BY JEREMY PEPPAS

UAMS Chancellor I. Dodd Wilson, M.D., former College of Medicine Dr. Dean Reece, MD, PhD, MBA and and Dr. James Suen, professor and chairman of the Department of Otolaryngology-Head and Neck Surgery gather around Dr. Brendan Stack, MD.

Dr. Brendan Stack is one of the rare 1-percenters.

Sure he's the James Y. Suen, MD, Chair in Otolaryngology-Head and Neck Surgery at UAMS, an internationally recognized expert in thyroid problems and has nearly as many letters after his name as the alphabet, but what makes him so special?

"I'm a college dropout, I did two years," Stack said, with a laugh. "Less than 1 percent of people go to medical school without a bachelor's degree. Conversely 15 percent of people go to (it) with graduate degrees. It is sort of like a bell curve."

Stack's collegiate career isn't typical of most dropouts. He entered Brigham Young University (BYU) with nearly two years of college credit he had earned while still in high school in Virginia and after two years in Provo, Utah, Stack, a devout Mormon, did two years of missionary work in Argentina and then was accepted to medical school at Eastern Virginia in Norfolk.

Not that skipping some college ended up mattering much.

"The two years I saved in college," he said, "I ended up doing eight years of post-graduate medical school training. All I did was displace the time. It wasn't like I was a Doogie Howser and got out at 22. It didn't work out that way."

And it wouldn't take much for him to get his degree.

"The reason why I didn't graduate from 'the Y' was, this won't mean much to most, but I didn't take the religious classes," Stack said. "That's all I'm missing. That's all I need."

BYU, like most other church-affiliated schools, requires religious classes for graduation. And in BYU's case, it means 14 credit hours of Bible study and electives.

Stack may have had a head start for medical school though. His father, Brendan Stack, Sr., is a dentist and an internationally known expert on Temporomandibular Joint Syndrome (TMJ) and both have spoken on the subject together on the lecture circuit.

But Stack now focuses on thyroid problems, an area in which UAMS is working diligently.

"What we have now is all the specialists in one place at the same time," Stack said. "So it is very focused."

The staff includes "three surgeons, two endocrinologists, one nuclear medicine doctor, two pathologists, one radiologist, and on the periphery, two ophthalmologists. It isn't much different from what we have done in the past, but it was all in different doctors' offices."

Stack gave an example of a recent first-time patient who had come in for a thyroid evaluation. Stack said that the patient was "seen by the endocrinologist, seen by the surgeon, had a biopsy, (which) was read by the pathologist. (The patient left) 90 minutes later with an operative date or a medical plan or whatever (was) appropriate."

"It's a convenience thing, but it is a much more patient-centered approach."

Stack said a few hundred thyroid patients are seen a month, but some are non-surgical patients or patients getting follow-up treatment.

The patients tend to be mostly Arkansans and are generally from outside of central Arkansas.

But where does UAMS stand nationally?

"You have M.D. Anderson down the road," he said of the Houston cancer facility. "For solid tumors in the head and neck, it is going to be hard to be as good or better than them. But with something like thyroids, they are doing it, but haven't emphasized it. So that gives us a niche opportunity for some national excellence."

And that is the goal. One advantage is being able to draw patients from all over Arkansas.

"Being a tertiary care center, we see enough of the higher-end things and enough of the strange things to keep busy," he said. "It isn't just Little Rock's population, it is the entire state."

Arkansas isn't like other places Stack has worked.

"Out west, we had a lot of patients from eastern Washington," said Stack, who did a fellowship in head and neck oncology and reconstruction at the University of Washington in Seattle. "What's in eastern Washington? The Hanford Nuclear Reservation, they tested nuclear weapons there. There are pockets around the country, they call them cancer clusters, but we don't have one in Arkansas."

So if the local incidence of thyroid cancer is around three percent and rising, the question is why?

"That's one of the questions we ask ourselves in these meetings," Stack said. "We are seeing more. We are more aggressively using the ultrasound, and that lets us find the smaller lesions and we can now put needles in the small cells and see if it is cancer. But what we don't know is if it is an improvement in the diagnostics or if more people are getting sicker."

While thyroid cancer is a problem, it isn't one of the three main thyroid problems.

"One would be a lump in the neck and or thyroid area," Stack said. "The other would be Graves' disease … The third would hypothyroidism or low thyroid. Sometimes it is associated with Hashimoto's thyroiditis. Those are the three main conditions. You can also have parathyroid disease, the names sound the same, but it is a different organ and a different biology."

Parathyroids are four small glands behind the thyroid and a problem there can be significant with older women, especially those who are post-menopausal or have osteoporosis.

"They regulate calcium," Stack said. "It worsens the bone diseases, they just leach the calcium out of the bones."

UAMS Chancellor I. Dodd Wilson, M.D., former College of Medicine Dr. Dean Reece, MD, PhD, MBA and and Dr. James Suen, professor and chairman of the Department of Otolaryngology-Head and Neck Surgery gather around Dr. Brendan Stack, MD, at when Stack received the James Y. Suen, M.D., Chair in Otolaryngology-Head and Neck Surgery.

February 2007