January 2022 Department of Surgery Newsletter

SURGERY NEWS January 2022

NOTES FROM THE CHAIR Here we are at the beginning of another year. We continue to battle the evolving COVID-19 virus, and continue to rise to the challenge of caring for patients in overburdened facilities. At times like these, I find it helpful to remind myself of what we have accomplished together. Over the past few months, we have had the privilege of experiencing a number of life-changing moments. The uplifting moment when two female cardiothoracic surgeons performed separate transplant surgeries at the same time; the gender-affirming moment when, at age 71, Michael finally became Michelle; the breakthrough moment when R01 grant funding boosted our research efforts in immunotherapy; to the moment a device trial changed the recovery path of a rectal cancer patient. I continue to be impressed by the amazing team members in our department and all that we can accomplish despite this pandemic. Please continue to take care of yourselves and your loved ones as we begin this new year. As always, it continues to be my privilege to share these highlights with you.

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

‘HERSTORIC’ MOMENT IN CARDIOTHORACIC SURGERY

ISSUE HIGHLIGHTS 7

RESIDENTS WIN BIG

R01 GRANT RECEIVED 14

8 2

CU cardiothoracic surgeon Jessica Rove, MD, performed a heart transplant at the same time Simran Randhawa, MBBS, was performing a lung transplant just down the hall.

GENDER AFFIRMATION

ELIMINATING ILEOSTOMY

Surgery News

CARDIOTHORACIC SURGERY CELEBRATES A ‘HERSTORIC’ MOMENT Two of the division’s female surgeons, Jessica Rove, MD, and Simran Randhawa, MBBS, recently performed simultaneous transplants. Greg Glasgow With two female cardiothoracic surgeons in its ranks, the Division of Cardiothoracic Surgery at the University of Colorado School of Medicine is ahead of the curve when it comes to gender representation in the field. By one recent estimate, just 8% of cardiothoracic surgeons in the country are female.

“The other surgeons were accusing me of doing a victory lap,” she says with a laugh. “And I said, ‘No, I’m not doing a victory lap, but actually this is kind of historic.’ Before Simran got here, we never even had the opportunity for two transplants to be happening simultaneously in thoracic, being done by two women.”

It’s a distinction that was made clear recently, when CU cardiothoracic surgeon Jessica Rove, MD, performed a heart transplant at the same time Simran Randhawa, MBBS, was performing a lung transplant just down the hall. When both surgeries were complete, Rove couldn’t resist celebrating.

Leading the way for female cardiothoracic surgeons

Rove arrived at the CU School of Medicine in 2018 as the school’s first female cardiothoracic surgeon; Randhawa arrived earlier this year, after completing fellowships at Washington University, Barnes-Jewish

Hospital in St. Louis, and St. Louis Children’s Hospital. The division also has two female fellows — Yihan Lin, MD, MPH, and Lauren Taylor, MD, and Alison Halpern, MD. Rove and Randhawa see themselves and their female fellows as part of a movement, locally and nationally, to increase the number of women in their specialty. “Women bring in more women,” Randhawa says. “The field being so heavily male-dominated for so long, it didn’t really attract many women. Now that we are starting to see more women, we encourage more interns who are female to think, ‘OK, this is

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January 2022 normal. It’s normal for women to be a CT surgeon; it’s normal for females who are CT surgeons to have a family, to have kids. That encourages younger

“She is really the reason I became a thoracic surgeon,” Randhawa says. “I did a lot of research on lung cancer screening with her early on, starting

“I was an intern on the thoracic surgery service here, and I got hooked right then and there. The mentorship was really great, the surgeries are very complex, and it’s technically demanding. And heart and lung physiology is always something that I’ve liked.” - Rove

females as residents to see that and have a career in CT surgery.” Their journey to the field For Rove, the journey to cardiothoracic surgery began several years ago, when she was a general surgery resident at CU School of Medicine. “I was an intern on the thoracic surgery service here, and I got hooked right then and there,” she says. “The mentorship was really great, the surgeries are very complex, and it’s technically demanding. And heart and lung physiology is always something that I’ve liked.” Rove did her fellowship at Washington University in St. Louis, to get a change of perspective and a new skill set, but when she returned to Colorado, she found all the qualities she liked about the program were still there. “I still love it for all the same reasons: the colleagues are fantastic, the trainees are great, the surgeries are good,” she says. “And it’s really exciting to be part of that change in gender in the field and to be a part of that wave. There were women who came before us who have done a lot and inspired all of us, but now we are actually seeing a wave of women join the field.” Randhawa also started as a general resident, training under thoracic surgeon Cherie Erkmen at the Einstein Healthcare Network Program in Philadelphia.

The next time something like that happens, Rove and Randhawa say, there may be even more female surgeons in the division. “We’re here to show other younger residents, both males and females, that it’s normal to be a woman cardiothoracic surgeon,” Randhawa says. “We’re here to stop the whole, ‘Oh, you’re female? How cool is that?’ It just should be normal.”

in my second year as a resident. I was so interested in lung cancer as a pathology, the screening process and everything about it. Just being with her and having her as my mentor, it really attracted me to thoracic surgery.” Slow path to acceptance Though their male colleagues at CU have welcomed them completely, Rove and Randhawa say they still struggle for full acceptance as female cardiothoracic surgeons. Often when they walk into a patient’s room with a male fellow, the patient will assume the fellow is their surgeon. Even the positive aspects of being a trailblazer can be a lot to handle. “People treat you like you’re an anomaly all the time,” Rove says. “When I first showed up, random people would walk up to me and say, ‘Oh, my gosh, it’s so exciting to see a female in cardiac surgery.’ People I didn’t even know would come up and talk to me about it. You might not even be thinking about it, but people comment on it, in both positive and negative ways. I would say our female fellows feel the same way. When you’re one trainee, you’re kind of that token person, and you feel like you represent your gender. But when there’s two or three, everybody’s their own person. You’re seen for being who you are, not for being, ‘Oh, you’re the female fellow.’” Which is what made those recent simultaneous transplants so special.

