Departments

The Yale Avascular Necrosis & Osteonecrosis program focuses on maintaining joint function in patients with avascular necrosis (AVN), a condition in which bone tissue dies as a result of a temporary or permanent loss of blood supply to the bone. Our patients receive coordinated care across a spectrum of treatments, including 3D surgical planning, regenerative medicine, osteoinductive adjuvants, hyperbaric oxygen treatments, and stem cell therapies. The goal is to provide the best opportunity for patients to maintain their native joints, as well as continuity, if they eventually require total joint replacement. As a leader in AVN treatments, our innovative program merges evidence-based regenerative medicine with novel surgical techniques. AVN and osteonecrosis can be medically complex. Coordination of services is necessary to understand the cause of the disease, evaluate the extent of the necrosis, and prevent further occurrences. Our program directly works with Yale School of Medicine’s Hematology, Oncology, Infectious Disease, Pathology, Radiology, and Alcohol Cessation services to help streamline care for patients and their families. We offer the following treatments for AVN- and osteonecrosis-related conditions: Hip and knee Lesion treatment: We offer a minimally invasive 3D personalized surgery to address AVN of the hip joint. This procedure, developed at Yale School of Medicine by a team of biomedical engineers, aims to improve patient outcomes and reduce the need for total joint replacement. Shoulder lesion treatment: We treat AVN-related shoulder conditions, with the goal of preserving the shoulder joint whenever possible. Our physicians are experts at both traditional and reverse total shoulder replacement surgery as well as minimally invasive techniques to allow patients to return to their normal activities as soon as possible. Foot and Ankle lesion treatment: Our specialists have developed treatment options for AVN of the foot and ankle joints that range from traditional, conservative approaches, such as generic or custom braces, to surgical management, including joint-preserving or -sacrificing procedures. The treatment options are tailored to each patient, depending on the stage and extent of their necrosis. Hand and Elbow lesion treatment: Our Hand & Upper Extremity experts offer treatment for Keinbock’s disease, Hegemann's disease, and Panner's disease. These include custom braces, joint-preserving procedures, and surgical treatments. Our specialists design treatment plans based on each patient’s stage of necrosis to improve functionality and quality of life. Hyperbaric oxygen treatment: Our specialists are recognized experts in the use of hyberbaric oxygen for the treatment of AVN with the femoral head. Our team is able to create individualized treatment plans for patients seeking this procedure. Stem cell treatment: During the procedure, a patient’s bone marrow is harvested, and stem cel

At the Yale Chronic Obstructive Pulmonary Disease (COPD) program, our highly trained and skilled specialists provide comprehensive and multidisciplinary treatment to patients with COPD, an inflammatory lung disease that obstructs airflow from the lungs, making it increasingly difficult to breathe. We care for individuals: With emphysema With chronic bronchitis With COPD with associated bronchiectasis With asthma/COPD overlap With COPD/obstructive sleep apnea overlap With combined emphysema and pulmonary fibrosis (in conjunction with our interstitial lung disease team) Who experience frequent disease exacerbations and/or hospitalizations Under consideration for surgical therapies for emphysema (such as bullectomy, lung volume reduction surgery, and lung transplantation) Who need a pre-operative respiratory assessment for other forms of surgery With a suspected genetic basis for their disease (such as alpha-1-antitrypsin deficiency) With chronic respiratory failure related to COPD Patients suffering from COPD may experience flare-ups that require hospitalization, leaving them feeling weaker. Our physicians tailor treatment plans to help them manage their COPD so that they can live life to the fullest. Our physicians are also exploring therapies and medications that can help patients in the future. Whether patients have mild symptoms, need rehabilitation, or assisted ventilation, we can help. We also offer lung volume reduction surgery or lung transplantation to eligible patients. The Yale COPD program is staffed by two pulmonologists, a pulmonary specialist nurse practitioner, nurses, and respiratory therapists with special expertise in COPD. We arrange visits for patients with other specialist providers as needed, including cardiologists, thoracic surgeons, thoracic oncologists, palliative care specialists, otolaryngologists, allergists/immunologists, sleep medicine specialists, and health psychologists. The Yale COPD Program receives referrals for patients with difficult-to-control symptoms and/or frequent acute disease exacerbations, those who do not respond well to routine medical therapies, those with co-occurring complex medical conditions or overlap syndromes (as detailed above), those who may require surgical therapies, and those who have advanced disease with chronic respiratory failure. Providers in the COPD Program perform comprehensive evaluations and develop individualized care plans for all patients, with the goal of partnering closely with each patient’s primary care and other specialist providers. In addition, opportunities to participate in clinical research trials of new therapies in COPD are often available through our collaboration with the Yale Center for Asthma and Airways Disease (203-500-3808).

