McMasters is the Ben A. Reid Sr., MD, professor and chairman of the Department of Surgery at the University of Louisville School of Medicine. He also serves as director of the Multidisciplinary Melanoma Clinic and is associate director of the James Graham Brown Cancer Center at UofL.

In his keynote address, titled “The Fundamental Difference Between Palliative Treatment and Palliative Care,” McMasters noted the audience was filled with those who have devoted their lives to the care of patients with cancer, and will perform research that will relieve suffering, improve quality of life, extend survival and find a cure.

Using one of his patients as an example, he argued that while regular tests and treatments make sense for patients whose cancer can be cured or their lives extended (with good quality), for those with recurring cancer who will eventually die from the disease, there is no evidence early detection of asymptomatic recurrence is any better than waiting until they are symptomatic. For those patients, regular tests and treatments can rob them of their quality of life.

“Our duty to our patients is to care for them, not just for their disease, but for who they are,” McMasters said. “Sometimes, it doesn’t make sense to put the patient through treatments and tests that in the end, won’t affect whether they live or die. They are often better served by living free of pain and suffering, happily in the company of those they love, doing the things that make life worth living.”

McMasters has personal experience of losing a loved one to cancer. He lost his son, Owen, to leukemia.

Also speaking on the topic during the keynote address was Shishir Maithel, MD, chair of the Winship Cancer Institute at Emory University.

McMasters specializes in melanoma, breast cancer, sarcoma, hepatobiliary tumors and pancreatic and gastric cancers. At the Brown Cancer Center, he works to identify the most effective combination of treatment including surgery, immunotherapy, targeted therapies, and radiation therapy for patients with all stages of melanoma.

He has been principal investigator or co-investigator of over 30 clinical trials, and president of the Society of Surgical Oncology, the Society of Surgical Chairs, the Western Surgical Association and the Southeastern Surgical Association. In 2018, he was named editor-in-chief of Annals of Surgical Oncology, and he has authored over 400 peer-reviewed publications and a book.

, is chief of Sports Medicine and an orthopedic surgeon with , and an assistant professor at the . A former football player and athlete himself, he specializes in sports injuries, and says it’s not uncommon for weekend or holiday warriors to end up in the emergency room after a fall on the slopes. But that doesn’t mean it can’t be safe, and there are ways to minimize your risk.

He said the biggest thing is to be realistic about your abilities, and not get overconfident. “People try to ski above their level. They get brave on the bunny slopes, then they think they can head for the Black Diamond,” he said.

For the uninitiated, Black Diamond slopes are difficult with steep gradients, and they are often full of bumps. A Double Black Diamond is the most difficult rating and should be skied by experts only. If you get on one of these and you’re not an expert — well, you were warned.

According to a review article published in a January 2018 issue of the Journal of the , the number of skier and snowboarder injuries continues to rise. The U.S. Consumer Product Safety Commission estimates more than 140,000 people were treated in hospitals, doctors’ offices and emergency rooms in 2015 for skiing and snowboarding-related injuries.

“It might seem like common sense, but don’t ski above your level of comfort, and wear proper safety equipment, such as a helmet, gloves and goggles,” Douglas said. “Always the helmet.”

A broken wrist or twisted knee can most likely be fixed, but a brain injury is much more serious.

The American Academy of Orthopaedic Surgeons says taking lessons is especially important for new skiers, and learning how to fall correctly can reduce the risk of injury.

Douglas said it’s also best to pick a time of day to ski when it’s less crowded, if you can. “It has happened on crowded slopes where a skier has been struck by someone else moving much faster than them.”

Common injuries

A wide range of injuries can occur, with injuries to ligaments more common than fractures. Douglas said the majority fall into two groups: Knee injuries, particularly to the anterior cruciate ligament due to twisting; and because skiers and snowboarders often put their arms out to break a fall, a broken wrist or shoulder injury such as a fracture, separation or dislocation. A separated shoulder is an injury to the ligaments that hold your collarbone to your shoulder blade.

Douglas said injuries to the upper body can be worse as that part “has an extra second to accelerate before hitting the ground.”

Skiers who fall on an outstretched hand while holding a ski pole can get “skier’s thumb,” an injury to the ligament that connects the bones of the thumb together.

Snowboarding injures tend to be more common and severe than skiing injures, Douglas said, as ski bindings are designed to come loose in the event of a fall, with the skis flying away, while a snowboard remains attached. With the snowboard strapped on, those who fall often suffer twisting or rotational injuries to the knees, as well as a broken wrist or separated shoulder. He said snowboarding injuries are more likely to require surgery or hospitalization.

