July 18, 2017 | A year ago, Reg Hamman of North Little Rock was convinced he had heart problems. There was discomfort in his chest that prompted him to visit his cardiologist.
“It turns out it was acid reflux,” Hamman said. “I was referred to my gastroenterologist who found out through an endoscopy that I had Barrett’s esophagus. I’d never even heard of Barrett’s before. Now suddenly I had it.”
Barrett’s disease is a relatively common pre-cancerous condition in patients with heartburn caused by the repeated exposure of the esophagus to acid refluxing from the stomach. It occurs in about 7 percent of people over age 40 .
Hamman, 71, is a zealous learner. He spent a lot of time finding out exactly what Barrett’s disease is, how to treat it, and which doctor he should see.
“I did a lot of research. I found several different states that had physicians that did the procedure to get rid of Barrett’s,” Hamman said. “After meeting Dr. Tharian, I felt comfortable UAMS was the place to be. Dr. Tharian explained the procedure carefully and with confidence.”
Benjamin Tharian, M.D., is an assistant professor and director of advanced endoscopy in the Division of Gastroenterology and Hepatology in the UAMS College of Medicine. He sees patients in the gastroenterology clinic.
“Barrett’s is concerning because it is a pre-cancerous condition,” Tharian said. “It is to the esophagus, what a polyp is to the bowel or a lump to the breast. We want to prevent it from developing into cancer.”
About a decade ago, the only treatments for Barrett’s disease was prescribing acid inhibitors and close monitoring that included endoscopies with biopsies every three years. If any worrying changes are noted in the biopsy under a microscope, patients used to be referred for an esophagectomy (surgery to remove the food tube).
Two revolutionary treatments have come available in the last 10 years: endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). Tharian is the only physician who offers the combo-treatment in Arkansas. Cryotherapy is done if RFA/EMR fails and esophagectomy would be the last option.
In EMR, the physician removes abnormal tissue from the esophagus through an endoscope after applying a band. For the radiofrequency ablation, Tharian uses an electrode mounted on a balloon catheter or a metal plate. The ablation coagulates the lining, which Tharian then removes. The scar from the ablation heals with normal tissue in a few days to few weeks. This is an outpatient procedure and the patient is able to eat regular food as early as three to five days depending on their symptoms. Side effects and complications are minimal.
“During his last endoscopy about a month ago (about a year after finding the Barrett’s Disease), we took multiple biopsies at different levels to look for any hidden glands or any changes. There is none at all. That’s the way we confirmed his Barrett’s was gone.”
Tharian says the procedure is successful in removing Barrett’s more than 80 percent of the time and eliminates the high-risk dysplastic tissue almost always. Patients will continue to be monitored long term for recurrence of the disease.
“The whole experience has been educational and positive,” Hamman said. “I feel great and I’m thankful that I’m healed.”
July 5, 2017 | Two years ago, Josh Martin wouldn’t have believed he could walk down the aisle at his own wedding.
Or easily navigate his classroom as an elementary school music teacher.
Or play disc golf with his friends.
Martin was diagnosed with multiple sclerosis in 2006, when he was a junior in high school. Every MS patient is different, but for Martin, the potentially debilitating disease that attacks the brain and spinal cord was stable at first, but about two years ago, it started having a big impact on his mobility.
“He’s been in a wheelchair, he’s been in a walker,” said Laura Barganier, a nurse practitioner at UAMS who has worked with Martin for several years. “Most of the time when he came, if he could walk, he could not stand up straight. His muscles were so tight in his legs that he couldn’t stand up, and he was dependent on the cane.”
Because of the signs that Martin’s condition was advancing despite his treatment regimen, Barganier recommended to Lee Archer, M.D., professor and interim chairman of the Department of Neurology, that they consider him as a candidate for Lemtrada, one of several new treatments to come on the market in the last few years that have greatly expanded physicians’ ability to tailor care to the individualized struggles of treating MS.
They have used Lemtrada to treat some of their MS patients with the most severe symptoms.
Martin began his Lemtrada treatments in March 2016. In the first year, he took five days of infusions. This year, he took three days of infusions. He will continue to return to UAMS for bloodwork once a month for five years to check for the potentially harmful side effects of the drug, but otherwise, the drug protocol calls for no further treatments. Before, he was taking daily injections or pills.
