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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.

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.


Next steps:

Kentucky Neuroscience Institute recognized for high-quality stroke patient care

The American Heart Association and American Stroke Association recently honored UK HealthCare’s Kentucky Neuroscience Institute (KNI) with the Get With The Guidelines-Stroke Gold Plus Quality Achievement Award and the Target Stroke Honor Roll Elite Plus Award.

These achievements recognize UK HealthCare’s commitment and success in adhering to the most current, evidence-based stroke treatment guidelines for stroke patient care and outcomes.

To receive the Gold Plus Quality Achievement Award, hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods. They must also achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke quality measures.

The Target Stroke Honor Roll Elite Plus recognition is given to hospitals that treat more than 75 percent of appropriate patients with clot-busting drugs within 60 minutes of arrival and more than 50 percent within 45 minutes.

The quality measures are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients. They focus on appropriate use of guideline-based care for stroke patients, including aggressive use of medications such as clot-busting and anticlotting drugs, blood thinners and cholesterol-reducing drugs, preventive action for deep vein thrombosis, and smoking-cessation counseling.

Larry Goldstein, MD

Larry Goldstein, MD

“Comprehensive Stroke Center status reflects our capability to provide the most advanced care for patients with stroke,” said KNI Co-Director Dr. Larry Goldstein. “These awards further underscore the hard work of our multidisciplinary team of neurologists, neurosurgeons, emergency physicians, nurses, therapists and others to optimize care delivery for stroke patients right here in Lexington.”

2017 marks the seventh year that KNI has received Gold Plus designation. It is the only hospital in Lexington to have both the Get With The Guidelines Stroke Gold Plus and Target Stroke Honor Roll Elite Plus designations.

The KNI Stroke Center is also certified as a Comprehensive Stroke Center by The Joint Commission – its highest honor.


Next steps:

Bruce Smith

Facing permanent brain damage, patient turns to UK for unlikely answer: a liver transplant

In 2011, Bruce Smith sat in his office preparing to make handouts for a meeting, like any other normal work day. But when he sat in front of his computer, he suddenly realized something frightening: He’d lost all understanding of how to use the machine. Bewildered at the sudden lapse in cognition, he said his coworkers thought he was joking around.

“I finally said, ‘I’m serious!'” Smith said. “‘There’s something going on here.'”

That moment was the first of many “lapses” to come. Smith was a diabetic, and his doctors initially thought his mental fog episodes were due to low blood sugar. When that was ruled out, they suspected he might be suffering from a series of mini-strokes.

“It was like I was taking a trip but never leaving the farm, you know?” said Smith, who is from Belfry, Ky. “I was awake but always taking naps.”

It wasn’t until Smith was referred to UK HealthCare that he got a diagnosis: hepatic encephalopathy, a term used to describe the mental fog that accompanies severe liver failure and a common occurrence in patients in need of a transplant. The liver’s job is to filter toxins from the body, and when it fails, the toxins accumulate in the bloodstream and wreak havoc elsewhere.

The team at UK determined that Smith’s liver was failing due to non-alcoholic cirrhosis. Although neither of his parents had the disease, one may have been a carrier and passed the gene down to Smith.

After getting a second opinion from the Cleveland Clinic confirming the diagnosis, Smith opted to remain at UK to be listed for a transplant. Liver transplant patients are assessed with a score known as the Model for End-stage Liver Disease, or MELD, which measures the amount of toxins in the blood and determines the patient’s position on the transplant waiting list. The higher the MELD score, the greater the severity of the disease and need for transplant.

Making the case for a transplant

Smith’s MELD score remained relatively stable for the next four years. However, his mental function continued to decline. As Smith’s symptoms worsened, his doctors at UK referred him to neurologists at the Kentucky Neuroscience Institute, where they diagnosed him with a much more serious condition.

“Bruce started out with hepatic encephalopathy, but then developed hepatocerebral degeneration, an extremely rare form of brain injury,” said Dr. Malay Shah, director of the liver transplant program at UK. “The exact cause of this disease is unknown, but liver transplant is the only cure.”

Many symptoms of hepatocerebral degeneration closely resemble those of Parkinson’s disease. In Smith’s case, he had trouble with speech, gait ataxia (uncoordinated movement and problems with balance) and ever-worsening dementia. Smith says he was essentially home-bound. He was unable to return to work, often couldn’t go to church and avoided going out for fear of experiencing an episode.

“I was asking, ‘Why me, Lord?'” he said. “‘What’s going on?'”

