Prairie Doc Perspective Week of November 23rd, 2025
“Strengthening Paths to Safety: Supporting Domestic Violence Survivors”
By Bridget Diamond-Welch, Ph.D
When someone escapes domestic violence, their journey to healing has only just begun. As physicians, you are often the first professionals to recognize signs of abuse and can play a pivotal role in connecting survivors to lifesaving resources. 
This is especially crucial in rural communities where you may be the only health care provider for miles and where stigma around domestic violence can be particularly strong. Recent research conducted across South Dakota and Iowa shelters with 47 survivors—focusing primarily on rural and Native American survivors—reveals crucial insights about the supports needed to rebuild lives after abuse.
Research in health care settings suggests that many abuse victims may disclose their situation to a health care provider before seeking specialized services, making physicians crucial gatekeepers to support resources. Below we discuss several of the key needs identified by survivors that would help them on their pathway to healing. 
Housing emerged as the most fundamental need. "I have a place to live. I'm not afraid that I don't have a place to sleep at night," explained one Native survivor. Rural survivors faced even greater housing challenges, with one Native participant sharing: "I got assistance for the deposit, but I'm kind of struggling with the utilities." Without stable housing, survivors often face impossible choices between houselessness or returning to abusive relationships.
Transportation barriers create profound isolation, particularly for rural Native survivors. "If they had a bus or something to bring us here, then more people would be willing to come," noted one rural Native survivor. Another rural Native participant explained: "I think we mostly just need help with gas cards" to get to services that may be located far away. 
Mental health support is essential, with many survivors defining healing in terms of emotional well-being. "I guess being able to talk without breaking down emotionally," explained one Native urban survivor. 
Physical health needs intertwine with trauma recovery. "I was really in bad shape. I had to stay in bed for a while and then go back to the hospital," shared a rural Native survivor. 
As medical providers, being aware of how abuse manifests in medical complaints, chronic pain, unexplained injuries, anxiety, depression and missed appointments can help identify patients in need of intervention. Pediatric screening is equally important, as children's health often reflects the safety of their home environment. Documenting findings thoroughly and creating a safe, private space for disclosure increases the likelihood that survivors will seek help when ready.
The consistent support of trauma-informed advocates proves transformative. "It's been a lifesaver. You're around people who know what you're going through," expressed a Native urban survivor. The role of physicians can be to support these survivors in connecting with local advocacy services. Reaching out to your local agency and requesting information on their services, brochures to share with patients, and a greater understanding of local support opportunities provides an essential way to support your patients’ health.
Prevention remains far more effective than intervention after trauma occurs. As trusted figures in rural communities, your advocacy can be particularly powerful in breaking cycles of violence where resources are scarce, but community connections run deep.
What can you do today to make a difference? Connect with your local domestic violence organization and invite them to come tell you about their services and leave fliers in your office. Have this as a resource to share with clients who you identify may be in need. If you do not know who your local provider is, you can find them at: https://www.thehotline.org/get-help/directory-of-local-providers/ 