Featured Experts

Jessica Rove, MD Assistant Professor Cardiothoracic Surgery

Simran Randhawa, MBBS Assistant Professor Cardiothoracic Surgery

Surgery News leak into their tissues, they can cause organ failure. It’s like trying to fill a bucket with holes in it.” DeBot began her research studying why endothelial permeability happens, and along the way found a specific mechanism, activated by trauma, that can be treated with existing medications. She and her fellow researchers are now testing those treatments on blood samples taken from trauma patients with the condition.

SURGERY RESIDENTS PLACE FIRST AND SECOND IN TRAUMA PAPER COMPETITION Margot DeBot, MD, and TJ Schaid, MD, impressed the judges at the recent American College of Surgeons event. Greg Glasgow Two general surgery residents at the University of Colorado School of Medicine — Margot DeBot, MD, and TJ Schaid, MD — placed first and second, respectively, in the District 8 regional competition for the 2022 American College of Surgeons’ Committee on Trauma Paper Competition in early December. DeBot and Schaid are both T32 NIH research fellows in the CU Trauma Lab. DeBot, who will present her research at the Committee on Trauma’s national conference in March, took first place in the basic science category for her paper and presentation “Shock Induces Vascular Endothelial Permeability After Traumatic Injury Through Breakdown of Endothelial Junctions Mediated Via Decreased Rac1/RhoA Activation

Ratio.” It is based on her research into the relationship among coagulation, inflammation, and immune response after trauma. “We used to view those as three separate things, but we actually found that they are all related,” says DeBot, whose research focuses on the crosstalk between inflammation and coagulation in trauma patients. “After trauma, you get an overactivation of the immune response. That can cause problems with coagulation or blood clotting, but it also can cause a leakiness of your blood vessels that we call endothelial permeability. And that’s a problem. If a patient needs a blood transfusion, the blood products we’re giving them aren’t necessarily staying where we want them to and when they

Schaid placed second in the basic science category for his paper “Trauma Induces Hemolysis, which is Associated with Worse Clinical Outcomes: Potential Role of Released Arginase-1, Depletion of L-arginine, and Reduced Production of Nitric Oxide.” Like DeBot, Schaid studies the effects of trauma on blood and how it contributes to the organ dysfunction trauma patients develop — with this study, particularly how trauma contributes to hemolysis, or the destruction of red blood cell membranes, causing the cells to break apart. “The red blood cells break apart, and the release of everything that’s inside of the red blood cells can wreak havoc and cause bad reactions downstream,” says Schaid, who found that hemolysis even extends to transfused blood in trauma patients. “My project was looking at what can happen after hemolysis in trauma, but it also raises important questions about why this happens in the first place. There’s something in the blood of trauma patients that predisposes their red cells to break up, and we’re working on figuring out what that is.”

Click here to learn more about their research.

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January 2022

SUPPORTING SURGEONSCIENTISTS LEADS TO BETTER PATIENT CARE Ernest E. Moore, MD, was recently listed among most-cited surgeon-scientists worldwide, emphasizing his career-long commitment to research. Rachel Sauer For the 50 years of his career, Ernest Moore, MD, a distinguished professor of surgery, has been eager to go to work – not just caring for patients or the challenges of the operating room, but for the myriad paths of research he has pursued since he was an undergraduate. Throughout his career, Moore has been not only a surgeon, but a surgeon-scientist who has delved into research on topics from the lethal triad of trauma-induced coagulopathy to the two-hit model of multiple organ failure, the role of enteral feeding in preventing lung failure, the mechanisms driving fibrinolysis shutdown, and the role of resuscitative endovascular balloon occlusion of the aorta in trauma resuscitation, among many dozen others. These basic science findings have led to changing paradigms in clinical care. Moore, for whom the Ernest E. Moore Shock Trauma Center at Denver Health

is named, recently was recognized by leading information analyst company Elsevier as being among the most-cited surgeon-scientists worldwide, and he has long been an advocate for surgeons in research. We recently discussed with him the importance of surgeons as scientists.

How do you define a surgeonscientist? A surgical scientist will see a problem based on their observations managing patients, collect information, then establish a research project in the laboratory to elucidate the underlying mechanisms. Then, they take this new information gleaned from laboratory investigation back to the patient bedside to determine if it will improve care. The objective of this patient-oriented

research is finding new and better ways to care for patients. When did you first become interested in research? I had a unique opportunity when I was going to college in western Pennsylvania, Allegheny College, where the University of Pittsburgh School of Medicine developed a novel program that provided a salary for college students to participate in basic research during the summer. I became inspired by observing research with some of the luminaries in surgery – Dr. Henry Bahnson, a cardiac surgeon who repaired the first torn aorta; Dr. Theodore Drapanas, competing to do the first human liver transplant; and Dr. Larry Carey, a surgeon defining the physiologic responses to shock.

Click here to read our entire interview with Moore.

Surgery News

WELCOME NEW HIRES FACULTY Brian Erdmann, PA-C Instructor Transplant Surgery Jocelyn Johnson, RN Professional Research Assistant Surgical Oncology Mahmood Kabeil, MD Professional Research Assistant Vascular Surgery

Jennifer Skrenta, MSPAS, PA-C Instructor Transplant Surgery Yi Sun, MD Research Instructor Surgical Oncology James Zhan, MD, PhD Assistant Professor Cardiothoracic Surgery

Lindsay Orcholski, MMS, PA-C Instructor Transplant Surgery

STAFF Blaire Balstad Research Services Professional Clinical Research Office Selena Day Program Coordinator Office of Education Jaymie Donner Training Program Coordinator Office of Education Arthur Yule Research Services Professional Transplant Surgery

FEATURED OPEN POSITIONS Advanced Practice Provider - TACS

Advanced Practice Provider - Breast

Pediatric Surgeon

The Division of GI, Trauma, and Endocrine Surgery (Trauma/ Acute Care Section - TACS) has an opening for a full-time faculty position. In close collaboration with a variety of surgical faculty, this position will provide inpatient and outpatient medical care services at UCHealth University of Colorado Hospital and its affiliates.

