(lively music) (intro music fades) - Hello, and welcome to "Prairie Pulse."

Coming up a little bit later in the show, we'll learn the history of the Bobcat Skid Steer Loader.

But first, our guest is Dr. K., from Sanford Health.

Dr. K., thanks for joining us today.

- Thank you for having me here.

And my name is Dr. Venkatkiran Kanchustambham, but the patients call me Dr. K. I'm a pulmonary clinical care physician at Sanford Fargo.

I've been there for now, this is my sixth year.

But I'm originally from India, southern part of India.

And I grew up on a very small farm, a small town.

And all my grandparents, my parents, all the farmers, I'm the first person to go to college.

And had my med school in India, and then I came to the United States in 2009.

Had my residency and fellowship in St. Louis, Missouri, St. Louis University.

And, after finishing my fellowship in pulmonary critical care, I came here to work for Sanford.

And so that, I'm married, I have a, my wife is a physician, too, at Sanford.

And I have two kids.

One is a four-year-old, the other one is eight months old.

- Well, tell us about the pulmonology work at Sanford.

And what does a pulmonologist do?

- Sure.

So pulmonology means it's lung.

Basically, lung pathology.

So, we predominately see patients with asthma, COPD, patients with lung cancer.

Patients with scaring and fibrous of the lung.

And, we also take care of patients in the ICU.

So patients when they are sick on ventilators, we are the ones managing those ventilators.

We also do procedures to go down into the lung, get specimens for the lung.

Like, tissue biopsies for lung cancer.

Then, apart from that, I am also specialized in advance procedures like patients having hard time breathing because they have a tumor in the lung, I go there and try to take it out, I put stents in the lung.

So, we do have those advanced procedure capabilities at Sanford.

- Yeah, let's turn to something I think you're also heavily involved in at Sanford.

And that's the study and treatment of COVID cases.

Especially, I think and understand, what's called long-COVID cases.

So let's start off with first, what is long COVID?

- Sure, the reason why, just to give a background is that, initially when we were the peak of the pandemic, when we had a lot of patients hospitalized in ICU, I think our initial goal was to get them better, keep them alive, and get them out of the hospital.

But at that time, I think we never thought about what is a long-term?

Like, what happens to these patients once they go home?

Do they recover?

What happens to them?

So and then, what we have realized is that there are two phases to COVID infection.

One is what we call acute COVID-19 infection.

That's usually when patients are symptomatic up to four weeks, that's the acute symptoms.

That most people go through, whether it's cough, shortness of breath, or wheezing, or any other usual symptoms.

But what we have realized is, apart from that acute phase, there are also a subset of patients that tend to have these persistence of symptoms, at least three months after the initial diagnoses.

So anytime you are having persistent, or symptoms lasting beyond three months, from the initiative diagnoses of COVID-19 infection, then we call them long-COVID or long-haulers of post-COVID.

And this can manifest in various symptoms.

- So with that, what are the symptoms people develop when they have long-COVID?

- Sure, so we, I would call this is more like an umbrella term that has many different symptoms.

But it's what I would call a multi-organ.

That means it can involve head-to-toe.

And the most common symptoms, one is fatigue.

People tend to be feeling very tired, and just drained.

That's probably one of the most predominate symptoms people feel.

The second is shortness of breath, lack of air.

When they do things, even at rest.

The third is cough, fourth is chest pain.

And along with that, people also tend to have what they call brain fog.

Which is where people have issues with recall, memory, concentration.

And then, followed by diffused body aches, chest pain, racing of heart, dizziness, lightheadedness.

So, you can pretty much have any organ involved with multiple symptoms.

But theses are predominate symptoms of fatigue, and shortness of breath.

- Well, I understand Sanford is involved in a big test study of this phenomenon.

Can you talk about that and the study?

- Yeah sure, so I think what right now, we don't have much in terms of research, understanding of what really drives patients with long COVID?

Like, who are the patients who had acute COVID, who go on to develop long-COVID?

We don't have a clear idea.

Plus, we also don't know how long they last, or what kind of symptoms last longer than the others.

And is there any other, if you know what causes these to last longer, can we prevent them.

So we don't know any of these.

So as a result, I think NIH has started a multi-state initiative called RECOVER.

Which is basically Researching COVID to Enhance Recovery.

Is an initiative to where basically they are recruiting patients who had COVID infection the last 30 days, or had COVID-like symptoms and tested negative for the last 30 days.

Basically, they are trying to recruit them, and they just follow them up, to see how many of these patients end up becoming, having long COVID symptoms.

And if they do, what kind of factors are predicting, so they are trying to create a database to better understand, and more about long COVID.

- So do you have a long COVID clinic at Sanford?

- Yes, yes.

