Arkansas Medical News featured the UAMS Trauma System and Ronald Robertson, M.D., professor and chief of the Division of Trauma, Critical Care and Acute Care Surgery in the Department of Surgery. Read the article for more information.

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., associate professor and division director in the College of Medicine Department of Obstetrics and Gynecology.

“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.

“If someone says go, we pack a bag and go.”

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.

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 programmed 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.”

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. Analiz Rodriguez, M.D., Ph.D., assistant professor in the College of Medicine Department of Neurosurgery, 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 College of Medicine 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.”

“Although research has made great strides in improving survival rates for children with acute lymphocytic leukemia, progress in AML, a less common less form of childhood leukemia, has lagged behind. Our research is a step forward in understanding how to better treat children with this challenging disease,” said Farrar, assistant professor in the UAMS College of Medicine Department of Pediatrics.

The study’s findings identified key differences between the molecular structure of AML in young patients as opposed to those who are older. Due to these differences, the researchers concluded that traditional therapies used to treat adults with AML are not effective for children and young adults with the same disease.

“One of our key findings is that there is a clear age continuum in the biology of AML. Because the disease develops differently in the young, middle aged and old, we know that we can’t use the previously accepted therapies that were designed for older adults and expect them to have the same outcomes for children and young adults,” Farrar said.

The study involved an analysis of the genomes of more than 1,000 AML patients treated nationwide through the Children’s Oncology Group, with ages ranging from 8 days to 29 years. Of that number, 200 had their entire genome sequenced for the study, however the group’s continuing research includes whole-genome sequencing for hundreds more participants.

Data also was gathered from about 400 of these patients to determine how their cancer cells read and interpreted the DNA changes.

“We need high-depth data on every AML patient we treat to get the best possible understanding of how this disease works at a molecular level,” Farrar said.

Most commonly diagnosed in older adults, AML starts in the bone marrow and can move quickly to the blood. According to the American Cancer Society, about 21,000 Americans are diagnosed with AML each year and about 10,600 die of it. As stated in the researchers’ paper, four out of 10 young AML patients do not survive long term.

Based on their findings, Farrar and his collaborators have already developed an improved system for determining the severity of AML in young people at the time of their diagnosis. The individual patient’s treatment is then tailored to the severity of their disease, with those who have less severe disease receiving treatment with fewer possible side effects.

This system is implemented at Seattle Children’s Hospital, where collaborator Soheil Meshinchi, M.D., of Fred Hutchinson Cancer Research Center, sees patients and will soon be integrated into national cooperative clinical trials for children and young adults with AML.

“Being able to identify whether a child has high-risk or low-risk disease is very important to their long-term outlook. For example, many of the drugs used to treat AML can cause young patients to have cardiac conditions as they age. If we can effectively treat their cancer with drugs that do not damage their heart, we definitely want to do that,” Farrar said.

Funded by the National Cancer Institute, this research effort is part of a program called the TARGET Initiative, which is focused on determining the genetic changes that drive the formation and progression of hard-to-treat childhood cancers. TARGET stands for Therapeutically Applicable Research to Generate Effective Treatments.

In addition to AML, the TARGET Initiative researchers also study acute lymphoblastic leukemia, kidney tumors, neuroblastoma and osteosarcoma.

Additional support for this study comes from the Arkansas Biosciences Institute, the Center for Translational Pediatric Research at Arkansas Children’s, Scientific Computing at Fred Hutchinson Cancer Research Center, the University of Southern California’s Center for High-Performance Computing, St. Baldrick’s Foundation and the Jane Anne Nohl Hematology Research Fund.

In addition to Farrar and Meshinchi, the paper’s lead authors include Hamid Bolouri, Ph.D., and Rhonda E. Ries of Fred Hutchinson Cancer Research Center and Timothy Triche Jr., M.D., Ph.D., of the Van Andel Research Institute and University of Southern California Norris Comprehensive Cancer Center.

