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PerspectiveBased on Science, Built on Trust
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Prairie Doc Perspective Week of August 17th, 2025
“Why Pelvic Health Matters: More Than Just Kegels” By Dr. Patti Berg-Poppe and Dr. Staci Wietfeld In our research and clinical practice experiences, a common theme emerges from people living with pelvic floor issues -- “I wish someone had told me about this sooner.” Through interviews and conversations, we’ve documented the stories of individuals who didn’t know what questions to ask, didn’t realize their symptoms were treatable, and often assumed they were alone. In her practice, Staci sees these realities unfold in the clinic every day, as both male and female patients arrive with frustration, confusion and a long history of being told that their concerns are normal, inevitable or simply something to live with. Pelvic floor disorders such as urinary incontinence, constipation, pelvic pressure, pain with intercourse and pelvic floor dyssynergia (poor coordination) are more common than most people realize. These symptoms affect millions of adults. Nearly one in four women and one in eight men in the U.S. will experience some form of pelvic floor dysfunction in their lifetime. Yet these issues are often dismissed, hidden or normalized. Although not uncommon, we want to emphasize that dysfunction in the system is not normal. It is treatable. Conversations around pelvic health often begin only after childbirth, surgery or the slow accumulation of symptoms that have significantly affected quality of life. By that point, the affected person is often dealing not only with physical discomfort, but with years of self-doubt or embarrassment. The pelvic floor is a group of muscles that sits at the base of the pelvis. These muscles are responsible for more than most people are ever taught. In both men and women, the pelvic floor supports the bladder, bowel, abdominal and reproductive organs. It helps control continence, allows for sexual function, and plays a role in basic breathing, posture and core stability. Despite all of this, most people grow up never learning about their pelvic floor, how it functions, or how to care for it. This lack of awareness isn’t just a missed opportunity for treatment; it’s a missed opportunity for prevention. Every human has a pelvic floor. Pelvic health should be part of basic health education, not a niche topic reserved for specialists. Young people deserve to understand how their bodies work, and that includes the pelvic floor. Learning about healthy habits, such as avoiding excessive straining, practicing coordinated breathing during physical exertion, and developing strength, coordination and flexibility throughout the hips and core, can make a meaningful difference later in life. And for those planning for pregnancy, knowledge of pelvic floor function before and during pregnancy can support smoother recovery and reduce complications down the line. Gaining understanding of how the pelvic systems change with age, after surgery, or with the hormone changes of peri- and post-menopause also offers people a chance to create change and retain optimal function. Kegels are often the only pelvic health advice people hear, but the solution is rarely that simple. Some individuals need strengthening; others need help learning to relax and coordinate pelvic floor muscles properly. Pelvic health is not a “one-size-fits-all” issue, and that’s why education before symptoms emerge is so important. When problems do arise, they’re worth bringing up. Leakage, pressure and pain are common, but they’re not normal or untreatable at any age. Pelvic health physical therapists and other providers trained in this area can offer effective, individualized care. But even better is helping people know enough to ask questions earlier, build healthy habits sooner and prevent dysfunction before it starts. Pelvic health matters. And the earlier we begin talking about it, the better. Patti Berg-Poppe is a professor and chair of the Department of Physical Therapy at the University of South Dakota. Her research focuses on pelvic health, including postpartum recovery and pediatric pelvic floor dysfunction, as well as motor control and learning in special populations. She has led interdisciplinary studies on the effects of intrapartum pelvic trauma on sexual function, return to participation and family well-being and has published on exercise interventions for conditions like diastasis recti and dysfunctional voiding in children. Staci Wietfeld is a board-certified orthopedic clinical specialist and certified pelvic rehabilitation practitioner. She specializes in treating complex musculoskeletal conditions and pelvic floor dysfunction, integrating advanced manual therapy and patient education to promote recovery and well-being. In addition to her clinical practice with Avera Health Systems in Sioux Falls, South Dakota, she contributes to research and public education on pelvic health and physical therapy. 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 August 10th, 2025
Running and Knee Pain: Debunking the Myths with Science By Matt Dewald, PT, DPT You’ve likely heard -- maybe even from a medical professional -- that “running is bad for your knees.” But robust scientific evidence, including X-rays, MRIs, population surveys and long-term data, tells a different story: recreational running doesn’t increase the risk of hip or knee osteoarthritis (OA). In fact, it may reduce it. Debunking the Arthritis Myth Despite popular belief, running isn’t a cause of OA. A 2017 meta-analysis in the Journal of Sports and Orthopaedic Physical Therapy found lower OA rates among recreational runners compared to sedentary individuals. More recently, Hartwell et al. (2024) surveyed 3,804 marathon runners and found no increased OA rates, even among those with decades of high-mileage training. Impressively, 94% reported no diagnosis of hip or knee OA, and many with more years and higher mileage reported less joint pain overall. The Osteoarthritis Initiative, a longitudinal study of nearly 4,800 individuals over eight years, adds further support. Runners showed no structural progression or narrowing in joint imaging, even among those with pre-existing OA. Interestingly, runners who continued to run were more likely to experience resolution of knee pain than those who didn’t. The Role of Metabolism in Joint Degeneration OA is increasingly understood as a metabolic condition rather than a wear-and-tear issue. Risk factors like obesity, high blood pressure, elevated cholesterol and insulin resistance, which are components of metabolic syndrome, can accelerate cartilage breakdown and raise the likelihood of requiring total knee arthroplasty (TKA). A large Norwegian cohort study (HUNT data) linked to the Arthroplasty Register found those with metabolic syndrome were significantly more likely to undergo TKA, even when adjusting for lifestyle factors. Similarly, a 2025 case-control study found that 68% of OA patients who had TKA met criteria for metabolic syndrome -- nearly double the rate