Although Smith’s liver toxicity remained stable – thus keeping his MELD score lower than necessary to receive a transplant – Shah said he knew he needed to push harder for Smith to be transplanted as soon as possible. He wrote a letter of appeal to the United Network for Organ Sharing (UNOS), a nonprofit organization that manages the nation’s organ transplant system, making the case for the severity of Smith’s situation.

“I appealed to UNOS to make Bruce’s MELD score higher than his lab values would suggest because hepatocerebral degeneration needs to be treated with a liver transplant,” Shah said. “Without an expeditious transplant, this disorder becomes permanent and irreversible. At that point, a transplant would be contraindicated because of the permanent neurologic damage from the disease.”

Shah’s appeal was successful, and on Sept. 27, 2015, Smith got a call from UK just as he was arriving home from church. He and his wife packed up and headed to Lexington to prep for surgery.

“I had all this happiness, excitement,” Smith said. “But also the fright of undergoing a major surgery.”

At 2 a.m. the next morning, Smith received his new liver – and a new lease on life. Since his transplant, things have improved drastically. He recovered fully from the surgery, and he underwent physical and occupational therapy to build back his strength and improve some of the basic skills he’d lost during his illness.

“I had to relearn how to write straight,” Smith said. “I had to use a ruler to sign paperwork.”

Becoming an organ donor advocate

As a surgeon who sees firsthand what a difference a transplant can make in the lives of his patients, Shah is passionate about raising awareness for organ donation. He notes that part of his job is making sure patients understand the gift they’ve been given.

“Our patients rely on the generosity of others to have a second chance in life,” Shah said. “And that’s exactly what I impart on my patients prior to transplant – that they and I literally owe it to the donor and their family to do the very best we can to take care of that generous gift.”

One way Smith is using his gift is by educating others on his personal experience. He is now a member and ambassador for Kentucky Organ Donor Affiliates (KODA), the organization that runs the Kentucky Organ Donor Registry, educates the public on organ donation and honors those who have given the gift of life. He was recently featured on a billboard for KODA in Eastern Kentucky and says sharing his story is one thing he can do to honor his donor.

“What a selfless decision that person, or their family, made,” Smith said. “This is my way of giving back. Hopefully, it will get folks interested in becoming a donor and ultimately making a difference in someone else’s life.”

“Bruce is a wonderful patient and a great donor advocate for KODA,” Shah said. “It’s nice to see folks like him work with the organ bank to help educate others in their respective communities about how organ donation can help their neighbors.”

Although he is unable to work, Smith has returned to an active lifestyle that includes walking, performing and creating. He plays guitar as a hobby and gives lessons to those in his community. He has a small workshop behind his house, where he dabbles in woodworking and metalworking. None of these things would have been possible without the transplant he received a little less than two years ago.

But perhaps most importantly, he says, he lived to be able to hold his first grandchild, born just over a month ago, with a second grandchild coming next month.

“You push through death’s doors and go through what I’ve been through,” Smith said, describing his thoughts when he first held his grandchild, “and I just thank God that I’m alive to hold this little thing.”

Smith holding his newborn granddaughter -- his first.

Smith holding his newborn granddaughter.


Next steps:

UK student celebrates graduation one year after suffering strokes

Allison Couri graduated from UK May 5, but hers was more than the ordinary triumph over class loads and term papers. With the help of stroke experts at the Kentucky Neuroscience Institute, the Peoria, Ill.-native triumphed over health problems few 20-somethings face.

A little more than a year ago, Couri, then 21, came to the UK HealthCare Emergency Department complaining of headaches and dizziness. A CT scan identified that she had a stroke, and she was admitted to the hospital and assisted by the stroke care experts at the Kentucky Neuroscience Institute. Couri suffered more strokes, leaving her with a gait, slurred speech and blurry vision. She was diagnosed with lupus, which can lead to a rare complication called inflammatory vasculitis a condition marked by inflamed blood vessels that can also cause strokes.

After chemotherapy to treat her lupus, rehabilitation to address the effects of the strokes, and with the help of her service dog, Magnolia, Couri was able to finish her studies at UK and graduate. She plans to pursue a law degree.


Next steps:

Dr. Craig van Horne, director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute, spoke about his aspirations and hidden talents.

Watch: 5 questions with neurosurgeon Dr. Craig van Horne

Neurosurgeon Dr. Craig van Horne came to Kentucky from Boston to pursue an idea: Could peripheral nerve tissue implanted in the brain reduce the symptoms of Parkinson’s disease?

Van Horne is the director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute. He focuses his research on cellular and surgical therapies for Parkinson’s disease.

