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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.
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:

stroke

6 ways to prevent a stroke

When it comes to preventing a stroke, simple lifestyle changes can make all the difference.

Strokes occur when blood vessels that carry oxygen and nutrients to the brain burst or are blocked by a clot. When that happens, brain cells begin to die, affecting a person’s memory and ability to control muscles.

Stroke is the fifth-leading cause of death in the U.S. and in Kentucky, but there’s good news: Nearly 80 percent of all strokes are preventable.

In celebration of American Stroke Month, we’ve put together a list of things you can do to live a healthier lifestyle and better your chances of avoiding a stroke.

1. Get moving.

Regular physical activity will help lower your cholesterol and blood pressure, two of the biggest risk factors for stroke. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health.

2. Stop smoking.

Smokers are twice as likely to experience a stroke as nonsmokers. That’s because smoking thickens blood and increases the likelihood of clots. If you’re struggling to quit smoking, ask your doctor for help. And check out our blog with tips and resources that can help you or someone you know start on the path toward success.

3. Eat your vegetables.

And beans, whole grains and nuts, too – all of which are staples of a healthy diet. Improving your diet will help lower your cholesterol and blood pressure and help you maintain a healthy weight. Check out our guide for kick-starting a healthy diet.

4. Drink less.

Alcohol can increase blood pressure and the risk of stroke. Moderation is the key: For men, no more than two drinks a day, and for women, no more than one.

5. Learn about Afib.

Atrial fibrillation, also known as Afib, is a type of irregular heartbeat. If left untreated, Afib can cause blood clots in the heart that can move to the brain and cause a stroke. Talk to your doctor about Afib if you experience symptoms such as heart palpitations or shortness of breath. Learn more about the UK Gill Heart & Vascular Institute’s Heart Rhythm Program and listen to a podcast with our Afib specialist, Dr. Ted Wright.

6. Understand the things you can’t control.

Although improving your diet, ramping up your activity and living a healthy lifestyle can all decrease your risk for stroke, there are some risk factors you cannot control. Things like age, gender and race all play a role in stroke risk, and even though you can’t change those factors, it’s important to understand if you’re more susceptible.

Click the icon below to see our Stroke Quick Facts inforgraphic.

Stroke quick facts infographic from UK HealthCare


Next steps:

  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
  • Dr. Gretchen Wells, director of UK’s Women’s Heart Health Program, writes about why knowing your family health history can help you understand your own risk of disease. Read her blog.

 

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:

The American Heart Association have promoted a simple, effective way to identify stroke. But the work of one UK resident could make it even better.

UK neurology resident proposes new way to identify stroke

Organizations like the American Heart Association have promoted the FAST concept to help people recognize the symptoms of stroke. FAST is a mnemonic that stands for facial drooping, arm weakness, speech difficulties and time. It’s used to help people understand the symptoms of a stroke and remind them to act quickly in seeking treatment because strokes can be debilitating or even deadly.

However, a study published in a recent issue of Stroke and authored by a resident physician at UK HealthCare might signal a change in how laypeople understand stroke symptoms and how first responders assess possible strokes.

Identifying areas for improvement

Dr. Sushanth Aroor, a fourth year neurology resident at UK, was inspired by a conversation with Dr. Larry B. Goldstein, co-director of the Kentucky Neuroscience Institute and Aroor’s mentor, to explore how many strokes were initially missed because the FAST mnemonic didn’t apply to them.

“Dr. Goldstein’s idea to look at FAST, which was prompted by a conversation he had with a medical reporter, was something that made a lot of sense to me as I would very often see patients presenting with strokes that were FAST negative,” Aroor said.

Aroor began by identifying all patients admitted at UK in 2014 who were ultimately diagnosed with stroke and then determined how many of those patients initially presented with the FAST symptoms.

“Of the 736 people included in the study, slightly more than 14 percent did not have FAST symptoms but were ultimately diagnosed with a stroke,” he said.

Aroor then tried to quantify additional presenting symptoms for these non-FAST stroke patients and identified two prevalent symptoms: problems with balance (42 percent) and sudden onset of visual problems (40 percent). This led to a modification of the FAST mnemonic to BE-FAST (B for balance and E for eyes).

BE-FAST could change public policy

“We were able to demonstrate that by adding these two symptoms to the FAST mnemonic, the proportion of stroke patients not initially identified was reduced to 4.4 percent,” Aroor said. “Focusing our education efforts on BE-FAST instead of FAST could help reduce the number of missed strokes, therefore improving access time to treatments that could reduce or eliminate disability.”