of those who avoided surgery. Why Running Helps Recreational running addresses key metabolic stressors that contribute to OA. It reduces body fat and inflammation by lowering levels of harmful adipokines, which are hormones released by fat cells that promote cartilage damage. Running also boosts insulin sensitivity and helps regulate blood sugar, reducing the low-grade inflammation associated with metabolic syndrome. From a mechanical perspective, running supports joint integrity. Cartilage thrives on cyclical loading, and running supplies the ideal stimulus to help it stay nourished. Maintaining a healthy weight is also crucial; every extra pound of body weight adds roughly four pounds of compressive force to the knee with each step. Strengthening muscles and building bone density through running improves joint stability, reducing the risk of deterioration. Smart Training = Injury Prevention Running injuries are more often linked to training mistakes than to running itself. Sudden mileage increases, lack of strength support or ignoring warning signs are common culprits. To minimize risk:
Bottom Line Far from being a joint hazard, running can be a powerful protector, especially for those managing metabolic risk factors. It strengthens supportive structures, counters inflammation and may delay or prevent OA and even TKA. With thoughtful training, running can help preserve joint health for decades to come. Matt Dewald is a physical therapist who holds a position as an associate professor in the University of South Dakota’s Department of Physical Therapy. He also serves as director of the Sanford Health and USD Sports Physical Therapy Residency, where he treats runners. His research focuses on running injuries, and he serves as education chair of the Running Special Interest Group within the American Academy of Sports Physical Therapy. A dedicated runner himself, Matt starts most mornings on the move outdoors. 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 August 3rd, 2025
Breaking the Silence: Ending the Stigma Around Addiction and Mental Health By Dr. Melissa Dittberner In South Dakota and across the whole United States, addiction and mental health struggles touch every community. Yet far too often, people suffer in silence—not because help isn’t available, but because stigma keeps them from reaching for it. Stigma shows up in many forms. It’s the harmful comments we hear about people who use substances. It’s the judgment directed at those struggling with depression, anxiety or trauma. It’s even the quiet self-blame people carry, believing they should be able to “snap out of it” or that asking for help makes them weak. Social stigma is deeply embedded in our systems and culture. It can show up in the way medical professionals talk about patients, in media portrayals that dehumanize or in policies that punish rather than support. When people internalize these messages, they may avoid seeking care altogether—also known as label avoidance. They fear being labeled as “addicts” or “crazy,” and would rather struggle alone than face the shame and judgment that too often follows disclosure. This silence can be and is deadly. Addiction is a treatable health condition. Mental health challenges are human, not moral failings. But when stigma gets in the way, it cuts people off from connection, care and healing. So how do we fight it? We lead with compassion. We create spaces where people are met with dignity, not dismissal. We challenge our own biases and educate ourselves on the realities of addiction and mental health. We tell the truth: recovery is possible, and people are so much more than their struggles. At the University of South Dakota, the Department of Addiction Counseling & Prevention is committed to changing the narrative. Our students and faculty work to educate, advocate and care for people across the region—whether in treatment settings, prevention programs or community outreach efforts. To help make that shift, faculty members in the department are using a grant to provide prevention, harm reduction, treatment and recovery services for those individuals with substance use disorders who are involved with the courts. The $2 million grant will integrate:
Ending stigma won’t happen overnight, but it starts with all of us. We can speak up when we hear harmful language. We can be a listening ear. We can make room for people to show up exactly as they are—and meet them with respect. Let’s be a community where no one has to hide their pain. Let’s create a South Dakota where people feel safe to heal. Melissa Dittberner, or “Dr. Mo” as she is known to her students, is a professor in the Addiction Counseling & Prevention Department at the University of South Dakota. She has a Ph.D. in counseling and psychology in education, master’s degree in addiction studies and a bachelor’s degree in health sciences. She does research on college students’ substance use, pedagogy, addiction and harm reduction. Not only is she very passionate about drug and alcohol prevention, helping skills and Telehealth technology, she has also worked on many grants surrounding substance use disorders. Dr. Mo is also a certified prevention specialist. In addition to her work at USD, she’s also worked with communities across the state to create addiction prevention programs like Straight Up Care Telehealth and Midwest Street Medicine. 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 July 27th, 2025
Feeling Dizzy? How Physical Therapy Can Help You Find Your Balance By Matt Leedom, PT, DPT, NCS Have you ever stood up too quickly and felt the room spin? Or rolled over in bed and suddenly felt like you were on a merry go round you didn’t ask to ride? Maybe you’ve started to notice you feel a little unsteady when walking or need to hold onto furniture “just in case.” If that sounds familiar, you are not alone. And more importantly, you are not without options. Dizziness and balance problems are surprisingly common. These issues can develop after a cold, a minor head injury, or simply as part of the aging process. But despite how common they are, they are often overlooked. Many people chalk them up to aging or learn to “just live with it,” avoiding stairs, skipping favorite outings, or giving up activities they enjoy because they don’t feel steady. That is where physical therapy can make a real difference. And no, it is not just about stretching or lifting weights. Physical therapists who focus on balance and vestibular care can help identify the source of your symptoms and offer practical, personalized solutions. Let’s start with one of the most common causes of vertigo: Benign Paroxysmal Positional Vertigo, or BPPV. It sounds complicated, but the fix is often simple. In BPPV, tiny crystals in your inner ear float into the wrong place and start sending confusing signals to your brain. The result? Sudden, brief spinning sensations with head movement or changes in position. A trained physical therapist can perform a series of head and body movements called repositioning maneuvers to guide the crystals back where they belong. Relief is often immediate. But not all dizziness is