Prairie Doc Perspective Week of May 10th, 2026
“Pump Handles and Public Health”
By Jill Kruse, DO
Health care is often thought of as something that happens one patient at a time in a clinic or hospital. Public health takes a broader view and is focused on improving the health of entire populations. In 1854, a London physician helped stop a deadly cholera outbreak by removing a simple pump handle. That moment would become one of the earliest and most powerful examples of public health in action.  Back then no one understood how cholera spread. Many believed it was caused by “bad air” or mysterious environmental forces. They did not know that it was actually caused by a bacterium that was spread through contaminated water sources.  
Dr. John Snow noticed a pattern. In London’s Soho neighborhood, a cluster of cholera cases seemed concentrated around a single public water source, the Broad Street pump. When he mapped where people lived, most of the infections pointed back to that pump. Even those who lived farther away, but became ill reported getting their water from the same source. Meanwhile, workers at a nearby brewery, who drank beer instead of water, were largely spared. The brewing process, alcohol and acidity of the beer made it difficult for the cholera bacteria or other pathogens to survive. 
Armed with this evidence, Dr. Snow convinced local officials to remove the pump handle. This cut off public access to the contaminated water.  After this happened, the number of new infections quickly declined.  That simple act marked the beginning of modern public health; using data, observation, and intervention to stop disease at its source.
Today, public health has evolved from reacting to outbreaks to preventing illness before it starts. Public health professionals work behind the scenes to protect and improve the health of communities.  They do this through providing education, guiding policy, and conducting research. They are the unsung heroes of healthcare. When Public Health works well, it can be almost invisible or easy to ignore. However, when there is a breakdown in Public Health services, the results can be devastating to a community and the effects are obvious.  
Federal, state and local health departments prepare for emergencies, monitor for disease outbreaks, ensure food safety, and safeguard water quality. They also advocate for health screenings in underserved or high-risk populations. Public health officials work to reduce barriers to care and promote healthier lifestyles for everyone. They may not be removing pump handles anymore, but they are still working every day to protect our water, our food, and our communities. They are helping us all, as we say on the show, to stay healthy out there people.
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 SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of My 3rd, 2026
A Bump in the Crossroads of the Body 
By Andrew Ellsworth, MD


When was the last time you thought about your neck?


It’s easy to overlook, but your neck is a remarkably busy place. It houses the spinal cord, carrying signals between your brain and the rest of your body. It allows food to travel from your mouth to your stomach. It delivers blood to your brain. It contains muscles that support and move your head, along with your vocal cords, thyroid, and parathyroid glands.


In many ways, the neck is a crossroads of vital structures, and it can offer clues when something is not quite right elsewhere in the body.


Take a moment and gently feel your neck. Become familiar with what is normal for you. If you notice a lump or something that does not feel right, it’s worth paying attention.


Many neck lumps are not dangerous. Some are simply swollen lymph nodes reacting to an infection. A cold, flu, sinus infection, strep throat, dental issue, or even a skin infection can cause lymph nodes in the neck to enlarge. These typically improve over a couple of weeks as the body recovers.


However, as with any area of the body, if you feel a new lump or bump, consider an appointment with your provider to have it examined. 


As a general rule, if a neck lump persists beyond two to three weeks in an adult, it should be evaluated. In children, lymph nodes may remain enlarged a bit longer and still be harmless, but in adults, persistence deserves a closer look.


The feel of a lump can also provide clues. Lymph nodes from infection are often soft, movable, and a bit rubbery. In contrast, a hard, fixed, or rapidly growing lump is more concerning and should be checked promptly. Lumps that continue to enlarge or change over time also warrant evaluation.


Other symptoms also matter. Fever, unexplained weight loss, night sweats, or difficulty swallowing are important signals that should not be ignored. Swelling in multiple areas of the body may suggest a more widespread process, such as some infections or, less commonly, a cancer like lymphoma.


Another common finding is a thyroid nodule, located in the front of the neck. These are fairly common and usually benign, but they are often evaluated with ultrasound to better understand their size and appearance and to determine if follow-up is needed.


Some people experience a “globus sensation” which is the feeling of something stuck in the throat when nothing is actually there. This can be related to acid reflux, post-nasal drip, muscle tension, or even stress and anxiety. Once again, persistent symptoms should be checked out. 


The bottom line is simple: if you notice a lump or bump in your neck, do not ignore it. While many causes are minor and temporary, some require further attention. When in doubt, have it evaluated.
A quick check today can provide reassurance, or catch something early when it matters most.
Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He 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 SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of April 26th, 2026
“Anesthesia: Biting the Bullet is No Longer Necessary”
By Andrew Ellsworth, MD


Anesthesiology is the branch of medicine committed to pain relief and patient care before, during, and after surgery and other procedures. It has origins in ancient times but made large advances in the last two centuries.


It is one of medicine’s greatest achievements that someone can comfortably drift off to sleep, have their knee replaced, or their gallbladder removed, and wake up with minimal pain.  


