Acupuncturists explain how can help if medication, therapy don't

By Dennis Kim and Norah Charles
University of Kentucky

Acupuncture involves the insertion of needles on specific points of the body. In Eastern terminology, it helps stimulate the flow of chi, which is the life force, along the meridians of your body.

In Western terminology, it helps send nerve fibers to the spinal cord, brainstem, the hypothalamus and pituitary gland. These fibers help release neurotransmitters such as endorphins, the body's natural painkiller, along with enkephalins plus norepinephrine, which helps inhibit the nerve pain fibers to suppress pain.

An acupuncture procedure (PeakStock/iStock/Getty Images Plus photo)

Acupuncture is non-medication. If a patient is having a condition that is not responding to medication, and they're not recovering fully with physical therapy or other kinds of therapy, we're sometimes able to make progress with acupuncture. We find that we get a lot of referrals from medical doctors who are trying to help patients, mostly with acute and chronic pain, find alternatives to medication.

The most common conditions that we treat with acupuncture in our clinic are musculoskeletal issues such as fibromyalgia, myofascial pain, carpal tunnel and arthritis. These, and other conditions that are treated here, involve neck pain, low back pain or any type of musculoskeletal issues.

The first session of acupuncture involves asking a lot of questions of the patient. Patients usually come in with a primary complaint and the acupuncturist needs details about what brought them into the clinic. The provider will usually go through questions involving other aspects of their health, such as health history, sleep, digestion and mood. This helps the provider develop a better diagnosis from the acupuncture perspective.

Another benefit of trying acupuncture is multiple conditions can be treated at once. If a patient presents with insomnia and also low back pain, those do not need to be separate treatments. We spend time talking with the patient at the beginning of the session to get an idea of what's going on with them in a whole health manner.

The acupuncture session lasts for about 20 to 30 minutes with the needles in, and follow-up sessions are scheduled as needed.

Acupuncture's benefits are cumulative. A patient who comes in with low back pain may notice relief after one session, but they will notice increased relief after more sessions. Everyone's body is different, and resukts depends on the condition, but we ask patients to give acupuncture three sessions to see if we can make any headway with their condition.

Dennis Kim and Norah Charles are licensed acupuncturists with UK HealthCare Integrative Medicine and Health.

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Demon Copperhead author and Ky. native Barbara Kingsolver talks about the opioid epidemic and Appalachia's difficulty with it

Barbara Kingsolver (Facebook photo)

Barbara Kingsolver says she intended her Pulitzer Prize-winning novel Demon Copperhead to be her "great Appalachian novel" that told the story of how the opioid epidemic has ravaged the region, and its impact on children. 

Ezra Klein of The New York Times interviewed Kingsolver, who grew up in Nicholas County, for his podcast, "The Ezra Klein Show." The Times transcribed the interview. It is wide-ranging, but a big chunk has her telling Klein how the opioid epidemic has impacted a whole generation of children who have become orphans and are being raised by grandparents and the foster system — and getting the bulk of their social services at school.

 

"We have a generation of orphans coming up through our schools," Kingsolver said, adding later, "There’s so many more kids in need than there are social networks to catch them — but the caseworkers are so overloaded and so pathetically underpaid. . . . This is something that I think the world needs to know about, this country — voters — need to know about. We need to know how this epidemic has left a generation of innocents that nobody’s taking decent care of. . . . These kids have been left behind. Our burdened public school systems are being asked to raise these kids." 

Klein and Kingsolver also talked about how Central Appalachia was targeted by Purdue Pharma with a drug that was so addictive and with doctors who were told otherwise. "This was done to them," Kingsolver said of her neighbors in southwest Virginia and southeastern Kentucky. "Nobody wants to be addicted."

Winner of the 2023 Pulitzer for fiction

Kingsolver also talked about the stigma associated with addiction and how people have been brainwashed to think it is a moral failing, instead of the brain disease that it is. 

