All posts by Christopher Boyce

Former UMKC School of Medicine residents team up on groundbreaking elbow transplant

Elbow550
Reggie Cook (front) with Eric Sides and Lisa Lattanza

Orthopedic surgeon Eric Sides initially laughed off Reggie Cook’s idea. Too crazy.

“I don’t understand why you can’t take my left elbow off and put it on my right side,” said the 37-year-old Cook, who lost use of his arms seven years ago after a car accident.

But then Sides thought about the suggestion, and it actually made sense. Cook’s left arm was paralyzed by nerve damage, but the joint was undamaged. The right arm had movement, but the elbow joint had been shattered beyond repair in the accident.

Sides’ thoughts then went to his friend, Lisa Lattanza, considered one of the world’s leading elbow experts. Training together at the University of Missouri-Kansas City School of Medicine led to their close kinship and prominent surgical careers.

Though their orthopedic residencies ended two decades ago and Lattanza is in California and Sides is in Texas, the two remained close. Sides talked to Lattanza about Cook’s unusual request and they came to a conclusion: Why can’t we do this?

They recently joined forces in what’s thought to be the world’s first elbow-to-elbow transplant. The groundbreaking surgery offers a new hope for Cook to live an independent life.

 A desperate request

Cook approached Sides, one of the most sought-after orthopedic surgeons in El Paso, Texas, when no other doctor offered options.

In January 2009 after a long night at work, Cook fell asleep at the wheel and crashed. He was in a coma for months. He suffered brain trauma, broke 14 bones in his neck and was left practically a quadriplegic.

Cook’s legs are partially paralyzed and he uses a wheelchair to get around. But his biggest challenge was the loss of mobility in both arms. A nurse came to his house each day to help him change, shower, use the restroom, make him something to eat, brush his teeth. Cook lives with his sister and her family. He credits her, his daughter and dark humor for keeping his spirit lifted.

There have been glimmers of hope before. His left arm is permanently nerve damaged and paralyzed, but an attempt to rebuild his shattered right arm showed promise. In 2013, an artificial joint made of metal and plastic gave him his right arm back —for a few weeks. The delicate joint ripped, a blood clot formed and became infected.

So doctors removed the joint to treat the infection, then reinstalled it. Another infection. Each time the joint was taken out, doctors had to scrape away part of the bone to get rid of the infection, until he had only a few inches of bone in the upper arm, and not much more of the bones in his forearm.

Doctors told him the artificial joint wouldn’t work. They didn’t know what else to do. That’s what led to Cook’s unusual request of Sides that brought in Lattanza, chief of hand, elbow and upper extremity surgery at the University of California, San Francisco.

UMKC School of Medicine Residency

Residents, then and now, divide their time among Children’s Mercy, Saint Luke’s Hospital and Truman Medical Center.

“Through UMKC, the surgeons we worked with were incredible,” said Lattanza, who completed her residency in 1998. “That’s where I learned how to perform surgery. Now I teach residents.”

She and Sides, who was two years ahead of her, were members of a tightknit group. The four-year program had three residents annually.

“We built such a close camaraderie as trainees because it could be so stressful at times,” Lattanza said. “We did battle together.”

“She’s like a sister to me,” said Sides, who completed his residency in 1996. “We would do anything for each other.”

Lattanza and Sides share a similar approach: they love surgery but detest bureaucracy. That the prospect of this surgery was completely out of the ordinary did not deter them.

“We’re doctors and we really want to help other people,” Lattanza said.

Sides accompanied Cook to San Francisco for an array of consultations and for the surgery on April 15 of this year.

A novel surgery

Planning the 12-hour surgery took more than six months. While it might seem like Cook had nothing to lose from the surgery, Lattanza said the surgery actually could have made things even worse for him. He could have lost his right arm. He could have lost the use of his right hand.

On the plus side: a transplant of Cook’s tissue meant no risk of the rejection that might occur with a donor elbow. And actual bone would hold up better than an artificial joint.

On the challenging side: elbows are among the most complicated joints in the body. Knees, shoulders and hips have only one connection where bones meet; elbows have three. And all of the nerves and blood vessels that serve the hand run over the elbow.

Another major complication in this surgery: Moving Cook’s own elbow from the left to right is the mirror image – or reverse – of the one it would replace.

Planning included simulated 3D computer surgery. They then practiced on cadavers to figure out the obstacles when moving the elbow from left to right.

“A big issue was making sure that we did not injure any nerves, which would have altered his hand function and made him worse,” Lattanza said. “Everything was very scarred from his first four surgeries.”

