SURGERY NEWS October 2021
NOTES FROM THE CHAIR The fall weather in Colorado is a mix of brisk mornings and afternoon sunshine. There is also anticipation in the air, as any day we could have our first snowfall. As I reflect on our accomplishments over the summer, I continue to be impressed and grateful for the vast expertise our department has on hand and the willingness of our team members to step up in any situation. From responding to a call for help while in flight, reaching out to our communities to address disparities in health care, or providing innovative surgical care for patients, our team members continue to be on the front lines. Additionally, I have enjoyed welcoming students, faculty, staff, and researchers from a variety of backgrounds that will further expand our expertise and innovative approaches to all tasks. As winter approaches, please continue to take care of yourselves and your loved ones. As always, it continues to be my privilege to share these highlights with you.
NEW VASCULAR SURGERY RESIDENCY PROGRAM
Richard D. Schulick, MD, MBA Professor & Chair, CU Department of Surgery Director, CU Cancer Center The Aragón/Gonzalez-Gíustí Chair
ISSUE HIGHLIGHTS 7
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PHYSICIAN ON BOARD
COVID-19 DISPARITIES 8
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A new Division of Vascular Surgery residency program will allow recent medical school graduates to begin their specialized vascular surgery training on day one.
ERICA’S COLON BACK ON THE ROAD CANCER
Surgery News
NEW VASCULAR SURGERY RESIDENCY INCREASES FOCUS ON SPECIALTY Recently accredited, five-year residency addresses national and statewide need for vascular surgeons through shorter training framework. Rachel Sauer The traditional path for surgeons after they’ve completed medical school is a five-year general surgery residency followed by a two-year fellowship in an area of specialization. Even for surgeons who choose their specialty in medical school, this has been the most common training path. However, a new Division of Vascular Surgery residency program will allow recent medical school graduates to begin their specialized vascular surgery training on day one. Medical students will be able to apply for the five-year Robert B. Rutherford Integrated Residency in Vascular Surgery, named in honor of the first chief of vascular
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surgery at the CU School of Medicine. The program was initially accredited in April 2021 by the Accreditation Council for Graduate Medical Education (ACGME) . “There are people who know even in medical school that they want to do vascular surgery, and this residency allows them to pursue that training in two years less time,” explains Max Wohlauer, MD, assistant professor of vascular surgery and associate residency program director. “They’ll learn how to be a surgeon, they’ll learn general surgery, but they’ll be able to train in vascular surgery for their entire residency.
“Nationally and in Colorado, there’s a vascular surgeon shortage, and there’s expected to be one for the for the next 20 years, so whether we train through the five-plus-two fellowship paradigm or the zero-plus-five integrated residency – and both are great paradigms, they’re both really effective – at the end of the day the finished product is equivalent and we’re addressing a serious health care need,” he says. Building on existing training resources Creating the new vascular surgery residency program was a process more than two years in the making,
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October 2021 says Trina Smidt, senior program coordinator for vascular surgery. Since 2013, the Division of Vascular Surgery has had a two-year fellowship program, which helped demonstrate the division’s educational capacity for the “There are new residency.
entered the program as a third-year resident after completing two years of general surgery training in the Department of Surgery residency program.
people who know even in medical school that they want to do vascular surgery, and this residency allows them to pursue that training in two years less time,” - Wohlauer
“By having the fellowship, we have a history of training vascular surgeons and we were able to show that we have the educational capacity and tools to support more trainees,” Smidt says. “The fellowship will continue and will run concurrently with the residency, so though the fellows and residents will have care of separate patients, they’ll still work together as one team and participate in didactics together.” Residents will train through rotations at UCHealth University of Colorado Hospital, Denver Health Medical Center, and the Rocky Mountain Regional Veterans Affairs Medical Center. Two participants have already transferred into the program: a thirdyear resident from the general surgery residency program and an intern hired outside the normal match paradigm who began the program three months ago, Smidt explains. Another trainee currently completing required research years in the general surgery residency also will transfer into the vascular surgery residency in June as a third-year trainee, along with an intern who will enter the program as a first-year trainee.
“We’re ramping up kind of quickly,” Smidt says. “Because we have the fellowship, we already have a really great didactics program and our faculty are well-versed in educating trainees.” Meeting a need for vascular surgeons The timing of the new residency was fortuitous for Nick Govsyeyev, who
“My first year I was introduced to the vascular rotation and enjoyed the cases a lot,” he says. “I liked how a case could have multiple different approaches to solve it and I knew that’s what I wanted to do. I would have been happy to go through the standard path, but this gives me more time on vascular rotations than I would have had.”
get calls from other surgeons to support on their surgeries.” Rafael Malgor, MD, associate professor of vascular surgery and program director, emphasizes the need the new residency program fills. “If somebody wants to come train in this part of the country or they are from Colorado and they want to do their vascular surgery training in Colorado, CU is the only place that trains future vascular surgeons,” Malgor says. “There’s a huge need for vascular surgeons and a huge capacity for teaching and learning here, so it’s important that we’re creating these opportunities.”
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For Lindsay Gallo, who entered the vascular surgery residency program in June as an intern, an interest in vascular surgery grew from research on opioid use disorders in which she participated while she was a student at Emory School of Medicine. “I started to see how much a patient’s prior history and surgical history can impact the approach you take in surgery,” she explains. “They may have a chronic history, or they may have a diseased vessel, so you realize that no two patients are the same and no two approaches are the same. Even for something that might be considered more common, like bypass, it’ll be different for every patient.” During the first two years of her residency, she’ll complete 18 months of general surgery training, including rotations in trauma and cardiothoracic surgery. This cross-discipline training is important, Wohlauer says, because “we’re the surgeons’ surgeons. We support other surgeons’ ability to be able to do their work and we frequently
Rafael Malgor, MD Associate Professor Vascular Surgery
Max Wohlauer, MD Assistant Professor Vascular Surgery
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Surgery News knowing that and knowing just your presence can help in what might be a really scary situation.” “Immediately back in physician mode” Aftab and Moazzam met while they both were students at King Edward Medical University in Lahore, Pakistan. They became good friends, but made different arcs across the globe for their residencies and internships. Unexpectedly, and thousands of miles from Lahore, they met up again on the Front Range.
