3-D Patient-Specific Surgical Correction ProgramThe orthopaedic surgery team is dedicated to improving function in patients of all ages who have been injured, developed a problem such as arthritis, or who were born with a bone or joint problem. Although there are standard ways of treating some of these problems, our team can more precisely address many orthopaedic issues with the use of 3-D modeling and virtual surgical planning using 3-D printed, patient-specific surgical guides. To find out more about this program, please fill out a brief survey . We have orthopaedic surgical specialists who are currently using 3-D technology to correct spinal deformity, post-traumatic mal-unions of long bones, congenital upper and lower limb deformities, complex joint replacement surgery (for hips, knees, shoulders, and elbows) and mal-alignment of joints and bones. We work closely with engineers, radiologists, and cutting-edge medical companies who assist in deploying this technology for our patients. Patients that have complex orthopaedic problems are evaluated by our specialists. If the problem is amenable to treatment with custom 3-D surgical correction techniques, a specialized high-resolution CT or MRI scan is obtained focusing on just the injured side (if only bone models are needed) or of the injured and non-injured analogous body part if virtual surgical planning and intra-operative patient specific guides are necessary. Using the data in the CT or MRI scan, a unique 3-D model is built on the computer using specialized image processing software. The 3-D models are then used to study the deformity/injury in detail prior to the actual surgery. The planning is completed with the surgeon and biomedical engineer working together to manipulate the images on a computer to plan the necessary cuts or bone excision to correct the deformity. Surgeons are able to make certain that the bones are corrected and straight, joints can bend and extend, and muscles and nerves are properly positioned. Patient specific guides are then printed in 3-D for use in the operating room during surgery, so that the virtual model can be replicated in the surgery for precise correction of each patient’s problem. These techniques have been shown to decrease surgical time and blood loss, as well as provide a more precise correction of the problem.
Abdominal ImagingThe breadth of experience among our doctors is reflected in their unique approach to patient care, management of complex medical cases, expertise in imaging guidelines and unwavering commitment to clinical excellence. Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose and treat medical conditions. It uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. An MRI does not use radiation. A computed tomography scan, more commonly known as a CT scan, is a diagnostic medical test that produces multiple images of the inside of the body. The cross-sectional images generated during a CT scan can be reformatted in multiple planes, and can even generate three-dimensional images of internal body structures. We also specialize in fluoroscopic imaging—real-time moving pictures displayed on a monitor. This specialized technology helps us detect conditions that affect the gastrointestinal as well as the urinary and reproductive (genitourinary) tracts. Our experts perform esophagrams, upper GI series and barium enemas to look for swallowing and digestion conditions. In addition, we do a variety of other imaging tests, including cystograms to detect voiding issues and hysterosalpingograms, which help us see if a woman’s fallopian tubes are open or blocked.
ACL Injury Treatment ProgramACL injuries are common. Approximately 175,000 ACL reconstructions are performed every year in the United States. An ACL tear renders the knee unstable and without surgery most people cannot return to cutting and pivoting types of activity and athletics. Furthermore, a knee with an ACL tear that is not operated on has a significantly higher risk of developing subsequent tearing of the meniscus (cartilage) and degenerative arthritis. For these reasons, most athletically active patients opt to have their ACL reconstructed. Advancements in video technology and surgical instrumentation have allowed ACL operations to be carried out using very minimally invasive techniques. However, not all surgeons are able to offer these cutting-edge techniques as they require the development of new and often more challenging surgical skills that have a steep learning curve and take time to master. Several of our Yale Sports Medicine surgeons are involved in the teaching of these techniques at courses offered throughout the U.S. To find out more about this program, please fill out a brief survey . The surgical faculty are all fellowship-trained and board-certified in Orthopaedic Surgery and the majority are sub-specialty board certified in Orthopaedic Sports Medicine. The team also includes a number of renowned musculoskeletal radiologists who we routinely consult and collaborate with on all aspects of imaging, including plain X-ray, CT scan, and high-resolution MRI. Our anesthesia colleagues are experts in the most up-to-date regional anesthesia techniques so that post-operative pain is kept to a minimum. Experienced and skilled physical therapists also play a critical role on our team. Utilizing the most current machinery and “return to sport” assessment tools, they help us determine when patients are ready to get back into the game. A team of orthopaedic physician assistants, skilled nurses, and athletic trainers round out our comprehensive and compassionate approach to care. ACL reconstructive surgery involves “replacing” the torn tissue with a tendon either from the patient’s body (called an autograft) or from a cadaver (called an allograft). Traditionally, the two most common autografts used in ACL reconstruction have been the bone-patellar tendon-bone graft and hamstring tendons autograft. Recently, the use of the central third of the quadriceps tendon (from the front of the knee) has become more popular, and surgeons in our program are now utilizing this graft on a routine basis for ACL reconstruction. The quadriceps tendon graft is robust and very strong and has a lower incidence of some of the more common complications seen with other graft sources such as anterior knee pain and numbness about the knee. While use of the quadriceps tendon still only represents approximately 11% of all ACL operations, our Sports Medicine division is on the vanguard of this movement as we strive to offer our patients what we feel is the best possible treatment for their cond
