Sept. 14, 2017 | Five-year-old Lilly Johnson may dream of going to Madagascar, but on a recent sunny Saturday she was happy to enjoy some wild animals a little closer to home.
As a patient of the UAMS Radiation Oncology Center (ROC), Lilly and her family were invited to enjoy a day at the Little Rock Zoo for the center’s ROC Star Kids event. The sixth annual gathering held Sept. 9 brought together childhood cancer survivors and their families from across the state. The UAMS Radiation Oncology Center is the only facility in Arkansas that provides radiation therapy for children.
Lilly’s parents, John Paul and Jennifer Johnson, drove their five children two hours from the south Arkansas town of Hermitage to participate. “Lilly dreams of going to Madagascar or Australia just to see the animals, so this was the perfect place for us to come and enjoy the day together,” said Jennifer. It also was perfect timing for Lilly, a Ewing sarcoma survivor, who had both celebrated her birthday and was declared to be in remission within the past two weeks. Ewing sarcoma is a tumor that forms in the bone or soft tissue and most often occurs in children and young adults.
“When a child is diagnosed with cancer, it affects the entire family. We are happy to provide this event each year for these special families to make memories and enjoy some relaxation together,” said Peter Emanuel, M.D., director of the UAMS Winthrop P. Rockefeller Cancer Institute and professor in the UAMS College of Medicine.
A total of 82 pediatric cancer survivors and family members joined in the fun, which included unlimited time viewing the animals; train and carousel rides; and lunch. The event is hosted by the Winthrop P. Rockefeller Cancer Institute Auxiliary.
For the parents, however, these events are more than just a fun family outing.
“Coming to ROC Star Kids reminds us we’re not alone. We share a camaraderie with the other families that helps us keep things in perspective,” said Steve Chamness, whose son, Zach, was diagnosed with medulloblastoma shortly before his second birthday. Although considered a rare cancer, medulloblastoma is the most commonly diagnosed malignant brain tumor in children.
Upon his diagnosis, Zach’s cancer had already spread to his spine and required both regular and high-dose chemotherapy with stem cell transplants at Arkansas Children’s Hospital, in addition to one month of radiation treatments at the UAMS Radiation Oncology Center.
Now 5, Zach is cancer free and attending kindergarten in his hometown of Cabot. “We’re just so grateful,” said his mom, Jill Chamness.
Jamie Weaver echoed that gratefulness about her daughter, Kaylee, and the care she received at UAMS. Diagnosed with neuroblastoma at age 3, Kaylee underwent 10 rounds of radiation therapy at ROC during her 15 total months of treatment. Now in second grade, Kaylee plays soccer, attends Sunday school and is “doing great,” her mom said, adding that she received clear scans earlier that week.
Prior ROC Star Kids events have been held at the UAMS Cancer Institute, an Arkansas Razorbacks football game, Little Rock’s Museum of Discovery and Dickey-Stephens Park. This is the first year to host the event at the Little Rock Zoo.
The program began with the encouragement and support of Arkansas’ former First Lady Ginger Beebe. Beebe’s granddaughter, Alexandria, was diagnosed at 11 weeks old with a tumor encircling her spinal column and was treated successfully at Arkansas Children’s Hospital.
Sept. 7, 2017 | “I never had any symptoms. That, to me, is the scariest part about it.”
Ermer “E.O.” Huddleston, 80, wasn’t expecting anything abnormal when he went to his Conway gastroenterologist for an endoscopy, where a tube with a camera and light is inserted in the throat to look at the digestive tract.
But his physician noticed an area near his pancreas he felt needed attention. The doctor ordered a biopsy and referred Huddleston to Benjamin Tharian, M.D, the director of advanced endoscopy who sees patients in the UAMS gastroenterology clinic.
“I guess he saw in the image a large, irritated spot. I never felt anything,” Huddleston said.
Tharian said Huddleston had an ampullary adenoma, a precancerous lesion at the opening of his pancreatic and biliary drainage tubes, and that it was good that the doctor noticed it early.
