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Advancing Care - 2024 | Issue 4


When GERD Leads to Barrett's Esophagus, New Treatment Can Help

For years, Jeff Bushey treated his persistent heartburn and indigestion with a combination of antacids and denial.

When he did see the doctor, his gastroenterologist diagnosed him with gastroesophageal reflux disease (GERD) and recommended that he change his diet, stop eating after 6 pm, lose weight, stop smoking and reduce his consumption of alcohol. "I never really followed the recommended lifestyle protocols," Bushey admitted.

Read more about treating Barrett’s esophagus

Early Diagnosis Is Key for Treating Rheumatoid Arthritis

Early diagnosis and treatment are critical for any medical condition. They’re even more important for rheumatoid arthritis (RA) because the damage the disease causes to joints cannot typically be reversed. If the disease is caught early, current treatment options can help RA patients lead fuller lives, according to experts from Yale New Haven Health.

“People will frequently ask me if they have arthritis,” said Robert McLean, MD, regional medical director, Northeast Medical Group, New Haven. “If they’re old enough, it’s almost always ‘yes’ because most people get some type of degenerative or osteoarthritis, which comes from normal wear and tear. But as a rheumatologist, I ask questions about the patterns of their pain which can steer us to something that may be rheumatoid arthritis or some other inflammatory arthritis.”

What is rheumatoid arthritis?

While osteoarthritis is a degenerative joint condition that results from breakdown of joint cartilage and bone, rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints. In RA, the immune system begins to attack the healthy joint tissue, leading to pain, swelling and loss of joint function.

“The most common symptoms of RA are joint pain, joint tenderness, joint swelling, morning stiffness and fatigue,” said Deborah Dyett Desir, MD, a rheumatologist with Yale New Haven Health and associate professor of Medicine at Yale School of Medicine. Dr. Desir is also the current president of the American College of Rheumatology. “RA is commonly thought of as a joint disease, but it can affect many parts of the body including the eyes, lungs, nerves or skin.”

The disease has a tendency to be symmetrical as well. “RA tends to impact both sides of the body equally,” Dr. McLean said. “It can show up in large joints like the knees, but RA generally impacts joints in the hands. We see it in the knuckles at the base of the fingers and in similar joints in the feet.”

How is it diagnosed?

The diagnosis of RA is largely a clinical one, said Dr. Desir. “While RA most commonly presents in what we refer to as ‘women in their childbearing years,’ it can be present in the very young, the elderly and certainly in men.”

Several blood tests, X-rays, MRI, and ultrasound can help diagnose RA, but no one test is perfect, and a blood test, together with a clinical exam and comprehensive medical history, constitute the gold standard for diagnosing RA. “There is no single laboratory test for the diagnosis of RA. This makes the medical history and physical examination very important,” she said.

Start with your primary care clinician

“If someone is having joint pain that just seems to be lingering, they should bring it up with their clinician,” Dr. McLean said. “Primary care is a great place to start because not everyone who has joint pain needs to see a rheumatologist. A primary care clinician can go through those first steps, and if they suspect an inflammatory arthritis, make a referral to a rheumatologist.”

RA damages the impacted joints and the damage frequently increases the longer the disease goes untreated. That damage can be irreversible. That is why Dr. McLean encourages patients to talk with their clinician when they first notice joint pain.

“We can run all of the tests and if we find that the patient has really high levels of some of these inflammatory markers, that’s a pretty strong signal that they will have a more aggressive course of RA,” he said. “When that’s the case, studies show that aggressive early treatment can really limit the extent of the joints getting damaged.”

New treatments prove effective

Treatments for RA include corticosteroids such as prednisone; disease-modifying anti-rheumatic drugs (including methotrexate, Arava, Plaquenil, and Azulfidine); and biologic medications and targeted therapies, according to Dr. Desir. Non-pharmacological therapies, including physical and occupational therapies, are also important.

Newer anti-inflammatory drugs called TNF (tumor necrosis factor) inhibitors have shown to be particularly effective at reducing RA damage in many patients who have not seen adequate improvement from older medications. “Some of the newer medications are more commonly known by their brand names like Enbrel® and Humera®,” Dr. McLean said. “Using these newer medications and treating RA earlier rather than later has led to improved quality of life for many patients, compared to years ago.”

People with RA tend to avoid moving the affected joints because of the pain and discomfort. Improving range of motion is a treatment goal, but Dr. McLean advises patients to wait until the inflammation subsides before starting any physical therapy.

“If there’s a lot of inflammation around a joint, we’ll see that the tendons are irritated and if you’re aggressively moving those joints, you can cause more harm,” he said. “Our goal is to quiet down the inflammation, get the patient feeling better, get the joint better and then start some range of motion exercises or physical therapy to strengthen the muscles and tendons.”

Over-the-counter meds for lower pain levels

For his patients who report lower levels of joint pain without a specific diagnosis, Dr. Mclean recommends over-the-counter medications like ibuprofen over the course of five to 10 days. “If that is effective, that’s great news because we know the inflammation can be controlled relatively easily. But if those over-the-counter pain relievers don’t help very much, that is a very important piece of information because now I know we have to look at stronger medications to help them feel better,” he said.

With so many treatment options for the different levels of severity of RA, Dr. Desir and Dr. McLean urge anyone who has a nagging pain in their joints to talk with their doctor.