“IS THERE A PHYSICIAN ON BOARD?” With nowhere nearby to land, Muhammad Aftab, MD, helps treat a boy having a severe allergic reaction on an international flight. Rachel Sauer You know how it is trying to leave for vacation – there’s always one last thing to do, one last note to write, one last end to tie up before committing to the rest and relaxation. But midway across the Atlantic Ocean, Muhammad Aftab, MD, an assistant professor of surgery in the Division of Cardiothoracic Surgery, was finally in vacation mode, ready for a five-day whirlwind through Rome and Athens with longtime friend Nauman Moazzam, MD. Then, an announcement over the airplane’s intercom: “Is there a physician or medical professional on board?” Aftab remembers looking at Moazzam for just a second or two, and in wordless agreement making the decision. They rose from their seats 4
and hurried to the back of the airplane to help. In what could have been an intimidating experience – not knowing what they’d find when they arrived unsure whether the airplane’s medical kit would contain the supplies they needed – Aftab says he gained a renewed commitment to using his skills and training to help when he can, and a newfound respect for airplanes’ medical kits. “It reminded me to never hesitate to help, to trust on your skills and go ahead and see what the circumstances are and do your best with the best intentions,” he says. “And especially on international flights, maybe people are not aware of it, but there are supplies and medication available to treat a lot of medical emergencies. So, I think
With their friendship renewed, they and another friend from medical school began taking annual trips together. Usually, they travel with their wives and children, but this year it worked out that the pair could do a Wednesday to Sunday long weekend in Rome, Italy, and Athens, Greece. So, they departed Denver in the early afternoon of July 28, landing at Newark Liberty International Airport a little before 5 p.m. They got a late lunch and, typical for physicians, did some last-minute work on their laptops while they waited to board their flight. Once they did, though, they stopped thinking about work and started thinking about making the most of their brief time in Rome and Athens, plotting how they could squeeze in the Colosseum, the Parthenon, the Vatican… And then the call for help over the airplane intercom.
Click here to find out what happened next.
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October 2021
WELCOME NEW HIRES FACULTY Marisa Baldassano, PA-C Instructor Transplant Surgery
Kate Laramie, PA-C Instructor GI, Trauma, & Endocrine Surgery
Jessica Saben, PhD Assistant Research Professor Transplant Surgery
Sarah Engel OED Trainer Finance and Administration
Cristan Carter Professional Research Assistant Plastic & Reconstructive Surgery
Nathaly Limon-De La Rosa Professional Research Assistant Plastic & Reconstructive Surgery
Michelle Santiago, DNP Instructor Pediatric Surgery
Micaela Galloway Research Services Professional Clinical Research Office
Caroline Credille, MSN Instructor Pediatric Surgery
Philip Logan, PA Instructor Cardiothoracic Surgery
Miranda Strom, AGACNP-BC Instructor Transplant Surgery
Amy Jarvis Administrative Assistant III Urology
Michael Cripps, MD Associate Professor GI, Trauma, & Endocrine Surgery
Ashley Ludden, PA-C Instructor Pediatric Surgery
Toshitaka Sugawara, MD Visiting Professor Surgical Oncology
Jacob Jesielowski Surgery Simulation Specialist Center for Surgical Innovation
Sarkis Derderian, MD Assistant Professor Pediatric Surgery
Jeffrey Lyons, NP Instructor GI, Trauma, & Endocrine Surgery
Kristen Way, PA-C, MPAS Instructor Transplant Surgery
Jocelyn Johnson Research RN Surgical Oncology
Cori Fratelli, FNP Instructor Cardiothoracic Surgery
John Malamon, PhD, MS Assistant Research Professor Transplant Surgery
Jodi Widner, MD Assistant Professor Surgical Oncology
Nargis Kalia Research Services Professional Plastic & Reconstructive Surgery
Lauren Giesy Professional Research Assistant GI, Trauma, & Endocrine Surgery
Holly McKibben, MSN Instructor GI, Trauma, & Endocrine Surgery
Alyssa Wolf, MSN Instructor GI, Trauma, & Endocrine Surgery
Elise Legge Research Services Professional Clinical Research Office
Christina Glenn, PA-C Instructor Transplant Surgery
Ethan Moore Professional Research Assistant Vascular Surgery
Daniel Wood, PhD, MBBS Professor Urology
Anna Massey Administrative Assistant III Urology
Mark Greyson, MD Assistant Professor Plastic & Reconstructive Surgery
Hunter Moore, MD, PhD Assistant Professor Transplant Surgery
Kasey Wood, NP Instructor GI, Trauma, & Endocrine Surgery
Sara Mattsen Administrative Assistant II Plastic & Reconstructive Surgery
Rachel Hall, PA-C Instructor Pediatric Surgery
Margo Nolan Professional Research Assistant Pediatric Surgery
STAFF
Anthony Mick Faculty Affairs Coordinator Finance & Administration
Alicia Heuser, PA-C Instructor GI, Trauma, & Endocrine Surgery
Connor Prendergast Professional Research Assistant Pediatric Surgery
Devri Beckett Administrative Assistant II Plastic & Reconstructive Surgery
Elizabeth Moore Lab Coordinator I Center for Surgical Innovation
Simone Jensen, PA-C Instructor GI, Trauma, & Endocrine Surgery
Andrea Qualman Professional Research Assistant GI, Trauma, & Endocrine Surgery
Amelia Corl Research Services Professional Clinical Research Office
Samuel Scott Data Analyst Transplant Surgery
Paul Joon Koo Choi, MD, MCh Professional Research Assistant Vascular Surgery
Christopher Quinn, MS Research Instructor Cardiothoracic Surgery
Eirin Cox Medical Student Coordinator Office of Education
Thelma Silva Accounting Tech II Finance & Administration
Mahmood Kabeil, MD Professional Research Assistant Vascular Surgery
Simran Randhawa, MBBS Assistant Professor Cardiothoracic Surgery
Khushnuma Damkevala Marketing & Digital Content Transplant Surgery
Georgia Steele Post Award Specialist Finance & Administration
Keri Krenowicz, PA-S3 Instructor Urology
Sara Roper, PA-C Instructor GI, Trauma, & Endocrine Surgery
Rachel DeDeyn Program Coordinator Office of Education
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Surgery News
DIVERSITY IN RECRUITMENT With the goal of becoming the most diverse, equitable, and inclusive department of surgery in the country by 2030, the Department of Surgery DEI Committee is examining everything from hiring practices and trainings to mentorship and patient care.
