Clinical Innovations

Handled With Care

The breast cancer journey is a delicate one. The breast team at UConn Health strives to guide each patient through every step of their individual path with an unmatched level of attention and comfort.

 

By Kim Krieger
Photos by Peter Morenus

UConn medical oncologist Dr. Susan Tannenbaum initiated the multidisciplinary focus of the breast program, connecting patient care to research and bringing accreditation through the American College of Surgeons, before handing the reins to surgeon Dr. Christina Stevenson.

UConn medical oncologist Dr. Susan Tannenbaum initiated the multidisciplinary focus of the breast program, connecting patient care to research and bringing accreditation through the American College of Surgeons, before handing the reins to surgeon Dr. Christina Stevenson.


Some people need no urging to get medical screenings. These are the people who see their dentist twice a year like clockwork, who make that annual preventive care appointment, and who don’t put off a colonoscopy.

But most people are not like that. Even a mammogram can be a tough sell. Getting your breasts squeezed between two cold plates and X-rayed while wearing an ill-fitting gown is nobody’s idea of a good time. And when a patient has already found a suspicious lump, there’s an extra layer of stress.

The radiologists and staff at UConn Health’s Beekley Imaging Center, part of the Women’s Center, do their best to dispel that stress. Good service and a relaxing atmosphere go a long way toward evoking a spa-like ambience. There’s comfortable seating, private changing rooms, warmed gowns that fit, appointments that start on time — and cookies.

The patients appreciate it.

“I’m always in and out,” one woman says to another as they ride the elevator up to the imaging center. “I stay for the cookies and juice,” says the other. They both laugh. The first woman proclaims, “It’s really nice up there!”

Indeed it is. And if a woman cares to linger over her cookies and juice, she can get her results on the spot.

“One woman, here in 2013, 2015, 2017, 2019, always reports the same symptoms. Lumps, terrible breast pain. She wants our attention. She is worried about breast cancer,” says Dr. Alex Merkulov, head of women’s imaging and a radiologist in the Imaging Center. “Our job is to remind her of the prior years and assure her that everything is OK this time, too. We treat people the way we would want to be treated.”

Merkulov is intensely attentive when you talk to him, and although his phone dings constantly, he gives you the feeling that all his focus is on you. However much time you need. He says working with each patient “is a personal relationship.” And he means it.

All a woman needs to start this relationship is an order for a mammogram from her primary care doctor. She makes an appointment and fills out a short questionnaire when she arrives. Does she have a lump? Pain? Have any family members had breast cancer? Depending on her answers to the questionnaire and the results of her mammogram, the radiologists may recommend she come in for more frequent screenings or have a consultation with one of the genetic counselors.

After her low-dose mammogram, the woman dresses, gets her cookies and juice, and hears her results within 15 minutes. If she’s in a hurry, she can leave immediately and get a phone call within two days letting her know if she needs any follow-up tests.

Most of the time, those results are A-OK. The radiologist gives the all-clear and says, “See you in two years.”

Dr. Alex Merkulov

“We treat people the way we want to be treated,” says Dr. Alex Merkulov, head of women's imaging and a radiologist in the Beekley Imaging Center. The large screens in the Center's imaging suite allow radiologists to show patients exactly what they're seeing after a mammogram and explain why they are or are not concerned.

Intimate, Holistic Care

Only about 10% of women have something in the mammogram that might indicate a problem. When that happens, the radiologist recommends a follow-up ultrasound or a special mammogram to detect the calcium deposits that can signal early breast cancer.

“I’m a frequent flyer” at the Beekley Imaging Center, says a patient named Patricia. Because she’s at high risk for breast cancer, she’s had tests often over the last 10 years. At some places she’s had mammograms, “you go in a basement, you don’t talk to anyone, you get a letter a week later,” she says. But UConn Health is completely different.

When she first started going, they modeled her risk. Patricia’s was off the charts, so they had her meet with a medical oncologist at the Carole and Ray Neag Comprehensive Cancer Center who specializes in breast cancer to discuss preventive options. After examining Patricia’s history in detail, the oncologist, Dr. Susan Tannenbaum, advised her that actually, she didn’t need to proceed with preventive medical oncology. On other visits, the radiologist has invited her into his office to view the mammograms displayed on big screens so he can show her exactly what he sees and explain why he is or isn’t concerned.

“They give you a lot of information in a caring way,” Patricia says. “I have too much going on to have my primary care doctor and OB/GYN booking appointments randomly — I need a team treating me holistically. This feels like intimate care from really great doctors.”

That focus on intimate, holistic care is evident even when a woman has a benign breast condition. Women with breast pain, breast infections, fibroadenomas, and other lumps that aren’t cancer see Dr. Dana Scott, an OB/GYN who specializes in benign breast conditions. The benign breast disease program she leads is unique in the area.

“I try to really listen to my patients and spend the appropriate amount of time with them to hear all their concerns,” Scott says. Sometimes the women need treatment, sometimes even surgery. But just as often, it’s the care and attention they get that is the most valuable. For “a lot of patients who are really worried they have breast cancer and they don’t, having someone who can listen to them, examine them, and provide follow-up is really important,” Scott says.

