When Wounds Won’t Go Away

When Wounds Won't Go Away

When Wounds Won't Go Away

Diabetes and poor blood flow can turn minor cuts and sores into major problems. KentuckyOne Health wound care centers have the expertise and advanced treatments to heal them.

Chronic wounds can occur anywhere on the body, but two of the most common locations are the legs and feet.

“Venous or arterial insufficiency can lead to blood flow or swelling complications, and in turn, cause ulcers on the legs or feet,” said Tina Hasty, BSN, CWCA, clinical program director at Saint Joseph Hospital Wound Care and Hyperbaric Oxygen Center, part of KentuckyOne Health. “Individuals who have diabetes may not notice a small wound on the bottom of the foot because the disease can cause nerve damage. Over time, these wounds may grow bigger without their knowledge, unless they check their feet regularly.”

Approximately 15 percent of patients with diabetes develop foot ulcers (open sores or wounds). This happens because healing is typically slower for those with diabetes.

“High levels of blood glucose can negatively impact one’s blood circulation and nervous system, which ultimately affects the body’s ability to heal,” said Timothy Ford, DPM, podiatric physician and surgeon. “It is very important for patients with diabetes to take care of their feet and look for any wounds. If not treated properly, wounds could lead to amputation.”

A Two-pronged Approach

If you have a wound that hasn’t healed in 30 days, you should visit a wound care center, where specially trained physicians and nurses can treat the wound and ensure you receive care for its underlying causes. KentuckyOne Health has three wound care centers, which are located in Bardstown, Louisville and Lexington.

“Our wound care team develops treatment plans for patients and as indicated, refers them to specialists, including vascular surgeons, infectious disease specialists and podiatrists,” Hasty said. “We have a variety of treatments we can use to heal wounds, including advanced dressings, compression therapy and hyperbaric oxygen therapy. Educating patients about their wounds is also an important part of our work.”

Have a wound that won’t heal? Learn more about treatments and find the wound care center nearest you.

This article originally appeared in the 2017 Summer edition of One Health Magazine. Sign up for your free subscription.

Innovative Intervention for Pancreatitis

Innovative Intervention for Pancreatitis

Innovative Intervention for Pancreatitis

Local doctors pioneer treating pancreatitis without the onset of diabetes at Jewish Hospital.

The pancreas is an organ located behind the stomach that produces enzymes to help digest food and insulin to control blood sugar. In some people, genetic predisposition, medical conditions such as gallstones or lifestyle choices such as drinking alcohol lead to inflammation in the pancreas called pancreatitis. This condition can be dangerous if left untreated.

Based on 2013 data from the Agency for Healthcare Research and Quality, chronic pancreatitis in Kentucky contributed to over 4,500 emergency room visits, 3,200 hospital admissions and approximately $75 million in annual medical costs.

“Removing the pancreas is the only way to cure pancreatitis,” said Michael Hughes, MD, transplant surgeon with Jewish Hospital, part of KentuckyOne Health, associate professor of surgery at the University of Louisville and surgeon with University of Louisville Physicians. “But the pancreas is responsible for creating insulin — the hormone that regulates blood sugar levels. Without the pancreas to create insulin, patients who have the organ removed to correct pancreatitis used to develop brittle diabetes. The islet auto-transplant procedure changes that.”

What Are Islets Cells?


The pancreas contains clusters of cells that produce hormones. These clusters are known as islets, and they are the source of insulin. In patients who undergo islet auto-transplant, their islet cells are harvested from the pancreas when it is removed. The process takes place at the Clinical Islet Cell Laboratory at the University of Louisville, under the direction of Balamurugan Appakalai, PhD, a leader in the field of islet cell transplantation.

Cells are processed into a solution that is then slowly reintroduced into the patient’s body through catheters connected to veins that feed the liver. The islet cells make themselves at home in the liver, where they begin producing insulin again. Doing this allows doctors to effectively prevent diabetes from developing permanently in patients who have had their pancreas removed.

