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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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Teeth restoration delivers beautiful smile, and confidence, for teen girl

A pair of words — beautiful smile — are heard all the time in dental and orthodontic clinics. These days, it’s practically an expectation for teenagers to, after wearing braces, end up with sparkling and picture-perfect teeth.

This wasn’t the case for Courtney Caudill. Whenever the Thornton teenager looked in the mirror, two other words came to mind: shark teeth.

Courtney's teeth starting high school
This photo of Courtney’s teeth was taken at another Denver-area dental clinic about five years ago, when she was starting high school.

“During my entire high school career, I barely found any photos of me showing my teeth,” she said. “It was a little sad and depressing that I was so embarrassed. You know, there was nothing I could do about it.”

Rare condition

She was born with ectodermal dysplasia, a condition that affects teeth, skin, hair, fingernails and eyes. In the mouth, the condition manifests in misshapen and often-missing teeth. Courtney’s permanent teeth didn’t come in until age 11 and her smile betrayed gaps where teeth should be. Many of the teeth that came in as permanents were conical-shaped — resembling those of a shark.

The condition left Courtney reluctant to smile much of her life, telling peers at every opportunity why she lacked “normal teeth.” Fortunately, teasing was kept to a minimum, mainly because her parents taught Courtney to be proud of herself and went out of their way to explain her condition to teachers and classmates. Entering college — she is currently a sophomore at CU Boulder studying psychology — the late-teen resigned herself to possibly no end in sight to this “very, very long journey” and “lifetime struggle.”

CU Dental School a ‘godsend’

Her mother, however, did some research and found the CU School of Dental Medicine and its Adolescent Dental Clinic, operated by Rick Mediavilla, DDS. After Mediavilla saw Courtney in June 2016, he carefully selected Kevin Moore, DDS, who at the time was a third-year dental student, to complete her care. Mediavilla saw a gentle chairside manner and excellent care standards in Moore, who immediately clicked with Courtney and began plotting her course toward a perfect smile.

Her father, Christopher, calls Moore a “godsend.” “When we first came and met Kevin, I just knew God had sent him to us. It was divine intervention.”

Christopher is made of strong stuff — he’s an Army veteran who has done two hitches in the Middle East — but he’s been reduced to tears — once when Courtney got crowns on her bottom teeth in May, and again when she received upper crowns in mid-October. Both procedures were performed by Moore, who is now in the general practice residency program at the CU Dental School, and overseen by Mediavilla and David Gozalo, DDS, a prosthodontist who specializes in replacement and dental implants.

Always smiling

Kevin Moore, DDS, places crowns
Kevin Moore, DDS, places a customized crowns — multiple-teeth bridges — in Courtney’s mouth during the Oct. 19 procedure.

After the latest crowns were placed, Courtney sat still in the dental chair, staring out the window and letting the profound change in her appearance soak in. The teen may have reflected on how, about two years ago, when a different Denver dentist suggested implants, at an out-of-pocket cost of $35,000 (the provider didn’t take her family’s insurance), she weighed the options and declined. Courtney knew that without sufficient upper-shelf bone, which was the case in her mouth, implants can fail.

Undoubtedly, the many disappointments she had endured over the years flooded her mind.

Christopher, meanwhile, stood nearby with reddened eyes. He could see the relief in his daughter’s expression. “We’ve noticed her whole demeanor has perked up incredibly,” he said. “She’s never let it bother her much, but now she’s persevered and she’s always smiling.”

Cutting-edge dentistry

model of Courtney's new smile
A model of Courtney’s new smile was created using a state-of-the-art software program and a 3D printer.

The story of this cutting-edge care in the CU Dental School includes a generous donation from Peebles Prosthetics, Inc., which supplies “removables” — dentures and arches — as well as “fixed appliances” — multiple-teeth bridges — to the CU Dental School. For Courtney’s upper mouth, she received a pair of three-unit bridges, which were fabricated by Peebles in consultation with the CU dentists. Company owner Rick Peebles watched the two fixed appliances — a donation valued at about $1,100 — transform Courtney’s smile at the Oct. 19 appointment.