Goldstein says that Aroor’s study could signal an enormous change in public policy.

“This is potentially a big deal,” Goldstein said. “As Aroor’s study is replicated and fine-tuned prospectively, his work could ultimately change how hospitals and first responders identify potential stroke victims, and change how organizations like the American Heart Association shape their public education campaigns.”

Gaining national notoriety

Other centers – many of whom were looking for hard data to back up their hunch about BE-FAST – are already taking note of Aroor’s study.

“We had been looking to switch to BE-FAST for about six months now but had no evidence-based practice to actually be able to implement the change until this study,” said Angie Russell, RN, BSN, stroke nurse program coordinator for the Lahey Medical Center in Massachusetts.

But Aroor’s study in Stroke provided the data Russell needed to revise Lahey’s stroke alert in-house policy to include BE-FAST. He is now working with her medical practice council to implement BE-FAST at Lahey’s five satellite facilities.

Aroor, characteristically modest, is quite pleased with how his study has been received.

“It’s nice to know that a lot of people are looking at this study and wanting to change how they teach the public how to identify strokes,” he said.

Check out the video of Aroor speaking about the promise of his work:


Next steps:

Carlee with Dr. Jessica Lee

Advanced medicine saved her life. This is how she said thank you.

Courtney Wilson’s life very nearly ended in 2013. She credits Dr. Jessica Lee and the stroke team at UK HealthCare with saving her.

The 30-year-old preschool teacher’s assistant from Russell County awoke one morning “feeling awful,” she said. She dropped her 2-year-old off at daycare and took her 5-year-old to school, then popped into the school nurse’s office for advice.

“All I could tell her was that I felt really bad and that my balance was off,” said Courtney.  “The nurse drove me to the Emergency Room right away.”

At Russell County Hospital, emergency room doctors examined her carefully but could find no other symptoms to explain Courtney’s troubles.  They consulted with Dr. Lee, director of UK HealthCare’s Stroke Center, who advised them to administer the clot-buster drug called TPA and send Courtney immediately to UK Chandler Hospital.

Lee and her team from UK’s Kentucky Neuroscience Institute were similarly confused by Courtney’s mysterious lack of neurological deficits.  But Comprehensive Stroke Centers like the one at UK HealthCare follow specific procedures when evaluating possible stroke patients. So, as part of UK’s routine screening process, Lee ordered a CT angiogram, which provides doctors with images of the vessels that supply oxygen-rich blood to the brain.

“When we pulled her scan up on the screen, it was shocking news,” Lee says. “We were stunned.”

Courtney had a thrombus — a blood clot — in what’s called “the artery of life.” This artery is the superhighway of arteries, serving areas of the brain that control heartbeat and breathing. Courtney was on the precipice of a massive stroke.

“I literally ran to her hospital room,” remembers Lee, “and sure enough, she was deteriorating before my eyes.  We absolutely scrambled from there.”

UK is fortunate to have a “dream team” trained to handle emergencies like this one.  Dr. Abdulnasser Alhajeri is an interventional neuroradiologist — one of only about 300 in the U.S. — and Dr. Justin Fraser is an endovascular neurosurgeon. Both doctors are able to navigate tools such as tiny catheters, wires and other devices through blood vessels to diagnose and treat illnesses of the spinal cord and brain — also known as the central nervous system. Because this requires only a tiny incision in the groin instead of the larger incision necessary for open surgery, hospital stays and recovery times are faster, complications are less likely, and patients can return home to their families more quickly.

But, in what Lee describes as “the perfect storm,” both Drs. Fraser and Alhajeri were in other operating rooms on separate cases.

Time for Plan B.

Lee assembled a second surgical team to perform the preliminary phases of the procedure. “I didn’t even wait for transport to come get Courtney,” says Lee.  “Our Stroke Unit senior staff and I took her to the surgical suite ourselves.”

Then, as if choreographed, Dr. Alhajeri stepped from one room to the next and began to work on Courtney. Using high-tech precision imaging to watch its progress, Alhajeri positioned the catheter in Courtney’s brain, attached a large syringe-like device and sucked the clot out, reopening the vessel in just 15 minutes. “It was like watching the pneumatic tube at the bank drive-in,” said Dr. Lee.  “Whoosh!  It was gone.”

“Courtney is a lucky young woman for many reasons,” says Alhajeri. “The doctor in the Russell County Hospital ER had the foresight to call our stroke team despite Courtney’s lack of major symptoms.  The TPA they gave her delayed her decline and bought us some time to perform the thrombectomy.”

