May 2023 Department of Surgery Newsletter

SURGERY NEWS

May 2023

NOTES FROM THE CHAIR

Earlier this year I was excited to announce the publication of the Department of Surgery’s Surgical Care Report, which highlighted the innovative work of each division, the Office of Education, and the department as a whole.

Our successes are due in large part to the diversity of thought and experience throughout the department. By balancing the clinical and research work of our physician-scientists, we can share our surgical knowledge while making new discoveries in patient care. In addition, we continue to excel at recruiting amazing new talent in a variety of disciplines, furthering our reach into unexplored areas of health care. Included in the following pages are the personal stories of some of the people who make up our department. I greatly appreciate the contributions of each individual to our accomplishments, and I hope you enjoy reading about them.

EVERY CHALLENGE BRINGS OPPORTUNITY

Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair

Innovation comes in many forms. During the pandemic, our faculty and staff shifted focus to providing critical care for our patients in many new and innovative ways.

WITH EVERY CHALLENGE AND OPPORTUNITY COMES INNOVATION

Innovation comes in many forms. Here are highlights from this year’s surgical care report.

Discovery - Patients Don and Amy Lovell share their story of his-and-hers transcatheter valve replacements and the amazing work of surgeons from the Division of Cardiothoracic Surgery.

Equity - The Division of GI, Trauma, and Endocrine Surgery highlights its extraordinary work to address health care disparities at the local, state, and national levels.

Breakthrough - Device innovation is at the forefront in the Division of Pediatric Surgery, which brought laboratory breakthroughs to the pediatric OR in the form of the Button Huggie.

treatment of his pancreatic cancer by the Division of Surgical Oncology, which has allowed him to live his best life.

Altruism – The Division of Transplant Surgery shares the story of Brandi Thornton, who has been a living organ donor – twice. Both donations were to strangers.

Endeavor – Several bowel cancer surgeries, followed by numerous corrective surgeries, left Pamela Jacobsen in need of complex reconstructive surgery that the Division of Urology was able to provide.

Foundation – At the core of great patient care is a foundation of great providers. The Division of Vascular Surgery shares its vision for growth.

Richard Schulick, MD, MBA Professor & Chair, CU Department of Surgery The Aragón/Gonzalez-Gíustí Chair

Visionary – Research by the Division of Plastic and Reconstructive Surgery investigates the possibility of whole-eye transplantation.

Confidence – Gerry Turner shares his story and praises the excellent

During the pandemic, our faculty and staff shifted focus to providing critical care for our patients in new and innovative ways.

Shelly Lange

innovation in the 2023 Department of Surgery Surgical Care Report.

CELEBRATING CU DEPARTMENT OF SURGERY WOMEN

Here are some of the top stories of women in the CU Department of Surgery.

Each year since 1987, the President of the United States has issued a proclamation designating the month of March as Women’s History Month. It is significant that the leadership of our country recognizes the importance of reaffirming the historical accomplishments of women with this annual proclamation.

Generations of women have endured hardships, exclusion, and discrimination and despite these

challenges have furthered equity and equality in our communities. As a nation, we have made great strides in medicine, technology, social justice, and much more through their unwillingness to surrender their dreams and goals. We would like to take this time to highlight a few of the great women and their work in the CU Department of Surgery.

Finding the Heartbeat in Medicine

The career turning point for Michael Wells, PA-C, MPH, came during heart surgery in an operating room at Emory University in Atlanta, Georgia.

He’d already completed his physician assistant (PA) and master of public health studies and had taken the uncommon step of a surgical residency – only a very small handful of cardiothoracic surgery programs in the United States offer PA residency programs, so admission is extremely competitive.

During his residency, he not only learned to be a surgical PA, but also learned the skills of endoscopic vein harvesting, drawing on his focus, determination, and dedication to achieve his goals.

SMOKING AND SURGERY: WHY THE TWO DON’T MIX

Doctors are always trying to convince their patients to stop smoking, but it’s a concern that’s especially vital prior to surgery, due to the effects smoking has on the body.

