Departments

Yale’s Department of Neurology has been at the forefront of cutting-edge clinical care and scientific discovery since it began in 1952. It was Yale scientists who discovered the genes that cause Multiple Sclerosis. Yale housed one of the first epilepsy monitoring units in the country, and one of the first stroke centers at its partner, the Veterans Affairs (VA) Center in West Haven. Today, our team of experienced doctors are committed to understanding and treating the entire spectrum of nervous system diseases. Expert physicians specialize in brain and nerve health for both children and adults. Specialized care is offered in the following areas: Amyotrophic lateral sclerosis (ALS), myasthenia gravis, peripheral neuropathy, neuromuscular disorders Alzheimer’s disease/cognitive disorders Epilepsy and neurophysiology General neurology, headache, pain Multiple sclerosis and neuroimmunology Neurodegenerative disorders Neurocritical care Neurological infections Neuro-oncology Parkinson’s disease and movement disorders Stroke and vascular neurology

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.

Yale Cancer Center is Connecticut's only cancer center designated as a Comprehensive Cancer Center by the National Cancer Institute—and one of only 57 in the nation. The significance of this designation has profound implications for those who choose Smilow Cancer Hospital as the place where they will be cared for and receive treatment for their cancer. National Cancer Institute cancer centers are national leaders in cancer research, prevention, detection, and treatment. This provides patients at Smilow Cancer Hospital with novel treatment options and expert care.

The Hepatic Arterial Infusion (HAI) Program at Smilow Cancer Hospital consists of a multidisciplinary team of nationally recognized physicians who are experts in diagnosing, treating, and providing care for patients with colorectal cancer , cholangiocarcinoma (bile duct cancer), and liver cancer . HAI is a specialized and targeted approach to deliver chemotherapy directly to the liver, primarily used in the treatment of advanced liver metastases from colorectal cancer, in addition to intrahepatic cholangiocarcinoma. Traditional systemic chemotherapy and immunotherapy may not provide enough concentration of the drug within the liver while minimizing exposure to the rest of the body. The procedure involves implanting an HAI pump (the size of a hockey puck) under the skin between the patient’s ribs and pelvis. The pump contains a catheter connected to the hepatic artery, the main blood vessel that supplies the liver with blood. This catheter allows for the direct infusion of chemotherapy drugs into the arterial blood supply of the liver. By administering chemotherapy directly to the affected organ, HAI will maximize the concentration of the drugs in the tumor tissue while minimizing their dilution and distribution throughout the rest of the body. The procedure typically lasts about three hours, and the pump will remain in the patient for several years. Patients will need to visit their doctor every two weeks to have the pump filled with chemotherapy, which takes approximately 10 minutes. Generally, patients will not notice the presence of the HAI pump, but should avoid rigorous physical activity, contact sports, or exposure to extreme heat, which could allow too much chemotherapy to enter the liver. The benefits of HAI include: Fewer side effects: The HAI pump allows for chemotherapy to be released directly into the liver, which is significantly more effective than traditional chemotherapy treatment. This chemotherapy remains in the liver and does not circulate throughout the patient’s body, thus limiting the side effects of treatment. Better outcomes: Chemotherapy is released into the liver continuously and is highly effective in reducing the recurrence of, controlling, or shrinking cancerous tumors in the liver. While uncommon, the HAI procedure does present a risk of complications, including infection, bleeding around the pump, or damage to the hepatic artery. Patients can be assured that our clinicians have extensive processes and procedures in place to ensure that risks are reduced before, during, and after surgery. Despite its benefits, HAI is not suitable for all patients. It is typically considered when the cancer is confined to the liver and systemic disease is limited. Patient selection is crucial, and our multidisciplinary team of medical oncologists, surgical oncologists, and interventional radiologists collaborate to determine the most appropriate candidates for this treatment.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a technique that delivers high doses of heated chemotherapy directly to abdominal organs to kill cancer cells that may remain after the surgical removal of visible tumors. It is typically used in combination with cytoreductive surgery to treat advanced-stage abdominal cancers such as peritoneal mesothelioma, stomach cancer, appendix cancer, and colorectal cancer, as well as ovarian cancer. Smilow Cancer Hospital physicians are national leaders in the delivery of HIPEC therapy, with a deep understanding of the types of cancer it can be used to treat, the nuances of the therapy, and its effectiveness. Clinical trials using HIPEC therapy are also available. Hyperthermic (or heated) intraperitoneal chemotherapy, called HIPEC for short, is a treatment for cancers that begin in or have spread to the thin layer of tissue that lines the abdomen and abdominal organs known as the peritoneum. After a surgeon removes all visible tumors from the abdominal (peritoneal) cavity in a procedure called cytoreductive surgery (CRS), heated chemotherapy drugs are pumped into the abdomen where they bathe abdominal tissues for about 90 minutes before being drained and rinsed from the abdominal cavity. In many cases, the goal of the treatment is to cure patients of cancer by killing any cancer cells that remain after cytoreductive surgery. HIPEC is used to treat cancers in the peritoneum, including those that have spread—or metastasized—from the gastrointestinal tract, colon, appendix, and ovaries, among other organs, as well as cancerous tumors that started in the peritoneum. Cancer that originates in the peritoneum is very rare. However, each year, around 60,000 people in the United States are diagnosed with metastatic cancer that has spread to the peritoneum from elsewhere in the body. People with these cancers often experience debilitating symptoms, including abdominal and back pain, nausea, constipation, and fatigue, and can have a poor prognosis. However, HIPEC, combined with cytoreductive surgery, can improve the outlook for many people with these types of cancers, helping them live longer and with an improved quality of life. For some people, HIPEC can result in a long-term cure. In other cases, with HIPEC, doctors can manage incurable cancers as chronic illnesses rather than as terminal diseases. The benefits of HIPEC include: HIPEC delivers a concentrated and targeted dose of chemotherapy . In HIPEC, highly concentrated chemotherapy is delivered directly to the inner lining of the abdomen, where it comes into contact with and kills cancer cells. By contrast, traditional chemotherapy is a “systemic” treatment: It is infused into the blood and reaches cancer cells by traveling through blood vessels. Unfortunately, traditional systemic chemotherapy is often ineffective in treating cancers in the peritoneum. This is due, in part, to the peritoneal-blood barrier, which obstructs the delivery of chemotherapy. Few

