May 21, 2018 | There were plenty of reasons why Seth Mohorn would need a feeding tube for an extended period after a recent surgery, but he was determined to quell them.
It did not matter that an everyday task would suddenly require more effort from him than ever before. He wanted to continue to eat and drink as he always had.
Mohorn, 46, of Springdale, has medullary thyroid cancer.
"This is a rare form of thyroid cancer that is very aggressive," said Mauricio Moreno, M.D., head and neck surgeon and assistant professor in the UAMS College of Medicine's Department of Otolaryngology. "It originates from the thyroid like other forms, but its treatment is not the same."
Chemotherapy, radiation and surgery have all been part of Mohorn's treatment. His most recent procedure in 2016 was the most extensive. Multiple tumors reappeared in Mohorn's neck, including one at the base of his skull.
To reach it, Moreno had to cut through layers of muscle and nerves, as well as Mohorn's jaw bone. The incision started under Mohorn's ear, extended to the middle of his neck and up through the middle of the jaw. Moreno dissected muscles and nerves in the area to lift the bone and access the tumor.
Mohorn left the hospital with a feeding tube. At his first post-operative visit two weeks later, he was ready for its removal.
Amanda Davis, UAMS Speech Pathology Program manager and Mohorn's speech pathologist, explained to him the long-term swallowing issues he would have as result of his surgery.
Ordinarily, the throat squeezes to push the food down into the stomach. The airway briefly closes to ensure no food falls through and into the lungs. Mohorn’s would not, Davis said, because many of the muscles that complete those tasks were involved in his surgery. He would have swallowing issues and be at risk of aspirating food into his airway, said Davis.
The result of a thyroidectomy in 2014, also done by Moreno, would also provide a stumbling block. The surgery included the removal of one tumor that encompassed Mohorn’s left vocal cord. That left his vocal cord paralyzed.
“The vocal cords are a protection,” said Davis. “If food gets in the airway, they will close off and induce a cough. With a paralyzed vocal cord, Seth would not be able to do this.”
After the type of surgery Mohorn endured, Moreno said it is common for his patients to be on a feeding tube for an extended period of time.
“The speech and swallowing impediments are pretty significant and we see it immediately after the procedure,” said Moreno. “The patient wants to be able to eat normally and swallow, but they just cannot because so many nerves and muscles are involved with that procedure.”
Davis recommended Mohorn move forward with a feeding tube while he recovered from surgery; however, Mohorn was adamant he could do without the tube with the support of his family and friends.
“We had a conversation about his wishes and he did not want a tube,” said Davis. “We struck a deal and told him to try it for two weeks and come back to see us.”
If he came back with other issues or significant weight loss, he would have to have a feeding tube inserted.
Davis walked Mohorn through the steps he would need to take. To start off, his food would need to be blended and his liquids thickened to the consistency of honey. Every bite would need to be consumed in teaspoon sizes alternating between food and drink each time.
To properly digest his food, Mohorn tucked his chin and swallowed three, four and five times for each bite. He was taught certain techniques to make sure his throat was clear. One was the supraglottic swallow. It required him to swallow, hold his breath, cough and swallow again.
“When we swallow, the airway closes so food can pass, but without proper control, you start breathing again,” said Davis. “If food or liquid is still there, it is likely to go in your airway, so this method acts as a precaution in case something does pass into the airway.”
At his first follow-up visit, he was progressing well, said Davis.
Davis recommended exercises Mohorn could complete at home to strengthen his muscles. With each return visit, he was better. Slowly, modifications were made to return him to a normal diet.
“The last time I saw him I walked in and he was eating a bag of chips,” said Davis. “I said, ‘I think you’re fine.’”
Moreno and Davis said they were both impressed by Mohorn’s drive.
“He was one of those patients with specific goals and willing to do what it took to get there,” said Davis.
“He’s a go-getter,” said Moreno.
Mohorn was thankful to be part the decision-making process in his treatment.
“Amanda was the greatest advocate,” said Mohorn. “She knew me far beyond what the folder said about me. She went and fought on my behalf to give me a chance.”
Mohorn was recognized by the Arkansas Speech-Language-Hearing Association in 2017 as its Adult Poster Ambassador. In his acceptance speech, he challenged the room full of audiologists and speech pathologists to be an advocate for their patients and develop relationships with them.
