bug bites

It’s bug-bite season – do you know how to protect yourself?

You step outside to enjoy the summer sun and before you know it, you’re covered in bug bites. Sound familiar? Insects thrive in hot and humid weather, which means outdoor activities during this time of year can quickly turn into a feeding frenzy if you don’t take precautions.

Bites from insects such as mosquitoes and ticks can cause annoying itchiness and spread more serious diseases, like Zika virus, West Nile virus and Lyme disease. Find out what you can do to keep you and your family safe from bug bites this summer.

Use insect repellent

Use EPA-registered insect repellents that contain DEET for protection against mosquitoes, ticks and other bugs. Other repellents protect against mosquitoes but may not be effective against ticks or other bugs.

If you are also using sunscreen, apply it first, let it dry and then apply repellent. Do not use products that contain both sunscreen and repellent. Do not spray repellent on the skin under clothing.

Consider using clothing and gear (such as boots, pants, socks and tents) that are treated with permethrin, which is an insecticide. You can buy pre-treated clothes or treat your own clothes. If treating items yourself, follow instructions carefully. Do not use permethrin directly on skin.

Cover exposed skin

As much as possible, wear long-sleeved shirts, long pants, socks and a hat.

Tuck your shirt into your pants and tuck your pants into your socks for maximum protection. Some bugs can bite through thin fabric.

Think about the indoors, too

Choose hotel rooms or other accommodations that are air conditioned or have good window and door screens so bugs can’t get inside. If bugs can get into where you are sleeping, sleep under a permethrin-treated bed net that can be tucked under the mattress.

Protect the little ones

Here are some helpful tips for applying repellent on children:

  • Do not use insect repellents on babies younger than 2 months old.
  • Do not use products containing oil of lemon eucalyptus on children younger than 3 years old.
  • Children should not touch repellent. Adults, apply it to your hands and gently spread it over the child’s exposed skin.
  • Do not apply repellent to children’s hands because they tend to put their hands in their mouths.
  • Keep repellent out of the reach of children.

For babies under 2 months old, protect them by draping mosquito netting over their carrier or car seat. Netting should have an elastic edge for a tight fit.

Pregnant women, be careful

Some infections, including Zika, can spread from a pregnant woman to her fetus, so pregnant women should strictly follow steps to prevent mosquito bites while traveling. In the case of Zika, because infection in a pregnant woman is linked to serious birth defects and miscarriage, the Centers for Disease Control recommends that pregnant women not travel to areas with Zika outbreaks.

When used as directed, EPA-registered insect repellents are safe and effective for pregnant and breastfeeding women.

When to seek help

If you’ve been bitten, be sure to see a doctor right away if you experience any of the following:

  • Difficulty breathing.
  • The sensation that your throat is closing.
  • Swollen lips, tongue or face.
  • Chest pain.
  • A racing heartbeat that lasts more than a few minutes.
  • Dizziness.
  • Vomiting.
  • A headache.
  • A red, donut-shaped or target-shaped rash that develops after a tick bite. This could be a sign of Lyme disease, which should be treated with antibiotics.
  • A fever with a red or black, spotty rash that spreads. This could be a sign of Rocky Mountain spotted fever, a bacterial infection carried by ticks, which should be treated immediately.

Next steps:

Alton Boyd

Meet Alton Boyd, UK HealthCare’s friendly first face

Alton Boyd never meets a stranger.

“I’m the type of guy that doesn’t have a frown on his face,” Boyd said. “I like to be a friendly person. I want to know people and what they do.”

His smiling face is the first that many people see when they come to UK HealthCare for an appointment or to visit a sick family member. For six years, Boyd, 86, has worked as an ambassador in the parking garage across from Chandler Hospital. He hands people their tickets at the front gate, provides directions and answers questions. More than that, however, he can, and often does, brighten everyone’s day.

Boyd discovered his people skills in 1967, when he began selling cars for Rudolph Chevrolet in El Paso, Texas.

“I enjoyed every minute,” Boyd said. “I didn’t care whether people bought a car or not. I wanted to make a friend out of every customer so they would remember my name the rest of their lives, and they did. And boy did it pay off for me! They’d bring their kids in there, their aunts and uncles, and I’d sell them a car.”