The Division of Surgical Oncology has two full-time faculty positions available. In close collaboration with breast/surgical oncology surgeons, this position provides inpatient and outpatient medical care services at UCHealth University of Colorado Hospital and its affiliates.

The Division of Pediatric Surgery has a faculty position available at the rank of assistant or associate professor. This position will perform inpatient and outpatient medical care services, and resident training for pediatric surgery at Children’s Hospital Briargate Center in Colorado Springs.

APPLY NOW

Click here to view all open positions.

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January 2022 “I think at that time people didn’t believe cancer could be treated by immunotherapy,” he explains. “Immunotherapy is targeting the immune system. It’s not targeting the cancer directly; you’re not directly targeting the enemy. But you boost the immune system, you help it fight. At first, I wasn’t very convinced.”

R01 GRANT BOOSTS IMMUNOTHERAPY RESEARCH Yuwen Zhu, PhD, receives National Institutes of Health R01 grant for research on tumor vasculature and immune checkpoint therapy. Rachel Sauer Some battles begin before a shot is even fired, with an army building bridges and grading roads, clearing and smoothing the path to make the invading force stronger and more effective. Some battles against cancer are following a similar strategy. Yuwen Zhu, PhD, University of Colorado Cancer Center member and associate professor of surgery at the University of Colorado School of Medicine, is researching ways to normalize tumor vasculature — meaning the tumor’s network of blood vessels — improving pathways to the tumor so drugs and the body’s immune killer cells can better reach and attack the disease. His groundbreaking immunotherapy research focused on tumor vascular normalization recently gained significant support from a National Institutes of Health Research Project Grant (R01). The research has the

potential to treat a wide array of cancers. The R01 grant will support the research Zhu has been conducting for more than 12 years. He and Richard Schulick, MD, MBA, director of the CU Cancer Center, along with Zhu’s former colleagues at Yale University, have a pending patent application for methods of treating a tumor by administering an agent to block a particular signaling pathway. Zhu’s research also is supported by an American Cancer Society Research Scholar Grant, a GlaxoSmithKline grant, and a $50,000 grant from Colorado-based Wings of Hope for Pancreatic Cancer Research. “Not directly targeting the enemy”

However, at the first meeting with his advisor Lieping Chen, PhD, Zhu began to appreciate how immunotherapy could be used to target cancer. Chen showed him the lab’s early work to modulate cancer cells and inoculate entire tumor cell lines as cancer vaccines by targeting tumor cells to express immunostimulatory proteins. “So, to me, I think this is Chinese medicine,” says Zhu, who is originally from Suzhou, China. “People talk about using a toxin against another toxin, so actually you can use a tumor to treat another tumor.” When he began his PhD work, a lot of research was looking specifically at PD-1, a protein found on T cells that is highly expressed in many cancers and helps keep the body’s anti-cancer immune response under control. From there, and during a postdoctoral fellowship in cancer immunology at Johns Hopkins University, Zhu transitioned his research to searching for novel immune checkpoints, looking at how to prevent certain proteins, or checkpoints, from slowing or blocking the immune system’s T cells as they attack a tumor. It is promising, important research, he says, “but only 20 to 30 patients (out of 100) can benefit from it, so how can you treat the other 70% of patients?”

Click here to read more about Zhu’s research.

When he first began studying cancer immunology as a doctoral student at the Mayo Clinic College of Medicine, Zhu says, he was initially skeptical. 7

Surgery News

GENDER AFFIRMATION SURGERY HELPS PATIENT FEEL WHOLE Christodoulos Kaoutzanis, MD, performed Michelle LeFree’s surgery in June, and she’s felt like her true self ever since. Rachel Sauer The victory lap came 50 years after high school, in a female restroom at Denver’s East High School. As a teenager, when everyone knew her as Michael, using the restroom designated for the person she knew herself to be wasn’t an option. She used the male restroom, joined the football team, and overthought every step she took and syllable she spoke, hoping it was enough to maintain the façade. Rarely did she have a moment of not feeling like she was playing a game she didn’t want to play. Christodoulos Kaoutzanis, MD Assistant Professor Plastic & Reconstructive Surgery

So at her 50th high school reunion, Michelle LeFree finally walked into the restroom designated for her. She stayed in there a few extra minutes just because she could — because she owed it to teenage Michelle who’d had

to stay hidden for most of her life. It wasn’t a matter of wanting to be a woman, LeFree says, but of simply being one. Through a series of often terrifying but necessary steps over the path of decades, LeFree finally attained the wholeness with her body that she’d been seeking her entire life when she had vaginoplasty surgery on June 25. She was 71 and acknowledges that Christodoulos Kaoutzanis, MD, an assistant professor of plastic and reconstructive surgery in the CU Department of Surgery who performed her vaginoplasty, could have turned her away for any number of reasons. “He could very easily have written me off and said, ‘You’re too old; you have too many underlying conditions; you’re about to die anyway,’ but he didn’t,”

