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Movember’s mission: make headway on men’s health

Philip Owens, an Army veteran-turned-scientist, believes the sideways glances that accompany his month-long mustache are a small sacrifice to raise money and awareness for men’s health issues.

For the month of November, Owens, PhD, an assistant professor in the Department of Pathology in the University of Colorado School of Medicine, is participating in the global fundraising campaign known as Movember. The Movember Foundation, whose slogan is “Changing the face of men’s health”, uses fashionably-unfashionable facial hair practices to start conversations around screening and treatment for prostate cancer, testicular cancer, mental health and suicide prevention. Owens belongs to the University of Colorado Cancer Center Movember Team, whose fundraising team of physicians and researchers raised over $9,000 in 2017.

Around Owens’ lab, the scruffy ’stache has elicited a bevy of amused responses. Meredith Provera, a professional research associate in the lab, says it was difficult to sustain serious dialogue after the facial hair appeared. “It was so hard to talk science,” she laughs.

As for his family: “My wife hates it,” Owens claims, “and my kids think it’s terrible.”

Repaying soldiers’ sacrifices

Philip Owens growing facial hair
Owens has received some guff from colleagues and his family about his scruffy facial hair this month.

Owens’ passion for men’s health started when he joined the Washington Army National Guard 10 days after his 18th birthday. Serving eight years as a medic in the 164th MASH (Mobile Army Surgical Hospital) and 6250th U.S Army Hospital, Owens left his military career with a sense of gratitude and wanting to repay soldiers’ sacrifices. As an early-career scientist at Vanderbilt University, Owens was inspired to participate in Movember by Bob Matusik, PhD, a tireless patient advocate and champion for research.

In 2017, Owens accepted an assistant professorship at the CU Anschutz Medical Campus and moved his passion for men’s health, along with his wife and three kids, west to Colorado.

Currently funded through the U.S. Department of Veterans Affairs with a Career Development award, Owens studies the metastasis of prostate cancer to bone. The lack of good treatment options for metastatic prostate cancer is personal to Owens, as veterans experience higher rates of aggressive cancer compared to the general population. Owens explains that bone metastases are relatively slow-growing yet can be extremely painful, resulting in very poor quality of life for patients for several years. “Survival per se is not the only problem,” Owens clarifies. “Another problem is pain.”

Owens’ lab studies the role of bone morphogenetic proteins (BMP) in bone metastasis. These proteins drive bone development in healthy individuals but get hijacked by prostate cancer cells. Because prostate cancer patients with bone metastases are of advanced age, recovery following a bone fracture is generally quite poor. “We need to gauge each patient for fracture risk and develop a treatment plan accordingly,” Owens says.

Conversation starter

How can mustaches jump-start conversations about men’s health? As men are generally less comfortable discussing and seeking preventative medical care, communicating with men about health concerns is uniquely challenging and requires a specialized approach, Owens says. “The best part is the mustache, right? Let’s be honest.”

‘We should all strive to die of something stupid, like a whiskey-fueled hot air balloon race against your 93-year-old best friend.’ – Philip Owens

He explains that his mustache is an automatic conversation starter and gives people a direct way to ask questions, get involved and contribute. As a fundraiser and cancer researcher, Owens appreciates the financial transparency of Movember. “It’s very obvious that the charity is using donations toward its stated mission,” he explains.

Funding health programs worldwide

Indeed, the Movember Foundation, started in 2003, is active in over 20 countries and globally raised $67.5 million in 2017. The foundation boasts 76.1 percent of funds raised are used to fund men’s health programs, over 1,200 to date. Examples of organizations which have received Movember funding include the LIVESTRONG Foundation, the Prostate Cancer Foundation and the Prevention Institute.

Owens typically shaves his usual beard on Halloween night; however, this year he was slated to give a talk to Cancer Biology faculty and students on Nov. 1, so he waited an extra day. “I didn’t want to distract from the science,” he says.

When asked what drives his commitment to improving treatment options for prostate cancer patients, specifically veterans, Owens says, “As a patient, if you survive beyond the primary diagnosis, not a day goes by that you aren’t waiting for the relapse.” He adds that the human experience should not end with a cancer diagnosis, but rather, “We should all strive to die of something stupid, like a whiskey-fueled hot air balloon race against your 93-year-old best friend.”

Guest contributor: This story was written by Shawna Matthews, a postdoc at CU Anschutz.

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Is there a penalty for weight loss?

Losing weight is difficult for most people, and keeping it off is invariably a struggle. Some studies have suggested that a greater than expected reduction in resting metabolic rate — the amount of calories your body burns at rest — may be one factor that contributes to weight regain after weight loss.