Adolescent MedicineThe Adolescent Medicine Program offers a broad range of clinical services to meet the health needs of those aged 12-25 years. This is a dynamic and exciting period of life, characterized by profound social, cognitive and physical change. The goal of adolescent medicine is to identify and build upon each teen’s strengths to support their general health and wellness. Adolescent and young adult medicine physicians are trained in these developmental needs, as well as in preventing and treating medical conditions that are common in this age group. A teen’s experience in adolescent medicine may be different from other visits to the doctor: Adolescent medicine physicians may work closely with other providers who specialize in mental health, nutrition, and social work. Secondly, each teen will be seen independently for part of the visit; the physician’s focus will be on the adolescent or young adult as an independent patient. Finally, some of the child’s care will be confidential. Adolescent and young adult medicine physicians are trained to assess all areas of children’s health, including their physical and mental health. Some areas, including mental or reproductive health, are considered confidential care, which is regulated by state laws for minors. When care is confidential, parents may not be told about all aspects of care by the clinician. Some parents may have concerns that important information may be hidden from them. However, it is important to note that if a teen talks about concerns related to physical harm, such as harming themselves, planning to harm someone else, or that someone is harming them, this information is not kept secret, and the physician works with the teen to identify next steps in how to get them help in those situations. Adolescent and young adult medicine physicians receive training on talking with patients about confidentiality and their rights as a patient, particularly for younger teens. These physicians also work with adolescent patients to consider ways to foster conversations with their parents about important topics, such as mental and reproductive health, so that parents can best support their teen and their health. Adolescent and young adult medicine physicians may require a referral for a clinic visit. Some conditions that may lead to a referral include menstrual disorders, contraception needs, sexual health counseling, mental health issues (such as depression, anxiety, and ADHD), substance use, and pubertal skin issues such as acne.
Adult Congenital Heart ProgramAs our pediatric congenital heart disease patients move from childhood into adulthood, our program is there every step of the way to make sure they receive continuous, comprehensive care for even the most complex heart disease. Our multidisciplinary integrated program was the first in the state dedicated to the care of adult patients with complex congenital heart disease, and encompasses the full spectrum of care, including imaging, exercise testing, and surgical as well as less-invasive catheterization therapies. Our patients can expect to receive detailed information about their underlying congenital heart defect, its management, and the implications on their future heart function. Patients in the program are assured of the careful transition of care from their childhood diagnosis into adulthood, and appropriate wrap-around care for adults who are new to the program. Commonly encountered problems related to adult congenital heart disease (ACHD) include the following: Unrepaired congenital defects Complications associated with early surgical repair Heart failure Heart rhythm problems, including pacemakers and defibrillators Pregnancy issues Our expert, board-certified cardiac physicians and surgeons treat these, among other heart conditions: Atrial septal defect (ASD) Ventricular septal defect (VSD) Atrioventricular canal defect Bicuspid aortic valve Pulmonary stenosis Coarctation of the aorta Ebstein's anomaly Transposition of the great arteries, including those who have had a Mustard or Senning operation or arterial switch operation Congenitally corrected transposition of the great arteries Tetralogy of Fallot Complex single ventricle patients, including those who had a Fontan operation Cyanotic heart disease Patients who had a Ross operation as a child Congenital coronary anomalies, including ALCAPA (anomalous left coronary artery from the pulmonary artery) Instead of delaying treatment for complex congenital heart disease, our state-of-the-art imaging, including echocardiograms (ultrasound) and MRI, allows for early diagnosis, before symptoms may interfere with a patient’s life. Our program also works closely with Yale's maternal-fetal medicine team to care for women with congenital heart disease before and after they give birth. Yale’s world-class congenital cardiac catheterization lab provides access to the latest advances in transcatheter valve placement, treatment of atrial septal defects, and all forms of congenital heart disease. We provide comprehensive electrophysiology services, including management of arrhythmias and placement of pacemakers and defibrillators.
