Today, the California native is walking, driving and traveling halfway across the country thanks to a new therapy offered at UAMS.

“I still have Castleman’s disease, but it’s under control and I feel great. I can’t ask for any more than that.”

What started out as chest pains and progressed to severe fatigue and night sweats, among other symptoms, practically incapacitated Pacheco for about 18 months.

“It was quite an ordeal,” said Pacheco, who saw 13 different doctors in his quest for answers.

Finally, in 2004, Pacheco was diagnosed with an extremely rare condition of the lymph nodes known as Castleman’s disease. Only about 200 new cases of Castleman’s are diagnosed each year in the United States.

“After my diagnosis, my wife, Charlyn, and I started doing research and quickly realized there was very little information available. We felt like we were in this alone,” he said.

After about four months, Pacheco located a treatment program in California and was preparing to start it when he heard about the work of UAMS’ Frits van Rhee, M.D., Ph.D.

As director of clinical research for the UAMS Myeloma Institute for Research and Therapy, van Rhee is internationally recognized as a Castleman’s expert and has developed one of the country’s top referral centers.

“Our research includes examining the genetic differences that predispose a person to Castleman’s and whether those differences, if they exist, affect how the person responds to treatment,” van Rhee said.

As a patient at UAMS, Pacheco travels from his Paso Robles, Calif., home to Little Rock about once a month to receive intravenous antibody treatment supervised by van Rhee. Pacheco has maintained this rigorous travel schedule for more than four years. His first two years of treatment required travel to Little Rock every two weeks.

The drug he receives, which is in the clinical trial stage, is called MRA and is designed to block the interaction between the immune protein known as Interleukin 6 (IL-6) and its receptor. Castleman’s patients overproduce IL-6, which causes the debilitating symptoms. If left unchecked, Castleman’s can progress to non-Hodgkin’s lymphoma or other malignancies.

The therapy, Pacheco said, has given him back his life.

 A routine motocross hurdle he safely navigated hundreds of times is at the root of the biggest hurdle Brent Adams has ever had to climb.

But thanks to the teamwork of several trauma experts at the University of Arkansas for Medical Sciences (UAMS), Adams is getting the chance to conquer the uphill battle – and so far, he’s winning.

An avid motocross competitor, Adams and some friends showed up at a dirt track in Mayflower on Dec. 8, 2007, to ride just as they had done dozens of times. Not long after unloading his bike, Adams rumbled down the track with his motorcycle aimed for “one of the easiest jumps out there.” But this time something was different.

“I don’t even know what happened, to be honest,” said Adams, now 28. “I simply hit the jump like I had done many times before, only this time I woke up about a month later and couldn’t walk.”

Nobody knows exactly what went wrong, but he figures his motion in flight somehow rotated forward to the point that he hit the track head first with the entire weight of his bike crashing down on top of him. The impact was so violent that his helmet was split in half.

When Adams arrived at UAMS, the outlook was not promising.

“I remember when he first got here he was in extremely rough shape,” said Terry Collins, trauma program manager at UAMS. “He was in extremely critical condition. He was unstable, with multi-system injuries. Our trauma team was activated with a multidisciplinary team of specialists that was assembled at the bedside when he arrived.”

Triumphant Return
Once Adams had been completely evaluated, the list of complications was seemingly endless.

“Spinal cord injury with vertebral fracture, collapsed lung, broken shoulder blade and upper arm, bleeding in the brain, bruised lungs, pneumonia, an infection in his blood stream …,” Collins read aloud from Adams’ chart. “It goes on and on … he’s very lucky.”

Nearly two years after the accident that left him in a wheelchair without full use of his legs, Adams recently returned to UAMS to meet the team that helped put him back together and set him on a path to recovery. Hearing the extent of his injuries for the first time, he embraced nearly a dozen UAMS doctors, nurses and specialists to whom he says he owes his life.

“I’ve been waiting for a long time to meet the group of people here at UAMS that saved my life that day,” Adams said. “I was in an induced coma most of the time I was here and I never really got to properly meet many of the surgeons and doctors who took care of me. It feels good to look them in the eyes and shake their hands.”

Back Together Again
The team of UAMS professionals, including T. Glenn Pait, M.D., director of the UAMS Jackson T. Stephens Spine & Neurosciences Institute and professor of neurosurgery and orthopaedic surgery, and Johannes Gruenwald, M.D., professor of orthopaedics, were equally as grateful.

“I remember Brent’s case well, and it’s great to see him in such great shape after the level of trauma he was in when he arrived,” Pait said. “It takes a strong will and a positive attitude to make it through situations like his and he clearly has both. If there was ever a good example of how important it is to have a trauma system in place, this is it.”

