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.


Next steps:

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.


Next steps:

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.


Next steps:

SMRI

Video: Take a tour of the Sports Medicine Research Institute

Lisa Cassis

Lisa Cassis, UK vice president for research

Written by Lisa Cassis, PhD, UK vice president for research.

The new UK Sports Medicine Research Institute, or SMRI, is a state-of-the-art, multidisciplinary facility that will allow UK researchers to study injury prevention and performance for professional and collegiate athletes, the tactical athletes of the U.S. military, and physically active people of all ages.

Watch the video below for an inside look at the equipment and technology that makes the SMRI such a unique and exciting endeavor.

The 10,000-square-foot facility, part of the UK Nutter Training Facility on campus, is spearheaded by the UK College of Health Sciences and is supported in part by a $4.2 million Department of Defense grant.

The SMRI is outfitted with sophisticated equipment to assess biomechanical, physiological, musculoskeletal and neurobehavioral health and is supported by a team of eight core faculty, staff and research assistants as well as 40 affiliate faculty.

A biomechanics laboratory conducts motion analysis studies using 14 cameras and a dual-force plate system in the floor, like the technology used to make video games and animated movies. Equipment shaped like a horse simulates realistic movement for jockeys and other equestrians.

A neurobehavioral lab uses virtual reality to assess visual acuity, reaction times and balance, which are critical measurements for concussion recovery. Other equipment is designed to measure oxygen consumption, workload and metabolic costs, physiological stress, and the influence of sleep deprivation and fatigue, all of which are important contributors to musculoskeletal strength, endurance, operational performance and injury risk.

The different branches of UK’s mission – education, research, service and care – converge in the work of the SMRI, and we look forward to the discoveries that will come out of this UK institute.


Next steps:

ultrasound-guided injections

Innovative pain-relief treatment allows woman to enjoy trip to Italy

Geri Maschio spent more than a year planning a girls trip to Italy, but pain in her hip threatened to keep her from getting on a plane and experiencing the cities she’d been dreaming about.

Maschio started experiencing pain in her hip two years earlier. She tried a variety of treatment options to find relief, but none fixed the issue. Unfortunately, physical therapy didn’t help, and Maschio needed a hip replacement.

She was referred by her primary care doctor to Dr. Jeffrey Selby, an orthopaedic surgeon at UK Orthopaedic Surgery & Sports Medicine.

By that time, Maschio’s pain had become too severe for her to continue without treatment. Hip replacements require about four to six weeks of recovery, but Maschio’s trip was quickly approaching, and she refused to forgo her long-planned vacation.

“I wasn’t going to be the person who bailed at the last minute – the trip was a year in the making,” she said.

Another route to pain relief

Luckily, Selby knew of another orthopaedic physician at UK who might be able to help. He referred her to Dr. Kyle Smoot, who suggested using ultrasound-guided injections to treat Maschio’s hip pain. The procedure required little recovery time and would allow Maschio to travel.

Ultrasound-guided injections are used to treat pain stemming from conditions like chronic tendinopathy, muscle tears and carpal tunnel. They’re used in a variety of joints – including the hip and knee – and can also be used diagnostically to identify and differentiate a patient’s pain.

Maschio felt prepared for the procedure, which was performed while she was awake and numbed, but wasn’t sure what the outcome would be.

“I trusted Dr. Smoot because I was totally confident seeing anyone Dr. Selby recommended,” she said. “And Dr. Smoot and the athletic trainer [Amy Waugh] were so kind when they explained everything to me.”

The day before her trip to Italy, Maschio had an appointment with Smoot to receive her injections. Recovery was simple, she said. She let the numbing medication wear off and then felt immediate relief from the pain that had threatened to keep her from going on the trip of a lifetime.

The very next day, Maschio got on the plane for an eight-hour trip. She spent 12 days in Italy walking five to seven miles a day – pain-free.

“I know I wouldn’t have made it on this trip without Dr. Smoot and Dr. Selby – I couldn’t have done it without them,” she said.


Next steps:

  • Learn more about UK Orthopaedic Surgery & Sports Medicine, which provides leading-edge treatment for a variety of injuries and conditions.
  • When Patty Lane was diagnosed with arthritis in her hip, she was told her time as a competitive triathlete was over. Not willing to give up on her dreams, Patty turned to UK Orthopaedic Surgery & Sports Medicine for a second opinion. Read Patty’s story.
elderly care

Improving elder care through physician-pharmacist teamwork

A new study from UK researchers shows that when physicians and pharmacists work together more closely, care for elderly patients can be improved.