Watch the video to learn more about islet auto-cell transplantation from Dr. Hughes.

“Islet auto-cell transplantation is a complex process that takes cooperation and collaboration during each step of the process,” Dr. Hughes said. “We are fortunate to be in an environment where medical professionals and institutions embrace the spirit of collaboration for the benefit of patients.”

To learn more about islet cell transplantation, call 844.739.2998.

A Growing Program


The islet cell transplantation program has, in a very short period of time, grown to become one of the largest in the world. Islet cell recipients experience excellent outcomes, raising the hopes for continued breakthroughs in the years to come.

Islet cells are separated from the pancreas in a clean room facility and will later be infused into the patient’s liver, where they will produce insulin to control the body’s blood sugar levels.

This article originally appeared in the 2017 Summer edition of One Health Magazine. Sign up for your free subscription.

Get Ahead of Hepatitis C

Get Ahead of Hepatitis C

Curing hepatitis C — a virus that attacks the liver — is possible. Screening is vital for identifying the disease early when damage can be reversed and before the organ has paid a heavy price.

Hepatitis C is contagious and spreads through contact with the blood of an infected individual. About one in five cases of hepatitis C infection is cleared naturally by the body; however, the remaining cases develop into chronic hepatitis C. Chronic hepatitis C infection causes inflammation in the liver that can lead to scarring and even organ failure if left untreated.

“Often, there aren’t symptoms with hepatitis C,” said Jenny Harkins, manager of the Hepatitis C Clinic and GI Motility Clinic at Jewish Hospital, part of KentuckyOne Health. “Individuals who have the virus may not realize it for decades. Then, one day, a routine laboratory exam will show elevated liver enzymes. The best way to know if you’ve been exposed is to test the virus directly using an antibody test, because not everyone will have elevated liver enzymes.”

By the time symptoms appear, hepatitis C may have already reached an advanced stage.


A Big Burden for Kentucky


The ability of hepatitis C to exist in the body for years without detection makes estimating the disease’s prevalence difficult for public health officials. One thing is clear: The virus is a major concern in Kentucky, where the rate of new infections is twice the national average, according to the Centers for Disease Control and Prevention. Two groups seem to be most vulnerable to hepatitis C: younger adults and baby boomers.

From 2008 to 2015, no state had a higher rate of new hepatitis C infections than Kentucky, according to the Kentucky Department for Public Health’s State Health Assessment Report, 2017 Update. In 2015, individuals 25–34 years old accounted for the largest proportion of new infections — 40 percent. The high rate of hepatitis C infection in Kentucky is closely related to the Commonwealth’s opioid epidemic, as sharing needles to inject heroin and painkillers increases individuals’ risk for contracting the virus.

For baby boomers, many cases of hepatitis C are likely traceable to health care services they received decades ago rather than to present-day substance abuse, according to Harkins.

“Baby boomers appear to be most at risk for having hepatitis C without knowing it,” Harkins said. “We think many of their infections occurred as a result of medical and dental procedures they had 30 to 40 years ago, when sanitation and sterilization protocols were less strict than they are today.

“Back then, it was common for providers to use the same equipment with multiple patients,” she continued. “Hepatitis C can be difficult to kill without proper sanitation procedures. Nowadays, medical equipment is either single-use or is sterilized after every patient encounter using a high-heat, high-pressure machine called an autoclave, which prevents infection.”


The Power of Screening


The CDC recommends individuals born between 1945 and 1965 get tested for hepatitis C, which providers can do using blood tests; the most common is the hepatitis C antibody test. Many patients diagnosed with the virus have reason to hope. An average of 12 weeks of oral medication therapy is enough to clear hepatitis C from the body, according to Harkins.

“Some think there is only one medication to treat hepatitis C, when in fact, there are 12 approved by the Food and Drug Administration,” Harkins said. “Treatment is typically easy. Since 2013, we’ve had effective, gentle medications that patients take for 8 to 12 weeks, sometimes up to 24 weeks, and they have cure rates as high as 100 percent in some cases. If you know you have hepatitis C, we can treat it, but you won’t know you have the virus unless you get screened.”


