​By Jill Kruse, DO
 
When my mom called me and said that my dad found four N95 masks in the garage and she wanted to send them all to me since I’m a doctor – That’s love.
 
When I reassured her that we had enough in clinic for now and that she should keep them, or at least keep two for her and dad – That’s love.
 
When I received the box in the mail, all four masks were there, lovingly wrapped in tissue paper with a note of encouragement – That’s love.
 
When I come home from work my children run to the top of the stairs yelling out, “Mommy’s home” – That’s love.
 
When I stop them from coming down to the landing until I can shower and change in the downstairs bathroom because I am scared that I might bring the virus home and I want to do everything I can to protect them – That’s love.
 
When a patient sends a message to local health care workers that they are thinking of us and praying that we stay well – That’s love.
 
When essential workers in any profession, show up to support their families and co-workers every day – That’s love.

When the local theater department makes masks for the hospital and uses it as a final project for students – That’s love.
 
When you order a take-out meal from a local restaurant or buy a gift card from a local small business – That’s love.
 
When you turn off the news and call a friend instead so neither of you are so lonely – That’s love.
 
When you practice social distancing, not because you are afraid, but because you do not want to add to anyone else’s risk – That’s love.
 
When teachers completely change the way they teach, with only a few days to prepare, and their eyes light up with happiness when they see their students on a Zoom meeting – That’s love.
 
When you are frustrated, angry, scared, or just don’t know what else to do, look for the love.  It is all around you. Sometimes we do not see it because we are so overwhelmed with all these other waves of emotions that try to drown it out, but it is there. It is always there. That’s love, waiting for you to find it.
 
Jill Kruse, DO, is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.        

​By Kelly Evans-Hullinger, M.D.
 
It is the year 2020, and we find ourselves in the midst of a rapidly changing, worldwide pandemic of a novel Coronavirus. This virus and public knowledge of it has spread and changed with greater speed than our scientific method can accommodate. Science, and the progression of medical knowledge, is by nature and necessity slow and methodical. This pandemic is neither. But we ought not abandon our deliberate striving for truth; not now, not because it feels too slow.

The gold standard in medical science, the randomized controlled trial (or RCT), is a relatively new development in the history of medicine. The British epidemiologist Sir Bradford Hill is credited with designing and publishing the first RCT in medical science, a study of streptomycin in treating tuberculosis, in 1948. Sure, even randomized controlled trials are never perfect, and they require large numbers of patients, time, and investment. However, their design does seek to remove variables that are sure to taint all other trial designs. They are the best we have, especially when it comes to evaluating a therapeutic intervention.

Much speculation has arisen, both in the medical community and the media, about possible drug therapies for this disease: hydroxychloroquine, azithromycin, remdesivir, convalescent plasma, and others. Why have so many physicians and scientists been less-than-fully-enthusiastic about these interventions? It is because we do not have sufficient data yet. There has not been time for any quality randomized controlled trials.

Still, if these things might help, why not just throw them at patients with severe cases of COVID-19? What do we have to lose? The truth is, the history of medicine is flush with examples of therapies that we thought would be helpful – studies in the lab were favorable, we had promising initial observational data, and expert opinion was in favor of it – but, when put to the test, they were not. In many of these cases the interventions turned out not only to be not helpful, but harmful, when they were tested in a randomized controlled trial.

We must demand a high threshold of proof before accepting therapy as effective. History has taught us that mistakes are made if we do not. We want solid evidence that an intervention helps more than it hurts before recommending we give it to everyone with this disease. Yes, even if it seems slow.

One thing is for certain: our collective scientific energy will be best spent investing in developing a vaccine for this highly contagious virus. Fortunately, there are very smart people all over the world working around the clock in this endeavor. A vaccine: now that would be a game-changer.

In the meantime, our best defense against this pandemic continues to be social distancing – so stay home and minimize contact with others. The more we flatten the curve now, the more people will benefit from the hard work of science in the future.
​
Kelly Evans-Hullinger, MD is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. 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.        