BPPV. Sometimes it stems from vestibular system weakness, where the inner ear is not working properly. This can be caused by a virus, changes that come with age or for reasons unknown. Other times, balance problems are linked to neurological conditions like Parkinson’s disease or stroke, or to weakness and reduced movement after illness. Even changes in vision or sensation in your feet can throw off your balance. That is why careful evaluation is so important. A physical therapist will assess how your eyes, ears, brain and muscles work together to keep you steady. Then they will create a personalized plan to help you feel more confident and stable. This may include exercises to improve gaze control, strengthen your muscles, practice safe walking and retrain your sense of balance. Most importantly, therapy helps you rebuild your confidence. When you are afraid of falling or feeling dizzy, it is easy to stop moving. But that can make things worse. Physical therapy offers a safe way to stay active and regain control. You do not have to live in fear of the next dizzy spell or miss out on the things you enjoy. If you are feeling off balance, ask your doctor if a referral to a vestibular trained physical therapist is right for you. The path to steady footing might be closer than you think. Matt Leedom, PT, DPT, NCS, is a board-certified clinical specialist in neurologic physical therapy and an assistant professor in the Department of Physical Therapy at the University of South Dakota. He earned his B.S. in psychology from USD and his Doctor of Physical Therapy degree from Creighton University. Leedom’s clinical expertise includes the treatment of individual neurological conditions, including vestibular disorders. His research focuses on improving mobility and quality of life for individuals with Parkinson’s disease, with current projects exploring cognitive flexibility training and non-invasive brain stimulation to address gait and postural impairments. 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 the Prairie Doc Facebook page), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of July 20th, 2025
Spiritual Pain and Grief By The Rev. Kari Sansgaard, Avera@Home Hospice Chaplain – Sioux Falls, SD After nearly twenty years of parish ministry, I entered the world of health care, which, I learned, abounds in acronyms. My first clue was in chaplaincy training, known as “CPE” (Clinical Pastoral Education), the required education for most hospital and hospice chaplains. CNA, SoB (Shortness of Breath), PRN, HoH (Hard of Hearing), and a myriad of other acronyms are now part of my own vernacular. QoL (Quality of Life) is the ‘big’ one in hospice, sometimes called “comfort care.” When quantity of life becomes diminished, it’s all about quality. Dame Cicely Saunders, the founder of hospice as we know it, understood human suffering as a combination of physical, psychological, social and spiritual pain. She famously said the following: YOU MATTER BECAUSE YOU ARE YOU, AND YOU MATTER TO THE END OF YOUR LIFE. I suggest that all people are spiritual, where spirituality is defined as the source(s) of meaning and purpose that guide and encourage us. Spiritual pain, then, is part and parcel of being human. I describe it simply as anything that breaks your heart. A pet dies; a friend moves away; a family member becomes estranged; a dream is not realized; divorce, death, broken trust, and so on. In hospice, when death is impending, spiritual pain can lead us to ponder existential questions, such as the following:
In addition to supporting areas of spiritual pain, chaplains are curious about sources of meaning in our lives (our spiritual resources). In whom or what do you place our ultimate trust? What people, experiences, music, places and/or Higher Power enliven your spirit and ground you? Life review in this realm can lead to laughter, connection and peace. SPIRITUAL CARE IS NOT AN OPTIONAL EXTRA FOR THE DYING. -Dame Cicely Saunders When we are grieving, spiritual pain can be exhausting. We can move through anger, sadness, numbness and peace in the course of thirty minutes. How do we ‘do’ life with the emptiness we feel? We are not made to endure this suffering alone. Grief groups, clergy, therapists, good friends, music, books, podcasts and nature walks, are among the resources available to us. It is important, in all life chapters, to nurture our spiritual resources. When crises come, our spiritual grounding can buoy us. As you tend to your body, mind and spirit through in this complex and beautiful life, may your QoL be well. Pr. Kari Sansgaard, is an ELCA pastor who serves as Avera Hospice Chaplain at Daugherty House Prince of Peace and Touchmark All Saints in Sioux Falls. 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 July 13th, 2025
“The Implant and Surgical Approach Choices Every Cataract Patient Should Understand” By Vance Thompson, MD Introduction Few decisions in life are more impactful than the choice to undergo cataract surgery—and how to have it done. Because cataract surgery is so common, many patients don’t realize it involves important decisions that can affect their vision for the rest of their lives. Modern technology has introduced new options for how the surgery is performed and what type of lens implant is used. These choices matter. Before we explore the available options, it’s important to first understand what a cataract is and the role of the natural lens in our vision. The Lens of the Eye Behind the pupil sits the eye’s natural lens. When we’re young (typically under age 40), this lens is flexible and able to shift focus to help us read and see clearly at all distances. It also contributes about 20% of the eye’s focusing power. As we age, this lens gradually becomes stiffer—often starting in our 40s—leading to difficulty seeing up close. This is why people begin to need reading glasses or bifocals. Over time, the lens also becomes cloudy, reducing the quality of vision even with glasses. When this happens, it’s called a cataract. Cataract surgery is one of the most successful and common procedures in the world. It involves replacing the cloudy natural lens with a clear artificial lens implant. Lens Replacement Surgery: More Than Just Cataract Removal During cataract surgery, we remove the clouded lens and replace it with a new, clear one. Some lens implants restore clarity but still require glasses—often trifocals—to help patients see far away, up close, and at intermediate distances (like a computer screen). Other advanced lens implants do much more. They restore both clarity and a full range of vision, often giving patients the ability to read, work, and drive without glasses—similar to the visual range they had in their 30s. It’s important to understand:
Surgical Technique: Manual vs. Laser Lens Capsule Opening The natural lens is housed in a thin, clear membrane called the capsule—imagine a grape inside a grape skin. During surgery, the surgeon must create a round opening in the front of the capsule, about 5.0 mm in diameter, perfectly centered over the lens. This allows the lens to be removed and the new implant to be placed in the capsule. After surgery, the capsule naturally "shrink-wraps" around the new lens implant. This process, called capsule contraction, helps hold the lens in place for the rest of the patient’s life--and does this the best if the opening overlaps the edge of the implant for 360 degrees. Achieving this ideal overlap is a key to long-term stability of the implant. There are two main methods for creating the capsule opening:
Conclusion When considering cataract surgery—or elective lens replacement—patients should be informed about:
Vance Thompson, MD is an internationally recognized specialist in refractive cornea, phakic IOL and lens replacement surgery. He is the Founder of Vance Thompson Vision Sioux Falls, SD and the Director of Refractive Surgery. Vance Thompson Vision has grown to serve the mid and mountain west with nine locations. Dr. Thompson also serves as a Professor of Ophthalmology at the Sanford USD School of Medicine. As a leading international researcher, he has played a key role in the development of the most advanced technologies and techniques for both laser and implant vision correction. He has a passion for research and development of new technologies and has served as the medical monitor or principal investigator in over 130 FDA monitored clinical trials studying laser and implant surgery. Dr. Thompson is the immediate Past President of the American Society of Cataract and Refractive Surgery (ASCRS) a nd is also on the Executive Committee as Vice President of the International Intraocular Implant Club (IIIC) that was founded in 1966 by Sir Harold Ridley, the inventor of the Lens Implant that revolutionized cataract surgery and refractive lens exchange. In addition, Dr. Thompson has published numerous papers and book chapters and is co-author of the textbook Refractive Surgery. He has lectured and taught advanced laser and implant surgery to thousands of surgeons all around the world. 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 July 6th, 2025
“Motion is Lotion; the Importance of Movement” By Anthony P. Fiegen, MD Orthopedic medicine is truly a team sport; we have the opportunity to collaborate with nonsurgical professionals, including physical therapists, occupational therapists, athletic trainers, among others, to deliver comprehensive musculoskeletal care. While there are proven surgical options to help our patients where indicated, in many cases, patients are able to achieve pain relief and improved function with nonsurgical treatment options. Much of orthopedic surgical training is appropriately dedicated to the planning and execution of surgery, but it is also important to understand and recognize patients who present with conditions readily addressed without surgery and the accompanying risks of invasive procedures. It is also important to advocate the idea of prevention. A phrase that is often loosely spoken within our clinic is, “Motion is Lotion.” What does this mean? This is a simple phrase to express the importance of movement and activity, whether that be independent exercise, supervised or specialized therapy, or simply taking a walk outside. With inactivity, we naturally are at risk for muscle loss, obesity, and the many adverse health conditions associated with obesity. It is important to consider exercise and its many health benefits. More specifically, resistance training and cardiovascular exercise have been shown to have robust benefits to our overall physical and mental health and function. The National Institute of Health has been studying the effect of strength training for more than 40 years, demonstrating beneficial results in adults including maintained muscle mass, maintenance and improvement of mobility, and increasing healthy years lived. Not all resistance training is the same, however, the effects on improved function largely are the same. Resistance training promotes muscle strength and growth, simultaneously improving our overall cardiovascular health. Studies have demonstrated that our muscle mass peaks around the age of 35. Naturally, muscle volume and performance decline slowly until we reach the age of approximately 65 where muscle volume loss proceeds faster. However, this decline in muscle volume and strength is substantially slowed by resistance training. Dr. Fielding with Tufts University, an NIH-supported scientist, has studied resistance training at a molecular level. His research has suggested that the best recipe for improving physical function and avoiding disability is a combination of walking and resistance training, whether resistance be against gravity or moving weight. The list of research-proven benefits of resistance training is quite impressive. In addition to improved muscle mass and cardiovascular health, resistance training offers improved metabolism and promotes weight loss of adipose tissue, increased bone density potentially preventing fractures associated with aging and fragility, improved balance and coordination, and natural release of anti-inflammatory mediators. Outside of bone and muscle anatomy, being active and exercising has been proven to reduce stress, improve our mood and cognitive performance, boost our energy and libido, as well as provide a mean of self-confidence. Now understanding the many benefits of physical activity, where do we start? If you are looking for some help, reach out to your physician, a personal trainer, or other trained professionals such as a physical therapist or athletic trainer for guidance. The health benefits will not be immediately realized, but you will eventually notice an improvement in your mood, and perhaps many years from now, also an improvement in your overall physical health. “Motion is lotion.” Let’s get out and move! Anthony P. Fiegen, MD is a fellowship-trained orthopedic sports medicine physician specialized in treating conditions of the shoulder, hip, and knee at the Orthopedic Institute. In addition to a comprehensive sports medicine practice and joint preservation, he also performs joint replacement of the shoulder, hip, and knee. Dr. Fiegen grew up in Madison, SD. He attended South Dakota State University competing for the Jackrabbits’ men’s basketball team from 2009-2013. Prior to joining Orthopedic Institute in 2024, Dr. Fiegen completed orthopedic surgery residency at Mayo Clinic in Rochester, MN. He then went on to complete a sports medicine fellowship at Wake Forest University in Winston-Salem, NC, where he served as a team physician for the ACC Wake Forest football, men’s basketball, and baseball teams. 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 June 29th, 2025
