Jan. 18, 2017 | Eighteen years ago, Gail Clayton received news that changed her life. Looking back, she says finding out she had breast cancer marked the beginning of new perspectives.
“When I was first diagnosed with cancer, it wasn’t the end of life as so many people think. To me, it was the beginning of life.”
Clayton and her husband, Raymond, have been married 46 years. He calls UAMS one of Arkansas’ best kept secrets.
“I don’t think people realize how amazing this institution is,” Clayton said. “You become friends with your doctors and nurses. It takes a village and I believe that village is right within these walls at UAMS.
She had breast cancer twice and was recently diagnosed with ovarian cancer. That prompted Clayton’s oncologist, Laura Hutchins, M.D., to refer her to gynecologic oncologist Kristin Zorn, M.D.
“Anytime we see a patient with a new diagnosis of cancer in the ovaries, fallopian tubes or the peritoneum (the internal lining of the abdomen), we think of a possible hereditary source for that cancer,” Zorn said.
Clayton and Zorn discussed genetic counseling and ultimately found Clayton had a mutation in one of the BRCA genes, commonly known as the breast cancer genes. Every person is born with the BRCA1 and BRCA2 genes, but women who inherit mutations of the genes have an increased chance of developing breast, ovarian, and other cancers.
Researchers’ knowledge about these genetic mutations has helped lead to development of a new class of drugs known as PARP inhibitors.
“PARP inhibitors capitalize on the genetic defect that’s already present in people who carry one of these mutations,” Zorn said. “It helps to kill the cancer cells that are accumulating DNA damage.”
There are three types of PARP inhibitors that have been FDA-approved over the past few years: olaparib, rucaparib and niraparib. Clayton is a part of a clinical trial that includes her taking olaparib.
“With PARP inhibitors, we first focused on people who carry a BRCA or similar mutation. We’re now finding many patients with ovarian cancer who do not have a mutation are responding to the drugs.”
Another advantage of this new class of drugs is that they can be taken orally rather than through intravenous infusion, making it more convenient for patients. This works especially well for Clayton who spends a great deal of her time seeing the world.
Since her first diagnosis, Clayton says she takes nothing for granted and began living in a way she may not have if not for the illness. She and Raymond Clayton have made lots of memories abroad. Sometimes their adult son Randy joins them.
“We’ve been to the Baltic States, Russia, Berlin, Sweden…”
She’s responded well to the clinical trial and shows no indications of slowing down.
“…England, Paris, the Caribbean, Ireland. It’s been a journey.”
“Part of the reason I’m so passionate about practicing at a place like UAMS, is that it helps us bring cutting-edge therapies to our patients,” Zorn said. “Sometimes we’re talking about a surgical advance, sometimes we’re talking about an advance in treatment.”
Zorn says genetic counseling and testing has become a standard of care in some of the most common gynecological cancers.
“While many parts of the country are having trouble keeping up with the change in the standard of care, UAMS has a genetic counselor embedded in our clinic so that we can accomplish that.”
“The way I see it,” said Clayton, “Even if the clinical trial didn’t work for me, maybe it would work for someone else. I’m grateful for the strides scientists have made in treating this disease.”
This clinical trial was developed through the NRG Oncology cooperative trial group of the National Cancer Institute. The only access to this trial in Arkansas is at UAMS.
Jan. 8, 2018 | Jacob Mauterstock can run a half-marathon in an hour-and-a-half. He’s in the gym every day. He demonstrates yoga poses at the drop of a hat.
“It’s a lifestyle thing,” said Mauterstock, 41, of Conway.
That approach to life remains steadfast, even though Mauterstock lost his left arm in December 2016. Despite this setback and thanks to in large part to his can-do attitude, Mauterstock was the first person in Arkansas to undergo a surgery that will allow him to use a robotic arm controlled by his thoughts.
UAMS is one of the few hospitals in the nation where the surgery is being performed. Mauterstock’s surgeons – John Bracey, M.D., and Mark Tait, M.D. – have advanced training in upper extremity surgeries and the latest procedures.