The resulting video provides a great overview of what it is like to work in our department while also highlighting that we understand the work is never completed. Our hope is that this video inspires all applicants to bring their unique individuality to our campus.
As part of our effort to increase and attract more diverse applicants to our team, we had team members share their thoughts on the importance of diversity, equity, and inclusion.
Click here to view.
FEATURED POSITIONS Advanced Practice Provider
Professional Research Assistant
Pediatric Surgeon
The Division of Plastic & Reconstructive Surgery (Hand Section) has an opening for a full-time faculty position at the rank of Instructor-Advanced Practice Provider. This is a clinical position under the direction of a faculty plastic surgeon. This position provides inpatient and outpatient medical care services at UCHealth and its affiliates.
The Division of Surgical Oncology is seeking a self-motivated, full-time employee at the level of research assistant to work with faculty investigators on a project studying interactions between cancer (primarily melanoma) and the immune system. The major responsibility of this position will be to process blood specimens from patients on a clinical trial.
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 Colorado and its affiliates.
APPLY NOW
APPLY NOW
APPLY NOW
Click here to view all open positions.
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October 2021 these patients faced before going to the hospital, as well as their experiences in the hospital and after being discharged. Colleagues at the University of California, San Francisco, interviewed an additional 30 patients at their locations.
ADDRESSING COVID-19 DISPARITIES CU faculty tackles the pandemic’s challenges in underserved communities Valerie Gleaton From the earliest days of the COVID-19 pandemic, communities of color have been hit hardest by the worst public health crisis in the past 100 years. Black and Hispanic community members were more likely to contract the disease, more likely to be hospitalized because of it, and more likely to die due to its effects. These grim statistics were driven by several factors: essential worker status, crowded housing and working conditions, reliance on public transportation, significant structural barriers to care, and a lack of accurate information about how to prevent exposure and protect against the virus, among others. Seeing these challenges, University of Colorado School of Medicine faculty sprang to action to help those most in need.
The research, published in JAMA Network Open, found that disease misinformation, financial pressures, and immigration concerns caused members of the Hispanic community to be at greater risk of exposure to COVID-19 and made them more likely to delay medical care. The study has led to local and national interventions to address these issues, including training staff at communitybased organizations and offering pop-up vaccine clinics in medically underserved areas. “It’s an important way to conduct research and effect change, which is to center the people who are marginalized and ask them to take the lead in creating strategies and solutions to mitigate the problem,” Cervantes says. Community outreach and education
Understanding the imbalance Lilia Cervantes, MD, an associate professor in the Division of Hospital Medicine, quickly saw the impact of COVID-19. While she was on the front lines, Cervantes began conducting research to understand the disproportionate burden Hispanic communities were facing and what interventions might help. “They are often our essential workforce, and many of them don’t have the option to not work,” Cervantes says, “so they have to place themselves and their families at risk by taking public transportation and sometimes having to work despite being ill.” Early in the pandemic, Cervantes interviewed 30 Hispanic patients who had been hospitalized for COVID-19 to understand the challenges
Long before the pandemic, husbandand-wife duo Kweku Hazel, MD, and Cynthia Hazel, DrPH, had already been conducting health-focused educational outreach, particularly within local Black communities. “We were talking about hypertension, diabetes, obesity, cancer — all of these diseases that were ravaging our communities,” says Kweku, a clinical faculty/fellow in the CU Department of Surgery. “Once the pandemic hit, we had people reaching out and asking us to explain what was going on and help them navigate all the information they were receiving.”
Click here to read more about CU faculty involvement.