Our uncompromising faculty and staff are dedicated to the welfare of children and adolescents. One of two major pediatric centers in Connecticut, Yale offers an extensive range of services for patients through our 14 specialties. In addition, we have several interdisciplinary centers and programs that involve collaborations with multiple departments throughout Yale Medicine and Yale New Haven Children’s Hospital. Thanks to our reputation for comprehensive pediatric care, we serve as a regional and national center for referral and consultation. Many of our physicians are internationally recognized for their innovative approaches to the diagnosis and treatment of conditions including arrhythmias, diabetes, cystic fibrosis, childhood cancers, juvenile diabetes, dyslexia, blood disorders, infectious diseases, and complications of premature birth, as well as many other disorders. We are leaders in the global pediatric community, advocates for childhood health and development, and innovators in research. We rank among the top pediatric centers in the country with respect to National Institutes of Health support for research. Neonatal and pediatric ICUs that serve our most vulnerable patients with the highest level of care 24/7 subspecialty telephone consultation service for primary care clinicians with expected response time of three minutes More than 20 years of experience with neonatal and pediatric Extracorporeal Membrane Oxygenation, a sophisticated machine that acts as an artificial heart and lungs, crucial for some seriously ill infants One-call center that provides centralized appointment scheduling for all pediatric specialties Close collaboration with other Yale departments to provide such services as molecular and genetic diagnostic services, state-of-the art management of high-risk fetuses and newborns, bone marrow transplantation, and management of complex malignancies

The Oligometastatic Cancer Program at Smilow Cancer Hospital consists of a multidisciplinary team of nationally recognized physicians and clinicians who are experts in providing care for patients with oligometastatic cancer. Oligometastatic cancer is a concept in oncology that describes a state of cancer progression in which the cancer has spread, but only to a few specific areas. Unlike widespread metastatic disease, where cancer has spread extensively to distant organs, oligometastasis involves a more localized and contained pattern of metastatic spread. Effectively, oligometastatic cancer represents a middle ground between localized cancer (cancer of one area) and widespread metastatic cancer. The clinical significance of identifying patients with oligometastatic cancer lies in its potential for more targeted and aggressive treatment approaches. Unlike widespread metastatic disease, where the primary goal may be palliative or to control symptoms, oligometastatic cancer offers patients an opportunity for interventions that can lead to a cure. This identification has been facilitated by advancements in imaging technologies, particularly the use of positron emission tomography (PET) scans. These sophisticated imaging techniques enable our clinicians to detect and visualize small numbers of metastatic sites that might be overlooked by conventional imaging methods. Here at Smilow Cancer Hospital, our multidisciplinary teams treat oligometastatic disease using the following treatment types: Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Hepatic Artery Infusion (HAI) The concept of oligometastatic cancer has gained increasing attention in the field of oncology, leading to clinical trials and extensive research aimed at refining its definition, understanding its behavior, and determining optimal treatment strategies. It is important to note that all cancer types are different and do not show an oligometastatic pattern, and the relevance of this concept varies across different tumor types. The management of oligometastatic cancer requires a personalized and multidisciplinary approach, considering factors such as the primary tumor type, the location of metastases, overall patient health, and treatment goals. Our team of clinicians collaborates directly with patients to identify the presence of oligometastatic disease, establish a tailored treatment plan, and enhance outcomes for patients in this unique stage of cancer progression. For gastrointestinal oncology-related appointments, view the profile of Kiran Turaga, MD, MPH . For gynecologic oncology-related appointments, visit the profile of Elena Ratner, MD, MBA .