By Richard P. Holm, MD
 
In a recent national survey, 26.9 million American adults age 18 and older reported experiencing vision loss. Of course, vision loss means blindness or the inability to see at all, but the definition also includes those having trouble seeing, even when wearing glasses or contact lenses. While not everything is preventable or reversible, early detection and intervention are among our most effective tools to prevent vision loss.
 
Mrs. E who lived well into her 90s, would come into my office, never complaining about her eyesight. However, the diagnosis of age-related macular degeneration (AMD) was obvious to me because, when she and I had a face to face conversation, she would look a foot to the left of my nose. The AMD had destroyed her central vision and she used her peripheral vision to see. AMD is the most common cause of blindness in the elderly. Risk factors include a family history of AMD, aging, smoking, obesity and hypertension. We can reduce our risk if we stop smoking, eat less, exercise and visit our eye doctor on a regular basis.
 
Almost the opposite of AMD is glaucoma, where the peripheral vision is lost, and the central vision is spared. This gradual and painless loss of vision is due to injury of the optic nerve and is commonly the result of increased pressure of the fluid within the eyeball. When glaucoma progresses, even the central vision can be lost but, if diagnosed early, treatment can help.
 
Diabetic retinopathy and cataracts are more common than AMD or glaucoma. Diabetes causes new tiny, and unfortunately very fragile, blood vessels to develop on the retina, and, when these delicate blood vessels bleed, they cause swelling, scarring, and progressive spotty vision loss. Cataracts, the leading cause of blindness in the world, cause the clouding of the lens of the eye.
 
For most of these eye conditions, there are methods to diagnose, treat and prevent the blinding consequences, yet many people skip regular eye exams. The message is staring you in the face, or perhaps a foot to the left of your nose…get your eyes checked every year. Due to the coronavirus pandemic, most non-urgent eye appointments are being deferred to the latter half of the year. Contact your eye doctor to discuss the best option for you.
 
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He was founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. Dr. Holm’s legacy lives on through his Prairie Doc® organization. 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.                                              

By Richard P. Holm, MD
 
During my lifelong practice of geriatrics, I observed many people reaching the end of their lives. Truth is, what I’ve seen is a mixed picture. The two patient stories I describe here are really a blend of hundreds of experiences.
 
Ms. A is in her late 80s, walks two miles every day, mostly outside but inside a wellness center when sidewalks are icy. She eats a balanced light diet and is connected to many friends. Ms. A is spiritually connected, and life has been and continues to be meaningful to her.
 
Ms. B is also in her late 80s, has never been much for exercise and now is unable to walk without the help of her walker. She lives in an assisted living center and has made some friends there but remains rather critical of them. Whenever her kids visit, she asks them to take her home. Ms. B had some tough times and some happy times during her life, but now, she remains rather bitter.
 
At age 82, comedian Rodney Dangerfield, who had studied the relationship between sexuality and longevity said, “I’m at the age where food has taken the place of sex in my life. In fact, I’ve just had a mirror put over my kitchen table.” Reading that made me laugh out loud, but I see Dangerfield’s comment as both funny and sad. Indeed, this thing called growing old is a mixed picture. Should we celebrate it or fear it? Does it give wisdom and meaning or just aches and pains?
 
I suggest we embrace both sides of the picture. Let’s choose to live as long and as well as our luck and genetics allows. We would all do better with regular exercise, eating less, connecting with both the earthly and the spiritual. Let’s also choose to kindly accept the fact that someday we will reach the end of our lives. We can take healthy steps by creating an advanced directive, by understanding the kinds and causes of dementia and facing the inevitable death of the ones we love. Embracing this mixed picture helps us in accepting aging processes we cannot change, avoiding suffering and savoring things that matter.
 
Bottom line lessons from Ms. A and B: Like any piece of art, we can choose how we view the picture of our own aging. Those who live with misery, anger and vengefulness will likely die that way. Those who glean meaning and joy from observation, giving to others and opening their hearts to the spiritual will find aging a grand masterpiece.
 