Adult Cystic Fibrosis ProgramOur team specializes in diagnosing, managing, treating, and researching cystic fibrosis. Our care teams are comprehensive and include nurses, registered dieticians, physical therapists, social workers, and respiratory cystic fibrosis specialists. We collaborate closely with our colleagues in the Yale Medicine Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care. In recognition of our commitment and accomplishments in improving care for people with cystic fibrosis, our program received a Quality Care Award from the national Cystic Fibrosis Foundation. Our services include sweat testing and blood testing for all known mutations related to cystic fibrosis. We offer a full range of treatments for all complications related cystic fibrosis, including those involving the respiratory, sinus, digestive, endocrine, and reproductive systems. Patients have access to comprehensive nutrition counseling and care, including pancreatic enzyme replacement therapy, screening for vitamin deficiencies, and the repletion of those vitamins. We also help patients manage cystic fibrosis lung disease with mucus clearance techniques, mucolytics, and preventive therapy for patients infected with pseudomonas.
Adult Reconstructive & Arthritis ProgramMore than 52 million adults in the United States suffer from arthritis, and our program is prepared to address this growing and debilitating chronic condition. Our physicians offer multidisciplinary care to relieve patients of their arthritis-related pain, restore their function, and improve quality of life. We provide diagnostic treatment and rehabilitation approaches for adult patients with degenerative and inflammatory arthritis. Our physicians have extensive experience with primary and revision joint reconstruction, including hip and knee replacement, primary and revision surgery, and arthroscopic procedures. Our team provides expert care for the following procedures: Hip and knee reconstruction Hip and knee replacement Arthroscopic procedures
Sleep Medicine ProgramWe care for patients with a broad spectrum of sleep disorders, including sleep apnea, insomnia, narcolepsy, and restless leg syndrome. We are accredited by the American Academy of Sleep Medicine, and evaluate, diagnose, and treat these disorders with a coordinated approach. We know that a good night of sleep matters. Other issues we treat include: Snoring Sleep apnea-related seizure disorders Circadian and shift work-related disorders Parasomnias, such as sleep walking and talking, and abnormal behavior during sleep Our internationally recognized physicians are board-certified in pulmonary critical care medicine or neurology. They also have additional certifications in sleep medicine. As an interdisciplinary program, we work closely with specialists in otolaryngology (ENT), neurology, cardiology, psychology, dentistry, and bariatric surgery. We offer a state-of-the art lab testing system to pinpoint patients’ sleep problems, as well as home sleep-testing systems. At the West Haven VA, we care for veterans, who frequently struggle with sleep issues related to posttraumatic stress disorder and traumatic brain injury. Our VA program includes six in-hospital monitoring beds and 30 home sleep-testing units. Through our Sleep Center in the Department of Pediatrics, we treat sleep disorders in children, and manage patients with congenital disorders that impact breathing during sleep. We have a three-bed testing unit in Yale New Haven Hospital specifically designed for children that includes dedicated staff who are experienced in dealing with children and their sleep disorders.
Advanced Endoscopy ProgramWe focus on diseases of the pancreas, biliary tract, and gastrointestinal tract, and evaluate patients with a variety of symptoms and diseases, many of whom require advanced endoscopic procedures. Our team members work closely with referring physicians to promptly perform procedures, consultations, and discuss management options. Using a multidisciplinary approach to complex conditions, we collaborate with pathologists, cytologists, surgeons, oncologists, and radiologists to deliver care. Our endoscopic ultrasound program is among the largest of its kind in New England, and our experienced physicians perform approximately 1,500 procedures annually. This sophisticated procedure includes fine-needle aspiration of masses, cysts, and lymph nodes located in and around the digestive tract. This highly sophisticated technique is used to stage malignancies of the esophagus, rectum, and pancreas. Other outpatient endoscopic procedures we perform include: Esophagogastroduodenoscopy (EGD), a diagnostic endoscopic procedure for the upper gastrointestinal tract Enteroscopy, an endoscopic procedure used to examine the small intestine Colonoscopy with difficult polyp removal Sigmoidoscopy stenting of the esophagus, duodenum and colon to treat obstructions
