By Debra Johnston, M.D.
 
Skin is the largest organ in the human body, but it’s easy to take it for granted. Unless we notice pain or itching or funny spots, most people don’t give it much thought.
 
However, the skin is critically important. It helps regulate our body temperature and fluid and electrolyte balance. It provides us critical information about our environment, and it protects us from invasion by the sea of germs we encounter every day. Some of the sickest patients doctors ever treat are those who have had significant skin loss, whether due to illness like toxic epidermal necrolysis, or injury like burns.
 
This important organ can give doctors clues to diseases elsewhere in the body. Rashes might suggest celiac disease, or an overactive immune system, or internal cancers. Skin discoloration might alert us to liver diseases, hormonal conditions, or dangerous exposures.
 
The skin itself is subject to diseases. Genetics plays a role in conditions like eczema and psoriasis. Sometimes our habits can set the stage for skin problems. Sun exposure increases the risk of skin cancer, but it also accelerates the development of wrinkles. Smoking does, too. 
 
So, what can we do to protect our skin, especially as summer approaches?
 
One big step is to protect it from the sun. Sunscreen is very useful! Use one that blocks both UVA and UVB light. Choose SPF 30 or higher, and don’t forget to re-apply every two hours. Most sunscreens break down when exposed to the sun, so even if you are wearing SPF100 it won’t last through the afternoon. Sunscreen takes about 15 minutes to bind to your skin and protect you, so put it on before you head out. Use enough: the average adult needs at least a shot glass worth for each application. One bottle might not last your family through the whole weekend at the lake. Water resistance is useful, but sunscreen is never truly waterproof, so re-apply after swimming or sweating. Ultraviolet light penetrates cloud cover, so sunscreen is important even on overcast days. Don’t forget your lips: many skin cancers develop there, so wear lip balm with SPF.
 
Sunscreen isn’t the only protective measure you can take. Consider the tried-and-true approach of covering up. Wear long sleeves and wide brimmed hats. Stay inside, if you can, especially during the parts of the day with the most direct sunlight.
 
Your skin has a big job, protecting you from the environment. You can return the favor, and protect it, too.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Jill Kruse, D.O.
 
Post-traumatic stress disorder, or PTSD, was first listed as a medical diagnosis in 1980. However, it has been recognized and called by many different names throughout history. The first recorded description of PTSD is in the Epic of Gilgamesh which dates back to 2100 B.C. In The Iliad and The Odyssey, Homer wrote about Trojan War soldiers exhibiting the symptoms of PTSD. Shakespeare described a character in King Henry IV who suffered from post-traumatic nightmares.

During the Civil War, the terms “irritable heart” and “soldier’s heart” were used to describe PTSD symptoms. In World War I it was called “combat stress” or “shell-shock”. In World War II it became “battle fatigue” and “combat exhaustion”. PTSD is not limited to soldiers, as the terms “concentration camp syndrome”, “survivor syndrome”, “battered child syndrome”, and “rape trauma syndrome” were all recognized as conditions in the aftermath of WWII. 

PTSD is a mental health condition resulting from experiencing trauma firsthand or from witnessing others undergoing a severely traumatic event. It can also result from repeated exposure to distressing details of an event. For example, many firefighters and other rescue personnel who searched for survivors after the 9/11 attacks suffer from PTSD.

The traumatic experience can lead to flashbacks or nightmares which can progress to physical reactions such as rapid heart rate or shaking when reminded of the event. Individuals with PTSD will often avoid any person, place, activity, or object that could trigger memories of the event. As a result, they may feel detached from others, or have persistent negative thoughts of themselves or others. They may have difficulty experiencing positive emotions like joy and happiness.

Another common symptom of PTSD is hyper vigilance and always feeling “on guard”. This in turn can cause problems such as excessive sleeping, irritability, aggressive behavior, heightened startle response, or difficulty concentrating. If these symptoms last more than one month and interfere with multiple areas of a person’s life, then they meet criteria for the diagnosis of PTSD.

