[Music] Lakeland Currents, your public affairs program for north central Minnesota.

Closed captioning is made possible by Bemidji Regional Airport, serving the region with daily flights to Minneapolis-St. Paul International Airport.

More information available at bemidjiairport.org.

Welcome to Lakeland Currents.

I'm your host Todd Haugen.

On this edition of Lakeland Currents my guest is Dr. David Wilcox.

He is from Sanford Health of Bemidji, a family medicine specialist and has been in family practice for many years and maybe nearly done with his career doing that, at least for now.

Again, welcome Dr. Wilcox.

Thank you.

It's great to be here and I appreciate the opportunity.

Dave you have been in practice here in Bemidji, family medicine, for many years, right?

35.

Every one of them has been great.

Appreciated the community and the patients I've been able to take care of over those years.

Are you retired yet?

It seemed like I think the Pioneer carried a story last summer that said you were retired and you had a big party.

Yeah, well, I retired on June 30th and after 35 years.

But my replacement needed to wait a few months before he was available, so I agreed to be interim part-time until his tenure started.

Have you, did you transition during the pandemic to like a spokesperson for Sanford?

Not really.

My role is the medical officer for Sanford Health of northern Minnesota, which is our region.

So my role is to be the quality, safety, and patient experience leader, if you will, for our physicians and our nurses and nurse practitioners, and PA's.

But, as you know, the pandemic created a tremendous kerfuffle in medicine, and we needed to have a lot of change very fast and my role led me to that portion of how do we do that right for Sanford and how do we do it right most importantly for our community.

A kerfuffle in medicine and in just about everything else I would have to guess doctor.

I mean did you ever expect to see something like that in your medical career?

It's a once in a lifetime, you know, a pandemic.

You think back in time, perhaps the Spanish Flu of the 1917 era, when a virus spread around the world so quickly because of, you know, then travel was by boat not by airplane, so we just accelerated that with Covid 19.

Interesting how old things are new.

The way viruses work hasn't changed terrifically.

The point of being vaccinated to prevent illness from viruses it hasn't changed significantly, but it was new and different and our human race wasn't used to it so of course it creates a significant amount of havoc to save lives and to reduce hospitalizations and not be overwhelmed, which was clearly evident in some of the countries in the world.

And nearly here, right?

Weren't there times when our hospital was nearly full at least in some floors?

Yes, and that was after creating some 20 or so extra beds and spaces and areas to take care of patients.

I was impressed by our team, which predicted at the most we would have about 42 people in the hospital.

These are all kind of math problems of how the virus spreads and I think on our peak we hit about 39 or 40.

So we had the blessing in the Midwest of time to prepare.

You know it started down the East Coast, moved west and so that gave us quite a bit of time to get ready, if you will.

Vaccinations, one of the things we're here to talk about in this edition of Lakeland Currents, Doctor.

We've already talked a little bit about it and Covid is not really over yet, is it?

Now there's a new booster that's available.

Absolutely.

There's a variant now called the xbb variant and they've created a new booster for that for this fall and vaccination is the most important way to prevent serious illness from viral diseases.

The interesting thing about viruses is they mutate readily.

They're not very stable and they adapt beautifully.

They may start out like Covid did, terribly dangerous and a lot of death and illness and hospitalization.

But over time they learn that if they kill their victim, they would be unable to reproduce quite as easily, so they modify and they change, sometimes becoming somewhat milder.

But it's important to know that more people are dying from Covid still than the flu or many of our other respiratory viruses.

It's still a significant impact.

So if someone has already had the initial Covid shot and then what were so far until this booster there were two others, weren't there?

I believe so.

We had a first round, and we know that when you get a vaccine over time your immune system reduces the effectiveness of that vaccine.

And so a booster is important.

And we're familiar with boosters: tetanus shots have a booster, measle shots have a booster.

Many times there's a booster in addition to the original vaccines.

Is this latest strain of Covid dangerous enough though to get the vaccination?

They're all dangerous, and like most viruses they tend to impact the older or the frail or the very young or people who have other medical complications.

