June 20, 2018 | As John Foster prepares for a summer of travel and merriment, he and his wife, Rebecca, are happy they have made health a priority.
Eleven years ago, Foster felt a lump in his neck while shaving. He said at first he thought little about it, assuming it may have just been a reaction to a mosquito bite.
“But it never went away,” Foster said. “When Rebecca felt it, she immediately said ‘We need to go to the doctor.’”
Rebecca Foster worked for 44 years as a registered nurse. She spent 24 of those years working at UAMS, 12 of those in oncology.
“As an oncology nurse, I knew how many people had successful outcomes from their cancer diagnosis,” Rebecca Foster said. “This gave me confidence and peace that Dr. [Brendan]Stack and UAMS would provide state-of-the-art medicine and that John would be telling of his successful outcome one day. For that, I am forever thankful.”
John Foster was diagnosed with stage 3 oropharyngeal cancer. The oropharynx includes the back wall of the throat, tonsils and the back of the tongue. He was treated by the UAMS team of medical and radiation oncologists, and his care was led by head and neck surgeon Brendan Stack Jr., M.D., who sees patients in the Head and Neck Oncology Clinic at UAMS.
“It was scary,” Foster said. “But I felt like I was in good hands. Dr. Stack is one of the
best in the world at what he does.”
Foster was ultimately treated with chemotherapy and radiation.
“Mr. Foster represents a typical head and neck cancer patient in that he was diagnosed, treated and came for follow-ups for five years.”
After being disease free for five years, Stack says patients “graduate” from routine follow-up appointments from the Head and Neck Oncology clinic. Foster continued to receive checkups from his primary care physician.
In September 2017, a lump in Foster’s left jaw prompted him to make an appointment with his primary care doctor at UAMS, Robert Lavender, M.D. Lavender referred him back to Stack who ordered a biopsy that confirmed there was a malignant mass in his largest salivary gland known as the parotid gland. Stack performed a parotidectomy in November and was able to remove all traces of cancer.
“I think the moral of Mr. Foster’s story is this,” Stack said. “You need to engage with your health care providers. Follow up as long as you are directed. And after routine follow up is concluded, always be on the lookout for new and unexplained symptoms in the area of your previous cancer. In this case, I think we were able to treat him very quickly because of his diligence and compliance.”
June 15, 2018 | Jim Kimbrough of Scott hadn’t been able to drink a cup of coffee without spilling it in three years.
That was until tiny electrodes were placed in areas of his brain that control movement in a procedure called deep brain stimulation.
The electrodes stimulate the area, and slow down the tremors, said Rohit Dhall, M.D., associate professor of neurology in the UAMS College of Medicine and director of Neurodegenerative Disorders at UAMS.
Since opening the UAMS Tremor Clinic nearly two years ago, Dhall said, hundreds of patients have been treated. Many of them have been diagnosed with a nervous system disorder known as essential tremor (ET).
Essential tremor is under-recognized, Dhall says, often because many patients don’t seek professional help or they learn to live with it. It is three times more common than Parkinson’s disease. But unlike Parkinson’s, tremors in ET patients worsen when they are using their hands.
“It used to be called benign essential tremor,” Dhall said. “But as Jim can tell you, it’s often not benign. It can be very disabling for people.”
Kimbrough, 75, was referred to UAMS when his tremors became disabling.
“I was tired of living,” Kimbrough said. “I wanted to leave here.”
Kimbrough said everyday tasks had become a constant source of frustration.
“I couldn’t get a key in a keyhole. I couldn’t pour or drink a cup of coffee without it spilling all over me. I couldn’t button a shirt or put toothpaste on a toothbrush.”
Kimbrough said his tremors became so bad, he would drink three glasses of bourbon and coke regularly just so that he could write legibly and function. A few weeks before his surgery, he’d tried cooking pancakes.
“It looked like a 4-year-old had been rummaging through the kitchen by the time I got through,” he said.
Kimbrough was determined to be as independent as possible, saying he didn’t want to burden his children. Kimbrough’s wife had passed away and he’d been living alone for the past few years. His medications helped for a while. But in late 2017, five years after his essential tremor diagnosis, Kimbrough and his doctor decided it was time for a surgery called deep brain stimulation.
“It’s like a pacemaker for the brain,” Dhall said. “Neurosurgeon, Dr. Erika Peterson places small electrodes into the areas of the brain that control movement. The patient is awake during the surgery.”
“Wide awake,” Kimbrough said.
“It can be a little scary for patients at first. But we do that because it’s the best way we can reliably test if we’ve hit the right target. It also allows us to ensure there won’t be major side effects from the electrodes as the patient comes out of surgery,” Dhall said.
