​“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.”

“Pneumonia Vaccine Saves Lives”
By Andrew Ellsworth, MD


Over one hundred years ago, the gold mining industry of South Africa had a problem: too many workers were dying from pneumonia. They turned to Dr. Almorth Wright, a British physician who had successfully created a vaccine against typhoid fever that saved countless lives of British soldiers in World War I and other wars. Wright and his colleagues developed an inoculation of killed pneumococci bacteria which resulted in a substantial reduction of cases of pneumonia and death in the miners.  


Pneumonia is an infection in the lungs that causes inflammation and accumulation of fluid or pus, making it difficult to breathe. Pneumonia can be caused by viruses, bacteria, and fungi. Risk factors for pneumonia include old age, young children, smoking, lung diseases such as chronic obstructive pulmonary disease and asthma, other chronic medical conditions, poor air quality, and more. 


Antibiotics have been revolutionary in treating bacterial pneumonia, decreasing the rates of death substantially. Unfortunately, antibiotics do not treat viruses, and early use of antibiotics in the course of a virus will not decrease the risk of pneumonia. If someone has cold symptoms, rest, fluids, time, and an expectorant like guaifenesin can be helpful. If symptoms get worse with the return or persistence of fevers, worsening cough, shortness of breath, or chest pain, please seek medical attention. 


Vaccines for pneumonia, influenza, haemophilus influenzae (Hib), and respiratory syncytial virus (RSV) have significantly decreased the rates of pneumonia. The pneumonia vaccine is now recommended for infants and young children, all adults over 50 years of age and those with certain chronic medical conditions.  The Centers for Disease Control and Prevention (CDC) lowered the age recommendation from 65 to 50 in October 2024 since adults aged 50+ are 6.4x more likely than younger adults to get pneumococcal pneumonia. 


The pneumonia vaccine has changed and updated through the years with the types of bacteria that are targeted. If you have already received a pneumonia vaccine, depending on what you have received and if it has been several years or if you have chronic medical conditions, you may want to talk to your healthcare provider about getting a new pneumonia vaccine.  


Prevention is the best way to fight disease. To prevent pneumonia, it is helpful to wash your hands, do not smoke, consider vaccination, and help keep your immune system strong by getting good sleep, exercising, and eating healthy.


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine 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. 

