April 21, 2017 | Using our hands to grasp a tool or offer a round of applause are simple tasks made possible by the presence of a tissue just beneath the skin called palmar fascia.
“It has a real function,” said Theresa Wyrick, M.D., associate professor of orthopaedic surgery in the UAMS College of Medicine. “It helps stabilize the skin under the palm so that you can hold things.”
Wyrick demonstrates on her own palm that the skin there is not as mobile as it is on the other side of her hand. The palmar fascia keeps the skin in the palm stable, Wyrick said.
“It’s really a beautiful design that allows us to grab things, hold tools and use the hand so that the skin is stable. It has the same function on the soles of the feet to help us walk and move around,” she said.
What happens in some people is that the palmar fascia turns into lumps, cords and nodules. That progression over time pulls the fingers into the palm, making a person unable to open his or her hands. It’s a benign condition known as Dupuytren’s contracture, named for the doctor who first described it.
Shawn Wilson of Cabot first noticed his fingers wouldn’t completely straighten about two years ago. He had been in a traffic accident March 2013. Several months following the accident, Wilson had been on medications, many of which made him drowsy.
“There were times I would sleep up to 20 hours a day,” Wilson said. “Much of 2013 and 2014 was a fog. But when I came out of that fog I really noticed how bad my hands were. My wife and daughter told me I had talked about my hands, but there’s not much I remember during that time.”
Once Wilson came off the medication, he was fully aware of how limited his hands were. He talked to his primary care physician in Cabot.
“He told me I hand Dupuytren’s contracture. I started researching online and found several specialists at Johns Hopkins in Baltimore. I fully expected I was going to have to have surgery.”
Wilson and his family flew to Maryland for an appointment. The doctor said there was medication that would help his condition without surgery. Xiaflex received FDA approval in 2010 for the treatment of Dupuytren’s contracture.
“He told me I could go back to Arkansas for that.”
Wilson went back to the Web and found Wyrick’s name as a physician who administers the drug.
“I saw different websites that rate doctors. Dr. Wyrick had the highest rating of any of the doctors who administered it. I called and made an appointment with her,” Wilson said.
Doctors can only administer two injections at a time every 30 days. In January 2017, Wilson had two injections in his left hand. He came back a month later for his third injection. By the end of March, Wyrick will begin injections on his right hand. Wilson says he’s pleased with the results so far.
“The previous treatment we had was pretty invasive,” Wyrick said. “We did a large surgery with lots of incisions throughout the finger extending into the palm, taking out all the palmar fascia involved in the condition.”
Wyrick said the time it took to recover from a surgery like that was extensive and included lots of therapy, lots of splinting and delayed wound healing. Many times it would take patients up to six weeks to get back to activities and they’d have to wear a splint all the time.
Wyrick says the injections have revolutionized the way doctors treat the condition. “We’ve almost completely moved away from the surgical treatment for Dupuytren’s contracture,” she said.
The injection only takes a few minutes and is done in office with no incisions, anesthesia or extended course of therapy.
“It’s basically an enzyme,” Wyrick said. “We place it into the thickened area of the palmar fascia. The enzyme breaks down the knotted area or cord over the course of several days.”
A few days after his injection in March, Wilson returned to have his bandages removed. Wyrick numbed the area and stretched the finger out by popping the cord that had been weakened by the drug.
Wilson has to wear a splint after his finger has been straightened, but only at night, for four weeks.
“Most patients are able to get back to their activities within 10 days,” Wyrick said. “That is a big difference from recovering from the surgery, which took several weeks.”
“Dr. Wyrick has been great. She explained everything and took her time with me. I understand why she has such a high rating.”
Dupuytren’s contracture is most common in men of Viking or Scandinavian descent over the age of 40 and affects about 5 percent of the population.
April 14, 2017 | Lesley Murphy is accustomed to waking up in exotic locations. From snow-covered Finland to the beaches of Bali, this 29-year-old professional blogger spends more than 300 days a year documenting her travels to vacation destinations around the world.