PTSD is best treated by psychiatrists and psychotherapists with special training in this condition. Treatment often involves a combination of medication and therapy. Support groups, exercise, and mindfulness practices are also healthy coping strategies. And, as with any sickness, compassion from family and friends is crucial.
While the name for this illness may have changed, PTSD has been acknowledged for centuries. If you or someone you know is suffering from PTSD, don’t wait. Talk to your doctor, counselor, or spiritual leader. For more information, call the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-HELP (4357) or text HELP4U (435748).

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

By Jill Kruse, D.O.
 
I enjoy visiting with my colleagues who are medical specialists. We dive in and explore the depths of a particular condition. However, there is something to say about the breadth of knowledge that a family medicine physician is expected to have. Your family doctor can run through the alphabet of conditions from acne to the zika virus.

A 2004 study in the Annals of Family Medicine found that a family medicine physician managed an average of 3.05 problems per clinic visit. For patients over 65 years of age, that number went up to 3.88 problems and patients with diabetes had an average of 4.60 problems addressed at each visit. A specialist physician will generally focus on one problem at each visit.
 
However, patients are not made up of individual problems. The body functions as a unit and issues in one area can affect another unrelated organ system. We know that chronic pain can lead to depression and vice versa. Stooped posture due to compression fractures from osteoporosis can lead to lung issues as the ribs cannot open up as fully as they normally do. We continue to learn more on how the micro biome of the bacteria in the body affect things from a person’s weight to immune system function. 

This is why it is so important to have a primary care physician and to make sure they have access to your complete medical history. With a comprehensive view of your records, symptoms that might otherwise seem unrelated can be assessed and may assist with diagnosis. Talk to your doctor to determine if all your medical information and testing results are consolidated into one record, especially if you have doctors who work in different health care systems.

The primary care physician also serves as a guide between the patient and the specialist, offering valuable medical detail to the specialist and providing clarification to the patient.

Recently I had a patient who timidly started their question with the preface, “I’m not sure if I should ask you this, but….” I quickly reassured them that in primary care, any question is fair game. If it is something that I can answer, I will. If I do not have the answer, I can do some research, consult with a colleague, or refer you on to someone who does have that answer for you. So, no matter your condition from acne and amblyopia to zika virus and zoster, your family doctor should have you covered. Go ahead, ask anything from A to Z!
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Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                                                                

By Andrew Ellsworth, M.D.
 
Since ancient times, marijuana has been used for medicinal and recreational purposes in many cultures. In the United States, it became illegal during prohibition, like alcohol. Later, under the Controlled Substances Act in the 1970’s, the federal government classified marijuana a Schedule 1 drug. This classification includes heroin, LSD, and ecstasy, all deemed to have no safe, effective medical use and a high potential for abuse.
 
This Schedule 1 status imposes bureaucratic and legal barriers, making it difficult to conduct scientific research on the medical benefits from marijuana. Studies that have been conducted are small and limited. Thus, physicians are less confident recommending marijuana for patients. Not to mention, use or possession remains illegal federally and in many states. 
 
The word cannabis refers to all products derived from the plant cannabis sativa. There are hundreds of compounds in this plant, called cannabinoids. Cannabidiol (CBD) is one of them, and tetrahydrocannabinol (THC) is another. The word marijuana often refers to products from the plant that contain large amounts of THC, which is psychoactive and can alter someone’s mental state. 
 
Cannabinoids can trigger receptors in the brain to release neurotransmitters to affect mood, sleep, pain, and memory. Drugs with cannabinoids may be helpful in treating nausea and vomiting from cancer treatments, loss of appetite and weight loss from AIDS, chronic pain syndrome, multiple sclerosis symptoms, glaucoma and children suffering from seizures. There may be other medical benefits we are not yet aware of. We need more research to determine safe treatments and establish confidence. 
 
Marijuana use can cause harm. It can do more than dull the brain and give someone the munchies. It can increase the risk of motor vehicle crashes. In some individuals it can increase the risk of developing schizophrenia or other mental illnesses. Frequent use by adults and use in adolescence can decrease attention and memory, or cause cannabis use disorder, which has symptoms of craving, withdrawal, lack of control, and negative effects on personal and professional responsibilities. Sometimes people develop recurrent severe vomiting. Vaping products with THC have resulted in severe lung injury. 
 