Deep brain stimulation, or DBS, is a surgical procedure that uses electrodes to stimulate areas of the brain, effectively overriding the damaged nerve’s electrical impulses and reducing many of the symptoms related to Parkinson’s disease. Van Horne is testing an experimental procedure called DBS Plus, which uses a patient’s own peripheral nerve tissue to prompt nerve regeneration and slow the disease process.

Van Horne says the teamwork and support at UK HealthCare – plus a healthy dose of Kentucky hospitality – fostered the atmosphere he needed to bring DBS Plus to fruition. (And having a lucky cap doesn’t hurt.)

Watch this episode of “Five Questions” to learn more about Dr. van Horne’s aspirations and secret talents.


Next steps:

Experimental treatment at UK targets Parkinson’s disease symptoms

About 14 years ago, Bill Crawford noticed a persistent twitching in one of his fingers that was interfering with his rehearsal time as the music pastor at Porter Memorial Church.

“It was driving me crazy,” the 57-year-old Lexingtonian said.

He’d noticed a few other things too, like weakness. He had mentioned it to his primary care physician, who ordered heart and lung function tests, but both were negative.

Finally, however, he was so weak that he could no longer ride his bike. “I just couldn’t seem to go,” he said.  So he made an appointment with a neurologist.

After a few minutes with Crawford, the neurologist asked him to return on Monday – and bring his wife, Lisa, with him.

On that dreadful day, the neurologist told Bill that he had Parkinson’s disease. At the time, Bill was just 44 years old.

“Obviously not what you want to hear,” he said. “But then I began to think of Michael J. Fox and all he had accomplished, and I thought I could do that too.”

Needing more than medicine

Eventually, though, the medicines that helped Bill control his Parkinson’s symptoms began to lose their effectiveness.

“There is no cure for Parkinson’s, and treatments we currently have at our disposal can only reduce symptoms,” explained Dr. John T. Slevin, a specialist at UK HealthCare’s Kentucky Neuroscience Institute, who began treating Crawford in 2006. “The disease progression inevitably overcomes the drugs’ capacity to alleviate the rigidity and tremor that are hallmarks of Parkinson’s.”

That meant that Crawford would go into what he called “full body charley horses” – sudden, painful involuntary spasms that left him paralyzed and lying on the floor for as much as 45 minutes.

“It was the pits,” Crawford said. Sometimes at the last minute he would be unable to conduct musical performances at church services, which was particularly disheartening. “I didn’t want to be a spectacle.”

It was then that Slevin suggested a treatment called deep brain stimulation, or DBS, and connected Crawford with UK HealthCare neurosurgeon Dr. Craig van Horne.

A new version of deep brain stimulation

Deep brain stimulation is a surgical procedure used to treat the problems associated with Parkinson’s disease. The procedure involves implanting electrodes into the brain that are connected to a small, pacemaker-like device implanted in the chest. These electrodes produce electrical signals that override the abnormal electrical impulses caused by the disease, which attacks and breaks down nerve cells in the brain.

The procedure isn’t suitable for everyone and requires thorough psychological testing and motion studies to ensure that a patient is ready for DBS.

“I wasn’t sure I would qualify,” Crawford said. “But I knew this was my last chance.”

Crawford considers it a blessing that he was, in fact, qualified to receive DBS. But then came an additional surprise: After further testing, van Horne told Crawford that he was qualified to participate in a study for a new version of DBS called “DBS Plus.”

The central nervous system – which comprises the brain and spinal cord – is unable to heal itself after injury or disease, van Horne said. However, peripheral nerves from the rest of the body are able to regenerate.

“Our study is designed to test whether taking a small part of peripheral nerve tissue and putting it in the brain would prompt healing in the areas of the central nervous system damaged by Parkinson’s,” he said.

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With DBS Plus, van Horne and his team (Greg Gerhard, PhD, and George Quintero, PhD) take a small piece of nerve tissue from the patient’s ankle and implant it in their brain.

Because the tissue is from a patient’s own body there are no concerns about rejection, and because the experimental treatment is applied during a procedure that was declared safe and effective by U.S. Food and Drug Administration almost two decades ago, DBS Plus is considered relatively safe with only minimal additional risk.

A marked improvement

Nonetheless, van Horne is cautious about the process of enrolling patients in the study.

“It’s more ethical, in my opinion, to wait until after a patient qualifies for the basic DBS before I tell them about my study,” he said. “I don’t want patients to elect to do DBS just because they want DBS Plus.”