At Yale Medicine, we specialize in a full range of digestive health care, from advanced endoscopy and colon cancer genetics to managing such conditions as inflammatory bowel disease and liver cancer. We treat complex gastrointestinal motility disorders, provide care for rare diseases, and support patients through liver transplants. Our dedicated team is committed to offering personalized and effective treatments for all aspects of gastrointestinal health. Specialized care is offered in the following areas: Advanced endoscopy: Specialized procedure using an endoscope to diagnose or treat complex issues in the digestive system. Colon cancer genetics: Study of genes that affect the risk of developing colon cancer. Gastrointestinal motility: The movement of food through the digestive tract. Inflammatory Bowel Disease (IBD): Chronic inflammation of the digestive tract. Liver cancer Liver transplant Lysosomal disease: A group of rare inherited metabolic disorders that result when lysosomes in cells cannot breakdown waste properly. Viral hepatitis: Liver inflammation caused by a virus, such as hepatitis A, B, or C, which can lead to liver damage.

At Yale Medicine, our colorectal surgery team specializes in surgical care for conditions affecting the lower gastrointestinal tract which includes your colon, rectum, and anus. We treat a complete array of conditions that range from non-cancerous (benign) disorders to cancerous (malignant) diseases, and they can involve surgical and non-surgical treatments. Expert physicians may also perform routine screening procedures, such as colonoscopies, to detect colon and rectal abnormalities, including cancer at an early stage. They work closely with gastroenterologists, oncologists, and other specialists to provide comprehensive care for patients with diseases affecting the lower digestive tract. About Us Specialized care is offered in the following areas: Colon and Rectal Cancer: Surgical removal of tumors in the colon and rectum. Inflammatory Bowel Disease (IBD): Including ulcerative colitis and Crohn's disease, which may require surgery to remove diseased portions of the intestinal tract. Diverticulitis: Inflammation or infection of small pouches that can form in the intestinal wall, sometimes requiring surgical intervention. Hemorrhoids: Swollen blood vessels in and around the anus and lower rectum that can cause discomfort and bleeding. Anal Fissures: Small tears in the lining of the anus that can cause pain and bleeding. Anal Fistulas and Abscesses: Infections in the anal gland that can form an abscess and may lead to an abnormal channel (fistula) between the inside of the anus and the skin. Rectal Prolapse: When part of the rectum protrudes from the anus. Fecal Incontinence: Inability to control bowel movements, which may be improved with surgery. Bowel Obstruction: Blockages in the colon or rectum that may require surgery to remove the obstruction. Polyps: Abnormal growths in the colon or rectum that can be benign or precancerous and are often removed to prevent cancer. Ostomy Surgery: Procedures that create an opening (stoma) for the body to eliminate waste, such as a colostomy or ileostomy, which may be temporary or permanent. Pelvic Floor Dysfunction: Disorders affecting the coordination of pelvic floor muscles and rectum, which may involve surgical repair. Colon and Rectal Trauma: Injury to the colon or rectum that requires surgical intervention to repair. Pilonidal Disease: A chronic skin infection in the crease of the buttocks near the coccyx.

