By Jill Kruse, D.O.
 
When I teach medical students, I always remind them that we will see people on the very best days of their lives and the very worst days of their lives. As a result, we will see every range of emotion in our patients and feel every range of emotion ourselves. This is especially true when giving someone a diagnosis of cancer.
Telling someone they have cancer is a daunting mission. Often, the patient suspects something serious when they are asked to come into the clinic to review results in person instead of getting a letter or phone call.

I always make a point to ensure my patients are accompanied by a family member or friend. Having another person in the room to support them is important, because often the person diagnosed with cancer does not always hear or remember much after the “C word” is spoken. The word can land a visceral reaction. And, while most of us know someone who has been affected by cancer, it is difficult to imagine what it feels like to have those words directed at you, until it happens.

After a diagnosis of cancer is given, the next steps can happen quickly. There may be referrals to a specialist. Sometimes follow up exams and tests are done as soon as they can be scheduled, even on the day of the diagnosis. Having someone else in the room to help keep track of the information and offer support is helpful.
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When the diagnosis of cancer is first spoken, there is usually one of the five emotions of grief that Elizabeth Kubler-Ross described. Most often, I see denial and anger. Later there is bargaining and depression, but on occasion there is acceptance. I have told people they have cancer only to see them smile, nod their head, and tell me that they already knew, and I confirmed their suspicions. Each person has an individual journey, and they will cycle through all these emotions, often more than once.

My hope as a primary care physician, is to never let my patients be alone in this journey. After a diagnosis of cancer, I refer my patients to specialists, but I am not done caring for the person. I let the oncologists take over in the fight against this disease. But I, and most primary care physicians, will always be there as a trusted advisor and friend who can help coordinate care and answer questions.

Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.  

By Andrew Ellsworth, M.D.
 
Depending on where you live, it looks like we may not have a “picture perfect” white Christmas this year. It seems fitting given the many things about 2020 which were not what we imagined, let alone “perfect.”

While the holidays can be a season of happiness and joy, for many they are accompanied by anger and sorrow. Missing loved ones from the past, remembering relationships that soured, thinking of hopes and dreams that never materialized can make customarily joyous Christmas carols sound like fingernails on a chalkboard. 

It can be hard to appear festive when inside we feel down. It may be tempting to hold our fears, failures, and bad thoughts to ourselves. Indeed, we may not want to broadcast our problems to the world, however, hiding and suppressing our feelings is not what the doctor recommends. Letting things build up and fester is not a good idea whether it be a boil on our skin or a strong emotion. 

If you are feeling low, talk to someone. Call a family member or a friend. If you do not have a particular person in mind, talk to a counselor, your doctor, your pastor, or call 1-800-273-TALK. It can also help to put your thoughts on paper. The point here is to let it out, identify it, talk, or write about it, and disarm it. Do not let dark thoughts overwhelm you and control you.

Exercise can help, too. Moving your body triggers your brain to release endorphins, the brain chemicals that facilitate feeling good. Activity gets your mind off things that cause you to worry and on to a brighter, healthier cycle of thoughts. 

Meditation, prayer, or yoga may be helpful. If you are not sure how to meditate, consider watching a how-to video on YouTube. Reach out to a church leader for guidance on prayer. If you’ve never done yoga, contact a local yoga studio or sign up for a class online.

People do care about you. I know there are many caring people in our communities. We see them unselfishly serve others time and time again. But they may need someone to talk to as well. If we all strive to open up to the people around us, we may find that we are all feeling a mix of emotions during the holidays.  

Yes, the days are short, and the darkness is long, but it will not last. December 21 marks the first day of winter and the shortest day of the year, after which the days get longer, and light extends the day. This year, on this same day, something called a “Great Conjunction” will occur. The planets Jupiter and Saturn will appear the closest they have been in almost 400 years. To the naked eye, they will look like one, bright star, thus earning the nickname the “Christmas Star.” Years ago, a star guided wise men toward a new hope. We too, can look for the light in and around us, bringing hope to our days ahead.  
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.        

By Kelly Evans-Hullinger, M.D.
 