Your Destination for Treatment


If you have been diagnosed but aren’t receiving treatment, the Hepatitis C Clinic at Jewish Hospital, part of KentuckyOne Health, can help. The Hepatitis C Clinic offers liver assessments and antiviral therapy.

“We want to ensure everyone has access to treatment for hepatitis C and, ultimately, cure them,” said Harkins. “Getting rid of the virus doesn’t just benefit the liver. It also reduces patients’ chances of developing other issues, such as insulin resistance, kidney disease and overall all-cause mortality.”

KentuckyOne Health also plans to open a Hepatitis C Clinic in Lexington at Saint Joseph East, part of KentuckyOne Health, in the future.

To schedule an appointment at the Hepatitis C Clinic at Jewish Hospital, call 844.258.6211. A referral from your primary care physician may be required.

Testing for hepatitis C requires only a simple finger stick similar to checking your blood sugar.

This article originally appeared in the 2017 Summer edition of One Health magazine. For more health and wellness stories, sign up for your free subscription today.

Herbal Supplements and Your Liver

Herbal Supplements and Your Liver

Herbal Supplements and Your Liver

While alcohol use can harm the liver — the organ that cleanses blood and fights infection — so can overusing certain herbal supplements and medications.

Typically, herbal supplements do not cause problems when used, especially if the person taking them isn’t on prescription medication. However, there are cases in which supplements do not mix well with medications and can lead to liver damage.

When listing your current medications for a medical provider or pharmacist, make sure you mention any herbal supplements you take. This helps your doctor avoid possible toxic interactions, said June Yong, MD, board-certified gastroenterologist and internal medicine provider with KentuckyOne Health Gastroenterology Associates.

“Herbal supplements can change the way your body metabolizes medications,” Dr. Yong said. “When this occurs, the medication may stay longer in the body than intended and build up a higher concentration of the drug. Both are dangerous to your health.”

Signs that herbal supplements are interacting negatively with medications in ways that could potentially harm your liver include:

  • Yellowing eyes or fingertips
  • Insomnia
  • Muscle aches
  • Dark yellow urine

“Extreme confusion is a sign of liver failure,” Dr. Yong said. “If you or a family member notice confusion coupled with debilitating fatigue, go immediately to the emergency room for care.”


Teaming Up for Liver Care


Patients with symptoms of liver failure undergo liver function tests to confirm or rule out this diagnosis. Those with elevated numbers can be referred to the liver transplant program at Jewish Hospital, part of KentuckyOne Health, and placed on appropriate medications. During this time, patients are given intravenous fluids and monitored carefully for appropriate oxygenation levels and normal bowel movements, since constipation can result in toxin buildup.

“If the liver doesn’t recover, we determine next steps, including candidacy for liver transplantation,” said Laura Smart, MD, transplant hepatologist and medical director for the liver transplant program at Jewish Hospital.

Talk with your primary care physician about the use of herbal supplements.


When Transplant Is Needed


An established program for almost two decades now, the Liver Transplant Program at Jewish Hospital, part of KentuckyOne Health, was the first of its kind in the Commonwealth of Kentucky.

“This robust program connects 50 patients per year with lifesaving liver transplants as soon as they become available, sometimes in as few as two days,” said Dr. Smart.

This article originally appeared in the 2017 Summer edition of One Health magazine. Receive more health and wellness news and information by signing up for your free subscription to One Health.

Finding Comfort With Palliative Care

Finding Comfort with Palliative Care

Finding Comfort with Palliative Care

Faced with life-limiting medical conditions, individuals and families can turn to the holistic approach of palliative medicine to improve their quality of life.

Living with a serious medical condition can be overwhelming for patients and families who are dealing with questions about everything from pain management to spiritual well-being. Palliative care is a field designed specifically around the needs of these individuals.