"We have been trained, culturally trained, to think of addiction in this way, as a personal failing that needs to be punished. Incarceration does not cure addiction any more than it cures cancer. Addiction is a disease," she said. "It’s impossible to describe how terrible this disease is, not just the dope sickness of it but the fact that your entire life has to become just a really difficult, hard work in process of, every morning, getting your means, getting your fix, getting through another day. And nobody wants to live like that." 

Kingsolver told Klein that she hopes her novel will help people have more compassion and think of people with addiction as having a disease and to get rid of the idea that you don't treat a person with addiction until they "hit bottom." 

"That’s how we treat the disease of addiction. And it’s incredibly inhumane. And effective treatment will only happen after we switch over from putting this in the hands of the police and the prisons to medical workers who can meet addicted people where they live and offer them the first steps of clean needles and fentanyl test strips so that they won’t die in the weeks that it will take for them logistically, physically, emotionally, to get to the beginnings of treatment," she said. 

And to those who maintain a moral objection to such "harm reduction" programs, she said, "It’s as if people feel that addicted people deserve to die. Imagine if we looked at any other disease that way."

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The 'sandwich generation' still supports its children while caring for its parents, which is playing a toll on its health

Cornell Cooperative Extension graphic

Kentucky Health News

America has Generation X, Generation Z and more, but it also has "the sandwich generation," adults between 40 and 59 who care for their aging parents and help support their own children. Most family caregiving falls to this generation, and most of the caregivers are women.

Historically, when people reached this age group, they became empty nesters. But the Pew Research Center "found 54% of parents in their 40s are caring for seniors while also financially supporting their adult children," says a study report from the Seniorly Resource Center.

"The sandwich generation is bound by a unique set of social and demographic forces that include a record number of aging seniors and financial challenges that have stunted the economic stability of their adult children," the report says. "As the prevalence of Alzheimer’s disease and other conditions linked to old age continue to rise, and the financial stability of young adults remains stunted, America’s ‘sandwich generation’ is seeing substantial declines in their own physical, mental, and financial health."

In Kentucky, 45.8% of caregivers have two chronic health conditions, 15.5% are mentally distressed, Alzheimer’s disease is expected to increase 14.7% by 2025 and 3% of homes are multigenerational, according to a news release about the study.

In a report titled "Valuing the Invaluable: 2023 Update," the American Association of Retired Persons found that there are 610,000 caregivers in Kentucky who provide 570 million care hours, at an estimated economic value of $8.6 million. 

The Alzheimer's Association says in Kentucky, 75,000 people 65 and older are living with the disease and 157,000 family caregivers bear the burden of caring for them, while providing 302 million hours of unpaid care.

The report offers tips to prevent caregiver burnout, such as creating a financial strategy, prioritizing self-care, delegating tasks, utilizing available resources, staying organized and communicating openly with family about challenges. 

The release added three suggestions:  

Respite care provides short-term stays for seniors to give primary caretakers a break. It is also a great way to try out senior living and some organizations provide respite grants to help offset the cost.

Assistive technology: Caregivers should use new technology. Grandpad is a user-friendly tablet with 24-hour live support; Lively is a waterproof watch that replaces emergency pendants like Life Alert; and caregiving apps such as Medisafe are designed to keep track of tasks.

Ask for help and be specific: Most people want to help their friends and family but don’t know how. If you are overwhelmed, it is critical to ask for help. Determine what needs to be done and assign people specific tasks.

The report also offered information on some support groups, including: 

• National Alliance for Caregiving: The NAC is a non-profit organization dedicated to supporting caregivers. You can visit their website at www.caregiving.org.
• Caregiver Action Network: CAN is an organization that provides education, support, and resources for family caregivers. They offer a helpline, support groups, and an online community. You can contact them at 1-855-227-3640 or visit www.caregiveraction.org.
• Eldercare Locator: This is a public service of the U.S. Administration on Aging. They can help connect you with local resources and support services for caregivers. You can contact them at 1-800-677-1116 or visit their website at www.eldercare.acl.gov.

