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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:

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:

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:

The Gensel Lab's objective is to determine how to harness reparative capabilities of inflammation in spinal cord injuries.

UK researchers discuss the search for cures to spinal cord injuries

John Gensel, an assistant professor in the physiology department and the Spinal Cord and Brain Injury Research Center, and two members of his lab team – Bei Zhang and Taylor Otto – were featured in the most recent UK Research Media podcast.

Taylor Otto, an undergraduate lab assistant in Gensel’s lab, described UK as being the full package. “We have it all here. It’s a good program to be able to come into, not really knowing what you want to exactly do in the science field, but being able to figure it out at the same time,” said Otto.

Bei Zhang, a research scientist, said that working with Gensel has motivated her to do the best science she can. “If we can work at our research project every day in generating different thoughts and prove our hypothesis, we can make a contribution to the cure for spinal cord injuries.”

The team’s objective is to determine how to harness reparative capabilities of inflammation in spinal cord injuries. “Our goal is to really find out what physiological factors regulate the reparative or pathological balance, and gain insights into developing therapies for that,” said Gensel. “The overall goal is to improve the lives of individuals with a spinal cord injury.”


You can listen to the full podcast below:


Next steps:

  • Learn more about spinal cord injuries and what makes them so difficult to treat.
  • The UK Spine Center brings together orthopaedic experts and neurosurgeons for an advanced approach to spine care.
UK Albert B. Chandler Hospital

KNI Stroke Center awarded for high-quality patient care

UK HealthCare’s Kentucky Neuroscience Institute (KNI) has received the Get With The Guidelines – Stroke Gold-Plus Quality Achievement Award by the American Heart Association/American Stroke Association for maintaining nationally recognized standards for the treatment of stroke patients.

KNI also received the association’s Target: Stroke Honor Roll Elite for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke.

Over 12 months, at least 75 percent of the hospital’s ischemic stroke patients received tPA within 60 minutes of arriving at the hospital (known as door-to-needle time). Stroke patients who receive tPA within three hours of the onset of symptoms may recover more quickly and are less likely to suffer severe disability.

This year marks the sixth year that KNI has received Gold Plus designation. KNI has been named to the Target: Stroke Honor Roll the past three years and repeats for the ‘elite’ level that was introduced last year.

Kentucky patients aren’t the only ones benefiting from this achievement.

“By participating in the Get With The Guidelines-Stroke program, we are able to share our expertise with other member hospitals around the country, including access to the most up-to-date research, clinical tools and resources, and patient education resources,” said Dr. Jessica Lee, medical director of the KNI Comprehensive Stroke Center.

Dr. Larry Goldstein, chair of the UK Department of Neurology and co-director of KNI, said that “Comprehensive Stroke Center status reflects our capability to provide the most advanced care for patients with stroke. 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.”

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States. In Kentucky, cardiovascular disease (which includes stroke) is the leading cause of death.  On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 785,000 people suffer a new or recurrent stroke each year.

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