Ancient civilizations used herbal remedies to help numb pain with forms of cannabis, opium, mandrake, or alcohol. Even by the time of the Revolutionary War, these remained the only options, which did little for the pain of an amputation. Survival depended on the speed of the surgeon. Patients would “bite the bullet” and literally clench down on a lead bullet or piece of leather to help endure the pain and protect their teeth. Surgeries were completed in minutes, and most amputees did not survive due to infection or blood loss.  


Major advances in anesthesia came in the mid-1800s with the emergence of ether and chloroform. American dentist William Morton was the first to publicly show ether’s use as an anesthetic, famously demonstrated at Massachusetts General Hospital in 1846.


During the Civil War, anesthesia became widely adopted in the military and used in the vast majority of surgeries. Typically, ether or chloroform was soaked in a cloth and placed over the patient’s face for inhalation. After the war, the physicians with a new understanding of anesthesia were dispersed across the country, and use of anesthesia went from a sporadic, questionable intervention to standard practice.


Epidurals are another major advance in anesthesia, decreasing the pain of childbirth, surgery, and some forms of back pain. Epidurals numb pain by delivering medication near the spinal nerves with an injection in the back. First developed in the early 1900’s, epidurals became widely used in the United States by the 1970’s. The addition of a catheter allowed continuous pain relief throughout labor, replacing a single injection. 


Modern anesthesia has continued to evolve. Propofol, first developed in the 1970s and approved in the United States in 1989, is now commonly used to start and maintain anesthesia. Often called the “milk of amnesia,” it works quickly and allows for a smooth, clear-headed recovery.
Anesthesia techniques continue to improve and become safer and more effective. With the expertise and close monitoring of an anesthesiologist or nurse anesthetist, patients can undergo complex procedures with excellent pain control and minimal risk. 


Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He 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).

Prairie Doc Perspective Week of April 19th, 2026
“Medications for treating substance use disorders”
By Kelly Evans Hullinger, MD
Substance use disorders like alcohol and opioid use disorders can be diverse, and every patient has a different story when it comes to their addiction. Social factors, genetics, history of trauma or mental health disorders, and many other contributors may be at play, which can make treatment of substance use disorders challenging.
Because of these challenges, successful treatment of substance use disorders often requires multiple approaches. Just like a patient with diabetes is best treated with diet, exercise, education, and medication, a patient with a substance use disorder is most effectively treated with a multi-disciplinary plan. For many patients, medication can be an important piece of the approach.
I have had several recent experiences with patients successfully abstaining from alcohol and opiates with the help of medication. The most common example that I see is alcohol use disorder, which can range from alcohol dependence to binge drinking behavior which causes disruption in a person’s social and family life and often leads to other medical problems.
One evidence-based option that I often use for patients with an alcohol use disorder is an oral medication called naltrexone. Recently, a patient who previously struggled with binge drinking described the effect of this medication to me, which was an enlightening explanation. “Doc, I’ve always been someone who, if I had one beer I was going to have 6 or 12 more. But on this med I can have one or two beers with my friends and I just don’t feel like having any more.” As a quite safe and accessible medication, naltrexone is an option I discuss frequently in my primary care clinic.
Another common and sometimes devastating problem is opioid use disorder. We have very good evidence that medications can significantly improve the probability of a patient being able to stay off opioids, and those options are gradually becoming easier to access as well. One of my patients who for many years struggled with opioid use disorder, even as it wreaked havoc on their life from a medical and legal perspective, has done extremely well with medication assisted therapy. They described the effect of medication as, “the first time I can remember that I have gone days without thinking about finding opioids.”
A current area of research is around GLP-1 agonists (commonly used in diabetes and obesity) as potential treatment for substance use disorders. While the verdict is still out on these, we may soon have some data on whether they hold up as effective treatment options for this group of patients as well.
While social support, therapy and counseling, and other facets of treatment will always be important, medications to help patients with some forms of substance use disorder are an essential piece of the puzzle. I have witnessed many of my own patients who have hugely benefited from those treatments. I am hopeful that medications will become easier for patients to access and have more options in the future.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group 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).

Prairie Doc Perspective Week of April 12th, 2026
“Death, Taxes, and Aging Eyes”
By Debra Johnston, MD


Benjamin Franklin famously wrote “in this world nothing can be said to be certain, except death and taxes.”


Franklin was a legendary intellect, and it’s hard to overstate the impact he had. But I’d suggest an addition to that particular quote, one with which I suspect he’d agree.


Most of us know him as one of the Founding Fathers, as the author of Poor Richard's Almanack, as the guy who flew kites during lightening storms. Perhaps less famously, Franklin was also an inventor. He is credited with the creation of the bifocal lens, reportedly inspired by his frustration with switching between pairs of glasses.