Injuries to novice skiers also tend to be less severe than for those who are more advanced, Douglas said. “More experienced skiers are also less likely to take a doctor’s advice.”

Whether novice or experienced, the American Academy of Orthopaedic Surgeons recommends the following to stay safe on the slopes:

Proper preparation

• Maintain fitness. Be in good physical condition when you set out. If you are out of shape, select runs carefully and gradually build your way up to more challenging trails. Many ski injuries happen at the end of the day, when people are tired and try to get in one last run.
• Warm up. Research has shown cold muscles are more prone to injury. Warm up with jumping jacks or running or walking in place for 3 to 5 minutes. Take a couple of slow ski runs before moving on to something more difficult.
• Drink water. Even mild levels of dehydration can affect physical ability and endurance. Drink plenty of water before, during and after.
• Know safety rules. Understand and abide by rules of the ski resort. Know general safety rules of skiing, such as how to safely stop, merge and yield to other skiers.
• Learn ski lift safety. Before your outing, learn how to properly get on and off a lift.

Ensure Appropriate Equipment

• Wear several layers of light, loose and water- and wind-resistant clothing for warmth and protection. Layering allows you to accommodate your body’s constantly changing temperature.
• Boots and bindings. Buy or rent boots and bindings that have been set, adjusted, maintained and tested by a ski shop that follows American Society of Testing and Materials (ASTM) standards.
• Check the binding of each ski before skiing. Bindings must be properly adjusted to your height, weight and skiing ability.
• Safety gear. Wear appropriate protective gear such as a helmet and goggles. Helmets are sport-specific, so do not wear a bike helmet on the slopes. Ski helmets should be worn.

Ensure a Safe Environment

• Stay on marked trails and avoid potential avalanche areas.
• Watch out for rocks and patches of ice on trails.
• Pay attention to warnings about upcoming storms and severe drops in temperature. Make adjustments for icy conditions, deep snow, powder and wet snow.

Prepare for Injuries

• Ski or snowboard with partners and stay within sight of each other. If you get ahead of your partner, stop and wait.
• Seek shelter and medical attention immediately if you, or anyone with you, is experiencing hypothermia or frostbite. Make sure everyone is aware of proper procedures for getting help if injuries occur.

“Three-hundred lung transplants is a significant milestone for Jewish Hospital Transplant Care,” said , director of the Transplantation Program at Jewish Hospital and chief of the division of Transplant Surgery at and the . “We recognize the selfless sacrifice of all organ donors, celebrate the improved lives of our organ recipients, and recognize the impact of everyone on the transplant team for their lifesaving and life-changing work.”

The 300^th lung transplant was performed Tuesday, Sept. 18, on a 71-year-old man from northern Kentucky who suffered from pulmonary fibrosis. The patient was on the transplant list for two months before undergoing a lung transplant. The surgery was performed by , surgical director of the Lung Transplant Program at Jewish Hospital and chief of Thoracic Surgery at UofL Physicians and the UofL School of Medicine.

“Each year, we are performing more and more lung transplants at Jewish Hospital, and it is exciting to hit this milestone as this momentum continues,” said Dr. van Berkel, “When I first started, we were doing between five to 10 lung transplants a year. Now we are closer to 20 lung transplants a year, and we’re trying to grow that even further.”

The first lung transplant at the hospital took place in 1991, and the first double lung transplant in 1995. Since then, transplantation has seen significant advancements in anti-rejection medications, surgical techniques and other technologies, helping Jewish Hospital achieve one-year survival rates higher than the national average.

In 2017, the Jewish Hospital Trager Transplant Center’s program with UofL became the first transplant program in Kentucky, and only the second program in the region, to begin offering Ex Vivo Lung Perfusion (EVLP). EVLP is a leading-edge technology that allows for an expansion of the Lung Donor Pool that will allow more patients to receive lifesaving lung transplants.  

“The Jewish Hospital and UofL transplant team are helping save lives in our community each day,” said Ronald Waldridge, MD, president of . “The team is one of the leading providers of organ transplantation in the United States, and milestones like the 300^th lung transplant remind us how important this work is daily. We’ve come so far since the first lung transplant in 1991, and we’re looking forward to many more lives impacted.”