Lattanza compared the surgery and its preparation to choreographing a complex ballet where everyone had precise moves to execute at specific points in time. The troupe was a team of more than a dozen surgeons, nurses and medical technicians. Surgeons performed simultaneously on both sides of Cook.

Due to state licensing restrictions, Sides did not get to scrub in to the surgery, but he participated.

“It was great to be in the operating room again with Eric again,” Lattanza said. “Everyone on the team performed flawlessly and I don’t think I have ever used all my skill and brainpower to this extent. It was exhilarating.”

Although there will have to be a follow-up surgery to reconstruct ligaments, the elbow transplant is so far a success. Cook remains in San Francisco with Lattanza examining him routinely and Sides checks in by phone.

As planned, Cook’s left arm was amputated during the procedure and he nicknamed the stump “Mighty.”

“He’s doing quite well,” Lattanza said. “After 10 days, he bent his arm and he hadn’t done that in seven years. He was quite emotional.”

“We are cautiously optimistic, but he has a long way to go. If the elbow heals and works, he definitely will be better off than when we started.”

Future

Sides, who specializes in adult reconstructive surgery and sports medicine, hopes to team up with Lattanza again.

If Cook’s transplant is successful, it could be a useful example for other patients. Sides said similar procedures could be used on legs or other parts of the body. One application might be a war-wounded veteran.

News of Cook’s unusual surgery has received national media attention. UMKC School of Medicine faculty and their former residency colleagues have celebrated the medical advance.

“It makes me and all of us very proud, because this really is a first,” said Mark Bernhardt, chair of the UMKC School of Medicine Department of Orthopaedic Surgery. “I worked closely with each of them each during their four years, and they were both bright, inquisitive, talented, committed residents.

“Look what teamwork did here. It proved it is a crucial part of patient care.”

Bernhardt announced that Lattanza will be the annual Dr. Rex L. Diveley visiting professor in April 2017 at the UMKC School of Medicine. She will interact and lecture with students and faculty for two days.

In an email, Lattanza wrote to Bernhardt and other UMKC faculty and colleagues.

“Every one of you was there in the operating room with us. We could not have even dreamed or attempted this without the fabulous training and confidence that you all gave us during residency.”

School of Medicine researcher published in New England Journal of Medicine

 Daniel Pauley, M.D., PH.D.
Daniel Pauley, M.D., Ph.D.

Daniel F. Pauly, M.D., Ph.D., professor of medicine, biomedical and health informatics, and chief of cardiology, is co-author of a research article published in the Jan. 21 issue of the New England Journal of Medicine.

The article examined peripartum cardiomyopathy — deterioration of heart function for women in their last month of pregnancy and up to six months postpartum — and how it shares some clinical features with idiopathic dilated cardiomyopathy, a disorder caused by mutations in more than 40 genes, including TTN, which encodes a protein.

“Peripartum cardiomyopathy is a poorly understood, life-threatening disorder,” Pauly said. “Our hope is that unraveling its molecular causes will lead to more effective treatments for the young mothers it afflicts.”

Pauly started at the School of Medicine in 2013.

The New England Journal of Medicine, first published in 1812, is the most widely read, cited and influential general medical periodical in the world.

 

Hoffman takes part in Google competition

Mark Hoffman
Mark Hoffman

Mark Hoffman, director of the Center for Health Insights, was one of 10 national finalists who competed in Medstro’s Google Wearables in Healthcare Challenge before judges on April 23 at Google’s Cambridge, Massachusetts headquarters.

“For me, this is about the opportunity to do some work at the leading edge and about broadening precision medicine, putting a very personal face — in this case some special children — on a technology initiative,” said Hoffman, who also serves as director of translational bioinformatics at Children’s Mercy.

Hoffman’s Challenge entry was on “Precision Medicine: Personalized ‘normal’ temperature,” proposing that the Raiing Medical iThermonitor could be used to study baseline “normal” body temperatures. The entry was among the 10 selected out of 89 entries by voters and judges, and the only one selected west of Philadelphia.

Though Hoffman didn’t win the $10,000 top prize for his entry, he received a dozen Raiing thermometers from the company to begin research.

“I’m excited to start this collaboration,” Hoffman said. “It was great networking all around and a great learning experience. I want to encourage students to compete in the future.”

Hoffman’s wearables entry was inspired by the multiple health challenges facing the Szajnuk family, the three grandchildren of the choir director at Hoffman’s church. The three children struggle with pain, inability to cool down when they become warm and other symptoms. Hoffman’s #Research blog post includes more information.

Before joining UMKC and Children’s Mercy in 2013, Hoffman spent 16 years leading genomics, public health and research initiatives at Cerner, where he was a vice president.