As a woman of a certain age, who has needed corrective lenses since childhood, I can well appreciate that frustration, and in turn, that invention! Our eyes are complex organs. In the very front, there is the clear dome of the cornea. Then we have the iris, the colored part of the eye. This is a muscle, and it controls the size of the pupil, the black central hole through which light is allowed entry. From there, light strikes the lens, which is pulled into different shapes by small muscles around its edge, and focused onto the retina in the very back of the eye. Specialized cells in the retina convert light to electricity, and the optic nerve transmits these messages to the brain. 


When I talk to my middle aged patients about symptoms they may be having, they frequently volunteer that they now need glasses for the first time, or that they have “upgraded” to those bifocals. They are usually surprised when I reassure them that this is not only normal, but frankly expected! The cells that create the lens loose the ability to repair or replace themselves over time. The lens becomes less flexible. It doesn’t change shape as easily, and as that happens the eye has a harder time focusing up close. Eventually, a person develops presbyopia: age related far-sightedness. 


This same process leads to a condition quite familiar to most people: cataracts. As those cells in the lens deteriorate, they become increasingly cloudy. Light has a harder time penetrating, and it may be scattered on the way through, instead of sharply focused. People may notice blurry vision, muted colors, glare around lights. They may need brighter light to read, and find it very difficult see at night. By 80, approximately 50% of people either have cataracts, or have had cataract surgery. 


Presbyopia and cataracts may be a normal, readily treated part of aging, but you shouldn’t neglect those eye exams. As we get older, other eye conditions become more common. Diseases like macular degeneration and glaucoma can be detected by the eye doctor well before they cause symptoms. Since those symptoms include irreversible vision loss, we should all be motivated to make that appointment!


Medicine is ever changing. Research avenues that seem promising turn into dead ends. Dead ends become detours to unexpected and exciting places. Maybe in the future, we will have drops or supplements or some other way to keep our eyes young. But for now, nothing can be said to be certain, except death, taxes. . .  and presbyopia.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings 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).

​Prairie Doc Perspective Week of April 5th, 2026
There’s No Place Like Home – Home Safety Evaluations
By Jill Kruse, DO
In my role as a hospitalist, I am always happy when a patient is healthy enough to be discharged.  A resounding majority of people want to go back to their home after they leave the hospital.  What we do not want is an unsafe environment leading to repeat injuries resulting in a hospital readmission.  
At discharge we can have members of the Home Health team perform a “Home Safety Evaluation”. Physical Therapists, Occupational Therapists and sometimes Speech Therapists will evaluate a person’s home for safety concerns and ensure it is set up optimally for best function.  The team looks at areas where injuries typically occur.  This could include the instillation of grab bars in the bathroom or having a shower chair.  Paying attention to slipping or falling hazards – such as throw rugs or loose stair railings.  Good lighting, especially on stairs and in hallways, can help prevent tripping and falling.  
Before hospital discharge Physical Therapists will evaluate how well a person can walk including their balance.  If there are steps in the home, they will ensure the ability to navigate stairs is evaluated.  They perform tests which can help predict who is at a higher risk for falling.  The proverb may be, pride goeth before a fall, but a walker or cane could help prevent that.  Unfortunately, too often pride is the reason that the walker or cane is not used in the first place.  Using someone else’s old walker may be a bargain, but proper walker and cane height is important. A used device may be more dangerous if not adjusted properly and therapists can help confirm they are at the correct height. 
Occupational Therapists evaluate a person’s ability to perform “Activities of Daily Living”. These include being able to feed, dress or bathe themselves, and using the bathroom.  They have lots of assistive devices, tricks and tips to assist people if arthritis, injuries, or recent surgery prevents the person from moving like normal.  
Speech Therapists are asked at times to assess a person’s cognition and “safety awareness”.  They evaluate and determine if this person can the person recognize an emergency and get to safety or call for help.  With dementia, the part of the brain responsible for logic and good decision making is no longer working.  Dementia patients often make impulsive mistakes such as walking into traffic or forgetting to turn the stove off after cooking.  
There is no place like home, but it needs to be a safe home.  With a few tips and modifications, your home can be a safer place to live thereby keeping you there longer.  We want you to “Stay healthy in 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).

Prairie Doc Perspective Week of March 29th, 2026
Anatomical Variations: Breaking Down the Basic Details of Tumors and Cancer
By Ethan L. Snow, PhD, MA


Cells are the basic building blocks of all living organisms. In a healthy body, cells follow an orderly life cycle: they develop from a systematic process called mitosis, perform important physiological functions to maintain body homeostasis (i.e., a stable internal environment), and die via apoptosis when they become dysfunctional, old, or no longer needed. This cycle is tightly regulated by DNA – the body’s genetic code that controls when and how each cell functions.


With about 30 trillion cells in each human body, some cells naturally develop mutations in their genetic code that disrupt their life cycle. Mutations can be caused by genetic issues, environmental exposures (e.g., tobacco smoke, radiation), infections, lifestyle, and other etiologies. Cells with mutated genetic codes are usually detected and removed by the body’s immune system, or they stop working and die on their own. However, sometimes these altered cells survive and gain a competitive growth advantage, causing them to replicate more rapidly than normal. Over time, this uncontrolled growth can create a mass of cells known as a tumor.