On Thursday, doctors and lung transplant recipients gathered at the to celebrate the 300^th milestone and the many lives that have been saved over the years thanks to lung transplantation. 

“When I first started my training, we used to have a firm age limit of 65. That was the absolute limit for transplantation,” said , medical director of the Lung Transplant Program at Jewish Hospital and a pulmonologist with UofL Physicians and assistant professor at the UofL School of Medicine. “These days, we are extending that age and our oldest recipient got their lungs at age 75, so we are continuing to push the envelope in terms of being able to offer transplants to older patients, and patients who are sicker who we would not have considered doing a transplant on 5 to 10 years ago.”

Dr. Jill Jacobs is among the 300^th lung recipients at Jewish Hospital. Jacobs was the 271^st recipient, and was also a double lung transplant recipient. Jacobs says she smoked cigarettes for about 40 years, and by the time she stopped, had already developed chronic obstructive pulmonary disease (COPD).  

“I had the transplant in February of 2017,” Jacobs said. “I have been extremely happy and grateful that I had doctors who have given me my life back. They’ve given me a new life, in fact.”

Jacobs said before the transplant, she couldn’t even do simple things, like getting dressed, without being short of breath. She says the has helped change her life.

“I can’t tell you how happy I am that I went to Jewish to have this done,” Jacobs said. “It’s a gift nobody can believe. It’s a miracle, in my opinion. A miracle.”

Earlier this year, the Jewish Hospital Trager Transplant Center – a joint program with the UofL Physicians, the UofL School of Medicine and KentuckyOne Health – also celebrated its 500^th heart transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

Hepatitis C, a blood-borne illness, is prevalent in the Louisville area and throughout the state. Currently, providers are encouraged to test for hepatitis C only in patients with certain risk factors or who are a part of the Baby Boom generation (born 1946-1964). 

“A growing body of evidence suggests age and risk-based screening is missing a significant number of people, including children, with hepatitis C infection. Universal hepatitis C screening will be a future standard of care,” said , a family nurse practitioner specializing in gastroenterology and hepatology who leads the Hep C Center at UofL Hospital. Cave is helping to organize the event.

Kentucky has one of the highest hepatitis C infection rates in the country – seven times the national average. “Up to half of patients who have it may not know they are infected, and people may carry the disease for decades before they have symptoms,” Cave said.

While in the past certain groups were known to be at risk, Cave said a recent spike in hepatitis C cases among those who have no or unrecognized risk factors has prompted health officials to consider screening all adults. This spring, the state of Kentucky passed a law requiring all pregnant women to be tested for hepatitis C, as the disease can be passed from mother to baby. The law went into effect July 1. Kentucky is the first state in the nation to require universal hepatitis C screening in pregnant women.

“The goal of the World Hepatitis Day screening event is to expand testing and awareness, link more people to curative treatment, and normalize the conversation about hepatitis C,” said Cave. “There should be no stigma surrounding hepatitis C. Anyone could have it, including babies.”

Screenings will be offered from 10 a.m. to 6 p.m. on Saturday, July 28. Screening is done with a simple finger prick, similar to checking a blood sugar, and results will be available on site in 20 minutes. Hepatitis C experts will be available at all sites to answer questions, and help link those affected by hepatitis C to appropriate care.

This is the second year UofL Hospital and community partners are offering the free screenings on World Hepatitis Day. Screening sites, staffed by more than 130 health care volunteers, will be set up in Louisville and Jefferson County, along with sites in Oldham, Shelby and Bullitt counties and Clark County, Indiana. Last year, 488 people were tested. Cave said she hopes to double that number this year.

There are some known risk factors for hepatitis C:

• Born between 1945 and 1965. The recommends screening for all baby boomers.
• A blood transfusion or organ transplant prior to 1992
• Had blood filtered by a machine (hemodialysis) for a long period of time because kidneys were not working
• IV drug use at any point in life, even if just once
• Intranasal drug use at any point in life
• HIV or hepatitis B infection
• Healthcare workers exposed to blood through a needle stick or other contact with blood or bodily fluids
• Exposure to contaminated tattoo equipment, including ink
• Men who have sex with other men
• Prior military service. “Older veterans are particularly at risk due to the use of the old ‘jet gun’ vaccinators by the military, and from combat injuries requiring blood transfusion,” Cave said.

Contaminated dental equipment, such as that used before most items were single patient/single use, may have also spread hepatitis C, and Cave said the virus can live on a surface for six weeks if not sterilized properly.

