July 2021 Department of Surgery Newsletter

SURGERY NEWS July 2021

NOTES FROM THE CHAIR Although the pandemic did not hinder our continued pursuit of excellence, our on-campus activities were drastically changed. It is a welcoming sight to see our campus coming back to life as staff and students return.

Over the past quarter, we have accomplished many things. Our state’s first lung transplant related to the COVID-19 virus, clinical advances in wide-awake hand surgery, a bariatric surgery public health initiative, and advancements in the treatment plan for esophageal cancer to name a few.

In addition, our graduation and awards ceremony introduced a new group of outstanding surgeons to the world of medicine. It has been my great pleasure to be a part of their training, and I look forward to learning of their accomplishments in the years to come.

As we make our way back to normal, please take care of yourself and your loved ones.

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

COLORADO’S FIRST COVID-19 LUNG TRANSPLANT

ISSUE HIGHLIGHTS 4

BARIATRIC SURGERY

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WIDE-AWAKE HAND SURGERY 9

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Bryan Raymond is the first person in Colorado to receive a lung transplant due to the COVID-19 virus.

2021 GRADUATION

ESOPHAGEAL CANCER

Surgery News

CU SURGEON PERFORMS STATE’S FIRST COVID-19 LUNG TRANSPLANT Greg Glasgow Bryan Raymond was very nearly just another grim entry on the ever-growing list of COVID-19 fatalities. But thanks to efforts by faculty members in the University of Colorado School of Medicine and Department of Surgery, Raymond is a COVID statistic of a different sort — the first person in Colorado to receive a lung transplant related to the virus.

“He was initially very sick and then he stabilized, but he still required the ECMO (extracorporeal membrane oxygenation) circuit to provide oxygen to his lungs because his lungs became so scarred down. It’s one of the oftenfatal complications of COVID,” says

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Robert Meguid, MD, MPH, associate professor of cardiothoracic surgery, who performed the double lung transplant on Raymond in March. “He was sick in our cardiothoracic ICU, and once the transplant pulmonology team became aware of him, they started the workup and deemed that he was a reasonable candidate for lung transplantation.

Thankfully, he survived.”

The COVID battle begins Raymond’s ordeal began in November in his hometown of Malta, Montana, when he began feeling feverish and short of breath. He tested positive for COVID-19 and began treatment in a

local hospital, but when his oxygen saturation level dipped to the mid-70s (above 90 is normal), he was flown to a larger hospital in Billings, Montana.

In January, he was flown to UCHealth University of Colorado Hospital, where cardiothoracic surgeon Muhammad Aftab, MD, put him on a ventilator and an ECMO circuit to keep his lungs working and his blood oxygenated.

“The whole month of January they were not unable to wean his sedation,” says Bryan’s wife, Trinity Raymond.

“He was heavily sedated because any time he would wake up, he would start coughing horribly, which in turn would mess up the ECMO circuit. And that’s

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July 2021 his lifeline. His lungs just scarred and were never able to get better.”

required additional hospitalization, but it wasn’t due to complications from the lung transplant; it was due to complications from the COVID making him bedridden for so long.”

Bryan slowly regained strength and began working with a physical therapist to get walking again — a prerequisite for This has been a massive effort by our receiving a lung transplant as it faculty and providers — physicians, tells doctors the nurses, respiratory therapists, patient is strong physical therapists and others — all enough to endure these support systems that got him the surgery.

kept him from becoming another COVID-19 fatality.

“There were so many different teams that put forth an effort to see me through everything,” Bryan says.

“Now we see the doctor, and he’s still seeing improvements, and he’s not too concerned about anything right now.

I think we’re doing as good as we can be. We just keep pushing forward.”

through it,” - Meguid

“His first PT sessions, they would sit him up on the bed and they would have to fully support his head, fully support his body — it was a lot of work to get him to walk,” Trinity says.

When he was strong enough, Bryan was placed on the transplant list, and it only took a week to find a match.

“To be this sick and still eligible for a lung transplant is pretty unusual,” Meguid says. “We do see patients that are this sick that do get lung transplants, but it’s probably one or two a year. He’s fortunate to have been able to do this. We are seeing patients with similar conditions and not surviving.”