Researchers at the University of Colorado Anschutz Health and Wellness Center (AHWC) recently conducted a study that suggests that resting metabolism is not lower than expected in a group of successful weight loss maintainers. These results differ from a 2016 study which focused on a small group of subjects from “The Biggest Loser” televised weight loss competition. That study, conducted by a federal research center, followed 16 men and women with class III obesity who lost an average 120 pounds in just a few months— and found they all put most of the weight back on over a period of years.

Resting metabolic rate is determined by the calories used by muscle, organs such as the liver and kidney, and to a lesser extent by body fat. The amount of calories the body burns at rest is known to decrease after weight loss as body size decreases, and this is one reason why it is so hard to maintain weight loss. “To keep the scale from titling back to your original body weight, you will need to eat fewer calories or burn more calories in exercise to stay in energy balance at your new body size,” says Victoria A. Catenacci, MD, a weight management physician and researcher at CU.

Controversial question

A question that generates some controversy, Catenacci said, is whether there is an additional “metabolic penalty” that occurs with weight loss — a decrease in resting metabolism beyond what is predicted from changes in body composition.

Victoria Catenacci
Victoria A. Catenacci, MD, a weight management physician and researcher

“The Biggest Loser” study suggested that six years after the weight loss competition ended, the contestants suffered an additional metabolic penalty due to their weight loss. Their resting metabolism had slowed to the point that their bodies were burning 500 calories a day less on average than the researchers predicted they should be based on their new body size.

CU researchers noted that the resting metabolism suppression of 500 calories a day had not been seen previously in weight-loss study literature; previous estimates of the metabolic penalty due to weight loss typically suggested resting metabolic rate was at most 40-150 calories below predicted values.

Significant health benefits

“News articles that came out after ‘The Biggest Loser’ study basically said, ‘Weight loss is a futile effort, so why bother?’” said Danielle Ostendorf, MS, ACSM-CEP, PhD, a postdoctoral fellow in the School of Medicine’s Department of Medicine at AHWC, and a recent graduate from the Colorado School of Public Health. Ostendorf was the lead author of the study recently published in The American Journal of Clinical Nutrition. “That’s problematic, because even some weight loss can result in significant health benefits.”

The CU study addresses the question of whether resting metabolic rate is lower than predicted in a group of individuals who are maintaining a weight loss. The CU researchers reached a different conclusion: “Results from our study suggest that sustained weight loss may not always result in a substantial, disproportionately low REE that inexorably predisposes individuals to regain weight,” Catenacci said.

Danielle Ostendorf
Danielle Ostendorf, MS, ACSM-CEP, PhD, a postdoctoral fellow in the Department of Medicine at the CU Anschutz Health and Wellness Center

The CU study divided 102 participants, ages 16 to 65, into three groups: weight-loss maintainers (individuals who had lost at least 30 pounds and kept it off for at least a year); controls of normal body weight (matched to the current Body Mass Index (BMI) of the weight-loss maintainers); and controls with overweight/obesity (matched to the pre-weight-loss BMI of the maintainers).

Comparing resting metabolism

“After comparing resting metabolism in weight loss maintainers to controls, and using several published equations to predict resting metabolism, we didn’t find much evidence of suppression of resting metabolic rate in our group of successful weight loss maintainers,” Ostendorf said. “We found that after adjusting for differences in body composition, resting metabolism in successful weight loss maintainers was on average only 14 calories a day lower than predicted.” However, there was variability with some weight loss maintainers showing a lower-than-predicted resting metabolic rate (by as much as 250 calories a day), whereas others showed that their resting metabolic rate was higher than predicted (by up to 150 calories a day).”

The CU team acknowledges that “The Biggest Loser” research used a stronger study design of longitudinal data collection (following each individual over time) compared to the cross-sectional design of its study. In addition, the CU study only looked at people who had been successful in weight loss maintenance. However, they noted that “The Biggest Loser” analysis was a small study of a group of individuals who exhibited extreme obesity. “These were people who lost a lot of weight over a very short period of time, so it may not represent what people experience when losing weight with more conventional lifestyle weight loss strategies,” Catenacci said. “To take that data and extrapolate it into this message that weight loss is futile — when that’s not the way the majority of people lose weight — just seemed concerning.”

Delving deeper

The CU team plans to delve deeper into this issue using data collected in an ongoing weight loss study in which participants are randomized to a lifestyle weight loss program involving either daily calorie restriction or intermittent fasting.  It has a cohort in the weight-loss program which is currently at the six-month mark; a second cohort is being assembled to start the program in January (see sidebar).

“It’s important to show that there is hope for people who want to lose weight,” Ostendorf said. “But it’s also important to recognize that a metabolic penalty may exist for some people who lose weight. It’s definitely a sensitive issue.”

WANT TO BE IN A WEIGHT-LOSS STUDY?

Volunteers are needed for a research study to learn more about the best eating patterns for weight loss within a 12-month behavioral weight loss program.