Marijuana has been used as a medicine for a very long time in various cultures. Yes, it can be addictive, and it can cause problems. Although, when you consider the harms from alcohol, tobacco, narcotic pain killers, and other medications, perhaps cannabis deserves a chance to be further studied and used when medically appropriate. 
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                                     

By Kelly Evans-Hullinger, M.D.
 
Life expectancy is a measure commonly considered when it comes to the overall health of a population. In this day and age, when most of us think about which medical interventions are most important to increase life expectancy, we probably think about things like treatment of cancer, interventions to treat heart attacks, or surgeries for life threatening illnesses. While those things are all important, their overall impact on a population’s life expectancy pales in comparison to the prevention of infectious disease.

Average life expectancy around the world has doubled in the last two hundred years, from about 40 years to 80 years, with the bulk of that change occurring long before we had effective cancer treatment or cardiac catheterization. Before the 20th century, infant and childhood death was extremely common due to infections spread by contaminated water and food. It is estimated that through most of human history nearly half of children died before adulthood, almost entirely due to infections.

Armed with the new knowledge of germ theory, societies in the late 1800’s began instituting early public health interventions such as sewage management, water treatment, milk pasteurization, and garbage collection, which resulted in rapid decreases in death from food and water borne infections, and thus increased population wide life expectancy.

Later, widespread use of vaccines for many fatal diseases led to enormous improvements in the health and longevity of populations across the globe. Try to imagine a world in which almost everyone is affected by the death of children due to polio, measles, smallpox, tetanus, the list goes on. That these deaths are now extremely rare or eliminated altogether is nothing short of a modern miracle, and we ought not take it for granted.

Antibiotic use has exploded since the discovery of penicillin in 1928, and the proper use of antibiotics continues to help us prevent early death due to infections that might have been fatal left untreated. Modern science has led to effective treatments for even the most challenging infections such as tuberculosis and HIV.

Modern medicine uses abundant, wonderful technologies and treatments which help us extend lives and reduce suffering of our individual patients. But statistically, no fancy new development is likely to have the quantitative impact on human society that compares to those early public health measures. As a society, we would be careless to forget the worth of our public health institutions which have helped us thrive and double our average life expectancy.

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

By Debra Johnston, M.D.
 
Lately my teenager has been fascinated by medical dramas. Although my “doctor self” is usually rolling my eyes throughout the program, it’s often a good conversation starter.
 
One recent show featured a pregnant woman who experienced one medical crisis after another. Her kidneys, liver, and lungs failed in succession as the team raced to identify the underlying obstetrical problem and find a treatment. At the climax of the episode, her heart stopped. Of course, being television, the correct diagnosis was made, the experimental treatment worked, and the episode ended with a perfectly healthy mother at home, holding her perfectly healthy baby.
 
For all the erroneous and outrageous details that transform bad fictional medicine into good TV, they did get something right. Pregnancy is a dangerous condition. In fact, in America, pregnancy complications account for approximately two percent of all deaths among women between the ages of 20 and 44.
 
To put the two percent into perspective, consider that pregnancy complications can only happen in the months during and immediately following pregnancy. On average a woman in the United States will birth between one and two children. This means that between the ages of 20 and 44, the risk of pregnancy-related death isn’t spread across those 25 years as are the risks of cancer or car accidents. It is concentrated into the relatively few months during which she is pregnant. And for women younger than 20 and older than 44 the risk of pregnancy complications is even greater but, statistically speaking, women in those age groups simply don’t have enough babies to categorize pregnancy complications as a major cause of death.
 
Consider also that death by violence is not counted as a pregnancy complication, even though pregnancy is a significant trigger for violence.
 
What’s more, consider that these risks are not distributed equally between women. Socioeconomic status, education, physical location, and race all impact the likelihood of pregnancy complications, and death from those complications.
 
Issues that affect pregnant people affect their whole family. In medical school, I was taught “nothing is worse for a fetus than a dead mother.” It’s hard to disagree.
 
So, what can we do to make pregnancy safer? The answer to that question is multi-faceted. Access to quality obstetric care is one factor. However, we must also ensure women are as healthy as possible before they conceive. They need good nutrition and safe places to live and work. They need education to know what is normal, and what is not. They and their families need access to psychiatric care to address mental illness and addiction.
 