The story behind the friendly face

Perhaps Boyd’s congenial personality derives in some part from meeting many different people over a life filled with varied careers. He worked in the post office as a young adult when his family lived in Carlsbad, N. M., where his dad had a job in the potash mines.

After retiring from the Marine Corps at age 22, Boyd and his wife at the time returned to Carlsbad. He went back to work at the post office during the day and then fixed cars from 6 p.m. until midnight in order to save enough money to buy a house.

“I did that for about five years and got enough money to pay cash for a house,” Boyd said. “I bought a brand-new three-bedroom house for $11,000, which you can’t do anymore!”

When Boyd moved to El Paso, Texas, to sell cars for Chevrolet, he knew no more about cars, or selling them, than the fact that he liked them. After the first year, Boyd grew frustrated with his lack of sales and lost interest in the job, but his boss must have seen something special in him.

“My boss, Jimmy Godwin, truck manager at that time, said, ‘Alton Boyd, you’re going to live with me for three months. I don’t want you to sell nothing; I’ll just pay you. Every time I move, you stay with me.’ And, you know, the second year I sold 30 cars a month. I couldn’t believe it. I made several $6,000 bonuses.”

During that time, Boyd and his wife purchased more than 30 acres of ranch land, where he planted alfalfa fields, built a house and put up a barn for Quarter Horses, dabbling in breeding and training them for racing.

Boyd sold the ranch and retired from selling cars in 1991, when he and his wife moved to Georgetown, Ky., to be closer to family. However, Boyd loves having something to do every day, so he found a job with Tower Automotive in Bardstown, Ky., for several years before coming to UK.

Loving life and work

Alton Boyd, 86, serves as an ambassador who greets patients and visitors entering the UK HealthCare parking garage. He enjoys helping people and putting a smile on everyone’s face.

Boyd has enjoyed every bit of his interesting life. At an age when many people enjoy retirement, he plans to continue as an ambassador in the UK HealthCare parking garage for as long as he is able, where he can enjoy two of his favorite hobbies: cars and talking to people.

“I love talking to people,” Boyd said. “I want them to smile when they talk to me. I kid them, and they smile and say, ‘Oh, Alton, you know everything about this place.’ I have a lot of people call me by my name. I like to help them with where they’re going, and they appreciate it because they’re lost when they pull in here. That’s what it’s all about. I just like to be friendly. I enjoy doing what I do.”

When Boyd isn’t making friends during work hours, he’s most likely making friends while playing golf or on his occasional visits to the racetrack. Should the opportunity arise someday, he can see himself returning to his favorite place: Rio Dosa, Texas.

However, for now, he’s content making people smile and easing their troubles, if only for a moment, as the first face they see when they enter the UK HealthCare parking garage.


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Tobacco free

We’re tobacco-free. Here’s why.

At UK HealthCare, we are committed to improving the health and well-being of all Kentuckians. As part of that mission, all healthcare sites and UK campus locations – inside and outside as well as parking areas – prohibit the use of tobacco products (cigarettes, e-cigarettes, cigars, snuff, snus, water pipes, pipes, etc.).

Why is UK HealthCare tobacco-free?

  • Simply put, tobacco use takes a significant toll on a person’s overall health. It increases risk for heart disease, stroke and lung cancer, and can cause damage to nearly every organ in the body.
  • Tobacco smoke can make breathing harder for others with asthma or other lung problems.
  • Quitting tobacco has a wide array of health benefits – from a healthier heart and lungs to whiter teeth and fewer wrinkles.
  • Seeing others use tobacco can trigger strong urges in those who are trying to quit.

Be a quitter!

We’re here to help. In fact, many of our patients, visitors and employees have stopped or are trying to stop using tobacco.

You can purchase nicotine replacement gum at the Kentucky Clinic Pharmacy, UK Chandler Hospital Gift Shop and University Health Pharmacy at a very low cost. Tobacco-cessation coaching is also available to our employees at no cost.

For more information to help you or someone you know quit, check out our tips for conquering a tobacco addiction.

Thank you for keeping UK tobacco-free.


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UK College of Medicine-Bowling Green

Video: New campus will help shape future of healthcare in Ky.

This time next year, the inaugural class of medical students at the new UK College of Medicine-Bowling Green campus will be attending their first course, kicking off an exciting new opportunity for future Kentucky clinicians.