“My number one goal is inspiring travel and showing people that if they get out of their comfort zones, they can make the world a better place,” she said.
Recently, however, the Arkansas native took a detour from her globetrotting lifestyle to focus on a very different subject — her future health. About three years ago, Lesley was living in Argentina when she received the call that her mother, Martha Murphy, was diagnosed with breast cancer. With no history of breast cancer in her family, the diagnosis came as a shock.
“It was my first year living abroad, and I felt so far away,” Lesley said. “It was a wash of emotions. You never want to hear the words ‘mom’ and ‘cancer’ in the same sentence.”
Martha Murphy, who was living in Fort Smith at the time, felt a lump in her breast before scheduling a mammogram in early March 2014. After it was confirmed she had stage 1 breast cancer, Martha immediately sought the advice of her next-door neighbor, who happened to be an oncologist. He recommended genetic testing to determine if she might have a mutation of one of the BRCA genes, commonly known as the breast cancer genes.
While every person is born with the BRCA1 and BRCA2 genes, women who inherit mutations of the genes have up to an 80 percent chance of developing breast cancer by age 70. If Martha tested positive for a gene mutation, it would mean her three adult daughters had the potential for it as well.
“My doctor in Fort Smith ordered the genetic test on the same day I was diagnosed, but it took a few days to receive the results,” Martha said.
The morning after her diagnosis, Martha decided she wanted to seek a second opinion at UAMS, Arkansas’ only academic health sciences center. After a reassuring visit on March 21 with breast surgeon V. Suzanne Klimberg, M.D., director of the Breast Cancer Program at the UAMS Winthrop P. Rockefeller Cancer Institute, Martha scheduled a double mastectomy for 10 days later.
Her breast reconstruction surgery was completed at UAMS in August, followed by an oophorectomy to remove her ovaries in September. A BRCA gene mutation also can increase a woman’s risk of developing ovarian cancer.
“When I look back, this experience was just a blip on my radar. While it was happening, I was in the midst of helping my eldest daughter plan her wedding. I didn’t have time to focus on myself, so I’m terribly blessed that I didn’t have any complications or need any chemo or radiation,” Martha said.
Klimberg also is a professor of surgery and pathology in the UAMS College of Medicine and director of the Division of Breast Surgical Oncology.
Martha received the results of her genetic test prior to her visit with Klimberg and was surprised to discover she did indeed carry the BRCA2 gene mutation. She immediately knew that she wanted her daughters to be tested as well.
“I told them, this is what we’re going to do. They needed to know if they had the gene mutation, so they could make informed decisions about their future,” Martha said.
Each child of a parent — mother or father — who carries a mutation in one of the BRCA genes has a 50 percent chance of inheriting the mutation.
Martha’s eldest daughter, Lauren, and youngest, Jordan, both underwent testing at the UAMS Cancer Genetics Clinic and received mixed results.
“After Jordan’s test came back negative, we were hopeful they all would,” Martha said.
That would not be the case, as Lauren’s results were soon found to be positive for her mom’s BRCA2 mutation. The UAMS Cancer Institute is home to the only clinical cancer genetics team in Arkansas. Although any doctor can order genetic testing — which is conducted using a blood or saliva sample — UAMS has the only board-certified geneticists and genetic counselors in the state who can diagnose rare syndromes and manage complex cancer syndromes, of which there are more than 50.
As for Lesley, finding time for the genetic screening was a challenge in itself. Because she was living in South America, did not have domestic insurance, and was launching her career as a travel blogger, the sense of urgency wasn’t strong.
“I would be in Arkansas for two days and then gone for a month, so there was never any time to schedule it. Two years went by before I was home for an extended time. That’s when Mom encouraged me to get it done,” said Lesley, who initially gained fame as a contestant on season 17 of ABC’s “The Bachelor.”
When her genetic test came back positive for the BRCA2 gene mutation, Lesley knew she had some choices to make. She looked to Kent McKelvey, M.D., director of Cancer and Adult Genetics Services, and the UAMS Cancer Genetics Clinic staff for guidance.