“Kevin told us about Courtney’s case and asked us about (a donation),” Peebles said. “We thought it was a great cause, and we like what he does as both a person and a dentist. A lot of the kudos should go to Dr. Moore for being a champion for Courtney.”

Emotional and impactful

Moore credited Peebles and his firm, because without their donation the dental work might not have been financially feasible for Courtney’s family. Lonnie Johnson, DDS, senior associate dean of clinics and professional practice in the dental school, ensured completion of the project by covering costs not met by Peebles and the family.

Dental team and Courtney Caudill
Courtney Caudill, center, had a top-flight team working on her case: From left, Rick Mediavilla, DDS; David Gozalo, DDS; Rick Peebles, owner of Peebles Prosthetics; and Kevin Moore, DDS.

Moore had performed a similar procedure on an 86-year-old patient, but Courtney’s case was profoundly different. “This is definitely rewarding,” he said. “With a teenage girl, giving her a smile is pretty emotional and impactful.”

The final product of Courtney’s crowns started with the dental school’s Trios scanner, which makes an oral impression by scanning teeth digitally, allowing them to be designed to the patient’s specifications. A model of her new smile was also created — the analog way — using a state-of-the-art software program and a 3D printer. Lastly, both the model and the digital imaging were sent to Peebles Prosthetics, which fabricated Courtney’s crowns using technology that further improves the design and quality of dental restorations.

‘Loving my teeth’

“Restored” couldn’t be a more apropos term. The journey that has stretched over a dozen years, and taken the Caudills to multiple dentists, has at long last come to an end. Courtney finally has a complete and picture-perfect smile.

‘This is definitely rewarding. With a teenage girl, giving her a smile is pretty emotional and impactful.’ — Kevin Moore, DDS

Christopher said, “I’m just so absolutely grateful. I don’t think I’ll ever be able to repay everyone for everything.” He looks to the CU Dental School to perform a similar miracle on his 13-year-old son, who suffers from an even more severe case of ectodermal dysplasia. “One down, one to go,” he said.

Courtney, meanwhile, finds herself shedding the occasional tear of happiness. Mostly though, she’s flexing those smile muscles that she has restrained for so many years.

“I’m loving my teeth,” she said, after living with her new crowns for a couple weeks. “I don’t think I’ve ever smiled this much in my life!”

Editor’s note: Ryan Nisogi, senior director of digital marketing strategy, Office of Communications, contributed photography and video, while Matt Kaskavitch, director of digital strategy, contributed video packaging to this report. 

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Crisis management and recovery focus of Public Health Case Competition

A flash flood that left a community with contaminated water and facing other public health emergencies was the dilemma given to over a dozen teams at this year’s Rocky Mountain Region Public Health Case Competition.

The sixth annual event took place at the CU Anschutz Medical Campus last weekend. The event, hosted by the Colorado School of Public Health (ColoradoSPH), provides students from all the schools at CU Anschutz and selected disciplines from the CU Denver and CU Boulder campuses, an opportunity to work in collaborative teams to develop innovative solutions to a real-world health problem.

Second place team public health case competition
The second-place team in the competition, along with ColoradoSPH Dean Jonathan Samet: From left: Kathy Pang, Amber Vaughn, Ronald Truong and Hannah Parris.

Prizes for the top three teams were varying amounts of scholarship money up to $1,000. Two teams were selected as people’s choice recipients, with each member receiving $100 each.

“Public health stretches across all disciplines,” said Tonya Ewers, director of communications and alumni relations for the ColoradoSPH. “This is a great practice-learning opportunity for these students to learn to work together to solve health problems.”

The teams each spent 24 hours analyzing the case of the Many Forks flood disaster as well as creating a public health solution. They presented their solutions to a panel of judges.

third-place team public health case competition
The third-place team in the competition, along with Dean Jonathan Samet: From left: Jenny Yoo, Katherine Myers, Hannah Marinoff and Riley Stanton.

The teams came up with holistic, collaborative and far-reaching plans to address the emergency as well as increase the town’s capacity for full recovery. The winning team, whose plan was titled “Many Forks, One Community,” offered a multifaceted response that included the launch of a community-led resource center to act as both an emergency gathering site as well as a resource for mental health services, such as group counseling and social events. It also included neighborhood-tailored recovery plans and a disaster preparation initiative that set up a town-wide disaster alert system (flood siren) to reach residents who don’t own a mobile phone.