Not All Women Are the Same

But what if a woman’s breast condition isn’t benign? If the follow-up scans reveal something that looks suspicious, the radiologists discuss the findings with the woman and advise her to come in for a biopsy, scheduled at her convenience for some time in the next day or two.

The tissue from the biopsy is evaluated by Dr. Poornima Hegde, a UConn Health pathologist who specializes in breast disease. A cancer diagnosis is only as precise at the pathologist who evaluates the suspicious cells, and Hegde is an expert. She looks at breast tissue all day, every day, and can make the call between cells that are just a little weird versus cells that mean malignancy.

“We try to reduce the ambiguity: either you’re OK, or you’re not,” says Merkulov, the radiologist. “Poornima is a godsend.”

If Hegde and the radiologists agree the woman has a cancerous mass, they spring into action. They contact the breast cancer nurse navigator and, often, the team’s social worker and bring them in to discuss the results of the biopsy with the patient. The nurse navigator will call the patient and answer any preliminary questions she has. The navigator also tries to identify any hurdles or barriers the woman might have to overcome to get treatment.

“You need to understand where people are coming from: people may have the exact same diagnosis but very different resources,” says Wendy Thibodeau, RN, one of the nurse navigators who works with breast cancer patients. Thibodeau speaks plainly, and intuitively grasps what you’re really asking with a question. Her role as a navigator is to coordinate care for the patient, offer her emotional support, evaluate any barriers to treatment, and help her get to the next step. She gives every patient her cell phone number and tells them they can call her anytime. Often, they call her to ask her to remind them what the doctor said, what they need to do. But other times, she must talk them down.

“Sometimes we have a patient whose first instinct is ‘Cut it off! Cut it out of me!’” Thibodeau says. “I have to call her and explain you can’t just cut; you need to do lots of tests to understand what we need to do to treat this.” Sometimes a woman will need chemotherapy before surgery to shrink the tumor. The nurse navigator can fit the woman for a cold cap to preserve her hair and meet her on the first day of chemotherapy for support. Or she might need other tests or treatments, and the nurse navigator can explain those and help her through them. Not all breast cancers are the same.

And not all women are the same, nor do they have the same needs. Both these points were highlighted during a tumor board meeting this summer.

The tumor boards are weekly meetings between the medical oncologist, the surgeons, the radiologists, pathologist, the nurses, and the social worker. Radiation oncologists, plastic surgeons, genetic counselors, and any others involved in the patients’ care also join. They discuss their cases that week. Typically, the radiologist will start off, to show the extent of the cancer in the breast and whether they believe it has spread. The pathologist will share and confirm with the team what she’s found.

The medical oncologist will discuss the best approach, the type of treatment this cancer responds to best, whether the patient will need chemotherapy. The surgeons consider the type of excisions they can offer the patient. The discussion about treatment is often collaborative, with the surgeons, radiologists, medical oncologist, and geneticists all weighing in. They also discuss cases post-surgery; did they find what they thought they would? Should treatment change
in any way?

Dr. Christina Stevenson

Dr. Christina Stevenson, surgical oncologist and breast program head, in the operating room.

The Road to the 'All-Clear' — and Beyond

And then there was a patient we’ll call Deborah. She was a 43-year-old single mother. She needed to come in for surgery, and soon. But she had no one to take care of her children for the 24 hours or so she would need for surgery and recovery. Everyone was worried about her.

Dr. Christina Stevenson, the surgical oncologist and head of the breast program at UConn Health, was the first person to bring up Deborah’s childcare predicament. She’d seen her the day before.

Typically, when Stevenson meets with a patient who needs surgery, they discuss surgical options: just the lump, or the whole breast? Perhaps the woman wants a reduction done at the same time, or implants put in for reconstruction, or her own tissue used instead of implants. Stevenson often consults with a plastic surgeon, and she does what is called oncoplastic surgery.

“I always try to preserve the breast in a lumpectomy to have the same size and shape we started with,” she says. “People worry they’ll have a divot. But we can move tissue around to help with the appearance.” She also has a few technological tricks, like the Biozorb sitting on her desk. It looks like an inch-long spring made of clear plastic. It’s actually resorbable suture material, studded with little metal clips. The sutures give a scaffold for the tissue to regrow upon, while the metal clips show up on a CAT scan or mammogram and help to focus radiation treatments, as well as follow-up in the future.

Stevenson is very calm describing all this; talking to her about breast surgery is almost soothing. Above her desk is an excerpt of a Christian prayer often attributed to Mother Teresa: “Dear Lord, Give skill to my hand, clear vision to my mind, kindness and meekness to my heart. Give me singleness of purpose and strength to lift up a part of the burden of my suffering fellow man.”