At Yale Medicine, our pulmonary, critical care, and sleep medicine physicians focus on your respiratory health. We have a team of specialists to diagnose, treat, and manage respiratory conditions that affect your lungs and breathing. From asthma to complex lung diseases, our goal is to help you breathe easier. Our doctors are board-certified in internal medicine, pulmonary medicine, critical care, and sleep medicine. These expert physicians work closely with specialists in cardiology, diagnostic radiology, and pathology to provide you with comprehensive care for your respiratory condition. Office visits take place at the Winchester Center for Lung Disease in North Haven, Connecticut. Our sleep specialists treat most types of sleep disorders and see patients at our sleep centers at 3 locations in New Haven County. Specialized care is offered in the following areas: Adult cystic fibrosis Asthma and airway diseases Bronchiectasis and chronic pulmonary infections Cardiorespiratory exercise testing Chronic obstructive pulmonary disease (COPD) Clinical research in a wide range of lung diseases Interstitial lung disease Lung cancer screening and pulmonary nodule evaluation Medical intensive care unit for pulmonary conditions Multidisciplinary sleep care Pulmonary embolism Pulmonary function laboratory Pulmonary vascular disease Sleep apnea and other sleep disorders Thoracic interventional pulmonary embolism Thoracic oncology Tuberculosis

Covering every aspect of health care for adults, Internal Medicine is the largest department in the Yale School of Medicine, and the largest clinical service at Yale New Haven Hospital. We provide comprehensive and specialized services in all areas in a variety of outpatient settings as well as the Veterans Affairs (VA) Connecticut Health Care System campus in West Haven. Our culture of collaboration and research gives patients access to expert opinions from nearly 1,000 doctors, as well as opportunities to get tomorrow’s health care today through more than 100 clinical trials. Most importantly, we attend to our diverse community of patients with compassionate, thorough care. Specialized care is offered in the following areas: Allergy & clinical immunology Cardiovascular medicine Digestive diseases Endocrinology General internal medicine Geriatrics Hematology Infectious diseases Medical oncology Occupational health & environmental medicine Nephrology Pulmonology, critical care & sleep medicine Rheumatology International reputation for work in understanding function, independence, and quality of life in older persons Key research breakthroughs of the past decade that include the development of a protective Lyme bacillus disease vaccine, exploration of the underlying causes of allergic disease, and the discovery of novel inherited immunological diseases Largest interventional cardiology program in Connecticut Major referral center for patients with type 1 and type 2 diabetes, as well as other metabolic conditions Nationally ranked program in kidney diseases and the largest kidney transplant program in New England, with multidisciplinary care clinics One of the largest peripheral vascular programs in the country, with leadership and participation in multiple new percutaneous device trials Once of only a few motility centers in Connecticut to provide all motility procedures and services Unique medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S.

The physicians in our General Internal Medicine section are national leaders in their fields, and provide dedicated, comprehensive patient care in both inpatient and outpatient settings at several sites across Connecticut: At Yale Internal Medicine Associates in New Haven, we provide state-of-the-art general medical care for adults. At the New Haven Primary Care Consortium (NHPCC), located at 150 Sargent Drive in New Haven, CT, we provide comprehensive primary care, as well as specialized programs in traveling health, rheumatology, dermatology, podiatry, mental health, and addiction medicine. The Occupational and Environmental Medicine clinic focuses on the diagnosis, treatment, and prevention of diseases due to chemical, biological, and physical hazards in the workplace and environment. The Primary Care Center located at the VA Connecticut Healthcare System in West Haven is also a major clinical and teaching site, and provides specialized Women’s Health and stroke care. The Medicine-Pediatric Clinic is located at St. Mary’s Hospital, 133 Scovill Street, in Waterbury. The Yale Addiction Medicine Consult Services provide hospital-based addiction assessment and treatment to patients who are hospitalized at Yale New Haven Hospital. Specialized programs in dermatology, mental health, rheumatology, and health care for travelers Medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S. Specialized program for the treatment of substance use disorders We are also involved in community outreach and service programs that expand the reach of our research and clinical programs. Our research programs in such areas as substance abuse, occupational medicine, and chronic disease management provide our patients in the community with a variety of opportunities to access care and improve their health. Many of our faculty members are graduates of the Robert Wood Johnson Clinical Scholars Program.