Doctors typically recommend palliative care for those with chronic conditions, such as:

  • Alzheimer’s disease
  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Kidney disease
  • Multiple sclerosis
  • Parkinson’s disease

Palliative care may also be an effective option for those who receive chemotherapy for cancer or are recovering from a neurological event, such as a stroke.

Why Turn to Supportive Care?


“The goal of palliative medicine is to improve quality of life for patients and their loved ones by taking a team approach to care,” said Billie May, MSN, RN, palliative care clinical nurse specialist with KentuckyOne Health Cancer Care in Lexington. “Palliative specialists perform in-depth individual assessments. The team of physicians, nurse practitioners, social workers and chaplains are available to each patient. We make sure everyone has the support they need to make informed decisions.”

Supportive palliative services assist chronically ill patients with issues, such as pain, nausea, loss of appetite and depression, that accompany their diagnoses. While these services may be initiated at any stage of a life-limiting health condition, the sooner palliative services are embraced, the more helpful they can be.

Palliative  Care Services


Palliative care services are available to patients admitted to Saint Joseph Hospital and Saint Joseph East, both part of KentuckyOne Health. Additionally, KentuckyOne Health Cancer Care in Lexington has a palliative care clinic twice each month for oncology patients.

“Patients and families who engage in palliative care services may have greater peace of mind during a time that can be very confusing and uncomfortable,” said Lynnette RauvolaBouta, vice president of mission integration with Saint Joseph East, Saint Joseph Hospital and Saint Joseph Jessamine, all part of KentuckyOne Health. “We strive to help them feel that they are being cared about as human beings so that they may focus all of their energy on the things that are important in their lives.”

“The palliative care team collaborates with patients’ other providers, such as primary care physicians and a variety of specialists. Together, we ensure care plans meet patients’ needs on every level — physically, emotionally, psychosocially and spiritually,” said May.

This story originally appeared in the Spring 2017 edition of One Health magazine. Receive more health and wellness news and information when you sign up for your free subscription of One Health.

Little Gland, Big Problems

Little Gland, Big Problems

Little Gland, Big ProblemsMany symptoms of thyroid disease start off subtly but can be signs of larger problems to come if dysfunction go untreated.

The thyroid is a small gland located at the base of your neck, above the collarbone. It produces hormones that play an important role in how your body functions.

How fast you burn calories, how fast your heart beats and how quickly certain organs work are all affected by hormones that originate in the thyroid.

“When your thyroid works correctly, your body gets just the right amount of the hormones it needs,” said Mary Self, MD, endocrinologist with KentuckyOne Health Endocrinology and Diabetes Associates. “Problems start to occur when your body begins to make too much or too little of one or more important hormones.”

Too Much of a Good Thing

Hyperthyroidism occurs when the thyroid produces too many hormones. Symptoms include:

  • Unexplained weight loss
  • Increased appetite
  • Rapid or irregular heartbeat
  • Anxiety and irritability
  • Difficulty sleeping
  • Shaking hands and fingers

Medication, surgery and other therapies can be used to reduce your symptoms and limit the amount of certain hormones being produced.

Running on Empty

When the thyroid doesn’t make enough of certain hormones, it is called hypothyroidism. Problems with this thyroid disorder include:

  • Fatigue
  • Weight gain and puffy face
  • Intolerance of cold
  • Dry skin and thinning hair
  • Depression and slowed heart rate
  • Fertility problems
  • Joint and muscle pain

Hypothyroidism is easily controlled with medication, including synthetic hormones. Doctors use a simple blood test and medical history to screen for hypothyroidism and hyperthyroidism and guide treatment.

Common Causes of Thyroid Disease

Two disorders are the most common causes of thyroid disease:

Hashimoto’s thyroiditis

“Thyroiditis” means a swollen thyroid. There are many reasons your thyroid may become inflamed.

In Hashimoto’s thyroiditis, your immune system’s antibodies attack the thyroid, leading to chronic inflammation. Over time, this reduces your thyroid’s ability to produce hormones.

