By Debra Johnston, M.D.
 
Obesity affects approximately 40 percent of American adults, and I’ve been one of them for nearly as long as I can remember. There are innumerable schemes that promise effortless, or nearly effortless, weight loss, and many diets that claim to be the best approach. 
 
Most of us recognize that if something seems too good to be true, it probably is. It’s much simpler to identify the miracle potion advertised on our social media feed as snake oil, than it is to sort through all the conflicting and seemingly changeable advice on what makes a healthy diet. Should we be cutting out fat, or cutting back on carbs? Is there a particular combination of foods or spices or supplements we should be eating to be slim and trim and healthy?
 
In truth, obesity is a tenacious disease, and many people successfully lose weight with any of a multitude of diets. Many people are also unsuccessful with those very same diets. 
 
Between my second and third years of medical school, I had a month without work or structured academic obligations to study for the important Step 1 board exam. Every morning, I would get up and exercise for an hour before I hit the books. I would prepare healthy meals, and snack on carrots and celery while I read. I was determined to lose some of my excess pounds and set a good example for my future patients.
 
At the end of that month, I’d lost two pounds. This was not at all what I had anticipated. I was frustrated, angry, and hurt. I felt that my efforts had failed. I felt that “I” had failed.
 
Let’s think about what “success” means. Although we may want to get down to our ideal body weight, very few people with obesity actually achieve that goal, especially without surgical help. From a medical perspective, loosing just five to ten percent of your body weight improves your health in a variety of ways. More importantly, the lifestyle changes that can lead to that weight loss have health benefits of their own. 
 
With the wisdom of nearly 30 years in medicine, I realize that by focusing on the scale, I hadn’t seen something even more important. Eating fruits and vegetables reduces the risk of heart disease, strokes, cancer, and many other chronic diseases. Daily exercise strengthens hearts and bones. In short, even without weight loss, exercise and a healthy diet are good for you.
 
Experts may debate the nuances of the “best” diet, but there are some fundamentals which can bring success with or without the loss of pounds. Eat a variety of produce, and lots of it. Watch the sodium. Minimize processed foods. Avoid added sugars and trans fats. Your diet isn’t something you are “on” or “off”. Your diet is the way you nourish your body every day, and success is the choices you make that support your health.
 
Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Jill Kruse, D.O.
 
Daylight savings time has just ended and now everyone has had the chance to “fall back” to standard time. While many people enjoy that extra hour of sleep that comes each fall, 63 percent of Americans say that they would support the elimination of seasonal time changes and there are some health issues to consider. The American Academy of Sleep Medicine also supports this stance due to the sleep disruption that occurs related to this biannual change.

Our body has its own internal clock called the circadian rhythm which helps set our internal sleep-wakefulness cycle. This cycle is sensitive to light, especially daylight. It is responsible for the production of melatonin and serotonin in our brain. Melatonin helps synchronize our sleep-wake cycle to our environment. Unfortunately, bright lights and anything with a back lit screen – phone, television, tablet, or computer - suppresses your body’s production of melatonin and can adversely affect your sleep quality.  

A study completed in 2020 by the National Institutes of Health found that 150,000 Americans experience negative health effects related to daylight savings time changes, mainly with the “spring forward” changes. The four most prominent health conditions with increased risks of occurring in the weeks following the time changes include the following: cardiovascular disease (including increased risk of heart attacks), increased risk of injuries, worsening of mental or behavioral disorders, and flares in immune related diseases.

What can you do to minimize your risk? Try to gradually prepare the body by slowly adjusting your sleep cycle before and after the time change to make the change less abrupt. One thing that will help is by slowly changing your bedtime in 15 to 30-minute increments each night until you get to your new desired sleep and wake times. In the hours leading up to bedtime, try to avoid bright lights and anything with a back lit screen. 

Going outside in natural daylight, especially in the morning, can help reset your internal clock. Light exercise in the morning or afternoon can help lower stress hormones and promote better sleep later that evening. Try to keep a bedtime routine and work to get seven to eight hours of sleep each night. A consistent schedule for when you go to bed and when you get up is much easier on your body and its internal clock. 

So, after you have changed your smoke detector batteries and reset all your clocks, remember to work on gently helping your body reset its own internal clock with healthy choices. This will help you transition to the new time schedule with ease. Your body will thank you.   
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Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Andrew Ellsworth, M.D.