---

“It’s rewarding to see the girls come in at the beginning of the day, anxious as they try things, and to see them by the end of the day, when they grab the drill and just do it, with total confidence and problem solving — that is so powerful,” said Theresa Wyrick, M.D., a UAMS orthopaedic hand specialist.

The program is organized by the Perry Initiative, a national nonprofit that aims to increase the number of women in orthopaedics and engineering through programs with students in high school, college and medical school. This was UAMS’ seventh year to partner with the Perry Initiative for the program, which in some years also includes medical students.

Wyrick, who is also vice chair of the orthopaedic surgery and an associate professor in the College of Medicine’s Department of Orthopaedic Surgery, spoke in the morning to the students about work-life balance. Erin Mannen, Ph.D., director of orthopaedic research at UAMS and an assistant professor in the College of Medicine, spoke about her work engineering new methods for treating hip dysplasia. Kasa Cooper, an orthopaedic surgery resident, talked about the process of getting into medical school.

“Engineering and orthopaedics work hand-in-hand, because a lot of the innovations in orthopaedics come from engineering approaches to problem-solving,” said Ruth Thomas, M.D., an orthopaedic foot specialist, professor in the College of Medicine and director of UAMS’ Center for Foot and Ankle Surgery. “We need women to be contributing to medical advancement in these areas. For example, Dr. Mannen’s work in hip dysplasia may allow a baby to be treated for hip dysplasia while being carried close to mom. Women are needed in these fields for the betterment of our world.”

In the afternoon, Wyrick, Thomas, staff from the Perry Initiative and other women with an interest in orthopaedics from UAMS and across central Arkansas led the students through hands-on modules that included casting, suturing (on pigs feet), breaking a bone and repairing it (external fixation), reconstructing a torn knee ligament, repairing a rotator cuff and inserting an intramedullary nail. They worked with “bones” made of compressed sawdust that mimic the density and feel of real human bones.

While medicine in general has not always welcomed women, orthopaedics in particular has been slow to open up. Only 6 percent of fully accredited practicing orthopaedic surgeons in the United States are women.

Thomas was the only female in her residency group and spent much of her early career alone as well.

.

“I definitely think programs like these are making a difference,” Thomas said. “Both ortho and engineering are now wide-open fields for women, when that wasn’t always the case.”

UAMS is proud to be a part of this trend, not only by partnerships with organizations like the Perry Initiative, but by having a Department of Orthopaedic Surgery with a robust representation of females.

“The whole purpose is to show these girls that they can do it, that engineering and orthopaedics are fun,” Thomas said.

Wyrick said it feels special to her just to get the experience of participating.

“At the end of the day, it’s about empowering the girls to do what they want to do. Go out and do it,” Wyrick said. “This is what an orthopaedic surgeon looks like. We all look like orthopaedic surgeons now.”

Medtronic Inc., a global medical device company, provided a $5,000 sponsorship for the program. The UAMS Graduate School provided lunch for the participants.

The medical director of the Arkansas Children’s Hospital Team for Children at Risk has received national recognition for her breakthrough efforts to prevent child abuse in the state and beyond.

Karen Farst, M.D., M.P.H., who also serves as the medical director of the Rebecca and Robert Rice Medical Clinic in the Clark Center for Safe & Healthy Children, was recently named the 2017 recipient of the Ray E. Helfer, MD, Award, a distinguished honor from the National Alliance of Children’s Trust and Prevention Funds and the American Academy of Pediatrics.

She also serves as an associate professor of Pediatrics in the University of Arkansas for Medical Sciences (UAMS) College of Medicine and holds the Jerry G. Jones Endowed Chair in Child Maltreatment at Arkansas Children’s.

The Hefler Award is given annually to a pediatrician who has demonstrated a contribution to preventing child abuse before it occurs, primarily through work with a state children’s trust or prevention fund.

The first physician board certified in Child Abuse Pediatrics in the state of Arkansas, Dr. Farst now serves on the Child Abuse subboard of the American Board of Pediatrics. She has written many peer-reviewed publications and book chapters and has lectured across the country.