AIDS Care ProgramEstablished in 1984 in response to the increasing number of individuals being treated for HIV/AIDS at Yale New Haven Hospital, our AIDS Care Program offers comprehensive services for adults, adolescents, and children with HIV. We provide primary and consultative medical care, counseling and testing, social services, patient and family support groups, and women's health services. Our participating physicians are board certified in internal medicine and infectious disease. In addition to routine diagnosis, treatment and follow-up care, specialty services are available in psychiatry, neurology, hematology, dermatology, women's health, and substance use counseling. Adult patients requiring hospitalization are admitted to an inpatient unit at Yale New Haven Hospital dedicated to the care of patients with HIV and AIDS. We offer clinical trials offering new and promising therapies for HIV and its complications. Individuals enrolling in these programs may receive their continuing care from their own provider or be monitored at the hospital. We hold weekly AIDS conferences to keep up to date on the newest therapies in HIV prevention and public health strategies, as well as to discuss complicated multidisciplinary cases. Our specialized services include: Outpatient, primary, and consultative HIV care Infusion therapies Subspecialty consultation in dermatology, neurology, psychiatry, women's health, and substance abuse Experimental therapies HIV counseling and testing Testing Rapid HIV testing, which is available to adults and teens who are registered with our Primary Care Center and Women’s Center. Early detection is important for better health outcomes. Adult Outpatient Care In addition to comprehensive HIV specialty/primary care, our clinic offers psychiatry/mental health support, social work, nursing, neurology, gynecology, and hepatitis C treatment for those who need it. We offer HIV care for pregnant women in collaboration with Yale obstetric and pediatric services. Pediatric AIDS Care Program We provide specialized medical, nursing, and social care for children and teenagers living with HIV/AIDS, as well as a transitional program for young adults into adult care. We also follow pregnant HIV-positive mothers who are in the care of the Adult Outpatient Clinic, including screening newborns. The Pediatric AIDS Care Clinic is located in the Pediatric Specialty Center at Yale New Haven Children's Hospital. Appointments may be made by calling the YM CARE Center at 1-877-925-3637 (1-877-YALE MDS).
Allergy & ImmunologyWe 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. Our service has specific strength in the management of inherited immune deficiencies, with a dedicated service that closely collaborates with Yale’s stem cell transplant experts. Through a long-standing collaboration with Yale Laboratory Medicine, patients have access to a broad array of state-of-the-art immunological testing. Among the conditions we treat are: Allergic rhinoconjunctivitis (nasal and eye allergies) Asthma Urticaria (hives) Medication allergy Chronic sinusitis Angioedema Hereditary angioneurotic edema Common variable immunodeficiency Secondary immune deficiencies We offer a full suite of specialized procedures, including allergy immunotherapy (“allergy shots“), allergy skin testing, antibody replacement therapies, drug desensitization, oral food challenges, and pulmonary function testing. We also offer asthma environmental controls and pharmacological controller therapy, intensive antihistamine regimens, biological therapy for hereditary angioneurotic edema, and intravenous and subcutaneous immunoglobulin replenishment. 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
Allergy, Asthma & Immunology Care in Pregnant MothersPenicillin allergies are commonly reported throughout the American population, but yet a small percentage of people are actually allergic to the antibiotic. This can be problematic in pregnant women, who often need antibiotics throughout the course of their pregnancy and after delivery. The Allergy, Asthma & Immunology Care in Pregnant Mothers Program identifies Yale Medicine obstetrical patients who report a penicillin allergy and asks them if they would like to visit an allergist to be tested, with the goal of clearing unnecessary penicillin allergies from their medical charts. Penicillin is typically the first antibiotic medication tried for an infection, and if it can’t be used, medical professionals need to try a broader antibiotic, which has increased risks and contributes to antibiotic resistance. And pregnant women who are believed to have penicillin allergies may have higher rates of C-sections and stay longer in the hospital, in addition to other risks. Therefore, it is key for pregnant women to know if they are actually allergic to penicillin, especially since many people who think they have an allergy either never actually had one or they outgrew it. For patients in the Allergy, Asthma & Immunology Care in Pregnant Mothers Program who agree to be tested, the procedure they undergo is typically done during the third trimester and involves a tiny needle poke of penicillin under the skin. If a rash doesn’t appear within 20 minutes, another poke is given. If the skin is still clear after 20 more minutes, the patient receives an oral dose of amoxicillin, a form of penicillin. The woman is carefully monitored in the office. If there is no reaction, she is cleared of the allergy on her medical chart. The program is led by a board-certified allergy and immunology specialist and a high-risk obstetrician-gynecologist. The physicians work with Ob/Gyns throughout Yale Medicine to educate pregnant women about the importance of allergy testing.