Richard P. Holm, MD passed away in March 2020 after a battle with pancreatic cancer. He was founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. Dr. Holm’s legacy lives on through his Prairie Doc® organization. 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. 

By Andrew Ellsworth, MD
 
When I come home from a day at the clinic and hospital, there is no better feeling than my children running up to give me a big hug. For the past couple of weeks, I have had to remind them to stop, and just do an air hug until I have had a chance to change clothes and shower. The idea is to wash away any germs and decrease the risk of getting my family sick after working with several patients and sick people during the day. Maybe these efforts are too much, or maybe they are not enough. 
 
The Covid-19 virus spreads through respiratory droplets, from talking, coughing, or sneezing, and appears to also spread via a fecal-oral route. The fecal-oral route is how the stomach flu often spreads, and many of us know how easily that circulates through families and daycares. Someone who has been to the bathroom may touch a doorknob or a serving spoon, which someone else touches before eating, and they may become infected. That’s why we need to wash our hands well and avoid touching our face and our food.  
 
Unfortunately, the virus can spread from people that do not have symptoms, or before they have symptoms which is why, I worry, I may not be doing enough to protect my family from the one person who puts them at the biggest risk: me. Some doctors and nurses are deciding to avoid their families altogether and live in the garage or the basement when they come home. I haven’t decided to do that yet, but maybe I should, or maybe I will. 
 
Pandemics and disease have separated families for longer than the history books can tell us. Before they knew the cause, our ancestors knew that if someone had smallpox, quarantine and fire were the only ways to help prevent the spread. People, houses, and entire cities were quarantined. Disease has arguably decided more wars than the battles themselves. During the 1918 influenza pandemic, soldiers from Fort Riley carried the disease to other American military bases and from there, to the battlefront in Europe.  
 
These lessons of history helped us learn about how to control disease. Advancements in infection control, medicines, and vaccinations have turned the tide and made many diseases a distant memory. For Covid-19, we do not yet have proven medications or a vaccine. However, we are learning more every day how to help those who are sick and how to better prevent the spread. In the meantime, my family and I will continue to practice social distancing and similar efforts to do our part to flatten the curve and slow the spread, to give us time to find treatments to combat this current scourge on humanity.  
 
Andrew Ellsworth, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.        

By Jill Kruse, DO
 
History has its eyes on you. That is a quote from the popular musical Hamilton, but as we are dealing with a global pandemic it also applies to all of us.  The year 2020 is going to be remembered someday in history books.  How it will be remembered is in part, up to us.  Will this year go down in history as a time of great selfishness – with people hoarding masses of toilet paper and masks?  Will this year go down as a time when we all came together to help our neighbors through this scary and uncertain time? 
 
There are heartwarming stories of people in Italy singing from their windows at night.  All these voices raised up together to bring hope and a small spark of joy.  Even though they are separated physically by the quarantine, they unite in spirit and in song.  In the United States there have been reports of neighborhoods that are connecting on social media to see who on their block needs resources.  They assign “team leads” to check in with each family to see if they need anything.  The “team lead” arranges for someone in the neighborhood to deliver groceries and medications to the doorsteps of the elderly or those quarantined. 
 
Families are home eating together each night.  Activities have been cancelled and the normal day to day busyness has gone away.  At my own home, board games are being pulled out of the closet, books are being read more, and family movie night is a regular occurrence.  There is no rushing to get out the door to this activity or that event.  In the midst of the fear and the uncertainty, I am trying to savor the quiet moments at home with those I love most. 
 
Now is the time to re-connect with family and friends that you “didn’t have time” to talk with.  Now is the time to send that text or email.  Don’t hesitate to make that phone call or Facetime someone who is important, but previously was not high on your list of things “to do”.  This past week I have had more phone calls and text messages from friends and family than I can ever recall before.  That has been a gift. 
 
Every day we write history.  Today we get to decide what people will remember about this year.  Let’s do everything we can to show how we can come together to save lives and overcome this disease.   
 
Jill Kruse, DO is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.        