But there are many cases of hepatitis C that are not tied to any risk factors, Cave said.
Left untreated, the disease can cause major complications. It can cause cirrhosis of the liver or liver cancer, and is a leading cause of liver transplant. Hepatitis C may also predispose those infected to diabetes and depression, and has an association with joint pain, certain skin disorders and lymphoma.

World Hepatitis Day is marked across the globe on July 28 every year. The purpose is to increase awareness of viral hepatitis, including hepatitis A, B and C. “We have a local goal to decrease the stigma about hepatitis C, and let people know it is easy to test for and treat,” said Cave.

“Some may still remember the old days of treating hep C when treatment was difficult,” Cave said. “It involved a triple therapy with interferon that lasted almost a year, with multiple side effects. Not everyone was a candidate for treatment, and some patients opted to not get treated at all.

“Today, hepatitis C is easily curable and relatively inexpensive to treat. Treatment is one pill, once a day, for 8-12 weeks – with minimal side effects. It is covered by almost all insurance plans, including Medicare and Medicaid. Cost and side effects are no longer an excuse to defer treatment.”

Partners with UofL Hospital in the screening event include the Louisville Metro Department of Health and Wellness, the Kentucky Department of Public Health, KentuckyOne Health, Volunteers of America, the Sullivan University College of Pharmacy, the nursing programs of Galen University and Bellarmine University, and University of Louisville Schools of Medicine, Nursing, Dentistry and Public Health.

Free hep C testing sites on July 28

• St. Matthews Mall (2 sites within the mall), 5000 Shelbyville Road, Louisville, 40207
• Walgreens, 3980 Dixie Highway, Louisville, 40216
• Walmart, 10445 Dixie Highway, Louisville, 40272
• Walmart, 500 Taylorsville Road, Shelbyville, 40065
• Walgreens, 152 N. Buckman St., Shepherdsville, 40165
• Walgreens, 4310 Outer Loop, Okolona, 40219
• Wayside Christian Mission, 432 East Jefferson St., Louisville, 40202
• CVS Pharmacy, 1002 Spring St., Jeffersonville, IN 47130
• CVS Pharmacy, 1950 State St., New Albany, IN 47150
• Kroger, 10645 Dixie Highway, Louisville, 40272
• Walmart, 7100 Raggard Road, Louisville, 40216
• Southwest Family YMCA, 2800 Fordhaven Road, Louisville, 40214
• Oldham County Family YMCA, 20 Quality Place, Buckner, 40010
• Kroger, 2710 W. Broadway, Louisville, 40211
• CVS Pharmacy, 3229 Poplar Level Road, Louisville, 40213
• Walmart, 11901 Standiford Plaza Drive, Louisville, 40229
• St. Stephen Church, 1018 S. 15th St., Louisville, 40210
• Churchill Downs, Backside

Dramatic, yes, but it’s a scene that could happen, and it’s the plot of a new CPR training film developed by a University of Louisville doctor. , physician director for resuscitation at and an assistant professor at the UofL School of Medicine, is hoping the novel approach will improve high school CPR training by helping students remember what they have learned by applying it to a real-life situation they can relate to.

CPR instruction in high school is now required by law in a growing number of states. Thirty-nine states have passed laws requiring the training before graduation, including Kentucky, which passed its law in 2016. Similar laws are being considered in the remaining states.

“The goal is to create a real, emotional scenario,” said Brown. “There are so many lives that could be saved if more Americans knew CPR, and we have all of these students coming out of high school with CPR training.”

About 4 million students per year now graduate with CPR training. Brown has studied CPR training in high school, with her work in the . She found CPR skill retention in high school students was poor, with only 30 percent able to perform adequate CPR six months after training. She also found that there was no standard method of implementation.

“We wanted to know, is there a better way to do it?” she said.

That’s where the film comes in. Working with the local and using $10,000 in grant money she received from winning the prestigious Stamler award for young researchers at Northwestern University last October, she modeled the film after one done in the United Kingdom, where CPR training also is required.

The interactive film, designed for classroom use in high schools and shot at by a local film company, forces students to make choices along the way about how to respond. It will be rolled out in local high schools this fall, then Brown will determine whether it improves skill retention. If it does – and Brown said she believes it will – the plan is to expand it across Kentucky and the nation.

“This could be a game-changer in the way CPR is taught in the United States,” she said.