“If it had been left too long, even surgery may not have been an option,” Tharian said.
There are two treatments for an ampullary adenoma, Tharian says. One is to remove the lesion endoscopically by inserting a tube down the throat with a camera and light on the end. It’s minimally invasive and may require only an overnight hospital stay. The other option requires major surgery to remove part of the pancreas, part of the bile duct and part of the stomach. It’s a complex operation known as a Whipple procedure, which is done normally for pancreatic cancer.
Tharian says the endoscopic option ampullectomy has been done in other states. But the operation he did for Huddleston was a first for Arkansas.
Tharian began by doing another endoscopy to confirm Huddleston had an ampullary adenoma. Then he did an endoscopic ultrasound.
“That essentially looks underneath the visible surface,” Tharian said. “We do this to see if the lesion is superficial or if it has grown deeper into the pancreas, needing invasive surgery.”
Tharian found that Huddleston’s lesion was treatable endoscopically. Next, Tharian carefully examined the area through a special endoscope in a procedure known as Endoscopic Retrograde Cholangio-Pancreatography or ERCP.
“During the ERCP, we opened up the pancreatic and bile duct and cut the lesion, the same way polyps are removed from the bowel. Then, I placed two temporary stents inside both the ducts.”
Tharian says the stents are necessary to keep the bile duct and pancreatic duct draining. Otherwise, scarring would lead to blockage that could cause pancreatitis or jaundice.
Huddleston had to stay overnight in the hospital because Tharian says the risk of pancreatitis is highest the first 24 hours following the procedure. It’s significantly less time than the possible seven-day stay that would have come with the Whipple procedure, in addition to being safer.
“He did very well,” Tharian said. “We sent the specimen to the lab and they confirmed it was a complete removal of the lesion.”
Huddleston’s wife, Mary, says this was their first experience with UAMS. She says she was pleased with the care and kindness of everyone she met.
“I don’t think I saw anyone that was having a bad day,” she said. “They kept me informed throughout the procedure and thankfully everything went smoothly.”
Huddleston will need to have follow-up endoscopies with his gastroenterologist at regular intervals and possible biopsies to make sure there is no recurrence of the disease.
Tharian says he has done five similar treatments since Huddleston’s procedure.
“Not every patient is a candidate for the endoscopic treatment,” Tharian says. “The main thing is to get to the lesion early enough. It’s often missed because the condition is asymptomatic and the lesion could be subtle and easily missed if the ampulla is not carefully examined.”
Huddleston is grateful his doctor caught the problem and avoided a complicated surgery, increased risks (especially with his previous history of cardiac bypass surgery) and long recovery. Having just turned 80, he looks forward to continuing the things he enjoys including spending time with his wife, instrumental music and playing golf.
“It sounds like a real scary thing, to me, that someone could have it and not ever know it until it was way too late,” Huddleston said. “I’m glad my doctor spotted it early and I’m grateful to Dr. Tharian.”
Sept. 1, 2017 | Since she was in her early 30s, Tracy Lamey has been coming to the UAMS Breast Center twice a year for breast imaging. Her mother was diagnosed at 39 with breast cancer, so that put Lamey at high risk for the disease.
“I come here because of the state-of-the-art technology,” Lamey said. “I also feel that the staff and my physician are very knowledgeable about the latest guidelines and what is best for my overall health. And I get my results before I leave. That not only gives me a plan of what needs to happen next, it eliminates the anxiety that sometimes comes with waiting.”
Gwendolyn Bryant-Smith, M.D., is chief of Breast Imaging at UAMS. She says the UAMS Breast Center is a one-stop shop with highly trained professionals at every helm. Today breast imaging is more than a mammogram.
