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Sen. Cory Gardner tours Steven A. Cohen Military Family Clinic

The Steven A. Cohen Military Family Clinic at the University of Colorado Anschutz Medical Campus celebrated achieving 100 clients with Sen. Cory Gardner (R-Colo.), who stopped by for a tour and conversation on how the clinic provides low to no-cost mental health services to post-9/11 veterans and their family members.

Sen. Gardner at Cohen Clinic
Sen. Cory Gardner (right) visits the Steven A. Cohen Military Family Clinic as part of its celebration of helping 100 clients since opening.

Gardner was impressed by the soft ambiance of the clinic, as well as the veteran and military family artwork exhibited throughout the facility. At one point, Gardner snapped a photo of two wooden hand-carved flags displayed in the clinic’s lobby, remarking on the craftsmanship of Colorado veteran Andrew Darr.

Following the tour, CU leadership including Regent and Board Chair Sue Sharkey, CU Helen and Arthur E. Johnson Depression Center and Cohen Clinic staff engaged in a robust dialogue with the senator. The discussion ranged on topics including the clinic’s day-one rollout of telehealth throughout Colorado, as well as the imperatives and challenges of providing comprehensive mental health care to rural Colorado veterans.

Gardner asked questions on the types of treatment provided by the clinic and expressed interest in working on legislation that supports veterans’ transition to civilian life. The visit was a capstone to the clinic’s celebration of helping 100 clients since opening last spring.

Guest contributor: Article submitted by Holli Keyser, communications and marketing specialist at The Steven A. Cohen Military Family Clinic. 

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Career Day offers exciting view of health care for high school girls

A group of 50 girls from Colorado high schools explored health care careers at the fourth annual Girls’ Career Day, hosted by the Center for Women’s Health Research (CWHR) at the CU Anschutz Medical Campus. The girls were exposed to numerous fields and chatted with successful women across campus.

Girls' Career Day
The girls were shown how to suture by medical residents in the Center for Surgical Innovation.

The all-day event started at a parent-daughter breakfast, where participants met representatives from the CU School of Medicine (SOM), College of Nursing, School of Dental Medicine, Skaggs School of Pharmacy and Pharmaceutical Sciences and the SOM’s Physical Therapy Program. After hearing from CWHR Director Judy Regensteiner, PhD, the group embarked on a tour of CU Anschutz’s bioengineering labs. They learned about pulmonary structure, vascular mechanics and, through a live monitor, observed how a rat’s brain functions.

Chatting with surgeons

In the Center for Surgical Innovation, the group practiced sutures and other fine motor skill tasks in one of the region’s most high-tech training facilities. The girls practiced their newly learned skills on a cadaver’s leg and observed the different parts of a human head while asking surgeons about their day-to-day lives. An 11th-grader from Vista Peak Prep said she liked “having (the medical residents) both teach actual technique and attest to their lifestyle as residents.”

At a “lunch and learn” the girls heard neurosurgeon Aviva Abosch, MD, PhD, speak about her educational journey and her current practice. Since most of the girls are starting to think about post-secondary education, they enjoyed hearing from a successful woman who had gone through almost 20 years of education and additional years of training.

The afternoon was full of hands-on activities. CWHR researcher Sarah Perman, MD, explained why she enjoys Emergency Medicine and demonstrated CPR on a mannequin, all the while discussing how important it can be to someone’s life to be able to perform CPR.

Practicing on a ‘patient’

Girls tour labs at CU Anschutz
The girls got to hold human brains as part of their tour of labs and surgical facilities at the CU Anschutz Medical Campus.

The girls also visited the ambulance bay, where Emergency Medical Technicians (EMT) revealed the similarities between an ambulance and emergency room.

After seeing a job that takes place more in the field, the girls saw other side of the job in the WELLS Simulation Center where they experienced a simulation with a high-fidelity mannequin/“patient” that was having respiratory problems. The girls took turns performing CPR, shocking the “patient,” and using teamwork skills. A girl from Manitou Springs High School said she enjoyed “interacting with people in the career rather than just having an informational booklet.”