Prairie Doc Perspective Week of March 16th, 2025
“Learning to Perceive: Visual Thinking Strategies in Medical Education”
By Donna Merkt, director of the South Dakota Art Museum at South Dakota State University
Effective medical diagnosis depends not just on looking, but on truly perceiving. Recognizing this, many medical training programs have adopted Visual Thinking Strategies (VTS) discussions about art to enhance students’ skills in nuanced observation, inference, and communication.  In 2004, Harvard Medical School pioneered use of VTS within medical education to refine the diagnostic and interpersonal skills of future healthcare professionals. Now, VTS is embraced in over 30 medical schools. 
Through inquiry-based, participant-centered VTS discussions about art, medical students learn to slow down, look carefully, analyze details, and refine their diagnostic reasoning. During the exercise, participants focus on an artwork while discussing their observations.  The facilitator begins with: “What’s going on here?” Seeks evidence by asking: “What do you see that makes you say that?” Then, spurs the participants with: “What more can we find?” The facilitator remains neutral, paraphrases comments, and points to the artwork to guide discussion. Without authoritative guidance, participants explore multiple interpretations freely. The conversation often lasts 20 minutes per artwork. (Conversely, most museum visitors spend 30 seconds or less with a piece.)  
A 2020 study at the University of Miami Miller School of Medicine, along with others, found that students who participated in VTS showed significantly improved observational abilities compared to peers who had not engaged with the program. By examining and discussing artwork through VTS, participants sharpen their ability to notice small but significant details and interpret ambiguous visual information, a process that mirrors patient assessments, where attentiveness and contextual understanding are key. For example, learning to analyze visual cues that might indicate emotions may enhance healthcare professionals’ abilities to interpret patients’ nonverbal cues, leading to more compassionate and attentive interactions.
VTS discussions engage participants in collaborative analysis, fostering both clear articulation of observations and active listening to others’ perspectives. A systematic review of studies regarding VTS in medical education, published in BMC Medical Education (2023), found that engaging in VTS improved medical students’ observation skills and enhanced their abilities to express their findings concisely and confidently. Further, VTS participants also support their interpretations with evidence—a critical skill in patient care, where diagnoses must be explained with clarity and justification. The structured discussion format of VTS also encourages strong communication, as well as cooperative analytical skills, which are essential for collaborative work within healthcare teams.
Attuning to a patient’s needs requires careful observation, but diagnosing complex cases also demands the ability to navigate uncertainty. Patients may present with overlapping or unclear symptoms, and medical professionals must carefully weigh multiple possibilities. VTS trains students to tolerate ambiguity by prompting them to analyze complex images without immediate resolution. Further, the process fosters active listening to alternative interpretations offered by others, often leading participants to refine their own thoughts. This practice fosters adaptability, allowing future medical professionals to confidently refine their assessments rather than defaulting to initial impressions.
By engaging with works of art in VTS discussions, medical students and practitioners develop sharper attention to detail, improved communications, and increased empathy.  Ideally, this reflective approach extends into clinical practice, allowing healthcare providers to take a more holistic view of their patients, ask insightful questions, thoroughly evaluate symptoms before reaching a diagnosis, and communicate thoughtfully with patients and families.
If you would like to learn more about Visual Thinking Strategies and potential partnerships, contact your local art museum. 
Select Sources: 
Agarwal, G.G., McNulty, M., Santiago, K.M. et al. Impact of Visual Thinking Strategies (VTS) on the Analysis of Clinical Images: A Pre-Post Study of VTS in First-Year Medical Students. J Med Humanit 41, 561–572 (2020). https://doi.org/10.1007/s10912-020-09652-4
Cerqueira, A.R., Alves, A.S., Monteiro-Soares, M. et al. Visual Thinking Strategies in medical education: a systematic review. BMC Med Educ 23, 536 (2023). https://doi.org/10.1186/s12909-023-04470-3 
Rezaei S, Childress A, Kaul B, Rosales KM, Newell A, Rose S. Using Visual Arts Education and Reflective Practice to Increase Empathy and Perspective Taking in Medical Students. MedEdPORTAL. 2023;19:11346. https://doi.org/10.15766/mep_2374-8265.11346
Donna Merkt is a certified VTS facilitator and has practiced VTS for more than 15 years, during which she’s led VTS conversations with thousands of students and adults, and trained numerous educators and medical professionals to use the method.  She currently serves as director of the South Dakota Art Museum at South Dakota State University. 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 streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.

Prairie Doc Perspective Week of March 2nd, 2025
“Businesses for Babies”
By Christina Young, Director for the Center for the Prevention of Child Maltreatment
When businesses support working parents, they're not just boosting their bottom line – they're helping prevent child abuse and neglect. In South Dakota, 72.5% of all children under age six have all available parents in the workforce, making family-friendly workplace policies crucial for our state's families. 
Research shows that workplace policies like flexible scheduling, paid family leave, and childcare assistance significantly reduce major risk factors for child maltreatment by decreasing parental stress and providing essential economic stability. When parents have the flexibility to attend school events, care for sick children, or work from home when appropriate, it strengthens family bonds and creates more nurturing environments. Access to quality childcare and living wages helps ensure families can meet basic needs without the overwhelming stress that can lead to crisis.
Prevention is far better – and far less costly – than intervention after abuse occurs. Studies show that every dollar invested in prevention can save up to seven dollars in future costs related to child welfare services, healthcare, and criminal justice. By creating supportive work environments, businesses play a crucial role in building the safe, stable, nurturing relationships children need to thrive. These investments in families today help develop healthier communities and a stronger workforce for tomorrow.
The Center for the Prevention of Child Maltreatment's "Businesses for Babies" campaign highlights South Dakota companies that have adopted family-friendly policies. By showcasing businesses that prioritize family well-being through flexible schedules, parental leave, and childcare support, the campaign aims to inspire more companies to implement similar policies. Together, we can create a business culture that strengthens families and protects our most vulnerable citizens – our children.
Christina Young has been an influential figure in the child welfare field for over a decade, dedicating her career to the well-being of children and families. She directed an in-home family services program covering 30 western counties in Iowa, demonstrating her commitment to community-based support. Christina has a bachelor’s degree in psychology and a master’s in human services administration. 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 or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.