Stevenson brought up Deborah’s case at the tumor board. The social worker and nurse and community navigators stepped in. Although it’s more common for the community navigators to set up rides to appointments, provide gas cards, or fit patients for a nice wig, their goal is to make it possible for women to get treatment. The social worker focuses on psychosocial needs, and here was a woman with very limited social support. The social worker spoke with Deborah often, exploring who could care for her children within her family and community. Eventually Deborah worked past her anxiety and began to make concrete decisions. After much discussion, she found it in herself to speak with her sister and ask for assistance in caring for her kids while she was in recovery. Her friend drove her to and from surgery. Thanks to everyone stepping up, Deborah was able to successfully complete the initial phase of her treatment.

After surgery, Stevenson follows up with the patient at 1.5 weeks, then three months, then every three to six months for two years, often alternating visits with the medical oncologist. Then, if all is well, the patient comes back for yearly mammograms for life. She comes in for her scans and her cookies and juice and, hopefully, gets the all-clear. And if not, then Stevenson and the rest of the team at UConn Health’s breast program will help her take care of it.

“Because breast cancer is fairly easy to treat, typically. Especially when we catch it early,” Stevenson says. “And when we do regular mammograms, we catch it early.”

Nurse navigators and nurses like Minal Dave, RN, often offer patients emotional support.

Nurse navigators and nurses like Minal Dave, RN, often offer patients emotional support.

Unparalleled

By Chris DeFrancesco

Dr. David Choi

Dr. Choi points out spinal tumors needing critical care.


When a man in his sixties recently went to UConn John Dempsey Hospital after four days of severe back pain, an MRI revealed a rapidly growing spinal cord tumor that was placing extreme pressure on his spine.

He was sent straight to the emergency department where Dr. David Choi, the only neurosurgeon in Connecticut with fellowship training in spinal oncology, met him.

But not for the first time.

“Because we’re local, I had been seeing this gentleman for months before this tumor problem arose, so I already knew who he was, I already knew what treatments he was going through, I knew his general attitude about the quality of life that he would want for himself,” Choi recalls. “Now thankfully he did not have any neurologic deficits, but there was just so much compression on the spinal cord that I didn’t want to wait for anything bad to happen.”

Right away — in the middle of the night — Choi operated to decompress the tumor and stabilize the spine with rods and screws.

“The decision to do surgery was a no-brainer for both of us,” says Choi. Before Choi, the product of an elite complex spine surgery fellowship at Brown University, arrived at UConn Health, patients like this one had to travel to Boston or New York City for the same level of fellowship-trained expertise.

Having a comprehensive spine surgery specialist like Choi provides “real-time coverage — you’re getting things done right as they happen, and that gives the best chance for improved outcomes,” he says.

It’s an example of a patient already under the care of familiar providers being able to stay at UConn Health for continuation of that care, including treatment by a spine surgeon with unique subspecialty training in treating spinal tumors.

“In some cases, tumors cannot be entirely removed, requiring further treatments after surgery, such as chemotherapy and/or radiation therapy, coordinated by oncologists and radiation oncologists,” Choi says. “In cases of metastatic tumors, other surgical tumor specialists may continue their involvement in treating the primary tumor.”

Spinal tumors can metastasize to the spine or originate in or around the spinal cord or in the vertebrae. A tumor in the bone can cause fractures and a partial collapse of the spinal cord. In extreme cases, fractured pieces of bone may affect the spinal cord and cause neurologic deficits such as limb weakness or incontinence. Similar neurologic defects can result from a tumor in or around the spinal cord, which can compress the spinal cord or the nerve roots that exit it.

“The possible permanence of these deficits makes surgery necessary,” Choi says. “If you’re not able to walk around, or if you have bowel or bladder issues, that’s a pretty big impact on quality of life for the rest of your life.”

Choi says the opportunity to shape spinal oncology care at UConn Health is what drew him to Farmington.

“Few physicians will have a chance to help develop a new division in a well-established institution,” he says. “UConn Health is poised to become a leading destination center for a wide variety of neurosurgical conditions, and spinal oncology is a field that will serve our community and state well.”

Choi’s addition is a cornerstone of the vision of Dr. Ketan Bulsara, chief of the Division of Neurosurgery, to expand UConn Health’s neurosurgical care offerings and make UConn a world-class destination center.

“Dr. Choi’s expertise adds to the excellent work that was already being done at UConn Health in collaboration between neurosurgery and orthopedic surgery through our comprehensive spine center,” Bulsara says. “His level of training allows him to offer a unique perspective and potential treatment options for spine/spinal cord tumors.”

It also adds to a multidisciplinary team of spine surgeons at UConn Health.

“The recruitment of his talent and clinical expertise buttresses the vision of our comprehensive spine program,” says Dr. Hilary Onyiuke, neurosurgical director of UConn Health’s Comprehensive Spine Center.

The elite skill of the growing neurosurgery program is expanding in other ways as well.

Dr. Kevin Becker recently came from Yale to build a neuro-oncology program in collaboration with the Department of Neurology and the Carole and Ray Neag Comprehensive Cancer Center. Bulsara says the arrival of Becker “continues to build on our collaboration with the Preston Robert Tisch Brain Tumor Center at Duke, bringing an additional dimension to our treatment paradigm.”