The film used six local high school and college actors, and paramedics from , who brought an ambulance for one scene. In the film, the coach (Brown’s real-life husband, who auditioned for the part) suffers cardiac arrest during basketball practice, and staggers out into the lobby, where he becomes unconscious and falls onto the floor. He is found by a player, who, along with the other students at practice, must call an ambulance and perform CPR on the coach together until the paramedics arrive. The coach regains consciousness, and the students are congratulated by paramedics for saving his life.

In the United States, 350,000 people suffer cardiac arrest outside a hospital each year. Only 30 percent get bystander CPR, which affects whether they survive, Brown said. Only 11 percent of the 350,000 receive CPR. Brown has said that if CPR survival improved by just 1 percent, 3,500 more people would live.

Expanding and improving CPR training has been a personal mission for Brown, who has worked for several years on unique approaches.  These days, effective CPR is hands-only, removing a barrier for some from the old mouth-to-mouth method. She also founded and directs a program called “Alive in 5” (), a 5-minute method of teaching CPR she developed.

The wants to double the percentage of cardiac arrest victims who receive bystander CPR by 2020, and CPR training in high schools has been endorsed by a variety of organizations.

“It’s important that people be willing to act, and that they remember the skills that they’ve learned,” she said. “As most cardiac arrests that don’t occur in a hospital happen in homes, it is likely they will save the life of someone important to them.”

See the filming

To watch a video on the making of the film, click .

With increasing evidence that an artificial pancreas can improve glucose control in patients with type 1 diabetes, investigators had sought to see if it could also help patients with type 2 diabetes.

The study also found the improved glucose control in patients with type 2 diabetes was achieved without increasing the risk of hypoglycemia. One of the major limiting factors in achieving improved glucose control is the increase in hypoglycemic events.

Conducted by researchers at the University of Cambridge and Manchester University in the United Kingdom, along with the University of Bern in Switzerland, the study was published to coincide with a presentation at the American Diabetes Association’s 78th Scientific Sessions in Orlando, Florida. 

It was notable as most studies of automated closed-loop insulin delivery systems include patients with type 1 diabetes, said Sri Prakash Mokshagundam, MD, an endocrinologist and diabetes specialist with University of Louisville Physicians. It also focused on hospitalized patients, where most studies have focused on outpatients who were already on insulin, he said. About 25 percent of hospitalized individuals have diabetes.

In the study, patients who were not already on a pump or sensor to control their diabetes prior to admission were placed on the system upon admission to the hospital. Mokshagundam said that using the technology in an inpatient setting has certain advantages, such as less burden on nursing staff as they try to manually adjust insulin doses. Meal-time insulin delivery still has to be planned by the health care team.

He said that while the technology helps in the acute setting, procedures need to be developed to transition it from acute to chronic care after patients leave the hospital.

He noted there also are some hurdles at this time to implementing the technology in the United States, as the technology used in the study has not yet been approved by the U.S. Food and Drug Administration for inpatient use here. A slightly different type of system has been approved for outpatient use, which uses a different algorithm to calculate the dose.

“The study that shows that this can be done, but we are still a ways off before this becomes routine practice,” Mokshagundam said. “There is some refinement needed.”

The technique, reported this week in the journal Nature Materials, uses synthetic hydrogel particles (microgels) to present a protein known as the Fas ligand (FasL) to immune system T-effector cells along with the pancreatic islets being transplanted. The FasL protein “educates” the effector cells – which serve as immune system watchdogs – causing them to accept the graft without rejection for at least 200 days in an animal model.

The FasL-presenting particles are simply mixed with the living islets before being transplanted into the mice, which suffer from chemically-induced diabetes. The researchers believe the FasL-presenting hydrogels would not need to be personalized, potentially allowing an “off-the-shelf” therapy for the transplanted islets.

Researchers from the University of Louisville, Georgia Institute of Technology and the University of Michigan collaborated on the work, which was supported by the Juvenile Diabetes Research Foundation and the National Institutes of Health.

“We have been able to demonstrate that we can create a biomaterial that interrupts the body’s desire to reject the transplant, while not requiring the recipient to remain on continuous standard immunosuppression,” said , the Dr. Michael and Joan Hamilton Endowed Chair in Autoimmune Disease at the University of Louisville School of Medicine and director of the Molecular Immunomodulation Program at the Institute for Cellular Therapeutics at UofL.

“We anticipate that further study will demonstrate potential use for many transplant types, including bone marrow and solid organs,” he said.