Tumors can develop anywhere cells are present (i.e., essentially anywhere in the body), and they are classified as benign or malignant. Benign tumors are non-cancerous, and they typically grow slowly and exhibit clear boundaries. Contrariwise, malignant tumors are invasive to nearby tissues – a hallmark of cancer – and are characteristically more aggressive. A biopsy is often necessary to confirm whether a tumor is benign or malignant. Notably, not all tumors are cancer (e.g., a benign tumor is not cancer), and not all cancers produce tumors (e.g., leukemia is a cancer of the blood).


A serious feature of malignant cancers is their ability to spread to other locations in the body – a process known as metastasis. Metastasis occurs when malignant cells break away from the original tumor, travel through the bloodstream or lymphatic system (or other pathway), and seed new tumors in other areas of the body. This makes cancer more difficult to treat and can provoke additional sequelae.


Clinical jargon associated with tumors and cancer can be daunting, but breaking down the terminology can be helpful. For example, the root words “hem-” means blood, “angio-” means vessel, and “-oma” means tumor, so a “hemangioma” is quite literally a “blood vessel tumor”. Additional terminology can be descriptive; for example, a “giant intramuscular lipoma” describes a fatty (“lyp-”) tumor (“-oma”) that is located within (“intra-”) a muscle (“-muscular”) and is at least five centimeters in any one dimension (the criteria for “giant” classification).


While loss of control is the foundational concept for tumor and cancer development, routine screening, avoiding carcinogens, and other controllable actions are important for preventing cancer, detecting it in early stages, and performing early interventional treatment. A lump, bump, or lesion might be just that, or it might be something serious. Tumors and cancer are complex, and they command respect and proper attention. It’s important to consult a physician about such concerns so they can execute a proper workup and assemble a multi-disciplinary healthcare team as warranted.


Ethan L. Snow, PhD, MA is a clinical anatomist who currently serves as an Associate Professor at South Dakota State University in Brookings, South Dakota. Dr. Snow leads the Snow Lab Research Team – a collaborative and interdisciplinary team of undergraduate students, professional students, faculty, and clinicians who analyze rare and unique clinical cases involving anatomical variations. 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 for the Week of March 22nd, 2026
“What the heart wants (is exercise)”
By Kelly Evans Hullinger, MD FACP
Cardiovascular disease remains the most common cause of death in the US as well as a very common cause of chronic illness and disability. Heart attacks, heart failure, and strokes result in about 2500 deaths per day in the US, according to the American Heart Association®. While huge strides continue to be made in treatment of these events, including medications and procedural abilities, as always, prevention is the best medicine.
Many risk factors exist for cardiovascular disease; some, such as genetics or family history, are out of one’s control. However, there are many things we can do to reduce our risk, including quitting smoking and controlling high blood pressure, high cholesterol, or diabetes. One behavior that applies to us all is to get enough exercise.
The American Heart Association® recommends getting at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise per week, preferably spread over several days in the week. Moderate exercise might include brisk walking, gardening, or leisurely biking. Vigorous exercise might include walking on an incline, jogging or running, or heavy yard work. Additionally, they recommend resistance or strength training be included twice per week.
Starting from sedentary? No problem, but don’t expect to go from zero to 150 minutes in the first week. Listen to your body; you can even start with walking or chair exercise for ten minutes per day. You will find that with consistency you will be able to build on that week to week. Most importantly, find a physical activity that you enjoy enough to keep doing. For many people, exercising with a family member or friend really helps.
We know that regular exercise can cut the risk of cardiovascular disease substantially; one large study showed a reduction in mortality by over 20%, with more exercise giving even greater protection. How exercise benefits the heart goes beyond its effect on obvious markers like weight; exercise improves blood flow in the vessels around the heart in a way that reduces future bad outcomes. As I tell my patients when we discuss exercise, its benefits are far greater than its effect on weight. Your heart will thank you for the exercise no matter what the scale says.
So let’s all get moving this week! Any exercise is better than none, and there is something out there for everyone. The heart wants what it wants, and that’s exercise.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group 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 SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of March 15th, 2026
“Old Age, Only 10 Years Away”
By Dr. Becca Jordre
Every year I ask my students, “How old is old?” The answers vary, but the most honest response I’ve ever received came from a patient who said, “Old is 10 years older than my age.” We all tend to push aging just out of reach, as though it belongs to someone else.
As a physical therapist, professor and researcher in aging, I see the consequences of that distance every day. When we mentally place older adults in a separate category, we give ourselves permission to speak and act in ways that quietly do harm. We call someone an “old lady” without pause. We dismiss a symptom as “expected at your age.” We offer the well-meaning but quietly deflating compliment that someone is doing well “for their age.” Each of these small moments narrows what we believe is possible for that person.
This is ageism. Generally unintentional, ever-present in our society.
The problem is not acknowledging that aging brings real changes. It does. Health conditions, pain, and mobility challenges become more common with age, but not in some uniform pattern that warrants focus on a number. The problem is when age becomes the answer rather than the starting point. When decline is the expectation, we stop asking about goals, we stop noticing strengths and we start designing lives around an assumed limitation.
Consider a common piece of advice: move to a single-story home as you grow older. It sounds reasonable. But research tells a more nuanced story. Studies have found that those living in homes with stairs showed less decline in physical function over time compared to those without. Climbing stairs is demanding, repetitive physical work for the legs and heart. Removing that daily challenge in the name of safety may quietly accelerate the very decline we hope to prevent.
This pattern holds more broadly. Research consistently shows that vigorous exercise, not just gentle stretching or slow walks, produces the greatest health benefits as we age. Higher-intensity activity improves strength, balance, heart health and cognitive function in people well into their 80s and 90s. When we steer older adults toward only the lightest, most cautious forms of movement, we deprive them of the very stimulus their bodies need. In trying to protect, we inadvertently take away opportunity.
Language works the same way. When family members, neighbors and health care providers speak as though decline is inevitable, we coach people toward caution, avoidance and withdrawal. Expectation shapes behavior, and low expectations are their own kind of harm.
The answer is not to ignore age or pretend it doesn’t matter. It is to treat aging as a human experience, seeing a person not as a number but as an individual with unique aspirations, interests and abilities. 
None of us are exempt from aging. We are all just at different points on the same road. The assumptions we make about older adults today are the assumptions that may one day be made about us. That alone is reason enough to think more carefully about what we say, what we recommend, and what we decide is possible with each passing year.
Dr. Jordre is a professor of physical therapy in the School of Health Sciences at the University of South Dakota. She earned her Doctor of Physical Therapy degree from Duke University in 2002 and her Ph.D. in Health Sciences from the University of South Dakota in 2021. She is board certified in Geriatric Physical Therapy and is a Certified Exercise Expert for Aging Adults. Her research centers on healthy aging, with a particular focus on athletes age 50 and older. 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).