Martin said he tried not to get his hopes up going into the treatment – after all, he had already had to readjust his mental image of what his future might look like several times in his young life.
“Knowing exactly what to expect, you still have a little bit of doubt in the back of your mind,” Martin said, “saying, ‘OK, well, I’m been in a wheelchair for over a year now, and then this is coming up, so try not to get too hopeful.’ But then it worked!
“I felt it the day of,” Martin said. “And then that next week it got better and better, and then over the whole year, I started to see more stability in my legs, get my strength back, and that was year one. It just kept on going through this year.”
It wasn’t long before Barganier was getting happy emails from Martin with pictures of him enjoying outdoor activities.
“It’s great to see him get back to the life he had planned,” Barganier said.
Martin said he was better able to function at his job teaching music and the physical agility that comes along with it. And then there was the added joy of being able to walk at his wedding to his wife, Reva, when they got married in November 2016.
“In the back of my mind,” he said, “and I think hers, too, I was constantly thinking, ‘well, am I going to have a cane walking down the aisle with my wife? Am I going to be able to dance with her at my wedding?’ And so that was something that weighs on you. And more her, I think, than me, cause the wedding’s a big deal. But even me, too, because you want to be able to do these things.
“And then when this treatment came through and I was walking without the cane, I was able to walk Reva down the aisle, and I was able to share my first dance with her. That’s a milestone, and we got pictures and videos of that, and I’ll always be able to look at it and remember that we beat MS at this time in my life and we’re able to do these things.”
Archer and Barganier said that Martin is one of about 40 people who they have treated with Lemtrada so far at UAMS. While the strong treatment won’t be a good fit for every patient, they’re optimistic about the responses they’ve seen to the drug and the other treatment options available. Also, with the addition of Carolyn Mehaffey, M.D., who is finishing her time as UAMS’ first MS fellow, getting advanced training in treating MS and other neurological conditions, the MS Clinic at UAMS is taking new patients.
“I just really have been thrilled,” Archer said. “In the last few years, we have gotten these really good options to start treating patients. It’s really gratifying to be practicing at this time.”
June 23, 2017 | Chancellor Dan Rahn, M.D., reflected on the accomplishments of his eight-year tenure at UAMS and the challenges still facing the institution as he delivered his farewell address June 22 in the Fred W. Smith Auditorium in the Jackson T. Stephens Spine & Neurosciences Institute.
“I think there is a lot to be proud of,” he said. “Every year we’ve struggled with resources, but nonetheless, when you look at the amount of investment in UAMS and the amount of mission that has been accomplished, it is truly remarkable.”
Academic accomplishments include more than 20 new or revamped academic programs and an overall on-time graduation rate of 86 percent. UAMS has also significantly expanded its residency programs, including ones in internal medicine (Northwest Regional Campus), vascular surgery, palliative care, cardiac electrophysiology, maternal-fetal medicine fellowship and general practice dentistry.
“This year, 100 percent of our College of Medicine graduates were accepted into a residency program, an amazing achievement,” said Rahn.
UAMS has also achieved continued accreditation from the Higher Learning Commission, the creation of a provost position, the introduction of the interprofessional education curriculum and the creation of a consolidated registrar’s office.
Research funding increased by more than 50 percent over the past three years, he said.
Clinically, significant changes included the implementation of the medical records system called Epic, the creation of the integrated clinical enterprise (ICE), the patient-centered medical home redesign of primary care practices, and the Level 1 Trauma Center verification by the American College of Surgeons.
UAMS has seen total operating revenues grow 50 percent — more than $500 million — between fiscal year 2009 and fiscal year 2018, largely as a result of clinical growth, he said.
UAMS has embarked on a number of vital partnerships that will help ensure our continued success, Rahn said, including the Partnership for a Healthy Arkansas, a restructured relationship with Arkansas Children’s and a growing collaboration with Baptist Health.
Significant investments in UAMS’ infrastructure — $460 million — have been made during the past eight years, Rahn said. This includes the $4.7 million earmarked in the 2018 budget to address immediate facilities and IT needs.
Rahn applauded employees for their part in cost savings initiatives that have resulted in more than $120 million in savings, even as he predicted that more savings would be needed.