Kimbrough says any nervousness he had regarding surgery all but disappeared on the day of the operation, Jan. 22.
“I was a little apprehensive,” he said. “I couldn’t understand how they would drill into my head without hurting me. Dr. Petersen was very calming. She’d asked me what kind of music I liked to listen to. I told her I like oldies but goldies.”
A playlist just for Kimbrough was playing in the operating room when he was rolled in.
“She talked me through the whole procedure,” Kimbrough said through tears. “When I got back to recovery, I asked for a cup of coffee. It was the first cup of coffee I was able to drink without spilling in three years.”
While there is often a genetic component associated with essential tremor, Dhall says 40 percent of the time there is no family history. Most people begin notice worsening tremors in their late 40s or early 50s.
“Not every patient will need surgery,” Dhall said. “There are first-line medications that can reduce tremors and for some people, a lifestyle change can help them maintain control.”
“To me, this is a miracle,” Kimbrough said. “I have confidence I can live alone and take care of myself. It’s a true blessing from God."
June 11, 2018 | Running is more than a hobby for Mary Ann Hansen. It’s a reprieve. It’s liberation from a past life.
Most runners make a connection with the road early in life that remains for a lifetime. Not Hansen. Her bond formed after she was 50 and following a hip replacement.
She noticed her hip pain several years ago. There was discomfort when she stood up or rolled over in bed, and there were instances of sharp pain. Still, Hansen did not expect her situation to warrant immediate action.
An x-ray showed the cartilage in her left hip was gone. With each step, each slight movement, her hip joint grinded bone on bone. Her physician referred her to C. Lowry Barnes, M.D., chair of the UAMS College of Medicine’s Department of Orthopaedic Surgery, who performed Hansen’s hip replacement.
It surprised her that hours after she left the operating room, staff was in her room, getting her up and moving.
“I thought, you have got to be kidding me,” said Hansen. “They had me moving right away.”
Same-day exercises are routine for orthopaedic surgery patients at UAMS. Quicker discharges, specialized surgeons and an experienced, designated hospital come together to form a standardized practice of care that UAMS research shows leads to better patient results and satisfaction.
Patients and families learn about procedures and recovery process during pre-surgery visits and classes. The staff is able to identify and lessen risk factors.
Patients are under the care of a specialized orthopaedic surgeon at UAMS. From hip and knee or foot and ankle, to sports medicine and trauma, all UAMS orthopaedic surgeons specialize in a particular service. It allows each surgeon to narrow his or her focus, stay up-to-date on best practices and provide a benefit to the patient.
UAMS’ hip and knee service includes four fellowship-trained surgeons, the most fellowship training in joint replacement in Arkansas.
The Department of Orthopaedic Surgery at UAMS includes a staff of nurses and health professionals dedicated to orthopaedic surgery patients. Most patients return home within 24 hours of the procedure and meet with a physical therapist before discharge.
“We have seen a lot of talk recently about robotic-arm technology in orthopaedic surgery, but we have identified a way to truly achieve better patient results and satisfaction without it,” said Barnes. “Mary Ann is back to doing more than before and there was no robotic-arm technology necessary for her operation.”
It was after Hansen’s hip replacement that she discovered running. In her mid-50s, Hansen was searching for an outlet from decades spent in the throes of an opioid addiction. She longed for a way to experience an exhilarating high without turning to prescription pills.
Her troubled journey began in 1996 when she was diagnosed with interstitial cystitis, also called painful bladder syndrome, a chronic pain disease of the bladder. It was like a constant stabbing in her pelvic area, said Hansen.
She was first prescribed hydrocodone to deal with the pain. From there, her prescriptions graduated to oxycodone, levorphanol, methadone and ultimately fentanyl patches.
When the pain pills were ineffective, she was prescribed benzodiazepine to help with the pain and sleep. That left her forgetful and unable to focus, so she was prescribed Adderall. When the Adderall affected her ability to sleep, she was prescribed sleeping pills.
“It was a steady diet of pills for many years,” said Hansen. “It was awful. I was just existing.”
Days out of a rehabilitation center, Hansen started running. First, it was one block at a time, running and walking.
“Before I knew it, I was running two blocks, then three, then four,” said Hansen. “I thought, ‘this is good, let’s do a marathon.’”
She ran a half-marathon in her first year of running. The next year, she completed the Little Rock Marathon. Now, she’s done five marathons, a dozen half-marathons and countless 5Ks and 10Ks.
This year, she’s participating in the Arkansas Grand Prix.