Bridget Diamond-Welch, Ph.D., is an associate professor and the Director of the Office of Research & Innovation in the School of Health Sciences at the University of South Dakota. Her research specializes in improving system response to interpersonal violence, specifically domestic violence, sexual assault and sex trafficking. Her work examines what survivors need to heal and seek justice, and how systems can improve to meet these needs. Recent publications include Journal of Forensic Nursing, Public Health Reports, Child Abuse & Neglect, and Journal of Interpersonal Violence. Her work has been funded by NIJ and OVW. 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 November 16th, 2025
Virtual Reality: A New Frontier in Mental Health Care
By: Carissa Regnerus, RDH, MA, FADHA, Regan Luken, RN, MSN, and Betty Hulse, PA-C, MSPAS
The USD School of Health Sciences Complementary and Alternative Medicine research team, in partnership with the South Dakota Human Services Center (HSC), has introduced virtual reality (VR) as a groundbreaking tool in inpatient mental health care. 
A pilot study, funded by the South Dakota Community Foundation, was implemented by the research team that reviewed the utilization of virtual reality as an additional tool for inpatient mental health care.  Liminal VR software, designed to increase relaxation and reduce stress and anxiety, was selected and viewed through VR headsets for an immersive experience. The participants attended VR sessions three days per week over the course of four weeks. Baseline measurements related to stress, anxiety and mood were taken prior to starting the course and after finishing each day of VR sessions. Quantitative and qualitative data were collected at the end of the four-week course. Data was also collected from staff who were involved with the participants.
One of the most compelling aspects of the study was its impact on engagement. Individuals who had previously disengaged from programming found joy and purpose in VR sessions. Notably, a typically reserved patient experienced emotional insight through immersive therapy, highlighting VR’s ability to foster self-awareness. Offering tailored experiences such as calm, awe and relief, the technology empowered patients to select sessions best suited to their needs.
With overwhelmingly positive feedback from both patients and staff, this initiative has demonstrated VR’s potential to enhance therapeutic outcomes—leading to improved mood and relaxation, and reduction in stress and anxiety.
The success of VR within HSC has inspired life skills staff to explore additional digital interventions, including YouTube-guided visual meditation. Recognizing VR’s potential beyond inpatient care, the research team is considering student-focused mental health applications and seeking funding to expand services into health care and educational settings.
Community Impact and Future Considerations
The study bridged service gaps and sparked discussion on alternative mental health approaches. Observing patients eagerly anticipating their sessions reinforced the power of brief interventions in shaping mood. The study encouraged staff to value every patient interaction, however brief, as a meaningful step toward healing.
South Dakota’s rural landscape can limit access to traditional mental health services. VR can bridge this gap by providing accessible, personalized mental health support in various settings, reaching more South Dakota residents. Mental health challenges are a growing concern in South Dakota. According to NAMI, 112,000 adults in the state live with mental health conditions and 448,334 South Dakotans reside in communities lacking sufficient mental health professionals. With VR's ability to deepen engagement and enhance therapy, could this technology alleviate provider workloads and shorten hospital stays? Additionally, the use of VR may prove beneficial in addressing substance use disorders, offering new insights into patient behaviors and motivations. Further research into community collaboration and stakeholder feedback could provide valuable data on treatment satisfaction, service quality and long-term patient outcomes.
As mental health care evolves, integrating VR offers a path toward innovation, healing and accessibility—helping individuals not just manage their conditions, but actively reclaim joy in their daily lives.
State MH fact sheet https://www.nami.org/wp-content/uploads/2023/07/SouthDakotaStateFactSheet.pdf SD 
https://dss.sd.gov/behavioralhealth/reportsanddata.aspx
Author Bios:
Carissa Regnerus, RDH, MA, FADHA, is a faculty member at the University of South Dakota (USD) Department of Dental Hygiene, where she has been shaping future professionals since 2001. As a member of the USD School of Health Sciences Complementary and Alternative Medicine research team, she actively explores innovative approaches to patient care, including the use of virtual reality (VR) in mental health treatment, and is beginning to investigate VR’s potential to reduce dental anxiety. Carissa teaches public health courses for dental hygiene students and is passionate about fostering community impact through progressive and inclusive healthcare strategies.
Regan Luken, RN, MSN, is a faculty member at the USD Department of Nursing and teaches in the MSN in Nursing Informatics and e-Health program. Leveraging technology in health care improves outcomes by creating a more connected and healthier community.  
Betty Hulse, PA-C, MSPAS, associate professor in the USD Physician Assistant Studies Program, has served as clinical education coordinator since 2008. Betty has experience working with psychiatric patients in the hospital setting as well as patients who have substance use disorders in residential treatment. She is a strong advocate for programs that increase access to treatment for mental health and substance use disorders. She is a proponent of the “Let’s Be Clear” initiative to saturate South Dakota with naloxone (Narcan) and empower anyone to reverse an opioid overdose and save lives. 
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 November 9th, 2025
Understanding Macular Degeneration: The Importance of Early Detection and Specialized Care
By: Jed Assam, MD, Founder and Vitreoretinal Surgeon, VRA Vision 

Age-related macular degeneration (AMD) is one of the leading causes of vision loss among adults over 65. This condition affects the back of the eye where light is processed by macula. The macula is the part of the retina providing sharp, detailed vision needed for reading, driving, and recognizing faces. Two categories of macular degeneration are “dry” and “wet”. This article will focus on dry macular degeneration and therapy options to help slow vision loss from it. 

Early Signs and Symptoms
Macular degeneration begins silently. Early symptoms may include mild blurring, difficulty seeing in low light, or the appearance of wavy or distorted lines. Later on, a dark or empty spot near the center of the vision can develop. In advanced stages, central vision may be lost entirely. Regular eye exams are crucial because early AMD can be detected during a dilated retinal examination or with specialized imaging. 

Impact and Risk Factors
A few major risk factors include age, family history, current smoking, and genetics.  Individuals with a family history of AMD should be especially vigilant about screening.