Prairie Doc Perspective Week of February 23rd, 2025
“Abnormal Electrical Signals”
By Kelly Evans-Hullinger, MD
Atrial fibrillation is probably a diagnosis you have heard of, if not because a friend or family member has it, because it has been mentioned in a public advertisement or pharmaceutical commercial. Atrial fibrillation (or “A-fib”) is the most common cardiac arrhythmia, a condition estimated by the American Heart Association to be present in more than five million Americans.
A-fib happens when abnormal electrical signals occurring throughout the cardiac atria (upper chambers of the heart) override the normal intrinsic electrical pacemaker. Sometimes this causes symptoms such as heart palpitations, dizziness, poor exercise tolerance, or heart failure. In many cases, however, patients have no symptoms at all. I can recall numerous instances of finding A-fib in a patient simply by listening to their heart on a routine exam and finding the heart rhythm to be irregular. The widespread use of smartwatches and other monitoring devices is alerting people to the possibility of A-fib with greater frequency.
Atrial fibrillation is diagnosed by an electrocardiogram (ECG) or a longer term heart rhythm monitor. When we find A-fib, we should look for any underlying causes such as heart valve problems, heart failure, and even thyroid disease. More frequently, A-fib does not have any single cause; it can occur for no particular reason, but a person’s risk of it increases with numerous factors including obesity, heavy alcohol use, high blood pressure, sleep apnea, and of course advancing age.
Treatment of atrial fibrillation has various options, which include medication to keep the heart from going too fast, medication to keep the heart in a normal rhythm, shocking the heart back into normal rhythm, or a catheter procedure to ablate the abnormally-firing portions of the cardiac tissue.
Of utmost importance, because in A-fib the atrial chambers do not effectively pump and empty blood into the lower chambers with each heartbeat, blood pools in some areas and has the risk of forming clots. This is why patients with atrial fibrillation are at elevated risk of a stroke and why for many of those patients we recommend taking a blood thinner long-term. We have tools to estimate stroke risk in an individual patient, so the discussion of blood thinners is one you should have with your primary care provider or cardiologist.
In summary, atrial fibrillation is a very common diagnosis, especially as patients get older. Our individualized approach to treatment focuses on control of symptoms and quality of life as well as reducing the risk of stroke. 
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 on streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.

Prairie Doc Perspective Week of February 16th, 2025
“There are more than ample reasons to be concerned about your vision ”
By Debra Johnston, MD


Recently, I had a gentleman come for an annual wellness visit. He hadn’t had one for quite some time, and I could tell he was a little uncertain about what to expect. He was patient while we reviewed his family history, and tolerant while we talked about diet and exercise, but he’d had enough when I asked about the last time he’d been to the dentist and the eye doctor. “What is this about?” he asked me, somewhat exasperated. I suppose people don’t usually expect to go to their primary care doctor and have her nag them about their teeth or their eyes! 


But both teeth and eyes are really important to your overall well being. There is ample evidence linking poor dental health to other issues, like heart disease and preterm births. The eyes provide clues to many systemic diseases, such as autoimmune diseases like rheumatoid arthritis, cancers, various infections, genetic conditions like Marfan’s syndrome, and of course more mundane issues like high blood pressure and high cholesterol. Naturally, I harp on people with diabetes to get to the eye doctor almost every time I see them! Diabetes can damage small blood vessels, and in the eye this damage may lead to blindness. 


Even if you don’t notice any problems with your vision, it’s important to see your eye doctor periodically. Diseases like glaucoma can be silent, and the visual loss so gradual that you don’t notice it until it is advanced. Glaucoma can be successfully treated, but only if it is detected! Macular degeneration is also silent in the early stages, but can be detected by a careful eye exam by an ophthalmologist or optometrist. 


Most of us understand instinctively that we would face additional challenges if we had poor vision. There would be no hopping in the car to drive to the store. There would be no picking up a magazine to leaf through in the waiting room. There would be no recognizing an old friend from across the street. We might not consider that these circumstances contribute to increased social isolation and depression, or increased risk of injuries. Some research links vision loss, like hearing loss, with dementia, although the nature of that relationship isn’t clear. Nevertheless, there are more than ample reasons to be concerned about your vision! 


In addition to those regular trips to the eye doctor, there are some steps you can take to protect your eyes. Keep your chronic medical conditions, like diabetes and high blood pressure, under control. Don’t smoke or vape. Wear sun glasses with UVB protection. Eat lots of fruits and vegetables. Don’t drink much alcohol. And of course, protect your eyes from injury: over a million Americans live with significant vision loss in at least one eye because of eye trauma. 