“It’s an endorphin high,” said Hansen. “Running has replaced the feeling I got from the opioids. It is wonderful.”
She has found another outlet through running: as a running coach at Hope Rises helping formerly incarcerated women who dealt with addictions re-enter society.
She designed her program as part of her graduate studies and she’s seen success. Two of her pupils have completed half marathons with her.
“I understand where they are coming from,” said Hansen. “To see the look on their faces when they finish is incredible. That’s why I do it.”
When she’s done with her master’s in Adult Education and Professional Practice, Hansen, a former music teacher, wants to go into Arkansas prisons and help women earn their GED.
Hansen can also be found enjoying another of her hobbies again — the local theater. She's been in multiple productions at the Argenta Community Theater in North Little Rock and the Studio Theatre in downtown Little Rock.
“Before, when I got up, I felt this incredible weight like someone was holding me down. Now, I wake up and I am ready for the day,” said Hansen. “I’m making up for lost time, definitely.”
June 5, 2018 | Teighler Kittler’s husband, Corey, was getting dressed for work Oct. 2, 2017, when he heard a long groan. He rushed to the bedroom and saw his wife, 37 weeks pregnant, on the bed clenching her fist and with a fixed stare.
It was over in a moment. He asked what happened and said he was taking her to the hospital. She managed to convince him she was fine.
Then it happened again.
After he saw the second seizure, he dressed her and rushed her to White River Medical Center in Batesville just seven or eight minutes away. As a cath lab nurse there, Teighler was required to live not more than 15 minutes away in case she’s needed for just such emergencies she was experiencing.
Physicians at White River Medical Center diagnosed her with a pulmonary embolism — a blood clot in the lung that was blocking blood flow to her heart. They put her on blood thinners and called for a med flight. The medical center’s helicopter was already in route with another patient, so they called for a helicopter transport from Searcy. The 24-year-old was med flighted to UAMS, arriving at 1 p.m. in critical condition and taken immediately to Labor and Delivery.
“None of us can explain it,” said Jill Mhyre, M.D., the obstetric anesthesiologist who treated Teighler at UAMS. “Most people die from this condition. It’s rare to develop this, and even rarer to live.”
In Labor and Delivery, Teighler’s team included Mhyre; obstetrician Chad B. Taylor, M.D.; trauma surgeon J.R. Taylor, M.D.; and interventional radiologist Mollie Meek, M.D. The team faced an ethical dilemma, Mhyre said. “‘Do we save the baby and risk losing the mother, or save the mother and risk losing the baby?’”
Teighler ordinarily would have been transferred to the Radiology Department to treat the blood clots, but Radiology couldn’t monitor the baby’s heart. Finally, the team decided that delivering the baby would help the mother.
They prepped her for a C-section. They decided she needed a blood transfusion because her heart was under tremendous strain. Also the baby’s heart rate began to drop, so they put her under general anesthesia and performed an emergency C-section.
Madelyn Kittler was born at 6:48 p.m. weighing 6 pounds and 10 ounces. She was perfect.
But Teighler was in serious trouble. Doctors put in catheters and gave her the blood-clot-busting drug tPA. They began chest compressions that broke up the clot. Doctors were using the catheters to pull out the blood clot from her arteries. But for every clot they pulled out, more were forming, which is usual for this condition, Mhyre said.
Teighler’s heart stopped three times on the table and three times they brought her back with chest compressions, Mhyre said.
Teighler’s family, including her mother, Carmella Phillips, didn’t get to see her until the next day. When Carmella entered Teighler’s ICU room, Teighler was sitting up on a ventilator texting.
Teighler said when she woke after surgery, her hands were tied so she wouldn’t pull the ventilator out. Her husband gave her his phone and she wrote “Untie me!” Her next message said “Where’s Madelyn?”
Five days later she went home. Her chest hurt for two months from the compressions.
“I thought I was going to lose my baby,” Carmella said of Teighler. “She’s my only child. It was a miracle.”
Mhyre directs the Division of Obstetric Anesthesia and has been named chair of the Department of Anesthesiology in the UAMS College of Medicine effective July 1. She said she’s been at UAMS since 2013 and never had a patient with a pulmonary embolism while pregnant. If it’s going to happen, it usually happens after the baby is born, she said.
Teighler was fortunate to have been brought to UAMS, the only adult Level 1 Trauma Center in Arkansas.
“We were able to mobilize resources not available at any other hospital in Arkansas,” Mhyre said. “For the C-section we gave her medication therapies that dilated her blood vessels. It took a huge team. There was medication, equipment and teams of people.”
Seven months later, Teighler said her doctors could find no genetic condition or other factor that caused the pulmonary embolism.