The CWHR is committed to introducing high school girls to careers in health care and looks forward to hosting the event again next summer.

Guest contributor: The story was written by Kat Libby, Center for Women’s Health Research.

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Cree-Green receives prestigious research award

Melanie Cree-Green
Melanie Cree-Green, MD, PhD

Melanie Cree-Green, MD, PhD, an assistant professor of pediatrics-endocrinology in the University of Colorado School of Medicine, is among 18 early-career physician scientists receiving 2018 Clinical Scientist Development Awards from the Doris Duke Charitable Foundation (DDCF).

Each award is in the amount of $495,000 over three years. The 18 scientists were selected from a pool of 264 competitive applicants by review panels of distinguished scientists. Applicants were evaluated on criteria such as rigor of unique research and commitment to excellence as independent clinical researchers.

Cree-Green’s project will study the use of essential amino acid supplementation to decrease metabolic disease in high-risk obese girls with polycystic ovarian syndrome.

“The Clinical Scientist Development Awards represent our flagship mechanism for fostering the careers of some of the most promising individuals in the biomedical research field today,” said Betsy Myers, program director for medical research at DDCF. “This year’s awarded scientists represent a vast range of expertise and approaches to improving patients’ lives, but have in common a commitment to improving human health now and in the long term. We are proud to support these physician scientists and excited to see how their careers unfold.”

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Building 500 renamed the Fitzsimons Building

The structure that has long been the centerpiece of the University of Colorado Anschutz Medical Campus — Building 500 — has been given a new name befitting its proud history and stature: the Fitzsimons Building.

The CU Board of Regents voted unanimously to rename the building that opened its doors in December 1941, four days before the attack on Pearl Harbor, and where thousands of soldiers were treated and Coloradans were born.

To commemorate the renaming, and to reflect on the CU Anschutz Medical Campus’s rich history, a celebration and sign unveiling took place Sept. 13 both inside and on the grounds of the stately art-deco building. The event was held 100 years after the opening of the first building on the army base that originally occupied the grounds.

About 50 people — including Regents, members of Colorado’s Congressional delegation, chancellors, the provost, deans, state legislators, Aurora council members and other dignitaries — attended the event. Remarks were delivered by CU President Bruce Benson; CU Anschutz Chancellor Don Elliman; Ben Stein, chief of staff for U.S. Rep. Mike Coffman (R-Colo.); and Sue Sharkey, chair of the Board of Regents. Paul Tauer, who was mayor of Aurora at the inception of the CU Anschutz Medical Campus, also attended.

‘Growing tremendously’

Benson recounted the modest start of CU’s School of Medicine in Old Main on the Boulder campus in 1883. The school had two rooms, two professors, two instructors and two hastily recruited students. “Apparently there weren’t enough sick people in Boulder, so the operation moved to Denver in 1925, eventually taking up residence at 9th and Colorado,” he said. “Our health sciences operations relocated to the CU Anschutz Medical Campus in 2006, and has been growing tremendously ever since.”

Fitzsimons Building
At the unveiling of the new Fitzsimons Building sign: from left, CU President Bruce Benson, Paul Tauer, former mayor of Aurora, CU Board of Regents Chair Sue Sharkey and CU Anschutz Chancellor Don Elliman.

Benson noted that when the U.S. Army a century ago opened the hospital in Aurora — first christened Fitzsimons General Hospital — it began a proud history of treating injured men and women of the armed forces. He said the legacy of care of the nation’s veterans has transitioned into health care for people in Colorado and beyond. “That’s why it’s important to maintain the Fitzsimons name … and to continue the legacy of the U.S. Army Medical Corps,” Benson said. “We should all be proud that the Fitzsimons name will help this facility begin its second century, and we can be equally proud of the thousands of men and women who have continued to live up to the proud history of health care at this facility.”

The building initially received the name Fitzsimons in honor of Lt. William Thomas Fitzsimons, a civilian surgeon serving as a medical officer who was the first U.S. Army officer killed in World War I.

Benson said he was sorry for the absence of Aurora Mayor Steve Hogan, who passed away in May after battling cancer. “Steve was a friend for many years and did a great job as mayor and member of the Fitzsimons Redevelopment Authority Board.”