From transplant to recovery The surgery took eight hours, and doctors kept Trinity updated throughout. Five days later, Bryan was breathing well enough to come off of ECMO. After four weeks of additional hospitalization — including two weeks on the rehabilitation floor —he was discharged.

“He was not the typical lung transplant candidate,” Trinity says. “Most of them walk into the hospital for their transplant because they’ve been fighting a disease for many years and they’ve had to live with it. Everything with the transplant went great, but we still had somebody who had lost 70 pounds, hadn’t eaten meals for over three months, so we had to work on getting him off tube feeds, making sure he could swallow well again. He

Team effort Meguid notes that during Bryan’s nearly three-month stay in the ICU, multiple teams from the University of Colorado School of Medicine helped with his care.

“This has been a massive effort by our faculty and providers — physicians, nurses, respiratory therapists, physical therapists and others — all these support systems that got him through it,” Meguid says. “It is definitely not, ‘Dr. Aftab put him on ECMO and I put lungs in him.’ It was a massive team effort that succeeded at getting him through this.”

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Trinity echoes the sentiment, saying that by the end of their hospital stay, many of the staff had started to feel like family.

“The doctors, physical therapists, occupational, speech, respiratory, the ECMO specialists, the thoracic surgeons, the whole pulmonology team — they’ve been amazing,” she says.

“We got so close to the cardiothoracic ICU floor because the people that were with him there had also been with him in the COVID unit. We cried when we had to leave to go to a regular floor.”

Muhammad Aftab, MD Assistant Professor Cardiothoracic Surgery

The journey back It will be at least six months until Bryan regains full lung function; he is looking forward to returning home to Montana and seeing his kids again. Until then, he is focused on recovery and grateful to the health care professionals who

Robert Meguid, MD, MPH Associate Professor Cardiothoracic Surgery

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Surgery News across multiple departments, from registered dietitians to psychologists to endocrinologists.

“The bariatric surgery program is very collaborative and multidisciplinary,” Pieracci says. “We used that to our advantage when we were discussing with our administration the notion of funding surgery for uninsured patients.”

BARIATRIC SURGERY PUBLIC HEALTH INITIATIVE More than two dozen uninsured patients at Denver Health receive affordable bariatric surgery.

Valerie Gleaton Fredric Pieracci, MD, MPH/MSPH, an associate professor in the University of Colorado School of Medicine Department of Surgery, is the senior author on a new paper published in Surgery for Obesity and Related Diseases that details the results of a public health initiative to provide affordable bariatric surgery to uninsured Denver County residents.

As director of the Denver Health Bariatric Surgery Center, Pieracci says he and his team have performed more than 500 bariatric surgeries over the past decade. Because Denver Health is a public safety-net hospital that receives money from the city, state, and federal government, almost all of those surgeries were performed on patients with Medicare or Medicaid insurance.

None of the patients were uninsured.

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“We were getting four or five — sometimes even 10 referrals a month for bariatric surgery that we had to turn away because they didn’t have insurance,” Pieracci says. “That’s when we started meeting as a team to try to come up with a solution.”

After garnering support from their colleagues, Pieracci and his team met with Denver Health’s Medical Necessity Committee, a group responsible for deciding which surgeries and other procedures are approved for patients without insurance. Life-saving treatments, such as cancer surgeries, are automatically approved, while procedures like cosmetic surgery are usually denied. Bariatric surgery existed in a gray area.

“It had never really been considered by that committee,” Pieracci says.

“So, we made a presentation explaining why we thought bariatric surgery should be covered, using the logic that the committee already covers surgeries that increase patient’s lifespans or help with other serious health problems. We said that bariatric surgery should be in that same category because we know that it increases longevity and cures things like high blood pressure and diabetes.”

The committee agreed, leaving one final hurdle: administrative and budget approval.

Those initial meetings eventually culminated in a new public health initiative spearheaded by Pieracci and his team.

Making their case Pieracci and his team started by creating a petition. “It was kind of a grassroots movement,” he says. The petition stated that bariatric surgery should be offered to all members of our community regardless of their ability to pay. They received more than 100 signatures from Denver Health providers

Click here to read the outcome of Pieracci’s presentation to hospital administration.