At UAMS, there are three fellowship-trained radiologists and a fourth radiologist with years of experience. Each is skilled at interpreting mammography, breast ultrasound, and breast MRI and performing breast biopsy procedures. Digital breast tomosynthesis, better known as a 3D mammogram — the newest mammography technology — is offered at the UAMS Breast Center. Bryant-Smith says it is an evolution of the 2D mammogram and was FDA approved in 2011. UAMS has had this technology since 2014.
“The value in a 3D mammogram is that we’re able to see through dense tissue. Dense tissue makes it very challenging to find cancer because it shows up white on a screen. Cancer is also white. It’s hard to differentiate between the two using 2D mammography. When using 3D mammography, we are often able to detect subtle masses that may not otherwise be seen.”
Bryant-Smith said the Breast Imaging Center does risk assessments on every patient.
“We ask them about family history, whether they’ve had children, taken hormones or had previous biopsies,” Bryant-Smith said. “Using that information, we calculate a number. Patients who score higher than 20 percent, are considered to be at high risk for developing breast cancer.”
The center offers additional screening with breast MRI for those patients considered high risk for developing breast cancer. Lamey has had a routine breast MRI for many years.
“It’s a quick procedure, 45 minutes and painless” Lamey said. “The imaging techs are very caring and thorough. I like that they’re able to see a lot more, and my physician shows me those images.”
Since she’s been going to the breast center Lamey has had three biopsies.
“For each of my biopsy results, my doctor called me personally,” Lamey said. “As soon as she gets the results, she immediately calls. The personal aspect has been huge, and it’s very important to me.”
“We really want to serve the patients of Arkansas well,” Bryant-Smith said. She encourages women to begin screening annually once they turn 40, or sooner if they’re at an increased risk. Screening mammography saves lives, she said.
“I have a family,” Lamey says. “I want to make sure I’m taking care of myself so that I can be there for them. The Breast Imaging team at UAMS gives me confidence that I’m doing everything I can to prevent cancer for myself.”
Aug. 29, 2017 | Baptist Health and the University of Arkansas for Medical Sciences (UAMS) have announced a statement of strategic intent, which reflects the two health care organizations’ commitment to offer a wider range of educational opportunities and deliver clinical care more efficiently.
The alliance will strengthen the two institutions’ collective ability to improve population health and care delivery across the state. This alliance is not a merger, as both institutions will retain their separate and unique organizational identities. The alliance and its components will be presented to the University of Arkansas Board of Trustees and the Baptist Health Board of Trustees for approval.
“Arkansas faces a wide range of significant health challenges, including obesity, cancer, heart disease, mental health and premature death,” said UAMS Interim Chancellor Stephanie Gardner, Pharm.D., Ed.D. “Through this enhanced alliance, UAMS and Baptist Health can better help address those challenges to improve the health and well-being of Arkansans.”
UAMS and Baptist Health are Arkansas-based organizations that share a vision of delivering exceptional clinical care and have executive leadership teams that are committed to this alliance.
"Collaboration is the key strength which will enable organizations like Baptist Health and UAMS to serve more Arkansans," said Baptist Health CEO Troy Wells. "The value of this alliance will be our collective efforts to improve health in a more deliberate manner to serve the needs of diverse communities."
The two organizations have worked together successfully and will be able to build on their ongoing experience of serving patients through multiple joint initiatives that include physical medicine and rehabilitation (early 1980s), vascular surgery (2013), maternal-fetal medicine (2017), and antimicrobial stewardship (2017), as well as emergency medicine and orthopaedics at Baptist Health Medical Center-Conway (2017).
In the education field, UAMS and Baptist Health will increase the number of students and other trainees by creating broader opportunities for teaching and learning. In the area of graduate medical education, Baptist Health and UAMS intend to launch new physician residency programs, beginning with internal and family medicine at the Baptist Health Medical Center-North Little Rock campus.
In the area of clinical services and population health management, the two institutions are evaluating ways to maximize existing and new resources to enhance health care quality, safety, service and access while reducing costs.