My answer to my patient’s very reasonable question was simple: anything that impacts your well being deserves consideration from your doctor. And that most definitely includes your eyes!


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 or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

​Prairie Doc Perspective Week of February 9th, 2025
Popeye and Testosterone Replacement
By Andrew Ellsworth, MD


A few (or more) years ago, Popeye the Sailor Man was an inspirational cartoon character. When needed, the superhero would quickly swallow some spinach and become strong, able to pack a punch that would defeat any evil villain. 


Nowadays, TV and internet commercials are encouraging men to consider testosterone replacement as the way to become stronger. While they are quick to tout the benefits, the risks are important and should not be ignored. 


Testosterone is the hormone in men that is produced from the testicles. It helps in sexual development in men, libido, erections, sperm production, muscle mass, and bone growth. It counteracts fat mass, stimulates red blood cell production, and plays a role in cognition and mood. 


If a man has low testosterone (hypogonadism), determined by at least two early morning fasting blood draws, and they have symptoms of low testosterone, then it is reasonable to consider testosterone replacement therapy. Signs and symptoms of hypogonadism include low libido, decreased erections, loss of body hair, low bone mineral density, gynecomastia (breast development), and small testes. 


Symptoms such as fatigue, depression, reduced muscle strength, increased fat mass, and low blood counts can be caused by a wide variety of factors, and should not be reasons alone to consider testosterone replacement. 


The best way to increase one’s testosterone is through good old diet and exercise. Studies have shown exercise, strength training, and weight loss all help to increase testosterone levels, oftentimes more than testosterone replacement does. Fat produces a hormone called leptin, which counteracts testosterone. Thus, losing fat and gaining muscle naturally increase one’s testosterone. Meanwhile, a healthy diet and exercise often boost energy, mood, and overall health.


The most effective method for testosterone replacement is by injection. There are also topical gels and patches. Any over the counter supplement that claims to boost testosterone is misleading and unlikely to have any significant effect on testosterone levels. 


Risks of testosterone replacement include prostate cancer, heart attacks, strokes, blood clots, acne, breast enlargement, sleep apnea, aggression, and can contribute to an enlarged prostate, which can cause urinary frequency or even urinary obstruction. While natural testosterone stimulates sperm production, testosterone replacement decreases sperm counts, decreases fertility, decreases testicular size, and decreases natural testosterone production. 


Testosterone levels naturally decrease as men get older. While some may advertise testosterone as a “fountain of youth,” the benefits are limited in this scenario and the risks increase as men get older. Popeye had the right idea. Putting in the work, and eating some spinach, is likely the better long-term plan. 


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine 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 (on SDPB most Thursdays at 7pm and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective for the week of February 2, 2025
“Teen Mental Health” 
By Jill Kruse, DO
The most recent survey of teen mental health by the Centers for Disease Control in 2023 revealed that 20.3% of adolescents in the United States have been diagnosed with a mental health condition. This reflects a 35% increase since 2016. The survey also found that 40% of teens reported persistent feelings of sadness or hopelessness, 20% seriously considered suicide, and, tragically, 9% attempted suicide.
These statistics should alarm any parent or grandparent of a teenager. As the mother of a 12-year-old and a 14-year-old, I often think about my children’s mental health and how to best support them. They are growing up in a world far different from the one I knew. Today’s teens face the challenges of social media, cyber bullying, academic pressure, and the struggle to fit in with their peers, all while navigating the changes of puberty.
Like every parent, I want my children to be happy, resilient, and safe. The first step is creating a space where they feel safe sharing their thoughts and feelings. Listening to them without immediately jumping in to solve their problems or dismiss their emotions is a crucial skill for parents to practice. Taking the time to talk and ask open-ended questions about how they feel can make a significant difference. What might seem minor to an adult with years of experience and perspective can feel overwhelming to a teenager. It is essential for our kids to know we are here to support them, no matter the size of the problem.
Another key parenting strategy is modeling good self-care and emotional regulation. That can mean working on improving our own mental health.  Showing teens how to be kind to themselves and handle life’s setbacks teaches them invaluable lessons. Mental health is not a one-time fix; it is a lifelong process. Adolescence is the ideal time to equip teens with healthy coping strategies. Teaching them how to handle stress and overcome failures prepares them to become thriving, well-adjusted adults.  
Parents should also trust their instincts when something feels off. If your teen shows a sudden drop in grades, stops enjoying activities they once loved, or seems persistently sad or angry, it’s time to seek help. If teens become more withdrawn or secretive, having a discussion about your concerns is warranted.  Resources like pediatricians, school counselors, and therapists can provide support and guidance.    
As a mother, I am committed to walking this journey alongside my children, every step of the way. Together, we can navigate the challenges, celebrate the victories, and build the tools they need for a happy, healthy future. 
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.