So because the fact that many of these patients may not have symptoms that I explained where chest x-ray, or a blood work saying, "Okay, you have this, and that's the reason why "you have these symptoms."

And the care was not coordinated, and it's all scattered around.

So we decided to start a clinic, where patients who had been diagnosed with COVID, and still have symptoms beyond three months, or who have been hospitalized because they were sick enough to be in the hospital with COVID, they still have symptoms beyond four weeks, we see them in the clinic.

Which is basically a multi-disciplinary clinic, where we have not only a pulmonologist, but we have a physician from physical therapy.

We have someone from speech therapy, who does cognitive functioning.

We have someone from psychology clinic, assessing their anxiety/depression, things like that.

We get lung function testing, we get chest x-rays, we get blood work.

It's a comprehensive workup to look for why the patients are having the symptoms and what we can do?

- Obviously COVID was introduced, or discovered, or whatever we so phrase that, only in what?

2000.

So here we are, in 2022, rather, 2022.

And in 2020, let me get it right.

And we are in 2023.

So, I assume these are early studies you're doing.

'Cause a long COVID, can long COVID last...how long?

- So that's a very good question.

So we really don't know, I don't have exact answer for this.

But what we know is, depending on the type of symptoms you have.

As I said, long COVID can be multiple symptoms.

Lots and lots of different symptoms.

So, some symptoms tend to last longer, up to a year.

Some can recover quicker.

So for example, if you have something like fatigue, that tends to last up to nine months, sometimes up to a year.

So for example, if you have lost of taste and smell, that can recover quicker.

Or, if you are short of breath, or chest pain, can come back within a few months.

So it depends on what symptoms you have.

But it also depends on the risk factors that you have, that may have caused the post-COVID symptoms you have to occur.

So for example, if you're older.

The chance of you having a longer COVID symptom is much more.

Or, if you are a female, and older, the risk is much higher.

Or, if you had pre-existing diabetes, or pre-existing lung disease like asthma, COPD.

The risk is higher, and the longer they last.

So it depends on what you have, and what kind of symptoms you have.

- Sure, so as I understand you saying it, well, I'll ask it this way: Is there any cure for long COVID?

Because, it is difficult to treat, you say.

And compared to what normal cases of COVID are.

Yes, unfortunately, we don't really have any specific medication that we can give to cure long COVID.

That's because this is a multi-system, multi-organ involvement, where you have non-specific symptoms.

That you really can't give a medication to treat.

But what we do usually, is we try to do what we call lifestyle changes.

So for example, if you have, for example, you are very tired and fatigued, what we tell, advise people is to do something called the four Ps strategy.

Like pacing, prioritizing, planning, and positioning.

That means you tend to have, so what you need to do, is basically when you're tired and fatigued, there are certain times of the day where you have most energy.

So that's the time you try to prioritize what you can do, what you need to most.

And the rest of the time, you kind of cut back.

And then, you also pace.

That means you don't strive to finish things.

You try to do things in parts, or you do it slower, taking breaks in between.

So that you can conserve your energy.

So this is what we call four Ps, or three-P strategy that we advise people.

We make people go to rehab, pulmonary rehab, to help with their deconditioning, weakness, to help with the shortness of breath.

And sometimes, if they are feeling lightheaded, dizzy, we tell them to get up slower, drink plenty of water, sometimes increase the salt intake.

We do compression stockings, things like that.

But otherwise, we really don't have a specific medication, or cure, that we can use to treat long COVID.

- Without violating any confidentiality, can you talk about any particular case, difficult cases you've encountered?

And how you've dealt with those?

- Yeah sure, so I think the most difficult cases that I've seen in long COVID, to post COVID clinic would be patients with predominately brain fog, cognitive dysfunction.

That means people are struggling to just do daily activities of living.

Just, you know, sometimes people have a hard time brushing.

People have a hard time putting on the clothes, because they don't know what to do.

Like they just can't think through multiple steps.

And people have, they just can't get out of bed.

And it's unfortunately very frustrating, because you do all these workup, and it's all normal.

Yet, they're really, really sick.

And that's where it's really hard to deal with them, because you don't really have a medication that you can give to make them feel better.

So this is where a lot of times working with speech therapy, neuro psych testing, rehab, sometimes working with employers to see if they can do part-time, or cut back on act, level, there.

And so those are the things we do, and that's where it's the most difficult type of patients that we deal with, is people with brain fog.

- Do you know, or can you calculate how many cases there have been of long COVID?

Or how many there are, or how many there have been?

Can you have those numbers at all?

- Sure so I think one thing that's hard to get an accurate number is because the definition of long COVID is different across the many healthcare systems, so it's hard to know.