Obesity is a common problem that can cause fatigue, diabetes, fatty liver disease, and sleep problems, and raise the risk of many cancers. It reduces energy, and can take the pleasure out of many aspects of life. Extra weight also places stress on vital organs, including the heart, liver, and kidneys, as well as joints and the reproductive system. Although organs can work under this extra stress for a number of years, eventually they are likely to fail. Most organs lose about 80% of their capacity before symptoms are evident, and by that time, it is often too late to return them to normal function. The conditions associated with obesity are: Cancer Cardiovascular disease Diabetes Liver disease Obstructive sleep apnea Losing weight can help improve and sometimes cure many of these conditions, as well as fertility issues. Losing weight can also lead to a life with fewer medications, lower health expenses, and overall greater enjoyment. At the Yale Metabolic Health and Weight Loss Program, we offer all nonsurgical weight-loss interventions in one location. Our philosophy is to focus on health, rather than specific disease, and to tailor our care to each patient’s specific needs and goals. The first step in our care is to determine weight-loss goals. Patients may need to lose 5 to 10% of their body weight to help in the treatment of a disease. We will help patients choose from interventions that include intensive meal-replacement programs, a range of medications, or endoscopic (nonsurgical procedure) options. Sometimes, there are additional medical necessities, such as an upcoming surgery, that require a specific weight-loss goal. We will explain the advantages and disadvantages of the various options, but the choice will depend primarily on what feels right to the patient. We provide therapies under the medical supervision of obesity experts. Patients can choose from the full range of tested interventions: Lifestyle changes: Nutrition counseling goes hand-in-hand with medical management of metabolic health. Care will include a personal visit with a registered dietitian with advanced training in weight management. OPTIFAST® program: OPTIFAST® is a medically monitored weight management program that allows patients, under the supervision of a physician, to consume a low-calorie diet and receive comprehensive lifestyle education. The OPTIFAST program provides full meal replacement for 12 weeks and transitions to self-prepared “everyday” meals in conjunction with comprehensive patient education and support, to help patients achieve long-term weight loss. Medications: All medications are used as part of a comprehensive program that includes proper nutrition and a healthy lifestyle. Contrave® is a single pill that contains two medications (naltrexone and bupropion) and is taken twice a day. It will reduce appetite and can produce weight loss in the 5 to 10% range. Phentermine is taken once in the morning, and is prescribed for a few weeks.

Pulmonary hypertension is high blood pressure in the arteries of the lungs, which makes the heart work harder and can lead to heart failure. If it is diagnosed properly and quickly, we have effective therapies that can slow the progression of the disease and possibly reverse some of the damage to the lungs and heart. Our doctors have extensive experience dealing with pulmonary hypertension, and we treat adults and children over the age of 12. We are fully committed to defeating pulmonary hypertension and caring for the disease regardless of its cause, which may include pulmonary arterial hypertension (PAH), pulmonary venous hypertension, or chronic thromboembolic pulmonary hypertension, among other causes. We are a national Pulmonary Hypertension Association-accredited Center of Comprehensive Care and Center of Excellence. As the only accredited pulmonary hypertension program in the state, we offer patient- and family-centered care to patients from throughout the Northeast. Our doctors, nurses, coordinators, and researchers are specifically trained and experienced at managing and treating patients with pulmonary hypertension. Patients will have access to other highly skilled specialists, including pulmonologists, cardiologists, rheumatologists, and gastroenterologists. We work closely with members of the Adult Congenital Heart Disease Program, General and Advanced Heart Failure Program, Hereditary Hemorrhagic Telangiectasia Program, and the Liver Transplant Program. We also work in concert with specialists in connective tissue disease such as scleroderma (we are a Scleroderma Center as designated by the Scleroderma Foundation), lupus, Sjogren’s disease, myositis, and dermatomyositis—pulmonary hypertension can be a serious complication of these conditions. Outpatient specialized clinic Designated floors in the hospital for pulmonary hypertension patients State-of-the-art heart catheterization laboratory Highly trained and qualified cardiologists who read echocardiograms focusing on the right side of the heart, which is a key clinical factor in patients with pulmonary hypertension Physicians, nurses, pharmacists, and quality-tested systems in place that provide effective complex therapies to patients in a safe environment.