Dr. Farst holds several positions of national leadership, including as past president of the Board of Directors of the National Children’s Alliance, the association and accrediting body for the more than 800 Children’s Advocacy Centers around the country and abroad.

A major innovator for improving the prevention of child abuse and neglect in Arkansas, Dr. Farst developed an interconnected network of medical providers in the state’s Children’s Advocacy Centers that supports local professionals in providing the best care possible to sexually abused children.

This model is uniquely suited to making care available to the greatest number of children in this large, rural state. Optimizing care at the time abuse is discovered not only gives the child the best start to recovery, but also aids local multidisciplinary team professionals in preventing further abuse from occurring.

“We are grateful for Dr. Farst’s unyielding commitment to vulnerable children,” said Jay Deshpande, M.D., chief medical officer of Arkansas Children’s and a professor of Pediatrics at UAMS. “Her dedication has resulted in systematic change that has improved their lives tremendously. No one could be more deserving of this award.”

The award is named for the late Ray Helfer, M.D., considered the “father” of children’s trust and prevention funds due to his concept that special funds could be used to ensure that our nation’s children grow up nurtured, safe and free from harm.

Dr. Helfer’s lifelong dedication to children serves as a model for all citizens. This award was established in his honor and was to be presented at the Alliance’s annual membership meeting held this month in Little Rock. The award is presented a second time at the annual meeting of the American Academy of Pediatrics.

ABOUT ARKANSAS CHILDREN’S
Arkansas Children’s, Inc. is the only health system in the state solely dedicated to caring for children, which allows the organization to uniquely shape the landscape of pediatric care in Arkansas. The system includes a 336-bed hospital in Little Rock with the state’s only pediatric Level 1 trauma center, burn center, Level 4 neonatal intensive care and pediatric intensive care, and research institute as well as a nationally recognized transport service. It is nationally ranked by U.S. News World & Report in pediatric cardiology and heart surgery, neonatology, pulmonology and urology. A sister campus is under development in Northwest Arkansas and will bring 233,613 square feet of inpatient beds, emergency care, clinic rooms and diagnostic services to children in that corner of the state. Arkansas Children’s also blankets the state with outreach programs that include telemedicine, mobile health, and school-based health solutions. A private not-for-profit, Arkansas Children’s boasts an internationally renowned reputation for medical breakthroughs and intensive treatments, unique surgical procedures and forward-thinking research and is committed to providing every child with access to the best care available, regardless of location or resources. Founded as an orphanage, Arkansas Children’s has championed children by making them better today and healthier tomorrow for more than 100 years. For more info, visit archildrens.org.
ABOUT UAMS
UAMS is the state’s only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; hospital; northwest Arkansas regional campus; statewide network of regional centers; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, Jackson T. Stephens Spine & Neurosciences Institute, Myeloma Institute, Harvey & Bernice Jones Eye Institute, Psychiatric Research Institute, Donald W. Reynolds Institute on Aging and Translational Research Institute. It is the only adult Level 1 trauma center in the state. UAMS has 2,834 students, 822 medical residents and six dental residents. It is the state’s largest public employer with more than 10,000 employees, including 1,200 physicians who provide care to patients at UAMS, its regional campuses throughout the state, Arkansas Children’s, the VA Medical Center and Baptist Health. Visit www.uams.edu or www.uamshealth.com. Find us on Facebook, Twitter, YouTube or Instagram.

# # #

Dec. 11, 2017 | Her youngest daughter, Cheyenne, covets new shoes like most 10-year-old children; her oldest child, 13-year-old Sequoia, continues to hit growth spurts every few months making new shoes a necessity; and she, 35-year-old Virginia Duck, has worn through the soles from her current pair of shoes.

Those circumstances made the annual Hearts2Soles event led by UAMS’ Ruth Thomas, M.D., at River City Ministry in North Little Rock a relief for Duck’s entire family.

Duck and her girls were three of the 60 homeless, working poor and disabled to receive free medical foot care, shoes and multiple pairs of socks Nov. 30.