Graves’ disease

In a healthy person, a pea-sized gland in the brain produces thyroidstimulating hormone (TSH) that tells your thyroid how much of certain hormones to make. Graves’ disease is caused when the body’s antibodies begin mimicking TSH, causing the body to produce more thyroid hormone than it needs.

Speak with a thyroid specialist at KentuckyOne Health to learn more. Call  844.297.8986 (Louisville) or 844.297.8987 (Lexington).

This article originally appeared in the Spring 2017 edition of One Health magazine. Receive more health and wellness news and information by signing up for your free subscription to One Health.

Get Hands-on About Your Health

Get Hands-on About Your Health

Get Hands-on About Your Health
Preventive screenings help you understand your state of health.

Health screenings look for the risk or presence of a wide variety of conditions, including diabetes, heart disease and certain types of cancer, to name a few. When done regularly, screenings can help pinpoint many problems early, when they may be corrected with lifestyle changes such as eating a healthy diet, exercising or taking medication.

Having the right screenings at the right time is vital.

Let’s Talk About It


“When — or even if — you need certain screenings depends on many factors, including your age, family history and other medical issues you may be living with,” said Ron Waldridge II, MD, physician executive at KentuckyOne Health Medical Group and family practice physician with KentuckyOne Health Primary Care Associates. “It’s best to have a relationship with a primary care doctor who can help you make smart screening decisions.”

Use your annual wellness visit as an opportunity to talk with your primary care doctor about screenings and check in regularly about any other medical concerns that may arise. Together, you and your doctor can design a wellness plan that uses screenings and preventive measures to help you stay healthier, longer.

Speak with your primary care physician to learn more about each type of health screening.

Looking for Lung Cancer


Statistically, cancer occurs more frequently in Kentucky than anywhere else in the U.S., and lung cancer in particular is a serious health concern in the Commonwealth.

“Hearing you have cancer is devastating,” said Hilary Deskins, RN, manager of cancer prevention services with KentuckyOne Health. “Our lung cancer screening program helps us diagnose this potentially deadly disease early. That’s important, because catching it early saves lives. According to the Lung Cancer Alliance, ours is the largest screening program in the United States.”

A lung cancer screening is done using a low-dose computed tomography (CT) scan.

Patients qualify for the screening who:

  • Are ages 55 to 80
  • Have a 30-pack-year smoking history (the equivalent of smoking one pack of cigarettes per day for 30 years)
  • Haven’t had a chest CT scan in the last year
  • Don’t already have symptoms of lung cancer
  • Still smoke or quit within the last 15 years

This article originally appeared in the 2017 Spring edition of One Health magazine. To receive more wellness news and information, subscribe today

5 Ways to Nip Your Allergies in the Bud [Infographic]

5 Ways to Nip Your Allergies in the Bud

Five Ways to Nip Your Allergies in the Bud

The Asthma and Allergy Foundation of America (AAFA) estimates that nearly 50 million Americans each year suffer from nasal allergies.

Kentucky is commonly ranked among the worst places to live with spring allergies by AAFA. While there is no known cure for allergies, they can be managed through prevention and treatment.

Review the infographic below for tips on how to manage your seasonal allergies, often referred to as hay fever, as trees and flowers begin to bloom.

Five Ways to Nip Your Allergies in the Bud


The Ten P’s: Tips for a Good Doctor Visit

Tips for a Good Doctor Visit

No matter how well-trained, motivated and compassionate your doctor is, you might not be getting as much out of your health visits as you can. The good news is that there are several things you can do to make the most of your office appointments.

Here are some helpful tips from a doctor about what you can do make your time together as meaningful as possible.

1. Prepare

Make sure you know the correct date, time and location of your appointment. If you have not been to that location before, look it up so you know where you’re going. Make sure to bring your identification, insurance card, and a list of your current medicines and allergies. If you are seeing a specialist, know the name of your primary care provider so the specialist can send a letter summarizing the visit. If the doctor might need to examine you, wear clothes that are easy to take off and put on.