During a recent visit to UAMS for a checkup, as Corey holds a healthy, sleeping Madelyn with Teighler at his side, Carmella looks over at the happy family. “I’m thankful for this hospital.”
May 31, 2018 | It was the summer of 2015 and Dottie Lobbs should have been enjoying her summer break. Instead, Lobbs, a special education teacher at Glen Rose High School in Malvern, was experiencing such severe fatigue that she knew something was wrong.
It was probably bronchitis or some other easily treatable condition, her doctor said. But the antibiotics she was prescribed did not make a difference. As the first day of the new school year rolled around, Lobbs went back to the doctor and was quickly hospitalized. Still, however, no one could not determine the cause of her fatigue or abnormal blood work.
That’s when she asked for a referral to UAMS.
Within three days of her first appointment she was diagnosed with chronic myelomonocytic leukemia-2 (CMML-2), a type of cancer that starts in the blood-forming cells of the bone marrow and spreads to the blood.
“It was totally out of the blue,” she said.
While some other types of cancer are staged by the size of the tumor, CMML is split into two groups based on the percentage of immature cells, called blast cells, in the blood and bone marrow. In healthy people, blast cells make up 5 percent or less of normally developing marrow cells. In CMML-2, the percentage of blast cells is between 5 percent to 20 percent in the blood and 10 percent to 20 percent in the bone marrow.
With a team led by Muthu Veeraputhiran, M.D., director of the UAMS Allogeneic Stem Cell Transplant Program, Lobbs was admitted to the UAMS hospital Jan. 8 where she spent about the next 25 days undergoing her first round of chemotherapy.
“For patients who are diagnosed with acute leukemia and have high-risk features, we use chemotherapy to get them into remission while we search for a suitable stem cell donor,” said Veeraputhiran, who also is an associate professor in the UAMS College of Medicine Department of Internal Medicine.
An allogeneic stem cell transplant is the only curative treatment for CMML and requires a donation of blood-forming stem cells from another person. The first allogeneic stem cell transplant in the UAMS Winthrop P. Rockefeller Cancer Institute’s program was conducted May 13, 2015. “Our first transplant patient is still doing amazingly well today,” Veeraputhiran said.
UAMS has the only adult allogeneic stem cell transplant program in Arkansas and performs about 20 transplants per year for patients with acute leukemia and relapsed lymphoma. Veeraputhiran was named director of the program in February 2017.
Luckily for Lobbs, her brother was a suitable match and agreed to undergo the process to donate his stem cells to her.
Finding a stem cell donor is not always that easy, although research is improving the odds, Veeraputhiran said. Siblings have only a 25 percent match rate, and often people must turn to the national Be the Match stem cell donor registry to search for an unrelated donor.
A new process, however, can use donors who are a half-match, by incorporating novel combinations of therapies that minimize the rejection process.
For racial minorities, this is an especially important breakthrough, as African-Americans and Hispanics have less than a 30 percent chance of finding an unrelated donor through the national registry.
“The number of racial minorities in the registry is not as high as we would like it to be,” Veeraputhiran said. The unrelated match rate for whites is 60 percent to 70 percent due to higher rates of participation in the registry.
To prepare for his donation, Lobbs’ brother underwent four days of stem cell stimulating shots and had a port inserted into his chest for the blood to be drawn. Most stem cell donations are done through a blood draw.
While her brother was undergoing his preparation for the donation, Lobbs’ process was much more intense. After her first 25-day stay in the hospital, she went home for five days before returning to UAMS for 25 more. A 10-day round of outpatient chemotherapy followed, and, another 10-day stint in the hospital, culminating with her stem cell transplant on April 20.
After another 20 days in the hospital, she was released, but still had daily appointments at UAMS that required a one-hour drive back and forth from her home in the Brush Creek community outside Malvern.
Finally, on the 100th day after her transplant, Lobbs was declared cancer free. After easing back into the regular routine, she returned to work full time in December 2016.
“I had the most positive experience at UAMS that I possibly could have had. Dr. Veeraputhiran and his team were so wonderful. I am so grateful,” she said.
Even after having spent so much time at UAMS, Lobbs did not hesitate to accept an invitation to return on May 11, 2018, for an event honoring all of the patients who have undergone allogeneic stem cell transplants at UAMS, along with their donors and loved ones.
The program’s first-ever Celebration of Life welcomed about 70 people to the UAMS Cancer Institute to reminisce and reconnect over their shared experiences.