“We were lucky that this surgery was part of our fellowship training,” Bracey said. “When we learned how to do it, we did so knowing that this was something that we wanted to bring back to Arkansas. Even though we did Jacob’s surgery soon after the accident, that isn’t necessary. For other upper body amputees, we can do this surgery up to 10 years after the amputation.”
Mauterstock was using an auger as part of a home improvement project with his fiancé when the sleeve of his shirt got caught. His arm was badly damaged, and he was rushed to UAMS, where Bracey and Tait performed an emergency amputation of his arm above the elbow.
Despite the extent of the injury, it is the philosophy of Bracey and Tait’s department – the Department of Orthopaedic Surgery in the UAMS College of Medicine – to help their patients live their best lives, whatever that looks like: knee replacements for the weekend warrior who wants to keep moving, hip replacements for the grandmother who wants to keep bending over to interact with grandkids, or whatever is necessary for active people like Mauterstock who don’t want an accident to define them.
So when they talked to Mauterstock after surgery, they told him about the procedure, called a targeted muscle reinnervation, which would prepare him for the robotic arm, called a myoelectric prosthetic. They moved some of Mauterstock’s nerves to remaining muscles on his arm. When the robotic arm is fitted in place, it will connect with those muscles and nerves to pick up electrical signals from his brain about movement.
The technology has been in use among military amputees for about 10 years and only recently has started becoming available for civilians.
“It’s amazing,” Bracey said. “The robotic technology has really advanced quite a bit in the past 10 years. They can create robots that can do almost anything, from the fine motor details of a robotic hand to things that are very sturdy like elbow function, lifting heavy weights.”
Eleven months later, Mauterstock is taking all the necessary steps to be prepared to receive his robotic arm, which will likely occur in 2018. He has been fitted with a temporary prototype of the robotic arm, and he is helping “train” the software that will allow his nerves and his future robotic arm to communicate.
While hooked up to electrodes that track his electrical impulses, Mauterstock is instructed to think things like “move your thumb” and “rotate your wrist.” The computer is keeping track of what signals are firing when Mauterstock thinks about these movements, and his robotic arm will be programed to recognize his specific thought patterns and respond to them.
The prototype he has now is heavier than the robotic arm, which will be made of carbon. And it is powered by his body movements, rather than his thoughts. For example, if he wants to bend his elbow, he shrugs his shoulder in a certain way.
He has attachments for the “hand” part of the arm that allow him to work out, hold on to bicycle handlebars and do yoga. Even though he has only had the prototype arm for a month, he is already adept at controlling its movements. As he strolls across the gym room floor, his movements look natural and totally under his control.
“I try to learn something new every day,” Mauterstock said. “Upon returning to work after my accident, I also started going back to the gym.”
The prototype arm allows him to work out both sides of his body, which he is eager to do in order to maintain – and rebuild – muscle mass on his left arm. In addition, Mauterstock is all about taking those daily, incremental steps that will pay dividends in the future.
“Thanks to my stubborn attitude, support from others, outstanding care and leading-edge technology at UAMS, I’m not going to let this accident change how I live my life,” Mauterstock said.
“Jacob is a perfect candidate for this surgery, and his outcome so far has been encouraging,” Bracey said. “That’s one of the great things about practicing medicine in an academic medical center setting – the chance to take part in cutting-edge advances like this.”
Jan. 3, 2018 | Carolyn Pry says members of her church congregation were surprised to see her in Sunday worship just days after she’d had brain surgery.
The 69-year-old retired school teacher from Emerson no longer has headaches or feels dizzy after two UAMS surgeons removed a tumor using a multidisciplinary, non-invasive approach.
Pry’s problems began when her local primary care physician discovered the pituitary macroadenoma following a minor stroke in April. After a referral to a specialist, Pry ultimately called UAMS for another opinion. Neurosurgeon Analiz Rodriguez, M.D., Ph.D., who specializes in primary and secondary brain tumors and endoscopy, was able to schedule her for the following week.