Prairie Doc Perspective Week of March 8th, 2026
Meaningful Living in Rural Communities: Pathways to Productive Aging
By: Whitney Lucas Molitor, Ph.D., OTD, OTR/L, BCG and Allison Naber, Ph.D., OTD, OTR/L
Living in rural communities offers unique opportunities to promote successful aging. Incorporating a purposeful lifestyle, developing social connections and engaging in daily physical activity is essential to achieving positive health outcomes and quality of life.
Finding purpose includes exploring the activities you already engage in and being open to new possibilities. Engaging in motivating activities provides a framework for a purposeful life. The selected activities can promote health, foster a sense of identity and give a sense of purpose in life while aligning with personal values and interests. While some daily activities are performed without much thought, identifying others may require careful exploration. 
In rural communities, consideration of the physical context is also essential. The American Occupational Therapy Association provides a framework that incorporates reflection on personal values, interests and prior life experiences. This approach, along with establishing priorities and goals, can be a valuable way to explore daily activities and create new opportunities for engagement that enhance purpose in daily life. To align life purpose with a rural context, it is essential to incorporate outdoor activities, find creative ways to connect with family and friends and explore opportunities with local groups. Activities can be modified to support evolving interests, abilities and desires. 
Establishing and maintaining strong social connections is critical to promoting healthy aging in rural communities. Older adults in rural areas may experience social isolation due to limited opportunities for interaction. This can be due to changes in overall health, technology barriers (limited internet access or limited computer or smartphone skills) or physical barriers (limited community mobility or driving restrictions). Social isolation can pose physical, psychological and behavioral health risks. Engaging in meaningful activities with others can help build relationships, find purpose or fulfillment and develop new hobbies or skills. Educational programs or groups are an excellent way to explore new leisure activities or learn strategies to improve health and well-being. Reaching out to family or friends, visiting your local senior center, attending community events, or joining a club can all provide a sense of connection, purpose and well-being.
In addition to staying socially connected, developing a regular physical activity routine is essential for older rural adults. Adults over 65 should set goals to strengthen their muscles and improve their balance by engaging in at least 150 minutes of moderate physical activity per week. Moderate physical activity increases breathing and heart rate, but you should still be able to talk while active. Beneficial activities include brisk walking, dancing, riding a stationary bike or NuStep, using weights or resistive exercise bands, gardening or participating in water aerobics. Consider setting a goal to move your body for 30 minutes each day to reduce sedentary time. Sedentary activities include watching TV, reading, sitting or lying down. Prolonged sedentary behavior increases the risk of poorer health outcomes among older adults. Intentionally participating in meaningful activities throughout the day will reduce time spent sedentary. Reduce sedentary behavior by standing during commercial breaks, walking around your home after a meal or stretching after reading the paper or playing cards. Incorporating the strategies mentioned in this article can promote well-being and enhance quality of life.