“I made a lot of friends while I was undergoing treatment, and it was good to see them,” Lobbs said, adding that visits from former transplant patients while she was hospitalized gave her hope that she would make it through as well. She hopes someday to pay it forward by volunteering with the program and offering living proof to patients that their disease can be overcome.
“Cancer is always scary, but acute leukemia and recurrent lymphoma are life-threatening emergencies. These patients beat the odds. We had this event to tell them we are honored to be part of their journey, and we believe their recovery is worth celebrating,” Veeraputhiran said.
In addition to Veeraputhiran, the transplant team includes physicians Pooja Motwani, M.D., and Appalanaidu Sasapu, M.D., both assistant professors in the UAMS College of Medicine Department of Internal Medicine; registered nurses, advanced practice registered nurses, case managers, social workers and staff of the UAMS hospital’s E7 wing and the UAMS Cancer Institute’s Infusion Clinic 4; and transplant coordinators.
May 29, 2018 | George Crocker is up to just about any challenge. A retired Army lieutenant general, Crocker spent the good part of his life defending his country both at home and abroad. From two tours in Vietnam to serving as commander at Fort Lewis in Tacoma, Washington, Crocker made a lasting mark through his distinguished military service.
That steely determination carried over into other parts of his life as well, and when he was told he needed treatment for prostate cancer, Crocker was ready to do whatever it took to take care of the problem.
“I told him, ‘We can take the prostate out,’” he said, recalling his conversation with UAMS urologic oncologist Rodney Davis, M.D., following his biopsy in 2017.
Davis, though, had other ideas. After studying Crocker’s medical history, which included a massive stroke two years earlier, Davis quickly determined that surgery presented too many risks.
“I wanted to find the treatment that was the safest and least stressful overall,” said Davis, professor and chairman of the Department of Urology in the UAMS College of Medicine. Surgery could have increased Crocker’s risk of a second stroke, so Davis recommended a course of radiation therapy instead.
Plus, radiation presented the definite possibility of a cure.
A resident of Clinton, Crocker was already confident in the ability of UAMS doctors to successfully treat the most complex medical conditions. When he fell to the floor of his garage unconscious in 2015, Crocker’s wife, Vonda, quickly called emergency medical services. They, in turn, alerted the emergency department at the Ozark Health Medical Center, a partner in the UAMS-led statewide stroke program AR Saves.
AR Saves, which stands for Stroke Assistance through Virtual Emergency Support, began at UAMS in 2008 and has grown to include 54 partner sites throughout Arkansas. It uses a high-speed video communications system to help provide immediate, life-saving treatments to stroke patients by enabling a stroke neurologist to evaluate whether emergency room physicians should use a powerful blood thinner known as t-PA within the critical three-hour period following the first signs of stroke.
After receiving the drug, Crocker’s cramped arm began to relax and he was transferred by ambulance to the UAMS hospital where he underwent a brain scan, was administered more t-PA and had two clots removed from his brain. In fewer than 24 hours, he was forming complete sentences and on the road to recovery.
Now, however, Crocker was facing a new challenge with his diagnosis of prostate cancer and he was trusting fellow Army veteran Davis to determine the best course of treatment. Davis, an Iraq war veteran who underwent military training at Fort Lewis and holds the rank of colonel in the U.S. Army Retired Reserve, assured Crocker that radiation therapy was the best choice to maintain his quality of life, as well as kill the cancer cells in the prostate and any malignant cells that might be adjacent to it.
Crocker began his round of 28 treatments in late 2017 at the UAMS Radiation Oncology Center under the supervision of Sanjay Maraboyina, M.D., assistant professor in the Radiation Oncology Department in the UAMS College of Medicine.
“When I first met with Mr. Crocker, I told him that recent clinical studies have shown a five-week course of treatment to be just as safe and effective as the typical eight-week regimen. It’s also more convenient for patients, who have to come in every day for treatment. I want to be sure our patients have access to the latest advancements, because this is truly what sets UAMS apart from other cancer centers,” Maraboyina said.
Although he is still experiencing some side effects related to the hormone therapy necessary to reduce his testosterone level, Crocker is back to his active lifestyle. Left unchecked, testosterone can stimulate prostate cancer cells to grow.
“Mr. Crocker had a fierce determination throughout his treatment and approached every obstacle related to his health in much the same way he has his military career. Together with his team of doctors, he was determined to beat prostate cancer,” Maraboyina said.
With a European vacation and reunion of his West Point class coming up, Crocker shows no signs of slowing down and is thankful he does not have to.
“Dr. Davis gave me clear and logical reasons for the treatment I needed, and the staff at the UAMS Radiation Oncology Center was first class in every respect. I couldn’t be happier,” he said.