Feb. 12, 2018 | Time seemed to have run out for Larry Guthrie, 49, on April 27, 2017.
But the statewide tele-stroke network and quick-responding emergency medical professionals in Bald Knob and Searcy all saved him precious time in stroke treatment and ensured that the saved time meant a saved life.
The tele-stroke network, the Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES), uses a high-speed video communications system to help provide immediate, life-saving treatments to stroke patients 24 hours a day. The real-time video communication enables a stroke neurologist to evaluate whether emergency room physicians should use a powerful blood-clot dissolving agent within the critical four-and-a-half-hour period following the first signs of stroke. That’s what it did for Guthrie, too.
April 27 started out like any other for Guthrie. After finishing his lunch at home that day, he returned at 1 p.m. to work at his job as street superintendent for the city of Bald Knob. It was the last time for some time that he would remember feeling well. Minutes later, he lost his ability to speak, and co-workers called an ambulance and his daughter, Kayla Webb.
“I didn’t recognize the symptoms at first because I didn’t lose functions in my arms and legs,” Guthrie said later. “I was still walking and could move my arms. I lost my speech. I could not talk.”
Northstar EMS paramedic Jason Pugh and EMT Tim Wisinger on seeing Guthrie in his work place immediately suspected his loss of speech was due to a stroke. They called ahead to the Unity Health – White County Medical Center in Searcy so the Emergency Department there would be ready to treat him when they arrived.
- 1:20 p.m. — Pugh and Wisinger arrived at Unity with Guthrie, and Guthrie immediately received a CT scan. That scan revealed a blood clot on his brain stem in the basal artery. The brain stem controls vital functions like breathing. Unity Health nurse Deonna Wisler and Guthrie consulted via the AR SAVES live video network with Benedict Tan, M.D., a stroke and neurocritical care specialist with AR SAVES at UAMS.
- 1:40 p.m. — A clot-busting medication, alteplase, was given to Guthrie under Tan’s direction.
- 2:20 p.m. — Guthrie arrived by helicopter air ambulance at UAMS Medical Center and was transferred to surgery.
- 2:25 p.m. — Guthrie started to experience difficulty breathing, and UAMS physicians inserted a tube into his trachea so a ventilator machine could breathe for him.
- 2:46 p.m. — Sertac Akdol, M.D., a UAMS interventional radiologist, began surgery to remove the clot.
- 3:11 p.m. — Akdol extracted the clot.
- 3:18 p.m. — Blood flow was restored to Guthrie’s brain stem, and he was moved to a room in the medical center’s intensive care unit.
Within a day after treatment, Guthrie had recovered most of his motor functions and his breathing tube was removed. He was discharged from UAMS Medical Center four days later.
“The expectancy with basal artery occlusion and stroke is slim to none,” Akdol said. “You expect them to pass away following one. There’s almost no hope in this type of situation. His survival was due to the quick action, and I can tell you the gears were well oiled.”
Both Akdol and Tan credited the AR SAVES network and the speed with which all members of the care team responded, from Northstar to Unity Health Hospital to UAMS.
“In this case the credit goes to a combination of the patient’s family, rapid response, AR SAVES, Unity Health Hospital and UAMS,” Tan said. “If one of those links was missing, he probably wouldn’t have survived. AR SAVES played a crucial role in responding to him in Searcy and transferring him to UAMS in the fastest possible way.”
By May 2017, Guthrie returned to work and has since experienced no symptoms. He said he is now more diligent about taking his blood pressure medication and monitoring his diabetes.
In addition to Tan and Akdol and the personnel at Unity, Guthrie said Northstar ambulance personnel also were key to his timely treatment.
“Those guys never get noticed for what they do,” Guthrie said. “I’ve been there and worked as a volunteer in an ambulance service and was a volunteer firefighter for 30 years. I know what they go through.”
On Nov. 14 accompanied by his wife, Anita and daughter, Guthrie reunited in the trauma room of the White County Medical Center with Pugh, Wissinger, Wisler and other staff at the Searcy hospital. Tan and Akdol spoke to him through an AR SAVES video connection.
Both Tan and Akdol complimented him on his recovery and his return to an active life. Near the end of their conversation, Tan asked him if he was taking his medication.
After Guthrie confirmed that he was, Tan said with a smile, “Good, because I don’t want to see you again … not on an AR SAVES monitor. We’ll see you outside, not in an ICU, not in an Emergency Room.”
“I don’t want to be there either,” Guthrie said as everyone laughed.
Feb. 1, 2018 | It was a slope he knew to avoid, but one his adventurous spirit wouldn’t let him.
“What I love about snow skiing is you’re in complete control of your destiny,” said 74-year-old Marcus Everett. “I got hooked on the speed.”
He was halfway down the mountain in Breckinridge, Colorado, in 2008, a location he’d frequented with cousins since the early 1990s, but an unexpected snowstorm had caused limited visibility on the slopes. Suddenly, a yellow ribbon appeared in front him, warning Everett of the point of no return.
“I turned quickly, hit an ice patch, did two 360s in the air and came down on the side of my right ski boot,” said Everett.
Everett, of Hot Springs Village, passed off his injury as a minor one, a sprain. In reality, he smashed leg bones into his ankle and damaged the joint.
The space between his two leg bones — the tibia and fibula — and his ankle was gone. It created a bone-on-bone rubbing in his lower right leg.
Yet, he marched on, continuing his normal activities. Everett had cultivated an innate connection with running, biking, swimming and skiing. The activities helped the former college basketball player, then in his late 40s and early 50s, return to a healthier, fitter version of himself.
As he got older, when most are slowing down, Everett was just getting started. He completed a couple marathons and triathlons, along with countless 5ks and 10ks.