It may not make for good TV, but in the real world, the starting place is as basic, and as difficult, as that.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Jill Kruse, D.O.
 
The saying goes “time heals all wounds”, but what happens when a wound does not heal? Wounds go through many stages while healing and complications at any step can prolong the process.
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The first step is stopping the bleeding. For people who are taking blood thinners like aspirin or warfarin, it may take longer for the bleeding to stop or clot. 

The next step after the blood starts to clot is forming a scab. This happens when blood vessels around the wound narrow and platelets in the blood clump together to create the scab. A protein called fibrin helps hold the clot in place. After someone has had a stroke or heart attack caused by a clot, they may be placed on medications to make the platelets more slippery and less likely to clump together. Medications like Plavix and Aggrenox make platelets slide past each other rather than clumping to make a clot which can delay the scabbing process.

At this point, the body cleans the wound. Blood vessels will dilate and increase blood flow to the area. White blood cells called macrophages arrive on the scene to clear out infection and release chemicals called growth factors and cytokines that help tell the body to form new skin cells. If the infection is not cleared by the body, the wound will not heal properly. 

The body also creates new blood cells to bring in nutrients and supplies to help heal the wound. Conditions like diabetes, atherosclerosis, known as hardening of the arteries, and high blood pressure, cause poor blood flow and can slow down wound healing. Smoking slows healing in many ways. Nicotine causes blood vessels to narrow and reduces the number of macrophages and fibrin in circulation. Carbon monoxide in cigarette smoke decreases the oxygen transport needed to help repair and rebuild the skin cells. 

The final step of wound healing is strengthening or maturation. At this stage the wound looks closed and repaired, but the tissues below are still being strengthened. The wound may feel itchy or tight and the skin may look slightly pink and stretched. After about three months the wound should be about 80 percent healed. It can take up to two years for the scar to remodel and achieve its final appearance. 

Yes, it takes time to heal all wounds, but if you have concerns don’t bide your time. Talk to your doctor to learn about options that can assist you through the healing process. We want to help your wound heal, all in good time. 
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Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. 

By Andrew Ellsworth, M.D.
 
Perhaps this has happened to you: Your recent cough kept you up for another night, so you went to the doctor. The nurse took your vitals, the doctor asked you some questions, listened to your lungs, maybe looked at your ears and your throat, and recommended rest, fluids, over the counter treatments, and time. It all seemed fine until you got home and realized the doctor did not “do anything” for you.
 
Why didn’t the doctor prescribe an antibiotic? What could it hurt?
 
The use of antibiotics has been a blessing and a lifesaver. On the flip side, antibiotic resistance and opportunistic infections have been on the rise. 
 
Our bodies naturally produce good, beneficial bacteria in our gut and on our skin. Antibiotics can kill off some of those good bacteria, causing diarrhea or a yeast infection. Other problems triggered by antibiotics are not immediately apparent. For example, normal bacteria on your skin may become resistant, causing methicillin-resistant Staph aureus or MRSA, which can cause a stubborn infection the next time you get a cut or scratch.
 
With less competition from normal bacteria in your gut, the bad bug Clostridioides difficile or C. diff can take hold causing severe diarrhea and inflammation of the colon which is hard to treat and even harder to eliminate. Or perhaps you may have an allergic reaction to an antibiotic, or worse, a severe sloughing of the skin called Stevens-Johnson syndrome and toxic epidermal necrolysis. All the above may cause hospitalizations and even death. 
 
Most cold symptoms like a sore throat or cough are caused by viruses. Antibiotics are not effective against viruses, and early antibiotic use, often in the first week of symptoms, has not been shown to decrease the risk of a bacterial infection taking hold. In fact, if one does take hold, it may become even more resistant. 
 
Your doctor wants to help you feel better. It would be quick and easy to immediately prescribe an antibiotic, but that may not be what is best for you and your health. After listening to you, reviewing your medical history, your medications, your vitals, and doing an examination, and after further conversation with you, I trust that if a test, an x-ray, or antibiotics are warranted, the doctor will likely recommend it.
 
If you feel like the doctor didn’t “do anything” for you, please consider the risks of antibiotics. Of course, if your condition does not improve, and you start to feel worse, notify the doctor. But, if you do get better without additional tests and antibiotics, consider being grateful. The human body is a marvel, often capable of doing the healing itself.
 
