November 2020 DOS Newsletter

NEWS NOVEMBER 2020

IN THIS ISSUE:

NOTES FROM THE CHAIR

In Memory of Mary Eiseman

2

Top Docs 2020

3

Welcome New Hires

3

Former Broncos Punter Speaks Out 4 About Prostate Cancer Cleft Lip 6 Transformation Boulder Woman Survives COVID-19 8 Thanks to ECMO Saving a Clown

10

Confidence After 12 Double Mastectomy Melanoma is a Priority for CU SOM & 14 Cancer Center Upcoming Grand 16 Rounds

closely with her late husband Dr. Ben Eiseman and knew the family well. She was an adventurous woman who loved the outdoors. Our sympathies go out to her family and friends.

Richard D. Schulick, MD

As we approach the year end, it is a good time to stop and take note of all that has happened over this eventful year. It has truly been a roller coaster from tragedy, suffering and death to great accomplishment and success. From things worth celebrating to remembering the hardships and those we have lost.

In September, we said goodbye to an amazing woman, Mary Eiseman. Many of us worked

While the unique circumstances of this pandemic have impacted many things, we are still providing an exceptional level of quality care to our patients. Stories about our patients include cleft-palate reconstruction, COVID-19 survival, prostate cancer awareness, breast reconstruction, saving a clown and melanoma care.

These are just a sampling of the great work our department accomplishes to "Improve Every Life."

can continue to innovate and discover new methodologies.

As always, it continues to be my privilege to share these highlights with you. I hope you enjoy the newsletter that follows, and please take care of yourself and your loved ones.

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

Additionally, 21 of our colleagues made 5280’s 2020 Top Docs list. We continue to strive to build a department full of uniquely talented and diverse faculty and staff. It is only through our uniqueness that we

Innovating Surgical Care Curing through Discovery Enlightening Tomorrow’s Leaders Daring to be Exceptional

www.cusurgery.com

This publication is viewable online at: http://issuu.com/slangesurgery/docs/November_2020_dos_newsletter

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Mary Harding and Ben Eiseman in England circa 1944

IN MEMORY OF MARY EISEMAN

Provided by Andrew Eiseman, September 25, 2020

Mary H. Eiseman passed away on September 11, 2020, after a long illness. Her late husband, Dr. Ben Eiseman, died in 2012.

Born in Thornton Heath, England, Mary grew up in Surrey, where her father was vicar at a parish church and chaplain at a private hospital.

During World War II she studied physiotherapy and was stationed at a hospital on the south coast of Cornwall. At a dance for American GIs, she met her future husband, Lt. JG Ben Eiseman of St Louis, Missouri. They were married

by Mary’s father just before Christmas in 1945.

After the war, the couple returned to the United States, initially settling in St Louis.

In 1952, Dr. Eiseman took a position at the University of Colorado School of Medicine, and the couple moved to Denver. Except for a 7-year hiatus in Singapore and Lexington, Kentucky, Ben and Mary lived in Denver the remainder of their lives.

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As Coloradans, they were great outdoor enthusiasts, climbing most of the 14er peaks, skiing, and backpacking and hiking in the Rockies, the Sierras, the Alps, the Himalayas, and the Andes; as well as in Japan, New Zealand and Kyrgyzstan. Mary climbed Mount Kilimanjaro in Africa, and hiked to the base camp of Mount Everest in Nepal, both within a few months of her 50th birthday.

Mary was an avid gardener and animal lover, working as a volunteer with the Denver Botanic Gardens and The Dumb Friends League, among many other charities.

Mary is survived by her four children, five grandchildren and two great-grandchildren. Friends are invited to remember her with gifts to Planned Parenthood of Colorado, the Denver Dumb Friends League, or the Trust for Public Lands.

Mary H. Eiseman 1922-2020

NEWS CONGRATULATIONS TO OUR 2020 TOP DOCS

WELCOME NEW HIRES

TopDocs Poster 2020 v1.ai 1 9/18/2020 9:13:02 AM

COLON & RECTAL SURGERY

COMPLEX GENERAL SURGICAL ONCOLOGY

Morgan Achterhoff, PA Instructor Plastic & Reconstructive Surgery Eric Ballon-Landa, MD Assistant Professor Urology Brittany Blass, PA-C Instructor GI, Trauma, & Endocrine Surgery

Eric M. Campion

Richard D. Schulick

Jon Vogel

FEMALE PELVIC MEDICINE & RECONSTRUCTIVE SURGERY

CONGENITAL CARDIAC SURGERY

Terra Busse, PA-C Instructor Cardiothoracic Surgery Nina Casanova, MD Sr. Instructor Urology

David N. Campbell

James Jaggers

Max Mitchell

Brandon Chapman, MD Assistant Professor GI, Trauma, & Endocrine Surgery

Rodrigo Donalisio da Silva

PEDIATRIC TRANSPLANT HEPATOLOGY

PEDIATRIC SURGERY

Daniel Connolly, PA-C Instructor Cardiothoracic Surgery Holly Harges, PA-C Instructor Urology

Denis D. Bensard

PEDIATRIC UROLOGY

Jennifer L. Bruny

David Partrick

PLASTIC SURGERY

Amanda Miller-Sarmento, NP Instructor Plastic & Reconstructive Surgery

Fritz Karrer

SURGERY

Israel Muro Hernandez, PhD Research Associate GI, Trauma, & Endocrine Surgery

Nicholas Cost

Duncan T. Wilcox

Robert C. McIntyre, Jr.

Corrine Wong

SURGICAL CRITICAL CARE

Ellie Karimkhani, MSN Instructor Transplant Surgery Madison Paul, BS PRA GI, Trauma, & Endocrine Surgery

THORACIC & CARDIAC SURGERY

Camille Stewart, MD Assistant Professor Surgical Oncology Clay Cothren Burlew

2 0 TOP 2 0 DOCS

Robert C. McIntyre, Jr.

Joseph C. Cleveland, Jr.