The Importance of Eye Exams and Specialist Care
Routine eye exams with an optometrist or general ophthalmologist are the first line of defense in identifying AMD. However, once AMD is suspected or diagnosed, referral to a retina specialist is essential. Retina specialists undergo additional years of fellowship training specifically in identifying and treating diseases of the retina and macula. This specialized expertise allows for detailed diagnostic imaging, tailored treatment plans, and access to the latest clinical advances in emerging therapies for AMD.

Current Treatments and New Technologies for Dry AMD
For patients with intermediate dry AMD, one of the most promising new therapies involves photobiomodulation (PBM) using the Valeda Light Delivery System, an FDA-authorized device. PBM works by exposing the retina to specific wavelengths of light that stimulate the mitochondria—the “powerhouses” of our cells. By energizing these tiny structures, PBM helps improve cellular metabolism and reduce oxidative stress thought to have a role in slowing AMD.

Clinical trials, including the LIGHTSITE III and LIGHTSITE IIIB, have shown that PBM can lead to improved visual function and contrast sensitivity in patients with intermediate AMD. These studies support PBM as a safe, non-invasive treatment option for eligible patients.

In addition, there are FDA-approved injections for geographic atrophy, a more advanced stage of dry AMD. These treatments aim to slow progression and preserve remaining vision, marking a major milestone for patients who previously had limited options.
For AMD that has advanced beyond the ability to benefit from the therapies mentioned there are still options. Many vision aids and tools are available today that can help optimize remaining vision. Getting a referral to a Low Vision specialist is another step available to help individuals affected by advanced AMD.

Treating Early to Protect Vision
Early identification and intervention is key. Just like controlling blood pressure or diabetes early to prevent complications later on, addressing macular degeneration before it becomes advanced can make a significant difference in the long run. Current therapy slows down AMD to keep vision better for longer, but does not completely stop or reverse dry AMD. Regular follow-ups and referral to a retina specialist can ensure timely diagnosis, access to cutting-edge treatments, and personalized care to preserve sight for as long as possible.
Dr. Jed Assam is a board-certified, fellowship-trained retina specialist dedicated to the diagnosis and treatment of AMD along with other macular and retinal disorders. He is the founder of VRA Vision in Sioux Falls, a Center for Excellence in Macular Degeneration, and is passionate about patient education and early intervention to prevent vision loss. 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 November 2nd, 2025
“Listen to your gut”
By Jill Kruse, DO
   People often talk about having a “gut feeling” or are told to “listen to their gut” when making a decision.  Do you know what your gut is trying to tell you?  There are multiple things that your digestive system can do to get your attention.  Do you know what your body is trying to tell you?  Here are some of the things your gut could be trying to say.
   Pain just below the breastbone that occurs soon after eating could be a sign of a stomach ulcer.  Pain that improves with eating, but then comes back 2-3 hours after eating could be a sign of an ulcer in the small intestine right past the stomach.  The pain from ulcers is often described as a burning pain.  This pain improves with acid blocking medication like a PPI (Proton Pump Inhibitor) or antacids. 
   The gallbladder can also cause significant pain in the right upper part of the abdomen, especially after eating fatty foods.  Often this pain will radiate to the right shoulder or between the shoulder blades.  It can lead to significant nausea and diarrhea.  This pain usually will come and go.  It can become very severe if a small gallstone gets stuck in the bile duct between the gallbladder and the small intestine.  Infections of the gallbladder can cause fevers and chills as well.
    Issues with the small intestine can also cause serious pain.  The condition of Irritable Bowel Syndrome (IBS) causes abdominal pain, bloating and changes in bowel movements.  IBS can cause severe diarrhea, severe constipation or both.  IBS is considered a diagnosis of exclusion since these symptoms can be caused by many other conditions like Microscopic Colitis, Celiac Disease, Crohn’s Disease, Ulcerative Colitis, Small Intestine Bacterial Overgrowth, and even Colon Cancer.
     However, it is important to note that not all pain in the stomach area is from the digestive system.  Heart attacks can also give symptoms of indigestion, nausea, vomiting, and stomach pain.  These subtle signs happen more frequently in women and can lead to delay in diagnosis.  Aortic dissections or ruptured aortic aneurisms can also cause severe, tearing pain in the abdomen that can radiate to the back or shoulders.
     If you notice your gut trying to tell you something, listen and get it checked out by a doctor.  Many of these issues have similar or overlapping symptoms. Finding a physician who can order and interpret the right tests to find the answer is key. Your gut knows when something is wrong, and you should trust it.   Listen to your gut and stay healthy out there.
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).
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