Dental Researchers Attack Painful Chemo Side Effect

chemo patient

An estimated 400,000 U.S. patients undergoing chemotherapy and radiation therapy each year develop painful mouth sores known as oral mucositis. Researchers across UConn are attacking this common side effect from several angles, with one team working to understand the root causes of the ulcers and another developing a better way to treat them.

Cancer drugs break down the mucous membranes lining the mouth, called oral mucosa, inducing painful lesions that can cause difficulty talking, swallowing, and eating. The pain can become so severe that patients require feeding intravenously or through a stomach tube. Other risks to patients include slower healing, decreased resistance to infection, and general failure to thrive. Secondary infection and potentially life-threatening systemic sepsis have also been reported.

While the pain that oral mucositis causes is certainly of great concern, perhaps the most harmful impact occurs when patients are in such extreme agony that their attending physicians have no choice but to prescribe undesirable dose reductions or treatment breaks in cancer therapy.

One UConn School of Dental Medicine research team published in Springer Nature’s Microbiome the most comprehensive study to date about the patho-physiology of oral mucositis in humans due to the effects of chemotherapy.

The team, led by Dr. Patricia Diaz, associate professor in the Department of Oral Health and Diagnostic Sciences, found that patients who developed the most severe lesions showed suppression of beneficial mouth bacteria and outgrowth of harmful ones.

Further studies are needed to understand which specific microbiome components are detrimental and in what manner they affect the oral mucosa’s ability to withstand a chemotherapy challenge.

Meanwhile, Dr. Rajesh Lalla, professor of dental medicine, is collaborating with UConn Board of Trustees Distinguished Professor of Pharmaceutical Sciences Diane J. Burgess, graduate student Tingting Li, and drug design firm Cellix Bio to develop a new, long-acting topical anesthetic that he hopes will someday replace current methods of treating oral mucositis.

The current first-line therapy at most U.S. hospitals is a mouth rinse containing the local anesthetic lidocaine, providing about 30 minutes of relief. The rinse numbs the entire mouth instead of focusing specifically on the sores, which poses safety concerns since it can inhibit the swallowing reflex. Patients are also often prescribed systemic opioids to treat the pain.

The team has developed an innovative formulation and novel patented compound that allows a long-acting topical anesthetic to be applied directly to sores. The researchers expect the more potent anesthetic should relieve pain for about four hours, eight times as long as the standard mouth rinse.
The compound also exhibits antimicrobial and anti-inflammatory effects naturally delivered by the medium chain fatty acid, which could reduce the severity of lesions from oral mucositis, says Lalla.

Lalla and his collaborators believe they are one to two years away from clinical trials in humans.

Better Urologic Cancer Detection

Dr. Ben Ristau uses ultrasound to guide a transperineal prostate biopsy.

Dr. Ben Ristau uses ultrasound to guide a transperineal prostate biopsy.


UConn Health urologists are at the forefront of new and improved approaches to detecting prostate and bladder cancer, the first and fourth most common forms of cancer among men.

When a patient needs a prostate biopsy, the urology team is among the first in New England to practice a new method called transperineal prostate biopsy, which offers distinct advantages in safety and precision over previous protocols.

Historically when a biopsy was needed, urologists would pierce the rectal wall with a needle to take a biopsy of the prostate. Known as a transrectal biopsy, the procedure carries a small but real risk of infection. Roughly three out of every 100 men who undergo a transrectal biopsy end up in the intensive care unit with sepsis, a potentially life-threatening condition related to the body’s response to infection.

“The other problem with the transrectal approach is the difficulty accessing some portions of the prostate,” says Dr. Peter Albertsen, chief of UConn Health’s Division of Urology. “The angle of the biopsy needle traversing the probe makes it hard to hit the apex of the prostate. With the transperineal approach, we are finding it much easier to access regions of the prostate which historically have been difficult to reach with a transrectal probe.”

With transperineal biopsy, the needle that retrieves the tissue sample goes not through the rectum but the soft tissue just outside and past it, guided by the latest ultrasound technology for a clear, real-time view.

“Fortunately there are no nasty blood vessels, there are no nasty nerves, and it’s a straight shot to get” to the prostate, Albertsen says. “And by not going through the rectum, we anticipate the risk of sepsis going to zero.”

For bladder cancer detection, the urologists are the first in central Connecticut to use a new blue light cystoscopy technology to illuminate tumors in the bladder and identify smaller cancers earlier than ever before.

Certain tumors are hard to detect using traditional white light cystoscopy, but turn pink under the enhanced imaging provided by the blue light.

“Recurrence rates for bladder cancers are somewhere in the 50–70% range. Using blue light cystoscopy, depending on the tumor type, can reduce the risk of recurrence by about 40%, which means fewer trips to the operating room,” says Dr. Benjamin Ristau, UConn Health’s surgical director of urologic oncology.