Whitney Lucas Molitor, Ph.D., OTD, OTR/L, BCG, is department chair and associate professor in the Department of Occupational Therapy at the University of South Dakota. Lucas Molitor is a licensed occupational therapist in Iowa and South Dakota. Her research interests include health promotion and productive aging. Allison Naber, Ph.D., OTD, OTR/L, is the academic fieldwork coordinator and an associate professor in The Department of Occupational Therapy at the University of South Dakota. Naber is a licensed occupational therapist in Minnesota and South Dakota. Her research interests include occupational performance and life balance, particularly as they relate to healthy aging. 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, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of March 1st, 2026
Cultivating Trust: A Trauma-Informed Approach to the Therapeutic Alliance
By Patti Berg-Poppe, MPT, Ph.D. and Shana Cerny, OTD, OTR/L, BCP


Health care professionals enter every patient encounter with the goal of helping individuals heal, yet many don’t realize how often past adversity shapes the way a person experiences care. Trauma, whether from childhood experiences, medical procedures, accidents, interpersonal harm or environmental conditions, doesn’t remain a distant memory. It becomes embedded in the body through biobehavioral adaptations that influence posture, muscle tension, breathing patterns, nervous system sensitivity and low body safety. When we understand that trauma lives not only in stories but also in tissues and reflexes, we begin to see why a trauma-informed approach is essential for building trust.


Trauma and adverse experiences are more common than we may realize. More than two-thirds of the patients that health care providers encounter in practice are likely to have experienced trauma in some form. Trauma‑informed care should be a universal precaution, guiding providers to assume that any patient may have a history of adversity, even if it is never disclosed. This mindset shifts the focus from “What’s wrong with you?” to “What’s happened to you, and how is it affecting your health today?” For clinicians who rely on touch, such as physical and occupational therapists, physicians, nurses and primary care professionals, this awareness is especially important. Touch can be grounding and healing, but it can also activate the sympathetic nervous system, triggering a stress response before a patient has words to explain why.


Trust becomes the foundation of the therapeutic alliance, and trust is built through safety, predictability and respect. Trauma‑informed practice encourages providers to slow down, explain what they are doing and invite patients into shared decision‑making. Simple actions, such as asking permission before touching, checking in about comfort, offering choices and being transparent about what comes next, signal to the nervous system that the environment is safe. These small shifts can reduce physiological stress responses and create space for true healing.


Research on trauma‑informed health care highlights how past adversity can influence patient engagement, adherence and outcomes. When patients feel overwhelmed, misunderstood or rushed, they may appear “non‑compliant,” when in reality their nervous system is doing its best to protect them. A trauma‑informed lens helps clinicians interpret these reactions not as resistance but as communication. It encourages us to look beyond the symptom in front of us and consider the whole person, including their history, their stress load, their strengths and their goals.


Holistic care means recognizing that physical symptoms rarely exist in isolation. Pain, fatigue, dizziness and muscle tension often have emotional and neurological components. When providers acknowledge this mind‑body connection, patients feel seen rather than dismissed. They’re more likely to share concerns, ask questions and participate actively in their care. This collaboration strengthens the therapeutic alliance, which research consistently links to better health outcomes across disciplines.


Trauma‑informed practice is not a specialty; it’s a skillset. It requires curiosity, humility and a willingness to adapt. It asks clinicians to be mindful of their tone, body language and pace. It reminds us that healing happens in relationships, and that every interaction, every moment of touch, every explanation, and every pause can either reinforce safety or erode it.


When we approach patients with the assumption that their bodies carry stories we cannot see, we create conditions where trust can grow. And when trust grows, so does the capacity for healing.


Patti Berg-Poppe, MPT, Ph.D., is a physical therapist, professor, and Chair of the Department of Physical Therapy at the University of South Dakota. She has published on trauma‑informed care, including work examining how adverse childhood experiences influence patient engagement and how trauma‑aware practices can strengthen therapeutic relationships. Her writing and teaching emphasize the importance of trust, safety and respectful communication in all health care interactions. Shana Cerny, OTD, OTR/L, BCP, is an occupational therapist and associate professor in the Department of Occupational Therapy at the University of South Dakota. Her research, service and teaching interests revolve around trauma-informed care, including publication of practice guidelines for trauma-informed occupational therapy, interventions for individuals after exploitation, and the effectiveness of a trauma-informed care curriculum for multi-disciplinary care providers. She is a Trust-Based Relational Intervention® Educator and co-creator of the Child & Adult Advocacy Studies graduate certificate at the University of South Dakota. 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, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

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Prairie Doc Perspective Week of February 22nd, 2026
“The Not-So Silent Struggle of Sleep Apnea” 
By Andrew Ellsworth, MD