Tradition of caring for veterans

Elliman said that in 1995, the Fitzsimons Army Medical Campus’s last year of operation, it generated $328 million in economic activity. Today, the CU Anschutz Medical Campus generates $4 billion in economic activity, on par with Colorado’s ski industry.

He noted that CU Anschutz continues its tradition of caring for our nation’s veterans, including:

Sharkey recounted her family’s ties to the Fitzsimons General Hospital, which in December 1941 became known as Building 500, a reference to the structure’s location 500 feet from the center of campus. She explained that in World War I the facility was first established to treat casualties of WWI, many of whom suffered from tuberculosis as well as chemical warfare. She pointed out that President Dwight D. Eisenhower suffered a heart attack in 1955 and spent nearly two months recuperating at Fitzsimons.

Sharkey said her brother, while a student at Colorado State University, suffered severe injuries in a car crash and spent five months recovering at the Fitzsimons Army Medical Center. She said her brother had hoped to serve in the military, just as her father had, but his injuries prevented him from realizing those dreams. “But he had the privilege and honor to meet these soldiers during the Vietnam conflict who had served and were recuperating,” she said.

Against the backdrop of this rich history, Sharkey said, the CU Anschutz Medical Campus is “leading us into a new era of health care, research and education. It is quickly becoming one of the leading academic medical centers in the country, and a top health care destination.

“We are fortunate to have this facility and the people who work on the leading edge of health care,” she added. “We’re also fortunate to inherit our tradition of excellent health care that has happened on this site now for a century. I trust we will do those who came before us proud.”

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Block Party reaches new heights

The Quad Bungee Trampoline towered over the CU Anschutz Block Party, its brave bouncers soaring and somersaulting high above the many food trucks, booths and tables in Bonfils Circle.

Block Party trampoline
Adrielle Seideman and Lizzie Ambros, both first-year College of Nursing students, enjoyed the Quad Bungee Trampoline at the Block Party.

Adrielle Seideman, a first-year student in the College of Nursing (CON), saw the contraption and knew what to do: “I want to do more things that scare me — it’s a goal.” So, she embraced her inner Cirque du Soleil and strapped in. “I call it the ‘who needs drugs?’ ride,” said Seideman, her face flush from exertion and adrenaline. “It was higher up than I thought it would be.”

Reaching new heights could have been the Block Party’s theme, as the sixth annual event broke records in terms of attendance (3,500), information booths (140) and official sponsors (eight).

Block Party attendees
With temperatures reaching the mid-90s, Block Party attendees took full advantage of the shaded tables at Bonfils Circle.

As always, the event offered a cornucopia of food, swag, games, live music and unexpected attractions — an oversized Venus flytrap, two butterfly women on standard stilts, an acrobat on spring-loaded stilts and a living “statue.” With temperatures hovering in the mid-90s, the shaded tables were easily among the most popular hang-out spots.

Flytrap at Block Party
A student at CU Anschutz gets up close to the Venus flytrap during the Sept. 12 Block Party.

Lizzie Ambros, another first-year student in CON who gravitated to the trampoline, said it was fun to see the campus “revving” back up after a fairly quiet summer. “Our interdisciplinary programs through school are starting up, and this event has the same atmosphere — all the different disciplines coming together,” she said. “It feels like we’re all part of the same home together. I like that feeling!”

A group of nurse anesthetists from University of Colorado Hospital, all in scrubs, enjoyed lunch while listening to the Guerilla Fanfare Brass Band. “It’s nice to get out of the OR and enjoy the fresh air, sunshine and blue sky,” one of them said.

Nurses at Block Party
This group of nurse anesthetists from University of Colorado Hospital enjoyed lunch while listening to the Guerilla Fanfare Brass Band.

Second-year School of Medicine students Carlos Jaquez and Hannah Imlay surveyed the food options while toting handfuls of swag (toothpaste and toothbrushes were popular items). Imlay enjoyed learning about other educational opportunities on campus, and Jaquez added, “It’s cool to see all the different organizations that are here on campus, as well as around the local community. It’s fun to find out about them.”