We offer state-of-the-art evaluation and treatment for patients with a wide range of lung disorders, including asthma, chronic obstructive pulmonary disease (COPD), emphysema, lung cancer, and undiagnosed or general respiratory problems. Many patients come to us with work-related pulmonary disease or with sleep disorders. They might not have a diagnosis, but have symptoms such as persistent or nagging cough, or shortness of breath at rest or with exertion. Our skilled, experienced specialists can diagnose and take care of difficult or unusual problems. The history of our center dates back more than a century, when it was set up through a bequest from Sarah Winchester in memory of her husband, William Wirt Winchester, and their young daughter, both of whom succumbed to tuberculosis. This gift resulted in the establishment of the original Winchester Hospital in West Haven, dedicated to the care of patients with tuberculosis. Today, the Winchester Center for Lung Disease at Yale New Haven Hospital is committed to the integration of cutting-edge patient care, education, and research across the full spectrum of pulmonary disorders. Our specialists are faculty members of the Yale School of Medicine Section of Pulmonary, Critical Care and Sleep Medicine, with national and international expertise in treating even the most challenging lung conditions. The center is continually evolving to meet changing needs. Most recently, in response to COVID-19, the center developed a Post-COVID-19 Recovery Program , which offers pulmonary-focused, multidisciplinary evaluation and care for patients recovering from COVID-19. In addition to our comprehensive general pulmonary practice, we offer the specialty center programs listed below. For more information about any of these programs, call the Winchester Center for Lung Disease at 203-495-2410. Adult Cystic Fibrosis Center Cystic fibrosis (CF) was previously thought of as a childhood disease, but is now considered a chronic disease because more adults in the U.S. are living longer with CF and maintaining good quality of life. The Adult CF Program provides team-based care for adults with CF on both an inpatient and outpatient basis. Our comprehensive program includes diagnosis, treatment, and counseling for sinus, pulmonary, gastrointestinal, liver, nutritional, endocrine, mental health, and reproductive issues. Chronic Obstructive Pulmonary Disease (COPD) Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease that blocks airflow from the lungs and makes it difficult to breathe. The COPD Program (including emphysema, chronic bronchitis, and asthma/COPD overlap syndrome) provides a personalized treatment plan for each patient to help manage their COPD. Whether patients have mild symptoms, need rehabilitation, or require assisted ventilation, we can help. Chronic Pulmonary Infection Research and Treatment (CPIRT) This program is focused on the leading innovative care and research for acute

The Center for Thoracic Cancers at Smilow Cancer Hospital consists of a multidisciplinary team of experts dedicated to providing evaluation of and treatment for patients with a thoracic malignancy, including lung cancer, esophageal cancer, thymoma, or chest wall tumors. Patients in Connecticut and beyond have access to nationally recognized expert clinicians, who provide an organized, collaborative approach to cancer care, as well as the latest technologies and treatments. Our team consists of a collaboration of specialty physicians, including medical oncology, radiation oncology, thoracic surgery, pulmonary medicine, digestive diseases, pathology, diagnostic imaging, and nursing. In addition to our expert clinicians, patients also receive comprehensive care to help with the physical, emotional, and psychological issues that are part of confronting cancer. Patients also benefit from the attention of the team's care coordinators, who make management of even the most detailed multidisciplinary treatment plan less complicated. Our team is active in clinical research, and focuses on developing advances to care in areas of thoracic oncology where the standard treatment needs improvement and where the optimal treatment approach remains unclear. To provide the best care, most of our patients are enrolled in a clinical trial where they can receive innovative therapy for their advanced disease, including immunotherapy, which was first used in clinical trials at Smilow Cancer Hospital. The Center for Thoracic Cancers offers second opinions that are easy, convenient, and all done remotely. Call (203) 200-LUNG for more information and learn how to schedule a second opinion appointment with one of our providers. Medical Oncology Our medical oncologists are nationally recognized for their leadership and expertise in lung cancer treatment and research, and are dedicated to offering personalized treatment options. Biomarker testing is often performed on the tumor to look for specific mutations that can be targeted by medication. There are currently FDA-approved lung cancer treatments for tumors showing abnormalities in EGFR, KRAS, ALK, ROS1, BRAF V600E, MET, RET , and NTRK genes. Recent studies conducted at Yale have led to FDA approval of drugs for the treatment of lung cancer, such as the immunotherapy drug Tecentriq (atezolizumab), which has been proven to improve patient survival for newly diagnosed NSCLC. This drug is designed to block PD-L1, a protein that was discovered by scientists at Yale and that has been instrumental in improving survival for lung cancer patients. Another FDA-approved drug, osimertinib, which stemmed from Yale Cancer Center and Smilow Cancer Hospital researchers, was approved for the treatment of adults with early-stage NSCLC with EGFR gene mutations. Surgery Many patients in need of surgery are referred for a minimally invasive surgery known as a video-assisted thoracoscopi

