How a Markey lab is helping stroke patients

When George Quintero first heard about a new clinical trial that could improve motor function in stroke patients, he knew he had to find a way to bring it to UK HealthCare.

Quintero, a research analyst for the UK Department of Neuroscience, first obtained a list of criteria to apply. The phase II trial required a physician with experience in frame-based surgery, which was easy for UK to fulfill: Dr. Craig van Horne, a neurosurgeon for the Kentucky Neuroscience Institute, has been performing this style of surgery on neurology patients for more than 20 years.

The second required element was a bit trickier. To be a treatment site for this innovative trial, the stroke team needed resources and buy-in from a stem cell lab with specific cell processing skills near the hospital.

“Originally, we thought we just needed a cell lab,” Quintero said. “We realized we didn’t have any experience in the sort of cell delivery we needed. My background is basic sciences and I have a plain cell lab, so it wouldn’t be sufficient.”

Finding the right lab

Quintero hunted for an appropriate lab across the city, beginning with UK’s Center for Clinical and Translational Science (CCTS). He combed through the work of individual investigators, and then tried to identify facilities around town that would have the means and experience to carry out the specific stem cell work needed for the trial.

After running into several dead ends, he stumbled upon the idea of bone marrow transplants, which use stem cells collected from bone marrow to repopulate the blood after aggressive treatment for blood cancers. Quintero finally had a lead: Just across the street from KNI, the UK Markey Cancer Center’s Blood and Marrow Transplantation (BMT) Program performs upward of 100 bone marrow transplants for patients each year.

Quintero reached out to Dr. Gerhard Hildebrandt, division chief of Hematology and Blood and Marrow Transplantation at UK. Although the work required was unrelated to the usual duties of the stem cell lab, Quintero says Hildebrandt was on board with the project.

“He was very excited,” Quintero said. “He thought that sort of stem cell delivery for neurological diseases would be a really advantageous thing for UK to have. So he was an early supporter of us moving forward, and he got me in touch with the group at the cell lab.”

Working together to improve patient care

Tucked away on the second floor of Albert B. Chandler Hospital, the three staff members of UK’s stem cell lab – lab manager Rita Hill and medical technologists Martha Pat Kinney and Giovi Hidalgo – quietly and efficiently go about their work of preparing stem cells for bone marrow transplant patients at the UK Markey Cancer Center.

Overseen by Dr. Roger Herzig, medical director of Markey’s Blood and Marrow Transplant Program, the lab processes stem cells for both autologous transplants – those using the patient’s own stem cells – and allogenic transplants, in which stem cells harvested from related or unrelated donors are used.

When presented the opportunity to help KNI participate in this trial, Herzig was immediately interested, having previously collaborated on other projects at UK HealthCare. Hill says the team wanted to help but had some initial reservations because of their already busy workload – to do the study, the Markey stem cell team would have to take on additional work outside of their usual service area.

“I first met Dr. Quintero and he gave us a protocol to look at, and wanted to know if we were interested,” Hill said. “We thought, ‘Yes.’ But there is a time constraint and with the BMT program rolling, we weren’t sure if we could really support it.”

For the trial to work, the stem cell team would have to work closely with Quintero and van Horne to ensure seamless patient care. The lab would receive genetically modified stem cells from the pharmaceutical company, process the cells for implantation per trial protocol, and deliver them to Quintero. Once he signed off, van Horne would initiate the procedure by drilling a small hole into the patient’s skull and injecting the stem cells into the brain. Because most of the patients in the trial would be traveling long distances just for this procedure, it was essential to have the process streamlined and efficient from start to finish.

“An idea is pretty easy to have and say, ‘Let’s do this!'” van Horne said. “But when you realize all the work that has to go into these things, it’s phenomenal.”

First, scheduling was key. Hill says Quintero and van Horne were willing to be flexible on the timing of when they could bring in patients, and they worked out a schedule that wouldn’t conflict with their normal duties for Markey.

Secondly, Hill and her team looked closely at the protocol, and noted some small elements of the process that could be improved. After several conversations, the company sponsoring the trial even adopted Hill’s suggestions and implemented them at other trial sites nationwide.

“One of the advantages of having Rita is that she has a lot of expertise in managing cell labs and the requirements of cell processing,” Quintero said. “She sort of gave some direction that the study needed, and the study welcomed that because they wanted the input from individuals to make the project better.”

Culture of collaboration

This recent trial is yet another example of what van Horne describes as “the proliferation of collaborative culture to solve human problems” across UK’s academic and healthcare campuses.