In 2013, five years after his initial injury, the arthritic pain in his right foot began to nag him more than ever. His physician referred him "to the best," as Everett recalls it, Ruth Thomas, M.D., UAMS foot and ankle surgeon and professor in the UAMS College of Medicine’s Department of Orthopaedic Surgery.
It surprised Thomas to learn of Everett’s exploits after looking at his ankle.
“She told me when I was done jogging, running marathons and snow skiing, to call her,” said Everett.
Over the next year, a series of epiphanies let him know it was time.
Everett ran his last 5k in 2013 in Hot Springs, the pain was more than he’d ever experienced. The next year, on another slope in Breckinridge, he had trouble controlling his skis and wrecked.
“I knew it was over,” said Everett. “I got up, put my skis on my shoulder and started walking.”
Befuddled, his cousin asked where he was going; Everett was matter-of-fact.
“I’m going to walk to the bottom of the mountain, catch the bus back to the condo and call Dr. Thomas and tell her I’ve just retired from snow skiing and to put me on the calendar,” Everett recalled.
In September of that year, Thomas performed a total ankle replacement on Everett.
“Mr. Everett was a great candidate for a replacement because he was active, motivated and had good motion in his ankle prior to the procedure,” said Thomas. “The total replacement allows him to keep his motion and return to normal activities without pain.”
Three years removed from the procedure, Everett has no signs of trouble or pain. He’s forbidden from running, playing basketball or any other activities of the like that put significant strain on the ankle, but he’s free to walk, ride a bike and even ski, said Thomas.
Everett has found fulfillment for his need to be active in kayaking, lifting weights and bike riding, and he’s thrilled with the results of his procedure under Thomas’s direction.
“I’ve had very little pain and virtually no problems,” said Everett. “I’m extremely happy with the results.”
However, Everett says he won’t be schussing down any Colorado slopes anytime soon at the behest of his wife, Bunny.
“Dr. Thomas told me as long as I glide down the mountain, I’d have no problem,” Everett said, smiling while pointing to Bunny. “She knows I’m not going to glide.”
Jan. 25, 2018 | Maintaining her vision while three rival eye conditions attempt to steal it away is a battle, but it’s one Pamela Morehart is able to win thanks to the UAMS Harvey & Bernice Jones Eye Institute.
“We have a blessing in the Jones Eye Institute at UAMS,” said Morehart.
First, there’s the macular degeneration, an eye condition that deteriorates the retina and causes the loss of central vision. Early indicators of it were discovered nearly a decade ago when a regular eye exam discovered drusen, a yellow accumulation in the retina.
For the past five years, she’s fought the condition with routine injections to stave off the growth of blood vessels on the back of the eye. Left untreated, these vessels leak and can cause poor vision and even legal blindness.
Morehart, of Little Rock, also has glaucoma, a condition where fluid pressure inside the eyes increases. Normally, this fluid flows in and out of the eye, but in glaucoma patients, the fluid collects and causes pressure damage to the optic nerve which can lead to vision loss.
Morehart receives treatment for both conditions at Jones Eye Institute from Sami H. Uwaydat, M.D., an ophthalmologist and associate professor in the Department of Ophthalmology in the UAMS College of Medicine. The monthly injections treat her macular degeneration and daily eye drops fight her glaucoma.
Subsequently, Morehart noticed a decline in vision due to cataracts. This brought her under the care of another institute ophthalmologist — Romona L. Davis, M.D., also an associate professor in the College of Medicine’s Department of Ophthalmology.
“Cataracts develop in almost everyone, eventually, but it’s a condition that increases in frequency with aging,” said Davis. “This makes her treatment more critical.”
Morehart, who enjoyed near perfect vision before her latest eye condition materialized, noticed a drastic change in her vision late in 2016.
“From one month to the next, my vision went from 20/20 to 20/80 or 20/100,” said Morehart.
In December of 2016, Morehart underwent her first cataract procedure with Davis. In March she had the second cataract removed. Morehart received intraocular lens implants in both eyes, a common treatment for cataract. The artificial lens replaces the natural lens when it becomes cloudy with cataracts.
“By removing the cataracts, we were able to sharpen her vision again,” said Davis.
Morehart said she’s incredibly appreciative of all Davis and Uwaydat have done to save her vision.
“There are so many wonderful physicians at Jones Eye Institute,” said Morehart. “We’re blessed to have a place like this that can give you your vision back.”
Morehart’s connection to Jones Eye Institute extends to her immediate family.
Her son, Austin, was 17 years old when a baseball incident resulted in a traumatic injury to his eyes and nearly around-the-clock care for the better part of three weeks by Joseph G. Chacko, M.D., and David B. Warner, M.D. Chacko is director of the neuro-ophthalmology service and a professor in the College of Medicine’s departments of Ophthalmology and Neurology. Warner is director of the cornea service and assistant professor in the College of Medicine’s Department of Ophthalmology.
“They feared he would lose sight in both eyes, but 10 years later, he has his vision, thanks to the Jones Eye Institute,” said Morehart.
Warner treated Morehart’s 82-year-old mother last year, fitting her with lenses to treat severe astigmatism that caused her eyes to be less round and more of an oblong shape.
“She would be legally blind without those lenses,” said Morehart.
Also last year, Morehart’s 82-year-old diabetic father received intraocular lens implants, like Morehart, in procedures done by Davis. This month, he renewed his driver license with 20/20 vision in one eye and 20/25 vision in the other.
“My son’s now graduating with his second engineering degree, I was able to work and pay for him to go to school, and my parents are able to run their business and keep their employees working,” said Morehart. “None of that would be possible without the Jones Eye Institute at UAMS.”
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.”