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January 2022 LeFree says. “He saw that it was a legitimate opportunity to salvage whatever time I have left and for the first time be my true self.” Never feeling right in her skin When LeFree was a confused 5-year-old who had no way of understanding why she felt so wrong in her body, there were no words for her experiences. There were only the curtains in her bedroom that she closed tightly and the resulting darkness in which she quietly played with her doll. “I don’t even remember how I got the doll,” she recalls, “I just knew I had to wait until my dad went to work and the neighborhood was quiet. It was unthinkable that I could let anyone know what I was doing or what I was feeling. I was the first grandchild in my family and the first-born of four sons, so I just had all kinds of pressure put on my shoulders.” And yet, when she was sure nobody was around, she would sneak into her mother’s room and put on lipstick, then desperately scrub it off, terrified to leave even a shadow of it. She would put on her mother’s girdles and wear them for a few hours before putting them back in the drawer. When Michelle was 12, she developed gynecomastia, or an enlargement of male breast tissue that often occurs at the onset of puberty. “Here I was developing breasts, and I thought all these prayers I prayed every night were being answered,” Michelle recalls. “But then my mother did what I’m sure she thought was the right thing and had them removed, and I couldn’t tell her what it was doing to me.” Through high school and into her adulthood, Michelle wore Michael like a suit that didn’t fit. She played football, she married the first girl she dated, she reached height after height through college, graduate school, and into her career in medical technology and imaging research and development— a career that began at UCHealth University of Colorado

Hospital when she was a teenager. She was known and respected in her field, she had a son and a daughter whom she loved dearly, and a lot of the time she felt like she couldn’t draw a deep breath. On business trips, she would sneak to adult bookstores whenever she could, not to buy pornography but to buy a magazine called The Tapestry that was written by and for transgender women. “Porn shops were the only places that sold it, even though it wasn’t that kind of magazine,” LeFree explains. “And it was always grouped in with these ‘she-male’ fetish magazines.” While working as a researcher at the University of Michigan in Ann Arbor, she saw an ad in The Tapestry for a therapist who could help her put words to what she was experiencing. “For the first time in my life,” LeFree says, “I didn’t have to explain myself, not that I ever had before. It made me feel like I’m not crazy and I’m not the only one with what I was still calling ‘this problem.’” Over the years, LeFree tried peeling back her male costume in fits and starts – buying entire female wardrobes again and again, only to get rid of them in shame; driving an hour south of Ann Arbor to spend time with a group of transgender women; wondering if she could ever feel like anything more than a woman with a big red beard.

World Experts in Pancreatic Neoplasms Expertscape rankings recognize Richard Schulick, MD, and Marco Del Chiaro, MD, among the top 0.1% of scholars worldwide. Rachel Sauer Richard Schulick, MD, MBA, chair of the Department of Surgery and director of the CU Cancer Center; and Marco Del Chiaro, MD, clinical director of the Hepato-Pancreato-Biliary Program and division chief of surgical oncology, were recognized in the Expertscape rankings as world experts in pancreatic neoplasms. “What this ranking means is that there are two experts who are surrounded by equally accomplished multidisciplinary team members who take care of pancreatic cancer patients,” Schulick says. “What this award does is really recognize the expertise of some of the individuals on the team.” Del Chiaro says the Expertscape recognition highlights an ongoing effort to cultivate and recruit experts in specific fields of treatment and research in strong programs, “and this recognition shows that investment is going in the right direction,” he says. “The University of Colorado has one of the strongest pancreatic teams in the country.”

Click here to read more about Michelle’s journey.

Click here to read additional comments from Schuilck and Del Chiaro

Surgery News

STUDY FINDS THAT PATIENTS APPROACH SURGERY WITH STRONG IDEAS ABOUT OPIOID USE Surgical resident Emily Johnson, MD, led research that can help surgeons communicate on safe opioid use after surgery. Rachel Sauer There’s a significant body of research on opioids – how they’re metabolized, how they react with other drugs, the physiology of addiction, and how they’re prescribed, among the many areas of focus. In conducting literature reviews of the research, though, Emily Johnson, MD, a first-year general surgery resident in the Department of Surgery, wondered: What do patients think about opioids? “That seemed to be the missing piece,” Johnson explains. “It’s important to understand patients’ thoughts and perspectives, what their hesitancies are, what they know about opioids, and opioid use before they go into surgery.” To learn more about patients’ beliefs and behaviors relating to opioid use following elective surgery, Johnson led a qualitative study, whose results recently were published in the Annals of Surgery, that found that the majority of the 21 patients interviewed arrived at their elective surgical encounter with strong, pre-formed opinions about opioids. “We know that 2% to 5% of patients who undergo surgery end up using opioids chronically,” she says, “which means that 95% to 98% don’t. But there’s a lot in the news about opioids and most people probably know 10

EmilyJohnson, MD General Surgery Resident

someone whose life has been negatively impacted by opioid use, so this research shows how important it is to make sure patients are receiving consistent education on how to use them appropriately, the right time to use them, and how to dispose of them properly.” Understanding patient perspectives on opioids Johnson became interested in learning more about patients’ perspectives on opioid use while she was a medical student at the University of Michigan. While there, she participated in the Michigan Opioid Prescribing Engagement Network (Michigan OPEN), a multidisciplinary initiative that develops a preventive approach to the opioid epidemic by tailoring postoperative and acute care opioid prescribing. Johnson and her co-researchers were able to recruit their study participants from the greater cohort of patients who go through a pain-sparing education pathway developed as part of Michigan OPEN. The research focused on people who had had one of four types of elective surgery at the same hospital.

knowledge and beliefs about opioids before surgery, and their opinions about opioid-sparing recovery – meaning recovery with limited or no opioid use – after surgery. “We were hoping to get a better sense of what any sticking points might be, what they may have had a hard time understanding, what their expectations were before surgery, and what their experiences were after surgery,” Johnson explains. One of the initial and strongest trends that emerged, she says, was that people were very influenced by information they received from the news and from friends and family, adding that “a surprising number of people we interviewed knew family members or friends who had had an addition to an opioid. They were all well aware that the opioid epidemic is a problem and that maybe hospitals and doctors contributed to this.” Study participants also pointed out that their pre-surgery education about opioids was delivered in a way that implied they’d never heard of opioids before, Johnson says. Because of their pre-existing awareness and expectations about opioids, many of those surveyed approached their surgeries already having set intentions for how they wanted to think about opioids after surgery. “They basically fell into two groups,” Johnson says. “People in one group were saying I’m not going to take any opioids ever, and another group was saying I’m going to need opioids and stop telling me my pain can be managed without them.”