“One of the things that I think is unique about UK is there’s really a culture of collaboration,” van Horne said. “I’ve previously been in other institutions where that culture doesn’t exist… It’s not, ‘This is too much, we just can’t do this,’ but ‘Oh, that’s a great idea, let’s figure out a way to make that work.’ And everybody stepped up and pitched in and made it happen.”

“This kind of collaboration is what keeps making the research and the medicine new,” Herzig said. “And that’s what keeps me coming back to work.”

It’s not the first time the stem cell lab has stepped up to help other across the medical campus. They’ve previously assisted with stem cell research in nephrology and cardiology. Participating in these outside projects has helped the team learn more about what properties stem cells possess aside from the ability to reconstitute blood, which may prove useful in future endeavors.

“Part of the academic mission is collaboration; that allows us to tackle problems that individually we can’t do,” Herzig said. “You never know what technique you have today that you’ll be able to transfer to a different situation tomorrow. The things that we’re learning from this are probably going to be helpful in other future projects.”

Hill and her team spend most of their working time in the lab, but they do personally deliver stem cells to the bone marrow transplant patients who are preparing to undergo their infusions, giving them a brief encounter with the person who will be benefiting from their work. In addition to simply “enjoying the science” of this new project, Hill says the idea of helping even more patients provides some extra personal motivation.

“Who knows, you could have a family member or loved one later on who suffers from a stroke, and this trial could benefit them in the future,” she said. “Why wouldn’t you want to help?”


Next steps:

  • Researchers are working hard to identify new treatments and strategies to improve health, but they need healthy participants and those with medical conditions to participate in clinical studies. Find out how you can participate in clinical research at UK HealthCare.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
stroke

When it comes to a stroke, timing is everything

Dr. Michael Dobbs

Dr. Michael Dobbs

Written by Dr. Michael Dobbs, a stroke expert at the Kentucky Neuroscience Institute and the director of the UK HealthCare/Norton Healthcare Stroke Care Network

A sudden onset of blurred vision, slurred speech, or numbness or paralysis in the face, arm, or leg can be indications of a stroke.

Many people experiencing these symptoms wait to seek help, but this can be a fatal mistake: The risks of permanent damage or death increase the longer treatment is delayed. In fact, six million people die and five million more become permanently disabled because of a stroke each year.

Nationally, the number of stroke deaths has declined, but in Kentucky, strokes are increasing. Yet stroke is a largely preventable disease: keeping blood pressure, cholesterol, weight and/or diabetes in check can greatly reduce the risk.

When a stroke occurs, however, the most important factor is time.

BE-FAST

Oct. 29 was World Stroke Day – a day to reflect on a significant cause of death and disability in the U.S. and the steps you can take to help reverse that trend. Take preventive measures, know the symptoms and BE-FAST if you suspect a stroke.

Balance – Does the person have trouble walking or standing?

Eyes – Are there any changes to eyesight, such as blurry vision?

Face – Do the eyes or mouth appear to be drooping?

Arms – Does the person complain of arm weakness?

Speech – Does the person slur their speech or mix up words?

Time – If any of those signs are present, it’s time to call 911.

If you or someone you are with show any of the above symptoms, call 911. It’s better to have a false alarm than to delay any treatment.

As with any medical issue, prevention is key in avoiding a stroke. High blood pressure and cholesterol are two main risk factors. Engaging in regular physical exercise, quitting smoking, and cutting back on salty and/or fatty foods can make a big difference.

Stroke Care Network

The Stroke Care Network, a partnership between UK HealthCare and Norton Healthcare, is an affiliation of 34 regional hospitals dedicated to the highest-quality stroke care. Based on extensive research, the Stroke Care Network has developed a system of care that provides prompt diagnosis and treatment to minimize the damage a stroke can cause.

A key step in stroke diagnosis is a computerized tomography (CT) scan to find bleeding in the brain or damage to the brain cells. Since 2015, the time it takes to get a CT scan read by doctors and begin a treatment plan has decreased from 52 minutes to 39 minutes in a Stroke Care Network hospital. Clot-busting medication may reduce long-term disability, but is only available within a few hours of the first symptom.


Next steps:

UK collaboration provides improved stroke care in Eastern Kentucky

Kentucky has one of the highest rates of stroke in the nation, and in Eastern Kentucky, the burden of cardiovascular disease is especially severe. An innovative program is improving patient outcomes and saving money in the region by providing intensive, personalized support for stroke survivors and their families.