In June, officials broke ground on a new facility at The Medical Center in Bowling Green, which will be home to the satellite campus. This four-year, regional campus medical school is the first of its kind in Kentucky and is a partnership between UK, The Medical Center at Bowling Green and Western Kentucky University.

The UK College of Medicine-Bowling Green will be a fully functioning campus, using the same curriculum and assessments as UK’s Lexington campus. The on-site faculty will have UK College of Medicine appointments and teach in small groups, and they will provide simulation/standardized patient experiences with lectures delivered from Lexington using educational technology.

For students, the program in Bowling Green offers many benefits: scholarships; smaller class sizes; and the opportunity to live, work and learn in an up-and-coming Kentucky community.

“I think the regional medical campus in Bowling Green offers a really exciting opportunity for a batch of young students to come in and essentially lay the groundwork for everything that campus does going forward,” said Austin Webb, a WKU graduate currently in his third year of medical school at UK. “They are also going to be directly shaping the healthcare in that region for years to come.”

Check out the video below to see how the new campus in Bowling Green will foster a new generation of Kentucky physicians and improve healthcare across the Commonwealth.


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DASH diet

The DASH diet is easy to follow and good for your health

Do you want to eat better, but don’t know where to start? Consider the Dietary Approaches to Stop Hypertension, or DASH diet.

The DASH diet was initially created to help lower blood pressure. But studies have also found the DASH diet to be one of the best options to prevent heart disease, stroke, diabetes and even some forms of cancer. Research also shows the DASH plan is safe and effective for short-term and permanent weight loss.

The best news is the DASH diet is easy to follow because it does not restrict entire food groups. Because the plan focuses on fresh fruits and veggies, controlling your calories is easier, too. Learn more about the DASH diet below.

What is the DASH diet?

The DASH plan is promoted by the National Heart, Lung and Blood Institute, part of the National Institutes of Health. The plan helps reduce the risk for serious health problems because it is low in:

  • Saturated fat
  • Cholesterol
  • Total fat
  • Red meat
  • Sweets
  • Sugary beverages

The DASH diet encourages:

  • Fruits
  • Vegetables
  • Fat-free or low-fat milk and dairy products
  • Whole-grain foods
  • Fish
  • Poultry
  • Nuts

The DASH diet is also rich in important nutrients such as:

  • Potassium
  • Magnesium
  • Calcium
  • Protein
  • Fiber

Tips for following the DASH diet

To reduce the amount of sodium in your diet, try these steps:

  • Choose fresh, frozen or canned vegetables that have low sodium or no added salt.
  • Use fresh poultry, fish or meat instead of canned, smoked or processed options.
  • Limit cured foods such as bacon and ham, foods packed in brine, and condiments.
  • Cook rice or pasta without salt.
  • Cut back on frozen dinners, packaged mixes, and canned soups or broths.
  • Rinse canned foods such as tuna and canned beans to remove some of the salt.
  • Use spices instead of salt to flavor foods.
  • Add fruit to breakfast or have it as a snack.
  • Treat meat as one part of the whole meal, instead of the main focus.

Some days you might eat more sodium or fewer foods from one group than the plan suggests. But don’t worry. Try your best to keep the average on most days close to the DASH plan levels.

Following the DASH diet

Here’s how much of each food group you should eat every day, based on eating 2,000 calories per day.

6-8 servings of whole grains. A serving size is about one slice of bread, 1 ounce of dry cereal or 1/2 cup of cooked rice or pasta.

4-5 servings of vegetables. A serving size is about 1 cup of raw, leafy vegetable or a 1/2 cup of cut-up raw or cooked vegetables.

4-5 servings of fruits. A serving size is about one medium fruit; 1/4 cup of dried fruit; 1/2 cup of fresh, frozen or canned fruit; or 1/2 cup of real fruit juice.

2-3 servings of fat-free or low-fat dairy. A serving size is about 1 cup of milk or yogurt or 1 1/2 ounces of cheese.

Up to 6 servings of lean meat, poultry, fish. A serving size is about 1 ounce of cooked meat, poultry, or fish, or one egg.

4-5 servings per week of nuts, seeds, legumes: A serving size is about 1/3 cup or 1 1/2 ounces of nuts, 2 tablespoons of peanut butter, 2 tablespoons or 1/2 ounce of seeds, 1/2 cup of cooked, dry beans or peas.