The pituitary macroadenoma is a tumor that forms on the pituitary gland, a pea-sized structure located at the base of the brain, just behind the bridge of the nose.
“To access the tumor, we had to go through the nose,” Rodriguez said. “Ideally, a neurosurgeon works with an otolaryngologist during this type of surgery because it results in a better outcome for the patient: less pain and faster healing.”
“I felt very good about Dr. Rodriguez from the moment I met her,” Pry said. “She and Dr. Kanaan both worked very well with me. They’re a godsend.”
Alissa Kanaan, M.D., director of the Rhinology Division in the Department of Otolaryngology worked alongside Rodriguez in the surgery.
Kanaan began the surgery by cutting through the nasal cavity to create an opening through the sinuses to reach the skull base where the tumor is located. She prepared a wide enough passage to remove the growth. Once she cleared the way, Rodriguez retrieved the tumor in small pieces.
After the surgery, Kanaan took out any debris that blocked air passages. And both doctors scheduled post-operation monitoring for the patient.
Pry says Kanaan, Rodriguez and their staffs are very compassionate and accommodating. On the day of her operation, each came by regularly to make sure her family was comfortable as they waited. And since Pry lives more than three hours away from UAMS, the physicians coordinated scheduling to make it more convenient for Pry.
“They made me feel like I’m the only patient they have,” she said. “I could not have asked for better doctors or facilities. I highly recommend UAMS to anyone.”
Dec. 28, 2017 | For UAMS, 2017 was a year of leadership changes and opening new buildings, of grants awarded for research and awards granted in recognition and praise.
In late December that University of Arkansas System President Donald R. Bobbit will recommend to the UA Board of Trustees that Cam Patterson, M.D., be the next UAMS chancellor. The board will meet by telephone to consider the appointment after the holiday break.
Patterson, currently senior vice president and chief operating officer at Weill-Cornell Medical Center, New York Presbyterian Hospital, is expected to join UAMS June 1 after seeing a major construction project on that campus through completion.
The other finalist, Stephanie F. Gardner, Pharm.D., Ed.D., interim chancellor, senior vice chancellor for academic affairs and provost at UAMS, will continue to lead the institution through the transition created when Chancellor Dan Rahn, M.D., retired July 31.
The University of Arkansas Board of Trustees voted in May to honor Rahn by naming the building that houses the College of Nursing, the College of Pharmacy, the Fay W. Boozman College of Public Health and part of the College of Medicine as the Daniel W. Rahn Interprofessional Education Building. It was dedicated in July in a public ceremony.
In May, UAMS opened a new, $10 million Family Medical Center on the UAMS West Regional Campus in Fort Smith. On the eastern side of the state in November, the university opened another Family Medical Center in Helena on the UAMS East Regional Campus, as part of its strategic efforts to expand its scope of clinical and educational services in the Delta.
Research funding at UAMS grew 53 percent during the last fiscal year, contributing to the Arkansas economy and bringing the potential to grow new businesses. From $111.6 million in fiscal year 2016 to $170.6 million in fiscal year 2017, which ended June 30, the total amount of grant awards received by UAMS for medical and basic scientific research surged strongly.
Other major developments and accomplishments include:
- UAMS and Baptist Health in August announced a statement of strategic intent, reflecting the commitment of the two health organizations to offering a wider range of educational opportunities and deliver clinical care more efficiently. Both institutions retain their separate and unique identities. The newly formed Baptist Health/UAMS Accountable Care Alliance will coordinate effective, high-quality care for patients receiving Medicare, initially caring for 50,000 Arkansans starting in 2018.
- The American College of Surgeons in April certified the UAMS Medical Center as an adult Level 1 Trauma Center, the only medical center in Arkansas to earn that status. To achieve the certification, hospitals go through a rigorous review process and must demonstrate they can provide the highest level of trauma care for the most serious and urgent cases.