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Surgery News
ERICA’S COLON CANCER DIDN’T STAND A CHANCE Steven Ahrendt, MD, uses HIPEC to treat patients with abdominal cancers. Greg Glasgow Erica Ramsthaler was only given three years to live when she was first diagnosed with colorectal cancer, but after transferring her care to the University of Colorado Cancer Center, she is thriving more than four years later. Ramsthaler’s cancer journey began in spring 2017, when she started having mild to moderate stomach cramps every night. She was afraid something might be wrong, but she feared she wouldn’t be taken seriously and waited a few months to get checked out. When she went in for an appointment, she was told she was probably just constipated. Steven Ahrendt, MD Professor Surgical Oncology
Then the pain got worse. Ramsthaler went back to her doctor, who scheduled her for a colonoscopy. “That’s when they found the initial tumor, and they ordered scans and
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other tests to confirm that it was also in my liver,” Ramsthaler says. “There was a mass in my abdominal cavity, and I had fluid in the abdominal cavity, so they drained that and found cancer cells in that, so they knew it had spread into my abdomen as well.” A second opinion that saved her life The news got even worse when Ramsthaler’s medical provider deemed her cancer inoperable. That’s when Ramsthaler, then 44, reached out to the CU Cancer Center for a second opinion. “My husband had heard about CU’s reputation, and he had a friend whose brother had gotten colon cancer treatment at UCHealth, so we called Dr. Messersmith (Wells Messersmith, MD, associate director of transitional research at the CU Cancer Center), and
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October 2021 he said it would be worth it to do a consult with him,” Ramsthaler recalls. Ramsthaler was already on chemotherapy through her medical provider, but Messersmith referred her to the CU Cancer Center’s colorectal/peritoneal cancer multidisciplinary clinic, where she was evaluated by CU Cancer Center member Steven Ahrendt, MD. “She’s a healthy young woman, and she wasn’t ready to throw in the towel right off the bat. She had received several months of chemotherapy, and she had a pretty remarkable response,” Ahrendt says. “The fluid disappeared, the lesion in the liver disappeared, but she still had a big ovarian mass.” To remove that mass, along with any other cancer cells in the abdomen, Ahrendt operated on Ramsthaler in January 2018. He worked to remove all visible signs of the cancer, but knew there were microscopic cancer cells remaining that could still do damage if left untreated. That’s when Ahrendt began a specialized procedure called hyperthermic intraperitoneal chemotherapy (HIPEC), in which heated chemotherapy drugs are pumped directly into a patient’s abdominal cavity after surgery to eradicate any remaining cancer cells. “It takes a million cells to be able to see a tumor with the naked eye, so if there are 1,000 or so free cells floating around in the abdomen, the idea is that if you can deliver a high dose of chemotherapy to the most at-risk area, you’ll get some benefit from that,” Ahrendt says. “We can usually achieve a concentration that’s 20 times higher than we could get through an IV with traditional systemic therapy.”
into the abdomen, surgeons physically rock the patient back and forth for around two hours to ensure even distribution. For patients, HIPEC has the advantage of being a single treatment done in the operating room, versus multiple treatments over several weeks. In addition to offering a higher dose of chemotherapy than patients could receive intravenously, the HIPEC treatment also keeps 90% of the drug in the abdominal cavity, reducing toxic effects on the rest of the body. Ahrendt helped expand the use of HIPEC at the CU Cancer Center in 2017, when he arrived from the University of Pittsburgh. “At that time, Pittsburgh was one of, if not the busiest departments in the world doing it,” he says. “When I had an opportunity to move here, there wasn’t a big program doing it in Denver. The program has really grown since I’ve been here over the past few years.” Living a normal life with encouraging progress For Ramsthaler, the combination of surgery and HIPEC was a success — the tumor is gone from her colon, and the HIPEC cleared the scattered cancer cells from her abdomen. She has had several small spots of cancer return in her liver, but she considers the surgeries she’s received to manage those a small price to pay to manage what was once a fatal diagnosis. “I’ve already made it past the three years that the doctors estimated I’d live if I just got chemo without surgery,” says Ramsthaler.
2021 Department of Surgery Top Docs Colon & Rectal Surgery Jon Vogel, MD Professor GI, Trauma, & Endocrine Surgery
Complex General Surgical Oncology Martin McCarter, MD Professor Surgical Oncology
Congenital Cardiac Surgery David Campbell, MD Professor Cardiothoracic Surgery
James Jaggers, MD Professor Cardiothoracic Surgery
Max Mitchell, MD Professor Cardiothoracic Surgery
Pediatric Surgery Annie Kulungowski, MD Associate Professor Pediatric Surgery
The HIPEC advantage Created in the late 1970s and improved in the intervening decades, HIPEC is a specific therapy for cancers that have spread into the abdomen. Once the fluid is pumped
Click here to read more about Erica’s progress after surgery.
David Partrick, MD Professor Pediatric Surgery Continued on page 12
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Surgery News
BARIATRIC SURGERY SERVICES FOR ADOLESCENT PATIENTS Fredric Pieracci, MD, MPH, discusses childhood obesity and guiding the process to make bariatric surgery available to adolescents. Rachel Sauer Over the past five decades, childhood obesity has transitioned from public health concern to public health crisis. In 1971, 5.2% of U.S. children ages 2 to 19 were experiencing obesity, according to the Centers for Disease Control and Prevention (CDC), a number that increased to 19.3% by 2018. Further complicating this health crisis is the ongoing COVID-19 pandemic, during which many U.S. children were unable to attend school in person, participate in their usual activities, or even play with friends. A study recently published in the Journal of the American Medical Association compared the body mass index (BMI) of more than 191,000 children during the same time periods in 2019 and 2020, and found that 39.4% of the children were overweight or obese in 2020 compared with 38.9% in 2019. “There are so many factors that have converged over the last 10, 20 years,” explains Fredric Pieracci, MD, MPH, professor of GI, trauma and endocrine surgery and director of the Denver Health Bariatric Surgery Center. “We’ve become more sedentary as a society, and not only are we sedentary, but we’re on our devices a lot more and there’s a quick fix of dopamine and other chemicals that are released when we have screen time. That just encourages us – adults and children – to spend even more time on our devices.”
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Fredric Pieracci, MD, MPH Professor GI, Trauma, & Endocrine Surgery
“Then, throw in the COVID pandemic with limited travel, limited gatherings, limited getting out of the house, on top of pre-existing socio-economic factors and health disparities, and it’s all contributing to a worsening epidemic of obesity,” he says. To address the epidemic of obesity among children, Pieracci and the bariatric team at Denver Health Bariatric Surgery Center are applying for accreditation to perform adolescent bariatric surgery for children age 15 and older as part of the center’s overall reaccreditation process in June 2022. Pieracci recently answered some of the most common questions he’s asked about childhood obesity and benefits of adolescent bariatric surgery.