So remember we get vaccines to reduce hospitalization and death, and they're very effective at doing that.

So those are available now at Sanford Health and other places around the region?

Absolutely.

And that booster may or may not be the last or will there be more do you think?

You will recognize that the flu vaccine, which has been around for years, changes a little bit every year.

They guess which strains will start and how this virus may mutate so I imagine Covid will do the same thing.

It will change and mutate and periodically we may need to get a booster.

And time will tell.

But for right now, as we get into the respiratory season, we're recommending boosters for Covid as well as the other two common respiratory viruses, which are RSV and influenza.

Why can't we combine the Covid boosters with a flu shot?

You can get two shots on the same day, which is one way to combine them, but they haven't yet put them into a magic vial with one shot for everything.

All right.

So flu shots, those are readily available now.

And what do we expect for the coming flu season?

It varies from year to year.

It tends to match up with how good our scientists guess at the best recipe for the year and about every six or seven years there's a major mutation for which the flu shot effectiveness drops.

An average somewhere between 30,000 and 80,000 people a year die from influenza, so it's still, that's a significant number of patients.

Are there normally side effects from flu shots?

Yes they're usually nuisance side effects, a little bit of a sore arm, sometimes people will get a mild headache or a little fever or some muscle aches, but that sure beats going to the hospital or more seriously having to use a ventilator or even dying.

Right.

Well I hate to give endorsements but I mean I had my flu shot for this year recently and I didn't have any side effects.

Neither have I had any from the the Covid boosters I've had so far.

I've not had the latest.

But Covid boosters, is the latest Covid booster are there very many side effects from that?

It's about the same as you'd expect from most vaccines, similar, mild pain at the injection site, sometimes some redness or a little swelling and muscle aches.

These are on the order of 15% or so for patients.

I think the latest I saw, and most of the others, is maybe 3 or 4% of anyone will miss a day of work or a day of activity or just feel tired and maybe not do an activity that they're planning for the day, but generally they're mild.

There are more severe allergies but those are very uncommon.

The benefits of vaccines are felt to be overwhelmingly in favor of the risks of these other problems.

I will just say for myself, I used to be highly susceptible to flu and mean I had a radio career before and the flu would knock out my voice for sometimes two to three weeks which made radio very difficult, and once I started getting flu shots I didn't have that problem anymore, so they sure worked for me.

But there's this other virus around which I don't know anything about.

You mentioned it to me last week when we chatted, RSV, respiratory syncytial virus.

Did I say that right?

Respiratory syncytial virus.

Absolutely.

Close enough.

They're making it harder all the time.

Right?

A little too hard for me.

What is that and how dangerous is it?

RSV respiratory syncytial virus has been around for a number of years.

I think actually Covid 19 made us understand the impact of RSV more than we ever have before, and it's probably ironic because in the last several years, as we went into flu season, it became more efficient.

No one likes to have a swab instilled in their nose to do a test.

Maybe some of you remember that from the Covid days, but that same swab can also test for RSV or the two types of influenza.

So we made a habit of efficiency of testing all four at once and we realized that quite a number of adults can get RSV and be hospitalized as well and so that was sort of a unique fallout from our managing Covid.

How dangerous is RSV?

It can cause serious illness and death.

Typically we've thought about it as a childhood disease because infants and newborns are the most at risk to get lung problems and wheezing and short of breath or require oxygen and it was a common hospitalization for very young children.

As we started testing we realized many older and frail adults and even some otherwise healthy adults would end up ill enough from RSV to be in the hospital.

What are the symptoms like?

Very similar.

We call this respiratory season starting about now.

It's when we all get put in the house together, illness that spreads by droplets coughing, sneezing, not washing your hands, etc.

It loves a small environment with a lot of people in it so welcome to winter in Minnesota.

But it spreads more easily and so that's how we get it and it's a runny nose, a cough, sometimes the fever, some people get breathing difficulties, especially folks who have lung disease or asthma.

They'll get very short of breath and require oxygen as this inflammation affects their lungs.

Sounds like what some of us call a cold others might call the flu, but it may or may not be either one.

Correct.