“She is also fortunate that UK has the resources to treat her. The next closest center that might have been able to treat her was an additional 90 minutes away.  She didn’t have 90 minutes to spare.”

Since her illness has an 80-90 percent mortality rate, the mere fact that Courtney is alive today is a wonder.  But the best part?

“The very few who survive this devastating event typically are left with substantial impairments, such as vision problems, the inability to speak or swallow, or complete paralysis,” says Lee. “But Courtney’s only residual deficit is some double vision on her far left gaze. We’re truly thrilled with her outcome.”

After Courtney’s close call, the Wilsons brought son Jaylynn into their family through adoption.

And now, just three years later, Courtney has yet another reason to feel blessed. On Sept. 1 of this year, she gave birth to a baby girl, who came into the world measuring 6 pounds, 11 ounces and  19.5 inches long.

Her name? Carlee.

“We are forever grateful for Dr. Lee and her medical staff,” wrote Courtney and her husband, Paul. “We wanted to honor her by naming our daughter Carlee.”


Next steps:

The implantable WATCHMAN device may help reduce risk of stroke for those with atrial fibrillation.

New device may reduce risk of stroke for Afib patients

Written by Dr. John C. Gurley, director of the Structural Heart Program at UK HealthCare’s Gill Heart Institute.

Dr. John Gurley

Dr. John Gurley

A new implant device may be a breakthrough for reducing the stroke risk for atrial fibrillation (Afib) patients. The WATCHMAN Left Atrial Appendage Closure (LAAC) provides a new option for patients with non-valvular Afib, who may require an alternative to long-term use of blood thinners.

UK HealthCare was among the first centers in the world to implant the WATCHMAN as an investigational device through a clinical trial in 2005. The device is now FDA-approved in the U.S. and more widely available.

Those with Afib are at a higher risk for stroke

Currently, about 5 million Americans are diagnosed with atrial fibrillation, the most common cardiac arrhythmia, where the upper chambers of the heart (atrium) beat too fast and with irregular rhythm (fibrillation). But having an irregular heartbeat is not the only challenge facing these patients. The condition causes them to be at a higher risk of experiencing a stroke – in fact, five times more likely compared to those without atrial fibrillation.

Because the heart does not beat properly in atrial fibrillation patients, blood may not fully pump out of the heart, causing it to pool and then clot in a pouch in the heart’s left atrial appendage. In some cases, the blood clots can break loose and travel in the bloodstream to the brain, resulting in a stroke.

Along with putting patients at a greater risk of experiencing a stroke, these types of strokes caused by atrial fibrillation often are fatal or very disabling.

Finding a new way to treat Afib

In the past, the most common treatment to reduce the risk of stroke in these patients has been to have them take a blood-thinning medication called warfarin. However, despite their effectiveness, taking blood thinners for long periods of time can be difficult for patients because it isn’t always well-tolerated and it presents a significant risk for bleeding complications. Overall, about half of atrial fibrillation patients appropriate for warfarin go untreated because of their inability to tolerate or adhere to the medication.

For patients seeking an alternative to warfarin, the WATCHMAN implant offers a treatment option that could free them from the challenges of long-term blood-thinning therapy. The catheter-delivered heart implant is a one-time procedure that usually takes about an hour.

During the procedure, the implant is designed to close off the left atrial appendage to prevent blood clots from entering the bloodstream that potentially could cause a stroke for higher risk patients with non-valvular Afib.

Once the left atrial appendage is closed off, patients may, over time, be able to stop taking warfarin.


Next Steps

What is atrial fibrillation?

What is atrial fibrillation? Our expert Dr. Ted Wright explains.

In honor of Atrial Fibrillation Awareness Month, we sat down with the UK Gill Heart & Vascular Institute’s Dr. Ted Wright to discuss the condition, how it’s treated and what you can do if you have it.

Watch our conversation with Dr. Wright below.

Atrial fibrillation, also known as AFib, is a type of irregular heartbeat. If left untreated, it can increase a person’s risk for stroke and heart failure.

Dr. Ted Wright

Dr. Ted Wright

Dr. Wright is a heart surgeon at the UK Gill Heart & Vascular Institute. He is UK’s leading expert in atrial fibrillation treatment and is the only doctor in the region performing the Mini-MAZE procedure, a surgical treatment for people with the condition.


Check out the first video in our interview series below where Dr. Wright explains what AFib is and how it’s diagnosed. Be on the lookout for more highlights from our conversation with Dr. Wright in the coming days.