And van Horne says he was thrilled that Crawford qualified for the study.

“When I met Bill for the first time, he was lying paralyzed on the floor in the treatment room,” van Horne recalled. “It was a startling and heart-breaking sight.”

Crawford received DBS Plus in August 2015. His family can’t get over the dramatic changes in his mobility.

“I’m climbing ladders now, I can plan our church’s worship time, I can lead the services, I can still lead others in worship,” he said.

The charley horses have gone away, and Crawford now takes just one or two pills a day, down from 12 before the surgery. A before-and-after video of Crawford walking the halls outside van Horne’s office is astonishing.

Promising results

To date, 34 patients have participated in the DBS Plus study with encouraging results.  Of the 17 patients that are 12 months out from their procedure, 65 percent of them have shown a clinically important improvement in motor performance as a result of the graft.

Van Horne is quick to point out that the study needs to be tested on a larger sample size at many other medical centers around the country before it can be deemed a viable treatment. Furthermore, he cautions, while 12-month results are promising, it’s important to evaluate effectiveness over a longer term. But assuming all goes as well as it has so far, DBS Plus shows promise as a means of slowing down the disease process.

Van Horne and his team garner no financial benefit from DBS Plus, which adds just a fraction of cost to the DBS surgery that is already covered by most insurance plans.

“Our payback is the gratification we receive in seeing our patients do well,” van Horne said.

Crawford understands that DBS Plus isn’t a cure for his Parkinson’s, but is delighted to have a little more time to enjoy life.

“‘Feeling the beat’ is critical to my work as a musician, and my Parkinson’s had begun to take that away from me,” he said. “I couldn’t even snap my fingers with the music anymore.”

But as he woke up from the surgery, Crawford said he instinctively began to tap his fingers like a metronome. Two members of the team, Julie Gurwell, the physician assistant responsible for programming the DBS equipment, and Ann Hanley, a Parkinson’s patient who personally accompanies patients through their surgeries, were sitting with him, and they asked him what he was doing.

“I was too emotional to explain but I managed to say ‘I can feel the beat.’ And they high-fived each other,” Crawford remembered.

“I just knew God had answered my prayers.”

Media inquiries: Laura Dawahare, UK Public Relations, laura.dawahare@uky.edu.


Next steps:

  • The promising results of Dr. van Horne’s DBS Plus treatment were recently highlighted in the Louisville Courier-Journal. Read the story here.
  • Learn more about the UK Movement Disorders Clinic, which provides specialized treatment for patients with a range of conditions and diseases including Parkinson’s, dystonia and Huntington’s disease.
In Berlin this past fall, a multidisciplinary team of UK scientists presented research on traumatic brain injuries in equine sports.

UK presents protocol on traumatic brain injuries in equine sports

Equestrian sports contribute to the highest percentage of traumatic brain injuries (TBIs) in sports, based on findings in the National Trauma Databank. Multiple concussions and head trauma can have long-term consequences, including acute injuries and neurodegenerative diseases.

First-ever international protocol

Health providers, researchers and other professionals from UK who work in the area of traumatic brain injury developed and presented the Saddle Up Safely Concussion Assessment Tool and Return to Riding Protocol for Concussions in Equine Sports at the 5th International Consensus Conference on Concussion in Sports in Berlin, Germany, this past fall.

The conference was hosted and organized by Fédération Internationale de Football Association, International Ice Hockey Federation, International Olympic Committee, World Rugby, and Fédération Equestre Internationale and has evolved into the world’s most influential process for policy makers on concussions in sport.

UK’s multidisciplinary team

Representing UK at the conference were Dan Han, chief of UK Neuropsychology Service and director of Neurobehavioral Studies Division; Bill Gombeski, senior adviser at UK HealthCare;  Fernanda Camargo, associate extension professor at the UK College of Agriculture; and Carl Mattacola, professor in the Athletic Training Program at the UK College of Health Sciences. Also playing a major role in the development of the concussion tool but unable to attend the conference were Dr. Erika Erlandson, assistant professor of Physical Medicine & Rehabilitation at the UK College of Medicine, and Jill Stowe, director of Equine Programs at the UK College of Agriculture.

The multidisciplinary effort represented Saddle Up Safety, the Kentucky Neuroscience Institute, the Sports Medicine Research Institute, the Spinal Cord and Brain Injury Research Center, Physical Medicine & Rehabilitation, the Equine Program, and UK HealthCare.

The UK team identified key questions that needed to be addressed in advance, identified and reviewed relevant articles, and developed early recommendations which they presented to conference attendees.