“The earlier you speak with your doctor, the quicker we can get a diagnosis and get started with these treatments,” Dr. McLean said. “And the sooner we start the treatments, the better off you’re going to be.”

Learn more about rheumatology at Yale New Haven Hospital. To find a specialist, call 888-700-6543 or visit our Find a Doctor

Hospital Care in the Comfort of Your Home

In March, Debbi Kinell of North Haven became the 1,000th patient to be cared for in Yale New Haven Health’s Home Hospital program.

Launched in 2022, the program provides hospital-level acute care and services to patients with heart failure, pneumonia, chronic obstructive pulmonary disease, cellulitis, sepsis, COVID and other conditions.

YNHHS partners with a vendor, Medically Home, to provide services through a combination of in-person visits and telehealth technology. Nurses provide in-person care twice a day, and a team of YNHHS physicians and nurses provide telehealth care. Advance practice providers also see patients in-person as directed by a physician, who performs daily virtual rounds.

Home Hospital patients can have lab draws, intravenous fluids, intravenous antibiotics, medications and medical equipment such as oxygen and nebulizers at home. The program currently accepts most insurance plans and traditional Medicare.

“I was in the hospital receiving fluids, and after consulting the medical team we decided that there was no sense taking up a bed when someone who was much more seriously ill could benefit,” said Kinell. “The way the nurses and doctors made all the arrangements, from the transportation home to getting all the equipment set up, it was just so easy. It could not have been a more patient-friendly program.”

“One of the biggest misconceptions about Home Hospital is that it is synonymous with homecare,” said Olukemi T. Akande, MD, medical director, Home Hospital. “It is very different. We care for people similar to when they are in the hospital including transferring them to a higher-level care in the physical hospital when necessary.”

Irene Glavan, 70, of Stratford, CT, was admitted to Bridgeport Hospital at 4 am with difficulty breathing after a rough bout of RSV (respiratory syncytial virus), one of the common cold viruses that can make some people very sick.

“I was anxious to meet with the doctors and know what was wrong with me,” Glavan said. “The nurse handed me a phone to chat with a doctor about being transferred home. The doctor explained there would be a full set-up in my home. It took several conversations for me to decide to try it, knowing I would be transferred to the physical hospital if needed.”

Glavan was taken home by an ambulance. Her home was outfitted with a router for WiFi, tablets to FaceTime a doctor, case manager and specialists, and several wearable devices with extra battery packs so her clinical team could get real time feedback on her vital signs. Her bathroom was even equipped with an emergency call system.

“We have shown that patients can receive the same quality of care in their homes, and that we can do it safely, consistently and with increased patient satisfaction,” said Carly Brown, MD, senior medical director, Clinical Operations, and Home Hospital medical director. “We believe that this program is a pivotal part of the future of medicine.”

Some studies suggest that patients hospitalized at home are discharged two days sooner, with lower rates of emergency room visits and hospital readmissions, and that patients are less likely to need physical rehabilitation afterward.

Kinell said that being home in her own bed and familiar surroundings meant less stress. “I think I healed much faster,” she said. “But the reason I was so impressed with Home Hospital care was my mother was one of the first patients the Home Hospital program cared for right after it began. My mother has benefited from the program twice now and the care she received was wonderful. That was how I knew it would be a great option for me.”

Home Hospital currently serves patients meeting certain clinical and social criteria who live within 25 miles of Yale New Haven or Bridgeport hospitals but is expected to expand to other YNHHS hospitals in the future.

Learn more at Home Hospital

Register for Smilow “Beyond Beauty Program” Workshops

The Beyond Beauty Program is a free service for current Smilow Cancer Hospital patients who are undergoing chemotherapy and radiation treatment and experiencing temporary visual changes to their hair, skin and nails. The interactive program, sponsored through The Cingari Family Boutique, features licensed cosmetologists, certified hair and wig specialists who are experienced in helping patients promote self-care and wellness during their cancer journey and beyond.

If you are a current Smilow patient, you may register for an interactive workshop at one of the following dates and locations:

  • June 19 from 9:30 -11:30 am at Smilow Cancer Hospital – Shoreline Medical Center, 11 Goose Lane, Guilford
  • June 26 from 2 – 4 pm at Smilow Cancer Hospital – Waterbury, Harold Leever Cancer Center, 1075 Chase Parkway, Waterbury

You must pre-register to receive your makeup toolkit on the day of the class. Sign up for the Beyond Beauty Program online or call the Cingari Family Boutique at 203-200-2273 (CARE).

Help for Those Living With Parkinson’s Disease

Join our exercise program for those living with Parkinson's disease. This class is held on Tuesdays and Thursdays from 10:30 am - 12 pm via Zoom and in-person in the Wellness Center at Yale New Haven Health at Home & Hospice, 753 Boston Post Road, Guilford. The cost is $6 per class (billed quarterly).

A free support group is held on the first Tuesday of each month immediately following class. Please call Susan Castagna at 203-688-9010 for more information and to register.

A virtual Parkinson’s Caregiver Support group is also available. Call Molly Standley at 475-308-0477 for more information and to receive the link to attend.

Find a Provider at YNHH

Are you looking for a physician? Call 888-700-6543 or visit Find a Doctor for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience.

Billing Questions?

Yale New Haven Health offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.