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 alliance will work with Medicare to make sure health care providers have a more complete picture of a patient’s health to deliver the right care at the right time and avoid unnecessarily duplicating medical tests.
UAMS and Baptist Health also have been in discussions with Arkansas Children's, Arkansas Blue Cross and Blue Shield, and Bost Inc. about forming Arkansas Advanced Care to serve Arkansas Medicaid recipients with behavioral health and/or developmental disability needs. This year, the Arkansas Legislature established the Provider-owned Arkansas Shared Savings Entity (PASSE), a new approach to managing Medicaid costs for eligible individuals with behavioral health and developmental disability health issues.
Arkansas Advanced Care would be a PASSE organization that would seek to work with the state of Arkansas to provide more efficient care and improve health and quality of life for these patients. Establishment of this PASSE organization is also contingent on approval from the UA Board of Trustees and the Baptist Health Board.
With more than 175 points of access, Baptist Health is an Arkansas-based, locally owned and managed, not-for-profit, and faith-based health care organization. Baptist Health is also Arkansas’ most comprehensive health care organization and third largest private employer with more than 9,100 employees operating nine hospitals. For more information about Baptist Health, visit the website at www.baptist-health.com.
UAMS is the state’s only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; a hospital; a northwest Arkansas regional campus; a statewide network of regional centers; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, the Jackson T. Stephens Spine & Neurosciences Institute, the Myeloma Institute, the Harvey & Bernice Jones Eye Institute, the Psychiatric Research Institute, the Donald W. Reynolds Institute on Aging and the Translational Research Institute. It is the only adult Level 1 trauma center in the state. UAMS has 2,870 students, 799 medical residents and six dental residents. It is the state’s largest public employer with more than 10,000 employees, including about 1,200 physicians who provide care to patients at UAMS and its regional campuses throughout the state, Arkansas Children’s Hospital, the VA Medical Center and Baptist Health. Visit www.uams.edu or www.uamshealth.com. Find us on Facebook, Twitter, YouTube or Instagram.
Statement of Strategic Intent
The University of Arkansas for Medical Sciences (UAMS) and Baptist Health share a common heritage and commitment to deliver to Arkansans exceptional clinical care and service for an affordable price. In recent years, we have built trust and respect between our organizations by working together to improve care delivery across a number of clinical services. Our work together has confirmed our ability to strengthen the quality, breadth and cost efficiency of our clinical programs for the benefit of those we serve. These early successes motivate us to explore where we might take our collaboration to a new level to deliver to our constituents a broader range of benefits across our patient care, educational and community service missions.
This statement of strategic intent reflects Baptist Health’s and UAMS’ commitment to work together to offer a wider range of educational opportunities and to deliver clinical care more efficiently and effectively than either institution can do on its own. Our goal is to work together and with like-minded organizations to strengthen our ability to improve health status and care delivery across the state. As our work continues, we will share with our colleagues and those we serve added information about our plans to realize that vision.
While maintaining our identities as separate institutions, Baptist Health and UAMS commit to work together in the future across a broader range of academic and clinical fronts for the benefit of all Arkansans. Our common goal is to offer enhanced clinical programs to patients and broader educational opportunities to our learners – supported by advanced technologies, a highly skilled workforce, and sophisticated patient education and care coordination capabilities. Working together, we will collaborate to promote responsible stewardship of public resources, foster economic development, and lead in the development of coordinated systems of care that advance our common health-promotion and illness-prevention goals.
Our future activities will build upon what we have learned from a number of specific initiatives through which UAMS and Baptist Health collaborate to serve patients today. These shared efforts include: Maternal Fetal Medicine, Physical Medicine and Rehabilitation, Vascular Surgery, eICU, Telehealth, and an Antimicrobial Stewardship program, as well as Emergency Medicine and Orthopedics at Baptist Health Medical Center-Conway. These collaborative initiatives have demonstrated a variety of benefits to our patients and the communities we serve.
