yourself and others that you could easily quit and will; but you never do.
 
By starting the conversation, you will have a clearer path toward the help you need. Your doctor can guide you to outpatient counseling or support groups, or perhaps treatment at a facility.
 
There is overlap between behavioral health and addiction in terms of risk factors. Much like behavioral health, addiction has an approximate 60 percent genetic hereditability. Mental health conditions and a history of trauma put you at greater risk of addiction. And like so many health conditions the earlier you start the worse the disease. Those who begin drinking before age 15 have a five times greater risk of developing an alcohol use disorder.
 
I’ve spent my career talking about and treating addiction. I see that the conversation is changing, and I’m heartened by it. There is a rising social consciousness about addiction. More and more we’re willing to have candid and productive conversations about it.
 
The next time your doctor asks you about alcohol consumption, take that as a prompt to have an honest conversation.
 
Matthew Stanley, D.O., a psychiatrist in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist and guest host this week on the Prairie Doc® television show. 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. 

​Prairie Doc® Perspectives for week of September 19, 2021

By Kelly Evans-Hullinger, M.D.
 
It is September, fall is in the air, and what we might call “respiratory season” is nearly upon us. Respiratory season refers to the colder months in which we spend much of our time indoors, maybe October through March. Normally, this season correlates with when we see high rates of typically seasonal respiratory infections such as influenza and respiratory syncytial virus or RSV.

Living through the COVID-19 pandemic has given us knowledge we can use to greatly decrease the spread of all respiratory infections. During the 2020-2021 respiratory season, rates of influenza were at historic lows in South Dakota and across the country due to the measures we took to decrease the spread of COVID-19. So, what are the lessons learned?

First and foremost, we should learn that when we are sick with respiratory symptoms, we should avoid spreading our illness to others. It remains essential that anyone experiencing symptoms of cough, fever, or cold symptoms be evaluated and consider testing for COVID-19, influenza, and possibly other infections to ensure avoidance of spread.

Second, if you are sick, even if you have tested negative for COVID-19, try to avoid spreading germs to others. We should especially avoid contact with those most vulnerable to respiratory illnesses – this includes the very young and the very old and those who have suppressed immune systems or chronic lung disease. If you must be around others, keep distance when possible, cover your mouth and nose when coughing or sneezing, and at best, wear a mask to keep those respiratory droplets out of the air. I now cringe to think of years past, when I would power through my common colds and see patients without a mask. I know I can do better in the future.

Finally, vaccines remain one of our best tools for infection prevention. Of course, vaccination against COVID-19 is crucial and has proven to be highly safe and effective. But let’s not forget other respiratory vaccines. It is time to think about getting your annual influenza vaccine. And if you are 65 years old or more, or if you have any medical problems increasing your risk for bacterial pneumonia, you should ask your healthcare provider about a pneumococcal vaccine.

We have the tools to keep ourselves and others healthy during the respiratory season. I, for one, hope that lessons learned during a respiratory viral pandemic might help us all do better in the future.
​
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 Debra Johnston, M.D.
 
What I remember most is the silence.
 
She was 19 years old, just starting her first semester of college. She had been transferred to our level 1 trauma center, intubated and in a medically induced coma. I was a third-year medical student, being introduced to the realities of medicine. Our team was clustered around her in the procedure room adjacent to the ICU while my senior resident inserted the central line we would use to quickly administer large volumes of medicine and fluids. 
 
ICUs can be busy, noisy places. This ICU was a large open room, with rows of beds surrounded by all the equipment needed to care for critically ill and injured patients. The sounds of machines whirring and beeping, of doctors and nurses and all the support staff, accompanied us in that little windowless procedure room.
 
The neurosurgery team solemnly filed through the door, eyes grim. They’d reviewed her CT scan. The pressure of the blood accumulating inside her skull had forced the base of her brain downward, into the space usually occupied only by the top of the spinal cord. We stared at each other in silence. We’d already lost the battle.
 
During the next few days, I watched her 20-year-old sister support their parents as we walked through the process of declaring brain death and deciding on organ donation. Other than the silence, the sister’s grief, and her courage, are my most potent memories.
 
Over the years, I’ve seen many lives irrevocably altered by brain injuries. Children thrown from their bicycles. Soldiers caught in blasts. Women battered by their partners. Seniors who slip and fall. Some patients fight to regain skills that were once effortless. Some succumb to their injuries or the consequences. The lucky ones sometimes don’t even realize how close they came to having their lives upended.
 
Our ability to help has improved significantly in the nearly 30 years since I stood at that young woman’s bedside. People survive injuries that would have previously been fatal. People recover enough to rejoin the community, instead of finishing their days in nursing homes. Nevertheless, too many still die, over 50,000 Americans every year. Nevertheless, survivors spend months relearning basic skills with the help of skilled therapists. Nevertheless, millions live with varying degrees of disability, despite aggressive rehabilitation.  
 
As with so many things, the best treatment is prevention. Buckle your children into their car seats. Use your seatbelt. Wear your helmet. Keep the guns locked up. Learn how to reduce the risk of falls, especially for the young, and the old. It’s much better to protect that fragile brain, than to try to put it back to rights.   
 
Debra Johnston, 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 Jill Kruse, D.O.
 
The kidneys may be called the Rodney Dangerfield of the body, as they often “don’t get no respect.” The National Kidney Foundation estimates that one in three adult Americans are at risk for kidney disease, yet these organs are mostly ignored unless they develop stones or stop working.

When healthy, kidneys work continuously at their main job of filtering blood to remove unwanted products and help produce urine. Kidneys clean approximately 200 liters of blood each day removing up to two liters of toxins, waste, and water in the process. Perhaps less well known is the fact that the kidneys are essential for many other functions in the body as well, including managing blood pressure and preventing anemia.

Kidneys release the hormone renin which is part of the complex renin-angiotensin-aldosterone system, or RAAS, instrumental in helping regulate blood pressure. RAAS regulates sodium and potassium absorption in the kidneys and balances fluid and electrolyte levels in the body, all of which have a direct impact on blood pressure.

When treating patients whose blood pressure does not respond to medications, heart doctors will examine RAAS function. They may also order an ultrasound of the kidneys. Sometimes this reveals a narrowing of the artery going into the kidneys which may be responsible for treatment-resistant high blood pressure.

Kidneys also secrete a hormone called erythropoietin which acts on bone marrow to help the body produce red blood cells. Without this hormone, people can develop anemia.

Vitamin D is converted to its active form by the kidneys allowing the body to use the vitamin to its advantage. Thanks to the kidneys, vitamin D helps balance calcium and phosphorus absorbed from the foods we eat. Without enough calcium, people can develop weakening of the bones and muscles.

Kidneys complete these and many other functions so efficiently that a healthy person can donate one and the remaining kidney will do the work of two. They work hard to help us, so let’s do our fair share to help them. If you have diabetes, work to control it as best you can because high blood sugars can damage your kidneys. And one thing all of us can do for our kidneys is to stay hydrated.

There is no doubt that kidneys deserve more respect. Talk to your doctor about blood tests or urine tests to check your kidney’s health and functionality. Kidneys…let’s show them some respect!

Jill Kruse, D.O. 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.