It seems that there’s still a prevalent mindset of, “Oh, they’re kids, the weight will just come off.” How do you address this? That is something we hear a lot, that they’re so much younger and have their whole lives ahead of them; do we really want to make permanent changes? But these changes are durable and safe, and they’re durable and safe over a lifetime. We also hear arguments that kids should just be better about diet and
exercise because they’re younger and more active. But once adolescents reach that BMI of 35, it just gets so much harder to do it through diet and exercise. And this isn’t even taking into account the complicating factors of socio-economics and environment. Denver Health also has a multidisciplinary program called Healthy Lifestyles Clinic for children 2 to 17 who are working on those behavior changes. They are supported by a medical provider, a registered dietitian, a behavioral health consultant and a health coach, and the Bariatric Center has a close working relationship with that program. As a result, patients and families have the option of selecting which level of intervention best meets their needs, and complicated patients who may benefit from surgery due to comorbidities or not making good progress can be connected directly with the Bariatric Center team. You mentioned that obesity disproportionately affects children from underserved and uninsured populations. How will you address these issues of access to bariatric surgery? We know that adolescents as compared to adults who have insurance claims submitted for bariatric surgery are more likely to be denied. So, we already have a plan for getting standardized appeal letters together to be able to fight to get it across the finish line. And we already have established a precedent to fund bariatric surgery for our patients who are enrolled in both the Denver Health Financial Assistance Program and Colorado Indigent Care Program.
Click here to read the entire interview with Pieracci.
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October 2021 coronavirus made news in December 2019. It began pinging on the radar of not only Cumbler and most health care providers, but members of the design and engineering team at Inworks, an innovation initiative on the CU Denver and Anschutz Medical campuses that has a longstanding design and engineering partnership with the CU School of Medicine.
MULTIDISCIPLINARY TEAM DESIGNS NOVEL MASK CU surgery professor Ethan Cumbler, MD, partnered with CU Inworks team and UCHealth 3D Print Task force through first wave of pandemic to address health care worker mask shortage. Rachel Sauer Ideas and innovation don’t always co-exist with convenience. On the CU Anschutz Medical Campus, the road to a novel mask design to address the first wave of the COVID-19 pandemic took some unexpected twists and turns. It wound from prototype hand-offs on front porches and at food trucks to 3D printers set up in basements and bedrooms and countless hours of Zoom meetings. The road to this mask – created through a partnership among Ethan Cumbler, MD, director of quality in the Department of Surgery, members of the CU Inworks innovation and design team, campus and community stakeholders, and the UCHealth 3D Print Task Force led by Elizabeth Harry, MD, associate professor of hospital medicine – began in “the dark days at the beginning of the first wave of the COVID pandemic, when there was an incredible amount of uncertainty,” Cumbler says. The collaboration led not
only to a novel filtered mask design that hospitals and health care institutions can deploy if personal protective equipment (PPE) shortages happen again, but it demonstrated what can be accomplished with multidisciplinary collaboration, adaptability, and strong community partnerships. A paper detailing the team’s processes and lessons learned was recently published in the American Journal of Infection Control. “It was a sense of community that I’ve never experienced before,” Cumbler says. “It was gratifying to feel this army of supporters behind us, and it was an example of something that an academic center was uniquely poised to do because we have these cross-campus partnerships and a tremendous amount of expertise.”
As the number of infections began to grow worldwide and in the United States, “there was an incredible amount of uncertainty,” Cumbler recalls. “We weren’t sure how the virus was spreading. We were unsure of how to protect health care workers or anyone from transmission. It was a time of real fear about the ability of the health care system to rise to the occasion and take care of the patients who were becoming ill.” Hospitals, clinics, and other health care providers were experiencing PPE shortages, an unexpected consequence of demand, materials shortages, and supply chain interruptions. “Almost from the beginning, we were working with hospitals and health care providers who were seeing shortages of face shields and other PPE,” explains Monika Wittig, assistant professor in the CU Denver College of Engineering, Design and Computing and associate director of Inworks. “We weren’t the only ones doing this — teams all over the world were doing similar work —but things were happening so fast that there wasn’t time to establish rapport and work collaboratively with parallel efforts, without slowing down our immediate pursuits.”
Click here to discover how this team designed their novel mask.
Seeing a need for PPE The journey to a mask design began when the first reports of a novel
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Surgery News
Continued from page 9
Pediatric Transplant Hepatology Fritz Karrer, MD
BETTER PATIENT CARE THROUGH CLINICAL PATHWAYS Jeniann Yi, MD, received a grant to study current systems and make improvements to standardized care plans.
Professor Pediatric Surgery
Pediatric Urology Duncan Wilcox, MD Professor Urology
Plastic Surgery Stephanie Malliaris, MD Assistant Professor Plastic & Reconstructive Surgery
Surgical Critical Care Clay Cothren Burlew, MD Professor GI, Trauma, & Endocrine Surgery
Robert McIntyre Jr., MD Professor GI, Trauma, & Endocrine Surgery
Thoracic & Cardiac Surgery John Mitchell, MD Professor Cardiothoracic Surgery
Urology Fernando Kim, MD Professor Urology
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Greg Glasgow Clinical pathways are a vital tool in providing patients with high-quality, standardized care, as well as improving the value of health care. But they are only helpful if physicians actually use them. With a focus on a specific pathway in vascular surgery, Jeniann Yi, MD, received a $24,000 Clinical Effectiveness and Patient Safety Grant from UCHealth University of Colorado Hospital to increase utilization of clinical pathways within the electronic health records system. “Electronic medical records are a great tool to help standardize the way we provide care and make it more efficient, especially when we can incorporate those pathways in a way that makes it easy to interface with our EMR as we’re providing this care,” says Yi, assistant professor of vascular surgery in the University of Colorado School of Medicine. “One of the things we’re trying to address with this grant is how to build pathways that are representative of the work we’re trying to do and the standard of care we’re trying to provide.”