Click here to read more about Johnson’s research.

During semi-structured interviews, the researchers asked people about their

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January 2022 the glycocalyx,” Wiktor says. “And that can cause other downstream effects. When the white blood cell sees an exposed lining of the blood vessel, they can get activated and can cause more inflammation – this can cause more fluid to leak out, causing more lung and organ damage. It’s a vicious cycle.” Anticipating the future of warfare and improving outcomes

FLUID DYNAMICS Greg Glasgow

Arek Wiktor, MD, is helping the military find better ways to treat burn patients.

The U.S. Department of Defense is funding a study by Arek Wiktor, MD, associate professor of GI, trauma, and endocrine surgery and interim medical director of the UCHealth Burn and Frostbite Center – Anschutz Medical Campus, to aid in treatment of military and civilian burn patients. The $1.5 million grant from the Department of Defense Military Burn Research Program will be used to study the effects of two colloids, plasma and albumin, in acute burn resuscitation over a three-year period. “When someone gets a large burn, over 20% of their body, they require a large amount of intravenous fluid to support their organ systems,” Wiktor says. “That’s called a resuscitation. Many different formulas have been developed to try to calculate how much fluid to give. You don’t want to give too much fluid because it can flood a patient’s lungs; it can cause a lot of complications. If you give too little fluid, then their organs can also suffer. There’s a fine line.” Colloid vs crystalloid fluids Like most hospital patients, burn patients receive what are known as “crystalloid fluids” — the clear IV fluids, such as saline, that typically hang over

a hospital bed. But burn patients also receive “colloid” fluids — a type of protein-containing solution that is used to treat patients who need critical replenishment. “The two most common colloids are plasma, which is a component of blood, and albumin, which is a protein found in plasma,” Wiktor says. “And there’s a debate about which one is better. Our burn center’s standard of care is to use the plasma, but other burn units’ standard of care is the albumin. This study is trying to see, ‘OK, if both are being used by different burn centers, is there one that’s better?’” In his DOD-funded study, which will start enrolling patients soon and run for three years, Wiktor will treat patients in the UCHealth Burn Center with both types of colloids to see which one provides better patient outcomes. The goal is to ultimately reduce the amount of fluid used in resuscitation, as well as to reduce the effects of a blood vessel complication that can happen in traumatic injuries such as severe burns.

The study is of particular interest to the U.S. military, Wiktor says, due to the new types of weapons that are being invented. The future of warfare will result in more blast and burn injuries that will need to be treated quickly and effectively. “They’re curious about how we can treat soldiers or civilians with better burn care earlier,” says Wiktor, who received the DOD grant with the help of the CU Anschutz Center for Combat Medicine and Battlefield (COMBAT) Research. “We want to see if we can decrease the amount of fluid that patients require, or if we can decrease their complications. It’s a very complex system to transport patients from the battlefield to a hospital, so the military is interested in seeing if there are therapies that can help stabilize a person more efficiently early on.” Vik Bebarta, MD, director of COMBAT Research, says, “The CU Anschutz Center for COMBAT Research is thrilled to support cutting-edge scientists like Dr. Wiktor who are creating breakthroughs in medicine.”

Click here to discover more about this DODfunded study.

“We’ve known for about a decade that when people get injured — if they’re shot, or stabbed, or in a car accident — that trauma causes inflammation that can translate into shedding of the lining of the blood vessels known as

Surgery News

Division of Cardiothoracic Surgery at CU School of Medicine Celebrates a ‘Herstoric’ Moment

Viral Tweet Puts Surgery Resident in the Spotlight

“Is There a Physician Onboard?”: Emergency over the Atlantic Reaffirms Surgeon’s Commitment

NEED FOR ORGAN AND TISSUE DONORS REMAINS STRONG Surgery Grand Rounds presentation highlights challenges caused by COVID-19 and developments in donor science.

Rachel Sauer

Two Transplant Doctors Explain the Basics of Organ Donation and What’s New in Transplants

Empower Field at Mile High in Denver seats about 76,000 – a huge space with the population of a small city when filled to capacity.

CU Surgeon Inspires the Next Generation of Women Surgeons

University of Colorado Surgeon Performs State’s First COVID-19 Lung Transplant

Gender Affirmation Surgery Helps Patient Feel Whole for the First Time in 71 Years

“But even if you crammed that stadium full of people, you still would not touch the national wait list (of people waiting for donor organs),” said Jennifer Muriett, MSN, chief operating officer for Donor Alliance, during the Department of Surgery Grand Rounds on December 13. The presentation was hosted by Jim Pomposelli, MD, PhD, surgical director of liver transplantation and professor of transplant surgery, and Donor Alliance is a supporter of transplant programs at the University of Colorado School of Medicine.