2-3 servings of fats and oils: A serving size is about 1 teaspoon of soft margarine, 1 teaspoon of vegetable oil, 1 tablespoon of  mayonnaise or 2 tablespoons of salad dressing.

Up to 5 servings per week of sweets: A serving size is about 1 tablespoon of sugar, 1 tablespoon of jelly or jam, 1/2 cup of sorbet or gelatin or 1 cup of lemonade.


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UK, Cincinnati Children’s team up to help 11-year-old with painful illness

Perched on an examination table at the Kentucky Clinic, Mackenzee Walters revealed a collection of bruises and scrapes on her knees – the traces of trampoline topples and skateboarding scuffs.

The 11-year-old shrugged off the purple blemishes while reviewing her summer routine with Kentucky Children’s Hospital (KCH) pediatric gastroenterologist Dr. George Fuchs. These were minor battle wounds – nothing comparable to the pain she knew just months ago.

Mackenzee was born with hereditary pancreatitis, an inherited disease that causes uncontrollable pain. The condition is marked by inflammation of the pancreas, the organ that makes enzymes to break down and digest food and that produces insulin necessary for blood sugar regulation.

Mackenzee’s life has been filled with extended absences from school due to pain and frequent hospitalizations to manage flare-ups of her pancreas. Since the age of 3, she has taken potent opioid medications in an attempt to control pain and followed a strict diet barring her from the foods children love, such as macaroni and cheese and mashed potatoes.

But this year, after a surgical intervention coordinated through a multidisciplinary team at KCH and Cincinnati Children’s Hospital Medical Center, Mackenzee has adjusted to a new existence — one free of sharp, unrelenting pain and miraculously, without a pancreas.

Innovative treatment for hereditary pancreatitis

In January, surgeons at Cincinnati Children’s performed an innovative procedure reconstructing Mackenzee’s gastrointestinal tract to function without the source of her pain: the pancreas.

Fuchs, Mackenzee’s primary gastroenterologist at KCH, in collaboration with the pediatric medical and surgical teams at Cincinnati Children’s, determined that Mackenzee was a candidate for a Total Pancreatectomy with Islet Autotransplantation (TPIAT) surgery.

Cincinnati Children’s Dr. Jaimie Nathan removed Mackenzee’s pancreas and sent the organ to the islet facility where the islets – or the cells within the pancreas that produce insulin needed for glucose metabolism – were isolated. The islets were returned within hours, with Mackenzee still on the operating table. Nathan transplanted the islets back into her liver, where the cells took up residence and resumed their essential function. Cincinnati Children’s is one of few children’s hospitals in the nation to offer the innovative TPIAT procedure.

The surgery is a new offering for pediatric patients ages 4 and older expecting a life of pain stemming from the disease. Fuchs said scientific knowledge of hereditary pancreatitis has expanded throughout the past decade, although many generations have suffered without medical treatment or relief.

Inflammation of the pancreas can lead to permanent damage and eventual organ failure. Until recently, doctors have focused on trying, with only limited success, to manage symptoms through dietary modification and pain management. Because eating triggers the flare-ups, many children diagnosed with the condition become frail and undernourished.

“If that individual’s eating is one of the stimulators of the pain, or the activity of the pancreatitis, then it’s just awful,” Fuchs said of the disease. “It inhibits their ability to take in food because it hurts. So, they can become undernourished. It can be very difficult for these kids, very difficult.”

Fuchs and Mackenzee at an appointment at the Kentucky Clinic.

‘All we’ve ever known’

Mackenzee is part of a long line of family members to inherit pancreatitis, although most of her relatives died early in life from complications related to the disease. Those victims include Mackenzee’s biological mother and an aunt who died at age 35. Mackenzee’s grandmother died at 36 from complications after an experimental procedure. Several of Mackenzee’s cousins also succumbed to the disease, one passing away at age 23 and another at 4 years old.

Kim Walters is Mackenzee’s mother and biological aunt and the oldest surviving family member with hereditary pancreatitis. She said until Mackenzee’s surgery, members of her family accepted the tragic fate of dying early or living with chronic pain. Walters, who is insulin-dependent because of damage to her pancreas, expected Mackenzee to have a similar fate or endure severe pain for the remainder of her life.

