Prairie Doc Perspective Week of April 20th, 2025
“Spring is finally here”
Kelly Evans-Hullinger, MD
Spring is finally here, and for many of us that brings the joy of returning to outdoor activities, planning summer vacations, and… well, allergies. Depending on the allergen, people can suffer from allergies any time of year, but spring is a particularly common time in our part of the world to hear my patients complain of seasonal allergies.
Allergic rhinitis most commonly manifests as runny nose, congestion, and sneezing. Other symptoms can include cough from postnasal drip or worsening asthma, hives, and itchy or watery eyes. Sometimes these symptoms can be hard to differentiate from a viral cold, but typically the symptoms are fairly classic and don’t require any testing.
I often have patients inquire about allergy testing. We might refer to an allergy specialist for testing in patients with severe symptoms that aren’t adequately improved with usual care. Testing might include blood or skin patch testing depending on the situation or allergen in question. However, the vast majority of patients can be treated without specialized testing.
Initial recommended treatments for allergic rhinitis are available over-the-counter. Antihistamine medications can reduce many of the symptoms. I recommend using second generation medications such as loratadine, cetirizine, or fexofenadine, which act more specifically for the targeted symptoms. First generation antihistamines such as diphenhydramine or doxylamine are less specific and thus have more problems with adverse effects. Common side effects include dry mouth and drowsiness, but we can see those first generation antihistamines cause more severe adverse effects such as confusion.
Another very effective option is an over-the-counter nasal steroid spray, such as fluticasone or various others. Taken daily these will reduce congestion, mucous, and post nasal drip. They are quite safe for long term use and should not have systemic side effects. Additionally, these can be used along with an antihistamine. 
Take care in the nasal spray aisle, however. Some other nasal sprays are vasoconstrictors, such as oxymetazoline, and while they will alleviate congestion, they should not be used more than three days consecutively. If so they can cause worsening congestion when the medication wears off, or a rebound effect.
In summary, allergies can be a real annoyance and truly make people feel rotten. Basic over-the-counter measures can be very helpful and are worth trying. If those aren’t working, though, time to talk to your primary care provider about other options or the need for further testing.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

​“Zip Code Matter”
Debra Johnston, MD


Those of us who make our homes in the rural midwest understand that we face medical challenges our countrymen in more populated areas don’t. For example, there are two pediatric rheumatologists in the whole state of South Dakota. . . and they are both based in Fargo. In contrast, there are 10 in the Twin Cities with the University of Minnesota alone. In Winner South Dakota, you are nearly 150 miles away from emergency access to a neurosurgeon, assuming you can go by air. No matter where you are in Connecticut, that help is no more than 50 miles away. 


These ideas are probably obvious to anyone reading this. If we haven’t had to travel for medical care ourselves, we know someone who did. But other factors, things that have an even bigger impact on our well being, may be less familiar. 


Economics plays a role, of course. Can you afford your medicine, or to go to the doctor? Do you have time off for that appointment? Are you choosing between keeping food on the table and a roof over your family’s head? Are you filling up on cheap empty calories, or are you able to buy fruits, vegetables and eggs? 


Where you live matters in other ways. Can you buy those healthy groceries nearby? Are there safe places to walk, and for your children to play? How clean is the air in your community? Does your home have lead paint or asbestos insulation? Is the water that comes out of your tap safe to drink, or is it contaminated with chemicals or lead? Does the noise in your neighborhood keep you awake at night? 


Zip codes can impact the infrastructure around you in ways that affect residents unequally. How accessible is the environment? Are people with mobility challenges able to easily enter retail spaces? Do they have housing options? Are the schools able to support children who face learning challenges? Can you find childcare while you work? Can you practice your faith in your community? Social engagement protects your well-being. 


Even our genes are affected by our environment. This is a fascinating new concept that many of us never study in school. Scientists have learned that external factors influence how our genes are expressed, without changing our DNA. These factors start working before birth: nutrition and stress experienced by a pregnant woman influences the development of her child, and has an impact not only throughout that child’s life but into subsequent generations. 


As we think about health, let’s not forget that we aren’t all starting in the same place. It’s worth thinking about how we can address some of those disadvantages.