By Andrew Ellsworth, MD
 
With the coronavirus causing school to be cancelled, my son brought his schoolwork home. He shared with us a Greek mythology worksheet about Pandora’s Box. If you aren’t familiar, the Greek god Zeus gave a wedding present to beautiful Pandora but instructed her not to open it. Like many of us, impatience and curiosity got the best of her and she opened it anyway which caused a lot of new problems.
 
Similarly, with Covid-19, this new virus is already out of the box. This is a global pandemic and we are being asked to be patient and conform to social distancing to help slow down the spread. This is our current challenge. Every day we hear about sporting events, concerts, schools, and travel plans being cancelled. This is the best-known method to slow the spread of Covid-19. The less we are mixing and mingling, the less the virus is spreading. 
 
When we slow the spread, we give our healthcare systems the best chance at having the resources on hand to keep up with the number of people who need help at any given time. In areas of the world where cases of Covid-19 were allowed to spike, the healthcare systems are overwhelmed. Some hospitals don’t have enough beds, enough ventilators, enough medicine to treat everyone that needs help. They don’t have enough masks and gowns to protect their staff. In these situations, doctors are having to decide who gets treatment, and who doesn’t.  
 
Thankfully, of those who become infected, possibly 80 percent will have only mild symptoms. Some may not have symptoms at all. However, we need to understand that some will become very sick and some will die. Unlike influenza, Covid-19 is a new virus. Therefore, none of us have immunity from the past or from immunizations. There is no herd immunity. 
 
That is why events are cancelled. That is why social distancing is urged. Since most people will only have mild symptoms and some people may not have symptoms at all, the virus can be spread easily without us realizing it. We all need to be patient and follow the instructions from health officials. By doing so, we can hopefully prevent a large spike of a lot of sick people at once and avoid a worst-case scenario.
 
My son’s main impression from his school lesson was that despite the sickness and problems that were released, Pandora closed the lid and held hope inside the box. I have hope that together we will contain this virus and, in the end, this, too, shall pass.  
 
Andrew Ellsworth, MD is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. 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.        

By Richard P. Holm, MD
 
Our nation has a large and growing public health problem called suicide. It is the tenth leading cause of death in the United States and it is preventable. The Centers for Disease Control indicates suicide was responsible for more than 47,000 deaths in 2017, resulting in about one death every 11 minutes and it affects all ages. Suicide is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age.
 
While the causes of suicide vary, depression is often an underlying factor. Most of us periodically have what is called "situational depression," such as the understandable sadness that follows severe loss or death, but what is more typical of harmful depression is when there is no particular situation, no identifiable “reason” for it.
 
The diagnosis of depressive disorder is not easy. We suspect depression when people experience chronic pain, find it hard to concentrate, are without energy, have flares of temper, sleep too much or too little, have a loss of appetite or have over-eating binges, have unexplained crying spells, or become filled with anxiety for minimal reasons. Often people make things worse by covering-up depression with alcohol, sleeping pills, anti-anxiety medications, or substance abuse, and these all make the diagnosis even more difficult.
 
The challenging concern is that with or without a diagnosis of depression, suicide remains extremely hard to predict. We know that “talking about it” is probably our most important means to help someone who is planning suicide. Although two-thirds of the people with depression do not seek or receive help; of the one-third that do get help and follow-through with treatment, 80 percent are better in four to six weeks.
 
Whenever possible, it’s best to guide people for whom we have concern to talk about their feelings with a professional. However, the most important preventer of suicide is, in many cases, the loved one, friend or kindly neighbor who can give that person an ear, offer true compassion and call for help when red flags are flying. You may never know it, but you might save a life by listening and being a friend.
 
If you or someone you know is struggling emotionally, help is available 24/7. Call the National Suicide Prevention Hotline 1-800-273-TALK (8255).
 
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. 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.        

By Richard P. Holm MD
 
He was my neighbor, a guy my age, a man of many talents and interests, and a dear friend. He was one of those fellows who would give the shirt off his back to help you, if needed. When he was diagnosed with cancer of the pancreas spread to liver, he, his daughters, and his friends knew how this was likely going to go. But we didn’t realize how graciously he would handle his dying process until it happened.
 