“Know their needs and know their characteristics and qualities,” said Mohorn. “In doing so, you push them to greater heights.”
He acknowledged that his cancer has put him “in the fourth quarter of life.” But Mohorn said he refuses to be driven by fear or anger. He said he’s learned to be content in the year since his cancer diagnosis. He is focused on his family and advocating for change.
May 14, 2018 | John Lee, of Little Rock, first noticed the small twitch in his fingers about seven years ago. He was in his 50s and Parkinson’s disease was at the top of his mind when he asked his primary care physician about it.
“My brother and my cousin both have it,” Lee said. “They’re younger than me.”
Lee’s uncle and grandfather were also diagnosed with Parkinson’s disease.
“With that kind of family history, you get a twitch and you start to wonder.”
At the initial visit to his doctor, Lee went through a series of cognitive and movement tests.
“He told me I was just a little nervous and prescribed me medication that would help me calm down,” Lee said.
The medication alleviated some of the symptoms, but Lee said it never really went away. He went back to his doctor two years later and this time his doctor referred Lee to Tuhin Virmani, M.D., Ph.D., co-director of the UAMS Movement Disorders Program. Virmani diagnosed Lee with Parkinson’s disease.
Parkinson’s is a degenerative disease of the central nervous system that leads to a deficiency of dopamine, a chemical in the brain important for movement, but patients with Parkinson’s have a wide range of symptoms that include changes in mood, sleep patterns, constipation, urinary changes and even memory. Most patients, Virmani says, are diagnosed in their late 50s and 60s. Many factors that happen over a lifetime eventually lead to development of the disease. While there is a genetic component, primarily in young onset Parkinson’s disease, many are diagnosed with no family history.
Since his diagnosis, Lee, a musician and broadcasting veteran, has been keeping busy voicing TV and radio commercials with Ron Sherman Productions in Little Rock. When he’s not working, he likes to make sure he’s active.
“I try to exercise as much as possible,” Lee said.
Exercise has been shown to potentially slow down the progression of Parkinson’s. So in addition to taking care of his six-acre property, Lee spends time playing drums (to keep his legs and arms busy) or singing and playing any of the variety of instruments he keeps in his music room.
The medication he takes, carbidopa/levodopa (or Sinemet), helps give the brain back the dopamine it is missing. Sinemet is the gold standard treatment for Parkinson’s patients, Virmani says, but it’s only one of the many treatments available for people in different stages of the disease. There is also deep brain stimulator surgery for people with more advanced disease. Lee visits Virmani every six months.
“He assesses my movements, asks me questions and has me memorize things,” Lee said. Then he laughs, “I’m terrible at memorizing. So I’m not sure what he can tell from that.”
He’s also a research participant in Virmani’s Gait Laboratory. Virmani studies a phenomenon in Parkinson’s disease where patients feel like their feet are “stuck or glued” to the ground, known as freezing of gait.
For the study, Virmani has patients walk on a mat so that he can objectively assess how their walking patterns change as the disease progresses.
“About 50-60 percent of patients with Parkinson’s develop freezing of gait,” Virmani said. “We’re trying to figure out why some do and others do not. Learning more about freezing of gait will help us develop therapies on how to slow its progression or prevent it from happening.”
Virmani says freezing of gait can cause a patient to lose his or her center of gravity, resulting in falls.
There is no cure for Parkinson’s disease, but Virmani stresses to his patients they can still live fulfilling lives decades after their diagnosis.
“They can still be functional members of society,” Virmani said. “And that’s our goal: to keep them as functional as possible for as long as possible.”
May 7, 2018 | On a normal day, Joan Baldridge could reach UAMS' campus from her Little Rock home in a few minutes. That was not the case in November when Baldridge ultimately needed care in short order.
Baldridge and her husband were at Cayo Espanto. The couple worked to pack and tidy up their villa on the private island off the coast of Belize. Their trip home was the next day. That’s when Baldridge fell on a concrete floor and injured her hip.
“I’m not sure how it happened,” she said. “It happened so fast. I was standing up one moment and the next I wasn’t.”
Baldridge quips that she is no stranger to orthopaedic injuries. She’s broken one hip and had a knee replacement, so she immediately knew something was wrong.
“I had never done something like that to my hip,” she said.
What Baldridge did not expect was the prolonged, harrowing journey home.