Prairie Doc Perspective Week of January 26th, 2025
“What can we learn from the dying?”
By Kelly Evans- Hullinger, MD
For the last five years, I have had the great privilege of serving my local health system as Medical Director for Home Hospice. Every week I sit in a meeting with the multidisciplinary caretakers on this team – the nurses who provide the great majority of the hands-on care, social worker, pharmacist, dietician, and pastor. We discuss all the patients currently under our care and discuss how we can improve each patient’s suffering and maximize their quality of life.
The patients we care for on home hospice are those we believe to be at the end of life. Some are actively in the dying process; others are stable, still going about their lives, but have a terminal disease with a high likelihood of death in the next six months. On home hospice, most patients either stay in their own home with help from a caretaker, often a family member; or they might choose to reside in a care facility where they can get more extensive needs met.
Our nurses and other staff get to know these patients and their families extremely well, and I truly enjoy hearing our patients’ stories relayed. I don’t always get to meet the patients cared for by our team, as most continue to stay under the care of their primary care providers while on hospice. But even when I am hearing their stories second hand, a theme stands out as a common sentiment of our patients - the desire to reflect on their lives.
Patients facing their own deaths want to talk about their lives. Our staff frequently tries to facilitate what they call a “life review” in which a patient can openly talk about their childhood, family, career, service, and sometimes their regrets. This is therapeutic for the dying patient and their loved ones. Even some patients with dementia, with no memory of recent years, can delight in recalling a story from their childhood, looking through old photographs, or listening to music they once loved.
I have recently thought about this particular human need – to reflect and remember one’s life. I take this as a reminder to both seek those stories from my own loved ones (gosh, I wish I had asked my grandmother more questions about her life) and, perhaps, to tell and write about the things in my own life I would want to be remembered after I am gone. For if there is another thing I’ve learned serving patients on hospice, it is that my death is also inevitable; but, I think, life’s finality is what gives it beauty and meaning.
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 on streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm.
​

Prairie Doc Perspective Week of January 19th, 2025
“Its Here”
Debra Johnston, MD


Lately I’ve been reminded of a blockbuster movie from my youth. It contains a scene that even those who never saw the film are likely to recognize. A sleeping family is jolted awake, and from the foot of the bed the young daughter sings “they’re here!” 


One might wonder why I’m thinking so much about Poltergeist. That quote started ringing in my brain during our last monthly clinic meeting, when our lab director reported on the previous day’s influenza statistics. Nearly 90% of the tests were positive. Respiratory viruses may not seem like a natural comparison to malevolent ghosts, but they’re here, and things are likely to get worse before they get better. 


Last season, there were over 20,000 confirmed cases of influenza in South Dakota. Over 800 people were hospitalized. Nearly 50 died. 


When I diagnose someone with influenza, I warn them to expect misery. They will likely have fevers, body aches, exhaustion, and of course cough. Some people are out of commission for only a few days, others for two weeks. Some people can barely get out of bed, and some people just feel a bit run down. 


The flu shot helps, but it is far from perfect. People who get the shot can still get influenza. Generally it is between 40 and 60% effective at preventing infection. Still, those who had the shot and get sick anyway are significantly less likely to be hospitalized. So long as influenza is circulating you should still get your shot. It isn’t too late even if you already had influenza, as the shot contains 3 different strains. 


Of course, things like washing your hands, not touching your face, and avoiding sick people are also useful. It can be hard to distinguish one respiratory virus from another. 


Influenza tends to strike more suddenly than many others, but symptoms have significant overlap. Testing is the best way to distinguish whether or not your illness is influenza. Influenza is also one of the few viruses for which we have specific treatments, so getting that answer can be useful. Treatment is generally used for those at higher risk, such as young children, people over 65, those who have chronic health conditions or are pregnant. Importantly, medicine should be started within the first 48 hours of illness. 