Making the Connection

By Stacey Mancarella

Illustrations by Yesenia Carrero

illustration of photos of unconnected symptoms

A rare but debilitating condition, hereditary amyloidosis (hATTR) presents as seemingly unrelated illnesses that mask the root cause. But increased awareness and new treatment options bring hope for sufferers of this devastating genetic condition.


We hear of it too often in health care. Even with the most diligent doctors and patients, sometimes figuring out the correct diagnosis of a rare medical condition can be a challenge.

Unexplained weight loss and diarrhea. Shortness of breath during exercise. Carpal tunnel syndrome. Weakness and difficulty balancing that gets progressively worse. Tingling or numbness in the hands and feet. Symptoms like these point to different culprits, bringing patients to a variety of specialists and glimmers of hope as they find potential answers. But treating one symptom doesn’t help the others, and everything gets worse.

This particular collection of ailments, among other symptoms, points to hereditary amyloidosis (hATTR), a devastating genetic disease that, up until recently, was considered untreatable. Dr. Fernanda Wajnsztajn is all too familiar with the plight of her patients who have searched in vain for a diagnosis. A neurologist at the UConn Health neuropathy clinic, Wajnsztajn specializes in peripheral neuropathy, damage or disease of the peripheral nervous system.

“Because some of the symptoms of hereditary amyloidosis are also seen in a variety of diseases, some of my patients went to several doctors for years until hATTR was suspected,” she says. “With a detailed history, we are also able to trace the heritage of patients, and, often, patients realize during the interview that some their relatives also have similar symptoms.”

Now these families have options. New drug treatments have been approved to treat neuropathy, the nerve pain, tingling, or numbness that’s a symptom of this little-known disease, and doctors at UConn Health have assembled a team to tackle hATTR head on.

Interpreting the Evidence

Wajnsztajn has been aware of hATTR since her days at Columbia University, where she was involved in research and clinical trials for hATTR therapies. Only about 50,000 people worldwide are affected by hATTR, “but we suspect that many cases go undiagnosed or misdiagnosed,” Wajnzsztajn says. “Our goal is to reach those people.”

Hereditary amyloidosis is caused by a hereditary mutation of the TTR gene. If one parent carries the gene mutation, offspring have a 50 percent chance of inheriting the disease. Hereditary amyloidosis wreaks havoc on the body by depositing amyloid proteins into organs, most commonly the heart, nerves, and digestive tract. These deposits cause the organs to function improperly, which eventually leads to a myriad of debilitating symptoms.

Even though the gene mutation is present at birth, most patients don’t experience symptoms until well into adulthood. And even once symptoms start, it can take years for a proper diagnosis.

“Hereditary amyloidosis is not a well-known disease. The patient can present with a history of heart problems and receive a diagnosis of polyneuropathy, but if the doctor isn’t familiar with it, they won’t put it together. It’s easy to miss,” Wajnsztajn says.

For example, two of the most common symptoms of hereditary amyloidosis are carpal tunnel and cardiomyopathy, or heart muscle disease. Because these two diseases are seemingly unrelated and treated by different kinds of doctors, hereditary amyloidosis can go undetected. The average delay in diagnosis is four years, and in that time, amyloid is continuously deposited into the affected organs, causing symptoms to worsen.

Even with the new treatments, a timely diagnosis is important as the medications cannot reverse the symptoms but only prevent further protein deposits that cause the condition to worsen. The earlier a patient can be identified and a course of treatment initiated, the slower the disease will progress.

Dr. Fernanda Wajnzsztajn (left) and Dr. Sarah Tabtabai discuss a patient case.

Dr. Fernanda Wajnsztajn (left) and Dr. Sarah Tabtabai discuss a patient case.

Case Closed

UConn Health’s multidisciplinary approach can shorten this delay, giving patients relief sooner and stopping hATTR in its tracks. Cardiologists at the Pat and Jim Calhoun Cardiology Center work hand in hand with neurologists from the peripheral nerve disease clinic to examine a patient’s symptoms, get that crucial neuropathy or polyneuropathy diagnosis, and schedule them for genetic testing to confirm a hATTR diagnosis. Once the diagnosis is confirmed, treatment can begin very quickly, and the deposition of amyloid into the organs is halted within weeks — sometimes within days — thanks to neurologists, cardiologists, neuropathy testing, and an infusion center to administer treatment being all in one place.

Two treatment options currently exist, one that’s infused intravenously every three weeks, the other given by weekly subcutaneous injection. These new treatments work by inhibiting the body’s ability to create the amyloid protein. They reduce the amount of the protein the liver can make by 84 percent, improving the patient’s quality of life. Clinical trials are ongoing, with the hope that such medications can treat other types of amyloidosis as well.

“Before medicines like this came along, there was really no therapy for this particular heart disease. It’s progressive and very debilitating, and the hereditary type, in particular, occurs in younger people,” says Dr. Sarah Tabtabai, cardiologist at the Pat and Jim Calhoun Cardiology Center at UConn Health.