“Each person ultimately has to make the choices that are best for themselves and their families. We are here to help people understand the evidence and options and guide them to make the best informed decisions,” said McKelvey, who also is associate professor in the UAMS College of Medicine Division of Genetics.
For Lesley, those choices were to undergo breast cancer screenings every six months in an attempt to catch any tumors in their earliest stages or have a preventive double mastectomy, followed by reconstruction. With her travel career in full swing, Lesley said the choice was clear.
“Because of my schedule, I didn’t foresee the twice-yearly screenings as a realistic option. While it may sound drastic to some people, having the surgery was definitely the best option for me,” she said.
The fact that Lesley was able to learn about her gene mutation and make the best choice for herself provides a sense of freedom and empowerment, McKelvey said.
“Given her active career and the fact that she gave this decision serious consideration, her choice to have elective surgery makes perfect sense,” he said.
Following the double mastectomy with UAMS breast surgeon Daniela Ochoa, M.D., Lesley’s risk of developing breast cancer will be reduced by about 95 percent. Nothing can eliminate the risk entirely, McKelvey said, however, surgery is the most effective strategy to dramatically reduce her risk of breast cancer and eliminate any future need for screenings. Ochoa is a professor of surgery in the UAMS College of Medicine Division of Breast Surgical Oncology.
“I saw this as a way to educate people and encourage them to be more knowledgeable about their own personal health decisions,” she said.
After a four-week break from traveling following her April mastectomy, Lesley will hit the road again in May, this time with Mom by her side.
“The doctors think I’ll be fine to travel by then, but she’ll be there for support if I need it,” Lesley said.
She will return to UAMS in late summer to complete her breast reconstruction process under the direction of plastic surgeon Eric J. Wright, M.D., associate professor in the UAMS College of Medicine Division of Plastic and Reconstructive Surgery.
Then, it’s back on a plane to her next destination. “I will always travel. I don’t know what my career will eventually evolve into, but travel is definitely what I’m passionate about and what makes me happy,” Lesley said.
APRIL 12, 2017 | Giving back to his home state is a goal Clinton McDonald takes seriously. For the fifth straight year, the Jacksonville native and Tampa Bay Buccaneers defensive tackle returned to Arkansas for a week of activities aimed at lifting up the community that gave him his start.
“Every time I come home, I get a certain feeling in my heart,” McDonald said. During his annual trips, one of his top priorities is spending an afternoon visiting with patients at the UAMS Winthrop P. Rockefeller Cancer Institute.
“We want to let them know that we’re thinking about them and praying for them. They are in a hard fight, and we’re here to give them a thumbs up and offer encouragement to keep going,” he said.
Accompanying McDonald on his visit were fellow Jacksonville native and Kansas City Chiefs tight end Demetrius Harris; Pine Bluff native and retired Carolina Panthers and Detriot Lions cornerback Dante Wesley; Cincinnati Bengals defensive end Michael Johnson; and Seattle Seahawks defensive end Lazarius Levingston.
“It’s easy to forget the struggles that other people are facing, but coming here and sharing some smiles is always a blessing,” said Johnson.
The patients agree that getting a surprise visit from NFL players is a boost to their spirits. Kansas City native Daniel Favela was shocked to have a member of his favorite team – the Kansas City Chiefs – stop by to shake his hand. “I couldn’t believe it when I saw Demetrius Harris. It made my day,” he said.
Patient John Stults Jr. also was surprised to meet McDonald, who happens to be the son of one of Stults’ coworkers and friends. “I’ve known Clinton’s dad for years, so it was exciting to finally get to meet him,” he said. Stults also found common ground with Johnson, who graduated from Georgia Tech, the same college Stults’ sons attended.
For Wesley, the visit was a personal one as his mother worked as a nurse at the Cancer Institute prior to her death in 2008. “I haven’t been back here in a long time, and it’s been nice talking to some of the nurses who remember my mom,” he said, taking the time to let some patients and staff members try on his two Super Bowl rings.