It began when the private island was unable to reach its preferred doctor on the mainland. She spent about 12 hours with her husband, George Ballard, and an attentive island staff without medical care. Finally, a helicopter and doctor arrived mid-morning. The helicopter took Baldridge to a hospital in Belize City.
The couple’s travel insurance company provided the next hitch in their journey.
“They insisted on an x-ray to prove my injury, but there were no x-ray machines on the island,” Baldridge said.
A scan with a portable x-ray at the Belize City hospital did not satisfy the company, either. It ultimately accepted a CT scan that indeed showed a fractured hip. By then, it had been nearly 18 hours since Baldridge’s injury occurred.
“We felt helpless,” said Baldridge. “We wondered if we were ever going to get home.”
Baldridge and her husband found strength through the island staff and medical team during her wait.
It took another handful of hours for the plane sent by the insurance company to arrive. Baldridge and her husband boarded the small, private jet around midnight. Their destination had been set.
As soon as Baldridge’s plane landed in Little Rock, she came to UAMS. Thirty-two hours after her injury, Baldridge could finally see the light at the end of the tunnel.
“I have never been so glad to be any place in my whole life,” Baldridge said. “I was totally focused, mentally and emotionally, on getting home and to UAMS. As we got to UAMS, it was just a relief.”
The afternoon of Nov. 9, Baldridge wheeled into an operating room at UAMS where Paul Edwards, M.D., hip-and-knee surgeon and professor in the Department of Orthopaedic Surgery, performed a total hip replacement.
Edwards said Baldridge’s injury occurred in the upper part of her femur, or thigh bone.
“The hip joint consists of a ball and socket,” said Edwards. “A portion of the ball is attached to the femur, which is known as the femoral neck. As we age, the bone quality and strength fades and the area is at risk for fracture in the instance of a fall or other traumatic incident.”
Robotic-arm technology has emerged as an alternative in orthopaedic surgery, the hope being automation provides more accuracy and better patient results. Research by UAMS orthopaedic surgeons shows achieving better patient results lies elsewhere.
Their work has molded a clinical pathway developed to the patient's needs. It begins with the first visit and ends with the last checkup.
The orthopaedics staff meets with patients and their families before surgery. Patients and their families learn about the procedure and recovery process. The staff is able to identify and mitigate risk factors.
All UAMS orthopaedic surgeons specialize in a particular service. This includes hip and knee, foot and ankle, shoulder and elbow, hand and upper extremity, back and spine, sports medicine and trauma. UAMS's hip and knee service includes four fellowship trained surgeons. It is the most fellowship training in joint replacement in Arkansas.
This allows UAMS orthopaedic surgeons to narrow their focus, stay up-to-date on best practices and provide a benefit to the patient, said Edwards.
A designated staff of nurses and health professionals tend to patients following surgery. Patients visit with a physical therapist and are moving the same day as surgery. Most return home within 24 hours of the procedure.
“We have seen this process minimizes the risk for readmissions, complications and leads to a faster recovery,” Edwards said. “New robotic technology has not shown the same advantages to patients.”
The UAMS process made Baldridge a believer.
“I cannot stress enough wonderful UAMS was to me,” said Baldridge. “Everyone was so helpful, understanding and kind, and the care I received was superb.”
May 1, 2018 | Angela Hall of Pineville, Missouri, was halfway through her pregnancy when she had a scare that sent her to her doctor in Rogers.
“I experienced some bleeding,” Hall said. “Having had a couple of miscarriages prior to this pregnancy, I was worried it could be happening again.”
Hall says once they determined the baby was okay, doctors did a specialized ultrasound that concluded she had placenta previa. Her placenta, the organ surrounding the baby in utero, was covering her cervix. This condition can cause bleeding during the second and third trimesters of pregnancy.
Hall’s obstetrician suggested she go to UAMS. She was transferred from Rogers to Little Rock at about 22 weeks along.
When she wasn’t in the hospital, Hall remained close. She temporarily moved into Markham House Suites across the street from UAMS.
“I was hospitalized a couple more times for bleeding. We decided to deliver at 34 weeks to get the baby out as safely as possible,” Hall said.
In addition to placenta previa, Hall had another placental abnormality called morbidly adherent placenta. It happens when the placenta grows into the uterus and doesn’t detach as it normally would after the baby is born. With this condition, the placenta can extend into surrounding tissues and other organs.