“Know your Family Health History” Roberta K. Olson, PhD, RN Foundational education as an RN with a BSN from South Dakota State University provided a broad understanding of how our bodies function. One of the lessons that was high lighted over the years was the need to pay attention to changes, e.g., my two sisters needed total knee replacement and so did I; my paternal grandfather had a massive stoke and died at the age of 61 years in 1948 from what? It was never diagnosed. My father thought that his dad, who was a farmer, was too stubborn to get regular check-ups from a physician and probably had heart problems in addition to his high blood pressure. When I was diagnosed with elevated blood pressure in 2015. My only symptom was ocular migraines; I started taking blood pressure medication. Both of my parents had low (normal) blood pressure and when I was pregnant with our two sons, my blood pressure was consistently in the low normal range. At first, I thought that perhaps the blood pressure machine wrong but with further tests, I was diagnosed with hypertension. My blood pressure stayed elevated even with the daily medications that I took to keep the hypertension in check. In June 2024 my pulse slowly dropped to 34 (normal is 70-80/minute). On Thursday my primary care physician ordered an echocardiogram for the following Monday because my pulse was 40 bpm in the office. On Sunday night at midnight, I was awake, got up and measured my pulse. It was 34 bpm. I debated whether to wait 10 hours for the scheduled echocardiogram or call 911. I called 911. The ambulance came at 12:30 a.m. and I was taken for an assessment to the Brookings Emergency Department. Further assessment indicated that I was in a 3rd degree heart block and would need a pacemaker. A cardiac surgeon had accepted the request from the Brookings ED Physician. By 4:00 a.m. I arrived at the Avera Heart Hospital in Sioux Falls via ambulance. I was monitored the entire time by the EMT. Further assessment was done by the technicians and at 8:30 a.m. I was on the operating table with the cardiac surgeon ready to insert a pacemaker. I stayed one night in the hospital for observation and was discharged on Tuesday morning. We are fortunate in South Dakota to have responsive EMTs, competent MDs at all times in the Emergency Department, and Cardiac Surgeons ready to assist as needed at the Avera Heart Hospital. Following the “organ recital” discussion with my sisters, I learned that a third cousin who lived in Illinois and is four years younger than I am also had a pacemaker inserted a few years ago. Our grandfathers were brothers. Genetics in your family history is important to know and understand. Dwelling on every ache and pain is not necessary but know your body and changes in the usual patterns of wellness. Post pacemaker my blood pressure is consistently within the low normal range. Roberta K. Olson, PhD, RN earned her MSN in Nursing of Children at Washington University, St. Louis, MO and her PhD in Higher Education at Saint Louis University. She served in four academic institutions prior to returning to her alma mater and serving the last 20 years of her career as the Dean of Nursing 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 June 22, 2025
“Oral health is a gateway to general wellness” By Paul Meyer DDS MS For much of modern healthcare, dentistry has existed apart from the broader medical system. Patients commonly have separate providers for medical and dental care, and this division is reflected in insurance models, education, and even cultural perception. Yet biologically, this separation is artificial. The mouth is a central part of the body, and its health is intimately tied to overall well-being. Studies of centenarians—people who live into their 100s—have shown a correlation between good oral health and longevity. While flossing alone may not extend your life, oral hygiene often reflects broader patterns of self-care. People who maintain their teeth through regular checkups and good habits tend to engage in other positive health behaviors, supporting the idea that oral health is a gateway to general wellness. Beyond its connection to systemic health, oral health also has a major psychosocial impact. A healthy smile can influence confidence, job opportunities, and social interactions. Teeth support essential functions like speech, eating, and self-expression—all of which contribute to quality of life at any age. This means not only is there a reason to maintain your teeth with brushing and flossing, but there are also benefits to improving them for both esthetics and function. One way to enhance a smile is by improving tooth alignment, which can benefit both function and appearance. Orthodontics—the dental specialty focused on straightening teeth and correcting bite issues—is often associated with adolescence, but treatment is increasingly common among adults. Advances in digital imaging and clear aligner therapy have made orthodontics more accessible and discreet. For many patients, even minor adjustments, such as moving one tooth or closing a small space, can be completed efficiently and comfortably with modern treatment options. These treatment options can now range from simple corrections to comprehensive care using either clear aligners or traditional braces. Importantly, they are often more convenient than people expect, with flexible solutions to fit different lifestyles and goals. The first step toward improving your oral health—or enhancing your smile—is establishing or re-establishing a dental home. Regular dental evaluations help detect and address problems early, before they become more serious or expensive to treat. Once a foundation of oral health is in place, patients can explore options to improve the shape, color, alignment, or function of their teeth. Whether you’re considering tooth whitening, replacing missing teeth, or straightening your smile, having a trusted relationship with a dental provider makes all the difference. Open conversations, regular care, and modern dental tools make it possible to achieve not only a healthier mouth but a healthier life overall Paul Meyer, DDS, MS, is an orthodontist proudly serving the Brookings, South Dakota community. After earning his dental degree from the University of Minnesota and completing his orthodontic residency at the Mayo Clinic, Dr. Meyer returned to his hometown to carry on the family practice at Meyer Orthodontics. He is honored to continue the practice founded by his father, Dr. David Meyer, providing expert, personalized orthodontic care to patients of all ages. 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 June 15th, 2025