“Patients who smoke are at a higher risk of a heart attack during or just after surgery, because smoking causes constriction of the blood vessels,” says Simran Randhawa,

MBBS, assistant professor of cardiothoracic surgery in the University of Colorado Department of Surgery.

“Smoking also is known to inhibit wound healing and cause problems with general anesthesia, and it can contribute to postoperative complications such as pneumonia and lung infections.”

Rachel Sauer

Greg Glasgow

Department of Surgery

WELCOME NEW HIRES

FACULTY

Kristen Alix, MS, APRN-BC, AGACNPBC, CVN Sr.Instructor

Vascular Surgery

Susana Arrigain, MA Sr. Research Associate

Transplant Surgery

Kimberly Berry, NP Instructor

GI, Trauma, and Endocrine Surgery

Nicole Ferreri, MS, PA-C Instructor

Plastic and Reconstructive Surgery

Ming Fu, PhD Assistant Professor

Pediatric Surgery

Jessica Graham, PNP-AC Instructor

Pediatric Surgery

Bridget Gresback, MSN, FNP-C Instructor

Urology

Hannah Griffin, PA Instructor

Pediatric Surgery

Kendra Keene, PA-C Instructor

Plastic and Reconstructive Surgery

Korah Kuruvilla, PhD Instructor

Pediatric Surgery

Lauren Lipes, DNP, RN, AGACNP-BC Instructor

Transplant Surgery

Kevin McLean, PA Instructor

Pediatric Surgery

Shane McNevin, MD Associate Professor

GI, Trauma, and Endocrine Surgery

Sean Meehan, PA Instructor

Cardiothoracic Surgery

Tu Nguyen, NP-C Instructor

GI, Trauma, and Endocrine Surgery

Shannon Phillips, PA Instructor

GI, Trauma, and Endocrine Surgery

Thomas Stoop, MD Visiting Researcher Surgical Oncology

Annabelle Thomas, NP Instructor

GI, Trauma, and Endocrine Surgery

Thomas Weaver, PA-C Instructor

Urology

STAFF

Chandra Beard

Business Services Senior Professional

Vascular Surgery

Alejandro de Jesus

Finance Program Manager

Finance and Administration

Danielle Grine

Administrative Assistant III

Plastic and Resconstructive Surgery

Isabel Hartwig

Research Services Professional

Clinical Research Office

Sarah Mattsen

Human Resources Professional

Finance and Administration

Alyssa Ontiveros

Residency Database Coordinator

Office of Education

Ashleigh Prout

Administrative and

Business Operations Manager

Urology

Elnaz Razani

Operations Administrative Assistant

Finance and Administration

KOVACS NAMED VICE CHAIR OF RESEARCH FOR CU DEPARTMENT OF SURGERY

Among her priorities are increasing collaboration and expanding the department’s reputation.

Elizabeth J. Kovacs, PhD, professor of GI, trauma, and endocrine surgery, has been named vice chair of research in the CU Department of Surgery.

In her new role, Kovacs is responsible for advancing the research mission of the department, with particular focus on deepening and broadening the department’s research portfolio.

This includes basic and translational science, outcomes, education, and clinical/health services research, as well as innovation pathways.

from Reed College and a PhD in cell biology from the University of Vermont. “It brings in better residents and faculty, it excites people about the field, and it allows us to shake up the dogma of how things are done and do them better. Gaining new knowledge is critically important to all of us.”

Kovacs joined the CU Department of Surgery in 2016; prior to that she was professor and vice chair of research in the Department of Surgery at Loyola University Chicago.

Elizabeth J.

PhD Professor and Vice Chair of Research Department of Surgery

“Research improves everything,” says Kovacs, who received a BA in biology

JOSUE ESTRELLA PURSUES TRAUMA SURGERY TO HELP UNDERSERVED COMMUNITIES

The fourth-year medical student took the next step on his journey to the specialty on

As the first one in his family to go to college, Josue Estrella had to navigate his own way through his undergraduate degree at the University of Michigan, where he first developed his interest in medicine.