Seideman took advantage of the event by not only squashing her fear of heights, but also chatting with folks from across the many disciplines at CU Anschutz. “I love meeting people in other schools and colleges,” she said. “I also love the live music, the creative vibe and the great green space here for people to do their thing and just enjoy themselves for a couple hours.”

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Lack of diversity in medical studies can cost lives

Two welcome guests
Lina Cheuy, chair of PDRD and chief communications officer for the Postdoc Association, and Jennifer Major, member of this year’s PDRD planning committee and next year’s PDRD chair, welcome guests with a smile.

Before the 1980s, doctors overlooked heart attacks in women, sending them home, often to die, instead of rendering life-saving treatment. More recently, young African-American athletes were misdiagnosed during routine physical exams as being at-risk for a deadly heart defect, with some players placed on dangerous medications or referred for invasive pacemaker implants they didn’t need.

Those are just two examples of how bias in medical research can have dire consequences, a message echoed throughout the ninth annual Postdoc Research Day (PDRD) on the University of Colorado Anschutz Medical Campus. Held this summer, the event’s theme was “Mosaic: Representing All Elements” and included postdoctoral researchers from the CU Denver, CU Anschutz and CU Boulder campuses and National Jewish Health.

Postdocs with congresswoman
Left to right: Matthew Davidson, PDRD planning committee member and government relations chair for Project Bridge Colorado; Leslie Herod, state representative for House District 8; Lisbet Finseth, Project Bridge Colorado member; and Erin Golden, vice president of the Postdoc Association and president of Project Bridge Colorado.

“The bottom line of our mission is to improve the health and well-being of Colorado and the world,” Vice Chancellor for Diversity and Inclusion Brenda J. Allen, PhD, told the audience gathered in Hensel Phelps West for the keynote address. Meeting that mission demands inclusion of people traditionally excluded in scientific endeavors, Allen said.

Postdoctoral researchers also snacked, networked and delivered more than 80 oral and poster presentations depicting their work. The day-long event, organized entirely by postdocs and one of the largest in the country, attracted more than 300 people, including State Rep. Leslie Herod, who attended for the second year in a row through the Project Bridge Liaison Program.

Who is at the table?

Women in STEM table
Jessica Ponder and Allison Porman of Women in STEM (science, technology, engineering and mathematics) represented just one of many student groups that took part in PDRD.

“You are here to do impactful research,” said Mónica Feliú-Mójer, PhD, keynote speaker and scientist-turned-communicator focused on making her field more accessible. “You want to solve difficult medical problems.” To do that, she said, requires diverse and multidisciplinary teams. “You have to ask the question: Who is at the table?”

Non-diverse research lacks perspective, she said, using the effect heart-disease guidelines written by white men and based on white-male studies had on women as an example. Because of research, death from heart attack in men began a steep decline in the ‘80s. For women, a similar drop in death rates didn’t occur until after 2000, when research finding gender-specific differences began catching up with medicine.

“When research is not representative of the society we seek to serve, it limits who is benefiting,” said Feliú-Mójer, pointing to the life-altering misdiagnoses of young African-American athletes. The players, whose gene frequencies differ from their white counterparts, were erroneously told after a biased genetic test that they suffered from a heart defect that could kill them instantly on the court or field.

Both sides of the microscope

Noting that fewer than 13 percent of racial minorities make up the workforce in science and engineering, Feliú-Mójer said that diversity must increase on both sides of the microscope and include multiple identities and disciplines in order for meaningful research to occur.

A 2016 report by leading researchers argued that multidisciplinary work was becoming critical for addressing the biggest challenges facing biomedical sciences, Feliú-Mójer said. And studies show that more diverse research teams have increased productivity, innovation and paper citations, she said.

Both Allen and Feliú-Mójer emphasized that inclusion and diversity, which is more about numbers, are not the same thing. “Inclusion,” Allen said, “refers to ways that, no matter who you are, you feel valued and respected and have a sense of belonging.” Ensuring inclusivity in the research enterprise falls on everyone involved, Feliú-Mójer said. “We all have that responsibility,” she said. “It will be challenging, but it will be worth it.”

