In the weeks before she was referred to Ayman Mahdy, M.D., a urology specialist at the University of Arkansas for Medical Sciences (UAMS), Williams had no choice but to buy adult diapers.
 
“I was at the extreme, and I needed help,” she said.

Williams, of Little Rock, received a comprehensive evaluation from Mahdy, who has expertise in voiding dysfunction, urinary incontinence, female urology, urodynamics and urologic reconstruction.

The evaluation included tests to rule out bladder infection and other curable problems. Mahdy conducted a urodynamic study – a performance assessment of the bladder and urethral function. This revealed overactivity of the bladder muscle, which was causing Williams to urinate involuntarily. The study also revealed a hypersensitive bladder, and a low cystometric bladder capacity, meaning she had the urge to urinate when only a small amount of urine was in her bladder.

Mahdy determined that there was no defined cause for Williams’ bladder overactivity. He recommended that she try an implant that uses electrical impulses to calm the sacral nerve, which influences the behavior of the bladder.

Before implanting the InterStim^® device under Williams’ skin at her lower back, Mahdy first had to test with a device that she would wear externally. The test device was linked to the sacral nerve with a tiny wire, and Williams tried it for five days. She kept a record of her experience and reported to Mahdy that she had 100 percent improvement of her urine leakage, 90 percent improvement of frequency symptoms and 70 percent improvement of urgency symptoms.
Mahdy and Williams were pleased with the results, so Williams chose to have the implant surgery. She was under conscious sedation for the 1 ½ hour procedure, and she went home the same day.

Made by Medtronic, the InterStim^® Therapy implant is the only FDA-approved device of its kind. The implant allows patients to resume daily activities without having to carry or see the device. A remote control allows Williams to turn it on and off and to change the stimulation amplitude up and down. Otherwise the device works on/off automatically.

More than a month after the implant, Williams said she is essentially cured, thanks to the device.

“It helped me instantly,” she said. “I’m just glad that I found UAMS and Dr. Mahdy.”

The oncologist had bluntly informed the 27-year-old Little Rock realtor that she had cervical cancer.

“I was in such a state I was dizzy. I went to my mom and said, ‘I need a second opinion.’ I wanted a doctor I could easily talk to.”

That’s when she called UAMS and Dr. Alexander “Sandy” Burnett. The gynecologic oncologist had recently become the first surgeon in Arkansas to use a robotic procedure called a trachelectomy to remove a patient’s cancerous cervix through small incisions in her abdomen while preserving her ability to have children. Could he help her?

As a young adult, Johnson-Davis was punctual in getting her annual Pap smear. Her grandmother had died from cervical cancer when her mother was just 10 years old. Johnson-Davis’ tests had always been fine until the spring of 2007 when it showed abnormal cells on her cervix.

She underwent a colposcopy, a procedure that uses an instrument with a magnifying lens and a light to examine the cervix, and a biopsy. Afterward, the doctor’s office called her to come in immediately.

“My stomach was in knots. I had no idea what they were going to tell me,” said Johnson-Davis.

Her gynecologist sent her to see the oncologist, who performed a procedure to remove the abnormal cells. After receiving the startling cancer diagnosis by phone, she went for her next appointment and was told, “You’ll never have kids. You need a full hysterectomy.”

Something rose up in her. She thought, “You’re not going to decide my future. I’m going to decide it.”

After she turned to UAMS, Burnett studied her file and repeated the colposcopy. The cancer had grown. Burnett recommended she undergo the trachelectomy.

But before she could be scheduled for surgery, she discovered she was pregnant. Surgery would have to wait. Since going into labor could disturb the cancer, Burnett scheduled a C-section two weeks before her due date.

A perfectly healthy Hadley Davis was born July 31, 2008. On Nov. 21, 2008, Burnett performed a robotic radical trachelectomy, removing the cervix and five lymph nodes. The cancer was finally gone.

“I just can’t thank Dr. Burnett enough,” said Johnson-Davis, now 29. “Had I not found him, I’d have a huge void in my life. I think I would have a little bit of a broken spirit.”

The new procedure allows a woman to have more children, though Johnson-Davis is not sure she will choose to due to the high risks. “Dr. Burnett is so positive. He said, ‘Give that baby some brothers and sisters. If you want to have another one, I feel confident that you can.’”

These days she is back working full time. She is grateful to her husband, Josh Davis, who with their parents helped care for her and the baby during her weeks-long recovery.

“We have such strong faith in my family. That’s the only thing probably that kept all of us from breaking down,” she said. “I tried to just hold positive and be so grateful that yeah, I’m going through this, but look at this blessing that I’m holding.”

UAMS’ James Yuen, M.D., (left) and Syed “Ash” Hasan, M.D., recently visited with Michael Jevicky (center), whose arm they saved after a motorcycle accident.