Hereditary Hemorrhagic Telangiectasia (HHT) is a genetic disorder that causes some blood vessels to develop improperly. Yale radiologists are developing guidelines for the evaluation of blood vessel malformations in the lungs (pulmonary arteriovenous malformations) in children with HHT. This innovative approach will replace CT scans, avoiding the successive and often unnecessary radiation exposure for children who have no symptoms. We are also developing guidelines for the diagnosis and treatment of malformed blood vessels in the brain (cerebral arteriovenous malformations), and aim to have these guidelines become part of the standard of care. Our physicians are also examining potential liver transplant guidelines for patients with HHT in heart failure. We are continuously analyzing existing data and conducting evidence-based research to develop new treatment methods that can impact the lives of patients in our care.

Our highly skilled cardiologists expertly treat and diagnose heart failure—a chronic, progressive condition in which the heart muscle can’t pump enough blood to meet the body's needs. In addition to caring for cardiac patients at Yale New Haven Hospital, we provide treatment to the rapidly growing number of outpatients living with heart failure in the community. We treat each patient with a personalized plan, carefully monitoring medications on an ongoing basis while minding other issues that affect cardiac health. We also educate patients and their families about lifestyle changes, prescribe and oversee exercise rehabilitation programs, and facilitate communication between the many professionals involved in outpatient care. Our physicians work as part of a multidisciplinary team to offer patients comprehensive care with the goal of prolonging their life and improving its quality. Treatment options may include medications, short- or long-term mechanical support, or heart transplant. Before treatment begins, we perform cardiac diagnostic procedures, such as stress tests, catheterization, and biopsies. We collaborate with cardiac-trained radiologists to provide noninvasive imaging studies including positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and 2D and 3D electrocardiography. At the Center for Advanced Heart Failure at Yale New Haven Hospital, we treat the full continuum of heart failure and offer a variety of medical and surgical treatment options. The center cares for patients with an LVAD (left ventricular assist device), a battery-operated mechanical pump that is surgically implanted and helps maintain the heart’s pumping ability when it can’t work effectively on its own. This is the only long-term mechanical circulatory support for patients otherwise ineligible for heart transplant. Our surgeons regularly perform heart transplants and LVAD implantations, and our heart transplant survival and post-LVAD rates are among the best in the region.

The Advanced Heart failure Program is a rapidly expanding service at the front lines of treating heart failure. Launched in 1988, the program builds upon decades of experience treating failing hearts. In 2019, we performed 49 heart transplants, putting us among the top centers of the country. Our left ventricular assist device program treats more cases than any other program in the Northeast. It provides heart pumps for patients who need support while they are waiting for a donor heart or who are ineligible for a transplant and need another permanent solution. Heart transplants are the gold standard treatment for patients with end-stage heart failure. But many face a long, difficult wait for a donor heart, and some don’t survive. Yale Medicine is one of a handful of centers in the country to push existing boundaries in heart transplant by aggressively seeking out donor hearts other centers turn down even though they may be suitable for some patients. This process, using what’s called “donation after circulatory death” (DCD) organs, is helping more of our patients get heart transplants sooner. What’s more, our one-year survival rates for heart transplants—93%—are better than the national average. Multi-organ transplants People who live with heart failure have a high likelihood of also having kidney dysfunction from a variety of causes, and this can be a limiting factor in being able to get a heart transplant. For these patients, our heart specialists collaborate with Yale Medicine’s world-class abdominal transplant team and have achieved a robust volume and successful track record in performing heart-kidney transplants. Pioneers in LVAD Yale Medicine helped to pioneer the use of left ventricular assist devices (LVADs), providing patients whose hearts are too weak to function on their own with implantable devices that can pump blood for them. Yale Medicine is one of the leaders in the Northeast in volume and outcomes with LVADs and is certified by the Joint Commission, the nation’s predominant standard-setting and accrediting body in health care. Each one of our patients is treated by a team that includes cardiologists, transplant surgeons, infectious disease specialists, nephrologists, critical care doctors, nurses, pharmacists, social workers, nutritionists, and transplant coordinators, among others. Transplant doctors at Yale are national leaders in the field. Currently, the presidents of United Network for Organ Sharing (UNOS) and the American Society of Transplantation are at Yale, and they have helped to write the guidelines for how to treat patients after solid organ transplants as the field advances. Outcomes above average Patients whose future once seemed difficult have survived for decades after a heart transplant or LVAD implant. The average one-year survival after a Yale Medicine heart transplant is 93%, which is higher than the national average. This is partly due to meticulous follow-up care that includes treatment with immunosu