Highlighting innovation

PDRD was conceived by postdocs nine years ago to showcase their work on campus and its imprint on the community. Other highlights of the day included:

“I was tearing up a few times during his talk,” said Allison Porman, a postdoctoral fellow in the School of Medicine. “He’s had to deal with a lot from birth (when he nearly died and was abandoned by his biological parents in the hospital)  to now. But to see him present what he’s gone through and accomplished is really inspirational to me.”

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Leading the fight against opioid epidemic

Ending the opioid crisis that claims the lives of tens of thousands of people annually is going to take years of hard, dedicated work. Saving the life of one person who has overdosed on opioids is surprisingly easy.

That was the lesson for U.S. Rep. Mike Coffman, R-Colo., and University of Colorado Anschutz Medical Campus Chancellor Donald Elliman. Coffman and Elliman were at the CU Skaggs School of Pharmacy and Pharmaceutical Sciences on Aug. 31 for a special event commemorating International Overdose Awareness Day.

The congressman and the chancellor were trained to use naloxone, a medication that saves lives by reversing opioid overdoses. Naloxone, also known as Narcan, is a nasal spray that is sprayed into an overdose victim’s nostrils. It quickly counteracts the effects opioids like heroin and prescription pain medication have on users and can revive someone dying from an opioid overdose in minutes. Other versions of naloxone include an auto-injector or a pharmacy assembled kit, but the nasal spray is the most popular in everyday use.

Multidisciplinary approach

School of Pharmacy Professor Robert Valuck, PhD, RPh, led the training. Valuck walked the audience through the few steps needed to administer naloxone before Coffman administered a sample dose (without the active ingredient) to a university employee.

U.S. Rep. Mike Coffman administering naloxone to attendee
U.S. Rep. Mike Coffman administers a sample dose (without the active ingredient) of a nasal spray to Tyler Payne of the Colorado Consortium for Prescription Drug Abuse Prevention during a recent event commemorating International Overdose Awareness Day at the CU Anschutz Medical Campus.

Coffman also learned about what CU Anschutz is doing to fight the opioid epidemic. The School of Pharmacy is the home of the Colorado Consortium for Prescription Drug Abuse Prevention, which is Colorado’s anti-opioid epidemic task force. Its members include faculty from the CU Schools of Medicine, Dentistry, and Pharmacy, the College of Nursing, and the Colorado School of Public Health, in addition to representatives from state agencies, law enforcement and community coalitions. Valuck is the consortium’s director.

In the past year, the consortium has consulted with state lawmakers about legislation, coordinated public awareness campaigns, supported research and helped distribute naloxone to community groups and law enforcement agencies.

Coffman was impressed with the consortium and CU Anschutz’s work.

“This is a model for the rest of the country,” he said. “I don’t think there’s any other way the state can affect the problem other than an interdisciplinary approach.”

CU Anschutz leadership sees how damaging the related opioid and overdose crises are. Elliman said the university is committed to its role in supporting the fight against the opioid epidemic.

In 2017, 1,012 people in Colorado died from drug overdoses; 560 people died from opioid overdoes, including heroin or prescription medication such as Vicodin or OxyContin.

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New discovery on T cell behavior has major implications for cancer immunotherapy

Scientists at the University of Colorado Anschutz Medical Campus have discovered that disease-fighting T cells, elicited from vaccines, do not require glucose for their rapid reproduction, a finding with major implications for the development of immunotherapies for cancer patients.

In the study, published today in the journal Science Immunology, researchers at CU Anschutz along with colleagues from the Mayo Clinic and the University of Pennsylvania, examined T cells that arose in the body’s immune system after they received a subunit vaccination – a vaccine that uses just part of a disease-causing virus.

They found that these critical white blood cells, which attack and kill infection, did not rely on glucose to fuel their rapid division which occurs every two to four hours. Instead, they used another cellular engine, the mitochondria, to support their expansion.