To be eligible you must:

  • Be a man or woman between 18 and 55
  • Be generally healthy without diabetes or heart disease
  • Be a non-smoker
  • Not currently exercising regularly
  • Have a BMI between 27 and 40kg/m2
  • Live or work within 30 minutes of the CU Anschutz Medical Campus

For more information about what you will receive, please contact the study team at DRIFT2@ucdenver.edu

There is strong data to suggest that humans are biologically predisposed to regaining lost weight. Factors other than changes in resting metabolism, such as increases in appetite and decreases in the amount of calories the body burns during exercise, may also play a role. So essentially, Catenacci said, losing weight and keeping it off is not as simple as just willpower.

“These studies don’t solve the issue by any means,” she added. “They are pieces in the puzzle. More data is needed before we draw any sweeping conclusions about the presence or absence of a metabolic penalty.”

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Answers To Every Thanksgiving Question You’ve Ever Had

Thanksgiving is almost here, and that means two things. Time spent with family and friends around the television watching football and turkey. Lots and lots of turkey. At this time of year, we often overindulge and loosen our belt and wonder how we fit all that stuffing and gravy into our stomach. Don’t worry. We asked leading health experts from the University of Colorado Anschutz Medical Campus a few of the Thanksgiving questions you’ve always wanted to know the answer to.

Mom’s turkey is legendary! Could I end up blowing a hole in my stomach by devouring too much turkey?

We’ve all been there. The awkward stares around the table as Uncle John says, “Who is going in for the last piece of that delicious bird?” You may wonder if it’s possible to overeat at your Thanksgiving meal to the point of health complications. “Thankfully the stomach has a thick muscular lining that makes it very resistant to stretch and pressure, so a perforated stomach is not really a concern on Thanksgiving Day,” says Paul Menard-Katcher, MD, assistant professor in the Division of Gastroenterology & Hepatology in the CU School of Medicine. “Unless you swallow a sharp turkey bone, so don’t do that,” he adds.

 

My grandma Betty makes her famous Thanksgiving casserole four weeks in advance and brags on how it keeps in the freezer. Needless to say, I’ll be passing on it this year. Is there any actual evidence that frozen food offers less nutritional value than freshly cooked food?

“There is very little nutritional value lost from freezing food in general, and food can be frozen for long periods of time which is one of the advantages of freezing,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. The USDA recommends freezing food as quickly as possible to maintain quality. When it comes to thawing, it’s actually the opposite. Turkeys may take days to safely thaw in your refrigerator, approximately one day for every five pounds of weight.

 

Is it the turkey that leads to Aunt Judy passed out cold on the reclining chair after our meal?

This one is as old as Thanksgiving itself. Turkey contains an amino acid called tryptophan that makes you sleepy, right? Wrong. “Turkey contains no more tryptophan than other foods and actually less than chicken!” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. “So, it’s likely not the turkey that’s the culprit but the high food and alcohol intake,” she adds.

 

If it were socially acceptable, I would drink right from the gravy boat. How much gravy is too much?


Gravy is the ultimate side at any Thanksgiving dinner. It helps the meal slide right down in all its sodium glory. However, Sarah Funk, RD, in the Division of Gastroenterology says it’s best to take it easy. “Gravy should be added to the meat for added flavor and moisture. If there is more gravy than meat, there’s probably too much gravy,” says Funk.

 

I’ve been told sweet potatoes are a healthier choice than white potatoes. Is that true?

Remember when your mom would tell you to eat all those colorful vegetables growing up? Maybe there is some truth to that. “Sweet potatoes and white potatoes have different nutrients. Sweet potatoes have more fiber (about 2 more grams more than white) and contain Vitamin A, while white potatoes don’t contain vitamin A but do contain more Vitamin C,” says Sarah Funk, RD, in the Division of Gastroenterology. “Include a variety of colors from fruits and vegetables — all in order to receive a variety of nutrients,” she adds.

 

I’ve heard cranberries are good for you and even prevent cancer and heart attacks. Should I load up on Thanksgiving?

Cranberries are commonly referred to as a superfood for their antioxidants and are rumored to help with all kinds of medical conditions from urinary tract infections to diabetes. But is that legit? “There is insufficient reliable evidence to support cranberry has any positive impact in the prevention of cancer and cardiovascular disease,” says Joseph Saseen, PharmD, at the CU School of Pharmacy. “Watch out for cranberry sauces and jellies. One typical serving (about half of an inch of the canned product) contains 86 calories and 22 grams of sugar,” he adds. I can already feel my blood sugar spiking!

 

I’ve heard that eating turkey without the skin is better for me. Is that true?

There are few things better in the world than lightly crisped turkey skin, but you may want to think again this year. “In a 3.5 oz portion of turkey breast, there’s almost double the amount of fat when the skin is left on versus if it is removed,” says Marsha Miller, MS, RD, at the CU Anschutz Health and Wellness Center. “If you’re looking for ways to reduce the calories in the meal, this is certainly one easy way to do it,” she said.