“With Mrs. Hall, we were able to make the diagnosis based on her ultrasound,” said Adam Sandlin, M.D., a maternal-fetal specialist and an assistant professor in the UAMS Department of Obstetrics and Gynecology. “Our goal is to identify these cases before delivery so that we can be prepared for any potential complications.”
An early diagnosis is ideal, Sandlin says. It helps them prepare for potential bleeding and decide the best way to approach the delivery.
For the first time this year, UAMS began utilizing a device that would hopefully help to prevent or severely decrease the need for blood transfusion at the time of delivery by slowing down blood loss in patients with these types of placental abnormalities.
It’s called REBOA, short for resuscitative endovascular balloon occlusion of the aorta. Cleared by the FDA in 2015, the Reboa device is a catheter with a deflated balloon that is inserted through the groin into the aorta, the main artery of the body, to slow down internal bleeding. If the patient begins to hemorrhage, a surgeon inflates the balloon to block the aorta, preventing the loss of too much blood while maintaining blood flow to vital organs such as the brain, heart and kidneys.
A multidisciplinary team of experts assembles for the procedure, including high-risk obstetricians, neonatologists, a trauma surgeon, and an anesthesia team specially trained for these cases.
J.R. Taylor, M.D., an assistant professor who practices in the UAMS Division of Trauma was trained to do this procedure during his fellowship at the University of Texas Health Science Center at Houston. He described the procedure as cutting edge and said UAMS is one of five places in the country regularly doing the procedure for placental abnormalities.
Taylor says the concept of using balloons on the inside of the artery to stop bleeding was first used in the early 1950s in the Korean War on two combat casualties. He says the technology began to improve in the 1990s with the advent of endovascular surgery, using catheters and wires to fix diseased and ruptured blood vessels.
“A group of forward-thinking trauma and vascular surgeons identified a need to control hemorrhage in combat casualties from Iraq and Afghanistan who were bleeding to death from injuries that couldn't be controlled with a tourniquet,” Taylor said. “The first papers outlining the technique came out in 2011. Since then the technology has improved so much that we are now able to close up the aorta with simple access thru the skin in patients bleeding to death.”
Hall never bled enough to require inflation of the balloon in her operation. Taylor says that is a win for both the patient and the team.
“In these situations, it’s better to have and not need than to need and not have,” he said.
Baby Alice was born Feb. 13 via cesarean section at 34 weeks and 5 days. She was in the NICU more than three weeks before she and her mother returned home to her five siblings and father.
“I’m grateful for Dr. Sandlin and Dr. Taylor. I knew beforehand I would be treated by the best. I’m glad I got to be here and survive.”
April 25, 2018 | A steady stream of healthy, happy and adventurous infants and toddlers visited UAMS Medical Center April 21 for the Seventh Annual NICU Reunion.
Karrissa Newby has been to the event once before, when her baby was about 3 months old and a very recent graduate of the UAMS neonatal intensive care unit (NICU). Kortlynn was born November 2015 weighing 2 pounds, 12 ounces at 28 weeks gestation.
“She was a perfect baby, just small,” Newby said. “It means so much to see the nurses and doctors who took care of Kortlynn in the three months she was here. They remember who she is. I’ve even become Facebook friends with some of her nurses. So they’re still involved in her growth and development.”
Newby says the light-hearted family atmosphere is what brought her back. The reunion for Newby included running into a fellow NICU mother and friend she’d made while her daughter was at UAMS. Lindsey Taylor had twins November 2015 at 30 weeks gestation. Kamdyn and Kudder were born on Taylor’s birthday.
“My water broke at 26 weeks. I was hospitalized and we tried to hold them in as long as we could.”
Kamdyn weighed 3 pounds, 12 ounces and Kudder was 3 pounds, 14 ounces. The brothers were well enough to go home before their due dates: Kamdyn on Jan. 29 and Kudder on Feb. 3. They were due Feb. 8. Kudder died May 30, 2016.
Taylor says her sister-in-law, Anna Michelle Cotner, was a source of encouragement and inspiration during the journey. The Taylor babies were born one week after Cotner’s baby, John, who had a 70-day stay in the UAMS NICU.
During the event, Kamdyn and John giggle and play while their mothers watch, occasionally reminding them to be gentle.