Hoffman took part in the recent Middle of the Map Fest, a panel discussion on “Homegrown Tech for Social Good.”

Center for Health Insights director leads medical wearables challenge

Mark Hoffman, Ph.D., is director of UMKC's Center for Health Insights.
Mark Hoffman, Ph.D., is director of UMKC’s Center for Health Insights.

Mark Hoffman, director of the University of Missouri-Kansas City Center for Health Insights, is a leader in the Wearables in Healthcare Pilot Challenge. Voting ends Saturday, March 28, and requires a short registration on Medstro, a social network for physicians, medical students, researchers and the interested public.

Winners of the seven initial awards are given the opportunity to pitch to Google’s Boston headquarters to win up to $10,000 to support the project. With less than a week remaining in the voting, Hoffman’s two entries — both emerging devices rather than inventions — were in the Top 5 of 89 entries and were leading their categories.

“For me, this is about more than prizes; it is about the opportunity to do some work at the leading edge and about broadening precision medicine and putting a very personal face, in this case some special children, on a technology initiative,” said Hoffman, who also is director of Translational Bioinformatics at Children’s Mercy.

Hoffman’s entries for wearables projects were inspired by the multiple health challenges facing the Szajnuk family, the three grandchildren of the choir director at Hoffman’s church. The three children struggle with pain, inability to cool down when they become warm and other symptoms. Hoffman’s #Research blog post includes more information.

Here are the voting site links to Hoffman’s entries:

Before joining UMKC in 2013, Hoffman spent 16 years leading genomics, public health and research initiatives at Cerner, where he was a vice president.

Collaboration to analyze local health in context of national data

Bioinfo550The University of Missouri-Kansas City’s Center for Health Insights and clinical partner Truman Medical Centers are announcing a collaboration to conduct data-driven research using Cerner Health Facts® de-identified real-world data and other capabilities.

Few academic research centers in the world have access to this vast amount of medical data. The information will be used to identify new research opportunities and analyze local health in the context of national data. This analysis can inform decisions that support improved care, reduced health disparities and lower costs.

This collaboration marks the first time i2b2 — Informatics for Integrating Biology and Bedside, funded by the National Institutes of Health — and Health Facts have been used together to fuel research in the Kansas City area.

“The centerpiece of this partnership provides tools to accelerate clinical and translational research and ultimately provide better health outcomes,” said Lawrence Dreyfus, UMKC vice chancellor for Research and Economic Development. “We couldn’t be more excited about the prospects that this partnership holds for healthcare decisions that ultimately improve care and reduce costs.”

“This collaboration further shows TMC is Kansas City’s essential hospital; with our large, diverse patient base we offer a vast array of varying health data that few, if any, other hospitals in the area can offer,” said TMC President and Chief Executive Officer Charlie Shields. “The long-term goal is to provide all patients better care with better outcomes at a lower cost and TMC is thrilled to be a part of the future of data-driven healthcare.”

“Cerner’s mission is to contribute to the systematic improvement of health care delivery and the health of communities,” said Matthew Swindells, Cerner senior vice president for population health and global strategy. “We’re excited to work with two excellent academic and clinical institutions like Truman Medical Centers and UMKC to help make that mission a reality and contribute to improving the health of the people of Kansas City.”

Through this collaboration, UMKC will serve as a key collaborator as new types of data are added to Health Facts.

“I am thrilled that the Center for Health Insights can foster new collaborations between UMKC, Truman Medical Centers and Cerner,” said Mark Hoffman, director of the UMKC Center for Health Insights. “There is much more that these organizations can do together to promote research and help improve patient care in Kansas City.”

School of Medicine recognizes Kansas City philanthropist James B. Nutter with honorary doctorate

The School of Medicine recognized Kansas City businessman and philanthropist James B. Nutter with an honorary doctorate during the commencement ceremony on May 22 at the Kansas City Music Hall.
The School of Medicine recognized Kansas City businessman and philanthropist James B. Nutter with an honorary doctorate during the commencement ceremony on May 22 at the Kansas City Music Hall.

Drive into the Westport neighborhood and you can’t help but notice rows of bungalows and older houses painted vivid shades of yellow, red, pink, turquoise and lavender. Called Nutterville, it is symbolic of James B. Nutter Sr.’s vision for a strong, bright, healthy urban core in Kansas City.

For his revitalization and philanthropic efforts, Nutter received an honorary doctorate from the University of Missouri-Kansas City School of Medicine during Commencement exercises Thursday, May 22 at Municipal Auditorium Music Hall.