Using data from the Alzheimer’s Association and federal agencies, Seniorly did state-by-state estimates of likelihood of increasing caregiver burnout. Kentucky was at about the national average.

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Health-care workers are more likely than law-enforcement officers to have injuries and illnesses that keep them away from work

Axios graphic

Kentucky Health News

"Health-care workers are increasingly being assaulted or shot on the job, making hospitals and clinics among the most dangerous workplaces in America," report Tina Reed and Jason Millman of Axios. 

They report that health-care workforce violence was a problem long before the pandemic, and then pandemic stressors such as backlash against public health measures and inadequate staffing have made matters worse.

In fact, "Data shows American health-care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement," according to  The Associated Press. And all of this can result in disrupted patient care and "alarming levels of burnout among the pandemic-fatigued health care workforce." 

"It used to be people had a respect for what was done in hospitals and the people who worked in those hospitals. That's not there anymore," National Nurses United Vice President Cokie Giles told Axios. 

Axios reports that "about three in four nonfatal workplace violence injuries involved workers in health care and social work in 2020, the most recent year for which statistics are available. And, "the frequency of injuries from workplace violence in health care has risen almost every year since 2011, reaching 10.4 per 10,000 full-time workers in 2018, up 62% from 6.4 per 10,000 in 2011, per the Bureau of Labor Statistics." 

Reed and Millman cite several examples that suggest that this trend has continued throughout the pandemic, with an increasing number of assaults involving guns. 

They also point to a recent survey of health care workers from Premier and the federal Agency for Healthcare Research and Quality that found 40% of health-care workers experienced workplace violence in the last two years.

Axios notes that hospitals are stepping up their efforts to " identify security risks, training staff on violence prevention and calling in counselors to de-escalate tense situations" and are beginning to invest in technology to help detect guns entering the building. Further, The authors write, there are ongoing efforts in Congress and statehouses to make health care settings safer.

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AppalReD Legal Aid to hold 20th annual Domestic Violence and Elder Abuse Awareness Conference via Zoom on Sept. 15

 

The Appalachian Research and Defense Fund of Kentucky is holding its 20th annual Domestic Violence and Elder Abuse Awareness Conference  Sept. 15 from 8:30 a.m. to 3:15 p.m. ET via Zoom.

The organization, which uses the brand AppalReD Legal Aid, said in a news release that it is using Zoom this year to allow people from all over Kentucky to participate. 

"Domestic violence and elder abuse challenge every community across the commonwealth," the release said.

The sessions will address several topics, including: when to call protective service, how to help survivors in recovery, advocacy for clients without homes, trauma-informed advocacy and communications challenges. 

The free event is open to everyone including legal professionals, health-care workers, social workers, counselors, nursing home administrators, educators, students, and community leaders. 

"By uniting people from various backgrounds, we can collectively make a significant impact on how we combat elder abuse and domestic violence and best serve those affected," said the release.

While attendance is free, pre-registration is required, and spots are limited. Click here to register. The Zoom link will be provided upon registration. For more information about sessions, CEUs, or speakers visit www.ardfky.org/dv23.

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Tiny antibodies hold big promise for cancer treatment, UK says

Alpacas are one of the few animals to produce nanobodies,
a promising tool for drug research and development.
(Photo: Ben Corwin, UK Research Communications)

By Elizabeth Chapin 

University of Kentucky 

Using antibodies derived from alpacas, a University of Kentucky research team has developed a tool that could lead to new therapies to stop the growth of several types of cancer.

While cancer researchers have known that a protein called PRL-3 is linked to the growth of colon, breast, lung, skin and blood cancers, there is little understanding about how it works due to a lack of tools to study it effectively.

With unique alpaca antibodies known as nanobodies, the team led by UK Markey Cancer Center researcher Jessica Blackburn developed the first effective tool to specifically target PRL-3.