So what can you do if you get sick? First, stay home! Get lots of rest. Drink lots of fluids. Fever reducers and over the counter pain medications can help you be more comfortable. Pseudoephedrine can help the congestion. Guaifenesin can help thin the mucous. Dextromethorphan or honey can help soothe the cough. 


Finally, watch out for signs that you are getting sicker instead of better. Influenza can lead to ear infections, sinus infections, pneumonia, and things that are even more serious, like bloodstream infections, inflammation of the heart or brain, and kidney failure. If something doesn’t seem right, get it checked out.


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 streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

Prairie Doc Perspective Week of January 12th
“The Seven Warning Signs of Cancer”
By Andrew Ellsworth, MD


Recently I was working with my son’s scout troop to help them achieve the personal fitness merit badge. This merit badge has many requirements including discussions about healthy habits, diet, and exercise. The scouts keep track of their exercise over a 12 week period and log everything they eat over a few days as well. One of the discussions covers the seven warning signs of cancer.  


This is a simple list of concerning symptoms to watch out for and reasons to go see a doctor. Indeed, with each of these I am reminded of patients that caught their cancer diagnoses early enough to get the treatments they needed. While having any of these symptoms certainly does not mean someone has cancer, it would be wise to seek medical attention.  


One warning sign is a change in bowel or bladder habits.  These could be signs of colon or bladder cancer.  


A second sign is abnormal bleeding. Blood in the stool and blood in the urine are symptoms to get checked out soon.  Abnormal uterine bleeding, which may include heavy or irregular periods, and bleeding after menopause, deserve more attention as well. 


If you experience a sore that does not heal on the skin or in the mouth, or see changes to moles or other skin lesions, then these may be a third sign of cancer that warrant an examination and possibly a biopsy to evaluate for skin cancer.  


Abnormal lumps or bumps is a fourth sign. If you experience a breast lump or thickening or change in breast tissue, please get this checked out as it could be a sign of breast cancer. A lump in the testicle could be a sign of testicular cancer. Persistent swollen lymph nodes warrant further attention. 


Unintentional weight loss is a fifth reason to see your doctor. While efforts at a healthy diet and exercise are good reasons to lose weight, bad reasons can include thyroid problems, depression, diabetes, and cancer. 


Trouble swallowing or ongoing indigestion or heartburn is a sixth sign that could be a sign of cancer of the mouth, throat, esophagus, or stomach.  


Finally, a seventh set of symptoms to watch for include a chronic cough or hoarseness that persists for a month or more. These could be a sign of throat or lung cancer, and warrant further evaluation. 


This list could be longer and more detailed, and having any of these symptoms can often be caused by benign, common reasons that are nothing to worry about. However, it is important to see your trusted physician or other medical provider if you experience any of the above symptoms. Please, do not delay and wait for a symptom to pass on its own. Your body is giving you a chance to get evaluated and help yourself. Pay attention!


Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine 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 streaming on Facebook and SDPB), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. 

Prairie Doc Perspective for the Week of January 5th, 2025
“Let’s Get Moving!”
By Jill Kruse, DO    
As we start the New Year, many people are making resolutions and setting goals for the next 12 months.  One of the most common resolutions is to be more active.  At Prairie Doc, we want all of our viewers to be both healthy and happy.  This week, On Call with the Prairie Doc will be showcasing different ways people can incorporate movement into their lives.  There is truly something for everyone.  
Personally, I’ve explored a variety of activities with varying levels of success and competence.   Regardless of the activity, what has made many of these experiences memorable and enjoyable are the people I have met along the way.  Some of my most cherished friendships have formed through shared activities, proving to be just as beneficial to my mental health as any physical benefits of the activity itself.   
Let me share some of the more unusual ways that I’ve stayed active throughout my life.  In fourth grade, I joined the wrestling team.  I became the first girl in my school to do so.  I was not particularly good, ending the season with a 1-11 record.  However, I was proud of myself for trying.  By sixth grade, two other girls joined the team with me.  
In junior high I tried volleyball, and while I loved, but was not very skilled.  The place I did excel in was taekwondo.  I started when I was ten and earned my 3rd degree black belt while in college.  When I was in medical school, I still found time for activities and needed to try things that were the complete opposite of my school work.  I tried rock climbing, belly dancing, and fencing.  All activities that were outside my comfort zone, but quickly became welcome breaks from studying.  
In Brookings, we are blessed with a multitude of activities in the area to try.  I have participated in an adult kickball league.  I have also started curling with the Brookings Curling Club.  This game involves not only skill and strategy but a little bit of luck.  On Prairie Doc, viewers will get to see me doing my favorite exercise activity, aerial silks.  My medical residency training was in Baraboo, Wisconsin, the home town of the Ringling Brothers.  I always loved the circus and aerial silks allows me to feel like I have joined the circus, if only for a few moments.  
Finding the right activity may take some trial and error, but once you find something you love it will be worth it.  So, as you set your goals for the coming year, consider trying something completely different.  You may just discover an activity that brings you joy and a new community of friends along the way.  Until next time, Stay healthy and active out there!
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 on SDPB, 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.