In the United States, some 1.25 million persons have type 1 diabetes, which is different from the more common type 2 diabetes. Type 1 diabetes is caused by immune system destruction of the pancreatic islet cells that produce insulin in response to glucose levels. Current treatment involves frequent injection of insulin to replace what the islets no longer produce. There is no long-term cure for the disease, though persons with type 1 diabetes have been treated experimentally with islet cell transplants – which almost always fail after a few years even with strong suppression of the immune system.

“Drugs that allow the transplantation of the islet cells are toxic to them,” said Andrés García, the Rae S. and Frank H. Neely Chair and Regents’ Professor in Georgia Tech’s George W. Woodruff School of Mechanical Engineering. “Clinical trials with transplantation of islets showed effectiveness, but after a few years, the grafts were rejected. There is a lot of hope for this treatment, but we just can’t get consistent improvement.”

Among the problems, García said, is toxicity to the islet cells from the immune system suppression, which also makes patients more susceptible to other adverse effects such as infections and tumors. Other researchers are exploring techniques to protect the islets from attack, but have so far not been successful.

The research reported in Nature Materials takes a totally different approach. By presenting the FasL protein – which is a central regulator of immune system cells – the researchers can prevent the immune system from attacking the cells. Once they are educated at the time of transplantation, the cells appear to retain their acceptance of the transplanted islet cells long after the FasL has disappeared.

“At the time of transplantation, we take the islets that are harvested from cadavers and simply mix them with our particles in the operating room and deliver them to the animal,” García explained. “We do not have to modify the islets or suppress the immune system. After treatment, the animals can function normally and are cured from the diabetes while retaining their full immune system operation.”

The hydrogels can be prepared up to two weeks ahead of the transplant, and can be used with any islet cells. “The key technical advance is the ability to make this material that induces immune acceptance that can simply be mixed with the islets and delivered. We can make the biomaterial in our lab and ship them to where the transplantation will be done, potentially making it an off-the-shelf therapeutic.”

In the experimental mice, the islets were implanted into the kidneys and into an abdominal fat pad. If the treatment is ultimately used in humans, the islets and biomaterial would likely be placed laparoscopically into the omentum, a tissue with significant vasculature that is similar to the fat pad in mice. Garcia’s lab has previously shown that it can stimulate blood vessel growth into islet cells transplanted into this tissue in mice.

In future work, the researchers want to see if the graft acceptance can be retained in more complex immune systems, and for longer periods of time. By reducing damage to the cadaver islets, the new technique may be able to expand the number of patients that can treated with available donor cells.

García’s lab uses polymer hydrogel particles that are about 150 microns in diameter, about the same size as the islet cells. They engineer the particles to capture the FasL – a novel recombinant protein developed by Shirwan and Esma S. Yolcu, associate professor of microbiology and immunology at the University of Louisville – on the particle surface, where it can be seen by the effector cells.

One of the 73 young patients who received a medal was 5-year-old Drew Krause, who has acute lymphocytic leukemia. Drew’s medal came from UofL medical student Luke Meredith, who ran the MiniMarathon.

Drew’s mother is herself a doctor – Andrea Krause, MD, a pediatric hospitalist at UofL. She said when Drew was diagnosed on Nov. 30, 2016:“the Krause family’s lives changed forever.”

Krause said she ran a half marathon when she was a fourth-year medical student. “At the time, that was probably one of the hardest things I had done, to run such a long distance. I didn’t think it was possible. I know a lot of the runners here today might have had their doubts about, ‘Am I going to finish? Can I do this?’

“So I told the students at the ceremony that long-distance running might help them understand what patients and their families go through, and thanked them, saying ‘true acts of kindness’ like the medal donations are really what gets you through. It is very true the statement that no one fights alone.”

The event was part of the “Medals4Mettle” program, an Indianapolis-based nonprofit organization that links athletes and critically ill individuals. Before the race, each medical student was matched with a child to whom they would be giving their medal, who they had a chance to meet with earlier this week.

Taylor Hodge, a fourth-year medical student at UofL and co-president of the Medals4Mettle chapter at the School of Medicine, said students “learn about disease, but it’s not every day that we learn what disease means to patients and their families.

“Meeting them gives you a little bit of insight into what they deal with every day. I’ve learned bravery is putting one foot in front of the other, even when all the cards are stacked against you and you don’t really feel like doing it.”