The findings, published in Alzheimer’s Research and Therapy, show the value of physician-pharmacist teams in providing more coordinated care for elderly patients, especially as it relates to prescription medications.

As people age, the number of medications they’re prescribed tends to increase, which makes both patient care and medication therapy more complicated. In the U.S., patients over 60 take an average of five medications, many of which are prescribed by different physicians. This increases the risk of inappropriate drug prescriptions and side effects, including cognitive impairment.

Ensuring medications are prescribed appropriately is especially important for patients living with Alzheimer’s disease and other dementias. Anticholinergic drugs – used to treat nausea, peptic ulcers, lung disease, dizziness and other conditions common in elderly patients – are often the culprits of inappropriate prescriptions.

Although they sometimes prove helpful, these medications have also been known to result in cognitive decline. Therefore, it is essential to find the right balance between risks and benefits for each individual patient.

Creating a medication therapy management team

In order to examine this further, Dr. Daniela Moga from the UK College of Pharmacy and Dr. Greg Jicha from the UK Sanders-Brown Center on Aging partnered to conduct an eight-week randomized trial with patients from Sanders-Brown.

Their aim was to investigate whether a targeted patient-centered, pharmacist-physician medication therapy management team intervention could reduce the inappropriate prescribing of anticholinergics. The research was the first step in evaluating whether intervention can improve cognitive function in patients.

Their findings showed promise. Compared to the control group, patients receiving the intervention showed a reduction in the number of prescribed anticholinergic drugs. In addition, patients appreciated the opportunity to participate in the study and recognized the importance of optimizing their medical treatment.

Expanding the research

Now with funding from the National Institutes of Health, Moga and Jicha will follow a larger group of patients for one year, and further evaluate the long-term effects of intervention by a medication therapy management team.

Physicians are constantly managing risks and benefits of medications with patients, and sometimes the potential for adverse effects is not fully recognized.

“When physicians and pharmacists work together, everyone wins,” Moga said. “It’s clear that including a pharmacist on the patient-care team means better outcomes and better healthcare for patients.”

“This study highlights the benefits of patient-centered medical teams that improve drug choices and the health of elderly patients, many of whom have highly complex medical conditions and needs,” said Greg Graf, assistant dean for translational research and UK College of Pharmacy faculty member. “The project is a collaborative effort between the UK Colleges of Medicine and Pharmacy, and we’re proud of the work we’re able to do together.”

This research was funded in part by the UK Center for Clinical and Translational Sciences, Sanders-Brown Center on Aging, the National Institutes of Health, the Office of Women’s Health Research and the National Institute on Drug Abuse.


Next steps:

Owensboro Health Markey

Owensboro Health joins Markey Cancer Center Research Network

Owensboro Health has joined the UK Markey Cancer Center Research Network (MCCRN), giving patients in Western Kentucky and Southern Indiana increased access to innovative clinical research studies.

Areas of research will include epidemiology, prevention and early detection of cancer. Markey is a National Cancer Institute-designated cancer center, which means Owensboro Health will have access to NCI-led trials in addition to MCCRN trials.

“Owensboro Health is proud to join the Markey Cancer Center Research Network, which is a distinguished and recognized name in cancer care and clinical research,” Owensboro Health President and CEO Greg Strahan said. “Owensboro Health exists to heal the sick and to improve the health of the communities we serve, and this partnership is a demonstration of our commitment to both parts of that mission.”

Owensboro Health was invited to participate in the Markey Research Network based on performance and achievements. Owensboro Health’s Mitchell Memorial Cancer Center serves the health system’s coverage area, a population of nearly 400,000 people across 14 counties in Western Kentucky and Southern Indiana. More than 1,000 patients are treated at the center annually.

“By becoming a member of the Markey Research Network, Owensboro Health is showing a commitment to helping us conquer cancer in the Commonwealth,” Markey Director Dr. Mark Evers said. “Clinical trials represent the latest, best treatment options for most patients, and being able to participate in major national and regional clinical trials right here in Owensboro means that patients are able to stay close to their own support systems at home and under the direct care of their doctors here.”