Medical Students Help Create Surgical Training Tool to Meet Local and Global Needs

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Young Craniofacial Patient Battles Multiple Surgeries With Positive Outlook Practicing Fire Safety in the Operating Room

The presentation addressed best practices and evolving concepts in donor science, which enable more organs and tissues to be considered for donation and allow them to be maintained for longer during the time between donation and transplantation. But underlying these innovations and developments is enormous need, Muriett said. The consistent need and the many lives that can be saved Currently, there are 106,000 people

nationally waiting for organ transplants, Muriett said, and every nine minutes someone new is added to that list. However, she added, 17 people on the waitlist die every day “and we know that if everyone who could donate did donate, we would no longer have deaths on the waitlist.” In the Donor Alliance service area, which includes all of Colorado and most of Wyoming, there currently are about 1,600 people on the transplant waiting list. “When you look at the need compared to what’s available, we serve 6 million people,” Muriett said. “Last year, of the 44,000 deaths that we had, if you drill that all down to unique opportunities of organ donation, 1% of deaths were eligible for donation.” That ended up totaling 215 organ donors in 2020, she added, as well as 1,899 tissue transplants; 4% of all deaths were potential tissue donors. Click here to review the Donor Alliance presentation.

Click here to read more about living organ donation.

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January 2022 may impede our ability to urinate well. Finally, there’s cancer screening. That involves PSA (prostate-specific antigen) testing, digital rectal exams (DREs) to check for signs of prostate cancer, and talking to men about testicular cancer and self-assessment for that. Dodge: Another part of men’s health that’s become more visible over the last several years is mental health. As we’ve started dealing more with sexual dysfunction and low testosterone, we’ve also started to see quite a bit more focus on depression, anxiety, and other concerns that guys have when it comes to mental health.

UROLOGY EXPERTS EXPLAIN THE BASICS OF MEN’S HEALTH David Sobel, MD, and John Dodge, PA, sat down with us for a Q&A for Movember. Valerie Gleaton Happy Movember! No, that’s not a spelling error. Movember has been celebrated each November since 2003 to bring awareness (and funding) to men’s health issues, particularly prostate cancer, testicular cancer, and mental health and suicide prevention.

Tony Grampsas Urologic Cancer Care Clinic - Anschutz Medical Campus.

To highlight this month, we interviewed two experts at the University of Colorado School of Medicine Division of Urology to learn the basics of men’s health from a urology perspective, as well as what men can do to protect themselves against some of the most serious men’s health issues.

What does “men’s health” encompass from a urology perspective?

David Sobel, MD, is a senior instructor of urology who practices at CU Medicine Urology South Denver in Highlands Ranch and UCHealth Surgical Care - Highlands Ranch Hospital, and John Dodge, PA, is an instructor of urology offering clinical care at the Urology & Urodynamics Clinic - Anschutz and the UCHealth

Sobel: Urologists are surgeons who operate on kidneys and bladders, as well as the prostate, the penis, and the testicles. Although we’re surgeons, a big part of our clinic is medicine-based. From a men’s health perspective, Urologists treat sexual function, which includes erectile dysfunction, low testosterone and curvature to the erection (called Peyronie’s Disease). Moreover, though, urologists help men with voiding or urination. All men have prostates, and as we get older, those prostates get larger and that

What are some of the most common men’s health issues — and the most serious? Sobel: It’s incredibly common to develop issues with urination and erectile dysfunction. I tell my patients a rough estimate is that about 50% of men over the age of 50, 60% of men over the age of 60, and 70% of men over the age of 70 will have issues with erections. As for the most serious, cancer is always the biggest concern, and prostate cancer is the most common cancer to occur in men. Fortunately, if we catch prostate cancer early enough, we have numerous treatment options that can reasonably result in a cure. In fact, sometimes prostate cancer is identified but felt to be a less aggressive form of cancer. In those cases, we may opt to just monitor the cancer, which is where we put the patient into an active surveillance protocol.

Click here to read our entire interview with Sobel and Dodge.

Surgery News

CLINICAL TRIAL ELIMINATES NEED FOR ILEOSTOMY DURING RECTAL CANCER SURGERY Jon Vogel, MD, is leading the CU Anschutz site of a nationwide study comparing the Colospan bypass device with standard of care treatment. Rachel Sauer

After the chemotherapy and radiation treatments, when she was discussing necessary surgery with her UCHealth Cancer Center care team, Irma Lechuga learned her rectal cancer surgery would include creation of a temporary ileostomy. Her treatment plan was a sequence of chemoradiotherapy, followed by an assessment of her response. If the cancer had completely disappeared, then her care team would consider non-operative management. But if the cancer didn’t completely disappear, the plan was for surgical resection and a temporary ileostomy.

Jon Vogel, MD Professor GI, Trauma, and Endocrine Surgery

The cancer, unfortunately, didn’t disappear, and that’s when she began considering her life with an ileostomy, which allows bodily waste to be rerouted from the colon to an external or internal pouch. Even though it would be temporary, the possibility of it knocked her sideways almost as much as a cancer diagnosis at age 29 did.

“I tried to stay positive, but it took a toll on me,” she recalls. “I was like, I can’t be a 29-year-old walking around with a bag attached to my stomach. I didn’t want to depend on anybody, I didn’t want my husband to have to clean the bag out, I didn’t want my kids to see that. I feel bad for thinking that way, because I know a lot of people live their lives with ostomies, but in the back of my mind I was thinking, I can’t push through this.” While she was still having chemotherapy treatments, though, she’d learned about a study being led locally by Jon Vogel, MD, a professor of GI, trauma, and endocrine surgery and colorectal surgeon at UCHealth University of Colorado Hospital. The ongoing study’s aim is to compare the Colospan CG-100 Intraluminal bypass device to a diverting stoma, the current standard of care for colorectal surgery. The Colospan device is a flexible silicone tube that is positioned inside the bowel during surgery, extending www.cusurgery.com

January 2022 above and below the site where the colon is reconnected to the rectum, to prevent internal leakage. After about 10 days, when the risk for internal leakage is reduced and the integrity of the resection can be confirmed, the Colospan device is removed without surgery. For Lechuga, the decision to become the first participant in the CU Anschutz Medical Campus study site was straightforward: “Dr. Vogel explained the risks to me and the potential benefits, and how there had been previous trials outside the U.S. And I knew that if it didn’t work, then an ostomy would still be an option, but I had a lot to gain if it was successful.” Knowing something was wrong For more than 10 years, Lechuga has worked in health care as a medical assistant. Because of her education and experience, she knew that the acid reflux and bleeding she began experiencing at age 27 weren’t normal. She’d always been very active – playing soccer since she was a child, swimming, hiking, and going to the gym – and enjoyed good health. Her increasingly frequent emergency room visits generally resulted in being sent home with Tums or Pepcid and an admonition to keep an eye on her symptoms.

of what was happening, but still were confused and scared. Meanwhile, Lechuga’s husband picked up overtime shifts to cover financial shortfalls from the days she couldn’t work during chemotherapy, and her parents and sisters offered tremendous support as well. The family, particularly the children, benefitted from therapy to help them navigate the experiences and emotions of cancer, Lechuga says.