“Anatomical Variations: Connecting Physicians and Anatomists” By Ethan L. Snow, PhD It’s remarkable how much anatomy education and medical practice overlap, yet anatomist-physician collaborations are often underutilized for improving student learning and patient care outcomes. Becoming an anatomist or a physician requires commitment to many years of education and practical training. Both generally require four years of comparable, comprehensive baccalaureate coursework followed by four or more years of concentrated graduate/medical education and practical training. Amid both career paths, students work diligently to achieve predefined benchmarks for competency in complex human anatomy, meticulous clinical applications, and interrelated skills. Nevertheless, it is natural for anatomists to lose insight about practical clinical skills and physicians to lose insight about anatomical intricacies – most notably while the other person is keenly maintaining expert-level knowledge and knowhow of that very information. Anatomical variations offer a course of action for efficiently and effectively addressing the “use it or lose it” principle for both experts. Human anatomy is taught and learned according to its foundational morphologic norm – that is, the typical configuration, form, and function of structures in the body. Understanding typical anatomy allows physicians to draw clinical insights from patients’ chief complaints. For example, knowing the typical arrangement of bones, muscles, nerves, and vessels in the body allows orthopedic physicians to discern differential diagnoses and establish safe and effective surgical and therapeutic treatment plans for patients with musculoskeletal issues. However, anatomical variations – structures that do not present in typical location or form – are common and can complicate both learning and medical practice. As authorities in the granularity of human anatomy, anatomists develop and maintain expertise about the development, presentation, and impact of anatomical variations, especially as they uncover specific cases during routine cadaveric dissection. As authorities in the minutiae of patient care, physicians develop and maintain expertise about adaptive clinical practices to address anatomical variations, especially as they come across specific cases during patient examinations and surgeries. In these regards, each professional can strategically benefit from the other’s expertise to create better outcomes, and this “bench-to-bedside” collaboration is known to promote translational medical education, high-definition patient care, and exemplary interprofessional behavior. Despite their inherent benefits, strategic anatomist-physician collaborations appear underutilized. Investigating anatomical variations cases permitted by cadaveric donors and/or living patients offers one way to encourage these collaborations. Common field interest seems to effortlessly reciprocate enthusiasm from both parties. Anatomists can leverage workload designated for research/scholarship and physicians can fulfill contractual service obligations, thus offering a manageable framework for each to strategically contribute expertise and achieve high-quality and high-impact productivity. Simultaneously involving students can further distribute workload while providing them with meaningful research experience and influential mentorship. As indicated, cadaveric donors and living patients play a critical role in this framework by willfully permitting analysis of their associated tissues and records. Human cadaver dissection offers complete and unrestricted views of anatomical variations, and patient records (diagnostic imaging, physician summaries, etc.) convey the clinical presentation and impact of variations. Anatomists, physicians, and students remain extremely grateful to each for their incredible contributions to advancing medical education and patient care. Ethan L. Snow, PhD is an Anatomist and currently serves as an Assistant Professor of Innovation in Anatomy at South Dakota State University 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 June 8th, 2026
“Pain Science: Rethinking How We Experience Pain” By Kory Zimney, PT, DPT, PhD is a professor at the University of South Dakota Pain is a universal human experience, yet it remains one of the most misunderstood aspects of health. Traditional views often equate pain directly with physical injury, but modern pain science challenges this simplistic understanding. Pain is a multifaceted phenomenon involving sensory, emotional, and cognitive factors. This perspective advocates for a holistic approach to pain management, emphasizing the nervous system's role and empowering individuals to retrain their pain response. Pain and Injury Are Not Always the Same Most of us can think of a time when we had an injury but no pain. Maybe you noticed blood on your body when out gardening, only to see a significant cut on your arm, or waking up and noticing a large bruise on your body, and you don’t recall what caused it. Sometimes, pain may have emerged after you saw the cut or bruise, but not when the injury happened. The opposite side further exemplifies the disconnect between pain and actual tissue damage: we can use the example of phantom limb pain, where individuals experience pain in a limb that no longer exists. These examples highlight that pain is not always a direct indicator of physical damage. In the first situation, we have injury and no pain; in the second, we have pain with no injury. Pain as a Complex, Multidimensional Experience Pain is not a simple signal proportional to the extent of tissue damage. The pathway of sensory information from the body travels to multiple areas of the nervous system, including the somatosensory cortex (for location and sensation) and the limbic system (for emotional processing). This interconnectedness underscores the sensory and emotional components of pain, making it a complex experience. The Brain's Role in Predicting and Protecting The brain plays a crucial role in interpreting signals and predicting potential threats, which can influence the experience of pain. For instance, gently stretching your finger backwards can cause discomfort before actual tissue damage occurs – a protective mechanism. Chronic pain often results from an oversensitive or overprotective nervous system, where the brain's predictions sensitize the pain response. People are not faking pain, and the pain is not made up in their head; the nervous system actually changes to make it more sensitive. Think of it like the motion detection lights outside your house, the sensitivity dial has been ramped up, a leaf falls off your neighbor's tree, and your lights go on, it is overprotective. Your brain also uses more than just sensory information to process pain or potential threats. Psychological factors (for example trauma, fear, thoughts, and emotions) and sociological factors (such as environment, stress, and lifestyle) interact with biological factors (immune and endocrine systems) to shape an individual's pain experience. Understanding Pain is Crucial for Recovery Understanding that pain doesn't always mean your body is damaged and that your sensitive nervous system can be retrained empowers individuals to challenge limiting beliefs and actively participate in their pain management. It involves a holistic approach, including improving lifestyle factors (diet, exercise, quitting smoking, etc.), addressing psychological factors (decreasing stress, reframing negative thoughts, and more), and promoting movement and daily activities. Understanding the complex nature of pain empowers individuals to actively participate in retraining their nervous system to reduce the impact of chronic pain and improve overall well-being. Kory Zimney, PT, DPT, PhD is a professor at the University of South Dakota, School of Health Sciences Physical Therapy Department and director of the PhD in Health Science program. He received his Master of Physical Therapy from the University of North Dakota in 1994. He completed his post-professional Doctorate of Physical Therapy from Des Moines University in 2010 and graduated with a PhD in Physical Therapy from Nova Southeastern University in 2020. Dr. Zimney is part of the Center for Brain and Behavioral Research at the University of South Dakota and the Therapeutic Neuroscience Research Group conducting research specifically in the areas of pain science and therapeutic alliance. Understanding Pain and What to do about it | Kory Zimney | TEDxUSD. 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 SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm on SDPB Radio. Prairie Doc Perspective Week of June 1st, 2025