While in Arkansas, McDonald also hosted the fifth annual Arkansas Iron Sharpen Iron Youth Cheer and Football Camp at Jacksonville High School for more than 700 student athletes ages 6-17. His fellow players assisted with the camp, which is conducted by McDonald’s nonprofit foundation McDonald Association Collective Collaboration – Light Into Darkness (MACC-LID).
To view more photos of the players’ visit, go to facebook.com/uamscancerinstitute.
April 11, 2017 | There are many things graphic artist and retired art teacher Jodi Shull loves about art, but she loves the vibrant colors most.
“I love being able to manipulate them in many ways,” she said.
Shull, 65, has made art a lifetime passion and career. She previously owned a studio in downtown Little Rock and spent 14 years as an art teacher at Little Rock Catholic High School.
Art is a part of her everyday life; however, it became a much smaller piece of her life when she began having trouble with her vision.
“Nothing was sharp,” said Shull. “It was as if every color had gray poured into it. The colors were muted.”
She stopped working with watercolors, unable to gauge how the colors interacted on the canvas.
As the effects of her deteriorating vision started to permeate other aspects of her daily life — Shull quit driving at night due to the glare from headlights and street lights — she sought help from Romona Davis, M.D., an ophthalmologist in the UAMS Harvey & Bernice Jones Eye Institute and an associate professor in the UAMS College of Medicine.
Davis discovered Shull had a cataract in her right eye.
“When the natural lens in the eye becomes cloudy we call it a cataract. Vision becomes blurred, often causing difficulty with night vision, or like Jodi, color perception,” said Davis. “It’s a condition we see commonly in patients over 65.”
Davis removed the cataract in December, and the improvement for Shull has been phenomenal ever since.
“By that evening, I could tell a huge difference in brightness,” said Shull. “I have paintings all around my home, and that night I could see the colors again.”
The procedure energized Shull, who completed 12 projects within a week of the surgery.
“That was probably one of the best months of my life,” said Shull. “I was able to do art and what I wanted to do again.”
One of those projects was a gift for Davis. At her next follow-up appointment, Shull gave her a painting she’d completed of how her eyes registered light during the surgical procedure.
“While manipulating the cataract during surgery, the patient may perceive changes in colors and shapes. They usually describe the colors as very pleasant. Jodi was able to articulate what she saw in more detail,” said Davis. “The painting, entitled ‘Cataract Surgery…What the patient sees,’ was one of the best gifts I’ve ever received.”
Looking back, Shull is extremely happy she sought help from Davis and addressed her cataract.
“You don’t realize it because it’s such a slow and gradual change,” said Shull. “I’m glad Dr. Davis was able to help me.”
April 3, 2017 | Mary Neal French went in for surgery to remove a bony tumor from her sinus last September and woke up to find the tumor gone. But her surgeon didn’t have to make a single cut.
French said she began having headaches with a lot of pressure in July. She believed it was a sinus infection but found it odd because she had never had a sinus infection, and it was not the typical time of year most people experienced sinus infections.
French’s primary care physician found through a CT scan of her sinuses that she had a bony growth on her left frontal sinus, and said an otolaryngologist would have to remove the tumor surgically. She eventually was recommended to Alissa Kanaan, M.D., an assistant professor and director of the Rhinology Division in the Department of Otolaryngology-Head and Neck Surgery in the UAMS College of Medicine.
“I knew it would have to be surgically removed. But I was shocked when I found out how they would have to do it.”
Kanaan was to team up with facial reconstruction surgeon Jennings Boyette, M.D. The doctors explained to French that they would have to make an incision above her forehead extending from one ear to the other. Then, they would peel down her skin from the forehead and drill a hole to reach the bony tumor. Once the tumor was removed, they would place a metal plate over the hole and reattach the skin to her forehead.