Her daughter and son, now 10 and 7, were old enough to understand some

However, because she qualified for and joined the trial, during her surgery Vogel positioned the Colospan device inside her bowel.

Working with a multidisciplinary CU Cancer Center team, Lechuga began six weeks of chemotherapy, followed by a four-week break and then eight weeks of chemoradiotherapy treatments. Through these treatments, she heard about and began researching ileostomies. Qualifying for the clinical trial “A lot of times when we treat people for rectal cancer, we use an ostomy,” Vogel explains. “It can be temporary or permanent. It depends on the patient and the precise location of the cancer and whether they’re going to have neoadjuvant therapy for the rectal cancer, which is the chemotherapy or radiation they receive before the surgical procedure. “While a temporary ileostomy is often used to prevent or lessen the severity of complications of rectal cancer surgery, the ileostomy itself may be problematic. It could result in dehydration, interference with normal

In late 2019, though, she experienced unstoppable bleeding and received a CT scan, the results of which were concerning enough that she was “I would say to anyone who’s sent for a colonoscopy. wondering about participating Following that, she in the trial that I’m so glad I received a rectal gave it a shot.” - Lechuga cancer diagnosis. “It was pretty shocking,” she says. “There’s no family history, I thought I was young and healthy, I was working out, I was eating healthy. It felt like it came out of nowhere. But I knew I had to fight with everything I had because I have small children and I need to be here for them.”

cancerous portion of the rectum then attaches the colon to the remaining portion of the rectum with a colorectal anastomosis, or surgical join.

activities, and requires another inpatient operation to have the ileostomy closed.”

“Basically, it’s a type of stent that allows bowel contents to pass through this tube without coming in contact with the surgical join,” Vogel explains. “You could describe it as a liner. So, while the surgical join between the colon and rectum is healing, it’s at risk for leakage. What this Colospan device does is prevent the bowel contents from having an opportunity to leak through this surgical join.” The Colospan device is held in place by balloons and a collar that is connected to a tube that passes through the abdominal wall. After 10 days, radiology scans are done to confirm there is no leakage at the surgical join, and then the Colospan device is removed without surgery or even anesthesia.

Click here to read more of Lechuga’s story.

In Lechuga’s case, had she not participated in the Colospan device trial, an ileostomy would have been part of the low anterior resection (LAR) surgery for which she was a candidate. During an LAR, Vogel removes the 15

Surgery News “Few things concern me more than walking into a room with someone who’s been newly diagnosed with cancer and they’re alone,” says Wells Messersmith, MD, CU Cancer Center director of translational research and professor of medical oncology who has treated Mark. “If you think about having to navigate the health care system, trying to review insurance forms, trying to get to appointments when you’re feeling nauseous from chemotherapy, for example, it highlights how having a caregiver or advocate by your side is so important.”

“YOU’VE GOT TO BELIEVE THAT YOU’RE GOING TO GET THROUGH IT”

Receiving a pancreatic cancer diagnosis

Mark Paskvan navigated a pancreatic cancer diagnosis with support from wife Monica and a multidisciplinary CU Cancer Center team.

So, his mind didn’t land on cancer when he started feeling that he couldn’t get through a workout at the gym without being exhausted. As the months passed, he felt increasingly sapped of energy, to the point that a mountain biking trip to Crested Butte drained him for weeks and he couldn’t get through a day of work at his job in telecommunications without being completely exhausted by the end of the day. “I remember coming home and going to bed at 6:30,” he recalls.

Rachel Sauer “Maybe this getting older thing just sucks and that’s how it is.”

biopsy the next day confirmed that it was cancer.

Mark Paskvan was trying to be practical and reconcile the exhaustion he felt after even light workouts with being a lifelong athlete, so that’s what he told himself: The shortness of breath and out-ofcharacter energy loss were simply side effects of being 58.

Though he didn’t recognize it at the time, Mark had reached a crossroads. What followed his August 1, 2017, diagnosis could have gone a lot of different ways, but two things happened to direct his journey to the cancer-free, active point he’s reached today: First, he was referred to a multidisciplinary team at the University of Colorado Cancer Center and second, Monica immediately booked a flight home from India and got a binder.

But the exhaustion continued and grew steadily worse, first to the point that he struggled to get through the workday without a nap, and finally to a degree that he knew what he was experiencing was more than just the prospect of a 59th birthday. And then he turned yellow. Appointments followed by tests followed by scans led to a tense “Can you come in Monday?” call on a Friday evening. After an agonizing weekend, Mark learned that a CT scan revealed a spot on his pancreas and results from a 16

Monica Paskvan is Mark’s wife of 25 years, his friend and companion who has supported and advocated for him through every step of his journey. While navigating cancer requires unimaginable reserves of internal strength, the burden is often made lighter by a loved one or friend to listen, advocate, take notes, or even just extend a hand to hold.

For most of his life, Mark could depend on his body to take him mile after mile of running or cycling. He moved to Boulder in 1986 and found a home on the miles of trails always with a mountain view. He was aware of histories of cancer on both sides of his family, but it wasn’t something he really thought about.