 

What tips would you give someone who wants to eat healthy during Thanksgiving?

This is the toughest time of the year to eat healthy. But there are things you can do to make your holiday less punishing on your body. Experts say a common mistake is not eating all day. “A big mistake people tend to make is to eat very little or nothing at all the whole day of Thanksgiving which often leads to overeating during the big meal,” says Cristina Rebellon, RD, at the CU Anschutz Health and Wellness Center. She recommends eating as you normally would and stay well hydrated. This will put you in a good position to not overeat.

 

How can the Thanksgiving cook make the meal healthier by substituting or preparing the meal in a different way?

 

  • Choose skim milk or 1 percent milk instead of cream or half-and-half.
  • Start with adding a smaller amount of fat and add as needed for taste.
  • To reduce added salt, season with herbs and spices and use low-salt broth or bouillon cubes.
  • Grill or bake instead of frying foods.
  • Try a fruit-based dessert. Substitute applesauce and yogurts for added butter and oils.
  • Leave sauces or dressings on the side to allow diners to choose how much of the higher-calorie items they want.
  • Offer up sparkling water or other low-calories drinks to help ease the calorie load for the meal.

Happy Thanksgiving to all from the CU Anschutz Medical Campus. With a little preparation and a lot of self-control you can have a healthy and enjoyable holiday surrounded by family and friends.

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Conference tackles challenging ethical dilemmas in health care

Health care professionals face ethical dilemmas every day. They don’t have the luxury to treat ethics and gray areas of morality as intellectual parlay, because these challenging situations arise with regularity.

Matthew Wynia
Matthew Wynia, director of the Center for Bioethics and Humanities, leads a session at the recent Aspen Ethical Leadership Program.

While medical ethics courses are part of academic programs, it’s rare to practice moving beyond the hypothetical and into the realm of reality. How should health care professionals act ethically?

This question and others were discussed at the third annual Aspen Ethical Leadership Program (AELP), held recently in downtown Aspen. The inclusive and forward-thinking program on ethical leadership is geared toward people across the health care spectrum — physicians, students, administrators, lawyers, insurance providers and other leaders. The program is led by founders Matthew Wynia, MD, MPH, director of the Center for Bioethics and Humanities at the CU Anschutz Medical Campus, and Ira Bedzow, director of the Biomedical Ethics and Humanities Program at New York Medical College.

Attendees participated in plenary sessions, panels and case studies, all in a highly engaged setting due to the intimate size of the three-day conference. Bringing together professionals from across the spectrum of health care to train in identification and generation of solutions to the ethical dilemmas of our modern age demonstrates the immense power of inter-professional collaboration.

Heard of ‘Hard Call’?

Check out this podcast that explores tough ethical decisions in health care.

An interesting component of this year’s program was that many cases fell into the black-and-white category, rather than morally ambiguous areas. Yet, even in situations where consensus regarding solutions was easily obtained, participants quickly learned that the development of policies to carry out those decisions was still quite difficult when confronted with the reality of their implementation.

Finances, a wide variety of stakeholders, conflicting values of autonomy and utilitarianism, and legal obligations — an array of factors must be considered and provide challenges to taking ethical action. The interactive programming of AELP could be likened to a mental gym where ethical muscles are built and strengthened.

Next year’s program will take place from Sept. 9–11.

Guest contributor: Taylor Soderborg, an MD/PhD candidate in the Integrative Physiology Program at the CU School of Medicine.

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Infants born to obese mothers risk developing liver disease, obesity

Infant gut microbes altered by their mother’s obesity can cause inflammation and other major changes within the baby, increasing the risk of obesity and non-alcoholic fatty liver disease later in life, according to researchers at the University of Colorado Anschutz Medical Campus.

The study was published in the journal Nature Communications.

“Alteration of the gut microbiome early in life may precede development of obesity instead of being caused by established obesity,” said the study’s lead author Taylor Soderborg, an MD/PhD candidate in the Integrative Physiology Program at the University of Colorado School of Medicine. “This is the first study to show a causative role of these microbes in priming development of obesity.”

Childhood obesity is a world-wide epidemic with recent predictions saying that 57 percent of today’s children will be obese by age 35. That parallels the rate of maternal obesity which is nearly 40 percent. Obesity increases the risk of non-alcoholic fatty liver disease (NAFLD) which impacts at least 30 percent of obese children. NAFLD can lead to liver failure, requiring a transplant.

Taylor Soderborg
Taylor Soderborg, an M.D./PhD candidate in the Integrative Physiology Program at the University of Colorado School of Medicine.

In this study, researchers looked at two-week old infants born to normal weight mothers and obese mothers.  They took stool samples from infants from both groups and colonized them inside germ-free mice.