Take a moment to breathe. Close your eyes. Slowly inhale through your nose, pause, and gently exhale through your mouth. After a few steady breaths, you likely feel more relaxed and ready for the day.
Now imagine plugging your nose and trying to breathe with your tongue pressed against the roof of your mouth, blocking the airway. You would quickly feel stressed and uncomfortable. Now imagine that happening over and over again, all night long.
That is what occurs with obstructive sleep apnea.
Obstructive sleep apnea happens when relaxed throat muscles and soft tissues collapse and block the airway during sleep. These temporary pauses in breathing—called apneas—cause lower oxygen levels. The brain senses the drop and briefly arouses the body to reopen the airway. This cycle can repeat dozens, even hundreds, of times per night. The result is fragmented sleep, low oxygen, and a body that never truly rests.
Sleep is when the body resets and restores itself. It supports immune function, heart health, metabolism, memory, mood, and emotional regulation. When sleep suffers, so does overall health. Poor sleep increases the risk of high blood pressure, heart disease, stroke, diabetes, cognitive decline, and even dementia. People who are chronically tired are also less likely to make healthy choices.
The gold standard treatment for sleep apnea is CPAP—continuous positive airway pressure. A bedside machine delivers steady air through a mask, keeping the airway open during sleep. Some patients benefit from BiPAP, which provides different pressures when breathing in and out. When used consistently, these therapies can dramatically improve sleep quality, energy, focus, hormone balance, and cardiovascular health.
Other treatments may help in selected cases. Weight loss, dental appliances, side sleeping, and certain surgeries can reduce airway obstruction. For patients who cannot tolerate CPAP, hypoglossal nerve stimulation (often known by the brand Inspire) is an option. This implanted device stimulates the nerve controlling the tongue, helping maintain an open airway during sleep.
Although sleeping with a mask may not sound appealing at first, some people feel better quickly and do well with it. Others improve once they are used to it. It often takes patience—trying different masks, adjusting pressure settings, or adding humidification. With proper support and follow-up, most people adapt well.
The benefits of treating sleep apnea far outweigh the risks of ignoring it. Restful sleep improves energy, protects the heart and brain, and enhances overall quality of life.
If you or someone you love snores loudly, stops breathing during sleep, or feels tired despite a full night’s rest, consider visiting your medical provider. Restoring healthy breathing at night may be one of the most important steps toward better health.
Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He 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).

Prairie Doc Perspective Week of February 15th, 2026
“The Bones of the Matter”
By Deb Johnston, MD


When I was in medical school, I learned that a shocking number of people would die or be admitted to a nursing home after a hip fracture. 


Even today, a hip fracture can be a devastating event for an older American. Up to 30% will die within the next year. Many more will loose independence and require admission to assisted living or a nursing home. Estimates vary, but it may approach 50%. As hard as it is to believe, these statistics are improved from my long ago medical school days.


As a doctor in training, the solution seemed obvious. If osteoporosis caused hip fractures, and hip fractures caused premature death and disability, then my mission as a primary care physician would be to prevent osteoporosis. I’ve been nagging my patients about their calcium and vitamin D intake and their weight bearing exercise ever since.


To be fair, the reality is a bit more nuanced. It’s true that osteoporosis is a major factor in hip fractures, but it is often accompanied by other issues: poor nutrition, poor balance, low muscle mass, and more obvious serious health conditions like dementia, heart disease, kidney disease, and diabetes. 


Similarly, preventing osteoporosis isn’t as simple as urging everyone to drink enough milk. Generally we can build stronger bones up until about age 30. After that, the goal is to maintain bone mass. Those critical years are often decades before a person starts thinking about their bones, and sometimes well before they start thinking about their health at all! 


Other habits also influence how strong your bones are at their best. Smoking and alcohol reduce bone mass. Weight bearing exercise increases it; while being sedentary has the opposite effect. Your body needs vitamin D to make bone, too, and deficiencies are surprisingly common. 


Other health conditions, and their treatments, can have significant influences on your bone health. The list is long: eating disorders, premature menopause, inflammatory bowel disease, seizure disorders, asthma, rheumatoid arthritis, chronic kidney disease, thyroid disease, cancer.


While preventing osteoporosis starts in childhood, hope is not lost just because you are well into middle age, or older. Talk with your doctor about what you should be doing to keep your bones healthy. Do you need help getting rid of nicotine, or cutting back on alcohol? Are you having trouble getting enough calcium or vitamin D? Are there medications you are taking that could be changed? Is it time to start screening?


While many people think about osteoporosis as a woman’s disease, it affects men too, albeit at lower rates. In fact, men may have a higher risk of death after a hip fracture. We all need to be thinking about our bones. It’s never too early. Or too late.


Dr. Debra Johnston is a Family Medicine Physician at Avera Medical Group Brookings 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).