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July 2021

PATIENTS GAIN IMMEDIATE ACCESS TO THEIR MEDICAL RECORDS Greg Glasgow Patients’ rights advocates scored a major victory in April, when a provision went into effect that allows patients immediate access to all information in their medical records, including physician notes and test results. The change is part of the 21st Century Cures Act, which was passed by Congress in 2016 and continues to be updated.

Many physicians, however, worry the change could cause more harm than good, as patients are now viewing and attempting to interpret test results before their doctor has a chance to call and explain things.

“These reports are set up in such a way that they’re very standardized, and they use a lot of medical jargon, so we worry: Will patients understand the results? Will it cause anxiety?” says Sarah Tevis, MD, assistant professor in the University of Colorado School of Medicine Department of Surgery and a member of the CU Cancer Center. “We don’t have workflows in place to have someone call patients immediately, so will it cause patients more anxiety to read this report they don’t understand and then wait for someone to call them? Will they be calling the clinic continuously, trying to get someone to explain it to them?”

Researching potential problems Before UCHealth University of Colorado Hospital adopted the change last fall (a subsequent delay moved the deadline for compliance to April), Tevis and surgery resident Laura Leonard, MD, started to worry about what immediate access would mean for patients and

providers. They began conducting research so they could develop best practices for the Diane O’Connor Thompson Breast Center at the University of Colorado.

test-result messages in cases where results are normal; and developing educational tools that can be integrated into the patient portal to help patients better understand their results.

“It could be a glossary of commonly used terms in breast cancer so they are getting vetted medical resources, as opposed to Googling on their own and possibly encountering misinformation,” says Leonard, who received a CU School of Medicine CEPS grant to develop the educational tools.

While the initial research was to aid providers and patients in the breast cancer clinic, Tevis and Leonard plan to share any helpful findings both within the CU School of Medicine and throughout the broader medical community.

Tevis and Leonard asked patients and providers what they thought was a reasonable window of time for a doctor to call to explain new test results. For “This is something that every abnormal or unexpected results, patients “I’m glad the days of patients said less than having to go to a medical records 24 hours; office and pay to have their records providers said more than 24. printed are gone, but I do think we

need to figure out how we can “As a result better support patients and health of that, we made sure the care teams” - Tevis communication we have with institution is experiencing across our patients sets clear expectations the country, so if we develop a tool for when they can expect a provider to or a system that works well, we will contact them,” Leonard says. absolutely try to get the word out The pair also asked patients to rate about it that so other centers that their level of understanding of certain are struggling can learn from our types of medical reports, while asking experience,” Tevis says. providers what they perceived their patients’ understanding level to be.

“Patients, in general, had a higher estimate of their level of understanding than providers did,” Leonard says.

Strategies to help The research revealed several strategies to help providers and patients at the breast cancer clinic through the change, including triaging messages so providers can call patients with worrisome results first; using the electronic medical record to automate

Click here to read more about Tevis’ and Leonard’s research.

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Surgery News

WIDE-AWAKE HAND SURGERY CU School of Medicine professor and surgeon Kia Washington, MD, cures conditions like carpal tunnel syndrome with the new technique.

Valerie Gleaton In the past, even relatively minor hand surgery was a major event. For patients, it required anesthesia and numerous hours at the hospital. And for hospitals and providers, it used up extensive material resources and time.

Now, surgeons like Kia Washington, MD, director of the Wide-Awake Hand Clinic at the UCHealth University of Colorado Hospital (UCH), can perform hand surgery in a matter of minutes — while the patient is still wide awake.

Lean and green hand surgery Kia Washington, MD Professor Plastic & Reconstructive Surgery

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Wide-awake hand surgery is part of the “lean and green” surgery movement, which aims to reduce the amount of medical waste generated by hand surgery. The procedure, also known as the Wide-Awake Local Anesthesia

No Tourniquet (WALANT) Technique, is most often used for carpal tunnel release, trigger finger release, mass excision, Dupuytren’s contracture release, and ligament repair.