The Kentucky Care Coordination for Community Transitions program − a partnership between the UK Center of Excellence in Rural Health (CERH) in Hazard, Appalachian Regional Healthcare (ARH), and the UK College of Health Sciences − integrates a CERH community health worker with the ARH rehabilitation team to help stroke survivors transition back to their homes and to facilitate a network of community support.

Established in 2014 with pilot funding from the UK Center for Clinical and Translational Science and ARH, the project evolved into a permanent program in 2015. Just past its two-year anniversary, the program has supported nearly 150 individuals, helping them adjust to the new realities of life after a stroke, learn about chronic disease self-management, navigate complex health care and insurance systems, monitor their rehabilitation, and connect with other survivors and caregivers.

Improving health and saving money

The program has markedly improved health and well-being for participating stroke survivors, among whom there have been zero 30-day hospital readmissions and only one emergency department visit (which wasn’t stroke related). This is compared to 19 percent and 8 percent, respectively, of the matched control group of stroke survivors who chose not to join the program. The result is not only better health and quality of life for survivors and caregivers, but also a cost savings of more than $1.4 million over two years to the local healthcare system.

“We’re keeping people healthier and saving a phenomenal amount of money for the health care system,” said Patrick Kitzman, PhD, founding director of the program and professor of physical therapy in the UK College of Health Sciences. “But we also concentrate very much on the caregiver and family − we always look at the whole unit with our follow-up education and support.”

In 2016 alone, the program supported 70 individuals, including 512 encounters between the community health worker and participants and more than 1,000 provided services. Half of participants needed assistance obtaining durable medical equipment, 71 percent needed assistance obtaining essential medications, and 35 percent needed assistance obtaining health insurance.

Personal care

A critical element of the program’s success is the integration of the community health worker, Keisha Hudson, with the stroke rehabilitation team at ARH. Hudson, who is from the local community, participates in the discharge planning for participating stroke patients so that she can establish a relationship with them and their families while they’re still in the hospital and get a head start on arranging for anything they might need when they get home − shower chairs, wheelchair ramps, medical equipment, etc.

Hudson then visits patients at their home within a week of discharge and provides weekly face-to-face meetings or phone follow-up calls which tapers to bi-weekly or monthly check-ins as patients improve. Some patients, however, have stayed with the program since its beginning.

As she works with patients and families, Hudson provides health education and tracks compliance with medical visits and medication; when she notices that a patient has missed an appointment or medication, she figures out why. Sometimes the problem can be as simple as the patient lacking transportation, in which case Hudson can help them make arrangements to get to the clinic or pharmacy.

Such attention and regular communication allows Hudson to develop a personal relationship with patients and their families to the extent that she can often sense when something is “off” and intervene before a serious problem develops. While none of the patients in the transition program have been readmitted to the hospital for stroke complications within 30 days of discharge, Hudson’s attentive care has led to life-saving interventions related to patients’ other health issues; nearly 60 percent of participants have five or more co-morbid health conditions. Once, while speaking with a patient over the phone, Hudson recognized that the woman’s breathing sounded especially labored, and she told the patient to go to the hospital immediately. It turned out the woman had a dangerous level of fluid on her lungs and needed urgent treatment. While making a routine visit to check on a different patient, Hudson arrived to find them in a diabetic coma. With yet another patient, she caught an infected surgical site that required immediate attention.

Connecting with the community

Hudson also hosts a monthly stroke survivor and caregiver support group. It meets at the hospital, which allows currently hospitalized stroke survivors or their caregivers to come downstairs from the care unit and connect with the group before they go home.

“The program has evolved in the community because we’ve built trust as people hear about us through word of mouth. Some patients and caregivers have become really big advocates for us. One of the patients we’ve worked with for a while has had people in his community who’ve had strokes and he himself has referred them to us. We’ve proven to our community that we’re here to help and we’re here to stay and when we say we’re going to do something, we do it − that’s helped a lot,” Hudson said.


Next steps:

  • When it comes to preventing a stroke, simple lifestyle changes can make all the difference. Here are six things you can do to help reduce your risk of a stroke.
  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients.
Markesbery Symposium

Learn about dementia, aging at the Markesbery Symposium

Why do some people stay intellectually sharp into their 90s, while others have memory problems? Is there anything we can learn from their lifestyles that can help everyone age successfully?