They discovered that the gut microbes from babies born to obese mothers caused metabolic and inflammatory changes to the liver and bone marrow cells of the mice. Then, when fed a Western-style high fat diet, these mice were predisposed to more rapid weight gain and development of fattier livers.

“This is the first experimental evidence in support of the hypothesis that changes in the gut microbiome in infants born to obese mothers directly initiate these disease pathways,” Soderborg said.

For the study’s senior author, Jed Friedman, PhD, MS, professor of pediatrics and neonatology at the CU School of Medicine, the findings offer potential hope for understanding how early microbes might go awry in children born to obese mothers.

“About 35 percent of these kids have NAFLD and there is no known therapy for it,” he said. “But if we can alter the microbiome we can change the course of NAFLD.”

Friedman said the study shows that the microbiome can cause the disease rather than simply be associated with it. Newborns of obese mothers, he said, could be screened for potential changes in their gut that put them at risk for NAFLD.

Jed Friedman
Jed Friedman, PhD, MS, professor of pediatrics and neonatology at the CU School of Medicine

“If we could modify the first two weeks of the infant microbiome, we could reduce the risk of this disease,” said Friedman.

That could be done through giving the infant probiotics or other supplements.

Soderborg said future studies on pre and probiotics are needed to better understand how they could help modify the risk of childhood obesity and the risk of liver disease in infants born to obese mothers.

The study co-authors include Sarah E. Clark; Christopher E. Mulligan; Rachel C. Janssen; Lyndsey Babcock; Diana Ir; Dominick J. Lemas; Linda K. Johnson; Tiffany Weir; Laurel L. Lenz; Daniel N. Frank; Teri L. Hernandez; Kristine A. Kuhn; Angelo D’Alessandro; Linda A. Barbour; Karim C. El Kasmi.

 

 

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Gone in 180 seconds: Scarves and cocoa hot items at debut of First Snow

Students excitedly stood in line, waiting for a warm cup of hot chocolate, an afternoon caffeine jolt and a special-edition CU Anschutz First Snow scarf on Monday.

“We were here right at 12 and there was already a line,” said first-year pharmacy student Jordan Burkdoll. In fact, by 12:03 p.m., all 200 scarves were handed out from tables set up at the Research and Education quads. Student Senate and the Office of Campus Student Services sponsored “First Snow,” a new annual tradition on campus that commemorates the first snowfall of the season with free hot cocoa, coffee and unique CU Anschutz black-and-gold scarves.

Carl Johnson, student engagement director, said, “We just want to celebrate what makes Colorado so special and capture how you feel when the first flakes begin to fall.” The goal is to foster a sense of community, school spirit and camaraderie across campus.

It’s safe to say this tradition will be sticking around (unlike the first snowfall!). Advice for next year? “More hot chocolate!” said pharmacy student Ashley Moe.

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Chancellor Don Elliman honored with American Cancer Society Champion of Hope Award

“I love my job. I get to go to work every day surrounded by people who are trying to make the world a better place: to give people life, to give people hope.”

With those words, CU Anschutz Medical Campus Chancellor Don Elliman accepted the American Cancer Society’s Champions of Hope Award on Saturday night, Nov. 10. Elliman was chosen for his distinguished service and leadership, and honored with this TRIBUTE VIDEO.

Dr. Schulick with Chancellor Elliman
Chancellor Elliman is congratulated by Richard Schulick, MD, director of the CU Cancer Center, at the ASC Champion of Hope gala.

The Champions of Hope Award recognizes outstanding partners of the American Cancer Society – of which CU Anschutz certainly is one. Since 1955, the Society has funded nearly 200 cancer-related research grants at CU, $31 million worth. Currently, it’s funding 17 multi-year research grants totaling $8.8 million in Colorado, many of which are at CU Anschutz. Elliman thanked the Society for its ongoing support of cancer research.

Speaking of his “belief that we will see more advances in health care in the coming decade than we’ve seen in the last 50 years, maybe longer,” Elliman noted that many of these breakthroughs are likely to be in the area of cancer care and cure. Citing immunology and immunotherapy efforts underway at CU Anschutz, he said “with CAR-T cell and other novel therapeutics, people who have failed all standard therapies and are out of options, have hope, and a good chance to cure. And that’s just one example.”

More than 300 people attended the Champion of Hope gala, held at the EXDO Event Center in Denver’s RiNo Art District. The event highlighted the Society’s accomplishments of the past 100 years as the largest nonprofit funder of cancer research in the United States, and raised more than $209,000 for cancer research in Colorado.

Elliman was quick to note that as much as he appreciated the honor, it was not his alone. CU Anschutz collaborates with cancer organizations, health care facilities, nonprofit organizations, government institutions and corporate sponsors to help achieve the common goal of eliminating cancer.