Ed and Margo Jevicky say a series of miracles saved their 18-year-old son, Michael, and his right arm when his motorcycle slammed into a Jeep. One of them was landing in the hands of two well-regarded, highly specialized University of Arkansas for Medical Sciences (UAMS) surgeons.

“UAMS is not just a hospital; it changes lives,” Ed Jevicky said. “It changed Michael’s. The outcome could have been so much different.”

The Jevickys, of Guy (north of Conway), recalled the experience during Michael’s follow-up visit with the two surgeons – Syed “Ash” Hasan and James Yuen, M.D. – who saved his arm more than a year ago.

Losing his arm was a real possibility because the trauma was extensive and unusual.

Hasan and Yuen, who have decades of experience between them, still marvel at what happened: A five-inch section of humerus bone from Michael’s upper right arm was ejected onto the pavement. It had come through a small hole near his elbow, and the bone was clean, free of any tissue.

Michael’s is such an unusual case that Hasan and Yuen said they’ve found no other like it in medical literature.

In addition, the main nerve in the arm – the ulnar nerve – had been severed. Hasan, an orthopaedic shoulder and elbow specialist with expertise in microvascular surgery, repaired the nerve using a microscope to align the matching fiber bundles.

Next, Yuen, a plastic surgeon with expertise in microvascular surgery, joined Hasan for a procedure that’s akin to a living organ transplant. The eight-hour surgery required taking a section of Michael’s lower leg bone to replace the missing segment in his arm.

The procedure is properly called a microvascular free-flap transfer or microsurgical composite tissue transplantation. Yuen, a surgeon at UAMS since 1993, has performed more than 700 such procedures, but most have involved cancer patients.

Yuen quickly determined that the only place to harvest a living bone large enough and long enough to replace the missing humerus was the fibula in the lower leg, which can be removed without significantly affecting a person’s mobility. He harvested an eight-inch segment of the fibula, along with its still-attached artery and vein. By leaving the ligaments in place at the ankle and knee, Michael would have almost normal use of his leg.

The fibula replaced the missing segment of humerus, and the artery and vein were attached using microvascular techniques to provide circulation to the transferred bone.

Michael, now 19, has nearly all the physical ability that he had before the accident, even riding his motorcycle.

While still in a cast he was able to use his right hand to type, and he later went to Alaska, where he hiked extensively. He noticed weakness in his leg, but additional physical therapy improved that, and today he notices only slight tingling in his hand.

At the time of his accident, Michael was riding from his home in Guy to the Christian Motorcyclists Association club, called Gap Riders of Conway. He was within a few blocks of the meeting when the Jeep pulled in front of him. He recently returned to a club meeting on his motorcycle, driving by the scene of the accident. When he arrived, members of the group stood and applauded.

But a few days later his wife noticed a significant bruise on that foot, and things got worse from there. Over the course of a few weeks the wound became infected and burst open near where Foust, a diabetic, had a recent amputation of his big toe. The infection began to invade bones, which prompted the amputation of the remaining four toes.

Treatment for the wound was standard saline wet-to-dry dressing changes, but there was no improvement in the intensely painful wound for more than a year.

A vascular surgeon determined that Foust, who has severe peripheral vascular disease, was not a good candidate for surgery and doubted that an effective treatment option was available. As a last resort he referred him to UAMS’ Keith G. Bennett, M.D., director of the UAMS Wound Center.

“It was one of the worst-looking wounds I’ve ever seen and one of the more challenging cases I’ve encountered,” Bennett said. “Without some immediate improvement, Mr. Foust was facing a below-the-knee amputation.”

Bennett’s first steps included making sure Foust’s blood sugars were normalized, that he maintained a normal blood pressure and was not anemic. He removed infected bone and tissue at the base of the wound. He then measured the blood/oxygen levels in the foot, which revealed that the oxygen level was so low it was doubtful the wound would ever heal.

Bennett put Foust on oxygen and the oxygen level in the wound area increased significantly. But the lack of blood flow inhibited healing. To promote better flow, Bennett tried a unique application of Clonidine TTS patches, used primarily to treat high blood pressure. Placed near the wound site, the patch increased the blood supply by relaxing the vessels’ muscular walls.

In addition, Bennett treated Foust intermittently with human growth factors and, an antimicrobial dressing.

The combination of treatments led to dramatic improvements over just a few months’ time; the wound closed, scabbed over and was completely healed within seven months of Bennett’s initial treatment. The patient was then weaned off the oxygen and Clonidine patches one month at a time.

“Dr. Bennett was the difference,” said a grateful Foust during a follow-up visit. “He saved my foot when nobody else could.”

By salvaging Foust’s foot, Bennett also likely extended Foust’s life expectancy.

Mortality after a below-the-knee amputation in diabetic patients is about 50 percent after five years. In addition, coping with a prosthesis requires 30-50 percent more energy, which makes it extremely difficult, if not impossible, for some elderly patients because their energy reserves are significantly below that of a younger patient, Bennett said.

