Prairie Doc Perspective Week of March 17th, 2024
“True Self-Care” By Debra Johnston, MD During our most recent family movie night, we watched one of my favorites: Encanto. At one point in the movie, a character who has been gifted supernatural strength confesses that she fears she will crumble under the weight of all that is expected from her. Although she accomplishes amazing things, it never feels like enough. She never feels like she, herself, is enough. Popular culture suggests she should prioritize "self-care," which is usually represented by manicures or massages and long soaks in the tub, or perhaps half an hour of meditation or spin class. Now, to be clear, I'm a big fan of massages and getting my nails done, and I spend a lot of my professional time nagging people about exercise, as my patients can certainly attest. But I'd suggest this perspective on self-care is at best incomplete. Protecting your mental well-being goes well beyond little escapes, and even beyond tending to your physical health. The specifics of true self-care are unique to each individual, because each individual is unique, in their needs, their desires, and their circumstances. You simply can't meditate quality daycare into existence, or a nasty coworker into a team player, or a loved one into sobriety. Self-care, meaningful self-care, means being able to recognize that you are human, and you have limits and that it’s not just ok, it's critical, to acknowledge and respect those limits. The demands vying for your time and energy are endless. Those resources, however, are not. True self-care means standing up for your right to be the one who decides how you will allocate them. This means setting boundaries, and that's an incredibly difficult thing to do. With those limits will naturally come guilt, because you simply can't do everything for everyone, or even all the things you yourself want to do. No one else can decide where your lines are, and no one else will hold those lines on your behalf. In order to hold those boundaries, you must be kind to yourself. Most of us have a perpetual self-commentary of criticism that tells us we could do better, we should do better, we aren't enough. Honest self-reflection is important, but why does that so often mean a laser focus on where we fell short, without recognizing how far we came? We internalize the message that if we can't keep up with demands that escalate until we crack, the fault is ours. It's not. To draw these boundaries, and make that self-compassion meaningful, we each must clarify our own values. Spending our limited energy in ways that conflict with the ideas we hold most dear is the antithesis of self-care. We need a clear idea of what those values are to hold that line. Massages and meal delivery services can be great tools, but the real key to protecting your mental well-being is a lot harder to define and a lot harder to do. Debra Johnson, 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 providing health information based on science, built on trust for 22 Seasons, on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central Prairie Doc Perspective Week of March 10th, 2024
“This Isn’t the Baby Blues” By Elizabeth A. Milton, LPCC, LPC-MH, MS Transitioning to become a parent can be one of the most pivotal changes in a person’s life. Rarely are the hard moments of this change talked about enough. For example, did you know 1 in 5 women and 1 in 10 men suffer from postpartum depression? Parents of any culture, race, age, or income level can be affected. We commonly hear and get confused about postpartum depression being the “baby blues”. This is a common misconception. The baby blues are very common and happen to 80% of women in postpartum. This occurs within the first few days and lasts a few weeks. The baby blues will usually go away with rest and time. Postpartum depression and postpartum anxiety are much more serious and will not get better without some sort of treatment. Postpartum depression and postpartum anxiety usually last weeks to months or sometimes years after childbirth, if not treated. Some of the red flags or symptoms one can look out for include: frequent shame, guilt, and sadness; feelings of rage, irritability; scary unwanted thoughts; lack of interest in caring for baby; difficulty in bonding with baby; loss of interest, joy, or pleasure in things you used to enjoy; disturbances in sleep and appetite; constant worry; racing thoughts; feelings of dread; physical symptoms like nausea, dizziness, and hot flashes; and possible thoughts of harming yourself or your baby. If you identify with any of these symptoms, please reach out to your doctor or mental health professional in your area. You know you best and if you don’t feel like yourself, there is no shame in asking for help. Becoming well and mentally healthy again are possible with treatment. Some of the common treatments for a person struggling with postpartum depression or anxiety can be seeing a counselor, medication management, bright light therapy, cognitive behavioral therapy, couples therapy, support from others, exercise, adequate sleep, healthy diet, yoga, and relaxation strategies. A healthy support network of friends/family can be so helpful for new moms and/or parents. Here are some tips on supporting your loved ones throughout this transition: Reassure her, this is not her fault, she will get better; Encourage her to talk about feelings; Help with housework without being asked; Encourage her to take some time for herself; Be realistic about what time you will be home, and come home at that time; Help her reach out to others for support; Schedule some dates with her and work together to find a babysitter; Offer simple affection and physical comfort. There are so many resources available especially at postpartum.net or by dialing 988. Please know this is a transition and transitions are temporary. With help, you can be well. Take care of yourself. Elizabeth provides counseling for individuals and families — primarily adolescents and adults in an outpatient setting at Avera Behavioral Health in Brookings, SD. She is a certified perinatal mental health therapist and works with depression, anxiety, stress management, trauma, interpersonal conflict, adolescent issues and women’s issues. She is also certified to teach Bringing Baby Home workshops through the Gottman Institute. Her practice includes trauma-informed counseling, individual dialectical behavior therapy, cognitive behavioral therapy, emotion freedom technique, and solution-focused and mindfulness strategies. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. Prairie Doc Perspectives Week March 3rd, 2024