“The School of Medicine advances the health of our community through research and the education of future physicians and health care providers. But the health of a community depends on more than good health care,” said Betty Drees, dean of the School of Medicine. “Mr. Nutter has a lifetime history of promoting health in Kansas City, not only through his generous philanthropy but by advocating for safe and affordable housing. He continues to make Kansas City a healthier community to live, work and enjoy.”

Nutterville surrounds James B. Nutter & Company, the national headquarters of the mortgage company he founded in 1952. In the 1950s and 1960s, Nutter refused to adhere to the discriminatory lending practices of the day. As a result, his company was one of the first to make home loans in black neighborhoods and to single women on a large scale.

Nutter has supported UMKC and the urban neighborhoods that surround the Volker and Hospital Hill campuses. Through his leadership, a fire station at 37th Street and Woodland Avenue was renovated to become the Ivanhoe Community Center. After the center opened in 2006, crime dropped and the number of drug houses decreased. He also helped establish the Jim Nutter Park in the Ivanhoe neighborhood, developed with Boundless Playgrounds, a nonprofit organization dedicated to building inclusive playgrounds for children with disabilities. He also endowed and the built the playground in front of Children’s Mercy.

At UMKC, students at the Henry W. Bloch School of Management attend lectures in the James B. Nutter Family Classroom. Nutter’s revitalization efforts helped bring businesses like Costco and Home Depot to the center of Kansas City.

Nutter’s generosity and commitment to Kansas City have been recognized through the years. In 2012 he was named Kansas Citian of the Year by the Greater Kansas City Chamber of Commerce and received the Harold L. Holliday Sr. Civil Rights Award from the NAACP’s Kansas City branch. He is a member of many boards, including the Harry S. Truman Library Institute, Children’s Mercy and Truman Medical Center Charitable Foundation.

Health Sciences students gather in team learning environment

Students from the UMKC Health Sciences Schools of Medicine, Dentistry, Nursing and Health Studies and Pharmacy gathered in the School of Medicine's Theater C and other classroooms across the Hospital Hill Campus on Feb. 21 for an afternoon of interprofessional education classes.
Students from the UMKC Health Sciences Schools of Medicine, Dentistry, Nursing and Health Studies and Pharmacy gathered in the School of Medicine’s Theater C and other classrooms across the Hospital Hill Campus on Feb. 21 for an afternoon of interprofessional education study.

Providing quality patient care in today’s world is becoming a team effort. Health care educators are taking a team approach to teaching it as well.

More than 560 students from the UMKC Health Sciences Schools of Medicine, Dentistry, Nursing and Health Studies and Pharmacy participated in an afternoon of interprofessional education on Friday, Feb. 21, with synchronized classes in classrooms throughout the Hospital Hill Campus. Classes included teleconferencing with UMKC School of Pharmacy students on the University of Missouri campus in Columbia, Mo.

During the classes, pre-assigned groups of students from seven disciplines — dentistry, dental hygiene, medicine, physician assistant, nursing, graduate nursing, and pharmacy —  learned about patient safety and worked together to solve problems in small and large groups.

Stefanie Ellison, M.D., assistant dean for curriculum at the School of Medicine, is one of the curriculum organizers.

“This won’t be just a one-day event,” Ellison said. “This will create a strong foundation for interprofessional education and collaboration at UMKC.”

Interprofessional education involves students from two or more disciplines learning together, with the charge of cultivating collaborative practice to provide patient-centered care.

“While interprofessional education is required by a number of accrediting boards, large scale instructional activities are rare, making this instructional activity unique,” said another of the curricular organizers, Linda Garavalia, professor and associate dean for academic affairs at the School of Pharmacy. “UMKC has been awarded interprofessional education grants for clinical experience but that involves a smaller number of students. This will add interprofessional education to classroom learning for a large number of students.”

School of Medicine plays host to Missouri Cures Foundation event

Ann Foundas, M.D., founding chair of School of Medicine's Department of Neurology and Cognitive Neuroscience, was one of two featured speakers at the Missouri Cures Education Foundation lecture on Oct. 2 at the School of Medicine.
Ann Foundas, M.D., founding chair of School of Medicine’s Department of Neurology and Cognitive Neuroscience, was one of two featured speakers at the Missouri Cures Education Foundation lecture on Oct. 2 at the School of Medicine.

Jackson County residents are in a vulnerable state of health, said Betty Drees, dean of the University of Missouri-Kansas City School of Medicine.