Debra Johnston, MD. is part of The Prairie Doc® team of physicians and currently practices as a Family Medicine Doctor at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB and  streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

“My Journey to Becoming a Hospitalist”
By Jill Kruse, DO


When I first moved to Brookings, the primary care physicians took care of their own patients in the hospital.  We would round on patients in the morning before clinic or try to sneak over during lunch or after clinic.  While I loved taking care of patients in the hospital, it was hard to juggle the responsibilities of both giving my attention to the patients in the hospital while seeing people in the clinic.  Any time the hospital nurse had a question; my clinic nurse would have to interrupt a clinic visit or wait for me to between patients.  This could lead to some less-than-ideal times where I was being pulled in multiple directions at once.  
Then about six years ago, the Brookings Health System decided to start a new program where there would be Hospitalist hired.  These would be doctors who would just take care of patients in the hospital.  Primary Care Physicians in the clinic would follow up after the hospital stay and resume care.  This had already been done for several years in Sioux Falls at the Sanford and Avera McKennan.  Despite the fact that I was familiar with what a hospitalist was, it was still hard to give up caring for my patients when they were in the hospital.  However, I learned to see these Hospitalists as valued colleagues who were giving my patients the time and attention that they deserved.  They could give better care and more attention as hospital medicine continues to evolve and advance.
During COVID, I started taking extras shifts to help out in the hospital on weekends.  This was a good way for me to keep up my skills for taking care of patients who were sicker than in the clinic.  In the clinic, we mainly focus on taking care of minor illnesses and injuries as well as managing chronic medical conditions and health maintenance visits.  I realized that I missed taking care of hospitalized patients and caring for people when they were at their sickest. 
 When one of the hospitalists left for a new job, I was asked if I wanted to take their place as a hospitalist.  After careful consideration of all the pros and cons, I decided to answer the call to this new challenge of being a hospitalist.  I am happy to see my former clinic patients, but now it is usually in the grocery store and at the post office.  However, it is extra special when I can care for them when they are admitted to the hospital.  I embrace this current chapter in my medical career and wonder how it will continue to evolve as medicine changes with time.  
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show, 2 podcasts, and a Radio program, providing health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central and wherever podcast can be found.

​“Colon Cancer Screening is Important”
By Andrew Ellsworth, MD


Colon cancer is the second leading cause of cancer-related deaths in men and women. The lifetime risk of developing colon cancer is 1 in 24 for men and 1 in 26 for women. Early detection and treatment are instrumental at improving survival rates, and regular screening decreases the risk of colon cancer in the first place.  


Colonoscopy remains the gold standard for colon cancer screening. While detecting cancer early on is important for survival from any cancer, detecting and removing precancerous polyps during a colonoscopy before they develop into cancer is the main reason regular screenings with colonoscopy have been found to reduce colon cancer rates. 


During a colonoscopy, with a patient asleep or sedated under anesthesia, a long flexible scope with a light and a camera is used to look throughout the large intestine, the colon, for any polyps or abnormalities. Those polyps can be removed with a forceps or a loop at the time they are detected. Afterwards, patients are monitored, wake up, have something to eat, and are ready to proceed about their day.  


Thankfully, a large majority of patients do not have any complications from colonoscopy. The complication rate depends on age and risk factors and the reason for the procedure. The overall rate is approximately 0.5%. The most serious complication risk, a perforation or tear in the colon, is about 1 in 1,000. 


Of course, oftentimes the worst part of undergoing a colonoscopy is the preparation beforehand; getting cleaned out. This is important so the physician performing the procedure has a good, thorough look everywhere in the colon. While cumbersome, with new strategies for doing the prep, many people find this process less awful than they used to.


Stool tests have been an easier, cheap, non-invasive method for colon cancer screening for many years. Often these tests look for blood in your stool. The latest, more expensive option, Cologuard, checks for blood and DNA abnormalities, and is the most successful of the stool tests at detecting colon cancer, at 94%. However, it is only about 43% effective at detecting advanced adenomas, those precancerous polyps that are already getting larger and closer to becoming cancer. This limits the test’s potential at preventing cancer.  


The Cologuard test should not be used for people with risk factors such as a history of colon polyps or a family history of colon cancer. A positive test result should be followed up by a colonoscopy.


The FDA recently approved a new blood test for colon cancer screening. However, it only detected 83% of colon cancers, and only 13% of precancerous advanced adenomas. With this poor detection rate, out of 100 people with cancer, the blood test would falsely tell 17 people that they did not have cancer, and it would miss most precancerous polyps. 


Ever since the Affordable Care Act in 2010, insurance companies have been required to cover colon cancer screening tests. This is because early detection not only saves lives but also saves money. 


Each method has its own pros and cons, so please talk with your doctor regarding which screening method makes the most sense for you. In the end,  “the best colon cancer screening method is the one that gets done.”