After getting a crash course in clinical work by working as a traveling medical scribe, setting up new teams in newly contracted hospitals around the country, he entered the University of Colorado School of Medicine in 2019. Estrella feels a special call to the field of trauma surgery, and his journey to

the specialty moved forward on Match Day, March 17, when he found out he matched to Boston University Medical Center for his general surgery residency. He plans to follow that with a one- to two-year trauma fellowship that will further expand his skills.

“I find trauma to be a very exciting field. I like the idea of showing up to work and not really knowing what’s going to happen,” Estrella says.

Match Day.

Greg Glasgow

Greg Glasgow

Kovacs,

Josue Estrella

General Surgery at Boston University Medical Center

THRIVING IN THE COMPLEXITY AND IMMEDIACY OF TRAUMA SURGERY

When Lauren Steward, MD, was 5, her parents presented her with three career options: doctor, lawyer, or engineer.

They’d offered the same options to her three other siblings, who didn’t bite, but their quiet, introspective third child gave it some thought. She wasn’t much of a talker, so being a lawyer didn’t seem like a good fit. Both her parents are engineers, “but they didn’t seem to be doing anything interesting,” she recalls, “so I thought, ‘I guess I’m going to be a doctor.’ And I’ve been on this medicine train since I was 5.”

There’s a lot more to the story, of course, but the theme is that she made the right choice for herself.

Now Steward, an assistant professor of GI, trauma, and endocrine surgery in the University of Colorado Department of Surgery, is working with CU colleagues to increase recruitment and retention of individuals from diverse backgrounds.

“I feel like I had all the resources I needed, but I feel very privileged to have had that,” Steward says. “I realize there are plenty of people who have not had access to that and who are incredible people who could bring so much insight and innovation to medicine. We need to be seeking out and supporting these people.”

Rachel Sauer

Lauren Steward, MD Assistant Professor GI, Trauma, and Endocrine Surgery

Lauren Steward, MD, is committed not only to improving care for ICU patients, but to growing the diversity of clinicians providing that care.

CU SURGERY ON THE FOREFRONT WHEN IT COMES TO WOMEN IN UROLOGY

Three of the four urology fellows are women entering a traditionally male-dominated field.

Greg Glasgow

If surgery is seen as a maledominated medical specialty, the stereotype goes double for the field of urology, with its focus on male concerns including erectile dysfunction, prostate issues, and vasectomies. A 2020 study from the American Urological Association, for example, found that women accounted for just 10.3% of all practicing urologists in the U.S.

Things are changing, though, as women pursuing careers in urology join the ranks of urology fellows at medical schools across the country. That includes the Department of Surgery at the University of Colorado School of Medicine, where three of the four current urology fellows — pediatric urology fellows Kristen Meier, MD, and Kelly Harris, MD, and reconstructive urology fellow Margaret Higgins, MD — are female.

Controversies in Transplantation: A Convention for Groundbreaking Ideas in Transplantation

The Division of Transplant Surgery in the Department of Surgery at the CU School of Medicine hosted its annual Controversies in Transplantation conference, which gathered the finest minds in transplantation science from around the country in Colorado. For more than two decades, this conference has served as a platform for groundbreaking ideas and discussions within the transplant community.

DUTCH SURGEONS VISIT CU TO LEARN PANCREATIC CANCER PROCEDURE

Marco Del Chiaro, MD, PhD, is an international expert on the operation that can help patients who were previously considered untreatable.

of surgical oncology in the University of Colorado Department of Surgery.

When surgeons from the Netherlands needed help establishing a national program for patients with hard-to-treat pancreatic cancer, they knew just whom to turn to: Marco Del Chiaro, MD, PhD, professor and division chief

“I’ve become pretty well-known internationally as one of the few surgeons doing a very specialized operation for locally advanced pancreatic cancer, which is a tumor of the pancreas that extends into the big

blood vessel around the pancreas,” says Del Chiaro.

Rachel Sauer

Khushnuma Damkevala

Can AlcoholAssociated Burn Injuries Impair Cognitive Function?