Gruenwald surprised Adams when he detailed the extent of the shoulder injuries he helped repair.

“His injuries were really among the worst I’ve seen,” Gruenwald said. “I remember it well. I’m very happy to get the chance to see Brent again.”

Hope for the Future
Adams spent 24 days in the intensive care unit and 40 days in the hospital. He had three surgeries and left with the determination that despite the odds, he’d someday walk again.

After intensive rehab stints with several specialists, Adams is beginning to regain some movement in his legs and is flexing his calf muscles and wiggling the toes on his right foot. He can nearly walk on his own with the help of a walker, though he’s counting on more rehab to better stabilize those efforts.

“I’m getting there,” Adams said. “The support of everyone involved, including family and friends and doctors, has been unbelievable from the beginning. Obviously I owe a lot to everyone and I’m extremely blessed to be here.”

Getting a new pair of shoes is a luxury for many people. But for others it’s a necessity.

That’s where the University of Arkansas for Medical Sciences (UAMS) comes in.

For the second year, doctors, nurses and volunteers from the UAMS Department of Orthopaedics provided foot exams, along with new shoes and socks, for homeless people in central Arkansas.

“It’s something we can do to help them get back to work and improve their daily lives,” said Ruth Thomas, M.D., orthopaedic surgeon.

A veteran of medical mission work around the world, Thomas took on the task of coordinating the now-annual event last year when contacted by orthopaedic foot and ankle surgeon Stephen Conti, M.D., of Pittsburgh, who was looking for someone to spearhead a program in Arkansas.

Conti’s teenage children, Matthew and Laura, founded the national organization Our Hearts to Your Soles in 2004 to coordinate shoe giveaways and foot exams for homeless people across the country.

Our Hearts to Your Soles works in partnership with Soles4Souls, an international charity that collects and distributes new and gently worn shoes to needy people around the world. Soles4Souls has given away more than 3.4 million pairs of shoes internationally, including more than 1 million to victims of the Asian tsunami and Hurricanes Katrina and Rita.

Former UAMS employee Sherry Holt worked with the staff of River City Ministry in North Little Rock to organize a foot care clinic and shoe fitting Nov. 19. Two hundred pairs of durable shoes were donated by Red Wing, and socks were provided by Snell Prosthetic & Orthotic Laboratory.

In addition to Thomas, four additional UAMS orthopaedic surgeons provided exams and offered recommendations on how to care for the feet. Nurses and technicians trimmed nails and treated calluses, while orthotists measured each person’s feet to ensure they received properly sized shoes.

“We hope that having sturdy, well-fit shoes will prevent them from developing other foot problems in the future,” she said.

While the main foot-related concerns for homeless people are calluses and fungal infections of the skin and toenails, Thomas and her colleagues were particularly aware of screening for diabetes-related foot problems.

“One of the first things we ask each person is if he is diabetic. We look specifically for blisters or rubbing or calluses, because those are things that can lead diabetics eventually to amputations if they’re not appropriately addressed on the front end,” Thomas said.

She said the need for continued medical care also was addressed with those who required it.

For Bridget Dooley, 44, of Hot Springs, the pain from fibroids was too much to bear.

“It would start hurting a week before my menstrual period and just got worse,” Bridget said.

Uterine fibroids are noncancerous growths of the uterus that affect up to 50% of women, but many are unaware that they have fibroids because they often cause no symptoms. When asymptomatic, fibroids generally do not require any treatment at all. However, many women suffer from abnormally heavy bleeding or constant lower abdominal pressure and pain.

For women like Nathalie and Bridget, the medical options have been limited.

Bridget had a grapefruit-sized fibroid surgically removed 12 years ago, but the fibroid grew back, as they usually do.

Nathalie discovered that she had multiple fibroids and was told incorrectly by two gynecologists that the only solution was complete removal of the uterus – a hysterectomy – the standard treatment until about 10 years ago. But after doing her own research, Massanelli discovered that there was a less radical, fertility-saving solution at UAMS.

The solution was a uterine fibroid embolization. This minimally invasive procedure is performed by an interventional radiologist who reaches the fibroids with a catheter that’s guided through the arteries. The catheter releases tiny particles that permanently block blood flow to the fibroids, causing the fibroids to shrink and the pain, heavy bleeding and other symptoms to go away.

Each of the women was able to go home after an overnight stay.

“UAMS did this procedure and the next month when my cycle came, I did not know it,” Bridget said of her February 2008 fibroid embolization. “I had an MRI in April this year and the fibroids are gone.” 

Nathalie had the procedure in March and wants to spread the word about its success.

“The embolization won’t keep me from getting pregnant, although I don’t have any plans for another child right now,” she said. “I think it’s important that more women know about it.”