Next steps:

  • The UK Gill Heart & Vascular Institute is a leader in diagnosing and treating abnormal heart rhythms, including AFib. Learn more about Gill’s Heart Rhythm Program.
  • Check out our Q&A with Dr. Wright about heart disease and African-Americans.
Jim Lester was in end-stage heart failure, but a doctor from the same hometown helped him to trust in a heart procedure that eventually saved his life.

Hometown connection leads to life-saving heart procedure

Jim Lester encourages others to listen to his heart. As you adjust the stethoscope’s earpieces and lean in, you hear an electronic whir and zing reminiscent of a video game. The sound that startles others makes Lester laugh. Apparently this is not the first time he’s unleashed this parlor trick.

Just two weeks prior, Lester was gravely ill, in end-stage heart failure, the result of a lifetime of repeated heart attacks (three), blood clots (four) and a stroke. His ejection fraction – a measure of the heart’s ability to pump blood – was less than 20 percent. A healthy person’s EF sits in the 50 to 70 percent range.

Lester remembers the conversation with Alexis Shafii, his physician at the Gill Heart Institute. “Dr. Shafii was straight to the point,” Lester remembers. “He said that I had to have an LVAD in order to survive.”

A left ventricular assist device, or LVAD, is a mechanical device that helps a weakened heart pump blood. “An LVAD doesn’t replace the heart,” said Dr. Maya Guglin, medical director of Mechanical Circulatory Support at the UK Gill Heart Institute. “It just helps it do its job.” However, Guglin was cautious. Implanting an LVAD requires open heart surgery and a lifetime of maintenance. It’s not a good fit for every patient.

A common connection

Lester was afraid of surgery. He kept asking whether there were any pills that could help him instead of this strange-looking machine. Then he met Sarah Branam, one of the three LVAD coordinators at the Gill.

“The team asked me to do some education with Jim, since he was very standoffish about the idea of having an LVAD,” Branam said. “I started discussing with him what his fears were with the LVAD, I just wanted to help relieve his concerns. And I always say, ‘Where are you from?’ and when he said, ‘Maysville, Kentucky,’ I was like, ‘Well, funny thing, so am I!'”

They bonded instantly. Lester knew Branam’s “Papaw,” Clarence Branam, and then knew he could trust Sarah. She understood Lester’s fear of the unknown, but she could also share her experiences with many patients with LVADs.

“I got to see patients go from being in the ICU, and being as sick as they are, to see them with quality of life: the stamina, no oxygen tank, being able to walk farther, getting back to what they wanted to do… it was just amazing,” Branam explained.

“I was awful scared, but after talking to Sarah and finding out she comes from Maysville, why, everything leveled out,” Lester said tearfully. “This little thing came in, and she would answer any questions I had, and took all my fears away.”

Even better: Lester qualified for a clinical trial to implant a new version of an LVAD called HeartMate 3.

The power of advanced medicine through clinical trials

According to Guglin, the HeartMate 3 is a tremendous improvement from its predecessor with a longer battery life, smaller profile and engineering that minimizes the potential for complications like blood clots and GI bleeds.

“That the Gill was included in this major clinical trial was a coup for us,” Guglin said. “It’s a signal that the cardiology world recognizes our expertise, our professionalism and our teamwork.”

And, Guglin adds, this also helps fulfill the heart institute’s academic mission, since high-profile trials like that for the HeartMate 3 expose Gill trainees to the newest available technology – technology that could become standard treatment by the time they are in their own practice.

On Aug. 8, Lester was implanted with the HeartMate 3. Everyone noticed immediately how improved he was.

“The biggest thing I saw about Jim before the surgery was how hard he was struggling to breathe. And the day after the breathing tube was pulled out, he did not need supplemental oxygen,” Branam said.

“It felt like I was getting too much oxygen,” Lester laughs.

A new lease on life

After a couple of weeks of recovery and therapy, Lester was discharged. What will he do with this new lease on life?

“Well, I aim to go home, sit on my front porch, watch the traffic go up and down the street, and hug my wife,” Lester said.

Lester was the Gill’s first HeartMate 3 patient, but three others followed within 10 days. This phase of the trial is now closed, but the UK will be involved in the next phase, a “Continued Access Protocol” that permits all qualifying patients to receive the HeartMate 3 while FDA approval is pending.

Based on her initial involvement with the HeartMate 3 trial, Guglin has great hopes for the device.

“It’s an amazing feeling when you come to see the patient next morning after the surgery and their skin color is different and there is life in them,” she said. “And when they are being discharged 10 days or two weeks later it’s gratifying to see how much they improved on your watch because of the intervention you were able to offer.”


Next Steps

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.