But based on what we know, based on the CDC definition, which is three months, or longer symptoms.

We know the prevalence, that means how many people end up developing long COVID after getting COVID, is around one in 13, I would say roughly around 7.5% of the patient population, that's ending up having long COVID symptoms.

But I don't have exact numbers for the state.

But that's the usual prevalence, is around one in 13 patients with COVID, end up having long COVID.

- Do you even have any idea of how many people are going undiagnosed?

- Absolutely, so I think that's where I think being aware, increasing the awareness is really important.

Because a lot of times, you don't need to have severe COVID infection to develop long COVID.

You can just have a very, very mild infection, test positive, but you can end up developing long COVID.

So because of that reason, I think people tend to equate being severely sick to having long COVID.

Because of that reason there is almost, I would say, two-thirds of the cases go undetected, because you're having all these different variety of symptoms that you can't put together.

So a lot of times, unless they come to a clinic like long COVID, or they see a pulmonologist, or someone who's been seeing COVID cases for awhile, it's hard to put them together.

So I would say at least two-third or longer, or more cases go undetected, because of that reason.

- Let me ask you this: why is the COVID strain so difficult to treat?

And why did it prove to be so deadly when it first emerged in 2020?

- Sure I think one is, it was a novel virus.

That means our human bodies have never been exposed to it.

So that is the first thing.

So since we've now been exposed to it, the way the body responds to it is different.

And because of that, I think it was pretty severe.

The second is, the variants that we saw later, like especially the Delta variant, that was really deadly, one was because it was extremely contagious, like it spread almost three to four times faster than a normal previous variant, so that was one.

Is extremely contagious.

Number two is, the way it multiplied in your lungs.

It was almost a thousand times more and faster than previous variants.

So that means the widest burden multiplied very quickly in your lungs.

And as a result of that, the body's response to that was much more severe, what we call cytokine storm, which is very basically, the body's trying to fight off these large, loads of virus.

And when that happens, it causes severe damage to the lungs.

So it was contagious, more contagious, reproduced faster in the lungs.

And because of that, the body's response was much more severe, causing much more damage to the lungs.

And of course, we didn't have the vaccines at the time, so that is the reason.

- Do you think down the road it will be a yearly vaccine that will be recommended and available to the public to combat COVID?

Is it just, sort of, some people now say, it's just part of life, part of the flu season?

- I think it's gonna be what it is.

So from being a pandemic bearer, it was severe, it was causing a lot of death.

Now, I think we're moving more toward the virus becoming, anamotic, something flu-like.

So, it's most likely down the road, we are looking at yearly vaccine, just like we're gonna get for flu shots.

So with the studies you're doing, what do you think, or what are the long-term effects of long COVID?

- So I think the biggest thing would be with the long COVID is, the effect it has on, I think one is most people are not able to go back to their previous baseline.

That means they're gonna have effect on employment.

How well they can go back to workforce.

So I think that's playing, so functional disability is a big, big deal, number one.

Number two is, I think, long COVID also has a significant effect on mental health.

So we have significant evidence regarding worsening anxiety, depression, things like that.

And number three is, the effect it has overall on heart disease, kidney disease, and things like that.

- Yeah, can you talk a little bit more about that heart and kidney damage, the issues that patients will have with long COVID?

- So we knew in the beginning itself, when people were developing COVID, severe COVID infection, were sick enough to be in the hospital.

We've seen quite a lot of cardiac complications from COVID.

Because COVID can cause your blood to clot much faster, quicker.

So as a result, people are having blockage in the vessels supplying blood to the heart, what we have heart attacks.

But because of the severe stress the body was under, people are also developing heart failure.

That is also causing significant irregular heartbeats, or abnormal heart rhythms.

So there was a significant burden of heart disease in patients who were acutely ill with COVID.

But now we know that it's not only just that.

But, as the patients recover, and get out of the hospital, are people who had mild enough disease, they also have significant heart disease burdens.

So, one of them is number one is, inflammation of the muscles that's around the heart, the pericarditis and myocarditis.

So that's something we know that does happen with COVID.

Any virus can cause inflammation of the muscles surrounding the heart.

So myocarditis, pericarditis, is one.

Number two is, there's also slight increased incidents, or increased documents of heart disease.

Like heart attacks, post-COVID patients, number two.

Number three is, it can also cause what we call, increased heart race and dizziness and lightheadedness.

What we call autonomic dysfunction.

Where just simple exercise, just getting out of the bed, or walking to the bathroom, can itself, make your heart rate race to like 190s, 200s.

And so, as a result, you feel dizzy, lightheaded.

So that's something we're seeing.

And the fourth is irregular heart beats, or other abnormal heart rhythms.

So, it definitely has some long-term effects on the heart.

