One afternoon Grace was gardening in her backyard in Springdale, Arkansas. While digging up a plant to give to a co-worker, she felt a fierce pain. “It felt like my head exploded,” she said. “At first, I couldn’t imagine what it was. I was really scared.”

The pain started going down her neck, so Grace thought she could be having a stroke. Grace knew she wasn’t able to drive, so she walked to her neighbor’s house to ask for help. Her speech was slurred, and right away the neighbor knew something was terribly wrong. Grace’s neighbor drove her to the local hospital, and a CT scan revealed a brain aneurysm. Since her local hospital was unable to treat a condition of this nature, Grace was airlifted to UAMS.

Grace was in intensive care until the procedure was performed. She was not allowed to watch TV or do other simple activities that might stimulate her brain and cause further bleeding. But Grace’s family could be there to comfort her, and that included her granddaughter, Isabella. “Everybody was so kind. They allowed my grandbaby to sleep in my arms,” Grace said.

Grace was comforted by the high quality of medical care she received from her UAMS physician, Dr. Eren Erdem. “He had a kind and gentle voice, and he explained all the pros and the cons,” Grace said.

“All my questions were answered. I never thought I wasn’t going to make it. They were confident of the procedure, and I was confident in their abilities.”

Since her aneurysm was already ruptured, the best course of action was to undergo endovascular coiling. This involved a catheter going through her groin area, and then being navigated through blood vessels up to the aneurysm. The coils, which are made of soft, platinum based hair-thin wires, are then wound into the aneurysm like a ball of yarn. Over time, the coils become a dense mass that prevents blood from going to that area and causing more damage. Eventually the coils turn into scar tissue.

The procedure has only been actively performing for about 15 years, Dr. Erdem explained. He has been performed the procedure for 10 years at UAMS. “Studies have shown that there is a better outcome with this minimally invasive surgery,” he said. “The patient recovery time is much faster.” Without the minimally invasive techniques, Grace’s quality of life would have been affected for months. Now this surgery is being used more frequently to treat brain aneurysms and has become the preferred method of treatment for ruptured aneuryms.

Grace’s procedure was performed on Isabella’s first birthday. “Everybody at UAMS was sensitive to that and let me be with my granddaughter,” she said. She spent a week in the hospital following the surgery, and she was grateful that the staff allowed Isabella to be there and help in the recovery process. “I couldn’t have asked for a nicer environment to have this done. It meant so much to be treated with such kindness, understanding and compassion. I don’t think that people in Arkansas realize the top notch health care we have available at UAMS.”

Since her surgery, Grace has shown no signs of complications. She feels that her attitude and outlook definitely helped her recovery process. She said that the procedure made her look at life differently. “It has made me realize the importance of the time that Isabella and I have and that we are able to build memories together.”

Grace has completely returned to normal activities including participating in many community activities. She has also helped other patients who have gone through what she did. She meets with people in the Springdale area who have shared her experience so that they can support and encourage each other.

Grace is extremely grateful to the treatment and care she received at UAMS. “Everybody at UAMS was wonderful to my children and grandchild. I owe my life to UAMS and Dr. Erdem,” she said.

Interventional Radiology
Department of Neurology

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.

The request for prayers came via e-mail from an old family friend, Tammy Hamelink, whose 23-year-old son, Kryn, was in desperate need of a kidney transplant.

As Pitcher’s mother read Hamelink’s e-mail aloud, Pitcher became curious, recalling her thoughts on her Web site blog: “What if I could do this? Can I really help in this way? As soon as Mom read Kryn’s blood type (O), my curiosity grew stronger. I knew that my blood type was compatible with his.”

Hamelink’s e-mail also mentioned a contact at the University of Arkansas for Medical Sciences (UAMS) – Diane Richards, R.N., living donor transplant coordinator – for those who might be interested in donating a kidney.

Pitcher, a student at Calvin College in Grand Rapids, made the call to Richards, who counseled her as she went through the testing that eventually led to Pitcher being declared a match in the fall.

“Basically, she has made herself available to me at anytime,” Pitcher wrote on her Web site blog. “I call. She answers. Yes, she is as busy as ever, my goodness. But yet she still has time to not only answer my phone calls, but go in depth and make sure all is well on this end.”