In 2001, the Yale Inflammatory Bowel Disease Program was formed to address the challenges faced by patients with complex, lifelong, gastrointestinal, inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Our team-based approach employs a gastroenterologist, physician assistant, and a team of nurses and medical assistants to share the responsibilities of our patients’ medical care. Following evidence-based guidelines, the IBD team will work closely together to plan and coordinate a comprehensive plan of care personalized to each patient, who will have the opportunity to meet the IBD team members during a visit. The key to effective management of the disease is coordinated care among specially trained, internationally recognized physicians with expertise in inflammatory bowel disease. Our experienced team also includes nutritionists, surgeons, radiologists, and pathologists. Our medical and surgical specialists are available at the same visit to provide comprehensive care. Our enterostomal nurses work with families to manage ostomy care and provide support. Treatment for ulcerative colitis or Crohn’s disease usually begins with medical therapy. While surgery can be a primary therapy for certain symptoms of IBD, it is usually reserved as a supplement to medical therapy. The goal of GI surgery is to restore function, using bowel-conserving surgery, including minimally invasive surgery where appropriate. In order to properly diagnose and treat patients with IBD, doctors must perform visual examinations of the gastrointestinal tract through procedures known as endoscopies. The three most common procedures are as follows: colonoscopy, upper endoscopy, and capsule endoscopy. Each procedure visualizes a different section of the gastrointestinal tract. Colonoscopy—Sigmoidoscopy: These procedures allow doctors to evaluate the entire large intestine and the end of the small intestine called the ileum. In patients with inflammatory bowel disease, a colonoscopy is required for evaluation of the disease activity and for colon cancer screening. Some patients may undergo a sigmoidoscopy, which only views the first third of the large intestine. Upper Endoscopy (EGD): This procedure allows evaluation of the esophagus, stomach, and duodenum. In patients with inflammatory bowel disease, an upper endoscopy evaluates disease involvement in the upper region of the digestive tract. Capsule Endoscopy: The newest diagnostic procedure, it allows evaluation of the small intestine not accessible by upper endoscopy and colonoscopy. A tiny camera contained in a capsule passes naturally through the digestive tract while transmitting video images to a data recorder. Images of the small bowel are downloaded to a computer and reviewed by a physician. Chromoendoscopy: Chromoendoscopy is a technique performed during colonoscopy to enhance the detection of pre-cancerous areas in the colon. It uses a blue dye that temporarily stains the colon wall du

The Yale Medicine Gastrointestinal Motility Program is led by a team of gastroenterologists who subspecialize in motility disorders. We work in collaboration with radiologists, colorectal, surgeons, GI surgeons, thoracic surgeons, urologists, urogynecologists, and physical therapists to care for patients with complex motility disorders. As part of our multidisciplinary approach, our team meets monthly to discuss complex cases to ensure that each patient receives an individualized treatment plan. We strive to provide excellent care in a compassionate way. Our state-of-the-art services include: The Bravo pH Monitoring System, a catheter-free instrument that measures acidity levels in patients suspected of having gastroesophageal reflux disease (GERD). A small capsule is attached to the wall of the esophagus, which transmits data to a pager-sized receiver, which is worn for 48 hours. During this time, patients push a button whenever they experience symptoms, so we can determine if the symptoms correlate with incidents of acid reflux. When the test is over, data from the receiver is downloaded to pH analysis software, where it is analyzed. The SmartPill Capsule, a new technology available at only about a dozen medical centers around the country. The ingestible, wireless capsule measures pressure, pH, and temperature as it moves through the GI tract, allowing physicians to identify where abnormalities in intestinal transit are located. The SmartPill transmits information to a data receiver worn by patients. After the capsule has passed from the body, patients return the receiver to the physician, who is able to display and analyze the data within minutes. Impedance monitoring is a catheter-based system that enables doctors to diagnose nonacid reflux. Patients wear the monitoring system for 24 hours, and push a button whenever they experience symptoms. Physicians then download and analyze the data to determine whether the reflux is acidic or nonacidic, and whether the symptoms correlate with incidents of reflux.

We provide care and treatment to children and adolescents with airway, breathing, and swallowing disorders caused by problems in the aerodigestive tract, including the throat, lungs, esophagus, and stomach. Our expert team includes specialists from pulmonary medicine, interventional pulmonology, gastroenterology, nutrition, otolaryngology, and pediatric surgery, as well as speech, language, and occupational therapy. Our dedicated feeding disorders team consists of gastroenterologists; a nutritionist; occupational, speech, and language therapists; pediatric surgeons; and a behaviorist. Together, we offer a unified approach to treat patients with advanced feeding issues. Conditions we treat: Aspiration and recurrent pneumonia Airway obstruction from tumors or other growths Bronchomalacia, tracheomalacia, and airway collapsibility Chronic cough Dysphagia Esophageal atresia Eosinophilic esophagitis Pediatric gastroesophageal reflux with persistent symptoms Laryngomalacia Stridor Glottic, tracheal, and bronchial stenosis (narrowing) of the airways Tracheoesophageal fistula Vocal cord dysfunction/paralysis Other medically complex thoracic diseases requiring coordinated subspecialty care We provide feeding evaluations for patients with: Craniofacial abnormalities Developmental or neurological disorders Dysphagia Failure to thrive G tube or NG tube management; tube feeding dependency Intestinal failure Minimal diversity in diet Oral aversions: sensory and/or texture issues TE fistula, laryngeal Cleft, vocal cord paralysis Tracheotomy