And as for the kidneys, what we've seen is people who have been hospitalized, initially acutely, almost one-third of the patients ended up having acute kidney injury, like having worsening kidney function while they were hospitalized.

And by the time they were discharged, only half of them recovered.

That means at 50% of persons still had kidney disease when they went home.

And then, at the end of two-to-three months, at least on-third still had kidney disease.

So that means, even if you're sick in the hospital with kidney disease, at least one-third still had long-term effects from what you had initially.

- So from your expert opinion, are vaccines the best way to avoid getting COVID?

So if someone who has had COVID, are they more immune to getting it again?

And so what I'm asking is, what is the best immunity people can have?

- Sure, so that's actually a very good question.

So the way I would put this is, let's say that you are vaccinated, okay?

And you are also, let's just go back.

So let's say that you've not been vaccinated, and you have not had a COVID infection yet.

The best way to prevent that is to get the vaccine, there's no question about it.

But let's say you are vaccinated, but you also get the infection.

So the question now is, how good is your natural immunity, compared to what you get from the vaccines?

So, initially we didn't have much data.

But what we know now from a couple of studies that were, that came out in late in 2022, is that if you had an infection, and if you looked at natural immunity, what we learned is it is effective up to almost 88%, to prevent you from having a severe COVID-19 infection.

But the take home point from this is not to, is that you should get vaccinated.

But if you do get infected by a breakthrough infection, your ability to fight that infection off is very high.

That is what I would say is the take home going from here.

It's not about what is better, but the hybrid immunity is better.

- Dr. K., we're about out of time.

So, if people want more information, where can they do?

Who can they contact?

- So, I would say sanfordhealth.org is the best place to get the information more regarding COVID.

- Okay, well Dr. K., again, thank you so much for your time.

There's more we can talk about with, maybe have you back another time?

- Sure, thank you.

Thank you so much for having me.

It was a pleasure.

- Stay tuned for more.

(upbeat music) In the 1950s, turkey farmer, Eddie Vello, approached the Keller Brothers with a need for a self-propelled loader.

Small enough to clean around the barn's upright poles.

Then, in 1957, the Kellers invented the precursor to the modern skid steer loader.

In this "Artifacts Spotlight," Chris Schuelke, with the Otter Tail County Historical Society, shares with us the history behind the first Bobcat.

- Hi, this is Chris Schuelke, with the Otter Tail County Historical Society in Fergus Falls, Minnesota.

And this is our "Artifact Spotlight."

(gentle music) One of the most common pieces of machinery that is utilized throughout the world, is the Bobcat self-propelled loader.

And it had its start right here in Otter Tail County.

So in 1956, Rothsay area, turkey farmer, Eddie Vello, was having issues cleaning his turkey barns.

Turkeys generate a lot of waste.

And so, in his pole barn, he had a number of poles, you know, located throughout, and so he could not find a machine that would circumvent the poles, and clean his barns in a more efficient timely manner.

So he contacted two blacksmiths, two machinists in Rothsay, Louie and Cy Keller, and came to them with a problem that "I need a machine to clean my turkey barns "in a more efficient manner."

So working together, the Keller brothers, and Eddie Vello solved the problem, and they came up with a self-propelled loader that was able to move around the poles in the turkey barn, and was able to clean the waste in a much more efficient manner.

And it was a new machine that no one had really seen anything like this.

A maneuverable was one of the big things.

Economical, dependable, it didn't cost a ton of money.

Especially, turkey farmers initially to clean their barns, but it had so many other uses.

Now, the Kellers eventually decided to patent this, so here's the original patent that the Keller brothers applied for with the patent office.

And it's the clutch drive mechanism that you'll see right here.

That is what the patent was for.

Not the actual, total machine, but the clutch drive that was totally unique.

No one had seen anything like that.

And eventually that's what became patented.

And became known as eventually the Bobcat.

Now, this happened in the late 1950s, when Cy and Louie Keller brought a prototype Bobcat down to the Minnesota state fair to demonstrate.

And representatives from Melroe Company were there.

And eventually that formed into a partnership with Melroe Company, to manufacture the Bobcat.

And the rest, they say, is history.

The Bobcat is now used throughout, not just the United States, but throughout the world for a variety of different purposes.

(gentle music) And again, the original, the first, was made right here, in Otter Tail County, and is now on display at the Otter Tail County Historical Society.

(upbeat music) - Well, that's all we have on "Prairie Post" for this week.

And as always, thanks for watching.

(upbeat music) - [Announcer] Funded by The Minnesota Arts and Cultural Heritage Fund.

With money from the vote of the people of Minnesota on November 4th, 2008.

(upbeat music) And by the Members of Prairie Public.

(quiet music fades out)