Bennett, who is board certified in surgery, plastic surgery and family medicine, said finding the right combination of treatments to heal Foust’s wound is a result of his training and experience.

“Wound care is like anything else; over time, you learn different tricks and caveats that will help you help the patient,” Bennett said. “But this case, in particular, required me to think outside the box a little bit.”

Bennett said that all wounds are different and tend to have their own “personality.” Treatments of difficult wounds have to be individualized in the majority of cases.

“This case is an example of just that, individualizing the treatment for Mr. Foust,” he said. “The result – success!”

“I met Dr. Nicholas at UAMS. His knowledge, kindness and confidence convinced me on the spot that he was the doctor for me. And I am glad.”

Kermit Tucker, a cancer survivor who works as an executive and lives in Hot Springs, Arkansas, was treated by our staff in the Orthopaedic (Orthopedic) Oncology Clinic at UAMS.

“An orthopedic surgeon saved my life. When my local doctor identified a tumor of the pelvis, he said I needed an orthopedic oncologist. I first researched several nationally known medical centers. Then I met Dr. Nicholas at UAMS. His knowledge, kindness and confidence convinced me on the spot that he was the doctor for me. And am I glad.”

“I can’t thank UAMS enough for giving me the chance to keep on living and loving my wife and kids.”

However, that very same night, Williams’ life took an unexpected turn. While getting ready for bed, he experienced a seizure and lost consciousness. His wife, Rhonda, called 911, and what followed took their lives down a path they never imagined.

“After they ran some tests, the doctor came in and told me that I had a brain tumor,” Williams said. The doctor informed him that while the tumor was probably benign, it was deeply embedded and definitely inoperable. He was prescribed seizure medication and discharged.

Fortunately for Williams, a friend recommended that he get a second opinion from Dr. M. Gazi Yasargil, professor of neurosurgery at UAMS. Internationally recognized for his expertise in disorders of the brain and central nervous system, Yasargil was named Neurosurgeon of the Century in 1999.

After reviewing his condition, Yasargil told Williams exactly what he hoped to hear. “Dr. Yasargil said that he felt sure he could remove the tumor and that I could lead a normal life. It felt like a miracle to hear those words,” Williams said.

Yasargil successfully removed the tumor but in the process made the unexpected discovery that it was a moderate grade tumor that would require radiation and chemotherapy.

After successful treatment, Williams was back to a normal routine and enjoying time with his friends and family. “I’m still taking it easy,” he said. “I don’t get to work or exercise the way I used to, but I’m just so happy to be here.”

He hopes his experience will help others see the value of second opinions. “Don’t ever give up. If you’re not happy with a diagnosis or a prognosis, don’t stop until you’ve exhausted all of your options,” he said. “I can’t thank UAMS enough for giving me the chance to keep on living and loving my wife and kids.”

“An orthopedic surgeon saved my life. When my local doctor identified a tumor of the pelvis, he said I needed an orthopedic oncologist. I first researched several nationally known medical centers. Then I met Dr. Nicholas at UAMS. His knowledge, kindness and confidence convinced me on the spot that he was the doctor for me. And am I glad.”

In the days and weeks after her daughter Kyra’s birth July 2 at a local hospital, Gillihan developed a blood clot in a main artery of her lung, then a massive hemorrhage in her uterus.

After going through 27 units of blood over a number of days, her bleeding still was out of control, her blood pressure critically low (90/50) her heart rate extremely high (130) – she was dying. Before her ordeal ended, Gillihan received 37 units of blood, about three times the amount in her body.

Gillihan wiped back tears as she recalled her near-death experience.

“I could tell by the way I felt that I was going to die,” she said. “It was hard because the last time I saw Kyra before I came to UAMS I was scared that that was going to be the last time I got to see her.”

Gillihan arrived at UAMS at midnight and was taken immediately to the angiography suite where her blood vessels were injected with dye to help X-rays identify the location of the hemorrhage. Doctors who saw it said it was among the worst uterine hemorrhages they had ever seen. An OB/GYN physician consulted with Ruizong Li, M.D., an interventional radiologist. A hysterectomy – the complete removal of the uterus – was one option, but the decision was made for Li to provide a less radical, less invasive approach: a uterine embolization.

A uterine embolization involves threading a catheter from the femoral artery in the groin to the uterine artery, where a series of tiny, sponge-like particles are released, explained Michael Beheshti, M.D., chief of the Division of Interventional Radiology at UAMS.

The particles stop the blood flow. For Gillihan, the procedure took about 45 minutes. She began to feel better almost immediately, and she was comforted by the sound of a nurse calling out her improving vital signs.

“Literally at the conclusion of the procedure her blood pressure was stable, her pulse rate stabilized, and she was able to go home a few days later,” Beheshti said.