John D. Mitchell

Fredric M. Pieracci

UROLOGY

Shuichi Watanabe, MD Visiting Researcher Surgical Oncology Sarah Zimmerman, PA-C Instructor Cardiothoracic Surgery

Rodrigo Donalisio da Silva Ty Higuchi

Paul Maroni

21 Surgeons | 12 Specialties | 8 Metro Hospitals Page 3

receiving a prostate biopsy from his local community hospital, he was encouraged to look at all options before deciding on his treatment course.

Bucky Dilts punting for the Broncos. Photo courtesy of Bucky Dilts.

FORMER BRONCOS PUNTER WANTS MEN TO SHARE THEIR EXPERIENCE WITH PROSTATE CANCER By: Noelle Musgrave, Department of Surgery, September 2020

Growing up, Douglas “Bucky” Dilts was all too familiar with the dangers of cancer. “My mother ran a cancer tumor registry at St Joseph's Hospital in Atlanta, Georgia, for over 25 years. She was always telling us about different types of cancer, so cancer was always at the forefront.”

privately discuss the topic of prostate cancer with me,” said Bucky.

Prostate cancer became something he often discussed with his father. Bucky’s father and uncle were diagnosed after the age of 50.

According to the American Cancer Society, second to lung cancer, prostate cancer is the most common cancer among men and can often be treated successfully. Early diagnosis is key in successfully treating the cancer and minimizing the side effects associated with current treatment options.

Bucky Dilts, a former Broncos punter, played during the 1977 and 1978 seasons. His career led him to play at Super Bowl XII against the Dallas Cowboys in 1977. As a Denver Bronco alumnus, he now wants to use his position in the community to advocate for men’s health.

Bucky was diagnosed with prostate cancer at the age of 55 and now advocates for prevention and early detection.

“I have seen repeatedly how others use my openness to Page 4

He discovered that many of his peers associated prostate cancer with anonymity due to the physical, especially sexual health implications from treatment.

The Kick-Off to Bucky’s Cancer Journey In 2009, Bucky began taking preventative measures by receiving the prostate-specific antigen (PSA) test from his primary care physician. They discovered his PSA level was 5ng/mL, a level that indicates more testing is needed per many national guidelines. After

another cancer center around the country, this was the best option for me, and luckily it was right here in Colorado.”

“Bucky has done quite well He researched multiple urology after his surgery. He lives a practices before deciding on the full life and I’m glad he’s used Tony Grampsas the experience to Urologic Cancer advocate for men’s Care Clinic on health,” said Paul Anschutz Medical Maroni, M.D., Campus at the associate professor University of in the Department Colorado Hospital. of Surgery, Urology Bucky underwent Division, program a radical director of the prostatectomy Urologic Cancer Care Paul Maroni, MD Center and CU Cancer in February of 2010 performed Center Member. by past faculty member of the Advocacy Aimed at CU School of Medicine, E. Informed Decision-Making David Crawford, MD. “I said, and Open Conversations I'm going to go where there is the most experience and who's Bucky’s experience navigating done the most surgeries. I was his treatment options and glad that I did because it really post-treatment care taught him worked out for me” said Dilts. many important lessons he wants to share: Bucky also emphasized another factor that led to his Talk to your doctor decision to select treatment about screening at the UCHealth University of Colorado Hospital. “As a Bucky attributes his teaching hospital, universities successful cancer journey to are always trying to develop his father. “He told me I have new ways and techniques to do to get a blood test around the things. In lieu of me flying off to age of 50.”

NEWS Following his father’s advice, Bucky was able to find that his abnormal results led to a diagnosis before the onset of symptoms. It becomes increasingly important to discuss your family history and risk factors with your health care providers.

Current recommendations from the American Cancer Society state that prostate cancer screening options should be discussed: • At the age of 50 – Average risk for men with at least 10 more years of life expectancy.

• At the age 45 – High risk for African Americans and men who have a firstdegree family member diagnosed at 65 or younger.

• At the age of 40 Higher risk for men with multiple firstdegree family members diagnosed at 65 or younger.

Be your own advocate Bucky would like to stress the importance of becoming your own healthcare advocate.

Eliminating fear and confusion with a new cancer diagnosis can help lead to a more informed decision-making process with health care providers. Bucky wants to support men in finding the courage to use research as a tool in fighting the cancer headon, “and then you're dealing with it; you're not sitting there thinking ‘what if’.” Knowledge is power. Once Bucky had researched his options, he felt

more empowered to deal with the road ahead.

As prostate cancer research continues to advance diagnostic tools, treatment options, and clinical trials, it becomes important to remain up to date on these developments. It is important to factor in the risks and benefits of each treatment approach with your healthcare providers.

Talk to your peers Bucky spoke with a colleague back in 2009 when he was first diagnosed that led him to seek care at the Tony Grampsas Urologic Cancer Care Clinic. “It was nice to know someone else had a good experience.” It put his mind at ease knowing this information before being faced with the decision of treatment.

Since being diagnosed, Bucky has noticed his peers being discreet when talking about their experiences with prostate cancer. “I'm more interested in getting people exposed to some of the things that are out there to alleviate some of the fear of the disease and fear of treatment.”

Continuing His Support in the Community

Although prostate cancer remains a common diagnosis among men, Bucky wants to increase the understanding that it can be treated successfully.

Early diagnosis offers the best chance at a successful treatment.

Bucky’s personal and family experience, coupled with his Broncos career, has given him the unique motivation to help his community here in Colorado. He has high hopes of increasing prostate cancer awareness and sees a future where it is in the likes of breast cancer awareness.

“There is not a very visible message for men to be informed about prostate cancer.

We have to get the message physically in our communities’ hands.” He wants the topic of prostate cancer to come out of hiding so men can have an open conversation saying, “Let’s grab a beer and talk.”

2.5 MILLION There are more than 2.5 million men in the U.S. who are prostate cancer survivors

AT AGE 50 Men with the average risk of prostate cancer should talk with their healthcare provider about PSA testing

Make an appointment with our partners at UCHealth to discuss your prostate cancer screening options.

1 in every 7 men are diagnosed with prostate cancer

SYMPTOMS MAY INCLUDE Weak Urine Flow Frequent Urination Blood in Urine Pain with Urination Pain in Hips, Spine, Ribs Douglas "Bucky" Dilts

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Jennifer’s mom, Maria Lopez, reconnected with the Cleft Lip and Palate Clinic to discuss additional surgical options.