“A lot of procedures in hand surgery can be performed with just local anesthesia,” Washington explains. “They don’t need to be done in the operating room where you’re using a lot of resources, like an anesthesiologist, extra drapes, or an IV.” Wide-awake surgery not only reduces the amount of surgical waste produced during these procedures (sterile draping, PPE, etc.), but it also benefits patients by reducing their medical costs, surgical risks, and time spent at the hospital.

Washington, who is also director of research for the Division of Plastic www.cusurgery.com

July 2021 and Reconstructive Surgery and a professor of surgery at the University of Colorado School of Medicine, helped develop the wide-awake hand surgery program over the last three years. It is one of the first of its kind in the Mountain West region. She began doing wide awake hand surgery nine years ago at the Veterans Affairs Hospital in Pittsburgh.

“It’s not necessarily for everyone,” she says. “Some people don’t do well with just local anesthesia, and some prefer sedation for their procedures. But it’s a great option for a lot of our patients. They can get in and out for their surgeries, and we save a lot of resources.”

Grandfather gives wide-awake surgery a shot One of those patients is Michael Powl, who suffered from the painful symptoms of carpal tunnel syndrome for about six months before being referred to Washington.

A retired utility worker from Pennsylvania, Powl moved to Colorado with his wife in 2008 to be near their children and grandchildren.

He and his daughter-in-law, Rubi, founded a business called Tiny Dog Leather Studio in 2018, producing handmade bags, wallets, and other leather goods to raise money for Children’s Tumor Foundation in honor of Powl’s grandson Jake. Jake was born with a genetic disorder called neurofibromatosis (NF), which causes tumors in the nervous system. The duo donates 10% of the proceeds from Tiny Dog to help researchers find a cure for NF. But in early 2020, Powl found the intricate work getting more and more difficult as his carpal tunnel symptoms worsened. What started as a tingling sensation in his hands progressed to numbness and then severe pain.

He tried physical therapy, but it didn’t seem to help, so his doctor referred him to Washington.

expecting was that she’d suggest he be awake during the procedure.

“She asked me if I wanted to be awake while she did the surgery, and I said, ‘What?!’” Powl recounts. “But then she explained how they do it and that it’s less intrusive and it takes less time. So, I said, ‘OK, let’s give it a shot.’”

Powl had his first surgery on his left hand in October 2020 and the surgery on his right hand the day before Thanksgiving.

“It was so quick,” he says. “It took longer to walk into the building than it did to have the surgery.”

And the experience of being awake during surgery?

“Dr. Washington and the other people in the room provided a very relaxed atmosphere, which is what you want when you’re going to have surgery, especially surgery while you’re awake,” Powl says. “If they saw that you were uncomfortable, they would start talking to keep your mind off of it. I was talking away and then all of a sudden Dr. Washington said she was done. Fifteen minutes and that was it!”

Although he still has some issues with arthritis, after surgeries on both hands, Powl says that his carpal tunnel symptoms are “100% gone.”

“There were certain things I couldn’t do with the leather work before that I’m able to do now even though I’m still recovering,” he says. “I would highly recommend this surgery,” he adds.

Being LGBTQIA+ On Anschutz Medical Campus The University of Colorado School of Medicine’s Center for Advancing Professional Excellence (CAPE) hosted the third installment in its virtual community event series aimed at connecting with the Anschutz community and amplifying diverse voices through candid conversations with members of underrepresented groups.

Coinciding with Pride Month, this month’s event was titled “Being LGBTQIA+ On Anschutz Medical Campus.” The six-person panel included a variety of CU Anschutz students, faculty, and staff discussing issues affecting the LGBTQIA+ community both on campus and in health care overall.

Click here to read more about the panel discussion.