“Sexual function and aging” By Dr. Lauren Wood Thum and Dr. Dennis Joseph Thum As husband and wife urologists, we talk a lot about sex (mainly at work). There are several issues that commonly arise in our patients that can lead to a less than satisfactory sex life. The great news is many treatment options exist. There are many factors affecting men and women as they age that can interfere with sexual relations. In women, vaginal dryness, prolapse and incontinence are most common. A decrease in circulating estrogen in peri and post-menopausal women leads to atrophy, or dryness, of the vagina that can result in pain. Symptomatic pelvic organ prolapse can create physical barriers to intercourse. Embarrassing urinary incontinence is another reason some shy away from intimacy. Nearly all women who are experiencing painful vaginal dryness or dyspareunia (pain with intercourse) can be safely treated with a vaginal estrogen cream. Unlike hormone replacement therapy (HRT), vaginal estrogen poses few risks and can safely be administered without fear of cancer, stroke or clotting problems. The cream is placed in the vagina several times weekly at night, helping to improve tissue quality and relieve symptoms of pain and dryness. For women who struggle with a vaginal bulge, many options exist to maintain sexual function. A pessary can be fitted in some women who are able to remove it themselves. More often, outpatient surgery is used to restore normal anatomy and maintain sexual function if desired. Incontinence, the involuntary leakage of urine, has many causes and several treatment options exist depending on the type. Diagnosing and treating male urologic factors are also key to maintaining intimacy. Erectile dysfunction (ED) is common in aging men for a variety of reasons including but not limited to vascular, hormonal and psychologic issues. Certain treatments for an enlarged prostate or prostate cancer can also lead to ED. The backbone of therapy for erectile dysfunction includes pills like Viagra or Cialis. For some men who do not respond well to these medications or have side effects that are intolerable, penile injections provide a simple and effective solution. As a last resort, surgical options are also available. Peyronies disease is another issue we frequently see in men that affects sexual quality of life. This is caused by deposits of scar tissue in the penis. This scar tissue can frequently cause curvature with erection, which makes sex difficult or painful. Excellent non-operative and operative treatments exist which can restore a couple’s sexual quality of life. Whether sexual intercourse remains a priority in your relationship as you age is a very personal decision and is ultimately up to you. If you are suffering from conditions interfering with your ability to be sexually active, many treatment options exist and we encourage you to speak with your doctor about these issues. -D. Joseph Thum and Lauren Wood Thum are both board certified Urologists at Urology Specialists in Sioux Falls, SD. Dr. Joseph Thum also sees patients in Worthington. In their free time, they enjoy the outdoors and spending time with their sons and German Shepherds. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. Prairie Doc Perspective For the Week of February 25th, 2024
“The Nagging Cough” By Kelly Evans-Hullinger, MD “I’ve got this cough that just won’t go away,” my patient says, and I know this story all too well. Chronic cough, a cough that lasts more than two months, is a common ailment which in most cases is benign. But for the patient it is both bothersome and worrisome. If your cough has lasted for less than two months it may just be the residual effect of an upper respiratory infection. Dry cough after having one of many viruses can last for weeks and weeks, and the only cure is time. In patients who do have chronic cough, my first task is taking a good history. Are or were they a heavy smoker? If so I will be more apt to rule out cancer and consider lung imaging. I will also be suspicious of chronic obstructive pulmonary disease (COPD) which can be diagnosed by breathing tests. But many of these patients have no or little smoking history so are at low risk for those things. Why are they coughing? I can think of a few common reasons. Mild asthma often causes cough at nighttime, in the cold, or with activity; it isn’t always accompanied by wheezing. Simple breathing tests in the office can help us diagnose asthma, and it can be greatly helped with inhaled medications. Post-nasal drip is extremely common, and we have probably all experienced it with a cold or allergies. For patients who have this chronically, the mucous produced in the nose drains down the throat, causing irritation to the upper airway and an annoying cough. If this seems likely, I suggest the patient tries a steroid nasal spray every day for a month or two, and if that resolves the cough we have our answer. Gastroesophageal reflux disease, or GERD, doesn’t always cause classic heartburn. As the stomach acid creeps up the esophagus, especially when lying flat at night, it can get high enough to irritate the upper airway and cause cough. As with post-nasal drip, sometimes we just try treating this ailment with an acid reducing medication for a couple months to see if this cures the cough. Finally, a commonly used type of medication can actually cause benign cough as a side effect. ACE inhibitors like lisinopril are excellent drugs for hypertension and heart disease, but around 5-10% of people will get a dry cough with it. If so, the cough resolves when we stop the med. Back to my patient. “Tell me more about your cough,” I say. “I’m confident we can figure out what is going on, even if it takes a little time.” 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 providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. |
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