Developing vaccines

Ross Kedl, PhD
Ross Kedl, PhD

“The knowledge that this magnitude of cell division can be supported by mitochondrial function has a number of potential practical implications for the development of future vaccines,” said the study’s senior author Ross Kedl, PhD, professor of immunology and microbiology at the University of Colorado School of Medicine.

Kedl said T cells responding to infection usually depend on glucose for fuel. So do cancerous tumors. When T cells come up against tumors, they end up competing for glucose and the T cells often lose.

But when a T cell doesn’t need glucose, he noted, it has a better chance of defeating tumor cells.

“T cells generated by subunit vaccination are ideally suited for use against cancer in conjunction with drugs that block aerobic glycolysis, a metabolic pathway to which the cancer is addicted,” Kedl said. “Tumor growth can be inhibited while the T cells are free to attack the tumor instead of competing against it for access to glucose.”

Lead author Jared Klarquist, PhD, explained that scientists have historically studied T cell responses to infection with the idea that if they could understand how the cells respond, they could create better vaccines. Kedl and colleagues had already discovered a non-infectious vaccine method that could induce the same level of T cell immunity as those using infection.

Since then, researchers in Kedl’s lab have found that the rules governing T cell responses to an infectious agent are very different from the cell’s response to a subunit vaccine. And the fact that T cells derived from subunit vaccines don’t require glucose to reproduce is a major finding.

Understanding immune response

Jared Klarquist, PhD
Jared Klarquist, PhD

“Prior to these findings, it was generally thought that whereas the mitochondria are good at making energy, T cells need glucose to produce the raw materials like proteins, fats and nucleic acids (like DNA) required to turn one cell into two,” said Klarquist. “Knowing how the immune response is fueled after vaccination provides potential opportunities for metabolic or nutritional interventions for boosting a vaccine-elicited immune response.”

Kedl agreed. “Perhaps most intriguing, however, is the application of this knowledge to cancer immunotherapy,” he said.

The lab is currently exploring how these strategies might positively influence the outcomes of immune-based cancer treatments that are already in the clinic.

The study’s other co-authors include Alisha Chitrakar, Nathan Pennock, Augustus Kilgore, Trevor Blain, Connie Zheng, Thomas Danhorn, Kendra Walton, Li Jiang, Jie Sun, Christopher Hunter and Angelo D’Alessandro.

 

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CU Orthopedics serves super-club of 10,000 kickers

The Colorado Rapids Youth Soccer Club (CRYSC) is partnering with leading sports medicine specialists at the University of Colorado Department of Orthopedics at the CU School of Medicine and UCHealth to ensure its athletes receive unsurpassed care as well as education about injury prevention.

Acting as liaison between CU, CRYSC and UCHealth is Head Athletic Trainer Julie Graves, MA, ATC, who became the full-time athletic trainer for the Colorado Storm soccer club two years ago. Her role has expanded as the Storm recently merged with CRYSC, creating a super-club of over 10,000 players ages 3 to 18. CU Orthopedics’ title sponsorship is similar to the arrangement with Storm, but “it’s just at a bigger volume,” Graves said. “We’ve had two years of providing top-tier care and it’s going extremely well.”

Responsive treatment

Julie Graves
Julie Graves, MA, ATC, is the head athletic trainer for the Colorado Rapids Youth Soccer Club.

Teaming with CRYSC and its five regions along the Front Range comes at an ideal time as the Department of Orthopedics is experiencing a high rate of growth. “Adding this to our portfolio positions the department for a high level of exposure across Colorado, and we look forward to strategically growing this relationship with the Colorado Rapids Youth Soccer Club over the next several years,” said David Kaplan, Orthopedics Department finance administrator.

Graves works with three medical directors who volunteer their time to provide care for club members. “We try to get our kids directly into one of those three first and foremost, but if they’re overbooked we find another CU sports medicine specialist to provide care,” Graves said. “This really gets them right where they need to go in an expedited manner.”