Yep.

It may be RSV.

So we could have possibly, some of us, may have had it and not known?

Absolutely.

Unless you had the swab.

Yes if you had a test, you'll identify and we can't test for every single virus that causes a cold.

There's many others as well, but these are common ones that we know people get very sick from.

So at least for now you should get a Covid booster and a flu shot and an RSV immunization.

Yes RSV is limited to the very young.

So children under eight months of age from infancy on.

And in fact we recommend getting an RSV vaccine for mothers between 32 and 36 weeks and that vaccine will cause immunity to cross the placenta and go to the baby and protect them for about six months.

So very important to get those done around this time of year.

So especially for kids and for people who are over 65.

That's correct.

The older population also is at risk, tend to have more medical problems and more respiratory problems, heart illnesses, people who have faulty immune systems, either because they may be taking a medication that causes their immune system to be suppressed or they may have an underlying disease that caused their immune system to be depressed.

But yes, 60 and up and then the very young.

I've read though that RSV immunizations are in somewhat short supply at least in parts of the country.

Yes, absolutely.

And everywhere has had a problem.

It's an issue of the message has gotten out very well and the supply chain hasn't caught up, which seems very familiar from the Covid days.

Sure.

So try to get those ASAP because we're there, it's that season again.

It's not caused by cold weather, it's like you said that we all tend to go inside more.

Yes.

Diabetes is another topic in health that we wanted to talk about in this edition of Lakeland Currents doctor, and diabetes seems to be something that we're seeing more of.

You would know a lot more about that than I would though.

Is that true?

It is true.

You know diabetes affects more than 90 million Americans.

There's two types of diabetes.

One we think of as type 1 or the young, which is a little different.

They have no insulin, their body immune system killed the cells that make insulin.

But for older adults, and that's 90% of the folks who have diabetes, it's type 2 diabetes, and that's related to diet and weight and genetic history and sometimes lack of exercise.

But it's very common.

What is diabetes and what role does insulin play in the whole problem?

Diabetes is an illness where your blood sugar, the glucose, goes out of control for some reason.

In the type 1 diabetic it goes out of control because they can't make insulin at all.

In the type 2 diabetes it's more about our body resisting what insulin we have and they may have high insulins.

So insulin is a protein in our body that helps us process blood sugar.

So if you don't have that protein or it's not working properly then your blood sugar goes too high and that's dangerous.

So when a diabetic has been diagnosed, and a doctor has prescribed using insulin in whatever regimen might be recommended, does that cure diabetes?

No it doesn't cure it.

It treats the symptoms and helps blood bring the blood sugar down.

But I'd like to make a really important point.

Insulin is not the answer for many of the type 2 diabetics.

There are many other pills but foremost it's lifestyle.

Even as much as a 5% weight loss can help improve your blood sugar and control the diabetes without medications, as can proper diet and exercise, which are just good health recommendations all around.

I've heard of cases of adult onset type 1 diabetes just lately and it was something that I hadn't certainly heard of.

What is that, is that a new thing?

I think it's more a delay in how long it took for that antibody, I talked to you about the immune system killing off what we call the eyelet cells or your ability to make insulin, and it just took longer to affect that person.

It's a very small subset of diabetes and so I really like to focus on the type 2 because that's most common.

And that can come on gradually as people age and they may mistake the symptoms for something else, right.

Absolutely.

There's many symptoms, sometimes you're thirsty a lot, sometimes you're eating a lot, sometimes you're going to urinate very often, and these are the signs of symptoms.

Sometimes it's blurred vision as your blood sugar gets so high the lens gets swelling and you can't see well.

The important thing to remember though is that there are many screenings available to discover this early and hardly anyone with type 2 presents with those dramatic symptoms.

You wouldn't want to miss them but it's better to be screened on a regular basis because the sooner you pick up diabetes and the better you control it, the better you do at reducing the complications, which are many.

If you don't treat it, and sometimes people have the attitude that well things I don't know about are just, you know, it's best if I don't know.

I'll just leave it alone.

Maybe it'll go away.

What do you say to that sort of attitude?