A woman had been feeling short of breath for several weeks. Physical activities which had previously been easy for her were becoming a chore. In fact, simply laying down resulted in difficulty breathing. She had gained some weight and her legs were swollen.

This woman was a patient of mine, and she was in heart failure. This doesn’t necessarily mean her heart was going to completely stop, but it was having trouble keeping up. For whatever reason, her heart struggled to pump, and fluid was building up in her body adding more strain. It was a vicious circle, and it was getting worse. 
After listening to her story, I completed a physical examination, and ordered a few tests. Then, I talked to my patient about heart failure. We agreed she would take medication to help her heart pump better and fluid pills to help decrease the swelling. 

Heart failure is often triggered by some type of damage affecting the heart’s ability to pump. Heart damage might result from a sudden heart attack blocking blood flow in an artery of the heart. Sometimes damage occurs slowly, blocking blood flow due to the gradual buildup of cholesterol known as coronary artery disease. Other causes of heart failure may include faulty heart valves, an irregular heart rhythm, high blood pressure, smoking, diabetes, or obesity. 

Myocarditis, or inflammation of the heart, can also lead to heart failure. Often temporary, myocarditis can be the result of a virus or other infections, drugs, chemicals, and other diseases.  

Sometimes the reason for heart failure may be a lung problem. The heart pumps blood through the lungs and back to the heart, then out through the body. So, if the blood is not flowing through the lungs efficiently, the heart can have trouble. Thus, a blood clot in the lungs, smoking, vaping, cancer, infection, or other lung problems can also lead to heart failure. 

I recently saw my patient again, and she feels great. She rarely experiences shortness of breath anymore. She faithfully takes the medications and keeps an eye on her weight and her diet, but other than that, she does not think much about it.
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If you are experiencing increased shortness of breath with activity, swelling of the legs, an unusual increase in weight, increased fatigue, chest pain, or if you feel like your heart is beating too quickly or not in a regular manner, please see your doctor. Your heart works hard so you can keep up your activities. Please make sure you return the favor. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

Prairie Doc® Perspectives for week of October 24, 2021
By Jill Kruse, D.O.
 
When we think of Henry VIII most of us envision an oversized man with multiple wives, a bitter personality, and a propensity for beheading his enemies. A lesser-known fact is that he suffered with chronic leg sores the last twenty years of his life. Living in a time before antibiotics, anesthesia, and proper wound care, this king endured excruciating ulcers with no cure available. Would history have been different if his sores could have been treated with today’s advanced wound care?  

As a young man, Henry was athletic and active. Unfortunately, he had multiple sports injuries, and one which occurred in January 1536 seemed to initiate chronic wounds. He was thrown off his horse at a jousting tournament and his fully armored horse landed on top of him. Reports from the time state he was unconscious for two hours and had several leg bone fractures. Initially he appeared to heal, but he later developed ulcers in his legs, and historians note at that point his personality changed.

His doctors lanced and drained his ulcers, but they never fully healed. There is much modern speculation as to what caused his sores. Likely the injury was the source, but his love of wearing garters around his calves also likely increased his risk for developing varicose veins and blood clots in his legs. His activity level dropped due to his pain and his weight increased. He was at increased risk for type 2 diabetes, high blood pressure, and high cholesterol. All these things together made him susceptible to leg ulcers from blood vessels that did not work well making it difficult for his initial wounds to heal.

If I were transported back to Henry’s court with the limited medical knowledge of that time, there would be little I could do to help him. However, if we were to transport Henry to modern day, we would observe his veins and arteries with ultrasounds. We’d use CT scans to see if infection had gone into the bone. We could determine his ankle-brachial index indicating how well his blood is flowing. And Henry would be given anesthesia while we probed and debrided the wounds. We could treat the root of the infection with antibiotics. And devices such as vacuum assisted closure (wound VAC) and hyperbaric oxygen chambers could help close sores that were left untreated in his time. 

History may have looked very different if King Henry had not fallen from his horse launching a cascade of medical problems. Today, we can learn from his misfortune and take advantage of current wound care treatments which avoid unnecessary suffering, and possibly…change the course of our history.

Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                   

​Prairie Doc® Perspectives for week of October 17, 2021
By Debra Johnston, M.D.
 
In medicine, we routinely ask people about their family health history. Knowing that your mother had diabetes, or that your grandfather battled alcoholism, helps us be alert for health conditions to which you may be predisposed. Sometimes, though, what is revealed by those histories isn’t a medical problem, but a family tragedy.
 