“It was really hard for me as a mother to see someone bullying my child for having a cleft lip,” said Maria. “I wanted to help my daughter.”

Jennifer Falomir-Lopez

TRANSFORMING HER OUTLOOK

Cleft lip repair surgery inspires teenager to help others By: Chanthy Na and Siyab Khan, Department of Surgery, July 28, 2020

As a young child, Jennifer Falomir-Lopez just wanted to look “normal” like all the other kids. She knew she was different but couldn’t explain to her friends why she looked different. Jennifer was born with a cleft lip and cleft alveolus.

“It was really hard for me growing up because kids didn’t really understand my condition and I didn’t know what I had,” said Jennifer. “I would always tell them I fell, or I hurt my face, those were just some of the things I would say, when I was asked.”

A cleft lip occurs when the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose.

An alveolar cleft is a cleft of the upper gum line. It most often accompanies a cleft lip and/or cleft palate.

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According to the Centers for Disease Control and Prevention, each year in the United States about 2,300 babies are born with a cleft palate and 4,000 babies are born with a cleft lip with or without a cleft palate.

The Beginning of Jennifer’s Journey Jennifer was referred to the Cleft Lip and Palate Clinic at Children’s Hospital Colorado by her pediatrician shortly after her birth. She had her first surgery when she was just five months old to repair her lip and nose, and a few months later she had an additional lip and nose revision.

As Jennifer started attending school, kids continually bullied her and always asked about her face, despite surgeries to correct her condition as an infant. She would tell her mom about these incidents and that she felt that she could not do much because of the way she looked.

In 2012, Jennifer and her family connected with Brooke French, MD, associate professor at the University of Colorado School of Medicine Division of Plastic and Reconstructive Surgery and co-director of the Cleft and Craniofacial Surgery Programs at Children’s Hospital Colorado. This connection would lead to a bond between Jennifer and French that has spanned the past eight years, multiple surgeries, and numerous follow-up visits.

“I met Jennifer when she was six years old and have watched her grow into the brilliant human being that she is now at 14,” said French. “She has always had a quiet confidence and focus.”

The Transformation Jennifer described feeling worried and scared before her first surgery with French.

She remembered hiding from her mom before she went to the hospital and shaking in the hospital bed before her procedure. However, French and team were able to calm Jennifer’s nerves and her revision surgery to repair her lip was a success.

Jennifer’s courage and perseverance were tested throughout her post-surgery recovery period. She found it difficult to not be able to do everyday activities, but after a six-month recovery, she was finally able to see her transformation.

“I looked at my face after six months and thought to myself that I looked really different,” said Jennifer. “I told my mom immediately that I wanted another one (another surgery)!”

Brooke French, MD

French and the Cleft Lip and Palate Clinic team at Children’s Hospital Colorado provided Jennifer and her family with additional surgical options.

This time, since Jennifer was older, she was included in those discussions. With a new plan in place and her family’s support, Jennifer continued her journey to repair her cleft lip and cleft alveolus. The transformation to repair her cleft lip

Jennifer would go on to have several more surgeries and bone grafts to repair her cleft lip and cleft alveolus, with her most recent surgery occurring in June 2019.

While the physical transformation of the surgeries can be seen, the impact has been even more profound.

Jennifer has flourished with each surgery and has become an advocate for those with cleft lip and/or palate.

She speaks openly and passionately about her

NEWS condition to help others learn so that other children don’t have to face the same challenges and bullying she went through.

Alex made a surprise visit to see Jennifer in the hospital.

She encouraged Jennifer with laughter and helped to take away the nerves of her surgery.

“My whole life I have lived with something that I can't control,” said Jennifer. “It’s no one’s fault that I have this condition, but I have had people judge and not accept me for who I am.”

"Alex has always supported me,” said Jennifer. “There were times we couldn't always hang out because I had to go to a surgery, or I had a doctor's appointment, but she has always been there for me.”

Jennifer continues to stay in touch with French. This spring in the midst of the pandemic, she partnered with French on a research paper covering the treatment of cleft lip and palate.

Through her paper for an education fair, Jennifer shared the experiences she and her family went through. Along the way, she taught her classmates about the experiences she and others have faced.

“Jennifer has strength and positivity that are inspiring,” says French. “I am grateful to know her.”

A Team of Supporters Jennifer will be the first to say she couldn’t have gone through this without the support of her family, friends, and the team at Children’s Hospital Colorado.

Her family has always stood steadfastly behind her, advocating for her best interests and future.

“My family plays an important role,” said Jennifer. “It’s important that the whole family is involved with the care of a kid with a cleft lip.”

One of Jennifer’s biggest supporters was her friend Alex, whom she’s known since preschool. During her last surgery,

Jennifer was also fortunate enough to have Maureen Andrews, RN, MSN, CPN, an advanced practice nurse and clinical nurse specialist for the Cleft and Craniofacial Program at Children’s Hospital Colorado by her side since she was born.

“As Jennifer has gotten older, she has had increased interest and motivation to be actively involved in her care,” said Andrews. “She has developed into a wonderful, insightful, caring person who has much to offer to those who come in contact with her.”

The Next Chapter The future is complicated by the pandemic, but Jennifer is looking forward to her freshman year this fall at Arrupe Jesuit High School located in northwest Denver.

She said she plans to continue to live life to the fullest, dancing and playing competitive volleyball for the first time for a school team.

One thing Jennifer is clear about is her future career and her passion to carry the torch that was lit by French. After high school, her goal is to go to college and medical school and become a surgeon.

“At first I wanted to be a teacher,” said Jennifer. “Then I met Dr. French. I saw the work that she did, and I really wanted to do that for other people. I want to help make kids feel better about themselves.”

The care Jennifer has for others is reflected in her courage to share her story and in her compassion for others.

“I had it really easy,” she said.

“I didn’t have a disease or syndrome, just a cleft lip and that was it. I felt like I never appreciated that.”