The discovery brings scientists one step closer to developing a drug that can stop the expression of PRL-3 and the growth of cancer, says Blackburn.

"The nanobodies are valuable new tools that can help researchers better understand how PRL-3 contributes to cancer progression," said Blackburn, an associate professor in the UK College of Medicine's Department of Molecular and Cellular Biochemistry. "Ultimately, this discovery opens up new possibilities for developing better treatments to fight cancer and improve the lives of patients."

The PRL-3 nanobodies, developed in collaboration with UK's Protein Core, showed promising results in lab tests highlighted in the journal PLoS ONE.

Blackburn says that the nanobodies' ability to locate PRL-3 within cancer cells will give researchers new insights into what other proteins or molecules it interacts with, which will add to the understanding of its function in cancer. Their ability to attach to PRL-3 could also have potential for therapeutic development.

"Nanobodies that target other proteins are already in clinical trials for a variety of human diseases, so it could be possible for a PRL-3 nanobody to be used as a drug to bind to PRL-3 and inhibit its activity," Blackburn said.

Alpacas are one of the very few animals that produce nanobodies, which are 10 times smaller than regular antibodies. Their size gives them the potential to enter a cell in ways that a normal antibody cannot, offering a promising tool for understanding disease and drug development.

UK is just one of a handful of institutions currently producing alpaca nanobodies used for biomedical research. 

This story has been edited by Kentucky Health News. Click here for the original.

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Attorney general files lawsuit against pharmacy benefit managers, manufacturers over alleged insulin pricing scheme

By Melissa Patrick

Kentucky Health News

Attorney General Daniel Cameron has filed a lawsuit against three pharmacy benefit managers and drug manufacturers over an alleged insulin pricing scheme.   

The lawsuit alleges that PBMs CVS Caremark, Optum Rx, and Express Scripts along with manufacturers Eli Lilly, Novo Nordisk and Sanofi have worked together to manipulate and increase insulin prices. 

PBMs act as middlemen between insurance plans and drug manufacturers; they determine what drugs are offered, how much someone pays for the drug, and how much the pharmacists are paid.

This graphic from the lawsuit "shows how collectively the manufacturers have exponentially raised
the prices of insulin products in near unison," the attormey general's news release says. 

A Cameron news release said, "The lawsuit alleges that instead of using such leverage to negotiate lower prices for their customers, PBMs have sought to increase their own profits by raising insulin prices. In that scheme, the insulin manufacturers artificially and willingly raised their reported prices and then deceptively refunded a significant portion of that price to PBMs through rebates, discounts, credits, and administration fees. . . . Executives for PBMs recently testified that between 75 and 84 cents of every dollar spent on insulin goes directly to affiliates of PBMs." 

The 133-page lawsuit states, "Insulins, which today cost manufacturer defendants less than $2 to produce and which were originally priced at $20 when released in the late 1990s, now range between $300 and $700." 

Cameron said in the release, “I understand the pain inflicted on Kentucky families by unfair and inflated insulin prices. The unlawful business practices that drove these increases have to end, and normal market forces must be allowed to lower the cost of insulin for all Kentuckians.”

Nearly 450,000 Kentuckians live with diabetes, and an additional 1.1 million are prediabetic.

Kentucky #insulin4all Chapter Advocate Angela Lautner told WKYT that it's time for both manufacturers and PBMs "to be held accountable for the massive insulin prices we see here in the United States" and questioned why they exist at all. 

“These lawsuits have been going on for a number of years, and it’s time that they come to a conclusion,” Lautner told the Lexington TV station. “Everybody knows that we are being taken advantage of and lives are literally being lost because of greed.”

Attorneys general from Arkansas, California, Illinois, Kansas, Louisiana, Mississippi, Montana, and Ohio have filed similar lawsuits in their states. 

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 that among other things, required the state to hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. Kentucky has saved at least $38 million from this move, money Gov. Andy Beshear has used to expand Medicaid benefits over objections of the Republican-controlled legislature. He and Cameron are running for governor. 

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