Going forward, UAMS will have to confront the uncertainty regarding the future of the Affordable Care Act and Medicaid expansion program called Arkansas Works, he said. An aging infrastructure must continue to be a priority. UAMS also must grapple with a revenue structure that derives only 10 percent of revenues from predictable sources such as tuition and state appropriations, with the rest coming from patient care revenue.
He cautioned employees that while an increase in the state appropriation for UAMS would certainly make life easier, it is unlikely. “I think it is going to be up to us,” he said.
“We are going to continue to see this institution succeed,” he said. “We are a mission-driven organization populated with dedicated, excellent people, and we succeed.”
In the future, UAMS will stay the course because it is on the right track, he said.
“UAMS has succeeded in making ourselves essential to our state,” he said. “This institution and its success are critically important to the future of Arkansas and the health of this state.”
Rahn ended his presentation with a blessing for UAMS going forward, emotionally reciting the lyrics from Nobel Prize in Literature winner Bob Dylan’s “Forever Young.”
May God bless and keep you always
May your wishes all come true
May you always do for others
And let others do for you
May you build a ladder to the stars
And climb on every rung
May you stay
May you grow up to be righteous
May you grow up to be true
May you always know the truth
And see the lights surrounding you
May you always be courageous
Stand upright and be strong
And may you stay
May your hands always be busy
May your feet always be swift
May you have a strong foundation
When the winds of changes shift
May your heart always be joyful
May your song always be sung
And may you stay
June 15, 2017 | Justin Treas is a busy man. The 29-year-old has a Ph.D. in environmental toxicology and has worked in cancer research. He’s married with three children and just earned his medical degree from the UAMS College of Medicine.
On March 28, 2017, Treas had a stroke that his doctors believe would have killed him if those around him hadn’t acted quickly and efficiently.
“I remember being with other students. The professors were teaching us about geriatrics,” Treas said. “I remember going outside because I wasn’t feeling well. Some friends came to check on me and quickly called Dr. Mendiratta. She took me to the clinic. They checked my glucose and other vitals. I was doing very poorly so they took me to the emergency department.”
There, neurology resident, Yu-Ting Chen, M.D. responded and quickly confirmed Treas was having a stroke.
Benedict Tan, M.D. listened as Treas recounted the events of that day.
“The fact that you can recall that much is very impressive,” Tan told his patient. “Once you see your CT scans, you’ll be impressed, too. Your clot was massive.”
Tan is the director of neurocritical care at UAMS, treating the most serious brain and spine cases in emergency and intensive care. He is the only neurointensivist in Arkansas.
“The stroke pager was activated, and we were called to the emergency room,” Tan said. “As soon as the CT scan was complete you could see the clot. That’s very unusual because it was probably the biggest clot I have seen without using further imaging techniques. We knew right away that he needed treatment immediately.”
Mehmet Akdol, M.D. an interventional neuroradiologist and assistant professor in the UAMS College of Medicine’s Department of Radiology, removed the clot after Treas received tPA. The tissue plasminogen activator is a clot-busting agent used to quickly improve blood flow to the brain. Tan says since the onset of the stroke was clear and verified by multiple witnesses, he felt confident to give him the clot-busting drug. Clot-busting medication is the first line of medication for stroke patients but must be used in the first three hours after onset of symptoms. Treas received tPA 19 minutes after he entered the emergency department.
“We used a microcatheter to grab the clot and pull it down like a cork screw, resuming blood flow to the brain,” Akdol said. “We have several cases that received this kind of treatment. What is unique in this case is the timing and aggressive treatment with no delay, which brought an excellent neurological result.”
“The staff, physicians and nurses were amazing,” said Debra Johnson, R.N., stroke nurse coordinator and outreach nurse for the AR SAVES program. “He was ranked a 26 on the National Institutes of Health (NIH) Stroke Scale. Twenty-four hours later, he was at a two.”
The NIH stroke scale increases with severity. The lower the score the less severe it is; anything above 20 is extremely severe.. Three nurses and a resident physician were recognized for their distinct aptitude in treating Treas by receiving an “I Saved a Brain” pin: Stacy Bennett, R.N; Emily Boyd, R.N.; Erin Sanders, R.N., and Heather McLemore, M.D.
It is uncommon for a person as young as Treas to have a stroke except in the case of traumatic injury. The size of the clot prompted Tan to examine Treas for signs of trauma around his neck.
“We later found out that the stroke was caused from a carotid artery dissection,” Tan said.
