Prairie Doc Perspective Week of October 26th, 2025
“The key to boosting immunity”
By Kelly Evans Hullinger, MD FACP


It’s hard to look at your television or social media and not see a headline about some “superfood,” supplement, or other product promising to “boost immunity.” And who doesn’t want to boost immunity, especially in a year in which measles outbreaks are becoming routine? Genuinely, there is one entity available to us that, more than any other fad, will help our immunity and protect us against infection: vaccines.
Vaccines are one of the great miracles in the history of science serving humanity. Whereas in centuries before, seeing children and young people die of infectious diseases was a universal experience, vaccines have truly changed the world in that regard. Diseases like smallpox and polio have been wiped out after being something parents feared throughout human existence.
With the huge successes of vaccines, in some ways we as a society have forgotten their wonderful impact. Measles, up until the 1960’s a disease that was commonplace and resulted in unfortunate deaths of infants and children, was rarely seen after widespread vaccination in the late 20th century and early 2000’s. Unfortunately, because of declining rates of childhood vaccination, that is no longer true. Various misinformation campaigns and, probably, a general sense of insignificance (no new parents remember anyone having measles), are to blame.
Measles is a highly contagious disease that statistically requires about 95% vaccination rate in a population to achieve herd immunity. Herd immunity status gives protection to vulnerable individuals including those too young to vaccinate (infants under one year of age). We have seen large outbreaks of measles in numerous states this year, generally in communities where that herd immunity is not being achieved. And because measles is so highly contagious, kids who have not been vaccinated may have to miss school for weeks to stay safe. Most sadly, we have seen deaths this year in the US from a disease which was considered eliminated as recently as 2020. Let’s hope this isn’t a sign of other preventable infectious diseases making a comeback.
So, if you’re looking to boost your immunity this season, of course I recommend a healthy diet, regular exercise, and adequate sleep. But if you want to make the biggest impact, talk to your doctor about vaccines and get caught up with evidence-based recommendations. Your immune system will thank you.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of October 19th, 2025
“Midnight Muscle Cramps? Here’s What Your Body is Telling You”
By Patti Berg-Poppe

You’re asleep when suddenly your calf tightens into a painful knot. You swing your legs over the side of the bed and stand up, trying to stretch the muscle and waiting for the cramp to release. It passes after a minute or two, but the soreness often lingers. These types of nighttime leg cramps are common and often harmless, but disruptive.

Studies suggest that up to 60% of adults experience leg cramps at night at some point in their lives. They become more common with age and can occur more frequently in people with certain medical conditions or those taking specific medications. 

The cause isn’t always clear, but several theories exist. One involves the gradual loss of motor neurons that occurs with aging. As nerve cells die off, the ones that remain may attempt to compensate by branching out to control more muscle fibers. This reorganization may make the system more prone to overexcitation, triggering cramps.

There is also a strong association between inactivity and muscle cramping. Many people spend long hours sitting or standing in place without moving through the full range of motion needed to keep leg muscles and tendons flexible. Over time, this can lead to muscle shortening, weakness, and poor circulation, all of which may increase the risk of cramping.

Daily activities that used to keep our muscles stretched and strong, such as squatting, kneeling, or walking on uneven terrain, are also less common in modern life. Without these movements, muscles like the hamstrings and those in our calves become less adaptable. The typical sleeping posture, with feet pointed down and ankles in plantarflexion, keeps the calf muscles in a shortened position for hours at a time. This posture may increase the likelihood of spontaneous nerve firing, especially during lighter stages of sleep.

Dehydration, electrolyte imbalances, and certain medications (such as diuretics) may also contribute to cramping. In some cases, leg cramps can be linked to medical conditions such as peripheral artery disease, diabetes or kidney disease.

Although painful, most nighttime leg cramps are not dangerous, and they can often be managed with simple changes. Stretching the calf muscles and hamstrings daily, especially before bed, may reduce the frequency and intensity of cramps. Staying physically active, including activities that strengthen the legs and promote circulation, can help maintain muscle function and flexibility. Walking, bicycling, heel raises and chair squats are practical options for many adults.

People who experience frequent cramps may benefit from adjusting their sleep posture. Using a pillow to keep the feet in a more neutral position, or avoiding heavy bedding that pushes the feet downward, can be helpful.

If cramps are severe, occur often or are associated with other symptoms, it’s worth talking with a health care provider to rule out underlying causes. In many cases, however, consistent movement, hydration and attention to daily habits can make a meaningful difference.