These are among topics to be discussed at the UK Sanders-Brown Center on Aging’s Markesbery Symposium on Nov. 3-4. Keynote speakers are:

  • Dr. Claudia Kawas of the 90+ Study which explores the fastest-growing age group in the U.S. Kawas appeared in a 2014 “60 Minutes” episode called Living to 90 and Beyond that explored the secrets to a long and happy life.
  • Rachel Whitmer, a national expert on risk factors for dementia, including obesity and diabetes. Whitmer was also featured on “60 Minutes” in a 2016 story about an extended family in Columbia with a genetic mutation that causes Alzheimer’s disease. Studying this family might help scientists discover ways to prevent the disease in the general population.

“Typically we focus on who gets dementia and why, but we can learn just as much from the people who don’t get Alzheimer’s,” said Linda Van Eldik, director of the Sanders-Brown Center on Aging. “We are delighted to bring two national experts to Lexington to continue this discourse.”

The scientific session will be at 10 a.m. on Friday, Nov. 3 in the UK Albert B. Chandler Hospital Pavilion A Auditorium. In addition to presentations by Kawas and Whitmer, there will be a judged scientific poster session and an update on research at the Sanders-Brown Center on Aging. Click here to register for the Scientific Session or call 859-323-5474.

The Community Session goes from 8:30 a.m. to noon on Saturday, Nov. 4 at the Lexington Convention Center’s Bluegrass Ballroom, 430 W. Vine Street. It will feature an “Ask the Experts” segment where participants can ask questions of Whitmer, Kawas and researchers from the UK Sanders-Brown Center on Aging.

A free continental breakfast on Saturday will be provided courtesy of the Lexington Legends. The event is free but registration is required. Call 859-323-5474 or click here to register for the Community Session.

Watch the video below to see Dr. van Eldik preview this year’s symposium.


Next steps:

Sanders-Brown Center researcher awarded grant to study Alzheimer’s prevention

Ai-Ling Lin, PhD

The National Institutes of Health has awarded a five-year, $2.88 million grant to UK Sanders-Brown Center on Aging researcher Ai-Ling Lin to study a drug’s potential to prevent Alzheimer’s disease.

Lin, an assistant professor at the Sanders-Brown Center, hopes to demonstrate that low doses of Rapamycin, a drug commonly used in organ transplantation, can restore brain function and prevent memory loss. Rapamycin is commonly used to prevent rejection of a transplanted organ.

“We hope our research will demonstrate that Rapamycin prompts tangible benefit by preventing the cognitive decline associated with Alzheimer’s disease,” Lin said.

Unique testing methods

Her study is unique in that it will also assess whether a relatively new imaging concept called multimodal MRI is effective in measuring the success of other potential treatments. mMRI uses traditional MRI plus another form of imaging (CT scan or PET scan, for example) to provide complementary information.

“We have two eyes for a reason. You can function with just one, but eyesight is improved when both eyes work well,” Lin said. “mMRI follows the same concept: multiple layers of data increase accuracy.”

Lin will be studying the drug in mice with the gene associated with an increased risk of Alzheimer’s. She will validate mMRI results with biological and behavioral tests to confirm the test’s accuracy.

A win-win

It will be a while before Lin’s research will be ready for human clinical trials, but mMRI as an alternative to other testing methods has the potential for speedy adoption, as the mMRI methods are readily available to be used in humans.

“Being able to test a drug and also a means of assessing other drugs in the future is truly exciting,” Lin said.

Linda Van Eldik, Sanders-Brown director, says that this latest grant is another important step in Sanders-Brown’s race against Alzheimer’s.

“As many as 1 in 5 people carry the Alzheimer’s gene APOE4, so the idea that a readily-available drug already demonstrated to be safe in humans might prevent what is arguably the most devastating and expensive disease in modern history is exciting,” said Van Eldik. “It’s a win-win for science and for the people it serves.”


Next steps:

Here’s how to improve your everyday memory as you age

Research shows that the human brain starts to shrink with age. When the brain shrinks, your ability to remember things can decline. You can help offset the decline in memory with regular activity that challenges both the mind and the body.

Here are some tips to help minimize age-related changes and improve everyday memory:

Stay active

Cardiovascular activity for 20 to 30 minutes at least three times a week is important for physical and mental health. Try walking, swimming or another activity that you enjoy. Physical activity enlarges the hippocampus (the most vital part of the brain for memory) and improves long-term memory.