When Pitcher learned that she was a match, she informed her parents, who embraced her decision.

“I just felt such a peace about it,” Pitcher said. “I was like, ‘I’m young, I’m healthy, I can do this.’”

Kryn’s kidney function, meanwhile, had dropped to about 8 percent. The loss of function was due to Alport’s syndrome, a hereditary condition that affects kidney function as well as vision and hearing. He was fatigued, retaining fluid, and there was an increasingly strong, ammonia-like taste in his mouth. Without a new kidney, dialysis was looming.

After Pitcher told her parents, she called Kryn’s family, and his mother answered. Pitcher recalled her reaction on her blog:

“Oh my goodness! Oh my goodness! Oh my goodness!… Tammy was a little excited. ”

Kryn wasn’t at home for Pitcher’s phone call that evening. “I was at youth group, and my sister pulled me aside and said, ‘We found a match for you,’ and I was like, ‘Yes!’”

Surgery was set for Dec. 9, allowing Pitcher to wrap up her semester work and to recover before the spring semester began. UAMS transplant surgeon Frederick Bentley, M.D., and laparoscopic surgeon Diane Rhoden, M.D., removed Pitcher’s kidney through a two-inch incision using minimally invasive techniques. Bentley then performed the transplant.

Two weeks after surgery, both Kryn and Pitcher were doing well.

“I feel great,” Kryn said during a follow-up visit three days before Christmas. “My energy levels are way higher than they were before the surgery.”

“It’s just been amazing how well it’s gone,” said Pitcher, who was able to leave the hospital after just two days.

Her father, Randy Pitcher, said the families were impressed by the UAMS experience.

“The hospital and the people here, even the housekeepers and the people who bring food are so polite and so accommodating,” Randy said. “They always have a smile and a kind word to say. I’ve never sat in a waiting room where they give you a beeper and update you every step of the surgery. It was awesome to get those updates.”

Bentley said it was rare to have such a young donor and recipient. Typical recipients are in their 40s and older, and living non-related donors are usually spouses.

Bentley noted that immediately after surgery Pitcher’s kidney function was reduced by half, but in six months it will be back to 85 percent.

“The other kidney works harder and actually gets larger,” Bentley said. “People live whole lives with just one kidney with no problem.”

Richards said she was impressed by Alissa throughout the process.

“It was remarkable to see her, as young as she is, come forward like she did,” Richards said. “She was willing to interrupt her whole life; it was truly a selfless act.”

Pitcher’s blog can be found at: http://alissakidney.blogspot.com/

Following his graduation, Palmalee wanted to join the military to serve during the Vietnam War. He failed the physical due to his poor eyesight and was rejected for military service.

After wearing glasses for 50 years, Palmalee was thrilled to be able to see clearly for the first time in his life following his cataract surgery at the UAMS Harvey & Bernice Jones Eye Institute. Doubting that the UAMS Eye Institute could help him because he had been treated by so many eye doctors during his lifetime, Palmalee was still willing to undergo cataract surgery by Dr. Romona Davis. Dr. Davis treated him like a family member and communicated her personal interest in his medical treatment, so he trusted that she would take care of him.

A day after his surgery, Palmalee was able to see clearly and even able to read license plates. Now he uses only over-the-counter reading glasses.

“I could not believe it could be done, but I was willing to try. And thank God I did.”

Relatives who had not seen him in years are astounded by the new Palmalee. Having worn glasses all his life, including a broken pair that had been taped together, his loved ones are very impressed by the improvement in Palmalee’s vision.

Due to his limited vision, Palmalee spent a lot of time in the house when he was young, and he developed a love for music. Able to play several musical instruments, Palmalee has performed with several musical groups during his professional career.

“I want to encourage people who have vision problems to come to UAMS for treatment. I’ve traveled around a lot, and people in Arkansas don’t realize that we have a world-class facility here in Arkansas.”

UAMS Eye Care
Harvey & Bernice Jones Eye Institute

Before successful treatment at UAMS, Ann Kincl was misdiagnosed by three eye doctors. Her eyelid gland malfunction caused great discomfort and pain, and she was constantly blinking.