“Teen Mental Health” By Curstie Konold MPH, CSW-PIP, QMHP The start of summer brings a sense of excitement for many teens. Take a moment to reflect back to your teen years. As we reminisce, we can likely all say that our adolescent years were a unique and informative time of our life. Mental wellbeing habits are often formed during this time as teens strengthen their social and emotional skills, laying a foundation of habits for the rest of their life. Consider what habits you perhaps formed during this time and what supports you had or needed when you were a teen. There are a variety of important skills that can enhance positive mental wellbeing, and by encouraging teens to practice them, it increases the likelihood of them utilizing them throughout their life. Mental health and physical health are interconnected, so when we encourage physical self-care, we also encourage mental self-care. Healthy nutrition, exercise, and staying active help to maintain positive mental wellbeing. Emotional self-care can also impact mental wellbeing, and it can be practiced through staying active in enjoyable hobbies, music, journaling, play, or spending time outdoors. Another important factor impacting mental wellbeing that teens face today is the growing use of social media. Having open conversations with teens about their social media use and how it can impact their mental health is crucial to supporting positive mental wellbeing. The Family and Youth Services Bureau guides parents to educate themselves on social media platforms, have an open-minded conversation about the benefits and risks of social media use, establish rules about privacy and boundaries, model healthy social media use to teens, encourage a balance of social media use with other activities, understand critical thinking and media literacy skills, and provide a safe space for teens to come to parents about managing difficult situations like cyberbullying. One of the most impactful things adults surrounding teens can do to support positive mental wellbeing is allowing themselves to be vulnerable enough to talk openly about mental health with teens. Mental health stigma is a large influence in deterring individuals from seeking help, and in order to combat this stigma, open and truthful conversations can encourage teens to not fear discussing their own mental health challenges. These conversations can open the door to understanding what is going on in a teen’s life, providing opportunity to practice healthy skills to promote positive mental wellbeing. Understanding brain development can also help adults recognize how to support positive mental health for teens. The pre-frontal cortex in the brain allows us to critically think, make sound decisions, and control our impulses; however, this part of the brain is still developing during adolescence and into early adulthood. This helps us understand why impulses and risk-seeking behaviors are common among teens. Having open conversations with teens allows for discussion of harm reduction strategies to reduce risk-seeking behaviors. Harm reduction seeks to meet teens where they are at in a nonjudgmental way. An example of this might be helping a teen access professional support services to manage mental health concerns and learn healthy coping skills. As you think of teens in your life and reflect back on yourself as a teen, consider what type of supportive adult would have positively impacted you during that time. You have the ability to provide a sense of connection and hope for a teen. You have the choice to be a caring adult in the life of a teen that guides them to practicing healthy skills to establish positive mental health for years to come. Curstie is a private independent practice licensed social worker and holds a Master of Public Health degree. She is the Associate Director at the Center for Rural Health Improvement (CRHI) at the University of South Dakota. Curstie owns Mindful Matters, LLC where she provides mental health services and promotes trauma-informed care to her clients. 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 SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm. Prairie Doc Perspective Week of May 25th, 2025
“Living with Parkinson’s Disease” By Dr. Kelly Evans-Hullinger “I am concerned your symptoms are due to Parkinson’s disease,” is something I have said to numerous patients over the years. This is a degenerative neurologic disease which is common enough that most patients have heard of it or even know someone living with it. Most commonly, the patient or their family might have noticed classic symptoms: a tremor, difficulty with movement like walking, or balance problems. Importantly, not all tremor is Parkinson’s, though that is typically the biggest concern my patients have. Parkinson’s disease is typically a diagnosis made by findings on history and physical exam; it is uncommon that further testing is used. Often, we will refer to our experts in neurology to confirm a suspected diagnosis. As a progressive neurological disease, we don’t currently have any tools to stop or slow the progression of Parkinson’s, but we have many tools to improve symptoms and quality of life. First and foremost, regular exercise is paramount for patients with Parkinson’s. Quality of life and functional status is better in patients exercising with moderate intensity 150 minutes per week. The type of exercise doesn’t necessarily matter, so find something that is enjoyable enough to stick with. Beyond independent exercise, specialized therapies administered by a qualified physical therapist and speech therapist can reduce symptoms. Physical therapists will help with walking, movement, and balance; speech therapists can improve patients’ speech and communication and, if needed, help with swallowing problems. Medications are commonly used to help with tremor and rigidity in Parkinson’s disease. Most often, the first line treatment is a medication called carbidopa-levodopa, and most patients see immediate gratification with the effect of the medication on their movement symptoms. If needed, other medication options can be added. Finally, options such as deep brain stimulation (DBS) can be used in more severe disease in which medications are not adequate to control motor symptoms. This involves insertion of a device into the affected area of the brain; electrical stimulation there alleviates those symptoms. Other interventions are sometimes used as well with the help of a specialty-trained neurologist. In summary, Parkinson’s disease is fairly common as people age, and most patients live for many years with the disease. It is important to be educated on the disease and all the options that might improve symptoms and quality of life while one lives with Parkinson’s disease, and a qualified physician can help tailor those treatments to each individual patient. 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 SDPB and streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm on SDPB Radio. Prairie Doc Perspective Week of May 11th, 2025