Sleep more

It is a common misconception that sleep needs decline with age. What often happens is sleep patterns change. As we age, we spend more time in lighter sleep stages than deeper sleep stages. Try and get as much sleep as it takes for you to feel rested (at least seven to nine hours), and this includes and encourages naps.

Continue to socialize

Being social and getting out improves your memory and your mood.

Be sure you can see and hear well

It is hard to learn new things and remember old things if you can’t see or hear well. Wear your prescription glasses or hearing aids if they are prescribed to you. Have your sight and hearing tested periodically.

Avoid distractions that divert your attention

Distractions can range from trying to do several things at once to loud background noises. Even your own thoughts can distract you. When you’re preoccupied, it’s harder to pay attention. Stay focused on one task at a time so you don’t forget directions or other important information.

Try new things

New experiences, such as going to a new place or even taking a different route to your usual places, can also improve recall. Trying new things activates the part of your brain that turns short-term memory into long-term memory.

Use these memory aids

Despite the best efforts, episodic memory, which captures the “what,” “where,” and “when” of daily life, declines somewhat over time. So does long-term memory. The American Psychological Association offers these suggestions:

  • Make lists of what you want to accomplish and check off items when they are finished. Follow your established routine.
  • Don’t hurry. Take your time learning new information or remembering old information.
  • Stay organized: Keep things you use a lot in the same place each time. Put your keys and other important things somewhere that you walk by frequently.
  • Make visual associations to remember names or places.
  • Keep a calendar or planner of important dates. Check it throughout the day.

How we can help

Normal memory problems should not affect your everyday life. If you occasionally forget where you put things, you might just need to get better organized. However, if you forget how to do something or what to do in certain situations, you should see a health care provider. These memory problems are not a normal part of aging.

The UK Memory Disorders Clinic at the Kentucky Neuroscience Institute offers a variety of services to individuals with memory problems and their families. Patients at the clinic undergo a complete evaluation from our team of experts to diagnose and treat a variety of memory disorders.


Next steps:

  • Alzheimer’s disease is a form of dementia that can affect mental capability and cause memory loss. It usually affects people who are 65 or older, so if there’s a senior in your life, be aware of these signs and symptoms of the disease.
  • Learn more about the UK Memory Disorders Clinic, which provides support to those with memory problems and their families.

Couple works with UK to help ALS patients maintain independence

Last month, the ALS Clinic at UK HealthCare earned a coveted recognition from the ALS Association: ALS Association Certified Treatment Center of Excellence. The certification honors UK’s commitment to research and patient care, which centers around a multidisciplinary approach where patients with amyotrophic lateral sclerosis, or ALS, see a variety of specialists in a single visit.

But the ALS Clinic – part of the Kentucky Neuroscience Institute – goes beyond those requirements, offering a valuable service called the ALS Equipment Loan Closet in partnership with the ALS Association’s Kentucky Chapter and Roddy and Kim Williams, who co-own APEX Mobility.

“ALS is decimating financially, as patients require expensive, customized equipment to help prolong their independence, and they often need it right away,” said Dr. Edward Kasarskis, director of the ALS Clinic. “The Loan Closet helps bridge the gap between a patient’s diagnosis and the time it takes for the equipment to arrive.”

Kim Williams said that a customized wheelchair for an ALS patient can have any number of features to help the patient navigate, sleep and/or stand. That level of technology comes with a steep price tag – between $25,000 to $30,000 – and the process can take up to eight weeks from insurance approval/reimbursement to equipment delivery.

Williams comes to KNI every Tuesday to visit with ALS patients and match their needs to what’s currently available, which can range from wheelchairs, walkers and lifts to speech-generating devices. The Loan Closet is stocked through equipment donations from the families of former patients. It’s supplemented by fundraising and is available free of charge to patients.

“ALS is often not diagnosed until the patient has significant symptoms, and you can’t just get equipment off the shelf,” Kim Williams said. “The Loan Closet exists so that the patient and his/her family can adjust more quickly,” adding that she and Roddy see it as critical to patient safety, independence and well-being.

According to Kim, Kasarskis approached Roddy about 13 years ago, asking for help on behalf of his patients.

“By the second time Roddy visited the ALS Clinic, he was hooked,” Kim said. “It became his passion to help these people.”

Since then, APEX Mobility has focused almost entirely on the needs of ALS patients. Kasarskis, who is similarly devoted to his patients, sings the Williams’ praises.

“Roddy and Kim do this with a generous heart, and in doing so make the lives of countless patients and families a lot better,” he said. “For that, we are so grateful.”


