Departments

Integrative medicine focuses on the whole person, is informed by evidence, and seeks to complement cancer therapy with appropriate therapeutic and lifestyle approaches to achieve optimal health and healing. Smilow Cancer Hospital’s Integrative Medicine Program provides evidence-based guidance about a wide range of complementary therapies commonly used by cancer patients and survivors. Our program aims to address the serious physical and emotional symptoms often experienced by patients before, during, and after cancer therapy. Our team has expertise in the practice and evaluation of complementary medicine, and can guide patients to make effective decisions on integrative therapies throughout their treatment program and beyond. We collaborate closely with each patient’s oncology care team to provide safe and effective care. Integrative medicine consultations Integrative medicine clinical consultations provide guidance for the safe use of dietary supplements/natural products, acupuncture, massage, meditation, and other complementary therapies. Massage Experienced and licensed therapists are trained in oncology massage, focusing on mitigating side effects from cancer and its treatment. Research has shown that massage therapy may reduce pain, promote relaxation, and boost mood in cancer patients. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Reiki Reiki is a complementary health approach in which practitioners place their hands lightly on or just above a person, with the goal of facilitating the person’s own healing response. This is to promote relaxation and produce stress-reduction effects. Appointments may be made by calling 203-200-6129. We accept debit or credit cards for payment. $70 per 60-minute appointment $40 per 30-minute appointment Nutrition Consultation The Integrative Medicine team offers guidance from our Oncology-certified Registered Dietitian to help individuals reach specific goals during or after completion of their treatment. Integrative Medicine Nutrition also supports the Supplement Clinic, where vitamins and supplements may be discussed to ensure they are safe and effective. They may also provide guidance on how to optimize their diet and obtain nutrients from foods whenever possible. Group Sessions Gentle yoga Group classes incorporate breathing techniques, physical postures, meditation, and relaxation, adapted to patient needs and limitations. T’ai Chi/Qigong T’ai Chi/Qigong is a centuries-old martial art and energy practice that uses gentle movement through postures to help promote mental focus, breathing, and relaxation. Students are taught the fundamentals of breath work, movement, and postures that develop into the T’ai-Chi form. The benefits are improved strength, mobility, alignment, pain control, and overall physical and mental rejuvenation. Meditation Meditation is a mind and body practice that has a long

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.

Quitting tobacco is difficult. In the tobacco treatment program at Smilow Cancer Hospital, we offer quitting strategies that combine counseling and drug treatment to help patients reduce nicotine withdrawal symptoms, cope with cravings, and break the cycle of tobacco use. Our program includes a multidisciplinary team of advanced nurse practitioners, psychologists, physicians, and research staff. We tailor treatment to each patient’s situation and tobacco use history. It is critical that cancer patients quit smoking after initial diagnosis. Quitting has been shown to improve response to cancer treatments such as therapeutic radiology, chemotherapy, and surgery; decrease the likelihood of second malignancies; and increase rates of survival. In general, the immediate health benefits of stopping tobacco use include: Increased blood oxygen levels Decreased heart rate, blood pressure, chance of heart attack The long-term benefits include: Increased lung health, fertility, and health of skin, teeth, and gums Decreased risk for lung and other kinds of cancer, as well as for heart disease The Tobacco Treatment Program operates on the principles of the U.S. Public Health Service Clinical Practice Guidelines. Our treatment strategies may include safe, effective FDA-approved medications such as nicotine replacement (patch, gum, lozenge, inhaler or nasal spray), bupropion (Zyban), and varenicline (Chantix). In addition, we provide individual counseling to help patients learn other ways to manage stress and improve mood, as well as develop new and healthy daily routines. Tobacco products are rapidly changing with the advent of new technology. E-cigarettes heat a liquid with nicotine and other chemicals in it. They are likely less harmful than cigarettes, but they are not harmless. The inhaled vapor contains toxic chemicals including cancer-causing agents and tiny particles that can enter the lungs. E-cigarettes also contain nicotine, which is what makes tobacco addictive. Any plans to use e-cigarettes to quit tobacco should also include a plan for weaning from e-cigarettes. Our program provides treatment for non-English speakers and includes Telehealth video visits. You can also get text support through SmokefreeTXT (Text YALE to 47848). We focus on helping our patients stop tobacco use–on their timeline–and gain specific skills to prevent or handle “slips” and maintain their long-term goals.