Carotid artery dissection is a tear in one of the two main arteries in the neck. It’s almost exclusively caused by trauma. Over time, the tear can get bigger and a clot will form around it, cutting blood flow to the brain. Tan says the trauma doesn’t have to come from an assault or something very severe. He says there have been examples of carotid artery tears caused from being hit too quickly, falling, whiplash, dancing violently or riding a roller coaster. Treas’ physicians believe a roller coaster may have caused his tear. He’d visited an amusement park two weeks prior.
“Rides like that can cause a tear because of the abrupt changes in gravity,” Tan said. “That creates a reversal in blood flow and in some degree can cause stress on the vessel itself. If the vessels obtain stress, they can tear and over time cause a clot.”
Akdol says Treas’ ability to make a complete recovery is because of swift reaction from those around him. “There was no waste of time. We have implemented a system here at UAMS that allows us to deal with these cases very quickly. This is why we want people to know the symptoms and remember the acronym FAST.”
F – Face Drooping.
A – Arm Weakness.
S – Slurred Speech.
T – Time to call 911.
Since the stroke, Treas has been recovering and says he’s been improving daily. He and his wife have a baby. Lillie Belle was born April 20. He graduated from UAMS on May 20 and he soon starts his internal medicine residency with hopes to eventually be an oncologist or cardiologist.
Read the Spanish version of this story here.
June 7, 2017 | If the circumstances surrounding Angel Castillo’s birth are any indication, his life will be full of surprises.
It was during a routine gynecological exam in January 2016 when Angel’s mom, Carmen Martinez, got some very unexpected news: She had cervical cancer. As a new mom to her then-6-month-old son, Santiago, Martinez feared the worst.
“I thought, what if I die and leave my baby,” she said.
Martinez was quickly scheduled for a consultation with UAMS gynecologic oncologist Alexander “Sandy” Burnett, M.D., who recommended she undergo a radical trachelectomy. This surgical procedure would remove the cancer but leave her uterus intact, allowing Martinez to have more children in the future if she chose. Burnett is a professor in the Department of Obstetrics and Gynecology in the UAMS College of Medicine.
A native Spanish speaker, Martinez used medical interpreters from the ANGELS program during her visits to UAMS. ANGELS (Antenatal and Neonatal Guidelines, Education and Learning System) is a program of the UAMS Center for Distance Health aimed at helping woman at high risk for complicated pregnancies receive the best possible care.
On the appointed day, Martinez and her husband, Luis Castillo, arrived at the UAMS hospital where she began being prepped for surgery. It wasn’t long, however, when she was told the procedure had to be postponed due to another unexpected surprise. A routine urine test had revealed she was pregnant.
“When they told me I was pregnant, I couldn’t believe it. Dr. Burnett sent me home to think about what I wanted to do next. I felt a little joy about the new baby, but also a lot of fear,” she said.
Together, Martinez and Castillo decided to continue with the pregnancy under the watchful eye of Burnett at the UAMS Winthrop P. Rockefeller Cancer Institute and Dawn Hughes, M.D., a fellow in the UAMS Maternal-Fetal Medicine Fellowship program.
During her medical residency at UAMS, Hughes trained under Burnett, who is board-certified in gynecologic oncology. Martinez’s case allowed the two to work closely again, this time to develop a personalized treatment plan for their patient.
According to a 2013 study published in the journal Therapeutic Advances in Medical Oncology, rates of cervical cancer during pregnancy vary from 0.1 to 12 per 10,000 pregnancies. While rare, it is reportedly the most commonly diagnosed gynecological cancer during pregnancy.
“Dr. Burnett and I spoke early on and decided to delay treatment for the cancer as long as possible. However, when a follow-up exam revealed that the lesion on her cervix was larger than expected, we determined the best course of action was to begin chemotherapy at 20 weeks into her pregnancy,” said Hughes.
A total of six chemo treatments took place in the UAMS Cancer Institute’s Infusion Clinic 1 under Burnett’s guidance, while Hughes performed multiple ultrasounds to monitor the baby’s growth.
“Mrs. Martinez was understandably nervous and always wanted to put the baby’s well-being ahead of her own. We assured her that most of our pregnant patients who undergo chemotherapy do incredibly well, and fortunately she and her baby were no exceptions,” Hughes said.