- Of the 308 Arkansas physicians named in May to the 2017 Best Doctors in America list, nearly 200 are on staff at UAMS. Best Doctors Inc., a health care information service company, formulated the list through a polling method that gathers opinions from thousands of doctors across the country. Physicians cannot pay to be included in the database and are not paid to provide input.
- The Arkansas State Senate in March recognized UAMS for it work to address health care disparities in diabetes among the Marshallese population in northwest Arkansas. A Senate Resolution commended three Northwest Regional Campus faculty members for creating and implementing the Family Model of Diabetes Self-Management Education to improve patient outcomes among the Marshallese in northwest Arkansas.
- Five regional UAMS Family Medical Centers and four UAMS primary care clinics in Little Rock in February joined more than 2,900 primary care practices nationwide in a partnership between payers and providers. Called Comprehensive Primary Care Plus (CPC+), the partnership is designed to provide access to quality health care at lower costs and will provide primary care practices with additional payment to improve coordination of care. CPC+ is administered by the federal Center for Medicare & Medicaid Innovation.
- At Match Day 2017 for the first time in several years, all of the graduating class of the UAMS College of Medicine“matched” with a residency after medical school. On March 17, senior medical students simultaneously across the nation opened the envelopes to reveal where they had matched to complete their residencies for the next three to seven years.
- UAMS in August was reaccredited for another 10 years by the Higher Learning Commission, the regional accrediting body for higher education institutions. Accreditation enables students to transfer credits and degrees to other accredited colleges and universities, and many organizations that offer professional licensure require graduates come from accredited institutions. Accreditation is also required for students to receive federal financial aid.
- For the fifth time in nine years, UAMS in February was ranked in the top 10 nationwide for the percentage of its graduating class to pursue family medicine. In the latest ranking, the UAMS College of Medicine was listed seventh in the nation by the American Academy of Family Physicians. UAMS was included on the ranking of Doctor of Medicine (M.D.) programs.
- UAMS created programs for three new degrees and a certificate in biomedical informatics to help professionals assess and manage large sets of medical and public health information. The Arkansas Department of Higher Education approved the three graduate degrees — Doctorate of Philosophy, Master of Science and Professional Master’s — and a Graduate Certificate Program in biomedical informatics at UAMS. The state’s approval of these advanced biomedical informatics degrees will position the university to be a national leader in one of the fastest- growing research fields.
- The Home-Centered Care Institute chose UAMS as one of eight Centers of Excellence for its Home-Based Primary Care program, a first-of-its-kind program designed to make high-quality, home-based primary care a more common practice across the United States. The institute’s curriculum will be used to help train future house-call physicians how to build medical teams going to the homes. Jasmine Brathwaite, M.D., who leads the House Call Program through the Donald W. Reynolds Institute on Aging, will be one of four instructors who will teach it and lead the initiative.
- Mark Smeltzer, Ph.D., professor in the UAMS College of Medicine’s Department of Microbiology and Immunology, in June was awarded $11 million in federal funding for Phase II of a program that supports microbiology and immunology research. Phase I of the Centers of Biomedical Research Excellence (COBRE) grant was awarded by the National Institutes of Health in 2012 at $10 million. The first COBRE grant allowed Smeltzer to establish the UAMS Center for Microbial Pathogenesis and Host Inflammatory Responses. Its focus is pathogens – bacteria, viruses and microorganisms – and the disease responses they cause in humans.
- The National Cancer Institute has awarded an $8.3 million grant to UAMS for expansion and enhancement of an archive containing freely accessible cancer medical images and data. The Cancer Imaging Archive is a free online service that hosts a large collection of cancer-related medical images available for public download. Since its formation about seven years ago, archive data has been used to produce almost 500 academic papers.
- Led by UAMS researchers, a new clinical study called STAMPOUT aims to help a drug user stay in treatment by keeping the effects of the drug from going into the brain. In October, the National Institutes of Health National Institute on Drug Abuse awarded the InterveXion/UAMS research team an $8 million, three-year grant to fund STAMPOUT (Study of Antibody for Methamphetamine Outpatient Therapy). This will be the first clinical study in methamphetamine users of a medication developed specifically for patients who are meth users.