“Hereditary pancreatitis is pretty much all we’ve ever known in my family,” Walters said. “It’s very excruciating every day. I had my children naturally without an epidural – I would rather have a child every day for the rest of my life than live with this disease.”

Teaming up with Cincinnati Children’s

In December 2015, after seeing many doctors around the country, Walters consulted with Fuchs at KCH. At the time, Mackenzee was suffering from unmanageable pain and taking a potentially dangerous level of medications without much relief. After ruling out the possibility of increasing doses of medication, Fuchs recommended Mackenzee as a candidate for the TPIAT surgery at Cincinnati Children’s. He contacted colleagues at Cincinnati Children’s and started the process of referring her for surgery.

“There was just nothing else. There were no other options to give her anymore because she was on [opioid] doses adults should take,” Walters said. “There was just nowhere else to go.”

Traumatized by losing her mom to an experimental surgery and seeing her daughter suffer in spite of 17 experimental surgeries, Walters was at first skeptical of the operation. Mackenzee was also afraid of undergoing a complex surgery removing an essential organ. But Fuchs, along with Dr. Maisam Abu-El-Haija, medical director of the Pancreas Care Center, and Nathan, the surgical director of the Pancreas Care Center at Cincinnati Children’s, explained every detail of the process and provided examples of real cases where children had recovered and enjoyed better lives.

“I came to the conclusion, if nothing else if she would just be pain-free,” Walters said. “If God chose to take her six months later, at least she would have six months of no pain. And that was our goal: to make her not have pain and be able to play and do what normal kids do.”

The 12-hour surgery was conducted at Cincinnati Children’s, with general follow-up appointments at KCH. Since her surgery, Mackenzee’s islets have rebounded in producing insulin. In fact, the amount of supplemental insulin she needs each day has dropped, and she no longer requires pain medication many months following her operation.

“I would predict she has a very high likelihood of becoming insulin independent,” Fuchs said. “She will no longer live in the hospital, which is what these children do before the procedure because they are in so much pain. I anticipate she will get on with her life, including getting into mischief as most kids do when they become teenagers. Hopefully go on to have a productive, full life.”

Helping others with the disease

People from Appalachia experience among the highest rates of hereditary pancreatitis in the nation. Fuchs hopes to extend advanced interventions and therapeutic options to affected children in Eastern Kentucky and surrounding areas.

In his first year working at KCH, Fuchs saw more cases of hereditary pancreatitis than in 15 years at his previous institution in Arkansas. Mackenzee’s family lives in Kenova, W. Va., but she receives primary gastrointestinal care and pain management services from Fuchs and Dr. Lindsey Ragsdale, a palliative and pain specialist at KCH. The ability to partner with Cincinnati Children’s Pancreas Care Center reduced the amount of travel time for Mackenzee and her family, keeping routine healthcare services more convenient while also giving them access to the services of a nationally renowned pediatric pancreas and surgery program.

Dr. Maisam Abu-El-Haija said the success of Mackenzee’s case is the result of like-minded doctors sharing a commitment to improving a child’s condition. The collaboration represented multiple disciplines and experts, including endocrinologists, pain specialists, psychologists, gastroenterologists, and surgeons at Cincinnati Children’s and KCH.

She commended Fuchs for initiating conversations with Cincinnati Children’s and pursuing a surgical intervention he believed would achieve the most advantageous outcome for the child, even if not performed at his own institution. She thinks the ability to collaborate with KCH will ensure more hereditary pancreatitis children will receive advanced surgical care without requiring the child’s primary care institution to “reinvent the wheel.”

“It stemmed from having common personalities and common goals,” Abu-El-Haija said. “I really value physicians like Dr. Fuchs. Basically, we both clicked on what we think is important, which is the outcome for the patient. Patients are best served closer to home, but no institution has everything.”

No longer worried about the future

Kim Walters said nothing makes her happier than to see her Mackenzee flipping on trampolines, eating birthday cake and being well enough to sleep over at a friend’s house.

Fuchs, who said most children gradually recover from the TPIAT over a prolonged period, considers Mackenzee’s rapid recovery an anomaly. Mackenzee came off a ventilator soon after surgery, and off of the feeding tube for nutritional support five weeks after surgery. She left the hospital prior to the expected discharge date, returning to school to finish the spring semester.