“Access to the tumor is complicated because of its location and proximity to the brain,” Kanaan said. “Typically, when lesions are significantly large in the frontal sinus, access through the nose is not adequate for safe and complete tumor removal. We predicted that a combined approach, along with directly accessing the tumor through the forehead would be the most effective way to remove it.”
“Obviously, that was very upsetting and scary,” French said. “I cried during the appointment. Dr. Kanaan and her nurse Vicky could not have been more loving and kind.”
French says she began to prepare herself mentally in the weeks leading up to the surgery. On the day of the operation, her family waited anxiously.
“The facial reconstruction surgeon was there standing by as I began seeing what I could do with my instruments,” Kanaan said. “I was able to pull portions of the tumor out through the nose. The more progress I made, the more encouraged I became. I kept saying, “let’s try this for 15 more minutes.’”
Little by little, Kanaan was able to remove the entire tumor through the nose. It took her six hours. French says her family was overjoyed when Kanaan told them that she was able to remove the tumor without making an incision. “It would have been easier had we done the planned procedure, but this is much better for her and was worth the extra effort. The recovery would have been extensive. Just talking about it was graphic and scary. I’m very happy we were able to remove the tumor endoscopically.”
“I was of course shocked when I woke up and realized what had happened,” French said. “I knew Dr. Kanaan was smart and wonderful. But this showed how much more talented and incredible she is. She truly went above and beyond to make sure I had the best care.”
March 21, 2017 | It was not uncommon for a seasoned sawmill operator like Mauro Santiago to remove a lodged piece of wood from his machine, but what happened the morning of Aug. 15 was anything but routine.
As he reached to free a piece of lumber, Santiago, 29, accidentally bumped a lever that activated his saw and severed his left hand across the palm.
Santiago didn’t realize what occurred until a co-worker said something, then, he noticed the detached piece of his hand on the floor.
His co-workers, including his brother, quickly responded by placing the severed hand on ice and driving Santiago from the sawmill in Atlanta, Texas, to a hospital about 30 minutes away in Texarkana, Arkansas.
“For them to have reacted that fast, I’m thankful,” said Santiago through his wife, who translated the Spanish to English. “They were the ones who did the most important part of what needed to be done at that moment. Without them, I might not have my hand.”
Upon seeing the severity of the injury, doctors at the Texarkana hospital decided to transport Santiago by ambulance to UAMS where three hand trauma surgeons — John Bracey, M.D.; Mark Tait, M.D.; and John Stephenson, M.D. — were waiting.
UAMS is the only hospital in Arkansas to offer round-the-clock service by hand trauma surgeons.
“It’s a unique instance at UAMS where we’ve recruited a core group of hand surgeons specifically trained in replantations and complex nerve cases,” said Tait. “We’re able to cover these type of injuries 24 hours a day, seven days a week for Arkansas and the region.”
About six hours after the accident, Santiago was in an operating room where the trio of UAMS surgeons worked for nearly 12 hours to reattach his hand. They reattached bones and tendons, microscopically repaired vessels to return blood flow, and completed nerve grafts to restore feeling.
“Working at a level 1 trauma center, it’s not uncommon to see the amputation of one or two fingers, but this case, in which the entire hand was amputated, is very rare,” said Bracey. “It was a detail-oriented, tedious procedure; however, Mauro’s hand was amputated in such a way that the detached part was still in good condition. It was the perfect circumstance for replantation.”
Seven months after his surgery, Santiago is able to move his fingers, grasp a pen and scribble on a piece of paper. He’s still regaining sensitivity and feeling and continues working on strength and movement in physical therapy.
“Our goal is to help him regain finger motion, so he’ll be able to grasp objects and be able to discern hot and cold sensations,” said Stephenson. “It likely won’t be fully functional again, but we want him to be as functional and independent with it as possible.”
Santiago said he understands his hand may never be the same, but whatever the outcome, he’s happy.
“I’m just thankful to have found surgeons who could reattach my hand,” he said. “Now, I’ll do whatever I have to do to make it work.”