Conducting research to build better care Collaborating with leadership from the Department of Medicine’s Hospital Medicine Division and the Department of Emergency Medicine, Yi and others in the Department of Surgery plan to survey inpatient providers from different specialties on their perceptions and expectations of pathways created within the electronic medical records application AgileMD. The information gathered will be used to create a roadmap that can guide the development and successful implementation of future pathways. “The point is to focus on what makes pathways useful for providers — what makes people want to engage with that pathway when they’re taking care of patients — as well as what specifically about an EMR-based pathway is helpful or potentially hurtful to users who would engage with it,” Yi says.
Click here to read more about the importance of EMR pathways.
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October 2021 had many extraordinary mentors throughout my career who have helped me become a better surgeon, clinician, and human being. Many of my students, residents, and fellows have gone on to become leaders across the country, and I can assure you they have given me much more than I have given them as a mentor. Being a mentor is all about taking the time to help a person navigate the path you once walked upon.
INSPIRING THE NEXT GENERATION OF WOMEN IN SURGERY Elizabeth Pomfret, MD, PhD, helps pave the way for future surgeons. Khushnuma Damkevala The University of Colorado Department of Surgery shines a spotlight on Elizabeth Pomfret, MD, PhD, chief of the Division of Transplant Surgery and the Igal Kam, MD, Endowed Chair of Transplant Surgery. Pomfret, whose career spans two decades, is considered one of the top transplant surgeons in the world. Among her many accolades, Pomfret was recently recognized by the International Liver Transplant Society for her continued contribution to the field of liver transplantation.
What inspired you to become a transplant surgeon? While I was doing my general surgical residency at Beth Israel Deaconess Medical Center, I learned more about transplant surgery and was completely
fascinated by it. I am inspired by the transformative nature of transplantation. We take a person from the brink of death, transplant them with a healthy new organ, and give them a new life. I love that we are giving people a second chance at life. That never gets old for me. As transplant surgeons, we form lifelong relationships with our patients and our patients are from all walks of life. One of your many awards was the American Society of Transplant Surgeons’ Francis D. Moore Excellence in Mentorship Award in 2018. What is your secret to being a successful mentor? As a transplant surgeon, I believe that mentoring is one of our most important jobs. It is imperative that we pass on our knowledge, skillset, and personal experience to the next generation of surgeons so they can learn from our successes and our failures. I have been fortunate to have
For the first time in 2019, women made up the majority of students in U.S. medical schools, according to the Association of American Medical Colleges. Do you have any advice for up-and-coming women doctors and women doctors interested in becoming transplant surgeons? Transplantation is the most fascinating area of medicine, and I would certainly encourage anyone to pursue it as a career. The transformation and impact brought by transplantation is something that I am continually awed by. Whether it is a kind person becoming a living donor or a grieving family making the extraordinary choice to help others at one of the saddest moments in their life, these are remarkable acts of humanity that continue to inspire. No one ever feels they have the time to do everything that they want to do, especially as a surgeon. When I went through my transplant surgical training there were fewer women, especially in leadership positions, but I was fortunate to meet Nancy Ascher, MD, and Kim Olthoff, MD, early in my career. They are brilliant role models for a young woman in transplant surgery.
Click here to read the entire interview with Pomfret.
Click here to read about living organ donation.
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Surgery News
CYCLIST BACK ON ROAD THANKS TO AORTIC VALVE EXPERTISE AT CU ANSCHUTZ Active 55-year-old feels stronger than ever after open-heart surgery five months ago. Chris Casey
Jonathan Fox happily entered his 50s with his identity, stress outlet and social life entwined in a heart-healthy activity – cycling – that would easily propel him into his golden years.
leads to turbulence, which stresses the valve leaflets and results in inflammation and a buildup of calcium on the aortic valve – much like corrosion inside a pipe.
But at age 52, the unexpected happened: He had a “heart episode” in the middle of the night. He felt tightness in his chest and pain shooting into his arm and back. He went to Denver Health Medical Center, and doctors found no heart damage, calling the episode a small heart attack. Adding to the mystery was the fact that Fox was adopted, so there was no family history to trace.
‘Changes your perspective’
“But they did an echocardiogram of my heart and they found, ‘By the way, you have this screwed-up aortic valve,’” Fox said. T. Brett Reece, MD Professor Cardiothoracic Surgery
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The valve was a concern, but doctors advised Fox to monitor it and return annually for an echocardiogram. He learned that a disfigured aortic valve
“Fast forward three years, I had my annual echocardiogram in June (2020), and my doctor calls: ‘You’re now clinically severe. So, you can have the surgery, and health insurance will pay for it,’” Fox said. Fox, now 55, had a stenotic valve in his aorta, narrowing the main arterial passage and blocking flow of blood into his body. In September 2020, he was referred to T. Brett Reece, MD, professor of thoracic surgery in the Department of Surgery at the University of Colorado School of Medicine, and John Messenger, MD, professor of medicine-cardiology in the CU School of Medicine. www.cusurgery.com
October 2021
Reece could relate to Fox’s experience. As an endurance sports enthusiast, Reece had a heart attack at a young age, 44, in 2017. He immediately knew what was happening and underwent a procedure performed by Messenger, who installed a coronary stent. “It definitely changes your perspective,” Reece said. “I try to make sure that people understand what’s going on.” ‘Fighting against that closed door’ Fox needed an intervention – and soon – because 75% of people with severe stenosis experience a fatal heart event within two years because the muscle simply wears out from “fighting against that closed door,” Reece said. “He was heading in the wrong direction.”
Allaying fears Fox, who’d previously only had stitches, admitted to a lifelong fear of doctors and hospitals. “But the heart attack in 2018 really lowered that phobia because I actually spent two nights in the hospital,” he said. “And then I went through all the pre-work for this – the tests, CAT scans, everything they put you through to make sure you’re going to survive this type of operation. All of the research and discussions were super helpful.”
Surgery and the road back Fox went in for his procedure at UCH on April 13, having accepted a new
Fox logs major mileage on his bike. He typically rides 4,000 to 5,000 miles a year, and he pedaled over 6,000 miles during the pandemic year.