Well it will come back to bite you because diabetes in the long run affects your vision.

So you may go blind or have significantly reduced vision.

It affects your kidneys, and, in fact, the majority of adults on dialysis now are type 2 diabetics that have had their kidneys affected, so that's a form of life support and it's not a great lifestyle.

It affects your heart and your blood system so that many more heart attacks, many more strokes.

Diabetes is a huge risk for all of these other common problems.

We may be told at our annual physical sometime by our physician, well, you're pre-diabetic.

What's that and can you move back again and not be pre-diabetic once again.

It's a matter of degree.

If you've been identified as pre-diabetic that's the shot across the bow.

That's the warning that if you don't do something to modify your diet or exercise that you will be affected by diabetes much sooner.

So getting your lifestyle under control then is a way to reverse the changes and control your blood sugar.

It's the high blood sugar over time that does damage so bringing that sugar down by some means, and it really is a a personalized illness, there are things that are unique to you and best treatments for you that start with diet, exercise, and healthy eating and losing weight.

But there's medications by mouth you can take.

There are some shots that aren't insulin that are as little as once a week that can help control your blood sugar and reduce all of those potential complications.

So if a person is pre-diabetic there's still time to right the ship so to speak.

Absolutely.

And delay the onset of full diabetes to the very best of your ability, and that could be forever.

People can be pre-diabetic for many, many, many, years and never develop diabetes.

But once you cross the threshold and you really are a type 2 diabetic, especially, can you ever get rid of it again?

I don't think you ever quote get rid of the diabetes, but you bring those blood sugars under control, you can normalize that.

One of the tests we do is called a hemoglobin A1c, sort of a 3 month average of where your blood sugars have been, but you can normalize that and that dramatically reduces any risk of complication.

And your blood might be normal most of the time.

People in medicine tend to look at the population to try to figure out well, who's most susceptible to a given illness.

For diabetes there are certain, is it gender?

Is there a gender difference?

Not significantly a gender difference.

Type 1 has a little bit of a gender difference but type 2 not.

And so getting it over time is a genetic predisposition.

It's a matter of managing your weight.

Certainly if you become overweight you'll get diabetes much sooner if you're predisposed.

And some age.

It gets a little worse with age.

And some people of some ethnicities may be more susceptible than others.

Absolutely.

Our Native American community familiar to all of us in this region of the state has a very high incidence of type 2 diabetes.

So if you are Native American or are susceptible for other reasons is there an inherited factor?

Could you be diabetic if your parents were?

Yes.

The type 2 is very commonly genetically predisposed.

So that might say that that person ought to keep a closer eye perhaps on the whole situation.

Absolutely.

If you have a lot of diabetes in your family, especially type 2, then you should listen to that warning and try to live the healthiest lifestyle you can to postpone the onset as long as you possibly can.

And again, since type 2 comes on kind of slowly and can be sort of ambiguous, what kinds of symptoms should people look for or be concerned about?

I think keeping up to date with your routine checkups, talking with your primary care physician, and doing screenings on a regular basis is important.

If you have a strong family history you can pick it up before you have any symptoms.

By the time you get those later symptoms, your blood sugar's probably been out of control for many years already.

In your family practice Dr. Wilcox I'm sure you've done many, many annual physicals for patients, and I would assume that that's something that you ask people to do on a regular basis, right?

Absolutely.

There's some routine screening of all sorts related to illnesses like diabetes, heart prevention, cancer prevention.

All of those things are part of having a checkup on a regular basis so things that we may not notice could be picked up in an exam like that.

Absolutely.

Other concerns as we head toward the winter season Dr. Wilcox?

Keep warm, wash your hands, do anything you can do to prevent the spread of viruses.

Right.

And keeping moving can help keep a person healthy can't it?

Absolutely.

Exercise is the best medicine if you listen to some people, and I would agree wholeheartedly.

It's an important part of your overall health.

Yet it's easy, especially with winter, to become even more sedentary than we already are in many cases .Yep, the line I like to use is not I can't exercise in the rain or I can't exercise because it's raining, it's more like how do I exercise when it's raining.