While she was embarrassed by her inability to maintain eye contact with others, her family and friends were trying to assist her in obtaining the correct medical treatment. Other doctors performed procedures and prescribed medication, but Ann’s eyes remained uncomfortable and her vision continued to deteriorate.

Dr. Nicola Kim of the UAMS Harvey & Bernice Jones Eye Institute finally identified her eyelid disorder, putting her on a simple regimen that eased her discomfort and frequent blinking. However, the previous use of steroid medication had led Ann to rapidly develop cataracts and glaucoma, so Dr. Kim offered a new, cutting-edge technology to treat Ann’s cataracts.

Ann had two surgeries, one on each eye approximately a week apart, to correct her vision with intraocular lenses. Designed to provide enhanced image quality and a full range of vision, these new lenses offered Ann the best opportunity for a life free of glasses and contacts, and Ann was a perfect candidate for this treatment.

“I have been truly blessed. In addition to Dr. Kim’s expertise in the field, she truly cares for you as an individual. Dr. Kim takes time with you, and that’s very important to me. She lets you know that she understands your personal needs and makes you feel at ease.”

Following her cataract surgery, Ann has near perfect vision and no longer uses glasses or contacts. And she does not require treatment for glaucoma because she does not require the steroid medications any more. Since she is also much more comfortable physically, her quality of life has increased, and she was able to return to her work tutoring students.

UAMS Eye Care
Harvey & Bernice Jones Eye Institute

Her mother died of breast cancer in 1969 at age 47. That’s just two years older than Rita was at the time of her diagnosis.

Those memories reawakened when one of her two daughters was diagnosed in 2009. As the James family soon realized, family history can be one of the best indicators of breast cancer occurrence.

Waging War
James’ cancer battle began Jan. 16, 1991, the same day fighting began in the Gulf War against Iraq.

“I remember waking up that day wondering if we were at war, but I was already at war against my cancer,” she said of the day she was diagnosed.

A mastectomy followed. Still, since her mother’s cancer returned after treatment, she wanted to consider all options — leading her to the Cancer Institute and Laura Hutchins, M.D., director of the UAMS Division of Hematology/Oncology. 

“I knew when I came here she’d be aggressive in her treatment, and that’s what I wanted.”

She began a six-month chemotherapy treatment. Hutchins sat with her through the first dose.

Through the treatments, James kept working as a math curriculum specialist with the Little Rock School District. She did not let the disease slow her.

Daughter Karen said her mother remained positive through the ordeal. ‘Mom taught us to appreciate every day and not to sweat the small stuff,” she said.

Winning the Battle
In 1996, she had her five-year checkup. It was a milestone, particularly since her mother did not survive five years after her diagnosis.

But it wasn’t long after that when Rita felt another lump. The cancer had returned, meaning a round of radiation therapy.

Cancer left the James family alone for 13 years. Then in May 2009, an abnormality showed up in a mammogram of Rita’s daughter, Jennifer, 40.

Knowing the family history, both Jennifer and Karen began having regular mammograms and checkups early. Jennifer was not surprised to find the abnormal area was malignant.

“I was scared just knowing what mom had been through,” said Jennifer, who had a mastectomy in July. “But I don’t think of breast cancer as a death sentence anymore. I found mine before I could even feel anything.”
 
Her prognosis is good. 

Forging On
Because of their strong family history, Rita and her daughters decided to be tested for genetic defects that can indicate an increased risk for breast cancer. About a third of patients with a family history of cancer will have such a genetic mutation.

Rita’s test showed a defect in one gene segment. Her daughters had a 50-50 chance of inheriting the defect that could mean an increased risk of cancer.
But it was Karen, not Jennifer, who had the genetic anomaly.

“I think the testing is important, but to me the results showed that family history can be just as important as genetics,” Jennifer said.

Karen took the results in stride, continuing regular checkups and self-exams. “It’s just something to stay on top of,” she said.

The women are adamant about the importance of mammograms, regular checkups and self-exams.

“I’m amazed at people who have a lump and don’t do anything,” Rita said.

“Or who won’t get a mammogram because they say it hurts too much,” added Jennifer. 

