By Kelly Evans-Hullinger
 
With 2022 nearly upon us, so too is the tradition of the New Year’s resolution. Merriam-Webster defines the New Year’s resolution as “a promise to do something differently in the new year.” I would argue that in practice, the resolution is less of a promise and more of a hope or intention.

My resolution for 2021 was to read 20 books by year’s end. I failed. I could blame my kids, work, other hobbies, but honestly I blame my phone! In my defense, I was in good company as a flopped resolver; less than half of New Year’s Resolutions are estimated to be successful.

An estimated 74 percent of adult Americans set a personal goal each year, the most common category being to improve health and wellness. If you are a regular at a gym or fitness center, you have witnessed the phenomenon of the January influx of attendees that typically trickles back down to baseline by March.

Whatever your resolution, there are some ways to increase your odds of being successful in following through in 2022. One tip is to make your goals follow the SMART mnemonic: Specific, Measurable, Attainable, Relevant, and Time-sensitive. Let me elaborate, using my failed 2021 goal as an example.

Specific: “Read at least 20 books this year” is specific, but I could have done better. Had I explicitly listed each book title up front I would have avoided time wasted searching for books throughout the year.

Measurable: My goal was easily measurable; just count the books. If your goal is not measurable there is no way to know whether you are on track to reach it.

Attainable: I did not set a goal to read 50 or 100 books in a year. I know people who read that much, and I admire them, but that was not realistic for me. Setting an unattainable goal may set you up to quit in the early stages.

Relevant: I set this goal because I enjoy reading, and I know I am a happier person when I spend my downtime with my nose in a book. Choose a goal that you care about, and maintain enthusiasm.

Time-sensitive: Most New Year’s resolutions will have a time frame of one year. But setting smaller time-sensitive goals can be helpful. I ought to have made a sub-goal to read two books per month to keep on pace.
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The New Year might be a great time to commit to a positive change in your life. I hope the SMART approach will help you (and me) succeed this year!

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 Jennifer May, M.D.
 
Food intolerance and food allergy are common these days. When I was a kid, no one asked about nut allergies or gluten sensitivities when inviting you to a birthday party. You could bring homemade snacks to school. Peanuts were served to everyone on airplanes. Today, we are constantly reminded to be aware and take precautions to help prevent exposure for those who are intolerant or allergic. 

Understanding the difference between allergy and intolerance is important. Allergies can result in life threatening reactions, whereas food intolerances are not life threatening but can be very problematic. Food allergies and intolerance have many overlapping symptoms making diagnosis difficult. 

Food intolerance is very common and is estimated to affect 20 percent of the world’s population. Food intolerance occurs when the body has a chemical reaction to eating a particular food or drink. Most food intolerance reactions involve the digestive system, skin, and respiratory system. Many of us have mild intolerance, say to dairy, but other common triggers are gluten, caffeine, and eggs.

Food allergies can be more serious and result from an inappropriate immune system response. Nuts, for example, are harmless yet the immune system can identify them as toxic. Even a small exposure can lead to a life-threatening reaction known as anaphylaxis. 

Thankfully, we have new approaches to manage food allergy. Today, we better understand how exposure to a broad variety of food in infancy can reduce risk of developing allergy as we age. Another option available is immune therapy for peanut allergy.

On the other hand, managing food intolerance requires an understanding of what food or ingredient triggers symptoms, then we focus on avoidance. We do not have immune therapy for food intolerance.  

Both food intolerances and allergies are becoming more prevalent. For example, between 2007 and 2016 there was a 377 percent increase in treatment of diagnosed anaphylactic reactions to food. Why are more people having challenges with food? It is not clear. Maybe it is our environment, our diet, or both. No specific cause has been identified.

Our world has changed and our treatments for food allergies and food intolerance have changed as well. It seems we will continue to have special dietary requests for a long time to come, so getting the right diagnosis is our most important first step. 
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Jennifer May, M.D. practices rheumatology in Rapid City, South Dakota. She 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.   

By Matthew Owens, M.D.
 
Emergency medical services (EMS) in rural America are in a state of crisis. Difficulty recruiting emergency medical technicians (EMTs) and the financial constraints of EMS agencies are the major causes of this crisis.