“I get the plaque,” he said, “but you are the real champions of hope.”

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After a ‘Lazarus’-like response to treatments, Shavvi is back to shredding guitar, loving life

Pumping iron. Shredding guitar. Hiking the mountains. Working in information technology. For Shuvanzan Dwa, the start of his 30s was a daily exercise in the things he loved.

Everything changed, however, when the young man began to notice a pain in his pelvis. The nagging ache persisted, and he figured it was a byproduct of weight lifting, possibly a muscle tear. One spring day while Shuvanzan (who goes by Shavvi) was at home, the pain intensified and he suddenly experienced gastro-intestinal bleeding. He called 911 and within hours was diagnosed with a mass in his pelvis.

Shavvi Dwa on guitar
Shavvi Dwa performs during a recent gig in Denver.

It turned out to be a rare form of sarcoma, and it was growing aggressively. “I thought, ‘No way, that can’t be,’” he said. “I was a fit guy. I ate a healthy diet. Didn’t smoke and hardly ever drank.”

The prognosis immediately got worse. The physicians at a south metro-area hospital administered radiation and chemo treatments. When Shavvi had a severe reaction to the latter, being left so weak he could barely walk, his family got the shocking news that his condition was terminal.

In a matter of days, however, he rallied and began to feel a bit better. Still, the prognosis he received from the physicians was bleak, and it continues to haunts him: You have weeks or possibly days to live, and we can’t do anything more. You should spend the rest of your days with your family.

‘This can’t be happening’

Shavvi was recommended to hospice, and his thoughts swirled: I want to go running. I want to go hiking. I want to be playing my guitar. They must be mistaken; this can’t be happening.

A friend offered a suggestion that, yet again, changed everything: “You should look at the CU Anschutz Medical Campus. They do research and clinical trials.”

He quickly got an appointment with Victor Villalobos, MD, PhD, director of the Sarcoma Medical Oncology team in the CU Cancer Center. Considering what Villalobos knew about Dwa’s case, “I was expecting him to be wheeled in,” the oncologist said, “but he walked in the room and looked super healthy.”

Leery after the serious reaction he’d already suffered from chemo, Shavvi initially opted to hold off for a month when he heard Villalobos’s recommendation for a chemo treatment. “At the end of June, Dr. V scheduled a scan and said, ‘It’s not as bad as when you were diagnosed, but the tumors are growing.” The sarcoma was in his liver and lungs.

Dr. Victor Villalobos
Victor Villalobos, MD, PhD

Villalobos put him on an intense regimen of chemotherapy, and the response was immediate. “The type of cancer he has is usually very resistant to chemo, but his behaved very differently,” he said. “He was literally like Lazarus, like he was resurrected. Shavvi had a dramatic response and was back to work, weight lifting and playing guitar soon after.”

That was two years ago.

Family, fan support

Shavvi, who recently underwent yet another cycle of chemotherapy (cycles usually last five days), is originally from Nepal. He was the lone member of his family living in Colorado, but after the diagnosis in spring 2017, his parents and sister moved here from Houston and New York, respectively.

The many people thrilled to see his recovery include the fans of KasthaMandap, the local rock band in which Shavvi plays guitar and sings. In February, KasthaMandap (a historical reference to Kathmandu) opened a show for Nepal Idols, and in August, Shavvi performed as the solo opener for Bipul Chettri & The Travelling Band, a well-known Nepalese group, at Cervantes Ballroom in Denver. “When we get an offer for a gig and I’m not fatigued, I always say, ‘Let’s do it!’” he said.

When Shavvi checks in for periodic chemo treatments at University of Colorado Hospital, he spends his days working on his computer or watching TV. The extensive World Cup soccer coverage brightened one of his five-day treatment cycles last summer.

Coordinated care

Shavvi Dwa on computer
Shavvi Dwa works on his computer during a chemotherapy cycle at UCHealth’s University of Colorado Hospital.

Lindsay Thurman, MD, assistant director of the oncology hospitalist service, said patients can get “pretty down from having to give up a week of their life, sitting in the hospital and getting chemo.”

But that’s not the case with Shavvi, she said. “He always rolls with it, always has a positive attitude. He’s easy-going and will let us know if something doesn’t seem right.”

Cancer Center patients receive multidisciplinary, one-stop-shop care. They see specialists in all medical disciplines at once rather than having multiple appointments. This coordinated care extends to the inpatient oncology service at UCHealth’s University of Colorado Hospital.

“Our goal is to ensure our patients get a consistent, clear message on their prognosis and treatment plan — no matter if they’re on the inpatient side or if they’re in the Cancer Center clinic,” said Thurman, who is also an assistant professor of Hospital Medicine in the CU School of Medicine.

