Prairie Doc Perspective Week of October 29th, 2023
Your gastrointestinal system – no reason to be grossed out!
Kelly Evans-Hullinger, M.D.
A common lament I hear from my patients as they try to discuss a real concern they have about their body: “I’m sorry; this is so disgusting!” Their cheeks burn with shame as they tell me how their bowels have betrayed them. No matter what the issue is, so many of my patients are mortified discussing their diarrhea, constipation, fecal incontinence. My response, always, is “you can’t gross me out – we talk about poop every day in this clinic!”
Plenty of things can go wrong in the gastrointestinal tract, and even minor issues can be really disruptive in a person’s life. Certain features of bowel dysfunction, like blood in the stool, abdominal pain, and weight loss, might signal more urgency to get a problem diagnosed and fixed. We certainly don’t want to miss things like tumors, ulcers, inflammatory bowel disease, and diseases that might affect absorption of nutrients.
Oftentimes, none of those “red flags” are present, but a patient’s gastrointestinal symptoms are affecting their ability to function at work or socially. In cases when we either have ruled out or have low suspicion for something “bad” we can still offer plenty to help with these symptoms. Sometimes that might mean trials of elimination of food types, dietary changes, addition of fiber, or other medications. GI symptoms might be a side effect of another medication. We frequently have to do some trial and error to find the right combination of things that improve an individual’s function, but usually we can do so. In some cases consulting with gut specialists, dietitians, even physical therapists, can be very helpful.
My point here is this: if you are having gut symptoms that are worrying you or disrupting your day-to-day life, let’s talk about it! Whatever discomfort you have discussing it, I promise, is not shared by your primary care provider or friendly gastroenterologist. We want to help you get answers. And even if there is not a simple diagnosis or fix to the problem, we want to help you be more comfortable leaving the house without worrying about what your gut will do. So please, don’t let feeling grossed out keep you from asking the question.
Prairie Doc Perspective Week of October 22nd, 2023
“Get your eyes checked!”
Andrew Ellsworth, MD
If you ever played baseball, you may have been told to “keep your eye on the ball.” When batting, a baseball player is taught to watch the ball the entire time from when it leaves the pitcher’s hand to when, hopefully, their bat smacks the ball for a hit. It may sound simple, but some pitchers can throw fast and sometimes they throw a curveball. Great hitters use their vision and spot the difference, helping them get a hit. Lose focus, and in the blink of an eye the pitch has whipped past them for a strike.
Like keeping your eye on the ball in baseball, I recommend you keep your eye on your eyes. Sure, you may have good vision, but that does not necessarily mean your eyes are in good health. It is important to see an eye doctor for a regular check up, to help spot any eye issues early.
There are several common eye conditions that can be seen early by annual eye exams. Cataracts, macular degeneration, glaucoma, and diabetic retinopathy are some of the examples. Catching these right away helps prevent or delay vision loss. Early detection allows for easier, more effective, and cost efficient treatments.
Cataracts are from clouding of the lens of the eye that can cause blurring and sometimes eventual blindness. Treatable with surgery, outcomes may be better when diagnosed early in the course.
Macular degeneration is a problem with the retina which can cause blurring and central vision loss. Early diagnosis and treatment helps slow the course of the disease.
Caused by increased eye pressure, glaucoma may lead to vision loss from damage to the nerve in the back of the eye called the optic nerve. Often people have glaucoma without knowing it until their vision slowly deteriorates. Once again, early detection is key for preserving vision.
Diabetic retinopathy is a common complication from diabetes that causes damage to the blood vessels in the retina, causing vision loss. If you have diabetes or pre-diabetes, please have an annual eye exam and tell your eye doctor so they know to look for associated eye problems.
Just like a baseball player needs to keep an eye on the ball to watch for changes in movement, I encourage you to get your eyes checked to detect changes in your eyes to prevent vision loss. So, the next time you hear a baseball fan yell “Get your eyes checked!” to an umpire, may it be a reminder to schedule your next eye exam.