Breast Cancer
Winthrop P. Rockefeller Cancer Institute

When attorney Ken Stoll of North Little Rock was diagnosed in 1991 with multiple myeloma, many would have called it a death sentence.

He now thanks his doctor who referenced him to the then-fledging program for multiple myeloma at UAMS. It was that doctor’s foresight, coupled with UAMS’ dedication to patients with this rare cancer of plasma cells, a type of white blood cell present in the bone marrow, that he believes gave him the last 18 years of his life.

“I feel like the Lord has blessed me and that I’m a living miracle.”

Stoll, 66, came out of retirement in 2006 and works as a general counsel for the Arkansas State Police.

The Myeloma Institute, established by Dr. Bart Barlogie in 1989 and now celebrating its 20th year, is internationally known and has treated more than 9,000 patients from every state and more than 50 foreign countries. The institute treats more multiple myeloma patients annually than any other facility in the country.

In the past 20 years, Myeloma Institute researchers bolstered the institute’s reputation through development of new treatments and greatly expanded understanding of the cellular and genetic mechanisms of the disease.

It was Barlogie’s dedication and passion that resounded with Stoll. “He was very caring and very knowledgeable. He put me at ease as much as anyone could at the time I was diagnosed,” said Stoll, who sometimes meets with newly diagnosed patients as “living proof” of hope in fighting multiple myeloma.

Barlogie credited “a determination by a team of clinicians and translational scientists who dedicated their professional mission to curing myeloma” for the institute’s success. He casts a large net, praising the nurses, support staff and all who have worked at the institute over the years.

“They have created a coordinated system that gives confidence and optimism to our patients,” he said.

Myeloma Institute for Research and Technology

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.

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!”

The 45-year-old Conway middle school principal and her nephrologist had been watching her kidneys deteriorate for 20 years as she went about her career and became the mother of three boys. But in 2009, her kidney function dropped to 8 percent. She became hypertensive, increasingly fatigued and lost 23 pounds with a persistent metallic taste that helped ruin her appetite.

She began the process of becoming eligible for a kidney transplant realizing that her rare AB blood type would make finding a match more difficult. Freyaldenhoven had to go through several health screenings that took three months to complete.

“I was hoping a match could be found before having to go on dialysis,” she said.

As she coped with the illness and waited, she kept her principal’s job and maintained as normal a life as possible, even flying to Daytona, Fla., with her husband, Todd, and children Friday, Nov. 6 to attend her sister-in-law’s wedding.

At close to 5 p.m. the same day, the UAMS Transplant Team learned about an available kidney from an Arkansas donor with AB blood. But a check of the database showed that the only other match was a patient too ill for a transplant. Without a patient, the kidney would have to be sent out of state within 24 hours.

“I turned to our coordinators and said, ‘can we have a miracle?’” recalled UAMS’ Gary Barone, M.D., kidney transplant surgeon. “I want to get someone worked up, listed and transplanted in 12 hours.”

UAMS Transplant Coordinator Fadelle Powell, R.N., checked the database of patients who were still awaiting eligibility and found Freyaldenhoven on the list. There were a few loose ends to be tied up, approvals needed, and some issues remained with Freyaldenhoven’s insurance company.

Rather than go home for the day at 5 p.m., members of the transplant team worked the phones well into the evening.

“We get one or two AB donors a year; it couldn’t wait until Monday,” Powell said.

Diane Richards, R.N., the UAMS kidney and living donor transplant coordinator, began making calls to find Freyaldenhoven, Powell said. “Then I got on the phone and called the people involved in giving final clearance,” she said. “This is usually done by our Transplant Committee.”

Meanwhile, Denice Roberts, registered medical assistant and transplant financial coordinator, contacted Freyaldenhoven’s insurance company.

Freyaldenhoven recalled the surprising phone call from UAMS’ Richards. “Of course we were all shocked and surprised, and there were lots of hugs and kisses and worries and thankfulness.”

After learning that her transplant was approved Friday night, she and her family flew back to Little Rock the next morning and she was admitted to UAMS early that afternoon. Barone transplanted the kidney that Saturday evening.

“I am doing wonderfully,” Freyaldenhoven said a month after her transplant. “The nurses and doctors here at UAMS and my surgeon, Dr. Barone, have been fantastic.”