Previously attempted treatments for hATTR symptoms were drastic, sometimes including heart transplants or heart and liver transplants, Tabtabai says. But with the new medications, “patients have had good outcomes with both their neurologic disease and their heart disease, and it sort of keeps things at bay.”

Close collaboration between the departments makes everything go smoothly for patients who have already waited so long for answers, says Wajnsztajn.

“We work very closely with cardiology to obtain the appropriate exams for diagnosis as quickly as possible. Despite being a challenging or daunting diagnosis, our patients feel fortunate that they finally have answers, and we are able to provide the most advanced treatments along with the support necessary,” she says.

Because of the high rate of misdiagnosis, the companies that produce the new medications are currently offering free screenings for patients with suspected hereditary amyloidosis. A patient simply has to schedule the genetic test at UConn Health, and the billing is handled directly through the hospital, creating a streamlined process for the patient.

Early diagnosis of hATTR can also bring awareness to family members who might be afflicted.

“Once a patient is diagnosed with hereditary amyloidosis, we can test blood relatives as well to identify any members of their family who may also have this disease,” Tabtabai says. “The hope is that, down the line, we can offer medications like this sooner, before patients become symptomatic or right at the onset of symptoms so that they fare even better as time goes on.”

Taking Control

By Delker Vardilos

Photos by Tina Encarnacion

UConn Health is the first hospital in New England to use a new robotic technology to diagnose lung cancer sooner, getting patients the treatment they need and saving lives.

Product images courtesy of Auris Health

Lung cancer kills about 150,000 Americans each year. But when it is detected early, survival rates improve exponentially. UConn Health is the first hospital in New England to use a new robotic technology to diagnose cancer sooner, getting patients the treatment they need and saving lives.


Supporters of U.S. Supreme Court Justice Ruth Bader Ginsburg breathed a collective sigh of relief this winter after two cancerous nodules were successfully removed from her left lung through a lobectomy. Ginsburg’s cancer was found during the routine testing done after the fit 85-year-old fractured several ribs in a fall, and for a moment the diagnosis cracked the seemingly invincible façade of the octogenarian icon.

Although Ginsburg’s cancer was found by chance, her story is a great example of how early detection and swift action can improve the likelihood of survival for lung cancer, the deadliest cancer for both men and women in the U.S. by a wide margin. More people die of lung cancer each year than of colon, breast, and prostate cancers combined, and more than half of people with lung cancer die within a year of being diagnosed, according to the American Lung Association.

“The accuracy of this is going to pan out to be second to none. I think this is the tip of the iceberg in diagnosis.”

But when the cancer is detected early, before it spreads beyond the lungs, the five-year survival rate jumps from 5 percent to 56 percent. The problem is, just 16 percent of lung cancer diagnoses come at an early stage, American Lung Association statistics show. Since lung cancer is the second most common cancer in both men and women, proper screening for those at risk could save tens of thousands of lives.

A revolutionary precision technology now at UConn Health is making early diagnosis easier than ever.

UConn Health is the first hospital in New England and among the first in the nation to offer robotic bronchoscopy on the Monarch platform from Auris Health, allowing physicians to quickly diagnose lesions detected through low-dose CT scans, including those that are small or in hard-to-reach parts of the lung.

“Before this technology, the targets would’ve had to be bigger. I wouldn’t be able to make certain angles without the robotic arm to navigate,” says Dr. Omar Ibrahim, UConn Health director of thoracic oncology and interventional pulmonology. “I have a higher degree of confidence and accuracy with this than with prior equipment.

“The ability to diagnose the cancers at an earlier stage will allow us to surgically manage the disease,” he says. “This is the only chance for a cure.”

probe snaking through lung

The Monarch platform’s advanced, precision endoscope allows physicians to access hard-to-reach parts of the lungs and their bronchi and to diagnose lesions earlier than ever before.

With its user-friendly, video-game-style controller, the Monarch platform allows the physician to move the endoscope up and down, left and right, forward and backward through a lung and its bronchi. Buttons on the controller make the scope of view bigger or smaller, while others control suction or irrigation. Procedures are done in the operating room under general anesthesia. Within about an hour, the doctor will biopsy the suspicious nodule and a lymph node for analysis by a pathologist. The patient can go home the same day.

If cancer is confirmed in the lung, it will then be staged to see how far it has advanced. A team of cancer specialists then develop an individualized treatment plan that is ideal for the patient and their specific type and stage of cancer. A patient’s treatment plan might include surgery to remove a small portion of the lung or the entire lung, radiation therapy, chemotherapy, medications,
and immunotherapy.

Not only does earlier diagnosis improve patients’ chances for survival, but it also helps reduce unnecessary stress, says Wendy Thibodeau, the lung cancer nurse navigator at UConn Health’s Carole and Ray Neag Comprehensive Cancer Center.

“We have had patients where initial and subsequent biopsies are inconclusive. A decision then has to be made: remove the nodule surgically, or watch it for growth,” Thibodeau says.

“This can be stressful on a patient. They either have to go through a significant procedure they may not have needed or wait to see if the nodule gets worse. This technology will give us better accuracy for appropriate tissue sampling, making the decision more clear.”