He knew something was definitely wrong when his skin and eyes began turning yellow and his urine was brown. He made an appointment with his physician on a Wednesday in late July and had a CT scan the following day, the results of which showed a spot on his pancreas.

Click here to read more about Paskvan’s journey.

www.cusurgery.com

January 2022

AB NEXUS FUNDS INTERCAMPUS RESEARCH ON SEPSIS Richard Tobin, PhD, will collaborate with Laurel Hind, PhD, of Boulder, to study the role of myeloid-derived suppressor cells in sepsis. Greg Glasgow Looking to improve methods to treat patients with sepsis, Richard Tobin, PhD, an assistant research professor of surgical oncology in the University of Colorado School of Medicine, and Laurel Hind, PhD, an assistant professor in the biomedical engineering program at the University of Colorado Boulder, are teaming up to study the role of myeloidderived suppressor cells (MDSCs) in sepsis. The research is funded by AB Nexus, a grant program that funds collaborative projects from researchers at CU Boulder and CU Anschutz that aim to improve

Richard Tobin, PhD Assistant Research Professor Surgical Oncology

human wellbeing through basic science and translational research approaches.

cancer, that results in the suppression of immune cells known as T cells.

When MDSCs go rogue Tobin, a CU Cancer Center member who studies the role of MDSCs in melanoma, says the cells appear to have a similar role in sepsis as they do in cancer, preventing the body from mounting an immune response to either a tumor or an invading pathogen. MDSC cells are naturally occurring and typically play a role in regulating the immune system, he says, but they can expand during cancer, inflammation, and infection. In

Large numbers of MDSCs also are present in sepsis, but their role is not as clearly understood. Tobin and Hind hope to gain a greater understanding of the role of MDSCs through their research, which will use in vitro and in vivo methods to further study MDSCs. Click here to learn more about Tobin’s research.

BREAST CANCER RESEARCH GATHERS DATA TO HELP WOMEN UNDERSTAND WELLBEING OUTCOMES AFTER SURGERY Sarah Tevis, MD, aims to develop a decision aid for women who receive a breast cancer diagnosis.

Sarah Tevis, MD Assistant Professor Surgical Oncology

Rachel Sauer When a woman receives a breast cancer diagnosis, she may have many questions about her immediate future – the stage of the disease, what treatment she’ll receive, where it will happen.

to answer. Since 2019, she and her multidisciplinary co-researchers have surveyed women diagnosed with breast cancer to better understand quality of life outcomes.

In the longer term, though, the questions become much more difficult to answer: Will I feel accepting of my body? Will I be sexually confident? Will I experience a lot of pain?

In a study published recently in the Annals of Surgical Oncology, her team presents data gathered from 3- and 6-month reported outcomes from patients who had lumpectomies and mastectomies.

These are questions University of Colorado Cancer Center member Sarah Tevis, MD, an assistant professor of surgical oncology, is aiming to help women diagnosed with breast cancer

A major goal of the research, Tevis says, is to develop decision-making tools to help women newly diagnosed with breast cancer understand what they

might experience in the long-term after diagnosis. “We’re hoping to collate a large group of patient data to get a sense of what the average patient experiences three months, six months, a year after treatment,” Tevis explains. “It gives us a foundation of data to be able to tell patients, ‘Here’s what other people in situations similar to yours have experienced.’”

Click here to discover more about wellbeing outcomes.

Surgery News

CONFRONTING MISOGYNY AND SEXISM IN MEDICINE Department of Surgery supports diversity, equity, and inclusion by initiating conversations about issues impacting people from underrepresented identities. Rachel Sauer For many women in the medical field, the common pressures associated with the profession – long hours, emotional toll, work/life balance – can be magnified by the added experiences of misogyny and sexism. From making less than their male colleagues to seeing people express surprise that they are the doctor, women’s experiences can be fraught and frustrating. Brian Shimamoto, MEd, manager of organizational and employee development for the CU Department of Surgery, has spent time studying misogyny and sexism and, most importantly, having conversations with women about them. He recently presented a Grand Rounds addressing whether misogyny surpasses sexism in modern medicine. We sat down with him to delve a little deeper into the conscious and unconscious misogyny that can impact women and those who identify as female in the medical field.

Historically, misogyny has been described as a hatred of or prejudice against women. That definition was always a little problematic to me because many men profess to love the women in their lives — their mother, their sister, their wife — and yet still conform to stereotypical gender ideas. Kate Manne, an Australian philosopher and author, describes misogyny differently. In her book “Down Girl” she describes misogyny as the law-enforcement branch of patriarchy which punishes women who violate patriarchal norms and expectations. This concept of misogyny explains how both men and women can participate in misogynistic behavior aimed at reenforcing gender stereotypes without “hating” women. In fact, she goes on in her book to suggest that we reserve the label of “misogynist” only for people who are constant overachievers when it comes to enforcing traditional gender roles, engaging in more extreme acts more frequently. Is it important to make that distinction between misogynistic actions and actually being a misogynist?

First, you are male… That’s true. Being male-identified, I’m relying on information I’ve gained from conversations with women/femaleidentified colleagues, and with a lot of research that’s out there. I see my role not as guiding the conversation, but being a part of it and helping to create spaces where women and those who identify as female feel safe and comfortable to honestly talk about their experiences. What’s the difference between sexism and misogyny?

Well, I certainly wouldn’t want to be called a misogynist, but if I’m honest, based on how Kate Manne describes it, I may have engaged in misogynistic behavior — reenforcing gender stereotypes — possibly without even knowing it.

Click here to read our entire interview with Shimamoto.

Sexism is sex- or gender-based discrimination that reflects patriarchal ideology and is used to justify or rationalize the idea that men are “superior” to women and better suited for certain roles in our society.