The second-place team focused on how the community, in the wake of a crisis, could best respond to the needs of children and youth, who make up 20 percent of the town’s population. The third-place team devised a solution focused on ensuring that community members have access, both immediately and for the long term, to clean drinking water.

Here are the results of the 2018 Rocky Mountain Regional Case Competition

First place ($1,000 scholarship each):

“Many Forks, One Community”

Team members and affiliations

  • Tamara Akers, ColoradoSPH
  • Robert Harr, ColoradoSPH
  • Jennifer Schulte, ColoradoSPH (Colorado State University home campus)
  • Jessica Stubblefield, ColoradoSPH

Second place, ($500 scholarship each)

“Learn, Empower, Action, Progress (LEAP): Many Forks’ Youth Program Helping Our Kids Leap Forward”

Team members and affiliations

  • Kathy Pang, ColoradoSPH
  • Ronald Truong, School of Medicine
  • Hannah Parris, ColoradoSPH
  • Amber Vaughn, ColoradoSPH

Third place ($250 scholarship each)

“Many Forks Clean WARS: Water. Access. Restoration. Sustainability.”

Team members and affiliations

Two teams received People’s Choice Awards ($100 scholarship each)

“Guidelines for Flood Disasters: A Plan for Prevention and What to Expect in the Moment of Crisis”

Team members and affiliations

  • Abdulrahman Alyamani, ColoradoSPH
  • Ann Giesenhagen, ColoradoSPH
  • Alexis Krause, ColoradoSPH
  • Simona Senovaityte, Skaggs School of Pharmacy and Pharmaceutical Sciences

“Flying Toward Better Solutions: Drones as the Future of Emergency Response”

Team members and affiliations

  • Sara Azimi, Skaggs School of Pharmacy and Pharmaceutical Sciences
  • Yuli Chen, ColoradoSPH
  • Leila Diab, ColoradoSPH
  • Elizabeth Kim, ColoradoSPH (CSU home campus)
  • William Windsor, ColoradoSPH

Editor’s note: Katie Brumfield, career services and practicum specialist, Colorado School of Public Health, contributed to this report.

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Researchers find common genetic link in lung ailments

An international research team led by members of the University of Colorado School of Medicine faculty has identified a genetic connection between rheumatoid arthritis-associated interstitial lung disease and idiopathic pulmonary fibrosis.

The findings are published in the current issue of the New England Journal of Medicine.

Joyce Lee, MD, associate professor in the Department of Medicine
Joyce Lee, MD, associate professor, Department of Medicine

“By uncovering this link in the genetic background between these conditions, we now know that rheumatoid arthritis associated-interstitial lung disease and idiopathic pulmonary fibrosis have similar causes and may prove to have similar treatments,” said first author Joyce Lee, MD, Associate Professor in the Department of Medicine.

Rheumatoid arthritis (RA) is an inflammatory and autoimmune disease that affects about 1 percent of the population. While it is commonly associated with progressive impairment, systemic complications and increased mortality, up to 60 percent of the patients with rheumatoid arthritis suffer from pulmonary conditions known as interstitial lung disease, which causes progressive scarring of lung tissue, lung impairment, and death.  Interstitial lung disease is a leading cause of morbidity and mortality in patients with RA.

Idiopathic pulmonary fibrosis (IPF) is the most common type of progressive lung fibrosis. Over time, the scarring gets worse and it becomes hard to take in a deep breath and the lungs cannot take in enough oxygen.  The average length of survival of patients with IPF is three to five years, and a critical unmet need is to identify patients before the lung is scarred irreversibly.

The investigators on the current study in the New England Journal hypothesized that there might be a common element in the genetics of RA-interstitial lung disease and IPF, so they studied a diverse population of patients with RA, including those who had and those who did not have interstitial lung disease. The study collected cases of patients from France, China, Greece, Japan, Mexico, the Netherlands and the United States. The number of study subjects totaled more than 6,000.