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

Our program, focused on adult primary care, is known for its excellence and emphasis on prevention and wellness. We efficiently manage potential medical problems as they arise, and collaborate with specialists when needed. Our practice includes internal medicine physicians, advanced nurse practitioners, a clinical psychologist, a social worker, registered-nurse patient care coordinators, licensed practical nurses, medical assistants, clerical office staff, and a practice supervisor. Our goal is to provide patients with the highest quality, personalized healthcare in the Patient-Centered Medical Home (PCMH) model of care. The PCMH model of care focuses on five areas: Building strong, collaborative health care teams that work together to meet the needs of patients Providing patient-centered care addressing the whole person, respecting patients’ values and preferences Coordinating comprehensive health care through clear communication among patients, families, caregivers, medical and behavioral health providers, hospitals, and other facilities Improving patients’ access to care, through such initiatives as expanded office hours and providing email access to electronic medical records Improving health care quality and standards by providing evidence-based care, patient and family education, and self-management support We would like to hear your direct feedback regarding your experience as a patient/family member of our clinic. Please visit the YIMA Patient/Family Comment Box to provide your feedback. Sign up for MyChart , our secure online patient portal, that gives you access to all of your Yale health information whenever you need it, wherever you may be.

We are internationally known for the care we provide for older people, helping them maintain their independence and quality of life, and manage multiple complex health conditions. Our team of geriatricians, geriatric psychiatrists, nurse case managers, patient care assistants, physical therapists, and neuropsychologists works closely with patients, their families, primary care providers, and other care providers to assess and develop a comprehensive plan for their care. Yale physicians have developed widely used interventions and support families facing such challenges as functional decline, disability, decision-making, and driving problems. The Connecticut Older Adult Collaboration for Health 4M (COACH 4M) grant provides multiple resources for older adults and their caregivers. The new video resource library offers a collection of brief videos for older adults and caregivers by experts in the field touching on a range of topics relating to health, well-being, caregiving, and maintaining creativity in aging. The COACH 4M project is pleased to provide an updated and expanded list of available resources and services for older adults in Connecticut, parts of southeastern New York and southwestern Rhode Island, and hopes you find the Geriatric Resource Directory a helpful guide to assist you in meeting the needs of older adults throughout the region. The new user-friendly version enables you to navigate the content through links in the table of contents and region list or using the Adobe bookmark feature. If you have any questions about the Resource Directory or have corrections to the content, please contact Dana Limone at dana.limone@yale.edu . View the Yale Geriatrics Resource Directory . Disclaimer: COACH 4M does not recommend or endorse the services provided by the organizations and individuals listed in the directory. Inpatient and outpatient geriatric consultations at the VA Connecticut Healthcare System in West Haven Syncope and Falls Assessment Program A prevention initiative for seniors at risk for falls, which has reduced falls and related injuries in many Connecticut The development of the Confusion Assessment Method, used internationally to diagnose delirium An Acute Care for the Elderly Unit at Yale New Haven Hospital, which aids with maintenance of function during acute hospitalization Outpatient consultations at the Dorothy Adler Geriatric Assessment Center Welcome to our video library! Here you will find a collection of brief videos for older adults and caregivers by experts in the field touching on a range of topics relating to health, well-being, caregiving, and maintaining creativity in aging. Each video is 15-30 minutes long and you can view the entire video or come back to it later. We are continuously expanding our offerings, so check in periodically to see new selections and let us know if there are topics you’d like to see addressed in the future. Contact eliza.kiwak@yale.edu with any questions or suggestions. This