What is Cleft Lip? The lip forms between the fourth and seventh weeks of pregnancy. Body tissue and special cells from each side of the head grow toward the center and join together to make the face. This joining of tissue forms facial features, like the lips and mouth. A cleft lip happens if the tissue that makes up the lip does not join completely before birth.

What is Cleft Alveolus?

The roof of the mouth is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy.

An alveolar cleft is a cleft of the upper gum line. It most often accompanies a cleft lip and/or cleft palate.

Content and images courtesy of the Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities Page 7

and direct the tubes into the heart. The tubes bring blood out of the heart, then through an oxygenator and back to the heart to be pumped to the body. ECMO does the “work of breathing”, thereby giving a person whose lungs are failing a chance to recover.

After returning home, Barbara has been enjoying short walks with her family.

Photo courtesy of Rebecca Taggart.

BOULDER WOMAN SURVIVES COVID-19 THANKS TO ARTIFICIAL LUNG TREATMENTS CALLED ECMO By: Katie Kerwin McCrimmon, UCHealth, July 17, 2020 (Edited due to space limits)

All of her life, Barbara has cared for others.

She was only 22 when she helped open Boulder’s Safehouse for women coping with domestic violence. She earned a degree in social work and helped resettle Soviet Jewish refugees. For many years, she worked at her synagogue, Congregation HarHashem in Boulder, to help interfaith families and families coping with grief or loss.

“She’s the kind of person who has spent her life giving to others and taking care of others. She is absolutely the most empathetic person I have ever known. She feels others’ pain, sorrow and loss in ways I cannot fathom,’’ said Gould’s husband, Allen, a 68-year-old retired lawyer.

Barbara wasn’t used to needing help herself.

Then, she got COVID-19. As her illness became worse and worse, she had to depend upon Page 8

countless folks from doctors to nurses to chaplains and palliative care experts.

Barbara ultimately needed caregivers at two hospitals, an emergency helicopter ride from one hospital to the other, rehabilitation at two facilities and those 65 days on a ventilator – three times as long as the average COVID-19 patient at UCHealth University of Colorado Hospital (UCH).

She also benefited from a medical “Hail Mary.” When she wasn’t improving on a ventilator at her hometown hospital, Barbara’s doctors at Boulder Community Health sought help from other area hospitals. They hoped to find a team that could give Barbara’s lungs a rest through a procedure known as ECMO, which stands for extracorporeal membrane oxygenation.

The kind she needed is known as “venovenous ECMO.” Doctors place large tubes in the patient’s neck or groin

One Denver hospital turned Barbara’s caregivers down because she already had been on a ventilator for more than a week.

Preliminary studies from China and Italy showed that many COVID-19 patients who received ECMO did poorly. For medical experts elsewhere, this was an alarming finding since ECMO had worked well during previous pandemics, including the H1N1 flu.

The team at University of Colorado Hospital had to consider Barbara’s circumstances carefully before accepting her.

Many critically ill COVID-19 patients also suffer severe kidney and heart damage as the virus wreaks havoc on their bodies. But Barbara’s heart was strong – both literally and metaphorically – and she never needed dialysis.

Rove and the team agreed to the transfer, and that’s when Barbara took an emergency helicopter from Boulder to Aurora.

“It was a long shot, but we considered her individual case and had to do what was right for her at the time, which was to give her a chance,” Rove said. “We have to be very forthcoming with families. I could not promise Allen that she was going to live. I said that ECMO would be her Hail Mary.”

ECMO Results in Colorado: Dramatic Lifesaving Outcomes

There were ups and downs throughout Barbara’s treatment, but the ECMO ultimately worked and she is now part of a forthcoming research study showing that Jessica Rove, MD critically ill Yes, Barbara was older than most patients with the patients considered coronavirus can indeed do for ECMO therapy. And, at well on ECMO. Nearly all of that point, she had been on a the COVID-19 patients at UCH ventilator for 15 days, well past who have had ECMO have the period thought to be critical survived. Barbara’s doctors to boost the chances will soon share their findings of recovery. in a medical journal so other doctors dealing with spikes in But, aside from the lung cases of COVID-19 around the damage, Barbara’s other U.S. and elsewhere in the world organs were holding up well. can boost their survival rates.

Dr. Jessica Rove, a cardiac surgeon and assistant professor at the University of Colorado School of Medicine, spoke with Allen and made the call.

NEWS “It’s absolutely incredible,” said Dr. Breandan Sullivan, another expert on Barbara’s team.

He’s an anesthesiologist and an intensive care unit (ICU) doctor. He’s co-medical director of the cardiothoracic ICU where Barbara received ECMO. Sullivan is also one of the authors of the study and is an associate professor at the University of Colorado School of Medicine.

“It just gives us so much hope. I think it’s not a matter of if, but when, we’ll see another surge in Colorado. Because of Barbara and how well she did, we will be able to offer this treatment to others,” Sullivan said.

What’s remarkable is how different the results were in Colorado compared with other parts of the country and the world.

“We have had this dramatic life-saving experience,” Sullivan said.

He attributes the success with ECMO here to teams that were not overwhelmed and had the expertise, energy and perseverance to safely treat COVID-19 patients with ECMO. “We also reserved this (treatment) for patients who had the greatest likelihood of success,” Sullivan said. “Some patients have lungs that are scarred and will never recover.”

Thankfully, that wasn’t the case with Barbara.

A new ECMO Technique: ‘Proning’ When Barbara arrived at UCH, her team was trying something

that they’d never done with ECMO patients in the past.

Around the world, doctors have learned that COVID-19 patients do better lying face down. In that position, gravity makes it easier for the lungs to exchange oxygen. The technique is called “proning.” But no one at UCH had ever tried it with patients on ECMO, which is already a complex procedure.

Surgeons place the tubes, known as cannulas, into large veins or arteries. The ECMO pump then pulls blood without oxygen into the machine’s artificial lung. The machine allows the patient’s lungs to rest and adds oxygen to the blood, warming it before pumping it back into the person’s body.

get off the ECMO. However, if the lung compliance still hasn’t improved, there will be nothing more they can do to save Barbara’s life. Prayers and healing thoughts please. Time for a miracle,” Allen wrote.