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central. 

By Kelly Evans-Hullinger, M.D.
 
Cancer is a broad term which encompasses many different diseases, and each type of cancer has different patterns and tendencies. But at its core, cancer means a group of cells which is growing uncontrollably, due to one or multiple genetic mutations.

Cancer prevention is a topic we see frequently in the media, and it can be hard to separate fact from fiction. Truthfully, many cancers occur at random, and even modern science does not yield any clues as to how to prevent such cancers. Supplements and products marketed as “cancer prevention” do not have sound medical data, and I would advise skepticism of any product purporting to “cleanse” or “detox.” However, there are environmental factors that increase the risk of many cancers. Let’s focus on those.

Smoking increases the risk of cancer – not just lung, but also bladder, kidney, cervical, and numerous other types of malignant tumors. Additionally, chewing tobacco significantly increases the risk of head and neck cancers. Quitting tobacco is the most impactful lifestyle change one can make to reduce their lifetime cancer risk.

Sun protection is essential for reducing the risk of most skin cancers, including melanoma and the more common basal or squamous cell cancers. Experts recommend sun avoidance, protective clothing, and use of sunscreen with SPF 30 or greater when out in the sun.

Human papilloma virus is a common virus which increases risk of cervical, penile, and many head and neck cancers. We have highly effective vaccines which can prevent this cancer-causing virus. The first vaccine is recommended at age 11 or 12, as it is most effective when administered in adolescence; but the vaccines are now FDA approved up to age 45.

Other components of a healthy lifestyle including a healthy diet, exercise, and lowering alcohol intake, can also reduce your lifetime cancer risk. Most importantly, have a yearly conversation with your primary care provider about age-appropriate cancer screening. In rare cases, a strong family history of cancer may warrant genetic counseling, as some inherited abnormalities merit more aggressive cancer screening. Thus, providing a thorough family history to your care provider is crucial too.

In summary, though many cancers appear out of sheer bad luck, there are many things one can do to reduce overall risk of cancer. None of those things include spending money on products touted as “anti-oxidant,” “detoxifying,” or “cleansing.” So, my advice: save your money and focus on the data-driven recommendations.
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Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.                     

By Debra Johnston, M.D.
 
Experts estimate that well over 80 percent of people will experience back pain at some point in their lives. Perhaps ten percent of adults experience it at any given moment. Back pain is extremely common, and people with back pain can be extremely miserable. It may hurt to move, sit, stand, lay, even breathe. No wonder back pain accounts for so many visits to the doctor!
 
When people with acute back pain come to see me, they often have a preconceived notion of what will happen. They anticipate I will talk with them, examine them, and many expect x-rays or an MRI. They are often surprised, and sometimes worried, when I stop short of ordering imaging.
 
My first goal when I see someone with acute back pain is to rule out rare conditions that threaten life and limb. Could this be a fracture? Cancer? Infection in the bone or spinal cord? Severe and rapidly progressing compression of the nerves? These conditions could require imaging for diagnosis and urgent treatment. However, they are uncommon, and unless specific “red flags” are revealed during the patient history and exam, it is extremely unlikely a rare condition is responsible for the pain.
 
Most acute back pain gets better in four to six weeks. Unwarranted imaging only increases medical costs and the likelihood of invasive treatment like surgery or injections but doesn’t get people better any faster. For most people, the best approach for relieving back pain is to stay as active as you can, take an anti-inflammatory pain medicine if you don’t have a reason to avoid them, use a heating pad, and perhaps have manipulation by a chiropractor, osteopathic doctor, or physical therapist.
 
When imaging is used, it is important to realize that something seen on an x-ray or MRI might not actually be responsible for the back pain. Indeed, it has been found that as we age, it becomes more likely that, even with no back symptoms, we will have abnormalities on imaging. This is true in about ten percent of people in their 30s; among the very old, the likelihood approaches 100 percent.
 
There is no one-size-fits-all solution to chronic back pain. It takes a knowledgeable clinician to tease out what might be causing the problem and which treatment might help. I urge caution if anyone tries to sell you a treatment without careful analysis of your individual situation. Your money might be better spent on a heating pad, and a gym membership.
 
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.