Next steps:

African-American medical research

How can medical research better serve minority communities?

A researcher at UK is urging her fellow health scientists to take a more holistic and thoughtful approach when it comes to studying dementia and other diseases in Blacks/African-Americans.

Eseosa Ighodaro, PhD

Eseosa Ighodaro, PhD

Eseosa Ighodaro, PhD, a researcher at the UK Sanders-Brown Center on Aging, is the lead author of a new paper published in the Journal of Alzheimer’s Disease that encourages health researchers to be proactive in addressing the challenges associated with studying dementia in Blacks/African-Americans.

The paper, co-authored by researchers at Sanders-Brown, the University of Washington, Rice University and Rush University Medical Center, assesses the barriers that hinder minority recruitment for dementia research and the misconceptions that potentially distort research results related to minority populations.

“This study helps to identify problems in dementia-related research that are both historical and ongoing,” said Peter Nelson, MD, PhD, who works at Sanders-Brown. “You cannot seek solutions effectively until you are forthright about the problems.”

Race vs. socioeconomic variable

The paper argues that using race as a variable in research can result in inaccurate data interpretation. The authors point to several studies exploring genetic ancestral markers and race self-identification to demonstrate that race is not a dependable substitute for genetics.

“Race is, in many senses, a social construct that evolves over time due to social policy, cultural beliefs and political practices, and that risks misinterpretation of the differences between individuals who identify with certain racial/ethnic groups,” Ighodaro said.

Instead, she suggested that socioeconomic status variables such as zip code, income level, education, access to medical care and other social determinants of health need to be included in data interpretation, pointing to two recent studies that demonstrated socioeconomic conditions were a better predictor of stroke risk and dementia than race.

Historical factors

Ighodaro also identifies the horrific and unethical biomedical experimentation on African-Americans that continued into this century as one of the culprits for the African-American community’s persistent mistrust of physicians and scientists.

As a result, some African-Americans, who fear they are “guinea pigs,” are less likely to participate in research or donate blood or other biospecimens, which can decrease Black/African-American representation in dementia research studies.

Furthermore, the paper asserts, there is a need for efforts to increase the “diversity of thought and identity” among scientists, which studies show will enhance the quality and output of research collaborations.

“Scientists need to think holistically about the determinants of health when studying underserved populations and break out of the conventional and erroneous mindset that genetics are the sole cause of health disparities,” Ighodaro said. “And we must acknowledge and address the historical horrific mistreatment of Blacks/African-Americans in biomedical research as a first step towards improved minority research recruitment.”

“These barriers to what’s called ‘better science’ won’t be easily abated,” she says, “but they are critically necessary to align the quality of our data with all the populations we serve – minority or otherwise.”


Next steps:

ALS Clinic team provides care, support for former UK Wildcat

Talbott Todd had a memorable football career as a UK Wildcat in the mid-1960’s, playing multiple positions for Coach Charlie Bradshaw.

Todd is perhaps most famous for his 1964 game-clinching fumble recovery that ended top-ranked Ole Miss’s 22-game regular-season road game winning streak. His tenacity on the field was acknowledged last year when UK named the alley between the football field and Nutter Field House “Talbott Todd Way.”

That same tenacity continues to serve him well today as he and his family deal with his 2015 amyotrophic lateral sclerosis, or ALS, diagnosis. ALS is a progressive neurological disease that affects the nerve cells in the brain and the spinal cord, eventually stealing from its victims the ability to walk, dress, write, speak, swallow and breathe. Most ALS patients die within five years of diagnosis, and currently, there is no cure.

“Everything about Talbott was happy, healthy and normal, but I noticed that every once in a while, his speech was slurred,” said Marilyn, Todd’s wife of 52 years. “The first doctor thought it was medicine side effects. A second doctor conducted every kind of test, but ALS was not in our thoughts at all.”

After he was diagnosed with ALS, Talbott and Marilyn made an appointment with Dr. Ed Kasarskis, director of UK ALS Clinic at the Kentucky Neuroscience Institute. The couple felt a connection the moment Kasarskis walked through the door – the result, Marilyn says, of his easy personality, patient listening and clear explanations.

“He acknowledged right away that this diagnosis was something no one wants to hear, but we weren’t entirely powerless in the situation,” Marilyn said. “Everything about him said, ‘This is not just about being sick.'”