Prairie Doc Perspective Week of February 8th, 2026
“Spring into Seasonal Allergies”
By Jill Kruse, DO
The groundhog may have seen his shadow, but Spring will be here soon.  While many of us look forward to warmer days and blooming flowers, those who suffer from seasonal allergies know that the return of grass, budding trees, and blooming flowers can lead to more sneezing than smiles.  Welcome to the Spring allergy season.  
If your seasonal allergies seem to be getting worse each year, it is not in your head.  A Study from the National Academy of Sciences in 2021 found that over the last 30 years the North American pollen allergy season has increased by approximately 20 days.  Pollen concentrations have also risen 21%.  The Spring tree pollen season has been starting earlier and the Fall ragweed season has been ending later.  
Seasonal allergies can develop at any time in one’s life.  The most common risk factor for developing seasonal allergies is family history.  If have family members with allergies, you have an increased risk of developing them as well.  Seasonal allergies are the sign of an overactive immune system that has mistakenly identified harmless substances, like pollen, as dangerous threats to the body.  This triggers an inappropriate defense response that leads to the common symptoms of allergies like runny nose, congestion, watery eyes, itching, and sneezing.  The immune system is trying to fight pollen like it would fight a cold. This is why it can be difficult to differentiate between allergies and illness.  
There are a few ways to help decrease the risk of children developing allergies.  Several studies have shown that children who visit a farm in their first year of their life or have furry pets have a lower risk of allergies.  In that first year of life, the immune system is busy trying to figure out what things the body needs to defend against and what things are safe to ignore.  The environment on the farm has so different allergens, that it allows the immune system to become tolerant of the harmless pollen and animal dander. However, once someone has allergies, and the immune system is sensitive to these substances, further exposure to allergens that are on a farm will not help.  It will just make the allergy sufferer more miserable.  
The first line over-the-counter treatment for seasonal allergies is intranasal corticosteroids such as Fluticasone (Flonase), Mometasone (Nasonex), and Budesoninde (Rhinocort).  These nasal sprays have been shown to be more effective than over-the-counter oral antihistamines such as Loratidine (Claritin), Fexofenadine (Allegra), and Cetirizine (Zyrtec).   If the spray does not give adequate control, then adding an oral antihistamine can help. 
If these medications are not effective, then seeing an Allergist is the next step to enjoying everything that comes with April showers and May flowers.  The groundhog says we have six more weeks to prepare for Spring.  Regardless of when it comes, everyone can enjoy Spring if they understand seasonal allergies and how to treat them.  
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).

Prairie Doc Perspective Week of February 1st, 2026
“Insomnia”
By Kelly Evans Hullinger, MD, FACP
Difficulty sleeping is an common concern we hear about in primary care. Many of us will have trouble sleeping on occasion, but when that is a persistent pattern causing distress or functional impairment, we call it insomnia. Insomnia can mean difficulty falling asleep, difficulty maintaining sleep, or waking early unable to fall back asleep. 
First and foremost, is the difficulty sleeping causing problems? If it is not resulting in problems with daily functioning, we may need to manage expectations around sleep. Not every person needs 8 hours per night, and if your imperfect sleep is perfectly tolerable, it is probably best to leave it alone. As we age, we need less hours of nighttime sleep; again, as long as you feel well during the day, that is just fine.
For those whose poor sleep is resulting in intolerable drowsiness or difficulty functioning at work or home, I have more questions. Is an acute illness or stressor contributing? Might there be another sleep disorder like sleep apnea or restless leg syndrome? Is pain, an urge to urinate, or some other physical symptom causing your awakenings? Is there underlying depression, anxiety, or other mental health concerns? Are you taking any medications or substances that might cause sleep disruption? Addressing any of these may significantly improve sleep. Alcohol is a common culprit; often assumed to help people fall asleep, alcohol actually yields poor quality rest.
Most patients with insomnia can be helped with behavior changes alone, or “sleep hygiene.” There are a few basic tenets, some more intuitive than others. First, optimize the sleep environment; ideally this means a dark, cool, quiet bedroom. Second, a consistent bedtime and wake time are very important, even on the weekends. This is particularly difficult for our patients who have jobs requiring rotating shifts. Next, find a bedtime routine which helps your brain wind down; think less screen time, and more reading, meditating, or listening to calming music. 
Finally, and less intuitive to most, if you do find yourself lying in bed for 20 minutes without falling asleep, get out of bed, try a calming routine over again, then get back into bed. More time spent not sleeping in your bed is more time your brain spends learning the bed is a place to be awake. Furthermore, it fuels anxiousness when we lie awake yearning for sleep, so it is best to break that cycle.
I see a lot of people tracking sleep with their smartwatch or other wearable device, and my advice is to be aware of potential pitfalls. We don’t have good evidence that the information all devices provide on sleep is accurate, and for most people tracking those statistics actually tends to increase anxiety around sleep which may worsen the problem.
Have you followed all the above advice but still suffer from insomnia? The gold standard treatment is cognitive behavioral therapy for insomnia (CBT-I) provided by a mental health professional. Beyond that we do have pharmacologic options, but medications for sleep can be fraught with potential problems, especially for our patients over age 65. Even some over-the-counter sleep medications can have significant risks in older patients, so please use caution and talk you your primary care provider.
Dr. Kelly Evans Hullinger practices internal medicine at Avera Medical Group 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, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).