Prairie Doc® Perspective Week of February 19th, 2023
“Is All High Blood Pressure Hypertension?”
​By Kelly Evans-Hullinger, MD


Many people find themselves being told, “your blood pressure is pretty high today!” You might be at the dentist’s office for a filling, in the emergency room getting stitches after an avocado mishap, or maybe you’re at your annual physical appointment. If you’ve never had high blood pressure you might be surprised at this news! Sometimes my own patients will call my office after such an event, “Doc, should I be on blood pressure medication?”


When we get these calls our typical answer is: maybe, but maybe not. Blood pressure is a dynamic measurement, affected by many things including adrenaline and other stress hormones. If you measure the blood pressure of healthy people who are in stressful circumstances, you will often find it to be high. This can certainly be true in healthcare settings – have you ever felt stressed or anxious when you are hurt in the ER or sitting in a dental chair? I will advise these patients to come into our office and check their blood pressure under less duress; oftentimes it will be normal and reassuring.


Sometimes, though, the stressful circumstance is our primary care office, the very place we try to screen for high blood pressure. Some patients have elevated blood pressure in their primary care provider’s office but not at home or elsewhere; this is often referred to as “white coat hypertension.” The only way to know for sure, though, is to check blood pressure at home or outside the clinic visit.


If a hypothetical adult patient, who is feeling well and has never before had hypertension, comes to their annual physical and has a blood pressure of 155/90, the first step is to repeat it after a period of 5-10 minutes of quiet rest. If it is still elevated we will arrange to check resting blood pressures at home or in a series of lower stakes visits to the clinic with a nurse.


The diagnosis of hypertension and decisions about treatment should be made if the average of those resting blood pressures are above the threshold for recommended treatment. Of course, if a patient truly does have hypertension we want to initiate lifestyle interventions and possibly medication to reduce the long-term risk of poor health outcomes. But when it comes to high blood pressure, it is rarely an emergency, and often collecting more data is better.

Prairie Doc® Perspective Week of February 12th, 2023
“Hidden in Plain Sight”
By Debra Johnston, MD

If I asked you to name a chronic disease, you would probably think of conditions like high blood pressure, diabetes, cancer, or dementia. The odds are, one of the most common chronic diseases would never cross your mind. 
World wide, this condition affects over 3 billion people, and causes significant physical and emotional suffering. Annually it costs the American economy upwards of 45 billion dollars in productivity. Our children miss nearly 35 million hours of school. Our emergency rooms field nearly 2 million visits. 
​
So what is it?
Dental disease.

Those of us whose experiences with dental disease have been limited to the occasional cavity, or perhaps wearing braces for a year or two, may be tempted to dismiss it as an inconvenience or annoyance, not a threat.  No doubt this impression is reinforced by the artificial distinction the insurance industry draws between our teeth and our bodies.

However, an unhealthy mouth can lead to what we all understand to be a serious medical illness: pneumonia, bloodstream infections, and malnutrition, to name a few. It is linked to heart disease and preterm birth. It can worsen other underlying diseases, such as diabetes. And many conditions, or their treatments, can in turn worsen oral health. 

In addition to the physical suffering, dental disease can cause significant social consequences. How often do we say, without even thinking, “They have a nice smile?” Consciously or not, we assess people by their teeth. Those with visible dental disease are acutely aware of this judgement. I almost never saw my wonderful mother in law with a full smile on her face, no matter how happy she was. She was just too aware of her discolored and crooked front teeth. The consequences are more severe for many others: lost job or educational opportunities, lost social standing, relationships that don’t move forward. Dental diseases can affect not just the appearance but the function of the mouth, impacting speech and communication, and even the fundamental daily activity of eating. 
Preventing dental disease begins very early in life, and continues indefinitely. Most people know brushing, flossing, and seeing a dentist regularly are important. They may know that sugar and tobacco are bad for their teeth, and athletes probably know they should wear mouth guards. Many people do not know that cavities are contagious: the bacteria that contributes is often spread from person to person, especially parent to child. They may not know that their sports drink or diet soda is acidic enough to damage the enamel protecting their teeth.
A healthy mouth is fundamental to health. When was your last trip to the dentist?