A team approach to ALS care

Every day about 15 people learn they have ALS, while tens of thousands more are living with the disease, which requires a dizzying array of treatments and services to help them stay mobile and independent. The ALS Association, headquartered in Washington D.C., was formed in part to provide people with ALS and their families the resources to live fuller lives.

Research has shown that multidisciplinary care, or the practice of having physicians and other healthcare professionals collaborate to provide the most comprehensive treatment plan for patients, helps people with ALS have a better quality of life and actually prolongs life in most cases.

Kasarskis (fondly called “Dr. K” by patients and staff) is committed to multidisciplinary care, and his ALS Clinic at UK is set up so that patients can typically see every member of the care team – neurologist, physical therapist, occupational therapist, respiratory therapist, nurse, dietitian, speech language pathologist, social worker, mental health professional and an ALS Association (ALSA) Chapter Liaison – in a single visit.

That, plus UK’s significant involvement in ALS research, has earned the ALS Clinic a coveted title from the ALS Association: ALS Association Certified Treatment Center of Excellence.There are fewer than 50 such centers in the U.S., and UK is the only one in Kentucky.

“The University of Kentucky continues to exhibit the highest levels of established national standards of care in the management of ALS, providing patients with high-quality compassionate care and support,” said Mari Bacon, executive director for the Kentucky Chapter of the ALS Association. “The care that people receive here is a model for other parts of the country, and I’m proud that we are able to recognize UK for its outstanding multidisciplinary approach to treating people with this devastating disease.”

Finding strength in the ALS community

Marilyn points out that an ALS diagnosis requires the entire family’s hands-on assistance.

“God blessed us with two sons,” she said. “Their love and support cannot be measured in time or money, and we could not do it without them.”

Marilyn also treasures the friendships she’s made through the ALS Association Kentucky Chapter support group meetings.

“We ask questions of one another and share ideas,” she said. “We support family members in their grief and keep up with each other long after the battle is over.”

ALS exacts a significant financial toll as patients tend to require expensive equipment to help prolong their sense of independence at home. A customized wheelchair, for example, can cost $25,000 to $30,000 and take several weeks to manufacture. The ALS Clinic at UK, in partnership with ALS Association Kentucky Chapter and volunteer Roddy Williams, helps manage the Loan Closet, which functions as a public library of sorts that supports patients until their own equipment arrives.

“ALS is often not diagnosed until the patient has significant symptoms, and you can’t just get equipment off the shelf,” said Kim Williams, Roddy’s wife and a partner in their business, APEX Mobility. “The Loan Closet helps bridge the gap while the patient waits for their new equipment to arrive.”

The Todds used the Loan Closet after Talbott was first diagnosed and are currently awaiting the arrival of his new customized wheelchair.

The ALS Clinic was recognized for its ALS Association certification during a reception and plaque presentation last week, and the Todd family was present to help commemorate the honor.

“What this clinic has done for us is immeasurable,” Marilyn said. “On a scale of one to 10, I’d give Dr. K a 20.”


Next steps:

No. 1 hospital in Kentucky

We’re the No. 1 hospital in Ky., again

UK HealthCare Albert B. Chandler Hospital remains the No. 1 hospital in Kentucky and the Bluegrass Region, according to the U.S. News & World Report’s Best Hospitals Rankings released today.

In addition, four major areas have achieved Top 50 national rankings, three of them for the first time. UK HealthCare rankings included: No. 37 in Diabetes and Endocrinology, No. 43 in Geriatrics, No. 44 in Neurology and Neurosurgery, and No. 50 in Cancer.

Along with the Top 50 rankings, UK HealthCare is ranked as high-performing in five other adult specialties – Gastroenterology and GI Surgery; Nephrology; Orthopaedics; Pulmonology; and Urology. Additionally, UK HealthCare was designated high-performing in eight common adult procedures and conditions: Aortic Valve Surgery, Heart Bypass Surgery, Heart Failure, Colon Cancer Surgery, Chronic Obstructive Pulmonary Disease (COPD), Hip Replacement, Knee Replacement, and Lung Cancer Surgery.

These recognitions cement UK HealthCare’s role as the major healthcare system best equipped to deal with our state’s unique health needs, said Dr. Michael Karpf, UK executive vice president for health affairs.

“We are committed to providing the best programs and best care available in Kentucky so that no one has to travel far from home for world-class advanced specialty care,” Karpf said. “These rankings speak to the hard work and dedication of our physicians, our nurses and our entire healthcare team.”