Shavvi admits he’s had some ups and downs over the past two years. He recalls the shock of looking in the mirror after completing one of his first rounds of intensive chemo. “When you’re a body builder, you look in the mirror to see if your muscles are toning,” he said. “Everything tone-wise was gone in a month or so. I thought, ‘This can’t be me.’ It was really hard.”

CONCERT T-SHIRT

Shavvi designed a T-shirt shirt to wear on stage. On the front it reads …

Tumors in my Body / Music in my Soul / Guitar in my Hand / Love in my Heart / Strength, Hope & / Courage in my Mind!

… and on the back: #ShavviStrong / #StrongerthanSarcoma / #CancerWarrior

Undeterred, Shavvi returned to his lifting regimen at the gym. Earlier this year, however, he eased off a bit when the lung tumor caused a bout of fluid buildup.

Mostly, though, he’s a good-natured, hard-working and hard-rocking guy. Shavvi always enjoys his interactions with Villalobos and the rest of his CU Anschutz medical team.

“I like the way Dr. V communicates. He explains everything really well,” he said. “If he decides to change medications, he explains what’s happening and why we should give it a try. It gives me a boost. It took a while for this all to sink in, but now, hey, I’m here and I’m able to do the things I love to do.”

Shavvi T-shirt
The T-shirt Shavvi designed for his concert performances.

Villalobos said sarcomas make up only 1 percent of all cancers. Although a cure has yet to be discovered for Shavvi’s sarcoma, the Cancer Center is constantly offering patients clinical trial options and the most cutting-edge therapies. “The center is bringing in national leaders on clinical therapy protocols,” Villalobos said. “We have internationally recognized programs for basically every cancer type.”

Back to rockin’

Villalobos will review how Shavvi responded to his last chemo cycle and then assess the next treatment steps. While developing cures for cancer is the ultimate goal, he said, “more likely we’ll be able to treat the disease and hold it at bay, essentially changing cancer from terminal to chronic disease like diabetes.”

With love in his heart, and strength, hope and courage in his mind, Shavvi, now 32, is the kind of patient who responds well to treatment. Sarcoma be damned. This #CancerWarrior is back to rockin’ and living life to its fullest.

Editor’s note: Photos in hospital room taken by Matt Kaskavitch, director of digital engagement, Office of Communications.

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Patients who used psychotropic drugs in suicide attempts were more likely to have had prescriptions for them

As prescriptions for psychotropic drugs increase, researchers at the University of Colorado Anschutz Medical Campus have found that prescribed access to anti-anxiety and anti-psychotic medications may make it easier for some patients to use the drugs in attempted suicides.

“In a study focused on people who attempted suicide, those who used a psychotropic drug in an attempt were 70 percent more likely to have prescribed access than patients who used other methods in their attempt,” said Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health at CU Anschutz.

Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health
Talia Brown, MS, PhD, lead author of the study from the Colorado School of Public Health.

The study was published last week in the Journal of Clinical Psychiatry.

Suicide is the 10th leading cause of death in the nation with 45,000 fatalities in 2016, more than 200,000 hospitalizations and 500,000 emergency department visits.

Survival often depends on the method used and the method usually depends on having physical access to it. Intentional poisoning accounts for 15 percent of all fatal suicides and between 54-68 percent of nonfatal suicide attempts. Drugs make up the vast majority of those poisonings.

The study investigated the association between prescribed access to psychotropic drugs and using them in a suicide attempt. The researchers used a large, nationally representative insurance claims dataset of 27,876 people who had attempted suicide at least once.

They found that 10,158 of them had used psychotropic drugs in their attempt. The most commonly used were antianxiety medications, followed by antidepressants, antipsychotics or mood stabilizers and stimulants. About 13 percent used more than one drug.

Overall, some 23 percent of those in the study who used psychotropic drugs in a suicide attempt had filled prescriptions for the drugs within 90 days before their suicide attempt. That led researchers to ask how so many other people who attempted suicide gained access to the medications they took.

Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

“The most likely options were from family and friends, previous prescriptions filled prior to our exposure period, medications purchased outside of insurance plans or on the black market,” the study said.

Brown said it was important to safely store all over-the-counter and prescription drugs, not just the most toxic, especially when there is a friend or family member at risk of suicide.

The findings offer a number of lessons and insights into prescribing these drugs, said the study’s senior author Heather Anderson, PhD, associate professor in the Center for Pharmaceutical Outcomes Research at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.

“Restricting or modifying access to psychotropic drugs will require increased attention by all healthcare professionals, particularly pharmacists who are well-positioned to talk to their patients about safe medication use and storage,” she said. “It is important to stay on top of a patient’s depression, stay on top of their prescriptions and monitor suicidal ideation.”

Providing medicine in blister packs has been successful in other countries in reducing deaths because it requires time and effort to remove enough of the drug for an overdose. And people can change their minds during that time.