A revolutionary precision technology is making early diagnosis easier than ever.

Routine screenings of high-risk patients — those with histories of smoking, especially — using low-dose CT scans and minimally invasive techniques help detect lesions and diagnose more people all the time.
The Monarch platform is the next step in improving outcomes for lung cancer patients, and Ibrahim sees even more groundbreaking advances on the horizon.

“Within the next year or two, this technology should allow us to treat lesions with radiofrequency ablation [a minimally invasive procedure that uses heat to destroy cancer cells],” Ibrahim says. “Diagnosis and treatment could be done all at the same time.”

In his time at UConn Health, Ibrahim has worked to improve the experience of UConn Health’s lung cancer patients, particularly through a multidisciplinary team that allows patients to come to one clinic to see a variety of doctors.

“Since we’ve enhanced and personalized the way we care for lung cancer, the number of lung cancer patients at UConn Health has quickly increased,” says Ibrahim. “Time to diagnosis and treatment is tremendously shorter, and patients are happier with the quality of their care.”

He believes the robotic bronchoscopy technology will allow the team to deliver even better results.

“The accuracy of this is going to pan out to be second to none,” says Ibrahim. “I think this is the tip of the iceberg in diagnosis, and the therapeutic aspect of it, which will evolve over time, is really exciting. Being at the forefront of that is amazing.”

Dr. Omar Ibrahim, UConn Health director of thoracic oncology and interventional pulmonology, demonstrates the Monarch technology.

Dr. Omar Ibrahim, UConn Health director of thoracic oncology and interventional pulmonology, demonstrates the Monarch technology.

MRIs Now Offered on UConn Storrs Campus

MRI service manager Elisa Medeiros prepares a patient for functional MRI testing at the Brain Imaging Research Center in Storrs.

MRI service manager Elisa Medeiros prepares a patient for functional MRI testing at the Brain Imaging Research Center in Storrs.


UConn Health patients in eastern Connecticut will now be able to get MRI scans done in Storrs just as if they were at UConn Health in Farmington, thanks to a collaboration between doctors and researchers at the two campuses.

UConn’s Brain Imaging Research Center (BIRC) houses a powerful 3 Tesla Magnetic Resonance Imaging (MRI) scanner that was installed in 2015 and originally dedicated purely to research. The BIRC’s machine can take detailed pictures of fine structures in the brain, do functional MRI, and spot tiny flecks of blood that might signal a concussion or spine injuries. But the state had not previously licensed the BIRC’s machine to perform medical work.

“Soon after I started as chair, it became clear we had a long history of our UConn Husky athletes having scans done on the outside. But then their docs would bring the scans to us for a second read because they trusted us,” says Dr. Leo Wolansky, head of radiology at UConn Health. “It’s our moral obligation to take care of our own people,” but it was a lot of unpaid work too, he observes.

When we read the scans, it’s no different than if patients were down the hall.

Wolansky worked with the team at BIRC, along with regulatory and business development staff at UConn Health, to get permission from the state to use the center’s machine for medical imaging. The machine was set up to run clinical scans, and hardware was installed to transmit medical data securely from the BIRC, which is located in the Phillips Communication Sciences Building in Storrs, to UConn Health in Farmington.

UConn Health doctors can now schedule MRIs for their patients at the BIRC in Storrs for Monday and Wednesday afternoons as easily as if they were going to the imaging center in Farmington. Urgent scans can be squeezed in at other times on a case-by-case basis. The BIRC capacity will free up some space at UConn Health, bringing new patients into the system, and is not expected to impact research done at the center at all.

“The biggest benefit is the integration between campuses. It’s a huge success for us to do this,” says Fumiko Hoeft, the director of BIRC, noting that revenue from the scans will enhance the financial stability of the center.

Wolansky, who is based in Farmington, agrees.

“Even though [patients] may be 40 minutes away by car, when we read the scans [at the imaging center in Farmington], it’s no different than if the patients were down the hall.”

New Program Promises Speedy Evaluation for Cranial Nerve and Brainstem Disorders

UConn Health Center Outpatient Pavillion


UConn Health this winter established New England’s first Cranial Nerve and Brainstem Disorder Program, bringing together a multidisciplinary team of experts to streamline care for patients with such conditions.

Led by esteemed neurosurgeon Dr. Ketan R. Bulsara and ear, nose, and throat specialist Dr. Daniel Roberts, the team collaborates with specialists from nearly a dozen departments and will encompass clinical care, research, and teaching.

“One of the core principles of patient care at UConn Health is a multidisciplinary approach to providing personalized care to optimize patient outcomes,” Bulsara says. “The Cranial Nerve and Brainstem Disorder Program extends that core principle by bringing together world-renowned experts in their fields. We are fortunate at UConn Health to have such an accomplished team across so many different specialties that is willing to work together to provide the best care for our patients.”