Earlier in my career, my older patients commonly told me that their grandmother, or even their mother, died in childbirth. Today, it is all too easy to forget just how perilous it can be to be pregnant. In the early 1900s, nearly one mother died for every 100 live births. Even today, approximately 800 women around the world die from pregnancy related causes EVERY DAY, and a woman’s lifetime risk of dying as a result of pregnancy hovers around one in 200. In some countries, that risk is around one in 20. In others, it is less than one in 10,000. Infants, and their older siblings, face a grim future without those mothers. Many infants don’t survive to their first birthdays. Older siblings have an increased risk of death before age five. 
 
Although most maternal deaths occur in the developing world, where access to trained birth attendants or clean birthing conditions is limited, the United States ranks disturbingly high among developed nations. In fact, our rates were higher in 2017 than in 2000. A woman’s risk of death varies with her age, education, socioeconomic status, and most dramatically, race. Black women face a risk of pregnancy related death more than triple that of white women, and indigenous women face approximately twice the risk. Wealth, health, and education are not enough to close these gaps. Serena Williams and Beyonce have both spoken publicly about their own life-threatening pregnancy complications. More research is needed to understand and address these disparities, and maternal mortality rates in general.
 
Sometimes death is caused directly by a pregnancy: bleeding, eclampsia, embolisms of amniotic fluid into the mother’s lungs, infections. Sometimes death results from the added stress of pregnancy combined with another disease. Weakened hearts, for example, may not meet the additional demands of pregnancy and delivery. Historically, influenza has killed disproportionate numbers of pregnant women. My own great grandmother was one of them. Similarly, a pregnant woman who contracts Covid is 20 times more likely to die than one who doesn’t. Women who struggle with depression or substance abuse may fall victim to overdoses or suicides triggered by the stress of pregnancy and caring for a newborn. Domestic violence may start or escalate during pregnancy, and too many women die at the hands of current or former partners.
 
The good news is that nearly two thirds of maternal deaths are thought to be preventable. We simply need the societal will to make changes and save lives.
 
Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

Prairie Doc® Perspectives for week of October 10, 2021
By Kelly Evans-Hullinger
 
In the last couple years, I have developed a renewed awe and appreciation of our scientists around the world who work for entire careers to advance science and medicine in their laboratories and beyond. One such scientist is Dr. Barry Marshall. 

Marshall is an Australian physician scientist, who in the early 1980’s along with his cohort Dr. Robin Warren, initiated a paradigm shift in the world’s understanding of gastrointestinal disease when they discovered the bacterium Helicobacter pylori. Prior to that, peptic ulcer disease was thought to be due entirely to lifestyle factors and stress. Marshall and Warren were ultimately able to show that H. pylori played a major role in maybe 80 percent of ulcers worldwide at that time.
 
H. pylori is an unusual bacterium in that it can grow and thrive in a highly acidic environment like the stomach, and for that reason it was difficult to grow in culture. It was found to be widespread around the world, partly due to poor water sanitation systems. The bacteria can invade the surface of the stomach and duodenum, causing inflammation of the stomach or gastritis, ulcers, and rarely, stomach cancer. We now know that if H. pylori is a causative factor in a patient’s stomach ulcers, eradication of the bacteria is an essential part of curing the patient’s disease. 

Now here is the greatest piece of this science story. At the time Marshall and Warren made their discovery, the worldwide scientific community was skeptical that H. pylori was an important factor in peptic ulcer disease. H. pylori did not grow in mouse or rat stomachs, so there was not a good way to study it in a traditional lab. Famously, in 1984 Marshall underwent biopsy of his own stomach, proving he did not carry the bacteria nor have any stomach disease. Then, he drank a beaker of H. pylori culture broth. What followed was an acute gastric illness, and after 2 weeks he had another biopsy showing proven H. pylori infection and gastritis. He then cured himself with an antibiotic and bismuth.

After Marshall’s case study was published, much further research ensued. Today, we can detect H. pylori in our patients with several noninvasive testing strategies, and if detected treat them with a combination of antibiotics and acid reducing medication. Surgery to remove a portion of ulcerated stomach, commonplace prior to this discovery, is now incredibly rare in the developed world. In 2005 Marshall and Warren were awarded the Nobel Prize in Physiology for their detective work.