In addition to Thomas and staff from UAMS, helping at the event were staff from Snell Prosthetic & Orthotic Laboratory and other volunteers. The event has been spearheaded since its inception by Thomas, professor in the Department of Orthopaedic Surgery in the UAMS College of Medicine.

The first Hearts2Soles event in North Little Rock was in 2008. Stephen Conti, M.D., an orthopaedic surgeon from Pittsburgh, who started Our Hearts to Your Soles that works in partnership with Soles4Souls, reached out to Thomas about starting a similar operation in Arkansas.

Since then, Thomas and her volunteers have set up at River City Ministry every year, except 2014 when a shortage of shoes forced the group to cancel, to help the less fortunate in central Arkansas.

“This is just one way we can help the homeless in our community,” said Thomas. “Obviously, the participants get a lot out of tonight, but so do our volunteers who come back year after year to help. We love being able to help.”

After signing in and receiving a plate of food, participants were called back one at a time for a foot bath in warm water, followed by an exam and pedicure. Then, each participant was fitted for a new pair of shoes donated by Red Wing Shoes, as well as a few pair of socks.

Waiting to be fitted for her own shoes, Duck smiled as Cheyenne showed off a new pair of colorful socks and Sequoia sported a shiny pair of white sneakers.

“This is important to us,” said Duck. “Most of the homeless and less fortunate need new shoes often, because of the amount of walking. Personally, I’m happy to see my girls so excited about getting new shoes.”

Dec. 12, 2017 | If nothing improves in dementia care in the next three decades, then by 2050 taking care of people with dementia will cost $1 trillion annually in the United States, a guest speaker warned Dec. 2 during the Dementia Update conference at UAMS.

That speaker, Constantine Lyketsos, M.D., professor of psychiatry and behavioral sciences at Johns Hopkins University in Baltimore, Maryland, along with other health professionals at the update sought to educate the physicians, nurses, pharmacists, dietitians, social workers and caregivers about dementia and how to improve care for patients.

Lyketsos also was the founding director of the Johns Hopkins Neuropsychiatry Service, which he led for over a decade, and is a world expert in the care and treatment of patients with Alzheimer’s disease and related dementias, especially those with behavioral and psychological symptoms of dementia.

Mark Pippenger, M.D., associate clinical professor in the UAMS College of Medicine Donald W. Reynolds Department of Geriatrics, introduced Lyketsos, then gave the audience of about 80 an overview of what dementia is and the most common causes of it.

In order of prevalence, the causes include neurodegenerative disorders like Alzheimer’s disease, dementia with Lewy bodies, vascular dementia and fronto-temporal dementia (FTD).

Pippenger said Alzheimer’s disease usually happens in older people, and memory loss is usually the predominant symptom. Lewy body patients also are older, but they often have a loss of motor control like that found in Parkinson’s disease. Vascular dementia often results from a known stroke, and FTD comes with behavioral changes and odd affect as the frontal and temporal lobes degenerate.

“In every case, we should give them the best, most accurate diagnosis possible,” Pippenger said. “We should always stop those drugs that can make dementia worse. We frequently see people on drugs that are making things worse.”

Lyketsos in his opening remarks echoed Pippenger’s assessment, but spotlighted the issue of agitation in dementia patients and how best to treat it.

“My focus is on agitation because it is one of the most problematic behaviors,” Lyketsos said. “There are few drug options that are safe. I want you to think about how not to use drugs, and not to use drugs that are harmful.”

He said in 2010, there were 35 million people with dementia, and by 2030, that total will rise to 50 million worldwide. There is no drug even in development that will stop dementia in its tracks, and as a society, we are underinvesting in drug development and treatment for it, Lyketsos said.

The conference was the second annual Dementia Update to be presented by the Walker Memory Center at the UAMS Donald W. Reynolds Institute on Aging. Pippenger is a behavioral neurologist and sees patients at the Walker Memory Center.

Following the presentations from Pippenger and Lyketsos, speakers in other sessions covered topics including support services and resources for community members; training in screening and diagnosis for professionals; medications, safety and legal matters; and strategies for handling difficult behaviors.