A world leader in equestrian sports concussion protocol

“It was clear that in the area of equestrian sports concussion and return to riding protocol, that UK is one of the world leaders,” Gombeski said. “Individuals attending the conference from around the world discussed the work that the UK group shared and to learn more about using the concussion assessment tool and return to riding guidelines that members of the Saddle Up Safely program created.”

The Return to Riding Protocol for Equine Sport is the first of its kind for equine specific head injury. Presentations (5 in total) by the UK team members will be published in the May 2017 issue of the British Journal of Sports Medicine. The conference recommendations created this year will come out online in February.


Next steps:

UK chaplain returns to work with renewed spirit following cycling accident

Exactly five months ago today, Laura Babbage had a devastating accident while biking through the French Alps with her 22-year-old son Brian.

Babbage, a chaplain at UK HealthCare, suffered a traumatic brain injury during the accident, which required months of treatment and rehabilitation. With the help of her care team at UK HealthCare and the prayers of friends and family, Babbage has returned to her work more than six months ahead of doctors’ estimates.

Babbage’s accident happened in France, she was airlifted back to Lexington and was treated at UK HealthCare. She completed her inpatient and outpatient rehabilitation at Cardinal Hill Hospital.

Babbage knows that many of her UK HealthCare family know her story, because she has heard of the many staff who prayed outside the door of her ICU bed and has delighted at the numerous people who’ve stopped her in the halls with a “welcome back!” smile or a hug.

“I’m overwhelmed by how much people rooted for me,” Babbage said. “There was an ocean of prayer entire churches I’d never heard of were praying for me. And I believe prayer, in all its forms, does matter.”

Read Babbage’s open letter of thanks to the UK doctors, nurses and staff who cared for her.

Using her experience for others

Since her return to chaplaincy about two weeks ago, Babbage has gone about her work with the grace and empathy that all who know her recognize: She is a patient and willing listener, she is trained to develop a relationship of trust without judgment and to add dimension to the skilled care provided by physicians and staff.

While Babbage acknowledges that, at least in the beginning, this ordeal was easiest on her – “I don’t remember a thing, but my family was sorely tested,” she said – she knows that this experience will help her do her job better.

“I am always aware of and sensitive to the desire for a visit from a chaplain as well as for prayer,” she said. “Chaplains are a listening presence for patients and families to help them begin to make sense of their situation. We are available for prayer if requested. Often we simply meet someone in the midst of their pain and suffering, aware of this special privilege.

“But now I have a deeper appreciation for families and their experience with their ill or injured family member since I’ve returned to work,” she explained. “Chaplains listen far more than we talk, allowing time and space for families to grasp the gravity of the moment. I have a heightened tenderness for family members now that I recognize what my own family experienced during my hospital stay. Like other chaplains, I will continue to learn.”

Returning to the patient’s bedside

Babbage and Joe Alverson, UK HealthCare’s director of pastoral care, were very careful to make sure she was prepared to meet and address patient and family needs.

“We wondered what would happen if I was needed to minister to a patient or family who’d experienced a trauma similar to mine,” Babbage said. “But we’ve been trained to eject ourselves from any situation if necessary – sometimes you’re not the right person for that patient, and sometimes they don’t want you there at all.  I felt I’d still be able to do that.”

Alverson remembers the shock and disbelief he felt when he learned that “one of our own” was in serious trouble.

“My first thought was for her – and my second thought immediately after that was for her family,” he said.  “As chaplains we see the sickest of the sick, and her condition was a huge worry for us.”

The pace of Babbage’s recovery was “beyond belief,” Alverson said.

“The first time I saw her was after she’d completed inpatient rehab at Cardinal Hill in September, and the first words out of her mouth were ‘When can I come back?'” he said. “I was excited for her, for me and for the hospital as well.”

Alverson knows that Babbage will make good use of her experience as she continues to care for others.

“We work in the midst of trauma and chaos every day, but to actually live that makes it more real,” he said. “I really look forward to seeing how her experience changes the trajectory of her work, but regardless of the exact path, I know it will be a good one.”

“We’re just thrilled to have her back.”

Media inquiries: Laura Dawahare, University of Kentucky Public Relations and Marketing, laura.dawahare.uky.edu


Next steps:

  • Learn more about Pastoral Care at UK HealthCare, where our chaplains are available to help patients, families and staff deal with spiritual and emotional challenges associated with medical events and crises.
  • The world-renowned doctors at UK Neurosurgery provides diagnosis and management of a wide range of conditions involving the brain, spine and nervous system. Learn more about the care we provide.