I wonder, had Dr. Marshall not risked his own health for his experiment, would our understanding have shifted so quickly? Maybe, maybe not, but the story sure wouldn’t be as captivating.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

Prairie Doc® Perspectives for week of October 3, 2021
By Andrew Ellsworth, M.D.
 
Imagine yourself in a blizzard so thick and cold and blinding that you could not see your hands right in front of you. Such blizzards were common 150 years ago on the upper great plains. Without much for houses and trees, the wind blew the snow with such force that the little ice crystals were more like little knives making it hard to keep one’s eyes open even if there was something to see. Thus, to get safely from the house to the barn, farmers often hung a rope between the two, to not get lost. It was literally a lifeline. Otherwise, one wrong turn and perhaps nothing would stop you from wandering across the frozen prairie. 
 
As a sixth generation South Dakotan, I cannot imagine some of the hardships my forefathers had to endure to survive. How did they feed themselves when the rains did not come, or when the fires did? How did they heat the house when the wood or coal had run out? How did they fight the boredom of months in a single room, not to mention the isolation?
 
There are many who still face those questions. Farming still carries great risks with drought, floods, or financial stress. There is the chance of failure, of losing the family farm, of choosing the wrong crops or the wrong time to plant in unpredictable markets with trade wars, changing weather patterns, and other factors. One little mistake may ruin a million-dollar piece of equipment or result in a lifetime disabling accident. 
 
Given these pressures, it may not come as any surprise that farming has one of the highest suicide rates in the nation, which has been rising over the last decade. Of course, you do not have to be a farmer to face financial, physical, or mental pressures that may contribute to feelings of helplessness, failure, loss of hope, and depression. You may be easily irritated and feel like sleeping all day, lack energy, and no longer enjoy what you once did.  
 
If you or someone you know needs help, please reach out. Hotlines available for those in crisis or for those looking to help someone else are the National Suicide Prevention Lifeline 1-800-273-TALK (8255) and the Avera Farm and Rural Stress Hotline at 1-800-691-4336.
 
Just as that rope was a lifeline from the barn back to the farmhouse years ago, a simple phone call can be a lifeline for those in need of help today. No matter your occupation or stage of life, please reach out if you need help. Even if it feels like you are in a blinding blizzard with nowhere to go, reach out and take hold of that rope, that lifeline, and make that phone call. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.  

​Prairie Doc® Perspectives for week of September 26, 2021
By Matthew Stanley, D.O.
 
Alcoholism, and addiction overall, isn’t a character flaw, or a weakness of self-control. It’s a disease. And, if you are like most of us, you’ve probably been affected by it. Maybe you struggle with alcohol consumption yourself or have a friend or family member who does. I rarely talk with anyone who doesn’t have a personal story about how addiction has affected their life.
 
In fact, about 14 million adults have an alcohol use disorder and there are about 95,000 alcohol related deaths every year in this country.
 
Unfortunately, we don’t think of it like any other medical illness, so we don’t usually talk to our primary care doctor about it. But that is one of the best places to start the conversation, during your yearly checkup, when you’re talking about health goals it is okay to say, “I think I have a drinking problem.” 
 
Some of the warning signs to look for in yourself or a loved one include sacrificing family bonds for your addiction such as missing a child’s ball game, concert, or graduation. Things that you were once passionate about fall by the wayside. You’re fatigued and foggy; barely able to get up in the morning. You have cravings for the substance. You’re counting down the time until you can get off work and have a drink. You are in danger of losing your job or important relationships, or you’ve gotten in trouble with the law. You tell yourself and others that you could easily quit and will; but you never do.
 
By starting the conversation, you will have a clearer path toward the help you need. Your doctor can guide you to outpatient counseling or support groups, or perhaps treatment at a facility.
 
There is overlap between behavioral health and addiction in terms of risk factors. Much like behavioral health, addiction has an approximate 60 percent genetic hereditability. Mental health conditions and a history of trauma put you at greater risk of addiction. And like so many health conditions the earlier you start the worse the disease. Those who begin drinking before age 15 have a five times greater risk of developing an alcohol use disorder.
 
I’ve spent my career talking about and treating addiction. I see that the conversation is changing, and I’m heartened by it. There is a rising social consciousness about addiction. More and more we’re willing to have candid and productive conversations about it.
 
The next time your doctor asks you about alcohol consumption, take that as a prompt to have an honest conversation.
 