“Have you pre-habilitated today?” By Joanie Holm, RN On a recent morning, the first story I heard on the radio was about Pre-habilitation prior to surgery. We have all heard of rehabilitation, but have you considered pre-habilitation, or increasing your exercise before surgery? Recent studies by Durrand, Singh and Danjoux of the National Institutes of Health (NIH) have documented what was inherently known- that building up a reserve of strength before surgery pays off. Makes sense, right! The physiological challenge of a major surgery has been linked to running a marathon. In both cases, preparation is critical. Surgery involving a major body cavity has an estimated mortality of 4%. Post- operative complications of a major surgery affect 15-40% and may increase the hospital length 2-4 fold as well as increasing readmissions. The NIH study demonstrated that increasing preoperative functional capacity promotes recovery, reduces complications and reduces healthcare cost. Later in the day, as I walked the track, my brain took a leap. Isn’t life our chance to pre-habilitate? Wouldn’t pre-habilitation help us if we caught COVID or Influenza? What if you or I suddenly need to have our appendix or gallbladder removed? What if we are in a car crash and have broken bones? What if we have a stroke or heart attack? Pre-habilitation through daily exercise, eating a balanced diet and moderate intake of harmful substances would increase our chances of survival and recovery without complications. Today and all of the tomorrows are our chance to prepare for the possibility of poor health. We are the key member of the prehab team. Take advantage of your health today to prepare for unexpected complications. Get up and get moving! Joanie Holm, RN is a one of the original founders of Healing Words Foundation/Prairie Doc Programming and is the current Board President. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm Prairie Doc Perspective Week of May 4th, 2025
SD BAND: Bridging Rural Behavioral Healthcare Needs in South Dakota By Ryan Groeneweg, Ed.S., BCBA As a school psychologist working for a small public school, I remember a teacher asking me to observe a student in her classroom. She expressed concerns about an elementary student’s unusual behavior, lack of playing with classmates, lack of communication and even some unusual motor movements, including flapping her hands. This was in 2001, and I was experiencing my first referral for a student who would eventually receive an educational diagnosis of autism. At that time, autism was considered rare, and providing educational support to meet their needs was challenging. I began to see a growing number of referrals, increasing communication and behavioral challenges, and came to realize that my training and experience as a school psychologist weren’t enough. In 2010, after completing the required coursework and supervision, and passing the National Behavior Analyst Certification Board examination, I began a career as a Board-Certified Behavior Analyst (BCBA) in South Dakota. At that time, fewer than 10 BCBA professionals were in South Dakota. Today, there are 88 active BCBAs registered in South Dakota, far below Minnesota (517), Iowa (282), and Nebraska (300). Even when compared to states with similar rural and frontier characteristics, South Dakota lags behind North Dakota (97), Montana (92), and Alaska (89). Currently, nationwide demand for behavior analysts is higher than ever. Annual nationwide demand for individuals holding BCBA certification has increased each year since 2010, with a striking 58% increase from 2023 to 2024. One major reason South Dakota has fallen behind was the absence of an in-state training program until 2021. Recognizing this critical gap, a partnership between the Public Health and Health Sciences programs in the University of South Dakota’s School of Health Sciences, the University of South Dakota’s Center for Disabilities, and LifeScape -a Sioux Falls-based non-profit organization- launched the Applied Behavior Analyst (ABA) two-year graduate program. This program aims to expand South Dakota’s behavioral health workforce and contribute essential public health services across the state. Students who complete the USD ABA graduate program must independently complete 2,000 hours of ABA supervised fieldwork experience. When you consider that most BCBAs in South Dakota live near the state’s larger population centers, Sioux Falls and Rapid City, it’s apparent that those supervised fieldwork experience hours are mostly completed where supervision is available. This barrier creates limited access to BCBAs in rural communities but highlights a great opportunity: addressing disparities in access to specialists in rural areas. South Dakota continues to experience critical shortages of professionals trained to support individuals with autism and other developmental disabilities. The South Dakota Behavior Analyst Network Development (SD BAND) was formed to address the critical need for enhanced behavioral health services and the greater integration of BCBAs throughout the state, especially in underserved rural communities. This network of state partners includes the University of South Dakota (USD), Community Healthcare Association of the Dakotas (CHAD), South Dakota Department of Social Services (SD DSS), South Dakota Department of Human Services (SD DHS), and the Community Support Providers of South Dakota (CSPSD). SD BAND is tasked with expanding the presence and collaboration of BCBAs within community health centers and other health care settings across South Dakota, to raise awareness among health care providers, adult service providers, and the broader community about the crucial role of BCBAs, and to facilitate their integration into existing service delivery options. Ryan Groeneweg, Ed.S., BCBA, Mr. Groeneweg has been the Director of Community Education at the USD Center for Disabilities since January 2019. In this role, he is the principal investigator (PI) for the South Dakota Department of Education Training and Technical Assistance Grant (2019 to present), and the South Dakota State Autism Grant (2019 to present). He is also an assistant professor at the USD School of Medicine and the program director for the USD School of Health Science Master in Health Science, with a Specialization in Applied Behavior Analysis (ABA) and the USD ABA Certificate Graduate program. Follow The Prairie Doc® at www.prairiedoc.org, and on social media. Watch On Call with the Prairie Doc, most Thursday’s at 7PM streaming on Facebook and listen to Prairie Doc Radio Sunday’s at 6am and 1pm. |
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