We provide expert evaluation and treatment to adult and pediatric patients across the entire spectrum of allergic and immunologic disorders. Our board-certified specialists have specific clinical and scientific expertise, and are highly capable of providing comprehensive, thoughtful care from the most common to the rarest conditions. Our physicians meet weekly to discuss the management of complicated cases. Yale has been the site of several key research breakthroughs in the field, including the discovery of new inherited immunological diseases and the development of a crucial understanding of the underlying causes of allergies. We offer comprehensive evaluation of both common and rare allergy and immunology conditions, including allergy skin and blood testing, oral food challenges, drug allergy testing, and contact dermatitis patch testing. We offer allergic rhinitis and asthma care through recommendations for environmental controls and pharmacological controller therapy, and biologic therapies for severe asthma, chronic rhinosinusitis with nasal polyposis, as well as chronic urticaria and hereditary angioedema. We have expertise in management of immune deficiencies with intravenous and subcutaneous immunoglobulin replenishment. We also provide consultations for drug allergy desensitization when needed. Among the conditions we treat are: Allergic rhinoconjunctivitis (nasal and eye allergies) Asthma Chronic rhinosinusitis Food allergy Insect sting allergy Medication allergy Urticaria (hives) Angioedema Hereditary angioedema Atopic Dermatitis Contact Dermatitis Common variable immunodeficiency Secondary immune deficiencies Our service has specific strength in the management of inherited immune deficiencies, with a dedicated service that closely collaborates with experts across other specialties. Through a long-standing collaboration with Yale Laboratory Medicine, patients have access to a broad array of state-of-the-art immunological testing. Our care for children and adolescents includes treatment for: Asthma Our doctors collaborate with colleagues in the Pediatric Asthma Program to ensure that our patients receive comprehensive asthma care, including: Evaluation, diagnosis, and management of childhood asthma for patients with varying degrees of severity Testing for allergic precipitants Mechanical analysis of respiratory function Outreach care at patients' homes when needed Allergy Testing for allergens, desensitization, and immunotherapy Allergic rhinoconjunctivitis Drug allergy Food allergy Insect venom allergy Urticaria (hives), mastocytosis, anaphylaxis Hereditary angioedema Primary Immunodeficiency and Recurrent Infections Testing for antibody deficiency, cellular immunodeficiency, and complement disorders Treatment of primary immunodeficiency diseases, including intravenous immunoglobulin therapy Evaluation and management of recurrent infections, including fungal infections

The Yale Allergy & Immunology Contact Dermatitis Program serves patients affected by one of the most common causes of both personal and occupational allergic skin diseases: allergic contact dermatitis (ACD). ACD is an immune reaction that typically causes a rash in response to a substance in personal care products, medications, or even diet. Other potential allergic sources include occupational exposures and biomedical implants, all of which can result in chronic and sometimes debilitating symptoms. Identification of the offending allergen is key to the rapid diagnosis and resolution of ACD. Patch testing, in which allergens are placed in chambers held in place with adhesive patches on the back, is the gold standard for the diagnosis of ACD. The testing usually takes place during three visits over the course of a week after the initial consultation is completed. At the first visit, the patches are placed, and a second visit occurs 48 hours later for patch removal. Between 72-96 hours after the initial patch placement, a third visit occurs with a final diagnosis and a physician follow-up. Occasionally, a fourth visit is needed for delayed reads of certain allergens. We have the ability to test to multiple extended allergen series, medications, occupational and healthcare-specific substances, as well as some product brought in by patients. We take a personalized approach to the diagnosis and care of patients with contact dermatitis. From the initial consultation and testing phase, where potential allergens will be determined, a custom patch test prescription is prepared, and, ultimately, allergen identification/avoidance strategies and a treatment plan are formulated.

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 Yale Hearing & Balance Program provides comprehensive care for adult patients with a variety of audiologic and vestibular diagnoses, disorders, and symptoms. We employ a patient-centered health care approach, working as a team of neurotologists, audiologists, and associated healthcare providers to implement evidence-based practice and innovative care. Our multidisciplinary team provides services ranging from diagnostic hearing and/or vestibular evaluations to audiologic rehabilitation, including treatment with hearing aids, osseointegrated devices, and cochlear implants. We know how hearing and balance disorders can isolate and limit our patients, so our team of highly skilled practitioners uses the latest research and technology to not only improve our patient’s daily functionality, but also their overall well-being. Just as every patient is unique, every hearing loss is different and requires specific treatment and rehabilitation options. At our program, we specialize in a variety of treatment options for hearing loss and tinnitus. We perform audiometric evaluations to determine specific hearing sensitivity. Based on the results, we may recommend treatment with hearing aids, osseointegrated devices, or cochlear implants. We also provide in-depth counseling on strategies for effective communication skills. When indicated, we also provide treatment for tinnitus through information counseling and sound therapy. Read about Medicare and Medicaid coverage updates for cochlear implants . Read answers to frequently asked questions about over-the-counter hearing aids Research has shown that patients benefit significantly from a multidisciplinary team approach. Our team includes highly skilled surgeons, audiologists, hearing aid technicians, and support staff. We collaborate weekly to discuss new cases, technology updates, and pertinent topics in our ever-changing field.