- A UAMS scientist reached a status few achieve by being awarded his third concurrent R01-type Research Project Grant by the National Institutes of Health (NIH). Daohong Zhou, M.D., received the $1.8 million grant to support his research on a therapy to prevent and possibly reverse a lung disease found in patients who undergo radiation therapy for cancer. Zhou is associate director for basic research in the UAMS Winthrop P. Rockefeller Cancer Institute and a professor in the UAMS College of Pharmacy’s Department of Pharmaceutical Sciences.
- The Arkansas Center for Health Disparities at UAMS in October was awarded a $7 million National Institutes of Health (NIH) grant for research on minority health disparities, including reducing tobacco smoke exposure among children in the Delta and studying HIV prevention among incarcerated African-Americans. The grant was awarded by the NIH’s National Institute on Minority Health and Health Disparities.
Dec. 22, 2017 | As a child, Laura Wright spent more than her fair share of time in the hospital.
She was born with a cleft palate and was diagnosed with Pierre Robin sequence, a condition in which children are born with a smaller than normal jaw, as well as a tongue that falls back in the throat and impedes breathing. Cleft palates are common with children who have Pierre Robin.
She also required several surgeries on her limbs as a child — something that doesn’t fall under a diagnosis of Pierre Robin.
It wasn’t until she was 27 years old and several weeks pregnant that Wright had a complete, accurate diagnosis.
She had campomelic dysplasia, a genetic condition that often results in short legs, dislocated hips, 11 pairs of ribs instead of 12 and clubfeet, among other symptoms, according to the U.S. National Library of Medicine. Distinctive facial features, such as a small chin, prominent eyes and a flat face, are typical of campomelic dysplasia — and Pierre Robin sequence is commonly seen in those with the disease.
Finally, Wright had answers.
She was also pregnant, and doctors were concerned about her baby’s development. At 17 weeks, her son Lane’s arms and legs were behind expected developmental milestones, and his head was measuring large. While his torso looked normal, his chest cavity looked small, Wright said.
Wright’s obstetrician Paul Wendel, M.D., sent her to the UAMS Prenatal Genetics Clinic. There she met Shannon Barringer, M.S., clinical services manager and a board-certified genetic counselor.
“When Laura walked in, I knew that she had something more serious than a cleft palate or Pierre Robin,” said Barringer. “In a way, genetic counselors are detectives. We are trained to look for specific features and medical histories that raise a big red flag. That was the case with Laura.”
After taking a complete medical history, Barringer and Wendel sent Wright to G. Bradley Schaefer, M.D., a UAMS geneticist, who made the campomelic dysplasia diagnosis.
“Shannon [Barringer] was with me when I received the diagnosis,” said Wright. “After Dr. Schaefer left the room, she took my hand and sat there with me. That meant more than any of the words she could have said.”
The next step for Barringer was giving Wright all of the information she needed to understand her disease, including the possible ramifications for her baby. Campomelic dysplasia is more often than not is associated with dying in infancy or at a young age, Barringer said.
“My first thought was would he be able to walk. I didn’t even think he could be born and not live,” said Wright. “Even though the team was worried about him, they didn’t let me know about that worry. They shouldered it themselves and laughed and helped me through it.”
Wright said she had mixed emotions about her diagnosis.
“Part of me was relieved to be diagnosed because I finally had an explanation for all of my medical issues. Part of me was scared because I was told Lane’s symptoms were more severe than mine were so we didn’t know what to expect,” she said.
“Throughout my pregnancy, I tried to maintain a calmness and remain positive so that even if he didn’t make it, he would be a happy baby when he was born.”
But Lane did make it.
Despite the expectation that Wright would go into labor early because of her small size (she’s only 4 foot 6) and the stress of the diagnosis, she carried Lane until he was 39 weeks old.