In the education arena, UAMS and Baptist Health seek to grow the number of students and other trainees by creating broader opportunities for teaching and learning. Already, our institutions are involved in the education of over 4,000 health care learners each year. Experience indicates learners trained in Arkansas are far more likely to build their careers here. Whether it’s a matter of meeting the educational needs of more Arkansans or attracting additional students from outside the state, our work together should enhance the state’s ability to attract, train and retain the best possible candidates. Through our collaborative efforts, Arkansans who seek to enter or expand their role in in the health care workforce will find a greater range of educational options available to them than either UAMS or Baptist Health could create on its own. We anticipate that several collaborative educational activities may emerge over time.
In the clinical services arena, Baptist Health and UAMS are discussing ways to deploy existing and new resources to enhance health care quality, safety, service and access while identifying opportunities to reduce costs and deliver value back to the community. In so doing, we will prepare our organizations and care delivery partners to thrive in the transformation from fee-for-service medicine to value-based health care. Our state faces considerable health challenges; by working together, we can have a greater impact in helping Arkansans lead longer, healthier lives.
Aug. 24, 2017 | All parents closely monitor their babies in the first weeks of life for milestones: he grabs your finger; she gazes into your eyes; he starts responding to noises.
But in the neonatal intensive care unit (NICU), baby’s first milestones take on even more meaning. They can be a sign of the baby’s health, and they can mean the difference between staying in the hospital and going home to be with family.
Progress can be celebrated in increments, and in the case of babies like Brixen, born five weeks early, it can be measured in fluid-ounces.
“He took a whole bottle today. Before, he wasn’t even drinking half,” said Lionel Whittamore, of Benton, Brixen’s father, with pride, catching his wife’s eyes. They shared what seemed like a still moment with a smile, while outwardly, life continued to swirl around them, specifically in the form of Huntley, 4, and Trace, 2, who were bopping around Brixen’s NICU room in matching overalls and who could have been twins except for a couple of inches of height, one blonde, one brunette.
One-month-old Brixen wiggled quietly in his mother’s arms while she, Stephanie Whittamore, and her husband told the story of his arrival.
“He has been so healthy in so many ways, it’s just his feeding that has been a problem,” Stephanie said. “All I want is for him to get better and come home.”
“If we can get him up to eight bottles a day, we can do that, we can bring our little guy home,” Lionel said.
Brixen’s feeding improved after his formula was thickened. UAMS speech pathologists working in the NICU were able to confidently identify the problem and consult with his treatment team to recommend the thickening because they were able to take a video with a fiberoptic scope through his nose and above his throat while he swallowed milk. They were able to see that he was having trouble swallowing properly and keeping the thinner milk out of his airway, causing him to aspirate and not want to take the milk.
This procedure (fiberoptic endoscopic evaluation of swallowing, or FEES) has been common at UAMS to evaluate swallowing in adults for more than 15 years, but only a few hospitals in the country have started recently applying the technology – with the help of smaller scopes – to NICU babies. On June 26, UAMS was the first hospital in Arkansas to perform the procedure on NICU babies, and its speech pathologists have performed several more similar procedures in the weeks since.
An alliance with pediatric ear, nose and throat (ENT) staff at Arkansas Children’s is in place so cases can get the follow-up treatment they need.
“UAMS is constantly striving to improve the practice and the quality of care provided to both premature and sick full-term infants and their families,” said Sara Peeples, NICU medical co-director. “ Implementation of this process is an example of the interdisciplinary collaboration that is the hallmark of our NICU: nursing, physicians, speech therapists, our pediatric ENT colleagues at Arkansas Children’s, patient education, and others worked together to make this possible. This has been the standard for many of the quality-improvement and evidence-based practice changes in our unit, and one of the things I like most about working here.”
The procedure has several advantages. Previously, the baby would have had to travel to Arkansas Children’s Hospital for a swallow study to be performed and would have swallowed barium products that are visible under X-ray. A video swallow study can’t be done with breastfeeding mothers and exposes the patient to radiation.