Graves has treated a variety of injuries on the field including dislocated kneecaps, labral hip tears and sprained ankles. However, treatment doesn’t stop on the field. Graves further develops the at-home rehab program, recommending exercises and stretches, and follows up on the player’s progress. Graves has also established an athletic training evaluation space inside the CRYSC Central Region headquarters where the members come to have their appointments. Having a dedicated space gives her the ability to see injuries within 24 to 48 hours, as well as provide treatment or taping before practice.

Positioned for injury prevention

The partnership between CRYSC and CU Orthopedics is a special one. Kaplan notes, “Becoming a sponsor uniquely positions us to focus on injury prevention with these young athletes and ultimately care for them at the appropriate location when an injury does occur. The Sports Medicine team across the School of Medicine has the expertise and experience to take care of the Colorado Rapids Youth Soccer Club athletes similar to the way we cover University of Denver athletics, University of Colorado athletics, Denver Nuggets, Colorado Avalanche, Mammoth, Rockies and Denver Broncos.”

For athletes, the presence of an athletic trainer takes away the worry of when an injury occurs and next steps. In the event of a more serious injury, Graves close working relationship with CU Sports Medicine specialists has afforded her the ability to refer athletes and their parents to the most appropriate specialist depending on location, severity, or type of injury. This is the same approach CU Sports Medicine takes with collegiate level teams and the professional teams they support.

Graves frequently hears from grateful parents. “I’ve gotten absolutely wonderful feedback from the athletes and parents,” she said. “They’re so grateful that the club has an athletic trainer and a huge orthopedic partnership that provides quick, effective and professional treatment for their kids.”

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Liver clinic targets silent epidemic with team approach

After watching the cafeteria lady’s husband die under his team’s care, Thomas Jensen, MD, began focusing on preventing the scenario from happening again. The patient, who had been unknowingly suffering from liver disease, had lost all function of the organ, leaving Jensen and his colleagues nearly helpless.

Wieland and Jensen
Amanda Wieland, MD, and Thomas Jensen, MD, flank a FibroScan® machine, which they often use to quickly and non-invasively assess patients’ liver health. The pair teamed up to launch the Multidisciplinary Nonalcoholic Fatty Liver Disease Clinic (NAFLD) in hopes of slowing an increasing epidemic.

Today, as an assistant professor on the University of Colorado Anschutz Medical Campus, Jensen’s memory fuels his outreach aimed at detecting what has become the most prevalent chronic liver disease in the United States. Rising in tandem with the obesity epidemic, Nonalcoholic Fatty Liver Disease (NAFLD) now strikes children as well as adults and is soon expected to become the top reason for liver transplants in this country.

“It was one of the toughest cases I saw in residency,” said Jensen, who joined the School of Medicine’s Division of Endocrinology, Metabolism and Diabetes in 2016. “He was intubated and on multiple medications and was very difficult to manage. I just remember thinking to myself: We need to have a better way of finding these people before it’s too late.”

Answering a call

Today, Jensen and Amanda Wieland, MD, of the Division of Gastroenterology and Hepatology, have launched the Multidisciplinary NAFLD Clinic, using a team approach that combines their expertise with that of top experts across the campus in decreasing the disease’s burden on patients and the health care system.

Red flags for NAFLD in patients

 

Obesity

Visceral fat (increased waist circumference)

Metabolic syndrome

Insulin resistance

Type 2 diabetes

High blood pressure

Sleep apnea

Some lipid disorders

High triglycerides

Some medications (e.g., some HIV drugs, Tamoxifen, Methotrexate, some steroids)

“Roughly 30 percent of the population has Fatty Liver Disease, doubling in incidence since the 1990s,” Jensen said. “We know that it’s not only preventable, but it also can be reversible largely through diet and exercise,” said Jensen, who hopes to extend the clinic hours with the addition of SOM’s Emily Schonfeld, MD, a gastroenterologist, to the staff this fall.

NAFLD – which results when fatty deposits (steatosis) collect in the liver because of something other than alcohol consumption – has strong links to obesity and heart and metabolic disease. While it strikes 8 percent of the lean population, NAFLD affects nearly 70 percent of diabetics and 80 percent of the morbidly obese.