The majority of South Dakota is considered a medically underserved area (MUA), indicating too few primary care providers, high infant mortality, high poverty or a high elderly population. Most of the MUAs are also designated as rural or frontier, increasing the likelihood of prolonged transport times to hospital-based medical care. Rural and frontier MUAs are historically served by volunteer EMS services.  Seventy three percent of EMS agencies in South Dakota utilize volunteers. In 2016, 32 percent of volunteer agencies reported missing calls due to staff shortages. These conditions have led to a disparity in mortality rate for traumas for rural residents.
 
An ad hoc group comprised of the University of South Dakota School of Medicine, South Dakota State Medical Association, Northeast and West River Area Health Education Centers (AHEC), Sanford Academic Affairs EMS Outreach, and Community Memorial Hospital in Redfield has received funding through the U.S. Department of Labor, and Substance Abuse and Mental Health Services Administration to combat the EMS crisis in South Dakota and improve health outcomes for rural residents.   
  
For many students, grant money is available to cover costs of the EMT training available at Sanford EMS Outreach. The synchronous online classes can be completed by the student at home, while the hands-on portion may require weekend travel. 

In addition, members of the ad hoc group developed the Dakota Responder class curriculum, the goal of which is to train more people. Through a unique collaboration with Agtegra, a farmer-owned grain and agronomy cooperative with more than 6,300 members-owners in eastern North and South Dakota, the Dakota Responder classes will initially be made available to Agtegra employees. Those who attend the classes will be trained to provide emergency care for serious bleeding, opioid overdose, and use of automatic defibrillators. Agtegra employees located in rural areas of the Dakotas are well-positioned to provide life-saving care until EMS personnel arrive on scene.   

Ultimately, the goal is to increase the number of trained EMTs to staff rural EMS centers and improve emergency response times. To encourage this endeavor in your community, share this information with your neighbors and contact your legislators and county commissioners to urge their support for local EMS centers where you live. 
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Matthew Owens, M.D. practices family medicine in Redfield, South Dakota. He is a contributing Prairie Doc® columnist and a guest 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.   

By Andrew Ellsworth, M.D.
 
As a family physician living on the upper Great Plains, I have many patients of Norwegian and German descent. Thus, I am familiar with some diseases that are prone to affect people of northern European ancestry. One such example is Dupuytren’s contracture. 
 
Dupuytren’s contracture is a gradual thickening of the connective tissue of the palm of the hand. It may begin innocently as a nodule in the palm or joint stiffness, which are common for anyone. However, with Dupuytren’s contracture, over time the fingers curl inwards and cannot be straightened. Cords can become visible in the palm of the hand. This is often a slow progression over several years and may or may not become painful. It can make it harder to grasp objects and use the hand in general. 
 
Sometimes called the “Viking Disease,” Dupuytren’s contracture most often affects men of northern European descent over the age of 50. Other risk factors making a person susceptible to this disease can include smoking, alcohol, manual labor, and being thinner. It would seem being a fan of the Minnesota Vikings may be a risk factor, but that is probably just coincidence. 
 
The condition is named after Guillaume Dupuytren, a French military surgeon who was skilled in anatomy. He described the condition well and was the first to perform a successful operation for it in 1831. Interestingly, Dupuytren gained prominence from treating Napoleon Bonaparte’s hemorrhoids. 
 
Although a steroid injection or physical therapy may be helpful, in general, Dupuytren’s contracture cannot be cured, only treated. For a long time, surgery was the mainstay treatment, especially for more advanced cases. Surgery can involve cutting the fascia, the affected layer of connective tissue. A less invasive procedure involves using needles to weaken the thickened cords of fascia.
 
In the last decade a new treatment became available. Injecting the enzyme collagenase weakens the bonds in the collagen of the fascia, releasing the contractures. Extracted from the bacteria Clostridium histolyticum, the collagenase offers an effective nonsurgical option for treatment. 
 
I am not sure what my Norwegian and German ancestors would have thought about injecting an enzyme from a bacterium into their hands. However, patients today appreciate regaining the use of their hands for daily activities and to clap and cheer for their favorite football team.
 
Andrew Ellsworth, 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.