The investigators found that a specific genetic characteristic, known as the MUC5B promoter variant rs35705950, which results in a marked increase production of mucus in the lung and is the strongest genetic risk factor for idiopathic pulmonary fibrosis, is also the strongest risk factor for RA-interstitial lung disease.

“These findings will enable us to identify those with rheumatoid arthritis who are at risk of pulmonary fibrosis and design interventions to potentially prevent patients with rheumatoid arthritis from developing progressive pulmonary fibrosis,” said senior and corresponding author David Schwartz, MD, Chair of the Department of Medicine at the CU School of Medicine.

The research in the study was supported by grants from Société Française de Rhumatologie; the Fondation Arthritis Recherche & Rhumatismes; DHU FIRE; the National Heart, Lung and Blood Institute; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (K23-AR051046); U.S. Department of Defense; the National Center for Advancing Translational Science; the Nina Ireland Program for Lung Health; Intramural Research Programs of the National Institute on Aging (NIA), part of the National Institutes of Health, Department of Health and Human Services.

Guest contributor: CU School of Medicine

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Study: Home care for knee replacement patients aids in recovery

A team of physical therapy researchers from the University of Colorado School of Medicine have conducted one of the first full-scale studies to assess the effectiveness of in-home physical therapy care for patients who have had knee replacement surgery.

The study analyzes Medicare home health care claims for patients treated with total knee arthroplasty in 2012 who received home health care services for their post-operation rehabilitation.

Generally, patients who received more physical therapy visits at home were able to recover better from the surgery. The optimal number of home-care visits by physical therapists was six to nine. Researchers also found that patients living in a rural area or having other complex medical conditions were associated with fewer, not more, home health care visits.

Jason Falvey, PhD
Jason Falvey, PhD, research physical therapist, CU School of Medicine’s Physical Therapy Program

“This study is important because some people have recommended saving money by curtailing the use of physical therapists for in-home care for patients who receive total knee arthroplasty,” said lead author Jason R. Falvey, PhD, research physical therapist with the CU School of Medicine’s Physical Therapy Program. “But those recommendations are based on a lack of research. Our study shows that patients recover better when they receive appropriate care.”

Based on a review of 5,967 Medicare beneficiaries, those who received fewer than five home health care visits by a physical therapist were associated with greater difficulty returning to activities of daily living. The survey of cases covered urban and rural locations across the United States. About 68 percent of the patients were women. Eighty-nine percent were Caucasian.

“This is one of the most commonly performed surgeries in the United States,” Falvey said, noting that more than 700,000 total knee replacements are performed each year. The number of cases is expected to increase to 3.5 million annually by 2030.

The cost of the procedure averages $23,000 to $27,000, according to the Centers for Medicare & Medicaid Services (CMS), with post-acute care responsible for a substantial portion of that cost. CMS has introduced a bundle payment model that combines the costs of hospital, post-acute-care and outpatient costs associated with total joint replacement. The bundles have the effect of incentivizing the discharge of patients from hospital to home.

“Our study may help care providers prescribe more optimal dosages of at-home physical therapy for these patients who are discharged,” said Falvey. “Low users of at-home physical therapy often had less social support and more complex medical conditions. Patients who don’t get the home health care visits they need can end up needing future hospitalization or institutionalization. The risks of not providing the appropriate level home health care may result in higher overall healthcare costs in the long term.”

The results of the study are published in the current issue of the Journal of Bone and Joint Surgery. Funding to support the study came from a scholarship from the Foundation for Physical Therapy and from grants from the National Institute on Aging, the American Physical Therapy Association Home Health Section, the Foundation for Physical Therapy, and the Center on Health Services Training and Research. Statistical resources were provided by the VA informatics and Computing Infrastructure.

Falvey’s academic appointment is in the School of Medicine’s Department of Physical Medicine and Rehabilitation. There are seven authors on the paper, including senior author Jennifer E. Stevens-Lapsley, PhD, professor in the CU Physical Therapy Program, director of the Rehabilitation Science PhD Program, and member of the Veterans Affairs Geriatric Research Education and Clinical Center.

Guest contributor: CU School of Medicine

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Our experts weigh in on acute flaccid myelitis cases

Several University of Colorado School of Medicine experts on acute flaccid myelitis (AFM) have been interviewed in recent news reports about an increase in AFM cases nationwide, including in Colorado.