Ultimately, Brown said, those at high risk for suicide with prescriptions for psychotropic drugs should be closely monitored for potential safety interventions.

The study co-authors include: Peter M. Gutierrez, PhD; Gary K. Grunwald, PhD; Carolyn DiGuiseppi, MD, PhD; Robert J. Valuck, PhD.

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Workplace-based Compositive Primary school to open in fall 2019

A private school serving students in preschool through fifth grade is planned to open in fall 2019 on the Fitzsimons Innovation Community, just north of the University of Colorado Anschutz Medical Campus.

For the first-year launch, Compositive Primary will open with classrooms for 3- and 4-year-olds, kindergarten and first grade. Applications for the 2019-2020 school year are due Feb. 1, and admission decisions will occur in March.

Compositive Primary courtyard
This is a rendering of the courtyard of Compositive Primary independent school, which is planned to open in the Fitzsimons Innovative Community in fall 2019.

A workplace-based school, enrollment preference will be given to children of parents working on the Anschutz Medical Campus, including faculty, staff and students at Children’s Hospital Colorado, University of Colorado Hospital and the Veteran’s Administration Medical Center.

Marcie Prokupek, director of outreach, said a school groundbreaking will take Nov. 16 at the site, 2345 N. Ursula St. The school will add one class per year until it reaches capacity through fifth grade in 2023-2024.

The school was founded by Betsy Callaway Considine, in tandem with the Colorado-based Considine Family Foundation, and operations will be primarily funded through various philanthropic sources. The per-student cost is $100 per month for the year-round school curriculum. Compositive Primary will also offer before-school (6:30 a.m. to 8:30 a.m.) and after-school care (3:30 p.m. to 6:30 p.m.); cost for these optional programs is similar to comparable area daycare services.

Embracing diversity

“We want to make the school accessible to all families regardless of income,” Prokupek said. “And we are really embracing diversity in our student body.”

ADMISSIONS OPEN HOUSES

Heather Mock, head of school, will provide information at open houses next week:

  • 11:30 a.m. to 1:30 p.m., Tuesday, Nov. 13, in Etai’s in Research 2
  • 5:30 p.m. to 7:30 p.m., Tuesday, Nov. 13, in the lobby of 21 Fitzsimmons, 2100 N. Ursula St.
  • 11:30 a.m. to 1:30 p.m., Thursday, Nov. 15, in Etai’s in Research 2
  • For more information, visit www.compositiveprimary.org  or email info@compositiveprimary.org

The school is planned to open with 68 students — 16 per classroom for ages 3 and 4, and 18 per classroom in grades K-5. When at full capacity with five grades, the enrollment will be 140. The school will operate with a 9-to-1 student-to-teacher ratio and multi-age groupings of children in classrooms. Compositive is planned with an eye toward the long term; it could eventually double in size to an enrollment of 280 students.

The school’s curriculum integrates cognition, character, health and well-being and community engagement. Heather Mock, head of school, said the school aligns with her philosophy of nurturing each child’s natural curiosity and joy of learning. She said the school aims to develop the whole child by cultivating essential skills, good habits and offering a rich learning environment.

Workplace-based school

The workplace-based school model makes sense in today’s age when both parents typically work. “Having your child’s school as a part of your work community is quite nice,” said Mock, who comes from The Alexander Dawson School in Lafayette, where she was associate head of school. “If your child has a performance or other function at school, you don’t have to drive across town to attend. We also want to encourage parent engagement … We believe in the idea that it takes a village to raise kids.”

The year-round model means that breaks are structured differently from typical schools. Summer break will last a few weeks and other short-term breaks will be scheduled throughout the school year. Compositive will offer enrichment programs during the breaks with a separate fee structure.

ALSO COMING SOON: AURORA SCIENCE & TECH

The next generation of health professionals and researchers will soon be learning in a STEM-focused school in the Fitzsimons Innovation Community.

Aurora Public Schools (APS) has authorized Denver School of Science and Technology Public Schools (DSST) to design a new Science, Technology, Engineering and Math (STEM) school for grades 6-12. Aurora Science & Tech (AST), the new school, is developing its academic program and STEM partnerships, according to Peter Sherman, founding school director. AST will open with 150 sixth-graders in August 2019, and will grow one grade level per year until it is 6-12 at full buildout.

The new DSST school will provide APS students with a robust STEM program and access to the CU Anschutz Medical Campus and its pioneering research labs. Application to AST will be available starting in January.

“For the first year, 2019-2020, we will be in a temporary facility nearby. In partnership with APS, there will be a new permanent facility on the north side of the CU Anschutz Medical Campus ready for students in August 2020,” Sherman said.

More information is available at www.dsstpublicschools/aurora-science-and-tech. For more information or to sign up for an open house or tour, please email Yunuen Cisneros at Yunuen.Cisneros@scienceandtech.org.

 

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