“We live in different counties,” Cotner said. “So we don’t get to spend as much time together as we’d like. We’re working to change that.”
Newby says she’s grateful for her daughter’s progress. Kortlynn is walking, talking and acting as any 2-year-old.
“She just tested above her age level at school,” Newby said.
The NICU Reunion had a superhero theme. Costumed characters added to the fun by interacting and posing for photographs. Batman, Wonder Woman and a crew from Star Wars were among the characters.
Rebecca Sartini, D.N.P, is the assistant director of nursing for newborn intensive care. She’s been a NICU nurse for 30 years.
“Our babies are our super heroes,” Sartini said. “So many parents look forward to seeing their primary care nurses and doctors again. They’re excited to show off their graduates and how much they’ve grown.”
Children also enjoyed a canine volunteer from UAMS’ animal-assisted program titled SPOT (Special Pets Offering Therapy). Many had their faces painted and others played a bean bag toss game outside.
The NICU reunion also served as an information and educational event for parents, including car seat checks, a reminder to keep babies on their backs for safe sleep and an offer of support with representatives from Love Lives, a UAMS perinatal bereavement program.
The 64-bed UAMS NICU offers all private rooms, including rooms equipped for multiple births. In 2018, UAMS became the first hospital in Arkansas to have a web-based Angel Eye Camera on every bed. UAMS is also the only hospital in central Arkansas to have received an international “baby friendly” recognition for its policies and procedures encouraging new mothers to breastfeed.
April 12, 2018 | UAMS patient C.M. McClain Jr. was not expecting to celebrate the final day of his treatment cycle with six NFL players, including a Heisman Trophy winner. But that’s exactly what he did.
The players came up one by one to shake his hand, introduce themselves and talk at length about his family, his treatment and why they have come back year after year to visit patients at the UAMS Winthrop P. Rockefeller Cancer Institute.
“One player told me that his mom had been a nurse at UAMS and taught him the importance of caring for others. Another player and I talked about race relations. We had some great conversations,” said McClain, a former college football player who is being treated in the Cancer Institute’s Infusion Clinic 1 for chronic inflammatory demyelinating polyneuropathy.
This was the fifth year that Denver Broncos defensive tackle and Jacksonville native Clinton McDonald organized his fellow players to visit the UAMS Cancer Institute.
“Coming back every year gives me perspective. The ultimate goal in life is good health, but cancer can affect anybody. We need to understand what other people are going through so we can make a difference in their lives and stay focused on what’s important in our own,” he said.
Accompanying McDonald on his visit were Jameis Winston, Heisman Trophy winner and Tampa Bay Buccaneers quarterback; Demetrius Harris, fellow Jacksonville native and Kansas City Chiefs tight end; Dante Wesley, Pine Bluff native and retired Carolina Panthers and Detroit Lions cornerback; Michael Johnson, Cincinnati Bengals defensive end; and Joseph Anthony “Red” Bryant, retired Seattle Seahawks defensive tackle.
“Every time I come back, it’s a blessing. Anything we can do to relieve someone’s stress and make them smile is worth it,” said Johnson, who has accompanied McDonald for the past four years. “Clint is one of the best people I know. If he’s involved in something, I want be involved in it too,” he said.
The group stayed about two hours and made their way between the Cancer Institute’s two infusion clinics, visiting with each patient, passing out autographed footballs and taking selfies.
“It’s pretty neat of them to take time out of their day to stop by. I was feeling down in the dumps this morning, so this was good timing. It keeps our spirits up,” said Cara DeFlorian, who was being treated for breast cancer and was accompanied in the clinic by her two teenage daughters.
In addition to the patients, the Cancer Institute staff also enjoys the players’ annual visit and appreciates their continuing dedication to the central Arkansas community.
“The fact that Clinton McDonald continues to organize this visit year after year is a real testament to the fact that he values his home state and wants to give back to it. Our patients are always thrilled to visit with the players, and we appreciate the fact that they take the time to come back each year,” said Cancer Institute Director Peter Emanuel, M.D., professor in the UAMS College of Medicine.
In addition to their visit to UAMS, the players also participated in McDonald’s annual Family Fun Day and Iron Sharpens Iron Youth Football and Cheer Camp on April 7 in his hometown of Jacksonville.