In a truly grand feat of modern science, The Human Genome Project, an international collaborative effort, set out in 1990 to map our genetic makeup using diverse human genetic samples. In 2003 the project was completed, ultimately showing about 20,000 human genes. Since that project’s completion, with ever-improving DNA sequencing technology, genomics researchers continue to gather more and more information about human DNA.
 
A single human cell contains a mind-numbing 6 billion base pairs (each base pair is one of four types of nucleic acid molecules) in its DNA, organized into 23 pairs of chromosomes. Fascinatingly, only about 1.5 percent of our DNA actually codes for proteins, while the vast remainder is noncoding DNA, serving a regulatory function or, at least as far as we understand, no function at all.
 
In 2007 the first individual human genome was sequenced and published. In 2008, James Watson (as in, the 1962 Nobel Prize winning Watson and Crick model of the DNA double helix) poetically had his genome sequenced and published. The ability to sequence an individual human’s genome held much promise, we hoped, in regard to predicting illness and personalizing medical interventions. But in 2020, this promise remains very much unfulfilled. In most cases primary care physicians don’t yet utilize genomics information in our daily practice. Why is this?
 
The short answer: It’s complicated. In some specific instances, genetic information can clearly convey an increased risk for disease. One example of this might be the BRCA gene mutation and associated risk of future breast or ovarian cancer. Because this specific gene mutation is so tightly linked with elevated risk, testing and finding the mutation in an individual (based on their family history or known relative with a mutation) can have direct practical implications on strategies for cancer screening or even consideration of surgery to remove the at-risk tissue.
 
Scenarios like BRCA mutation are outliers, however. When we look to common diseases, such as cardiovascular disease or diabetes, finding genetic information useful gets, well, complicated. In these cases, what we have found is that many genes are involved, and it is extremely difficult to estimate how much a mutation in one of those genes affects overall risk. That’s not to mention all the environmental factors which may affect risk as much or more than the genetic profile.
 
Genomics remains a vast, new, and thus-far difficult to access specialty of medicine. At its current rate of growth, however, I am confident my previous statement will not remain true during my career in medicine.
 
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. 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.

By Andrew Ellsworth, M.D.
 
Success in life and all its phases can be measured in many ways. Some reminisce of their glory days in high school. Maybe they were captain of the football team or homecoming queen or won the state chess championship. Others excelled in college, graduated summa cum laude, were invited to all the parties, or landed the dream job. Some worked their way up the corporate ladder or took on a big loan and built a successful business over years of hard work or taught multiple generations of students. Hopefully, most have worked and saved enough through the years to finally retire.  
 
After accomplishing the prior phases of one’s life, what does a successful retirement look like? Sure, we plan and save for retirement all the time, but when it finally comes, are we ready for the next phase of our lives?
 
There are many ways to thrive and enjoy retirement. Some savor time on hobbies, travel, play cards, sew, enjoy gardening, get involved in a church, or volunteer. Some make things or fix things or find a part time job and have some enjoyment while also earning a wage. Some surround themselves with family, helping to connect the generations.
 
Unfortunately, some do not enjoy retirement. Health issues, financial troubles, and relationship problems are just some of the ways that can make it difficult. Some people, despite the best ways of planning and saving for retirement, may have lost identity and have no idea what to do next. As in any situation, to be successful, one must find meaning and purpose.  
 
It must be extremely hard to dedicate one’s life to a calling and purpose, only to one day be told to move on. It must also be particularly challenging to have a plan for retirement, only to have those dreams set aside due to changes in health or financial hardships. 
 
Covid-19 has certainly put a wrench in many people’s plans for retirement, as well as most everyone else’s plans. Certainly, with many things postponed, changed, or cancelled this last year, we have all had a chance to reconsider what we spend our time on and what things may be worth a risk.  
 
As we enter a new year and changes ahead, whether that be retirement, a new job, a new relationship, or a new normal, I would encourage you to find purpose and meaning in what you do. When you get up for the day, set a goal or find some way to make it meaningful. That is how we will all excel in this new chapter of our lives. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.