Research by Elizabeth J. Kovacs, PhD, finds elevated delirium scores in burn-injured patients who use alcohol.

The relationship between alcohol use and burn injuries is a negative one in multiple ways. Not only are about 50% of adults who sustain burn injuries intoxicated at the time of injury, suggesting that alcohol use may have contributed to the incident, but alcohol use among burn-injured patients is associated with more severe complications, delayed recovery, and increased morbidity and mortality.

“Return to work or normal life can be impaired or delayed for burn-injured patients who use alcohol,” says Elizabeth J. Kovacs, PhD, vice chair of research and professor of GI, trauma, and endocrine surgery in the University of Colorado Department of Surgery. “Every organ of the body is affected by alcohol because it enters your bloodstream. If you look at the data on alcohol use and injury recovery, it affects everything from the cardiovascular system to the lungs, liver, and pancreas, and even fracture repair.”

That’s primarily because alcohol in the body alters inflammatory responses, she says, making it harder for the immune system to do its job.

EARLY DETECTION AN IMPORTANT FACTOR IN HIGHLY TREATABLE TESTICULAR CANCER

Paul Maroni, MD, emphasizes speaking up to a health care provider when something doesn’t feel right.

Testicular cancer is a highly treatable cancer that isn’t always easy to talk about.

Though incidence of testicular cancer is low in comparison with other common cancers, it is one of the leading cancers in young men. The good news is that it’s a very treatable cancer whose five-year relative survival average for all stages is 95%.

Despite this, some young men may hesitate to mention concerns to their health care providers who stress the importance of early detection and of

speaking up about anything that doesn’t seem or feel right.

Paul Maroni, MD, an associate professor of surgery in the University of Colorado School of Medicine, says that early detection of testicular cancer is vital and clinicians much prefer that a patient mention a concern and it turns out to be benign than a meaningful cancer progresses in silence.

Maroni also discussed who is at risk and what signs to watch for with testicular cancer.

Rachel Sauer

Greg Glasgow

PROGRAM WORKS TO CLOSE RACIAL GAPS IN KIDNEY TRANSPLANTATION

Recent research shows that patients in the CU Hispanic Transplant Program benefit from improved communication and cultural understanding.

Rachel Sauer

Kidney disease is sometimes called the “silent disease” because it can be symptomless in its early stages. An estimated 90% of Americans who have chronic kidney disease (CKD), may not even know they have it until it is advanced.

About 37 million adults in the United States have CKD, which, if left untreated, can progress to end-stage renal disease. Adding to these alarming data are significant disparities impacting Hispanic populations. Adjusting for age and sex, the prevalence of end-stage renal disease is almost 50% higher among Hispanic patients than nonHispanic white patients.

The University of Colorado Department of Surgery aims to

Gift From Patient’s Family Funds Exploration of New Treatment for Esophageal Cancer

Greg Glasgow

Funding from the Paul R. O’Hara Seed Grant Fund at the University of Colorado Anschutz Medical Campus will allow Akshay Chauhan, MD, associate professor of GI, trauma, and endocrine surgery in the CU Department of Surgery to explore new methods of detecting and treating esophageal cancer.

“While overall cancer survival has improved, the prognosis of esophageal cancer continues to be dismal,” says Chauhan. “Despite recent improvements in screening and therapeutic strategies, esophageal cancer is often diagnosed in its advanced stage, underscoring a dire need to identify biomarkers to direct targeted early treatment.”

address an area in which disparities are especially prevalent: kidney transplantation.

In research published in 2022, CU researchers noted that Hispanic patients have less access to transplantation than non-Hispanic white patients.

Two of the main culprits in kidney failure are diabetes and high blood pressure, explains Sixto Giusti, MD, an assistant professor of renal diseases and hypertension in the CU School of Medicine, conditions that significantly impact Hispanic populations.

ENJOYING THE GIFT OF TIME AFTER A PANCREATIC CANCER DIAGNOSIS

Carolyn Degrafinried couldn’t ignore her lingering feeling that something was off and persistently requested more testing. In April 2015, an endoscopy showed that not only was the mass on her pancreas a tumor, but it was cancerous.