Alternatively, this procedure can be done at the bedside in the UAMS NICU, can be done while a mother is breast feeding her baby, and allows the speech therapists to evaluate different interventions or feeding positions in real time. This evaluation can give parents and health care providers peace of mind because it takes the guesswork out of whether the babies are swallowing correctly and safely. For some, that may mean additional much-needed treatments, but for others, it could confirm that they are swallowing well and can go home sooner than they otherwise might have.
Because they are one of the first in the nation to use the procedure on NICU babies, Peeples hopes UAMS will be able to contribute to the body of emerging research into the technique and that the tool will be an educational opportunity for the medical staff and parents alike.
For now, little Brixen is working hard to accomplish the goals that will help him join his family at home. Today, he is working on each swallow, so that tomorrow, he can be healthy enough to join his energetic older brothers in the many milestones that lie ahead.
Aug. 21, 2017 | For about six years, Megan Parrish didn’t know what was happening to her own body.
The teenager would miss school and outings with her friends due to bouts of extreme nausea, pain and dizziness. Her behavior also changed, although she couldn’t pinpoint any reason or pattern for the psychological and physical symptoms.
“For a while everyone wrote it off as teenage angst, but it was stressful and scary. I was a really sick teenager who couldn’t participate in activities with my friends. It was tough,” said the now 29-year-old Parrish.
After an array of medical tests failed to find a cause for her seemingly unrelated symptoms, Parrish continued to experience bouts of illness throughout her teenage years. Finally, at age 18, a long-awaited answer arrived.
“My doctor started to look at the big picture and decided there could be something that tied all of these things together,” she said. It was then that he was able to confirm Parrish was living with a rare blood disorder known as acute intermittent porphyria (AIP).
“Just having a name for it was a relief,” she said.
According to the National Institutes of Health, porphyrias are rare disorders in which the body fails to produce the enzyme needed for the production of hemoglobin in red blood cells. Because hemoglobin carries oxygen from the lungs throughout the body and helps the liver function normally, a deficiency can affect a person in multiple ways.
While there are several types of porphyria with differing symptoms, AIP is known to cause everything from abdominal pain and vomiting to hallucinations and muscle weakness. It is usually passed genetically from parent to child.
“Although AIP is the most common type of porphyria, it is still rare,” said Peter Emanuel, M.D., a hematologist and professor of medicine in the UAMS College of Medicine. “It is often misdiagnosed and can be challenging to treat,” he added. The exact rate of porphyria cases is unknown, in part because its physical, neurological and psychiatric symptoms mimic other more common conditions.
After her diagnosis was confirmed, Parrish was referred to UAMS for specialized treatment. Soon afterward she met Emanuel, who developed the treatment regimen she has maintained for the past 10 years.
“Because AIP is intermittent, Megan goes through good cycles and bad cycles. We adjust her treatments and clinic visits to meet the needs she has at the time,” Emanuel said.
Parrish’s primary therapy involves weekly IV infusions lasting from 60-90 minutes. Although AIP is noncancerous, she is seen in the UAMS Winthrop P. Rockefeller Cancer Institute, where Emanuel serves as director.
In addition to her infusion treatments, Parrish also comes for follow-up visits every four to six weeks during good cycles and more often when her symptoms flair up.
“When I’m in the midst of an outbreak, I can experience anything from mild nausea to pain that feels worse than a broken bone. Sometimes I will have insomnia for days. Thankfully, I’ve been on an upswing this year and have been having fewer incidences. It’s easier to manage when I listen to my body,” she said.
Although AIP is incurable, research is underway to discover new treatment methods for people with the disease. Parrish is hopeful that a clinical trial will soon be available at UAMS that could offer her the latest therapies before they are widely available.
She also is thankful to live near UAMS where a specialist is just minutes away.
“I can’t say enough good things about Dr. Emanuel. He makes me feel like a part of the treatment process. I’m lucky to be here,” she said.