He was treated and truly helped by chemotherapy for a while, but gradually the tumor cells developed resistance to the drugs and the oncologist suggested no more chemo. He was ready to have only pain meds and hospice. In the end, per his direction, with the help of hospice and the caring people at the small-town nursing home, he shuffled off this mortal coil comfortably, surrounded by his family and friends.
 
Fortunately, he had a compassionate and grounded primary care doctor and oncologist team who were realistic and knew when to stop intervention; loving daughters and friends to surround him with support; plenty of ready-to-heat-and-eat tater-tot-like hot-dishes; an advanced directive that said he was not to have medical intervention if pointless; and plenty of pain medicine for comfort. When I visited him two days before his death, despite an expanding belly full of cancer, he told me he was getting enough meds and was comfortable. Most important, he was absolutely not fearful but courageously accepting of the dying process.
 
In comparison, I find it tragic and too common that patients and families are overwhelmed with a fear of death. Some suggest this disabling dread comes from our cultural practice of covering up death with the intent to make life easier. Thus, a lifelong apprehension and running from death has become the norm.
 
Bottom line, too many people choose to be dragged through unnecessary suffering at their end of life, and too often doctors and nurses comply. We could do a better job stopping unnecessary medicines, touching our patients more and providing comfort to not only the patient, but to the patient’s family as well.
 
Dying people have the right to ask for and be reassured that enough comfort medicine will be provided and that it’s going to be alright. Our profession has been improving in this regard, but certainly could do better. When it’s time, it’s important that we all have the opportunity for a comfortable death, just like my neighbor.
 
Richard P. Holm, MD is currently living with pancreatic cancer. He is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. 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.        

By Richard P. Holm, MD
 
As I was researching the history of Native American health care, I took note of the various terms used early on by indigenous people to describe European immigrants. Initially, the references had to do with skin color. Several tribes labeled Europeans as “white skinned,” or “yellow-hided.” Some tribes still use the term “umsewah,” meaning “bleached wood.” 
 
Other tribes described Europeans as “hairy mouthed,” “hair faces” and “dog faces,” referencing facial hair on European men. Ears were also important in naming. One tribe characterized the immigrants as “ears sticking out” because they did not have long hair covering their ears as did Native Americans. Some say that the ear label referred to that tribe’s word-meaning for donkey or mule.
 
As time went on, Native Americans began to describe Europeans based not only on how they looked, but on how they behaved. A Lakota word for Europeans is “wasichu,” which means, “taker of the fat, or a greedy individual.” Recognizing the transgression over the last two centuries, I can’t blame the Lakota for choosing the label, “wasichu.”

These Native American words reflect the impact of two cultural world’s colliding and reveal a disharmony resulting from the loss of access to traditional hunting and farming lands, the loss of family and language as children were shipped to boarding schools, the loss of self-respect with isolation on the reservation and much more.  The result of all this has been decades of health disparities. For example, American Indians are 50 percent more likely than white people, to have a substance abuse disorder, 60 percent more likely to commit suicide, twice as likely to smoke cigarettes or to die of childbirth, three times more likely to die from diabetes and five times more likely to die of tuberculosis.
 
But change is coming. Revered Oglala Lakota medicine man, Black Elk, prophesized that with the seventh generation following the tragic Wounded Knee massacre of 1890, Native American people would begin to recover from the historical trauma experienced since the collision of these cultures in the mid-19th century.
 
From 1890 to 2020, that’s one hundred and thirty years. Divide that by seven and, right now, you have 19-year-olds who constitute that seventh generation. It’s time for those of us with ears sticking out and those without, people of all skin colors and cultures, to create an environment that allows all people to come out of poverty and help make positive changes in Native American health care.
 
Richard P. Holm, MD is founder of The Prairie Doc® and author of “Life’s Final Season, A Guide for Aging and Dying with Grace” available on Amazon. 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.