Prayers Answered and a Safe Landing Just a day after Allen sent out his urgent plea for prayers, a crazy thing happened. Barbara had a dramatic turnaround.

Dr. Maung Hlaing delivered the good news to Allen, Rebecca and Sam.

After getting treated at UCH, Barbara received critical care at Kindred Hospital Aurora, a transitional center where caregivers helped wean her from the ventilator. Then, in a move that brought her nearly full circle, Barbara finished her inpatient treatments at UCHealth Broomfield Hospital’s rehabilitation unit, a joint venture of UCHealth and Boulder Community Health.

“It’s an incredible journey.

This is someone who otherwise would not have made it,” said Rove, the doctor who green-lighted Barbara’s ECMO treatments.

Specially trained nurses, advance practice providers and doctors need to monitor the patient around the clock in case anything goes wrong.

Flipping patients requires six people and adds additional risks. Nonetheless, the team gave it a shot. The team proned Barbara for 18 hours, then put her on her back for six, then flipped her to her belly again.

They continued the proning maneuvers for several days.

An Urgent Call for Prayers At first, Barbara didn’t seem to improve. In early May, Allen sent out a last call for help: “Friends, the doctor let us know today that Barbara’s time on the ECMO has not helped her lungs as much as had been hoped. They will try a couple more interventions over the next few days to see if she can improve enough to

Friends, neighbors and synagogue members greeted Barbara Gould when she arrived home this week. Some wiped tears away. Others blew kisses.

“This is one of the most remarkable recoveries we’ve seen,” Sullivan said of Barbara.

He’s now working with colleagues at Boulder Community Health and other hospitals that don’t have ECMO programs. Sullivan and his team would like to offer the treatments as soon as possible to any COVID-19 patients whose lungs need a rest.

UCH has the largest ECMO program in the Denver area, Sullivan said.

“It’s a long, long road. She really did all the work. I cannot emphasize how hard it is. These patients have to learn to sit up and walk again,” she said.

“The credit goes to Barbara herself.”

Her family and her community also played a key role.

Allen has always believed more in logic than the power of prayer. But, he finds himself in awe of his family’s experience.

To read this story in its entirety visit: https://tinyurl.com/ BarbaraonECMO

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idiopathic pulmonary arterial hypertension.

Fran Etzkorn at UCHealth University of Colorado Hospital on Aug. 27, 2020.

Photo courtesy of Fran Etzkorn.

THREE NEAR-FATAL DISEASES LATER, THIS ‘CLOWN’ IS GETTING BUSY LIVING By: Todd Neff, UCHealth, September 18, 2020

Fran Etzkorn survived three life-threatening conditions so she could get back to clowning around. Literally.

Her health care story, which unfolded at UCHealth University of Colorado Hospital on the Anschutz Medical Campus (UCH), not only reflects Etzkorn’s grit and desire to continue to serve, but also encapsulates in a single patient’s story several stunning advances in medical science – advances that have enabled her remarkable recoveries from health emergencies spanning pulmonology, cardiology, and oncology.

Etzkorn, 80, is much more than a clown, but she is indeed a clown – Kolo the clown. She got into clowning through EasterBunnying, which may or not be the usual career path.

Over the next few years, she clowned at hospitals, in parades, for kids, and at clowning competitions. She did sight gags; she told jokes. Some typical clowning, she avoided.

Page 10

“I don’t do balloons, and I don’t do face paint. People say, ‘What do you do?’ I say, ‘I just clown.’

I don’t like kids standing in line,” Etzkorn said.

Idiopathic Pulmonary Arterial Hypertension Toward the end of the 2010s, she noticed she was increasingly short of breath. A community clinic in Boulder diagnosed asthma. The drugs didn’t help. In 2012, she arrived at UCH on the recommendation of a doctor at National Jewish.

By that point, Etzkorn’s health had declined to the point that, when golfing with friends one day, she found herself too tired to get out of the cart to walk over to her ball on the fairway.

At UCH she came under the care of Dr. Todd Bull, a University of Colorado School of Medicine pulmonology and critical-care medicine specialist and director of UCHealth’s Comprehensive Lung and Breathing Program.

This definitely wasn’t asthma, he recognized, but rather

Pulmonary arterial hypertension happens when the lungs constrict the blood flow coming from the heart. It’s often caused by the narrowing of blood vessels due to inflammation or other causes.

That strains the right side of the heart, which has to work harder to pump blood into the lungs. Pulmonary arterial hypertension symptoms include shortness of breath, fatigue, dizziness, fainting spells, and edema-caused swelling. The added stress on the heart’s right ventricle can lead to heart failure.

“Idiopathic” meant it wasn’t clear what was causing Etzkorn’s PAH. What was clear that it had to be treated quickly.

“Historically, people usually died within two years of diagnosis,” Bull said.

The past two decades have seen the approval of more than a dozen drugs to treat PAH, and survival rates have gone up, Bull said. The most potent of these medications are called prostanoids; Bull started Etzkorn on one of these – treprostinil (trade name Remodulin). It’s a powerful vasodilator, meaning it opens up blood vessels. Often, patients work their way up to Remodulin. Etzkorn jumped straight onto it due to her disease’s severity.

She got back to clowning.

She volunteered at a hospital in Longmont and at nursing homes; she helped out at “PH in the Park” walks sponsored by the Pulmonary Hypertension

Association. In addition to her standard outfit, Etzkorn brought along Corny the Corndog (a faux ear of corn harnessed to an invisible dog leash) and a “Port O Potty” she wheeled along with her. This was a plastic fire hydrant whose principal role was to conceal her oxygen tank. She brought along some pals, too.

“Her whole clown community comes out to support her, helps with the kids, drives the golf carts around, and helps direct traffic,” Bull said.

Word got out, and soon she and her Colorado Clown Alley pals were doing a 5K walk or other fundraiser every couple of weeks during the warm months, for conditions as diverse as cancer and apraxia.

The World Clown Association took note, presenting her with its Humanitarian Award.

Fran Etzkorn as Kolo the Clown.

Photo courtesy of Fran Etzkorn.