They considered a transcatheter aortic valve replacement (TAVR), which Pre-surgery, he kept worrying: “‘What is the intervention in about 90% of am I doing with the next 20 years if I cases similar to Fox’s. But Reece and can’t exercise, if I can’t ride bikes at the Messenger, who are affiliated with UCHealth, The team at CU Anschutz was discovered that amazing. I’m feeling better than I used Fox’s coronary to feel. I’m coming back from rides and arteries, which looking at the data going, ‘Wow, that’s branch off from the fastest time I’ve ever ridden that the aorta’s route.’” – Fox root, came off so low that a percutaneous valve insertion could end up covering level that I used to? I’ll have all these the coronaries and result in a heart friends who are leaving me in the dust. attack. I was just a mess.” The multidisciplinary team advised open-heart surgery and placement of a bioprosthetic – the Inspiris Resilia Aortic Valve – which is made of bovine pericardial tissue and suited to patients’ active lifestyles and, unlike a mechanical valve, has no need for long-term anticoagulants. The bioprosthetic is relatively new technology, having been used by the CU Anschutz team for about three years. “It’s designed for young people that are going to need another intervention down the road,” Reece said.
at UCHealth University of Colorado Hospital (UCH).
He credits Reece and Messenger, along with their physician assistants and other specialists, with being “awesome, kind and understanding” in answering all of his questions. “They just really helped me get informed,” Fox said. “It was the only thing that got me over the fear of going in, because by the time I got there I’d asked every question that I could. So, I was probably 90 percent less terrified than I would have been otherwise.”
job the night before the operation. The seven days in the hospital after surgery were marked by extreme weakness and laboring to walk up and down the hall. His new job started June 28, after several weeks of physical rehab resulted in a gradual strengthening of his body. Still, he was worried about his mental sharpness. “The first month I was a little foggy, but I sort of hit my stride now … I’m much more clearheaded because I know that I don’t have this, ‘Am I going to be normal?’ feeling hanging over my head. I’m now feeling like I’m pretty much normal.” Fox, now five months out from surgery, also feels he has turned the corner physically. “The team at CU Anschutz was amazing … I’m feeling better than I used to feel,” he said. “I’m coming back from rides and looking at the data going, ‘Wow, that’s the fastest time I’ve ever ridden that route.’”
Click here to read more about Fox’s story.
It also didn’t hurt that two of his cycling friends had undergone successful heart surgery in the past decade. One of them had open-heart surgery performed by Reece 10 years ago 15
Surgery News
YOUNG CRANIOFACIAL PATIENT BATTLES MULTIPLE SURGERIES WITH POSITIVE OUTLOOK The Crouzon syndrome patient’s “superstar” team of CU doctors and surgeons has been working with her since birth. Valerie Gleaton “Basketball, playing with sheep, playing with goats, playing with dogs, horse camp, friends ...”
Plumhoff. “It’s been pretty special, because they’ve been with Danner since she was about a day old.”
Nine-year-old Danner Plumhoff is rattling off a list of her summer plans. Many of these activities wouldn’t have been possible for her last summer, when she was fresh off an intensive craniofacial surgery. It was her biggest surgery to date, but as a child with a rare variant of Crouzon syndrome, it was hardly her first.
Two key members of Danner’s team are Brooke French, MD, an associate professor in the University of Colorado School of Medicine’s Division of Plastic and Reconstructive Surgery, and Corbett Wilkinson, MD, an associate professor in the Department of Neurosurgery. Before she was even 14 months old, Danner had two major surgeries with French and Wilkinson to open the front and back of her skull to
“We have a superstar team at Children’s Hospital,” says Danner’s mother, Sara
allow room for her growing brain and to move her forehead and orbital bone forward to protect her eyes. Wilkinson also gave Danner a ventriculoperitoneal shunt to combat her hydrocephalus. “So many of her early surgeries were to prevent harm and actually save her life,” French says. “Then, as she got a little bit older, we started to do things to try to improve her facial balance and function.”
Click here to read more about Danner’s Journey
ROBOTIC WHIPPLE PROCEDURE OFFERS PANCREATITIS PATIENT RELIEF Marco Del Chiaro, MD, performed the surgery to remove Christina Gonzalez’s pre-cancerous cyst and address her recurring pancreatitis. Valerie Gleaton After suffering from painful bouts of pancreatitis for more than a decade, Christina Gonzalez felt resigned to a seemingly endless cycle of procedures. The 34-year-old mother of three, a nurse manager at Lemay Avenue Health & Rehab Facility in Fort Collins, Colorado, started experiencing intense abdominal pain about 11 years ago. After speaking with her primary care doctor and visiting an urgent care clinic, she was diagnosed with pancreatitis, or inflammation in the pancreas (the long, flat gland behind the stomach that
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produces enzymes that aid in digestion and hormones that help regulate the way the body processes glucose). Although many cases of pancreatitis are linked to excessive alcohol consumption, Gonzalez explained to her doctors that she wasn’t much of a drinker. An MRI confirmed that her issue wasn’t alcohol, but rather pancreatic divisum, a congenital condition that occurs when the ducts of the pancreas fail to fuse together properly. Gonzalez’s gastroenterologist referred her to Marco Del Chiaro, MD, professor
and division chief of the Surgical Oncology Division in the CU School of Medicine Department of Surgery, in October 2020. Del Chiaro recommended a robotic Whipple procedure to both remove the cyst and address the underlying cause of her pancreas divisum.
Click here to find out more about Gonzalez’s experience.