Matthew Stanley, D.O., a psychiatrist in Sioux Falls, South Dakota is a contributing Prairie Doc® columnist and guest host this week on the Prairie Doc® television show. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central. 

​Prairie Doc® Perspectives for week of September 19, 2021

By Kelly Evans-Hullinger, M.D.
 
It is September, fall is in the air, and what we might call “respiratory season” is nearly upon us. Respiratory season refers to the colder months in which we spend much of our time indoors, maybe October through March. Normally, this season correlates with when we see high rates of typically seasonal respiratory infections such as influenza and respiratory syncytial virus or RSV.

Living through the COVID-19 pandemic has given us knowledge we can use to greatly decrease the spread of all respiratory infections. During the 2020-2021 respiratory season, rates of influenza were at historic lows in South Dakota and across the country due to the measures we took to decrease the spread of COVID-19. So, what are the lessons learned?

First and foremost, we should learn that when we are sick with respiratory symptoms, we should avoid spreading our illness to others. It remains essential that anyone experiencing symptoms of cough, fever, or cold symptoms be evaluated and consider testing for COVID-19, influenza, and possibly other infections to ensure avoidance of spread.

Second, if you are sick, even if you have tested negative for COVID-19, try to avoid spreading germs to others. We should especially avoid contact with those most vulnerable to respiratory illnesses – this includes the very young and the very old and those who have suppressed immune systems or chronic lung disease. If you must be around others, keep distance when possible, cover your mouth and nose when coughing or sneezing, and at best, wear a mask to keep those respiratory droplets out of the air. I now cringe to think of years past, when I would power through my common colds and see patients without a mask. I know I can do better in the future.

Finally, vaccines remain one of our best tools for infection prevention. Of course, vaccination against COVID-19 is crucial and has proven to be highly safe and effective. But let’s not forget other respiratory vaccines. It is time to think about getting your annual influenza vaccine. And if you are 65 years old or more, or if you have any medical problems increasing your risk for bacterial pneumonia, you should ask your healthcare provider about a pneumococcal vaccine.

We have the tools to keep ourselves and others healthy during the respiratory season. I, for one, hope that lessons learned during a respiratory viral pandemic might help us all do better in the future.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

​By Debra Johnston, M.D.
 
What I remember most is the silence.
 
She was 19 years old, just starting her first semester of college. She had been transferred to our level 1 trauma center, intubated and in a medically induced coma. I was a third-year medical student, being introduced to the realities of medicine. Our team was clustered around her in the procedure room adjacent to the ICU while my senior resident inserted the central line we would use to quickly administer large volumes of medicine and fluids. 
 
ICUs can be busy, noisy places. This ICU was a large open room, with rows of beds surrounded by all the equipment needed to care for critically ill and injured patients. The sounds of machines whirring and beeping, of doctors and nurses and all the support staff, accompanied us in that little windowless procedure room.
 
The neurosurgery team solemnly filed through the door, eyes grim. They’d reviewed her CT scan. The pressure of the blood accumulating inside her skull had forced the base of her brain downward, into the space usually occupied only by the top of the spinal cord. We stared at each other in silence. We’d already lost the battle.
 
During the next few days, I watched her 20-year-old sister support their parents as we walked through the process of declaring brain death and deciding on organ donation. Other than the silence, the sister’s grief, and her courage, are my most potent memories.
 
Over the years, I’ve seen many lives irrevocably altered by brain injuries. Children thrown from their bicycles. Soldiers caught in blasts. Women battered by their partners. Seniors who slip and fall. Some patients fight to regain skills that were once effortless. Some succumb to their injuries or the consequences. The lucky ones sometimes don’t even realize how close they came to having their lives upended.
 
Our ability to help has improved significantly in the nearly 30 years since I stood at that young woman’s bedside. People survive injuries that would have previously been fatal. People recover enough to rejoin the community, instead of finishing their days in nursing homes. Nevertheless, too many still die, over 50,000 Americans every year. Nevertheless, survivors spend months relearning basic skills with the help of skilled therapists. Nevertheless, millions live with varying degrees of disability, despite aggressive rehabilitation.  
 
As with so many things, the best treatment is prevention. Buckle your children into their car seats. Use your seatbelt. Wear your helmet. Keep the guns locked up. Learn how to reduce the risk of falls, especially for the young, and the old. It’s much better to protect that fragile brain, than to try to put it back to rights.   
 
Debra Johnson, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.