Pulmonary Arterial Hypertension and TAVR Five years passed. Then another major health problem emerged.

Severe aortic stenosis was sharply lowering the blood flow through her heart’s aortic valve – the gateway to the body’s blood flow. The Pulmonary arterial hypertension that had

NEWS threatened heart failure was under control; now the failing aortic valve posed a different, serious threat.

Again, not many years ago, Etzkorn would have had few options. Given her age and her pulmonary hypertension, open-heart surgery to repair the valve would have been too risky.

But now there was another option: trans-arterial valve replacement, or TAVR. CU School of Medicine and UCHealth Interventional cardiologists Dr. John Messenger and Dr. John Carroll had been doing TAVR procedures since 2012, when the procedure to insert replacement heart valves via a catheter inserted through the femoral artery was still in clinical trials. TAVR’s initial U.S. Food and Drug Administration approval was for patients too ill to undergo an open procedure.

The FDA has since broadened its approvals to the point that TAVR is the first-choice option for nearly all patients, Messenger said.

The combination of Bull’s management of her pulmonary arterial hypertension and TAVR’s minimally invasive nature (patients don’t even need general anesthesia, Messenger said) made Etzkorn a good candidate. On Sept. 27, 2017, Messenger, with help from CU School of Medicine and UCHealth cardiac surgeons Dr. David Fullerton and Dr. Joseph Cleveland, replaced Etzkorn’s aortic valve via a small incision near the groin.

detaching and moving the stomach, which McCarter did – and then the removal of the lower two-thirds of her esophagus and the upper quarter of her stomach, which Meguid performed. Adding to the technical challenge was David Fullerton, MD Joseph Cleveland, Jr., MD the surgeons’ use of a da Afterwards, Messenger Vinci surgical robot to minimize says==id, “She dropped off trauma and speed recovery. clown noses for the entire team.”

Given how difficult Etzkorn’s recovery was, going with the And Now, Cancer robot may well have saved her.

Rather than the typical one or Another two years of living two days spent in postsurgical and clowning passed before intensive care, she was there for Etzkorn’s third mortal health 20 days. care battle in the span of seven years – this time with esophageal cancer.

A visit to UCHealth Longs Peak Hospital confirmed the diagnosis. She continued her care at UCH with oncologist Dr. S. Lindsey Davis. As cancer of the esophagus often does, the cancer was growing at the juncture of the stomach and the esophagus. Etzkorn went through chemotherapy and radiation treatment, but the tumor remained.

Davis recommended surgery to remove it. On June 6, 2019, cardiothoracic surgeon Dr. Robert Meguid and cancersurgery specialist Dr. Martin McCarter suited up to perform the surgery with one small addition from the normal garb: stickers from Etzkorn in the shape of a yellow heart with a smiley face with a red clown nose.

This was a major surgery – an eight-hour affair involving

saw a familiar sense of humor reemerge.

“That’s when I knew Fran was feeling better – when she started busting out the various clown jokes and clown paraphernalia,” he said.

Meguid put one of those yellow heart stickers on his eyeglasses case back home. Every day, when he takes out his contacts and puts his glasses on and vice-versa, he thinks of one of his favorite patients ever, he said.

The affection goes both ways.

“I wouldn’t be here if it weren’t for them,” Etzkorn said.

“There were two nights when I thought I wasn’t going to get better,” Etzkorn said. “When I thought it was over.”

Robert Meguid, MD

She went home in early July 2019 and has been getting stronger ever since. The pandemic has put a damper on clowning, but in late May, she suited up and performed below the second-floor window of an 85-year-old woman confined to an extendedcare facility. Given the distance, she did sight gags involving a big camera, some oversize flowers, and Martin McCarter, MD Corny the Corndog.

Bull checked on her daily, as did Meguid. During one of those dark days, Meguid took her hand and told her that the cancer was gone, and that the hardest part was behind her.

Etzkorn made her mind up to push ahead.

“I think you will yourself to feel better,” she said. “I think you get to the point where – what’s the saying? – get busy dying or get busy living.”

As she got busy living, Bull

“Clowning is my life. It has helped me understand other people who have illnesses, and I’m more aware of other peoples’ feelings, I think,” Etzkorn said, and chokes up for a moment. “It’s just what I do.”

To read this story in its entirety visit: https://tinyurl.com/ Kolotheclown Page 11

raspberries and blackberries along the side,” said Carta.

“Whenever I’m stressed out, I think about Grandma and Grandpa’s house.”

Eric, Laina and Ela

IMPROVING CONFIDENCE WITH RECONSTRUCTIVE SURGERY AFTER A DOUBLE MASTECTOMY By: Siyab Kahn, Department of Surgery, October 21, 2020

Knowing your family health history is one of the first steps to finding out if you may have a higher risk of cancer and might need early screenings. Ela Carta is no stranger to the struggles of having a family history of cancer. At the age of 30, Carta’s aunt, Audie, began urging Carta to get a mammogram. With a long family history of breast cancer and fibrocystic breast disease, Carta knew she had to be proactive with her health.

“When you have fibrocystic breasts, everything feels like a bump, and you can’t tell what you’re feeling,” said Carta. “Every now and then I would feel something new or something would change, and I would visit my doctor. I started to get really frustrated, and I felt like I was a timebomb.”

According to the American Cancer Society (ACS), breast cancer cells usually form a tumor that can often be seen on an X-ray or felt as a lump.

Breast cancer occurs almost entirely in women, but men can Page 12

get breast cancer too. Breast cancer can spread when cancer cells get into the blood or lymph system and are carried to other parts of the body. ACS estimates that in the United States, more than 275,000 new cases of breast cancer will be diagnosed in women in 2020.

With rising cases each year, breast cancer continues to affect many families. Carta’s story is a testament to the strength of hope and early detection.

Journey to Colorado While her parents served in the Navy, Carta spent her childhood with her grandparents in Medford, Oregon. She recalls this time as being one of the best in her life.

“They had a vineyard and a big creek in their backyard. You would have to take a ladder to get down into the creek.