Mitchell Memorial Cancer Center also holds multiple accreditations and recognitions. These include accreditation from the American College of Surgeons Commission on Cancer and the CoC’s gold award, the highest recognition that body offers. Mitchell Memorial Cancer Center is also accredited by the National Accreditation Program for Breast Centers and the American College of Radiology and is an ACR-designated lung cancer screening center.

The importance of clinical trials

Clinical trials are key to developing new methods to prevent, detect and treat cancer, and most treatments used today are the results of previous clinical studies. These may include studies in which patients who need cancer treatment receive their therapy under the observation of specially trained cancer doctors and staff. Patients who volunteer for cancer treatment studies will either receive standard therapy or a new treatment that represents the researchers’ best new ideas for how to improve cancer care.

“Cancer care is constantly improving, due in part to the groundbreaking work being done in clinical research,” said Dr. Tim Mullett, medical director of the MCCRN. “Our state has some of the worst cancer incidence and survival rates in the entire country, and we at Markey have an obligation to address this devastating disease. By increasing access to many of our current clinical trials through the Markey Research Network, we have an opportunity to make real progress in improving cancer statistics in Kentucky.”

Markey’s clinical trials focus on the prevention, early detection and treatment of cancers with the highest incidence and mortality in Kentucky. These include lung, colorectal and cervical cancers. Owensboro Health is now one of six research sites in the MCCRN, and the first site in Western Kentucky. The MCCRN includes the following sites:

  • Hardin Memorial Hospital, Elizabethtown
  • King’s Daughters Medical Center, Ashland
  • Owensboro Health
  • St. Claire Regional Medical Center, Morehead
  • St. Mary’s Regional Cancer Center, Huntington, West Virginia
  • Tri-State Regional Cancer Center, Ashland

Watch the video below to find out how the Markey Research Network is bringing the future of cancer treatment to patients all across Kentucky.


Next steps:

massage

Massage might help those who can’t exercise, says UK research

An illness, an accident or even just getting older can limit a person’s ability to exercise. Rest is an essential component of healing, but it also atrophies muscles.

“People who are unable to exercise due to, for example, a recent surgery or illness, lose as much as 3 percent of their muscle mass per week,” said Esther Dupont-Versteegden of the UK College of Health Sciences. “That doesn’t sound like much, but it can make recovery much more difficult, especially for the elderly.”

Dupont-Versteegden and her College of Health Sciences colleague Tim Butterfield have been testing an inexpensive, noninvasive treatment that appears, in preliminary studies, to aid in the recovery of muscle mass and reduce muscle atrophy: massage.

“Our research proposes that massage may stave off atrophy, even if you aren’t able to get up and move around,” she says.

Massage mimics the effects of exercise

Proteins are the basic building blocks of all of the body’s tissues, especially muscle. The complicated metabolic process that turns protein into muscle, called protein synthesis, increases muscle cell size, which in turn strengthens muscle fibers. But one of the crucial ingredients for muscle growth is exercise.

“However, there are times and circumstances in which exercise is not possible, because of a severe illness or surgery, for example,” Dupont-Versteegden says.

According to Butterfield, it appears that massage mimics the effect of exercise by sending signals to the muscle to begin protein synthesis. And there’s perhaps an even more intriguing finding: Massaging one limb seems to confer benefits to its corresponding muscle on the other side as well.

“We’re not sure why yet, but if we could understand the mechanisms for this crossover effect, it could have real healing benefits for patients with wounds to one limb – for example, car accident victims or wounded soldiers,” Butterfield said.

Better health for Kentuckians of all ages

Their initial work is promising enough to earn a five-year, $2.1 million grant from the National Center for Complementary & Integrative Health. The research grant will further their study in conjunction with Benjamin Miller and Karyn Hamilton, both researchers at Colorado State University.

Dr. Scott Lephart, dean of the UK College of Health Sciences, says that Dupont-Versteegden’s and Butterfield’s work demonstrates how research can uncover new, cost-effective ways to improve health for Kentuckians of all ages.

“The loss of skeletal muscle mass and the inability to recover from atrophy are major contributors to disability and a major factor in the elderly’s loss of independence,” Lephart said. “This work exemplifies our college’s commitment to optimizing health for Kentuckians of all ages and beyond.”


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