Prairie Doc Perspective the week of October 15th, 2023
By Debra Johnston, MD
Aristotle is said to have referred to the female as a mutilated male, and this philosophy seems to have carried forward into much more modern times.
In 1977, official FDA guidelines recommended that women of “childbearing potential” be excluded from early stage clinical trials. Men, particularly white men, were considered the ideal model, from which the success and side effects of any particular treatment could be judged. Somehow, women’s menstrual cycles made them too difficult to study, while simultaneously being irrelevant to the results. The thalidomide tragedy quite reasonably brought fetal wellbeing to the front of researchers’ minds, but there was reluctance to wait for animal teratogenicity data before starting human trials. Companies often interpreted childbearing potential to mean childbearing age, and then extended that ban to all women, in all stages of research. Studies carried out in the mid to later part of the last century frequently enrolled thousands of participants, but no women at all. This was even true in purely observational studies, where nothing was being trialed or tested.
Then, in 1993 congress passed a mandate that women be included in NIH funded trials, and the FDA changed their guidelines. Now they said that the population studied in trials should be representative of the people likely to be treated with an intervention if it were approved. This meant that most studies had to include people of different ages, races, and genders.
Once scientists started looking, it became evident that the differences among us translate to differences in the way diseases develop, the way conditions present, and the way we respond to potential treatments. We may need different doses. We may experience different side effects. We may need different treatments altogether. This can be true for differences based on age, race, health status, and, of course, sex.
The scientific landscape is very different today than it was in 1993, but we still have a long way to go. A recent review of studies involving cardiovascular disease, cancer, and mental health interventions found that just over 40% of study participants were women. Cardiovascular disease and cancer affect men and women almost equally. In mental health research the situation is worse: women make up approximately 60% of those affected, but still, just over 40% of those enrolled in trials.
Everyone deserves to know that the recommendations their doctor makes are backed by science that includes people like them. Many treatments work just as well in people of different races, ages, or genders. But many don’t, and we won’t know if we don’t ask that question.
Prairie Doc Perspective Week of October 8th, 2023
“Getting under your skin” with Varicose Veins
By Jill Kruse, DO
From the back of our hands to the back of our legs, pale blue blood vessels are visible just under the skin. Oftentimes these veins are flat and not painful. However when these vessels become abnormally swollen or dilated, they are called varicose veins. This swelling is caused by the valves inside the veins becoming weak and no longer sealing tightly. Varicose veins can become painful, quite large and stick out from the surface of the skin.
In order for blood to return from your feet back to the heart, the blood must be pumped up against gravity. Check valves in the veins are what keep the blood from pooling back down the legs in between heartbeats. When the heart beats (called systole), the valves open and allow the blood move upward. When the heart is paused, filling for the next beat (called diastole), the valves close and keep blood from flowing back towards the feet. As we age these valves become weak and do not fully close, then the surrounding veins become swollen with extra blood causing varicose veins to occur.
Women are also more likely to develop varicose veins than men due to hormonal changes during pregnancy and menopause. Standing or sitting in one position for long periods of time can also increase the risk of developing varicose veins since leg muscle contractions also help move the blood up against gravity. Older age, obesity, and family history are all common risk factors.
Varicose veins do not just look unsightly; they can also cause pain in the legs. They often lead to an aching or heavy feeling in the legs. Varicose veins additionally lead to burning, throbbing, itching or muscle cramping in the legs. If that is not bad enough, complications related to varicose veins can include ulcers, bleeding, or blood clots.
Unfortunately there is not a way to repair these valves once they are damaged. However, there are some things you can do to help manage varicose veins. Wearing compression stockings can help decrease swelling in the legs. Frequent movement of the legs such as pumping your ankles a few times an hour, raising your legs above the level of the heart for 15 minutes a few times each day, increasing exercise, and losing weight can all help increase blood flow.
If these measures do not give the relief you need, then it is time to talk with your doctor and discuss seeing a specialist for more advanced treatment. There are several different treatments available and they can help you find the one that is right for you. While varicose veins may be below the surface, do not let them get to the point where they really “get under your skin.”