On Nov. 16, 2016, 5-lb., 14-oz. Angel made his debut via a scheduled C-section, which was immediately followed by a hysterectomy. The experience brought Martinez full circle to the day she found out she was pregnant. “It was a relief to see he was strong and healthy,” she said of her new son.
Martinez’s time at UAMS touched not only her own family, but also those around her. “There was something very special about Mrs. Martinez. She was my first pregnant patient, and on top of that, there was a language barrier to overcome,” said Cyndi Root, R.N., a nurse in the Cancer Institute’s Infusion Clinic 1, who quickly developed a bond with Martinez. “We love all of our patients. They are our family,” she said.
To honor Angel’s birth, the nurses of Infusion Clinic 1 decided that a special gift was in order. They purchased blue yarn, which UAMS chaplain Beverly Milford had blessed by her church, St. James United Methodist Church. Then, volunteers in the Cancer Institute’s Sit & Knit group created a one-of-a-kind baby blanket, which was presented to the family about four months after Angel’s birth.
For now, Martinez is relieved to have two healthy sons and no sign of cancer. “If the cancer doesn’t return for five years, they will declare me cancer free. Angel will be 5 years old then, and that will be a happy day,” she said.
June 1, 2017 | When Mark Harper went to see his gastroenterologist last September, he wasn’t expecting a cancer diagnosis.
“I never had any symptoms,” he said. “I went in because I promised my wife I’d go see Dr. Henry Rogers before he retires.”
Harper considers himself lucky. The doctor in Pine Bluff did an endoscopy and saw something he found concerning. He ordered a biopsy and found Harper was in the early stages of esophageal cancer.
“He referred me to UAMS because they couldn’t do an ultrasound in Pine Bluff. Dr. Tharian took it from there.”
“We rechecked the sample here with UAMS pathologists and confirmed that Mr. Harper did have cancer in the lining of his esophagus,” Tharian said.
Harper has Barrett’s disease, a relatively common pre-cancerous condition in patients with heartburn caused by the repeated exposure of the esophagus (the tube that carries food from the mouth to the stomach) to acid refluxing from the stomach. Barrett’s is found in about 7 percent of those over age 40, even more in patients with reflux disease. In a small minority, Barrett’s disease develops into esophageal cancer, which why early recognition and monitoring is important.
Before he began treating Harper’s cancer, Tharian first made sure the cancer had not spread into deeper layers of the esophagus or other parts of the body by doing an endoscopic ultrasound and CT scan. The cancer was found to be limited to the inner lining of the esophagus. “It’s great the cancer was discovered at an early stage,” Tharian said.
Most people with Barrett’s disease won’t develop esophageal cancer, though it remains the most common risk factor for this cancer. The incidence of this cancer has increased by 500-600 percent since 1970. It remains one of the fastest growing cancers in the U.S. with less than one in five surviving up to five years after diagnosis.
Patients at risk of Barrett’s disease — those with reflux symptoms, smokers, overweight, and those with history of dysplasia on previous biopsies or a family history of esophageal cancer — should be screened with an upper endoscopy.
Those with the disease should be monitored closely by a gastroenterologist with endoscopies and biopsies.
“You have to look carefully for any lumps or bumps within the Barrett’s lining and suspicious or abnormal areas. Early recognition of high-risk lesions will enable early referral to an interventional gastroenterologist.
In Harper’s case, once Tharian determined the cancer was limited to the lining of the esophagus, he performed a tissue biopsy from some lymph nodes in Harper’s chest to see if cancer was present there. It also came back negative. Tharian then endoscopically removed a portion of his patient’s esophagus with the tumor.
“Once the pathologist confirmed that the lesions were removed, I treated the rest of the Barrett’s lining of the esophageal wall using radiofrequency ablation.” The lining would heal eventually with regeneration of normal tissue.
Harper now has to make sure the disease doesn’t return. Because his esophageal junction — the place where the esophagus connects to the stomach — is not tight, Tharian said, stomach acid will continue to enter the esophagus causing a likely recurrence.
“We’ve removed the cancer,” Tharian said. “The next thing to do is prevent it from returning. He’ll need to stay on his acid suppressant medication and have the esophageal junction tightened through minimally invasive surgery. Endoscopic treatment of Barrett’s disease is a cost effective and safe treatment with excellent results. It improves the quality of life.”