Walters doesn’t worry as much about Mackenzee trying once unthinkable foods to digest, such as steak, or passing out from pain at a friend’s house. The thought of losing Mackenzee doesn’t haunt her anymore. After scouring the nation looking for options for Mackenzee, she found an answer in Fuchs and the providers at KCH and Cincinnati Children’s.

“To discover that it’s right here at your back door where they’ve actually accomplished the research and figured out how to give her a better life and prolong her life, I was a little dumbfounded, I guess,” Walters said. “Because everyone thinks living in the boondocks, we don’t have good doctors, but we have some of the best doctors in the world. From Cincinnati to here at UK, there are some of the best doctors.”

Today, Mackenzee radiates with energy and giggles about her second belly button, a token left from her surgery. Mackenzee now thinks about the future and wants to become a fashion designer. She lists off all the activities she can do now, like help her mom cook and mop the floors.

“I can eat. I can go to school,” Mackenzee said. “Now I have more than just one friend. I can do other stuff than just lay in bed all day. Do different things.”


Check out our video that tells the story of Mackenzee’s journey and the collaborative work between KCH and Cincinnati Children’s that helped her find relief from her debilitating disease.


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postpartum depression

If ‘baby blues’ persist or worsen, it’s time to talk to your doctor

From sleep deprivation to learning how to breastfeed, you face a lot of challenges as the mother of a newborn.

As you adjust to these challenges, it’s not uncommon to experience mood changes or feelings of sadness. These “baby blues” will often go away after a few weeks.

Sometimes, though, mothers of infants can develop symptoms that are more severe and last longer than baby blues. This is known as postpartum depression. One study has shown as many as one in every seven mothers of newborns suffer from this debilitating condition.

Luckily, most women find that treatment helps.

What is postpartum depression?

Postpartum depression can start at any time during your baby’s first year. Usually, you’ll start to feel its effects during the first three weeks after birth.

You might feel sad, hopeless or guilty because you may not feel like bonding with or caring for your baby.

Postpartum depression doesn’t just affect first-time moms, either. You can experience it even if you didn’t have it with your previous children.

Why does it happen?

There are many causes of postpartum depression, including:

  • Hormone levels. Your hormone levels increase when you’re pregnant. After your baby arrives, they drop suddenly. This quick change can trigger depression in some women.
  • A history of depression. If you’ve previously had depression or if it runs in your family, you may be more susceptible to postpartum depression.
  • Other stress and problems. If you didn’t want to be pregnant or if your partner and family aren’t helping you care for your baby, you’re more likely to become depressed as a new mom. Postpartum depression is also more common among women with other stresses such as financial issues, problems with drugs or alcohol, or relationship troubles.

Symptoms

Postpartum depression varies among women, but here are some of the most common symptoms:

  • Sadness, loss of hope or despair.
  • Feeling unable to care for your baby or do basic chores.
  • Crying a lot, sometimes for no obvious reason.
  • Trouble bonding with or feeling close to your baby.
  • Less interest in other things you used to enjoy.
  • Too much sleep.
  • Trouble with focus, learning or memory.

Diagnosis and treatment

Only a doctor can diagnose you with postpartum depression. But if you think you have it, make an appointment right away. There are treatments that will get you back to feeling like yourself. They include:

  • Medication. Your doctor might decide to prescribe you antidepressants. If you’re nursing, be sure and tell your doctor. He or she can prescribe an antidepressant that is safe for nursing mothers.
  • Counseling. Talking to a psychologist or therapist can also help. You can learn ways to recognize when you’re having negative thoughts so you know how to better deal with them.

Postpartum psychosis

Postpartum psychosis is a rare and serious form of mental illness that can happen with postpartum depression. Symptoms often begin during the first two weeks after your baby is born and are more severe than those for postpartum depression. They include:

  • Frequent crying and irritability.
  • Lack of energy.
  • Trouble concentrating and making decisions or confusion.
  • Inability to sleep.
  • Feeling hopeless.
  • Lack of interest in eating.
  • Thoughts of harming yourself or your baby.

Postpartum psychosis is a medical emergency. If you think you might be experiencing symptoms of postpartum psychosis, call your doctor immediately.