Prairie Doc® Perspective Week of February 5th, 2023
​“The Benefits of Sleep: Why You Should be Sleeping More”
By Jill Kruse, DO


Most people know that getting enough sleep is important for their health, but many do not realize that there are specific health benefits that come from getting a good night’s sleep.  Getting enough sleep can improve your mood, help you maintain a healthy weight, and reduce your risk of chronic health problems like diabetes and heart disease.   Sleep can even help boost your immune system and improve memory.
Despite knowing that sleep is important, according to the CDC, one in three adults do not get enough sleep.  The National Sleep Foundation found that almost half of all Americans say they feel sleepy during the day between three and seven days each week.  Many untreated health conditions can interrupt or affect sleep.  Issues from an enlarged prostate, hot flashes from menopause, sleep apnea, acid reflux, and restless legs are just some of the conditions that can keep us from a good night’s rest. A lack of sleep can also affect or worsen depression and anxiety.  Unfortunately depression and anxiety can make falling asleep much harder causing a cycle of worsening mood and sleep difficulties.  
Weight can also be affected by the lack of sleep due to the hormones that help regulate your appetite and sense of fullness. Lack of sleep increases the hormone ghrelin, which increases appetite.  Even partial sleep deprivation can increase the body’s resistance to insulin.  This can increase blood sugar levels and contribute to the development of diabetes.   
Loss of sleep affects the risk of heart attacks and high blood pressure.  This is related to the hormone, cortisol which is on a circadian rhythm and increases in the morning hours.  Increased cortisol helps to awaken you and peaks about thirty to forty-five minutes after awakening. One study found that there was a 24% increase in heart attacks on the Monday after Daylight Savings Time.  This increase is thought to be related to the hour of sleep lost and increased cortisol levels.     
Certain immune components work more while you are sleeping to help repair the body and fight infections.  Good sleep helps consolidate memories,  improves creativity, and can even improve sports performance.  
Getting a good night’s rest is not just nice,  it is imperative to your body’s health.  If you are having trouble sleeping, it is important to talk with your health care provider to see what can be done to help your sleep improve.  He or she can also help rule out any underlying health conditions that could be impacting your ability to get the rest your body needs.   Count some sheep and get some extra ZZZ’s so you can “stay healthy out there!”     

Prairie Doc® Perspective Week of January 29th, 2023
“It’s time for your checkup”
Andrew Ellsworth, MD
Recently I received a mailing from my clinic reminding me it is time to schedule my annual preventative care physical.  Apparently, doctors need to go to the doctor, too, even when they feel fine. 


As a primary care physician, one of my passions is preventative care. Preventative care is focused on catching problems before they even start to cause symptoms, catching issues early when they are easier to treat. 


Whether you want to call it your annual physical, your yearly checkup, or an annual wellness visit, this appointment gives the time for you and your provider to decide what tests, screenings, and interventions may be done to help you become and stay more healthy.  One of the broken aspects of our healthcare system is our focus on problems, playing whack-a-mole, barely getting ahead, and spending too much money way too late on problems that could have been cured a lot sooner, a lot cheaper, with a little bit of effort at prevention. 


This visit may go in a variety of ways depending on your age and risk factors.  If you are over age 45, you should probably consider your options for colon cancer screening.  If you are a woman over age 40, perhaps you should consider breast cancer screening. If you are a man over age 55, perhaps you should consider prostate cancer screening.  Any of these screenings may need to start earlier if you have a family history of cancer. 


Meanwhile, the visit should probably include a discussion on your mental health, your diet, and your exercise routines. Granted, these discussions take time. If you have a list of problems and symptoms you want to discuss, then perhaps you may need a separate visit to address your concerns, apart from the appointment to cover some of these preventative care topics. 


Perhaps this visit will help give you a nudge to quit smoking, and a chance to catch lung cancer early by scheduling a screening CT scan of your lungs. Perhaps this visit will determine that you have high blood pressure or high cholesterol, and interventions could decrease your risk of a heart attack or stroke. Perhaps this visit will catch skin cancer early.  Perhaps your provider will identify a medication you do not need anymore, or identify an over-the-counter medication or supplement you should or should not be taking such as vitamin D or aspirin. Are you taking your medications correctly?


The list goes on and on. Pap smears for cervical cancer screening.  Reviewing your immunizations and updating a tetanus shot. DEXA scans help determine the strength of your bones and catch osteoporosis, trying to decrease your risk of a fall and a hip fracture.  


I suppose I better make that appointment for myself!