The program guarantees rapid evaluation of patients, regardless of whether they were diagnosed recently or long ago. Patients or practitioners can submit a request through the center referral portal, which is staffed by Bulsara and Roberts. For neurosurgical or ear, nose, and throat issues, the patient will be offered an initial evaluation appointment that is within a week of their request.

If the cranial nerve or brainstem issue is not related to the ear, nose, and throat or a neurosurgical issue, the physicians will connect the patient with the appropriate service.

“To have patients be able to access care in a very timely and expedited fashion is key,” Roberts says. “A patient can call us and we’ll say, ‘We’ll see you within a week’ to get the ball rolling and help direct them through this complicated process.”

Areas of care include acoustic neuromas; blood vessel problems including aneurysms, arteriovenous malformation, and cavernomas; brain tumors; hemifacial spasm; meningioma; neurofibromatosis; skull base tumors; trigeminal neuralgia; and taste and smell disorders.

“Brainstem and cranial nerve disorders are quite rare, and often require experts from different areas for complicated issues,” Roberts says. “We’re excited about the future of this.”

Care is offered at UConn Health’s Outpatient Pavilion in Farmington and at its community clinics in Southington and West Hartford.

Visit the Cranial Nerve and Brainstem Disorders Program website for more information.

Advanced Aneurysm Stent Means Safer Treatment

Magnetic resonance image shows a cerebral artery aneurysm.

Magnetic resonance image shows a cerebral artery aneurysm.


A new minimally invasive procedure has emerged as a safe way to treat certain brain aneurysms, and UConn Health’s Division of Neurosurgery is among its earliest adopters. The advancement, based on a stent that’s been in use for a decade, is known as the Neuroform Atlas.

“It’s a microstent,” says Dr. Ketan Bulsara, chief of UConn Health’s Division of Neurosurgery. “Sometimes the anatomy may prevent the navigation of a larger stent into the appropriate target area. The advantage of the microstent is, given its small size and smaller equipment requirements, we may be able to get into areas that we couldn’t normally navigate.”

That ability further broadens the range of lesion types that can be treated through minimally invasive means. Most patients who undergo this procedure can go home the following day.

An aneurysm occurs when part of an artery’s wall weakens, causing the artery to bulge. Aneurysms are usually asymptomatic but in some cases can rupture and cause life-threatening internal bleeding. When this occurs in blood vessels leading to the brain, it causes a hemorrhagic stroke, which requires emergency care.

Once an aneurysm is detected, it is important to get an assessment for its risk of rupture as soon as possible. Bulsara says about a third of patients who suffer a ruptured brain aneurysm die, and another third who make it to the hospital don’t fully recover.

“We’re in a time right now where the technological advancements in devices and microsurgical techniques are being made so rapidly that it’s imperative, to maintain the best possible outcome for all of our patients, that we offer the latest, newest technologies that have been deemed safe,” Bulsara says. “Our use of this stent is another testament to that. It continues to add to our treatment armamentarium and increases the number of diseases we can treat safely.”

The first Neuroform Atlas stent placement at UConn Health was among the 20 cases neurosurgeons completed in UConn Health’s new hybrid operating room within the first month of its opening.

UConn Health First Hospital in U.S. with Augmented Reality Surgical Microscope

Dr. Ketan Bulsara and Dr. Daniel Roberts use the new augmented reality microscope

Dr. Ketan Bulsara and Dr. Daniel Roberts use the new augmented reality microscope in the hybrid OR at UConn John Dempsey Hospital.


UConn Health is the first hospital in the nation to acquire a high-tech surgical microscope with augmented reality capabilities to visually assist surgeons during complex neurological and spinal surgeries. This technology — the latest added to UConn Health’s state-of-the-art hybrid operating room — provides surgeons with an enhanced 3D visualization of the surgical field at the highest magnification possible. It can also illuminate the blood flow through various brain tissues, making more precise surgical interventions possible.

“The advanced augmented reality, image-guided microscope allows us to go beyond what we can normally see with our naked eye and traditional microscopes. It allows practitioners from multiple surgical specialties to treat even more complex lesions more safely,” says Dr. Ketan Bulsara, chief of the Division of Neurosurgery at UConn Health.

The microscope’s unique FusionOptics technology allows a surgeon to see greater anatomical detail with increased sharpness, such as the tiny distances between the smallest blood vessels and nerve structures, without needing to refocus the microscope. It also has the ability to brightly light up tiny blood vessels in the brain to distinguish them from other surrounding brain tissue, helping surgeons navigate the complex and delicate surgical field.

The microscope also includes a video camera that allows surgeons to choose one of three enhanced overlays to amplify the view of the surgical field. The three views are a real-time, highly magnified naked anatomy; a black-and-white, fluorescence-enhanced view to see greater tissue dimensions and blood flow; and a brightly colored, fluorescence-enhanced view of naturally colored anatomy to see the intricate blood flow and tissue outlines during a microsurgical procedure.

The ARveo Augmented Reality microscope is made by Leica Microsystems, a developer and manufacturer of microscopes and scientific instruments for the analysis of microstructures and nanostructures.