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Down syndrome and Alzheimer's disease

Understanding the link between Down syndrome and Alzheimer’s

Written by Elizabeth Head, PhD, and Frederick Schmitt, PhD, the principal investigators for the Aging and Down Syndrome Research Study at UK.

People who have Down syndrome may develop Alzheimer’s disease at a younger age than people without Down syndrome. However, recent research has shown that some people with Down syndrome might not develop Alzheimer’s or other dementias at all.

Doctors and researchers don’t know why some people with Down syndrome develop dementia, either earlier or later than normal, while others don’t. But we’re working to find out.

Currently, only a few of the approved drug treatments for Alzheimer’s disease have been tested for use by people with Down syndrome, and these treatments offer few benefits. That’s why it’s critical for us to learn more about normal aging and Alzheimer’s disease in people with Down syndrome.

At UK, we have been funded since 2009 by the National Institutes of Health to follow a group of volunteers with Down syndrome. We’ve learned about several important changes that happen in the brain as people with Down syndrome age.

Connections in the brain

We’ve learned that connections in the brain called white matter tracts – like the “wires” connecting different parts in our brains – may be different in people with Down syndrome.

The frontal lobe, which is important to our personality, memory and actions, appears to be less strongly connected to other parts of the brain in people with Down syndrome. As these individuals get older, these connections become progressively weaker, possibly leading to personality changes and memory problems.

Changes in proteins

We’re learning that there may be changes in some blood proteins in people with Down syndrome that indicate the need for different Alzheimer’s treatments.

Some of these changes include higher levels of a protein called betaamyloid, which increases with age and may suddenly change as someone develops dementia. Other proteins include those involved with the immune system and inflammation, which appear to be more common in people with Down syndrome as they get older.

Helpful testing tools

We’ve learned about which kinds of learning and memory tests are helpful for diagnosing Alzheimer’s disease and which are not. This understanding will help us when we study whether certain treatments lead to learning and memory improvements in people with Down syndrome.

Our work to understand Down syndrome and Alzheimer’s disease continues. If you are at least 25 years old, have Down syndrome and are interested in participating in our research, please contact Roberta Davis at 859-218-3865 or Roberta.Davis@uky.edu.

Participation involves an annual visit including blood measures for wellness, neurologic examinations, tests of learning and memory, changes in walking, and brain imaging. More information is also available at www.uky.edu/DSAging.


Next steps:

Dr. James Liau

Dr. James Liau: How I help families navigate the cleft care journey

Written by Dr. James Liau, a plastic surgeon at UK HealthCare who specializes in cleft lip and palate repair.

July is a special time of the year for me since it’s Cleft and Craniofacial Awareness Month.

Although I do all aspects of plastic surgery, pediatric cleft care is what I’m passionate about.

So, what are clefts and how are they treated? What can you expect if your child is born with a cleft? I’m here to help answer those questions and help you and your family navigate the cleft care journey – from birth through adulthood.

What is a cleft?

A facial cleft is an area where there is an absence of tissue or abnormal tissue. Although there are multiple types of clefts, cleft lips and cleft palate are the most common. Some patients may have both cleft lips and cleft palate, while others may have only cleft palate.

Unfortunately, we’re not entirely sure why clefting occurs. Although clefts are a lifelong condition, I feel very strongly that there is no reason they should limit a child’s potential in life.

Treatment in the first year of life

I like to fix cleft lips at about 4 to 6 months of age, and then fix cleft palates around 10 months to 1 year of age. Timing varies for each family. I always tell parents that the most important thing is to go home, bond with their newborn and not worry about the cleft until at least several months after birth.

As a parent myself, I understand that no one wants their child to have surgery. Unfortunately, a child with a cleft lip and palate will need two surgeries in their first year of life. Both surgeries will be overnight stays in the hospital to make sure pain is controlled and the family is comfortable with the postoperative care.

The lip repair is the most dramatic, but postoperative care is relatively easy. Cleft palate repair can make eating challenging as it requires the child to temporarily be on a diet of only thickened liquids, such as applesauce.

Childhood

After the first year, cleft care is put on the back burner as we monitor speech development. As a child nears the age of 3, we have to be vigilant about their ability to communicate. Kids with cleft palates can develop hyper-nasal speech, a condition that occurs when the palate can’t close off the nose. This is called velopharyngeal insufficiency, or VPI.