Gillihan’s mother, Michelle Spence, of Melbourne, said she will never forget the treatment her daughter received at UAMS.

“The doctors and nurses were right on the ball,” she said. 
 
Beheshti said the uterine embolization is a straight-forward procedure, but uterine hemorrhages are uncommon enough that many doctors aren’t aware of the treatment options beyond a traditional hysterectomy. UAMS, for example, sees only a few uterine hemorrhages each year, he said.

“Too often, patients like Christina end up in an operating room and have a hysterectomy, which prevents a woman from ever having another baby,” Beheshti said, adding that an embolization preserves a woman’s ability to have children in the future.

Gillihan has been advised by doctors not to have more children, given the complications she experienced this summer. But she says she’s just grateful for the opportunity to be Kyra’s mother.

“I’m thankful for the doctors at UAMS,” she said. “They fixed me up and made it to where I could be with Kyra now.”

Joannie Cayce was able to get her life back after undergoing hip resurfacing surgery. She recommends UAMS to anyone else needing hip surgery: “When the pain in my hip became unbearable, I went to the experts at UAMS. Because I was younger than most people needing a hip replacement, Dr. Evans recommended hip resurfacing as an alternative. It was the first surgery of its kind in Arkansas and worked like a charm. Now I’m back to my charitable works like donating quilts and other items to the needy.”

During a routine physical exam at age 10, Jeff, a self-proclaimed “military brat,” was found to have protein in his urine. Because he lacked any other symptoms, doctors were unable to determine the exact cause. However, they suspected Alport Syndrome, a hereditary kidney disease that also can affect hearing and vision.

“The military doctors told my parents that most Alport patients would either require a kidney transplant or would pass away by age 19,” Jeff said. They also told his parents to discourage any physical activity for fear it would worsen the condition.

“I was fortunate that my parents didn’t listen to the doctors. They let me do what I wanted to do,” he said, which included becoming an all-American distance runner in high school and college.

Jeff’s athletic ambitions didn’t end at graduation. In fact, he set his sights on the ultimate goal: competing in the Olympics. In 1988, after qualifying as a member of the Olympic cycling team, Jeff’s dream could have come to a screeching halt when, during a training session, he was hit by a car.

“It was only three weeks before the games, so I didn’t make it to the Olympics that year,” he said. Instead, he was treated by doctors at UAMS for shoulder and neck injuries. “They got me back on my bike as soon as possible,” he said of his doctors in the Department of Orthopaedic Surgery at UAMS.

Jeff soon returned to intense training and began preparing for the 1992 Olympic games in Barcelona, Spain, where he finished eighth in the kilometer track cycling event.

“I returned from the Olympics, was preparing for the World Championships and then planned to turn pro,” he said. It was then, at age 26, that the effects of Snodgres’ Alport Syndrome became a reality.

After getting sick during his intense workouts, Snodgres made an appointment with Dr. George Ackerman, then-chairman of the Department of Internal Medicine at UAMS and the physician who had followed his condition since age 18.

The prognosis was grim: Jeff was in end-stage renal disease. “At that point I shouldn’t have been walking around, much less riding a bike, running, swimming and lifting weights,” he said. 

Jeff went on dialysis and three months later — the very day he had planned to run a 10K — received word that a kidney was available. Dr. Gary Barone, clinical director of the UAMS Kidney and Pancreas Transplant Program, performed the surgery.

It wasn’t long after his recovery that Snodgres felt the call of the road and started training again. In 1994, 1996 and 1998 he participated in the U.S. Transplant Games, taking home gold medals from each. The Transplant Games is a four-day athletic competition for recipients of organ transplants and is the world’s largest gathering of organ recipients and donor families.

In 1998, he also took first place in cross country mountain bike in the 30-34-year-old class at the NORBA (National Off-Road Bicycle Association) National Championships, as well as a bronze medal at the International Cycling Union World Championships. “I was really proud of that,” he said.

After returning from the world competition, Jeff soon became ill. Tests revealed that he was again in renal failure, and he was put on dialysis. After nine months, a kidney became available. Barone performed the second surgery in 1999, and his follow-up care is still monitored by Dr. Sameh Abul-Ezz, professor in the Division of Nephrology.

Although he had to put aside his athletic lifestyle for several years following his second transplant, Snodgres is now training again, this time with the ultimate goal of competing in the Iron Man World Championship in Hawaii, which includes a 2.4 mile swim, 112 mile bike race and 26.2 mile run.

He also now works in the place where he has been a patient for more than 20 years. “I’ve always loved UAMS. It’s an honor to have been a patient here for so long,” he said. “When I decided to change careers about five years ago, my best friend encouraged me to come to work with him in Information Technology. It’s been an amazing journey going from being a patient to being a member of the UAMS family.”