Prairie Doc Perspective Week of December 29th, 2024
“Save and Preserve through movement”
By Carter Holm, RN
“Lack of activity destroys the good condition of every human being while movement and methodical physical exercise saves and preserves it”. Plato said that some 2300 years ago. It is not news to anyone that moving the body is the best way to stay healthy. But sometimes life gets in the way, whether in the form of a motor vehicle accident, a nerve condition like Guillain-Barre syndrome, or a health condition like a stroke, there are times in life when knowing that exercise is good for you is not enough. And it is during those times that physical therapy becomes crucial. 
My work in inpatient rehab places me directly in connection to a wonderful team of physical therapists, and I see first-hand the role they play in helping our patients overcome adversity. Strengthening the muscles is just one aspect of their jobs, they must also help the patients learn to adapt. For example, if an elderly patient has a stroke, in addition to helping the patient work on strengthening the affected side, therapists are tasked with optimizing the patient’s abilities, while helping them overcome their disabilities. They do this is tons of different ways, including introducing adaptive equipment, like walkers, canes, crutches, hemi-walkers, slide boards, etc.. They also help train patients in alternative lifestyle changes, sometimes the best way to overcome a problem is to find a workaround, and physical therapists are experts at problem solving with their patients, and coming up with safe and effective ways to help them improve.
Luckily, exercise is its own reward, and my patients almost always feel better, although a little worn out, after a good session. And this is because our body rewards itself with neurotransmitters following physical activity. Endorphins are released giving people that ‘runner’s high’ sensation, endorphins can relieve pain, reduce stress, improve mood and overall feelings of wellbeing. Working with physical therapists can cause a patient to release dopamine, the ‘feel good’ hormone, which causes improved mood, increased attentiveness, and can even improve memory and learning. Exercise also releases serotonin, which combats depression, improves sleep-wake cycles, and plays a role in digestive health. In my line of work we often talk about pre-medicating the patient, giving a pain medication before the patient needs to do something physically taxing. But it is striking how rarely we need to give pain medications after a patient finishes working with PT. Nature has taken care or that, by providing a built in system of pain relievers, mood improvers, and anti-depressants that accompany exercise.
Every patient is different, and so is the plan of care developed by the therapy team. If you or a loved one is dealing with a health condition that may require physical therapy, I want to be a calming voice or assurance, the therapist or team of therapists will customize a plan of care focused on the patient’s specific needs, that will help them adapt to changes, regain what they can, and improve the patient’s wellbeing. 
Carter Holm, RN is a Registered Nurse at Avera McKennan in Sioux Falls Specializing in inpatient rehabilitation. Holm is a Certified Rehabilitation Registered Nurse and works with patients through their rehabilitation from strokes, brain injuries, spinal cord injuries, and trauma. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook and instagram featuring On Call with the Prairie Doc® a medical Q&A show celebrating its 23rd season of health information based on science, built on trust, streaming live on Facebook most Thursdays at 7 p.m. central. 

Prairie Doc Perspective Week of December 22nd, 2024
“FDA Approval”
By Debra Johnston, MD


Most of my family dreads the thought of going to a museum with me. It really doesn’t matter what the museum is, or how interested they might be in the subject, they’d prefer to do something, perhaps anything, else. 


I recognize that I am the problem. I love museums. One of my early memories is of exploring the King Tut exhibition at the Chicago Field Museum, and being drug out by my exasperated parents long before I was ready to leave. I wasn’t done reading all that fascinating information. 