2. Paperwork

If you are seeing a doctor for the first time, you might be told to expect new patient paperwork in the mail. Look for it. If you do not receive it, call the office. People in the office might be able to email it to you. Then fill it out. Do not try to decide what you think the doctor needs to know and withhold information. Humor the doctor by filling it out accurately and completely. Office personnel are accustomed to seeing information presented in a certain way, and may need to follow a sequence for computer entry of information.

3. Person

Consider bringing another person with you to your appointment to act as another set of eyes and ears. On the other hand if you have young, active children consider leaving them with a sitter so you can focus on your visit.

4. Punctual

Often you will be told both an appointment time and an arrival time. Take traffic and unfamiliar surroundings into consideration when planning travel time. You may have to sign more forms after you arrive, so if you arrive just before your appointment time you will be behind. If you are flustered because you are late, you will not be thinking clearly when it is your turn to see the doctor.

5. Play

It’s not fair and it shouldn’t be this way, but at times you will have to wait. Bring a book or another diversion to occupy yourself while you wait. You will be in a better mood when it’s your turn to see the doctor.

6. Phone

Your health demands focus. Turn off your phone when the doctor or nurse is in the room.

7. Purpose

This is one of the most important points. Think about the reason for your visit, and tell the doctor or nurse practitioner within the first few minutes. Do not tell a story to explain the background or build dramatic effect; these can come out with further discussion. Get right to the point. For example, “I am here to discuss my blood pressure medicine. My blood pressure has been high, and I am having strange sensations. I wonder whether they might be side effects of the medicine.”

8. Participate

Be there mentally and take part in your visit. Your doctor or nurse practitioner is making decisions based on your responses to questions, so answer questions as best you can. Do not say what you think they want to hear. For example if your physician prescribes a medication but you do not take it, say so. Or if your doctor explains the results of a test and asks whether you understand, do not say yes if you do not.

9. Pen and paper

If you do not have a scribe to help you, bring something to make notes about the topics you discussed. You might even ask the doctor to review what you wrote to ensure it is accurate. Keep your notes in a binder or notebook, and bring it with you to every appointment.

10. Plan

This is very important. Make sure you understand the plan before the visit ends. For example you might say, “So I am going to stop taking Toprol, and start Diovan. I am going to come back in 6 weeks for blood work and a recheck. Is that right?” You both should be clear about what should happen next.

Being an advocate for your own healthcare does not mean you have to be suspicious or confrontational, but it does require some thought. It will help you to think about your appointment before, during and after the visit. You will learn more about your health, be more satisfied with your experience, and position yourself for a longer, happier life.

Remember your P’s!

Dr. David LipskiDavid Lipski, MD

Dr. David Lipski practices venous and lymphatic medicine at KentuckyOne Health Vein Care Associates.

Flipping the Health Care Switch

Flipping the Health Care Switch
The transition from high school to college isn’t the only change teens need to make as they enter adulthood.

Between the ages of 18 and 21, most young adults make the switch from their pediatrician to a primary care physician who focuses on adult care.

Ben Rambicure, MD, family medicine physician at KentuckyOne Health Primary Care Associates, recommends families start looking for a new provider early so everyone is prepared.

A 3-step Process

Age 12

Teach preteens how to discuss their health care. Adolescents should be familiar with their personal and family history, as well as any medications they take on a daily basis.

Age 17

Start the search for your teen’s adult primary care physician and help your teen understand health insurance coverage.

Ages 18-21

Make an appointment with the internal or family medicine physician for your teen.

“At this point, teenagers can call their pediatricians and say, ‘I’m scheduled to see this provider on this date at this time,’ and arrange for their medical records to be transferred,” Dr. Rambicure said. “Because everyone is on the same page regarding medical history, screenings, vaccinations and lab work, teens can expect a smooth transition.”

This article originally appeared in the Fall 2016 edition of One Health Magazine. Subscribe to One Health Magazine to learn more about Primary Care information from local experts.