If the cause goes unaddressed, liver inflammation, scarring and cell death (nonalcoholic steatohepatitis, or NASH) can result, ultimately leading to permanent tissue damage, or cirrhosis.

Missing a silent killer

With top-of-the-line screening equipment, the clinic’s team can identify cases and determine the severity, generally non-invasively, steering patients down the road to reversal. Jensen hopes more patients and primary care doctors, who often don’t have the knowledge, ability or time to effectively treat NAFLD patients, will seek expert care for themselves or their patients.

While primary care physicians routinely check liver function with blood tests, the Dallas Heart Study found the lab work was not a reliable marker, leaving patients undiagnosed, Jensen said. “On ultrasound, researchers found that up to 80 percent of those patients who did have fatty liver had normal-looking enzymes,” Jensen said.

Because doctors once thought simple steatosis would never progress to inflammation and scarring, non-specialists sometimes downplay early NAFLD, Jensen said. But studies now suggest within a six-year period, up to 40 percent of those patients do develop NASH.

“So, our sense is that it’s not only important to screen but to look at the risk factors that might suggest patients are susceptible and to monitor those patients.”

Life-changing diagnosis

Having lost his brother 10 years his junior last year to long-undiagnosed NAFLD, Aurora resident Dennis Ipsen considers himself lucky that his doctor sent him to Jensen and Wieland. The pair quickly detected the disease and began monitoring Ipsen.

“That’s what I liked the most,” Ipsen said of Jensen’s expertise and team approach. “He was Johnny-on-the-spot looking for this, and he knew what he was dealing with, and he brought in the other doctor very quickly,” said Ipsen, who has diabetes and heart disease. “The sooner it’s detected, the better off you are.”

Ipsen’s only new directive so far: maintain his chosen Weight Watchers diet plan. “I’m hoping that’s all I need,” he said.

“I just remember thinking to myself: We need to have a better way of finding these people before it’s too late.” – Thomas Jensen, MD

Rx: Weight loss

A healthy diet, exercise and weight loss is often the only prescription necessary with early diagnosis, Jensen said. “We know that with a 5 percent weight loss, you can reverse the level of fat in the liver,” he said. “And with a greater-than 10 percent weight loss, you can even start seeing reversal of fibrosis (early stages of scarring).”

At the NAFLD clinic, patients receive counseling on controlling related conditions and on ways of achieving weight loss, from fitness apps to bariatric surgery. “I had an obese patient with moderate steatosis,” Jensen said. She was a candidate for bariatric surgery and opted for that route. One month and 15 pounds later, a recheck found her fatty liver was completely resolved, Jensen said.

In addition to the Metabolic and Bariatric Program for severely overweight cases, the NAFLD clinic works closely with the CU Anschutz Health and Wellness Center in helping patients master lifestyle changes and achieve weight loss.

Keeping the faith

Valerie Frank family
Valerie Frank stands front and center of her family, which includes eight grandsons. Frank travels from her Sterling home to the CU Anschutz Medical Campus for specialist care for liver disease.

Although Valerie Frank’s disease had progressed to cirrhosis by the time she found the clinic, the Sterling resident dropped more than 40 pounds since diagnosis and holds out hope that Jensen’s and Wieland’s care can keep complications at bay.

“It’s still good to know,” said Frank, who has diabetes and spent more than a year seeing doctors and undergoing tests trying to find an answer for fatigue and abnormal blood work. She finally told her doctor she gave up. “And he said: Let’s try one last thing. Let’s have you see Dr. Jensen and Dr. Wieland at UCHealth.”

Three weeks later, after making the two-plus-hour trip from her Sterling home, Frank was diagnosed. Now, despite the drive and higher out-of-pocket costs, Frank said she will continue under the doctors’ care for as long as they can help her and would encourage other liver patients to do the same.

“Absolutely. From the minute I walked in, I felt a connection with them both,” said the mother of three and grandmother of eight grandsons. With cirrhosis, her prognosis is not certain, but she’s sure of one thing: The doctors are doing everything they can to give her the best outcome. “I’m feeling well. I’m doing well. You can’t give up on hope,” she said. “I have total faith in them.”

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