Medals4Mettle was founded in 2005 by Dr. Steve Isenberg, an otolaryngologist in Indianapolis. Isenberg said he had just finished running the Chicago Marathon when he learned a patient of his, who also happened to be a close friend and fellow doctor, had been readmitted to the hospital severely ill. He went up to his room, with the medal in his pocket from the day before. He put it around his friend’s neck.

“It was an amazing moment for us, and after he died, his wife told me how much that meant to him,” said Isenberg, who came from Indianapolis for Saturday’s ceremony in Louisville. He said he started the organization because he thought maybe the experience could benefit others.

UofL’s program began in 2008 as the first medical-school based Medals4Mettle program in the country. It has continued to grow, and Dr. Isenberg said it has provided template for other medical schools across the U.S. “It helps the students realize what they are really training to do,” he said.

“As we end American Heart Month, it’s the perfect time to share this wonderful news,” said Mark Slaughter, MD, surgical director of heart transplant for University of Louisville Physicians and Jewish Hospital, and professor and chair, Department of Cardiovascular and Thoracic Surgery, UofL School of Medicine.

Dr. Slaughter performed the 500^th transplant on Feb. 21, on a 59-year-old man who had a left ventricular assist device implanted to support his heart until the donor heart was available for transplant. An LVAD is a surgically implanted mechanical pump attached to the heart.

The first heart transplant at the hospital, which was also the first heart transplant in Kentucky, took place on Aug. 24, 1984, performed by the University of Louisville’s Laman Gray Jr., MD. The state and region waited in suspense as 40-year-old Alice Brandenburg received a new heart. The surgery, which took seven hours, was groundbreaking at the time. The UofL and Jewish Hospital transplant team is one of the leading providers of organ transplantation in the country.

“Jewish Hospital is a place where miracles happen every day and patients’ lives are changed forever,” said Ronald Waldridge II, MD, president of Jewish Hospital. “Five-hundred hearts is much more than a milestone. It represents the life-changing impact on our patients, their families and the entire region. Together, with UofL, Jewish Hospital’s Trager Transplant Center is investing in research, technology and advance procedures to increase access to transplant services.”

On Wednesday, doctors and heart transplant recipients gathered at the Jewish Hospital Rudd Heart and Lung Center to celebrate the 500^th milestone and the many lives that have been saved over the years thanks to heart transplantation. 

“The 500^th heart transplant is a reminder of the commitment by Jewish Hospital and the University of Louisville to provide advanced therapies for patients with advanced heart failure,” Slaughter. said. “We’ve come a long way since Dr. Gray broke ground with that first heart transplant more than 30 years ago. Every day, we continue to advance the science of heart transplantation here at UofL and Jewish Hospital. I’m excited about the future of this program, and I’m confident that we’ll mark a lot more milestones over the next 30 years.”

For Dr. Gray, Wednesday’s celebration marked decades of dedication to the heart transplant program.

“After performing the first heart transplant, it means a lot to me to see the 500^th and where we are today,” Gray said. 

Gray continues to research new ways to help patients with heart disease at UofL’s Cardiovascular Innovation Institute, a center focused on bio-adaptive heart innovations, including the integration of heart-assist device, biodfeedback sensors and related technologies. In 2001, Gray and the Trager-UofL surgical team implanted the first fully implantable replacement heart, the AbioCor.

Today, patients like Jeffrey McMahan continue to benefit from the heart transplant program. McMahan was the center’s 479^th heart transplant, and he attended the celebration on Wednesday along with other recipients.

Before his heart transplant, McMahan, 61, was no stranger to the procedure – it had helped save many of his family members. The Memphis, Indiana, resident had four family members receive heart transplants – two by University of Louisville surgeons at Jewish Hospital. In 2015, McMahan learned he, too, needed one.

“I was serving in the military at Fort Knox when I developed a cough,” said McMahan. “It finally got bad enough that doctors flew me to Jewish Hospital, where I was diagnosed with a cardiomyopathy, a condition where the heart muscle is weakened. I learned that I would need a transplant in the next 10 years, but that timeframe quickly changed to 10 months after my condition worsened.”

On Aug. 15, 2015, McMahan was added to the organ donor transplant list. A month later, he received the transplant that forever changed his life.

“I wouldn’t have lived without the transplant,” McMahan said. “It means a lot to be here to celebrate the 500^th. I’m forever thankful to the transplant team that helped save my life and gave me more time with family.”