Powl was thrilled when Washington said he’d be a good candidate for carpal tunnel surgery. What he wasn’t 7

Surgery News

WELCOME NEW HIRES FACULTY Robert Clower, PA Instructor Transplant Surgery Adam DeMey, PA-C Instructor GI, Trauma, and Endocrine Surgery Joseph Jacaruso, NP Instructor GI, Trauma, and Endocrine Surgery Taryn Ketels, NP Instructor GI, Trauma, and Endocrine Surgery Katherine Knott, PA-C Instructor Surgical Oncology Anna Linton, PA-C Instructor Pediatric Surgery

Caitlin McCarthy, CPNP Instructor Pediatric Surgery Cassandra Murphy, AGACNP-BC Instructor Surgical Oncology Stephanie Schneider, PA Instructor Cardiothoracic Surgery Kerr Thurmon, MD, MPH Associate Professor Urology

STAFF Tisha Allen Administrative Assistant III Cardiothoracic Surgery

Ashley Carlson Training Program Coordinator Office of Education Finance and Administration Jin Cha Professional Research Assistant Plastic and Reconstructive Surgery Moriah Denler Residency Database Coordinator Office of Education Finance and Administration Deesa Dontamsetti Business Intelligence Analyst Finance and Administration Andrea Pina Research Services Professional Clinical Research Office Finance and Administration

FEATURED POSITIONS Post Award Specialist

Medical Director of Burn Surgery

The Division of Finance and Administration is recruiting a post award specialist. Functions include contracts and grants solicitation and administration, grant/agreement preparation, review and negotiation, regulatory compliance, sponsor communication and post- and pre-award management, human subject compliance, research animal management, research laboratory coordination and instruction, environmental health and safety, radiation control, hazardous materials use, disposal and training.

The Division of GI, Trauma, and Endocrine Surgery’s Burn Surgery and Surgical Critical Care Section is recruiting a medical director of burn surgery at the rank of assistant professor or associate professor. This position is responsible for staffing and call coverage for the burn surgery service and the burn intensive care service, participation in medical student, advanced practice provider students and fellows, surgery residents, and fellow education, and scholarly activity commensurate with qualifications.

APPLY NOW

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APPLY NOW

Click here to view all open positions.

Plastic Surgeon The Division of Plastic & Reconstructive Surgery is recruiting a residency trained plastic surgeon for a 1.0 FTE position available at the rank of assistant professor or associate professor. The position will primarily focus on adult general plastic surgery (including reconstructive, microsurgery, breast surgery, and aesthetic/ cosmetic surgery) and will involve care of patients at the University of Colorado Hospital and its affiliates.

APPLY NOW

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July 2021 The first was to read for pleasure and pursue hobbies outside of their careers.

Secondly, he told them that “it’s OK to say you don’t know something.”

“You’re not the finished product yet,” he said. “Your education will continue after you leave.”

Nehler also encouraged the future surgeons to be present with their friends and family. “Your time is your most valuable asset, particularly outside of the hospital,” he said.

“Make sure they know they have your attention.” Finally, he reminded the graduates to take care of themselves as well as others, and to give back to the next generation of surgeons.

CELEBRATING OUR 2021 GRADUATES The event was held at the Denver Botanic Gardens and recognized award winners, faculty, and graduates.

The evening concluded with some parting thoughts from the graduating chief residents, including a special acknowledgement of the 2020–2021 intern class (first-year residents) for their commitment and hard work during an especially challenging year.

Valerie Gleaton The University of Colorado School of Medicine Department of Surgery hosted its Resident and Fellowship Graduation at Denver Botanic Gardens on June 11.

The evening began with a welcome message from Richard Schulick, MD, MBA, chair of the department.

“To say the least, it’s been a rough year and a half,” Schulick said, referencing the COVID-19 pandemic. “The surgeons graduating tonight, along with the faculty and hospital staff, put themselves selflessly in harm’s way every day. In the beginning of the pandemic, we had no idea of the risks or the dangers, but we did it anyway.

Because that’s what we do.”

Schulick went on to congratulate the evening’s graduates. “Surgery is such a great calling, and you have chosen the most noble and rewarding profession,” he said. “Go forth and make us proud, as we know you will. You have learned,

you have certainly endured, you have saved many lives, and you have proven yourselves. Congratulations.”

After Schulick’s remarks, a variety of awards were presented, including the Medical Student Awards, the Professionalism Awards (a new set of awards this year to recognize trainees and faculty who demonstrated professionalism within various specialties by going above and beyond the call of duty), the Residency Awards, and the General Surgery Chief Resident Awards.

Click here to view award winners from this year.

The awards were followed by the presentation of nine Research Fellowship Certificates by Schulick and Mark Nehler, MD, then the 32 Department of Surgery Residency and Fellowship graduates.