It was all sand, so you could squish your feet around, pick up pretty rocks, and there were

Carta moved to California at age 5 and then lived in several cities before moving once again at age 13 to Grosse Ile, Michigan, where she lived with her other grandmother and attended high school. It was 12 years ago that Carta decided to visit a friend in Colorado and found her home. She fell in love with the state and immediately began plans to move west.

“I came to Colorado and it felt like I was home immediately,” said Carta. “I didn’t want to leave, so when I got back to Michigan, I made arrangements to get back to Colorado.”

She began searching, applying, and interviewing for jobs.

After several offers, she was ready to begin her next chapter in Colorado.

Making a Decision to Save Her Life After Carta moved to Colorado, her aunt began urging her to start getting mammograms because of their deep family history with breast cancer. Her aunt had a ductal carcinoma – a common form of breast cancer — and had a double mastectomy procedure in her early 40s. Carta’s mother was also diagnosed with metastatic breast cancer and died on May 8, 2018, a day before Mother’s Day. Because of her family history, her aunt suggested Carta consider a double mastectomy.

“She asked me how I felt, and I told her, ‘I’m going to get it.

There’s no question,” said Carta.

Carta began to visit doctors to discuss her options and best practices. She completed a genetic test and because of her family history was able to get approval from her insurance to continue with a double mastectomy procedure.

Through all of this, Carta was also going through a divorce, but she only had one goal in mind: to survive for her daughter.

“It was awful to think about disfiguring my body in that way,” said Carta. “At the same time, I didn’t want my daughter to see me suffer through cancer. That’s the main reason I did it. I felt like I would have more control if I didn’t wait until after I was diagnosed with cancer.”

At the end of 2011, Carta completed her double mastectomy, and with the help of her aunt, she began the recovery process.

Reconstructing Her Body and Life Following the double mastectomy, Carta began the breast reconstruction phase. There are many different options and types of breast reconstruction procedures. Some are done (or started) at the same time as the mastectomy, while others are done later. Carta’s first restoration procedure created more challenges.

One of her implants slipped out of position, and she had

NEWS significant scarring from her previous procedure. Carta struggled with her selfconfidence and felt hopeless.

looking for throughout this experience.

“For me, the time that I looked disfigured was really destructive to my selfconfidence,” said Carta. “Before I put on my makeup on, I would get fully dressed because I didn’t want to look at myself. I was very unhappy with the way I looked.”

Despite the challenges with her first reconstruction procedure, Carta’s resilience kicked in once again. She decided to do additional reconstruction with a new provider. She conducted hours of research to find a surgeon who would fit her needs.

David Mathes, MD

“I went to see Dr. Mathes, and I remember one of the first things Sara Douglass told me was, ‘This is a process, and we’re in this together,’” said Carta. “That was the best thing anyone has said to me throughout this experience.

That really kept me going.”

Carta put her faith in Mathes and his team, who conducted at least half a dozen surgeries on her, including implant removal, nipple reconstruction, DIEP flap, fat grafting and new implants.

"It was an honor to work with Ela through her reconstruction process,” said Mathes “Her positive spirit stood out every step of the way. It was clear that she gained perspective through her journey and was able to advocate for herself in a meaningful way. It was a true partnership."

Sara Douglass, PA

In 2017, Carta met David Mathes, MD, professor and division chief at the University of Colorado School of Medicine Division of Plastic and Reconstructive Surgery.

During her first visit with Mathes, Carta described being apprehensive due to her previous experience. Mathes, along with Sara Douglass, PA, an instructor with the Division of Plastic and Reconstructive Surgery, gave Carta the hope and comfort she had been

Carta described the “incredible feeling” she had being able to look at herself in the mirror again and talked about how Mathes gave her confidence to take her life back.

It All Comes Down to Family, Friends and Support Carta’s team of supporters have given her the biggest motivation to continue fighting.

Her daughter, Laina, has always been her top priority.

Now a senior in high school,

Laina has the goal of becoming a statistician while also serving her community.

“This girl has such a positive attitude. She’s always been an honors student and has always pushed herself,” said Carta. “I love reading the stuff that she’s written. It’s very inspirational.

She’s like an old soul. She has a really beautiful perspective.”

Carta’s friends Kristi and Eric also played a major role throughout her journey. Kristi, who is also a breast cancer survivor, and Eric, whose father passed from cancer in 2017, gave Carta the tools and support she needed. Their shared experience would help to build a stronger bond between all of them. And that bond also led Carta and Eric to begin dating in 2014.

“These are people with a lot of empathy, compassion and support. I’m lucky I have them,” said Carta.

Carta also attends a prayer group every week. The group, which she started attending four years ago, encouraged her to give to others while going through her own struggles.

Carta and Eric are planning to build a home in Morrison, Colorado, inspired by her grandparent’s home in Oregon.

“I get to re-create my happy place with the person I love,” said Carta. “There’s everything to look forward to. Everything in my daughter’s life I look forward to.”

Carta’s strength, resiliency and compassion shone through as she shared her story and journey.

Her advice for other breast cancer patients? “Do research on your surgeon.

Your decision is always going to be your own,” Carta said.

“Whatever your decision is, it’s not wrong. Accept and love yourself regardless of physical appearance.”

“They are amazing. I don’t know what I would have done without them!”

The Next Chapter Throughout her procedures and recovery, Carta has continued to work as an emergency room nurse at UCHealth. She has a strong belief that giving back is the best thing an individual can do during hard times.

Page 13

“My goals for the program are to increase our local, national and international presence and to actively contribute to the body of knowledge of how to best treat patients with melanoma,” stated Stewart.

Camille Stewart, MD

MELANOMA CARE IS A PRIORITY FOR THE CU SCHOOL OF MEDICINE AND CANCER CENTER By: Jessica Cordova, CU Cancer Center, October 28, 2020

If you live in or have visited Colorado, you most likely noticed that the state loves its outdoors. With 300 days of sunshine a year, many enjoy hiking, playing at a park or grabbing a craft brew on a patio. But with that love of sunshine comes an increased risk for skin cancer.