It has been an exciting year for the Jewish Hospital Trager Transplant Center and University of Louisville team. In December 2017, the center – a joint program with the UofL School of Medicine and KentuckyOne Health – broke its all-time record for number of organs transplanted in the center’s 53-year history, with 175 organs transplanted in a year. The center also achieved several other milestones in 2017, including its 5,000^th transplanted organ, its 3,000^th kidney transplant and its 900^th liver transplant. In addition to Kentucky’s first heart transplant, the program is known for performing Kentucky’s first adult pancreas, heart-lung and liver transplants.

But the 500^th heart transplant and other milestones wouldn’t have been reached without organ donors, noted David Lewis, director of Transplant Services at the Jewish Hospital Trager Transplant Center.

“We often encourage people to sign up as organ donors to help save lives. The need for organ donors is unfortunately greater than the number of people who donate, so each day, an average of 20 people pass away while waiting for a transplant in the United States,” Lewis said. “Knowing that we have helped save 500 people in need of a new heart is a wonderful feeling, and it would not be possible without the donors and their families.”

Video of the first heart transplant at Jewish Hospital is .����

The study, “,” appears today on the website of the Journal of the American College of Surgeons in advance of print publication.

“We found several good things happened by the expansion of Medicaid,” said the study’s senior author, Hiram C. Polk, Jr., MD, of the division of surgical oncology in the Department of Surgery at the UofL School of Medicine. “It really did work. The care was better because people were getting what they need.”

Since passage of the Affordable Care Act in 2010, 32 states and the District of Columbia have expanded Medicaid coverage, with the federal government covering the increased costs. Kentucky is one of the Medicaid expansion states, and the study looked at the effects of the expansion here.

“What we learned is that the expansion of some form of third-party coverage for health care leads to people doing more things that are intrinsically good for their health,” said Polk, who also has served as Kentucky’s public health commissioner.

UofL researchers who were co-authors on the study were Nicolas Ajkay, MD, as first author; Neal Bhutiani, MD; Jeffrey Howard, MD; Charles Scoggins, MD; and Kelly McMasters, MD, PhD. Also involved were researchers from the University of Kentucky.

The researchers looked at breast cancer as a marker of the impact of Medicaid expansion as it is “a very common cancer,” Polk said. “Our goal was to get an early measure of what really happened with Medicaid expansion.”

The study evaluated measures related to breast cancer from 2011 to 2016, using 2014 – the year Kentucky’s Medicaid expansion went into effect- as the cutoff between pre- and post-expansion.

“We knowingly took on the possibility of making too early of an observation on Medicaid expansion, but the degree of change that occurred so promptly in two years surprised me,” Polk said. “It’s amazing these changes happened in just two years.”

Researchers examined the Kentucky Cancer Registry for all women ages 20 to 64 who were diagnosed with breast cancer between 2011 and 2016.

From 2011 to 2013, 635,547 screening mammograms were performed in the state. That number increased to 680,418 from 2014 to 2016.

In 2011, 208,600 screening mammograms were performed, compared with 234,315 in 2016.

The number of screening mammograms covered by Medicaid increased from 5.6 percent before expansion to 14.7 percent after, and the number of women who had screening mammograms and were uninsured declined almost tenfold, from 0.53 percent before to 0.05 percent after expansion.

Breast cancer incidence and treatment rates did not vary significantly from year to year. But the changes in the rates of early-stage vs late-stage disease treated in the pre- and post-Medicaid expansion periods were statistically significant. 

Early stage (stage I-II) breast cancers accounted for 64.5 percent of the diagnoses in 2011-2013, compared with 66.7 percent in 2014-2016. Late-stage (III-IV) cancers accounted for 15 percent, compared with 12.9 percent.

Rates for breast-conserving surgery increased significantly after Medicaid expansion, from 44 percent pre-expansion to 48.8 percent, while rates of other resections, including mastectomy, declined, falling from 50.5 percent to 44.5 percent.

While the time from diagnosis to surgical treatment for the disease was shorter before expansion, an average of 28.6 days compared with 36, two other key treatment variables were either unchanged or improved after expansion: time from the operation to chemotherapy (47.5 days before, and 46.6 days after); and time from the operation to radiation (96.4 days before, and 91.5 after).

“Chemotherapy and radiation didn’t happen as quickly as we’d like,” Polk said.

The study noted the findings were mirrored by experiences in other states, but Polk said a thorough analysis of the Medicaid expansion in Kentucky requires longer-term study. 

“Two years is a very short run,” Polk said. “But on the other hand, it’s a very pure study.”