Statistics flashed on a big screen behind Drees at “Accelerating Cures in Our Community,” a program about the latest in medical treatments that could help area residents. The school, the Kansas City Area Life Sciences Institute and the Missouri Cures Education Foundation sponsored the Oct. 2 event. A few of the stats:

  • 20 percent of Jackson County residents report a vision problem
  • 13 percent of Jackson County deaths are from suicide
  • The prevalence of alcohol and drug use and Alzheimer’s are higher than most counties in the U.S.

Wayne Carter, president of the Kansas City Area Life Sciences Institute, discussed how the initiative for the Jackson County Translational Medicine Institute would address such critical local health issues. On the ballot Nov. 5, the institute — a partnership between UMKC, KCALSI, Children’s Mercy and Saint Luke’s Health System — would mean $800 million additional research dollars over 20 years that would generate more grant funding, jobs, economic development and, most importantly, more prevention, diagnoses, treatments and cures for what is ailing residents in Jackson County and across the country.

The added bonus, Carter said, is that 20 percent of the proceeds from commercialization of discoveries would come back to Jackson County to address heath.

Two UMKC School of Medicine department chairs discussed their promising research.

Nelson Sabates, chair of the Department of Ophthalmology and director of the Vision Research Center at UMKC, said the Jackson County population is at high risk for eye diseases including age-related macular degeneration, diabetic retinopathy and glaucoma.

“The aging baby boomer population makes the treatment of eye-related disorders a huge priority,” said Sabates, president and chief executive officer of Sabates Eye Centers.

The National Institutes of Health’s National Eye Institute estimates that currently more than 38 million Americans ages 40 and older experience blindness, low vision or an age-related eye disease. This is expected to grow to 50 million Americans by the year 2020. Sabates showed what typical vision looks like for those who have age-related macular degeneration, glaucoma and diabetic retinopathy —effective long-term treatments are not available for these conditions.

“We’re seeing younger patients all of the time because of diabetes and childhood obesity,” Sabates said.

The Vision Research Center at UMKC has a number of potential drugs and medical devices that are potentially ready to go through U.S. Food and Drug Administration approvals and then to patient care.

Anne Foundas, founding chair of the medical school’s new Department of Neurology and Cognitive Neuroscience, is building a clinical and research enterprise designed to develop new treatments for debilitating brain disorders in our region.

Foundas, who recently came to UMKC from Louisiana State University, showed the results from patients who stutter. An ear device has shown improvement on correcting speech.

Foundas also talked about her translational research in stroke treatment. Currently, stoke is the third most common cause of death.  One of the problems that occur in stroke survivors is spatial neglect, the inability to respond or orient with surroundings. Although speech, memory and other abilities might be spared in brain-injured patients with spatial neglect, the prognosis for recovery of independent function in patients with spatial neglect is worse than other disabling effects.

Foundas and collaborating researchers tested prismatic goggles on right-brain injured patients. The results demonstrated that patients’ functional activities improved after two weeks of prism adaptation treatment and continued improving for four weeks after.

Curators review design for housing on Hospital Hill campus

HHhousing
An artists’ drawing of the proposed student housing on Hospital Hill.

The University of Missouri-Kansas City has taken another important step toward the first student housing for the Hospital Hill Campus.

The Board of Curators of the University of Missouri System, meeting June 13, in Columbia, reviewed its design. More than 2,900 students attend the UMKC Schools of Dentistry, Medicine, Nursing and Pharmacy located on the Hospital Hill Campus.

The housing would give those UMKC students more options to be closer to classes and become a part of the community. Kansas City leaders have stated that student housing near the Hospital Hill campus would help redevelop surrounding neighborhoods.

The project, estimated at $30.33 million, will be funded by $26.63 million in debt financing and $3.7 million from Missouri state tax credits. Curators approved the plans for the student housing last January during a board meeting in Kansas City. Plans are for the apartments to be completed in July 2014, in time for use in the 2014 fall semester.

Gould Evans of Kansas City designed the project that includes 245 beds of apartment-style housing and 196 parking spaces located on the northeast corner of East 25th Street and Troost Avenue.

“The design is similar to the look of Oak Place Apartments,” said Bob Simmons, UMKC Associate Vice Chancellor of Facilities. The apartments at 5050 Oak St were built in 2008. “They have a contemporary look.”

The brick and cement-board-siding apartments will be a mix of one-, two- and four-bedroom units on five levels. The housing includes gated fences for secure private courtyards with exterior tables and grills. Building entry will be by card access and security cameras will be at all entrances and public areas. A pedestrian pathway across Troost Avenue will connect to the Hospital Hill Campus. A bus stop and bike racks are included in the design.

The plan is for the student housing to be a certified Leadership in Energy and Environmental Design (LEED) facility.