If this can’t be fixed by speech therapy, another surgery may be necessary. I like to do this before the child starts preschool or kindergarten, as this is when kids really start interacting with their peers and speech becomes very important in making new friends.

At this time in a child’s life, we can also discuss whether a small touch-up to the lip or nose is necessary. I defer this decision to the child and family. Kids don’t comment negatively on physical differences until they’re at least 7 years old, so touch-ups at this age are only necessary if the cleft is bothering the child. My goal is that the first repair is perfect enough to avoid a revision!

Between the ages of 7-9, the child will start seeing an orthodontist. If there is a cleft in the gum line, we will need to put a bone graft in that area when the child’s permanent teeth come in, which usually occurs around this time.

The timing of this procedure can usually be coordinated over several months, and most families choose to do it during summer or winter break. For this operation, I use a less-invasive technique that involves harvesting bone from the hip. Postoperative care depends on the child: Some kids will stay overnight for pain control, while others will not.

Teenage years into adulthood

In the teen years, we can revisit the idea of a revision. This is when I do a lot of rhinoplasties, or nose reshaping. Naturally, we are focused on getting the nose to look more symmetrical, but we are also focused on opening the nasal airway so that breathing through the nose is normal. This is an outpatient procedure.

During the teen years, we may also do jaw surgery to improve how the face looks, and in more severe cases, to improve the airway in the nose and upper mouth.

As you can see, cleft care requires lots of coordination over many years. I tell all my families, “My role is to be your quarterback.” Raising a child is hard enough without worrying about cleft care, so my job is to make sure we don’t miss anything and to seamlessly work cleft care into what is happening in the family’s life.

I’m always honored to be able to help patients and their families navigate the process of cleft care. All children deserve a chance at a bright future, and I hope my work can help make that happen.


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Dr. Carolyn Hettrich

Shoulder specialist, researcher joins UK Sports Medicine team

UK Orthopaedic Surgery & Sports Medicine welcomed shoulder specialist Dr. Carolyn Hettrich to the team earlier this summer. Hettrich will see patients, take care of UK athletes and conduct research.

Originally from Portland, Ore., Hettrich has studied and worked across the country. She completed her undergraduate studies in Los Angeles at Pomona College and went to medical school at the University of Washington. After graduating medical school, Hettrich completed a residency at the Hospital for Special Surgery in New York and a fellowship at Vanderbilt University. She has spent the past six years working in Iowa.

As a member of the team at UK Sports Medicine, Hettrich said she is looking forward to providing care for patients with shoulder disorders and conducting leading-edge research studies.

In fact, one of the reasons Hettrich decided to join UK HealthCare is because of UK’s emphasis on research.

“I’ll have the opportunity to do the research I’m interested in,” she said.

Hettrich’s research interests focus on three areas: clinical outcomes after shoulder surgery, computer modeling for shoulder replacement, and tendon and bone healing. Hettrich is the principal investigator on the largest prospective study in the world for shoulder instability surgery. The study has 950 patients currently enrolled and is operating at 12 sites nationwide.

Her research expertise meshes well with work already being done at UK Sports Medicine, particularly the work of Dr. Christian Lattermann. Hettrich and Lattermann are both part of the Multicenter Orthopaedic Outcomes Network (MOON) and share a mentor.

“We are very proud Dr. Hettrich joined UK Sports Medicine,” Lattermann said. “She brings an extraordinary expertise in shoulder-related, patient-centered translational research, which accelerates our efforts at UK to become a national leader in patient-related outcomes research.” Additionally, she is an outstanding shoulder surgeon, Lattermann said.

When she’s not conducting research, treating patients or working as a team physician for the UK football team, Hettrich is looking forward to continuing her advocacy work on behalf of her patients. Her master’s degree in public health focused on health policy gives her insight into how she can advocate for her patients and research funding.

Each year, on Research Capitol Hill Days, Hettrich takes patients to meet with congressional leaders in Washington D.C. to show the direct impact of research funding. Hettrich is especially interested in musculoskeletal research because musculoskeletal conditions affect half of the adult population in the U.S., with expenditures related to these conditions accounting for nearly 6 percent of the gross domestic product.


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