Patti Berg-Poppe is a physical therapist and professor at the University of South Dakota. Her work centers on helping people understand the connection between movement, health and maintaining independence and engagement throughout life. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays on SDPB at 7pm on YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of October 12th, 2025
“The What If’s”
By Debra Johnston, MD

Let’s call her Sarah, although that wasn’t her name. I’d had the privilege of delivering her, and the fun of watching her grow into a precocious toddler, with an impish smile and a joyous laugh. Then I had the responsibility of explaining her autopsy report to her devastated parents. 

She’d died from an infection that her young, previously healthy body just couldn’t fight. It hadn’t taken long; she’d started running a fever the night before, and her parents brought her to the clinic the next afternoon. The flight crew hadn’t even gotten to our ER before she lost the battle.

Of course we all had “what ifs” to torment ourselves with. What if mom had breast fed for longer? What if dad hadn’t taken her to that play date, with the little friend who had a runny nose? What if the doctor (me) been more detailed in the “how to tell when she’s really sick” discussion? What if her parents had brought her to the ER that morning, instead of to the clinic that afternoon?

The “what if” that has tormented me the most, though, is what if she’d been born just a year or two later?

The infection that killed my little patient was caused by streptococcus pneumoniae. The original version of the Prevnar vaccine, which taught a child’s immune system to fight 7 strains of that bacteria, was introduced in 2000. Shortly after, the rates of serious infections from these bacteria dropped precipitously, and not just in the children who got the shots. Adults also benefited, to varying degrees. 

One modernized version of the Hippocratic oath contains the phrase “I will prevent disease whenever I can, for prevention is preferable to cure.” I don’t remember if my classmates and I said those particular words on graduation day, but it’s a philosophy I wholeheartedly endorse, and one I try to live by. I nag my patients to eat more fruits and vegetables, and to get their calcium. I nag them to exercise more. I nag them to quit smoking. I urge them to get to the eye doctor, and to the dentist. I remind them that seatbelts save lives, that helmets save lives, that smoke detectors save lives. That vaccines save lives. 

I don’t know that the Prevnar vaccine would have saved little Sarah. No vaccine is perfectly protective. She might still have gotten seriously ill. She might still have died. 

But I do know it would have shifted the odds in her favor.  

Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm, YouTube and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of October 5th, 2025
“From Maiden to Mother to Matriarch: Understanding the Transition of Perimenopause”
By Jill Kruse, DO
Women experience distinct stages throughout their lives.  In literature, these are often described as the maiden, the mother, and the matriarch phases.  The transitions between these phases can be challenging times for a woman.  Perimenopause is the transition between mother to matriarch.  
The prefix peri- means around, about or near, and menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months.  The average age of menopause is 51 years old.  Perimenopause typically starts for women in their 40s and lasts between four to ten years. In some cases, it can start as early as 30s or as late as 50s.  
During perimenopause, the ovaries start producing fewer hormones. Estrogen and progesterone levels can vary significantly week to week leading to the symptoms associated with perimenopause. Because of these hormonal shifts, lab tests for hormone levels can be unreliable for diagnosis. Elevated Follicle Stimulating Hormone (FSH) and low Estradiol levels in a woman over the age of 45 can suggest menopause, although repeated testing is usually needed to confirm a diagnosis.  Thyroid Stimulating Hormone (TSH) is often checked in women, since low TSH can mimic perimenopause or menopause symptoms.  
One of the first perimenopause symptoms many women experience is menstrual cycle changes.  Menstrual cycles may become more irregular, longer, shorter, heavier or lighter. Hormonal changes can also lead to hot flashes, night sweats, vaginal dryness, sleep problems, mood changes, and ‘brain fog’. Slower metabolism during perimenopause can also lead to weight gain in some women.  
While perimenopause is a natural part of aging, there are lifestyle changes and medications that can help minimize its symptoms.  Limiting alcohol and caffeine, improving sleep quality, and reducing stress can all help diminish hot flashes.  Doing more weight bearing exercises and taking a Calcium with Vitamin D supplement can help reduce the increased risk of osteoporosis and heart disease, which is caused by the decrease in estrogen.  Quitting smoking is also an important step to help minimize symptoms of perimenopause and menopause.  Discussing with your physician can help you find one of the multiple prescription medications that are available to help reduce symptoms.  
Although this transition from mother to matriarch is not always smooth or easy, knowing what to expect can help alleviate anxiety and fear.  Making healthy lifestyle choices and maintaining regular doctor visits are key. If you are experiencing symptoms, speak with your doctor about possible treatments and how to best support your well-being through this important life phase. 
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).