“Denver is the Mile High City, and studies suggest that living at elevation, where there is less atmospheric protection from UV rays can contribute to the development of melanoma,” said Camille Stewart, MD, assistant professor in the Division of Surgical Oncology and University of Colorado Cancer Center member. “It is a bigger problem for us in Denver and in Colorado than in other places.”

Melanoma is the most serious form of skin cancer but is less common than basal cell carcinoma or squamous cell carcinoma, which together are known as non-melanoma skin cancers. According to Page 14

the American Cancer Society, it is estimated that there will be close to 2000 new cases of melanoma of the skin in Colorado this year, around .02% of the population. Luckily, being close to the sun and enjoying the outdoors does not make us the state with the highest percentage. That unwelcome title falls to the state just west of us, Utah, with .04% of people being diagnosed this year. However, Colorado belongs in the unwanted category of the 10 states with the highest rates of death for melanoma.

CU Department of Surgery Melanoma Program With this data in mind, many partners in the CU School of Medicine are focusing efforts to reduce the risk of melanoma, catch it early and deliver effective treatments.

One way they are doing this is with the recent hire of Camille Stewart, MD, director of the Melanoma Program within the Department of Surgery.

In the past there were not many effective treatments for melanoma. This left surgery, sometimes radical surgery, as the primary treatment option.

“There have been major advances in research and treatment for melanoma, making this an exciting field to be in right now,” said Stewart.

Right now, there are more than 50 clinical trials around the treatment and detection of melanoma taking place at the Anschutz Medical Campus.

On top of providing patientcentered care in the clinic,

Stewart wants to keep a component of her work in research helping learn more about new treatment options.

CU School of Medicine providers can offer more than clinical trials to patients -- they also have a melanoma multidisciplinary tumor board discussion weekly. This program provides melanoma patients with care options from multiple specialties including surgical oncology, medical oncology, dermatology, radiation oncology, radiology, and pathology.

Between the clinical trials and the tumor board, the Anschutz Medical Campus is the goto place for Coloradans and residents of surrounding states to receive the latest, most up to date treatment care for malignant melanoma.

NEWS Treating Cancer in the Time of COVID-19

KEEPING OUR CAMPUS SAFE

As Stewart starts her new role, it is hard not to recognize that we are currently in the coronavirus pandemic.

“We don’t want to minimize what is going on in the world or act like it is not important, but we are not going to stop the work being done in the cancer community or stop taking care of these patients that need us,” said Stewart.

Cancer patients still need to prioritize screenings and treatments to allow for early detection and to prevent cancer progression.

“I am confident that we are going to be able to make cancer treatment a priority in spite of being in the middle of a pandemic,” said Stewart. “It is difficult to envision that there is a priority that is bigger than COVID-19 right now, but I also do not want to minimize what is happening in the lives of people who have cancer. We do not want this pandemic to prevent them from getting the care that they need.”

Camille Stewart, MD

“We have had to modify our workflow to ensure that patients are safe.”

Dr. Stewart will be seeing patients at: • Anschutz Medical Campus • Highlands Ranch UCHealth Cancer Center • Cherry Creek UCHealth Cancer Care and Hematology Dr. Stewart was trained in general surgery at the University of Colorado, and in Complex General Surgical Oncology at City of Hope in Duarte, California. She is director of the Melanoma program, and also sees patients with sarcoma and gastrointestinal cancers.

Stewart has even investigated the use of personal protective equipment (PPE), which was published in the Annals of Surgery. Along with a team, she looked at what forms of PPE are appropriate and could reduce the spread of the coronavirus for surgical teams.

“I feel passionate that we are still able to deliver excellent care if we are cautious and thoughtful about the ways that we do it,” explains Stewart.

#CUANSCHUTZTOGETHER Page 15

NEWS NOV 2

Grand Rounds | 7-8 am Patient Centered Outcomes Clinical Trials, Comparison of Drugs vs Antibiotics (CODA) Trial as Case Study Lisa Ferrigno, M.D., M.P.H. Assistant Professor GI, Trauma, and Endocrine Surgery University of Colorado Hospital Utilizing Electronic Health Records to Achieve High Value Care in Surgery Jeniann Yi, M.D., M.S.C.S. Assistant Professor GI, Trauma, and Endocrine Surgery University of Colorado Hospital

NOV 9

NOV 16

The Evolving Role of Endovascular Techniques in Vascular Emergencies Melanie Hoehn, M.D. Associate Professor GI, Trauma, and Endocrine Surgery Denver Health Medical Center

A Journey of Joy and Discovery - Life as a Surgeon-Scientist

Grand Rounds | 7-8 am

Health Service Research in Surgery Simon Kim, M.D., M.P.H. Associate Professor Urology University of Colorado Hospital

14th Annual John R. Lilly Memorial Lectureship in Surgery | 7-8 am

Diana L. Farmer, M.D. Chair, Department of Surgery UC Davis Health

DEC 7

DEC 14

Robotics in General Surgery: An Expensive Gimmick or the Wave of the Future?

Krysztof Wikiel, M.D. Assistant Professor GI, Trauma, and Endocrine Surgery Rocky Mountain Regional VA Medical Center

Adventures in Health Care Government and Corporate Relations

Grand Rounds | 7-8 am

Resilience and Positive Psychology Coaching in Surgical Trainees Nicole Christian, M.D., M.S.C.S. Assistant Professor Surgical Oncology University of Colorado Hospital

Grand Rounds | 7-8 am

Jeff Thompson, M.P.A. VP of Government and Corporate Relations UCHealth

NOV 23 Holiday Observance

No Grand Rounds due to Holiday

NOV 30 Grand Rounds | 7-8 am

Update on Thyroid Cancer Christopher Raeburn, M.D. Associate Professor GI, Trauma, and Endocrine Surgery Rocky Mountain Regional VA Medical Center Native Nephrectomy in Pediatric Kidney Transplant Michael Wachs, M.D. Professor Transplant Surgery Children's Hospital Colorado

DEC 21 Holiday Observance

No Grand Rounds due to Holiday

This publication is viewable online at: http://issuu.com/slangesurgery/docs/November_2020_dos_newsletter

DEC 28 Holiday Observance

No Grand Rounds due to Holiday

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