AFM is a devastating polio-like virus that strikes children, causing weakness in the limbs and other muscle groups. In the most severe cases it can cause respiratory failure.

This week, outlets including CNN, U.S. News & World Report, Science and Wyoming Public Media quoted Samuel Dominguez, MD, PhD, associate professor, pediatrics-infectious diseases; Kenneth Tyler, MD, Louise Baum Endowed Professor and Chair of the Department of Neurology; and Kevin Messacar, MD, assistant professor, pediatrics-pediatric hospital medicine.

According to the U.S. Centers for Disease Control and Prevention, there have been 38 confirmed cases of AFM in 16 states as of Sept. 30. The numbers of cases appear to be climbing, with several additional cases being reported in Colorado, Illinois, Washington and Minnesota.

Here are a few of the recent stories:

Wyoming Public Media, Oct. 17

Colorado is home to mysterious neurological disease, and researchers tracking it

U.S. News & World Report, Oct. 16

CDC warns of polio-like virus striking more U.S. kids

Science, Oct. 16

United States reports new cases of puzzling, polio-like disease that strikes children

CNN, Oct. 13

Young survivor of rare polio-like illness now thriving

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Opioid education day focuses on solutions to crisis

The Physical Therapy Program in the University of Colorado School of Medicine recently held an educational day titled, “Pain & Healthcare in Society: Changing Attitudes, Behaviors and Health Systems to Address the Opioid Crisis.” The event drew 250 students, alumni and community members from various disciplines.

The event was focused on improving pain management through a better knowledge of systems-level barriers to achieving effective collaboration, a deeper understanding of pain management across health care disciplines and examples of innovative approaches to pain management and collaboration.

Opioid educational day
On stage from left, Anthony Delitto, PT, PhD, of the University of Pittsburgh, and Robert Saper, MD, MPH, of Boston University, address the audience at the recent opioid educational day on campus.

“The scope of the opioid crisis and the challenges of caring for people with pain are sometimes overwhelming,” noted Andrew Kittleson, PT, DPT, PhD, core faculty, Physical Therapy Program. “This event showcased so many brilliant and compassionate people — both nationally and right here in our community — who are working to make a difference.”

CU welcomed speakers from other areas of the University, including Venu Akuthota, MD, chair of the Department of Physical Medicine & Rehabilitation; Rob Valuck, PhD, of  the Skaggs School of Pharmacy and Pharmaceutical Sciences; and Daniel Goldberg, JD, PhD, of the Center for Bioethics and Humanities. Participants from other institutions included Colorado Rep. Chris Kennedy (D-Denver) and national thought leaders Anthony Delitto, PT, PhD, FAPTA, dean of rehabilitation science, the University of Pittsburgh; Alice Bell, PT, DPT, of the American Physical Therapy Association; and Robert Saper, MD, MPH, from Boston University.

Areas of discussion were focused on the history and scope of the opioid crisis, barriers and opportunities for inter-professional collaboration and examples of innovative solutions and ideas for managing pain holistically, equitably and effectively.

Not just a day of presentations, a core group of professionals met following the event to brainstorm action items for the Physical Therapy Program, UCHealth and the CU Anschutz campus community.

Event sponsors were RehabVisions, Aegis Therapies and New Health.

Guest contributor: Natalie Ianniciello, communications & relations specialist, Physical Therapy Program.

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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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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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Video shines light on an often hushed disease

In recognition of Inflammatory Bowel Disease (IBD) awareness month, students Diana Ir, Hailey Hyde and Jacqueline Garner in the Colorado School of Public Health created a public health awareness video about the disease. IBD, which includes Crohn’s disease and ulcerative colitis, currently affects about 1.6 million Americans.

Featuring Brett Forrest, a local reporter, and his personal experiences with IBD, the group hopes to shine a light on a stigmatized disease.

“Medications, surgery and lifestyle changes can have a life-changing effect for those who are suffering from IBD,” said Ir of the importance of spreading awareness. “Our message and goal is to encourage individuals to contact their physicians if they believe they may have IBD or symptoms of IBD. Through this video, we hope to reduce stigmas associated with the disease.”

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