‘We’re ready no matter the situation’

This year’s U.S. News & World Report rankings cover nearly every hospital in every community nationwide. The rankings are grounded in objective data and offer patients a rich resource on their hospital choices. More than 70 percent of the rankings are based on objective data, with U.S. News analyzing more than 2,600 metrics across 21 data-driven specialties and procedures and conditions. The result is thousands of data points on hospitals that excel at treating the most challenging cases, those that do best in more routine procedures and those that provide top local care.

“UK HealthCare is a place where you feel safe because you know we’re ready no matter the situation or illness,” said Colleen Swartz, UK HealthCare’s chief administrative officer.

“If you have someone you love who lives in Kentucky, you will need UK HealthCare at some point in time. Whether it’s someone with a newly diagnosed cancer, or a premature baby, or a critically ill or injured child, or brother or mother or sister, you want to know that a place like this is ready to go when you need us.”

Diabetes & Endocrinology

This year’s rankings included a major leap for UK’s diabetes and endocrinology program. The specialty at UK HealthCare, previously unranked, is now No. 37 in the country, a testament to both the clinical care and research at the UK Barnstable-Brown Diabetes Center.

“We are one of the few places in Kentucky where all these services are provided either under one roof or where we can engage people to help you in all these different arenas,” said Dr. John Fowlkes, director of the Barnstable Brown Diabetes Center.

This collaboration and patient-centered care offered at the Barnstable Brown Diabetes Center provide patients with outstanding clinical care throughout their lifespan and for all aspects of their health, said Dr. Lisa Tannock, chief of the Division of Endocrinology and Molecular Medicine.

“Our physicians, advanced practice providers, endocrinology fellows and staff, including expert-certified diabetes educators, continually seek opportunities to teach advanced patient care based on our ongoing research into the best ways to prevent and treat diabetes and endocrine diseases,” she said.

Geriatrics

UK HealthCare was ranked No. 43 in Geriatrics. The U.S. News Geriatrics rankings represent how well hospitals treat older patients across a wide range of medical issues and conditions.

Dr. Shawn Caudill, professor and chief of the Division of General Internal Medicine and Women’s Health, sees increasingly more geriatric patients in UK HealthCare’s outpatient clinics. He said the rankings are an indication of the high-quality care that UK HealthCare provides to a population that is living longer than before.

“We’ve had lot of success in overcoming the things that used to kill people – heart attacks, strokes, lung disease – and we’ve done interventions to help keep people going longer,” Caudill said. “And now it is important for us to continue to help take care of them.”

Neurology & Neurosurgery

For the first time, UK HealthCare is nationally ranked for its neurological care, coming in at No. 44 in Neurology and Neurosurgery.

“This is something we’ve been working on for the past two years,” said Dr. Larry B. Goldstein, the Ruth L. Works Professor and chair of the UK Department of Neurology, and co-director of the Kentucky Neuroscience Institute (KNI). “It’s wonderful to be able to have our faculty and staff receive this recognition for all the great things they’re doing.”

Fellow KNI Co-Director Linda Van Eldik, who also is director of the UK Sanders-Brown Center on Aging, was pleased with national rankings in Neurology and Neurosurgery as well as Geriatrics.

“This is really a culmination of the work we’ve been doing for many years in the areas of brain,” Van Eldik said. “It’s recognition from the outside of what we already knew – that we were doing leading-edge work and we are continuing to enhance our excellence.”

Cancer care

Cancer care was included in the Top 50 for the first time – although it has consistently been designated as high performing for many years. Still, the move up is indicative of the Markey Cancer Center’s continued emphasis on providing exemplary care as the state’s only National Cancer Institute (NCI)-designated center.

“We see 50 percent of our patients coming from Eastern Kentucky, which has some of the highest rates of cancer in the country – particularly lung cancer and colon cancer. So the Markey Cancer Center is vitally important to our region,” said Dr. Mark Evers, director of the Markey Cancer Center.

The people behind the scenes

In acknowledging all of UK HealthCare’s national rankings and achievements, one factor is always first to be attributed to success – the people who work here.

“I’ve been here almost a year and a half, and to see what the University of Kentucky and UK HealthCare has achieved, really in a short time, is remarkable,” said UK College of Medicine Dean Dr. Robert DiPaola. “And to see the passion of the people here behind the scenes doing the things that make a difference for our patients – it is absolutely amazing. I know that going forward we will continue this trajectory.”


Hear more about this awesome recognition, including comments from some of UK HealthCare’s leaders, in the video below.


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