Right.

Think of some alternatives, or put your rain coat on.

Certainly harder if it's 35 below.

Absolutely.

Well, as we just have a few minutes left of our show today, Dave as you come toward the conclusion of your career and your family practice, and before you might do whatever you might do in retirement, what would you say some of the highlights of what you've done in medicine have been?

Oh it's always about the patients.

I've been blessed to take care of so many people from so many walks of life and we rub shoulders to shoulders with so many different cultures and backgrounds in this part of the country.

That's the reward is being able to help people.

It seems simple, but it's certainly a caring drive that I've had and the beauty of our nature and community here is wonderful and the beauty of the people has been wonderful over those years.

We certainly have more capability in our community here in Bemidji these days than we used to have.

For instance, there's opportunities for much more treatment than we used to have, isn't there?

Absolutely.

It's been amazing.

I came here and I was the 25th doctor of a small group of clinicians in this community and now Sanford, as it is today, has over 170 clinicians between physicians, nurse practitioners and PA's.

We've developed a cardiac service that takes care of immediate heart attacks by solving the problem here in Bemidji instead of transferring on.

Radiation oncology, the Cancer Center, it's been phenomenal.

There are so many things that I've seen grow over the years and it's really been a a blessing to be part of it.

Do you have plans for your retirement?

Will you be involved in any certain activity?

My joke is my first plan is to have no plan.

I've had a very planned life for 35 years between patients and appointments and commitments.

And as usual it'll be some travel, see family, grandchildren, and do those sorts of things first before I decide on if there's any other big adventure to be taken.

One thing that I think has helped my health since retiring a little over a year ago now is sleep, and I didn't used to get very much sleep.

These days I get a lot more more, which I think has really been helpful for me.

But sleep is a really healthy thing isn't it?

Absolutely.

Getting enough sleep is incredibly important.

It's a foundation of how well our immune system works and how we process our day as well as take care of our health overall.

The stressors of not sleeping, if you want to keep with the theme, increase cortisol, which can increase weight.

It's part of our stress mechanism.

So it's unhealthy not to get an adequate amount of good, restful sleep.

Maybe that's why I've lost a little weight.

I was careful though, I wanted to resist the retirement 15 I call it, with, you know, always being near the refrigerator.

Right.

Back to immunizations for just a second though Dr. Wilcox.

If a person wants to go out and get a flu shot, a Covid booster or an RSV shot, at this point do you need a referral?

Can you just go get those?

At Sanford Health we have a routine shot clinic every single day.

You can use your my chart account to sign up for a time to get your immunizations.

You can walk in.

We have some what we call flu blitzes, say boo to the flu will be coming up for children.

So there's lots of opportunities, and many of the pharmacies also have immunizations available.

So check with your my chart and maybe get in touch with your physician about this.

Yep absolutely.

I'll caution Medicare patients just for a moment.

I'm in that age group but Medicare covers certain immunizations as part of your healthcare visit with your clinician.

But certain number of vaccines they only cover at a pharmacy distant from an appointment.

So you can't always get all of your shots.

It's complicated.

I'm new to Medicare, haven't memorized it yet, but just a little warning.

Get your immunizations but talk to your health care provider about which ones are appropriate for which time and at what location.

But don't put it off.

They're one of those things that are easy to put off, aren't they?

Yes, absolutely.

I'd like to bring one thing back.

I failed to mention about the vaccines important to our Native American Community.

There are a certain number of young children, infants that are at very high risk of getting RSV and ending up in the hospital, and you spoke about ethnicity before.

Our Native American community is at very high risk, so not only should they get a a vaccine for RSV this year as they go into their first flu and RSV season, but they should get a second immunization for RSV next year at the same time.

So that's a high-risk community based on ethnicity.

Dr. Dave Wilcox, thanks for being our guest on this edition of Lakeland Currents and thanks for all your good work in the community over so many years.

Thank you so much.

It's been a blast.

That's Lakeland Currents for this time.

I'm your host, Todd Haugen.

Hope to have you join us once again soon on Lakeland Currents on Lakeland PBS.