While he had a cleft palate at birth, none of Lane’s other health issues surfaced until he was six months old. At that time, he had surgery to widen his airway. At eight months old, doctors discovered he had difficulty swallowing (dysphagia) and gave him a gastrostomy button (G-button). Lane was fed exclusively through the button until he was 2 years old.
With 5 years and 10 surgeries under his belt, Lane is the happiest little boy, said Wright. “If you looked at him without knowing his medical history, you wouldn’t be able to see it.”
Wright said she is grateful for her team at UAMS.
“It was one of the hardest times of my life, but the compassionate care of Shannon and Dr. Wendel made it easier.”
Dec. 18, 2017 | After 40 years, Jerry and Sharon Moskwiak were ready to leave the cold Michigan winters behind.
They considered a move to their favorite vacation spot in South Carolina, but there was one catch: The nearest academic health care center was at least one hour away.
Because Sharon had worked for 35 years at the University of Michigan, including several years in their medical school, the couple was familiar with the advantages of receiving health care in an academic research setting.
And, because Jerry was a 25-year lung cancer survivor and lived with other chronic illnesses, access to quality health care was one of their top requirements when searching for a new place to call home.
That’s when they turned their sights to Little Rock.
“I grew up in Little Rock and knew the health care was exceptional. That was one of the main reasons we decided to move back here,” Sharon said.
After getting settled into their new home, the Moskwiaks set about finding a primary care physician. Their first and only stop was at the University of Arkansas for Medical Sciences (UAMS), Arkansas’ only academic health care center. During one of his initial appointments, Jerry received some unexpected news that convinced them they had made the right move at the right time.
“The doctor noticed a spot on my chest X-ray, and the next thing I knew we were discussing a plan for chemo,” Jerry said.
The spot was diagnosed as a subtype of non-Hodgkin lymphoma known as mantle cell lymphoma (MCL). This type of lymphoma can be fast growing and is most commonly found in men older than 60.
He was referred to Appalanaidu Sasapu, M.D., a hematologist oncologist at the UAMS Winthrop P. Rockefeller Cancer Institute, who scheduled him for six rounds of chemotherapy to occur every 28 days. Sasapu also is an assistant professor in the Department of Internal Medicine in the UAMS College of Medicine.
“Dr. Sasapu was very clear and told us exactly what his course of action would be. He was confident that what he was prescribing would work for me, and he was right,” said Jerry.
In fact, after Jerry’s fifth round of chemo in October 2016, Sasapu gave the couple good news: The treatment was successful, and he did not need to receive the final round.
“I’m very happy with Mr. Moskwiak’s progress. He is a wonderful gentleman who always has a smile on his face, and his wife is a great caregiver for him,” Sasapu said.
Unfortunately, the good news was short lived when a follow-up scan revealed that Jerry was now facing another challenge: His lung cancer had reappeared after 25 years.
“The first time Jerry was diagnosed, he had surgery to remove the upper lobe of his right lung. This time the spot was in the lower lobe of his left lung, and he wasn’t a candidate for surgery due to his other health concerns,” Sharon said.
After an unsuccessful attempt to freeze the tumor with cold gases in a process called cryoablation, Jerry began a course of radiation therapy under the direction of Sanjay Maraboyina, M.D., assistant professor in the Department of Radiation Oncology in the UAMS College of Medicine.
“Just like Dr. Sasapu, Dr. Maraboyina had a very positive attitude and prescribed an aggressive treatment plan. They both kept the ball rolling in the right direction,” Jerry said.
Maraboyina recommended a highly precise treatment known as stereotactic body radiotherapy at the UAMS Radiation Oncology Center targeting the spot on his lung. This was again good news as only three treatments were required instead of a daily course over several weeks.
“Dr. Maraboyina was a godsend. The care I have received has been exceptional,” Jerry said.
Although both cancers are now in remission, Sasapu recommended Jerry undergo maintenance therapy with the immunotherapy drug Rituxan every two months for two years to keep the lymphoma at bay. With about one year left on that regimen, he is proud to say he feels great. “I’m more than happy with this outcome,” Jerry said.