In May 2020, Wells Messersmith, MD, associate director of clinical services for the CU Cancer Center and division head for medical oncology in the CU School of Medicine, contacted Degrafinried with the news that surgeon Marco Del Chiaro, MD, PhD, a professor and chief of surgical oncology in the CU School of Medicine, had newly joined the faculty and was internationally recognized for resecting tumors of the pancreas infiltrating arteries and veins.

“Dr. Messersmith brought her to my attention, and there was still a very bad vascular situation but no apparent liver lesion,” Del Chiaro says. “She had been very stable on chemo for many years, and Dr. Messersmith asked if I felt comfortable trying to take the tumor out. I said, ‘It’s really risky but I think we can try.’”

At each decision point, Degrafinried drew strength not only from her sense of self and self-advocacy, but from her family, her faith, and a multidisciplinary care team that partnered with her to create an adaptable treatment plan. In November 2022, she received the news that she showed no evidence of disease.

A multidisciplinary CU team worked with Carolyn Degrafinried, and she now shows no evidence of disease.

Rachel Sauer

FDA ISSUES NEW MAMMOGRAPHY GUIDELINES FOR WOMEN WITH DENSE BREASTS

New regulations will improve early detection and raise awareness among health care providers.

Camille Stewart, MD, Named to National Cancer Institute

Early-Stage Surgeon Scientist Program

In an effort to help more women with dense breasts understand their screening options, the Food and Drug Administration on March 9 updated its mammography guidelines to require mammography facilities to notify patients about the density of their breasts. The new rule amends regulations issued under the Mammography Quality Standards Act of 1992, a law passed to ensure quality mammography. The amendments are required to be implemented within 18 months.

For her innovative research on how cannabinoids affect the tumor immune microenvironment in melanoma, Camille Stewart, MD, an assistant professor in the Division of Surgical Oncology, has been named to the 2023 cohort of the National Cancer Institute’s Early-Stage Surgeon Scientist Program (ESSP). The National Cancer Institute coordinates the United States National Cancer Program and is part of the National Institutes of Health.

TALKING ABOUT ORGAN TRANSPLANT WAITING TIMES

Emphasizing the need for greater consistency in the terms used to define and discuss how long patients may be waiting for an organ.

One of the first questions patients often ask when they enter the list for a transplant organ is, “How long will I be waiting?”

In a recently published editorial, Jesse Schold, PhD, director of transplant outcomes and policy in the Colorado Center for Transplantation Care,

Research, and Education and associate vice chair of policy and outcomes for the University of Colorado Department of Surgery, highlighted the need for greater consistency in the terms used to define and discuss waiting time.

Rachel Sauer

Greg Glasgow

Greg Glasgow

Caring for Patients on the Business Side

Leah Lleras, MS, interviews Stephanie Farmer, MHA.

For Stephanie Farmer, MHA, an “aha!” moment in her career happened as an undergraduate working in the University of Colorado Department of Obstetrics and Gynecology. In that role, she began to see how the business and administration aspect of health care can play a significant part in patient care, and how she could have a role in that care.

In honor of Women’s History Month, Leah Lleras, MS, director of finance for the Department of Surgery, interviewed Farmer, vice chair of administration for the Department of Surgery and the CU Cancer Center.

Sharing a Surgical Legacy

Physician assistant Whitney Herter, PA-C interviews Elisa Birnbaum, MD.

In honor of Women’s History Month, Whitney Herter, PA-C, BS, a senior instructor in surgical oncology at the University of Colorado Department of Surgery, talked with Elisa Birnbaum, MD, professor of GI, trauma, and endocrine surgery, about her illustrious career.

Birnbaum worked at Washington University, Barnes-Jewish Hospital, and St. Louis Children's Hospital in St. Louis before coming to the University of Colorado, where she is part of the UCHealth University of Colorado Hospital’s Multidisciplinary Women’s Pelvic Health and Surgery Clinic.

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