Perhaps this explains why my Apple News Feed often presents me with historical trivia. Recently, I encountered a description of a patent medication marketed well into the 20th century that almost stopped my doctor heart. This particular product was targeted to parents, promising a myriad of benefits from soothing their fussy infant to freshening his breath. I have no doubt those fussy babies stopped crying. The combination of alcohol and opioids is generally pretty sedating. It is also pretty dangerous, and some of those babies never woke up. 


It wasn’t until the Pure Food and Drug Act of 1906 that companies were required to specifically identify the presence and amount of certain ingredients, at least in products sold across state lines. Importantly, this law did not prohibit the sale of ingredients like cocaine, chloroform, or formaldehyde in over the counter medications. It simply said that if those ingredients were present, and the product wasn’t being sold in the same state where it was manufactured, the label had to say so. At least now those parents knew they were giving morphine to their children! 


This same act prohibited “filthy, decomposed, or putrid animal or vegetable” material in food products. Admittedly, this applied only to items transported from out of state. If your groceries came from your own state, you were on your own. 


Over time, amendments to that original law, court decisions, and new laws brought us to the expectations we as consumers have today: 
-That manufacturer claims about food and medication are true 
-That medications and medical devices are safe and effective
 -That we can find information about the potential risks and side effects of a treatment
 -That product labels are accurate 
-That common allergens are identified 
-That imported foods and medicines are held to the same standards as domestically produced products 
-That ongoing monitoring of products occurs 


Still, the system is imperfect. There aren’t enough inspectors, and there isn’t enough post-market testing. Changes in drug manufacturing processes have introduced risky chemicals that go undetected for years. Contaminated foods sicken and kill before they are identified and pulled out of the food chain. 


Concerningly, people are often unaware that many products aren’t regulated even to these imperfect standards. Herbal and nutritional supplements aren’t reviewed even for safety prior to sale. Most skin and hair care products are classified as cosmetics and can also be marketed without any FDA approval (sunscreen is an exception). 


History has important lessons to teach us. Maybe I should be dragging my family along to those museums after all.


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 streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.  

Prairie Doc Perspective Week of December 15th, 2024
“Plastic Surgery: Transforming Lives Inside and Out”
By Jill Kruse, DO


When many people hear the term plastic surgery images of Hollywood stars trying to fight back the effects of aging come to mind.  It is easy to assume that plastic surgeons just deal in vanity.  However, that would minimize everything that these talented surgeons accomplish with their scalpels.  The term “Plastic Surgery” comes from the Greek term “Plastikos” meaning “to shape or form.”  
Plastic surgeons work to form or change the outward appearance of people for a variety of reasons.  They work on reconstructing how a person looks after having a disfiguring injury such as a severe burn or major trauma.  They can also help with patients who have had an amputation.  The goal is to try to give the person the appearance closer to what they had prior to the injury or minimize the outward appearance of damage.  
For patients who were born with cleft lip and/or palate, plastic surgeons perform surgeries to close the defects in the lip and roof of the mouth that did not close properly prior to the patient being born.  These abnormalities can make eating and speech development difficult.  Plastic surgeons will often need to perform a series of surgeries to slowly repair and restore the appearance and function of the lips, nose, and mouth.  
Women who have suffered from breast cancer may elect to have surgeries to repair or replace the breast tissue that was removed in order to remove the cancer to save their life.  After major weight loss, many patients have excess skin folds that do not go away when the weight is lost.  The extra abdominal skin can hang down like an apron and chafe surrounding skin as well as get skin infections.  Plastic surgery can be performed to remove this excess skin.  
Whether for cosmetic or reconstructive reasons, the surgeon’s job is the same.  Their job is to help improve how someone feels about their appearance and improve function.  What may seem like a minor issue to a stranger could be the only thing that patient sees when the look in the mirror.  While we say beauty is only skin deep, many people have been teased or criticized for the way they look.  Plastic surgery can change this if the patient desires.  
The plastic surgeon can help change the outward appearance of a person to help them feel more confident and comfortable with their body.  The various applications of their skills are so numerous, that it is hard to list them all.  In the hands of a skilled plastic surgeon, the transformation goes far beyond appearances, helping patients reclaim their confidence, functionality, and quality of life.  Thus, plastic surgeons truly can transform lives both inside and out.  
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 on SDPB, 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.