Pediatric Otolaryngology is dedicated to ensuring the highest quality of care to children with ear, nose, and throat disorders. Our care team comprises board-certified pediatric otolaryngologists, nurses, audiologists, and speech/swallow pathologists, all specially trained to care for the development and special needs of children. We treat children from birth to 21 years of age with a wide range of ear, nose, and throat conditions. Working with the child and family, our physicians collaborate with other pediatric specialists such as pulmonologists, gastroenterologists, plastic surgeons, general surgeons, oncologists, and oral surgeons to develop an individualized care plan to offer the most effective treatment options. We understand that children need to feel safe during any testing procedure, including those of a routine nature. Our team is highly experienced in working with children. We take extra measures to ensure that the child’s needs are met. We make each child feel safe and comfortable and offer toys for younger children with shorter attention spans. Parents are allowed and encouraged to accompany their child during all testing procedures. Our team includes nationally recognized, board-certified pediatric ear, nose, and throat surgeons. They work with licensed audiologists and nurse practitioners to address each child’s needs as they treat and manage their ear, nose, and throat condition, hearing impairment, or hearing loss. Nurse Coordinators Our ENT Nurse Coordinators are available to support our coordination of all care needs from initial contact with first appointment and throughout the continuum of care. As the main point of contact, the nurse coordinators are the liaison between patient and physician, and coordinates multiple care needs from answering questions and concerns, to planning for diagnostic tests and procedures. Multidisciplinary programs We collaborate with primary care providers and other specialists to optimize each child’s health and provide a comprehensive network for his or her care. By working with multiple multidisciplinary programs, we can ensure that children are receiving the care they need per their specific treatment plan. The programs that we work closely with include: Pediatric Audiology : Our audiologists are pediatric-trained and dedicated to improving the lives of children with hearing difficulties. Highly experienced, they collaborate with otolaryngologists to provide appropriate options and interventions for hearing loss using the latest technology. These options include hearing aids, bone-anchored hearing aids, and cochlear implants. Aerodigestive Program : Pediatric specialists provide comprehensive care for airway breathing, feeding, and swallowing disorders caused by problems of the aerodigestive tract. The team comprises otolaryngologists, gastroenterologists, pulmonologists, nurses, nutritionists and speech language pathologists. Speech & Swallow Program : The Speech and Swallow Progr

The Pituitary Program is a destination center for the clinical management of pituitary, parasellar, and anterior skull base disease delivering state-of-the-art, multidisciplinary care. It is the referral center for the state of Connecticut for treatment of complex pituitary and sellar-parasellar pathology using the expertise of minimally invasive endoscopic skull base surgery jointly performed by neurosurgery and ENT. Patient cases are reviewed by a multidisciplinary pituitary tumor board, with intraoperative hormone monitoring, intraoperative MRI, and whole exome sequencing of tumors for potential genomic-based diagnosis and treatment. The Yale endocrinology team and other supporting subspecialties follow each patient during the hospitalization for uninterrupted endocrine care. We aim to maximize the quality of care and the ultimate outcome of each patient. To ensure the best care possible, we co-manage the pituitary disorder with each patient’s primary care physician, and actively seek second opinions, exploring dynamic testing and pituitary hormone replacement therapy options. Yale New Haven Hospital is a regional center for pituitary surgery, and our physicians have specific expertise in treating a variety of neuroendocrine diseases, including Cushing's disease and adult growth hormone deficiency syndrome. We also evaluate and treat reproductive disorders in collaboration with the sections of Reproductive Endocrinology and Infertility. Additionally, we work closely with colleagues in neurosurgery, surgical endocrinology, therapeutic radiology, and other departments to make sure patients benefit from our patient-centered, team-based approach. Combined with first-rate technology at Yale New Haven Hospital, the Yale Cancer Center and the Department of Neurosurgery’s Gamma Knife Center, the Pituitary Program is uniquely positioned to offer every diagnostic and treatment option available, including: Dynamic pituitary magnetic resonance imaging (MRI), an enhanced diagnostic imaging technique Inferior petrosal sinus sampling to sample hormones from the veins that drain the pituitary gland 3-D conformal radiotherapy to better target tumors Intensity-modulated radiation therapy, an advanced high-precision technique Transphenoidal surgery performed through the nose and sphenoid sinus Gamma Knife surgery (stereotactic radiosurgery) performed at the Gamma Knife Center, the only dedicated Gamma Knife facility in Connecticut. At Yale New Haven Children's Hospital, our longstanding pediatric endocrinology clinic provides the same services and excellence of care that adults receive.