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October 2021
SURVIVING A 1-IN-5-MILLION LIVER CANCER Patient Ella Neal found new hope for her disease at the CU Cancer Center and UCHealth University of Colorado Hospital. Greg Glasgow The doctors she saw initially didn’t seem too concerned, but 22-year-old Ella Neal knew something was seriously wrong. A persistent, unusual abdominal pain was keeping her up at night and distracting her from her studies at the University of Colorado Boulder. Scans showed a 7-centimeter lesion on her liver, but doctors told her merely to come back three months later to see if the lesion had grown. Unsatisfied, Neal went to a number of other doctors, finally ending up in the multidisciplinary clinic for liver cancer at the University of Colorado Cancer Center. There her case
was evaluated by experts from many different specialties, including transplant surgeon Megan Adams, MD, who finally was able to solve the mystery. The lesion was actually an orange-sized tumor in her liver that needed to be removed. Once Adams — an assistant professor of surgery at the University of Colorado School of Medicine — removed the tumor and had it biopsied, Neal got even worse news: She had stage IV fibrolamellar hepatocellular carcinoma (HCC), a very rare liver cancer that tends to strike children and young adults.
Neal is now undergoing adjuvant chemotherapy and immunotherapy — therapies that happen after surgery to wipe out any remaining cancer and to prevent the disease from recurring — with Alexis Leal, MD, assistant professor of Medical Oncology.
Click here to learn about Neal’s treatment.
THE PANCREATIC CANCER BATTLE THAT BONDED A PATIENT AND HIS PHYSICIAN Gerry Turner credits Richard Schulick, MD, with helping him beat pancreatic cancer. Greg Glasgow Knowing that jaundice can be a symptom of pancreatic cancer, along with loss of appetite and weight loss, Turner’s doctor sent him for imaging tests, where it was discovered that something was blocking his bile duct. Further scans showed a tumor on the head of his pancreas, and Turner was sent to UCHealth University of Colorado Hospital, one of the main clinical sites of the CU Cancer Center, for surgery and treatment. Staying at UCHealth for care was an easy decision for Turner, as the CU Cancer Center has been named a National Pancreas Foundation Academic Center of Excellence for pancreatic cancer. It is the only such center in the Rocky Mountain region.
“It was an early discovery, fast diagnosis, and good doctoring,” Turner says. “The cancer team really took action.” That action began with a visit to the CU Cancer Center’s multidisciplinary clinic for pancreatic cancer, where Turner’s chart was reviewed by doctors from all of the major specialties that treat pancreatic cancer in order to determine the best course of action. Twenty to 30 of these expert physicians typically meet together in person to discuss each patient and then then come together to meet with the patients and families. Turner says the multidisciplinary review process gave him a lot of confidence in his diagnosis and treatment.
“He got his care through gastroenterology experts, medical oncology experts, and surgeons — the fact that we had some of the world’s best doctors all in one clinic, ready to help him, I think was very helpful for him,” says Richard Schulick, MD, who performed a seven-hour surgery on Turner in January 2018. Turner, who was 74 at the time of his surgery, will continue to see Schulick every six months to monitor his progress and to keep track of the remaining portion of his pancreas. Click here to discover more about Turner’s care.
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Surgery News sanity and navigating a “house filled with raging hormones,” she says with a laugh. At an appointment several days later, a mammogram precipitated an ultrasound, which revealed a mass concerning enough that her physician asked her to return for a biopsy that same afternoon.
YOUNG MOM’S JOURNEY HIGHLIGHTS IMPORTANCE OF EARLY SCREENING Rachel Sauer
Her physician called her as she was heading into the courtroom to prepare it for a hearing. It was the news she didn’t want to hear: breast cancer. She opened the courtroom, then asked another division clerk to cover for her. She held it together until she got home and told her husband. Originally, she was referred to an oncologist in Glenwood Springs but couldn’t get an appointment for several weeks “and I wasn’t having it,” she says. “The next day I asked my doctor to send my referral to (the CU Cancer Center at) Anschutz.” Beginning a course of treatment
Kirsten Stewart was just putting on lotion, like she does every morning after her shower. That particular morning, though, she noticed something different: a lump that hadn’t been there before and that definitely wasn’t normal. She was only 30 years old. “I freaked out a little bit,” she recalls. “I ran downstairs and made my husband feel, and right away he said we should call the doctor.” What began in February 2019 has become a more than two-year breast cancer journey that Stewart has navigated with her family, with a multidisciplinary team at the CU Cancer Center and the Diane O’Connor Thompson Breast Center, and with a newfound drive to educate and advocate for younger women being screened for breast cancer. “I want to tell every woman I know, and especially younger women, to know your body – know when you feel good and know when you don’t feel very well,” she says. “You want to know what your breasts feel like and what’s your 18
normal, and don’t just brush it off if you feel worried or concerned or if you have a family history of breast cancer. “I didn’t have any genetic factors and I don’t have a family history, but I knew something wasn’t right.” Waiting for a diagnosis In regular times, Stewart’s “normal” is about 90 miles an hour. She and her husband of six years, Doug, have four children – Stewart adopted her husband’s three children from his first marriage – ages 16, 14, and two 12-year-olds. Their life together is a whirlwind of 4-H, sports practices, and hiking on the weekends. She’s always made it a point to listen to her body. When she felt a lump in her left breast, she knew it shouldn’t be there. An agonizing weekend followed, and first thing the following Monday, she called her primary care physician. When she’s not working as a judicial assistant in the 9th Judicial District in Glenwood Springs, Colorado, Stewart is on the go, working out to maintain her
“When she first came to see us, we recommended she start chemotherapy and then began to have the conversation about different surgical options,” says Sarah Tevis, MD, assistant professor of surgical oncology, who performed Stewart’s cancer surgeries. However, Stewart had developed a significant infection at the site of her biopsy – so serious that she developed an abscess and spent several days in the hospital – “so now she had an open wound and we were talking about starting chemotherapy, which is immunosuppressive,” Tevis says. “We had to regroup and factor that into the multidisciplinary discussion.”
Click here to read more about Stewart’s journey.
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