In his remarks, Nehler, the surgery residency program director, offered some words of advice to the graduates.

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Surgery News

CSI Trainings, R&D, and Education

CSI CELEBRATES ONE YEAR IN NEW LOCATION The Center for Surgical Innovation is looking forward to expanding its offerings in the post-pandemic future.

The Center for Surgical Innovation hosts trainings on surgical procedures and medical devices, conducts both internal and external research and development, and gives back through community education.

Here are just a few examples: •

Stryker Corporation recently brought in 100 surgeons from Latin America to train on new orthopedic procedures.

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Stephen Cass, MD, MPH/MSPH, a professor in the Department of Otolaryngology, trains new surgeons to insert cochlear implants into the skull.

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Campus researchers received a grant from the Department of Defense to conduct cadaveric tests on different types of military helmets.

FBI SWAT-team emergency medical technicians did hands-on training with trauma surgeons and emergency medicine specialists, using human cadavers to learn how to open airways and stanch bleeding in the field.

The CSI hosts an annual event for female high school students who are interested in future careers in the STEM and health care fields where they learn how to suture, first on synthetic skin and then on real human tissue.

Valerie Gleaton When Sarah Massena joined the Center for Surgical Innovation (CSI) as executive director in 2007, she saw the role as an ideal way to merge her interests in science and business.

“It was an amazing opportunity where I knew that every day would be different,” Massena says. “I didn’t want a job where I had to sit at a computer and do the same thing all the time — I like to be up and moving, I like meeting new people, so it was a really good fit.”

The CSI was founded two years before that in 2005, as a collaboration between three surgeons: Thomas Robinson, MD, Fernando Kim, MD, and Todd Kingdom, MD. In 2007, the five surgical departments on campus, Surgery, Neurosurgery, Orthopedics, Otolaryngology (ENT), and Obstetrics and Gynecology joined forces to become members of CSI. The center started as a place to train the School of Medicine’s internal residents.

But as interest grew and they were asked to host more trainings, Massena says they realized the model wasn’t financially sustainable.

“We started thinking about ways that we could be profitable,” Massena says.

“Surgeons and nurses and other health care professionals get approached by the medical device industry all the time because they want to train people on their products. It seemed like a perfect match.”

Now, medical device companies bring people from around the world to the CSI to train on specific procedures and new devices. Other external clients use the center’s resources to conduct their own research and development.

“There are a lot of these centers around the nation, but I think we stick out because we are truly multidisciplinary — we can do any surgical procedure that exists, even if it’s not part of our five founding surgical departments.”

Click here to read more about the CSI and their post-pandemic plans.

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July 2021

INVESTIGATING A BETTER TREATMENT FOR ESOPHAGEAL CANCER Greg Glasgow Looking for better ways to treat patients with esophageal cancer, University of Colorado Cancer Center member Martin McCarter, MD, is investigating whether a new treatment sequence will result in better outcomes.

As they await the results of a group of clinical trials — including one at the CU Cancer Center — McCarter and other University of Colorado researchers (led by surgery resident Bobby Torphy, MD, PhD) looked at data from the National Cancer Database to see if they could identify other patients who have undergone the new sequence, and what the outcomes for those patients were. The group published a paper in the Annals of Surgical Oncology in April detailing their findings.

We sat down with McCarter, professor of surgical oncology at the University of Colorado School of Medicine, to talk about the data and the next steps in his research.

What is the motivation behind these esophageal cancer clinical trials and your review of the National Cancer Database data?

The big picture is that outcomes for esophageal cancer are still very poor, even in patients who can undergo an operation, and we’re constantly looking for ways to improve that. The current standard of care is a combination of chemotherapy and radiation given together, followed by surgery. Treatment sequencing has evolved in other areas, particularly rectal cancer, in what is referred to as a “total neoadjuvant approach,” in which patients get prolonged chemotherapy, followed by radiation therapy, then followed by surgery. They’ve been doing that in rectal cancer, and that has resulted in some improvements in cancer

outcomes. The data for this approach in esophageal cancer is limited, but in our minds it would make sense to try it. There are a couple of early-phase trials looking at that sequence, to see if it can help improve things for patients with esophageal cancer— including an investigator-initiated study here at CU led by CU Cancer Center member Jeffrey Olsen, MD. It’s going to take a few years for those trials to mature, but in the meantime, we wanted to look at a large national database to see if we could determine if other people have been using this sequence. We used the National Cancer Database to ask that question, and we found about 5% of patients were getting this prolonged sequence. Based on the data, it appears that those patients actually have a better survival rate than patients who just get chemo and radiation prior to surgery.

How does the sequence you’re proposing differ from the current standard of care?

The current standard is that patients get five weeks of radiation, and they get a little bit of chemotherapy at the beginning and in the middle of that radiation therapy. Then they wait six or eight weeks, then they have surgery. This new approach adds chemotherapy for two to three months first, then transitions to chemo and radiation therapy, and then on to the surgery. The thought behind it is that in general, people don’t die from the local cancer; they die from cancer that has spread microscopically before we even see it. If we treat them aggressively with chemotherapy first, then we are attacking the microscopic disease first and then following that by trying to control the local disease with radiation and ultimately with surgery as well.

Click here to read the entire interview with McCarter.

Click here to view a list of open clinical trials.

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Surgery News Encouraging the next generation of doctors No matter the age group he’s speaking to, Bartley never turns down an opportunity to motivate young people and give them encouragement to see themselves someday working as physicians.

VIRAL TWEET PUTS SURGERY RESIDENT IN THE SPOTLIGHT Greg Glasgow Matthew Bartley, MD, MS, has gone viral (as in trending in the world of social media).

The CU Department of Surgery resident visited his 5-year-old son’s classroom on June 18 to talk to the students about what it’s like to be a doctor. The photo he tweeted of the occasion quickly spread — first among his friends and coworkers, then even farther. It currently has more than 35,000 likes.

“I was getting so many notifications, I had to turn off all the Twitter notifications on my phone,” Bartley says with a laugh.

Representation matters Bartley, who has visited his son’s classroom before and also makes regular visits to local high schools, sees those appearances as important motivation for young people — especially Black males like himself — to get interested in careers in medicine.

“It’s hard to become something you’ve never seen, which is what I wrote on my Twitter post,” says Bartley, a general

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surgery resident who attended the University of Missouri-Columbia School of Medicine. “I was fortunate to grow up with a father who was in medicine, so I grew up with a lot of Black men around me who were all doctors. When I go to these high schools and talk to a lot of these kids, they’re so amazed that I’m a Black doctor, not to mention a surgeon.

A lot of them think they could become a basketball player or a movie star before they could become a doctor.”

As for kindergartners and gradeschoolers, Bartley says, he’s always amazed at their curiosity.

“I tell them what the day-to-day of being a surgeon is like, and most of them want to know what’s my favorite part of my job,” he says. “I tell them, ‘People come in on their worst day, and I get to help them, and they leave the same or better as when they come in.’ A lot of them want to know if there are other people like them in the hospital, and who do I work with in the hospital — even though they’re 5-year-olds, they’re very inquisitive and fascinated with the job.”

“I think it gives them that spark they need to say, ‘Yes, you can do this.’

Here’s somebody who’s done it who’s not very different from you,” he says. “It’s more important to do it when they’re younger, so they really have the idea and mindset that it’s something they want to do. It’s easy once you get into high school, and even college, to have people discourage you and choose something else. If you get it in your head when you’re really young — young people are driven, and they do what they want to do no matter what people say.”

Increased diversity is a primary goal of the CU Department of Surgery’s Diversity, Equity and Inclusion Committee. Formed in fall 2019, the group is examining everything from hiring practices and trainings to mentorship and patient care. Of particular interest is increasing the number of people from backgrounds underrepresented in medicine — women, people who identify as LGBTQ, people of color, people with disabilities, veterans, and people serving in the military.

Fan club Bartley is still going through the responses and direct messages that came as a result of that viral tweet — everything from requests to speak at other schools and compliments on his trademark cowboy boots to encouragement from other Black professionals.

“Being the only Black male in the CU surgery program, it made me feel like I have a lot more people out there rooting for me than I think,” he says.

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