Spotlight

Spotlight on Services: Orthodontics

Dr. Flavio Uribe
Dr. Flavio Uribe, UConn School of Dental Medicine

Whether the need is for a straighter smile or better bite, the Center for Orthodontic Care at UConn Health, located in the 6th floor of the Outpatient Pavilion on the Farmington campus, is ready to offer a customized treatment approach. Dr. Flavio Uribe, interim chair of the UConn School of Dental Medicine Division of Orthodontics, is clinic director.

Why is a healthy smile so important, particularly in children?

Creating beautiful smiles that will have a lasting effect on the well-being of our patients is at the core of what we do as orthodontists.

Smiles are contagious and help to spread positivity and joy. Children’s perception of their smile can influence their self-esteem and psychosocial development. Having a beautiful smile can help patients look and feel better about themselves, which has a significant impact on multiple aspects of their life.

As orthodontists, we are always striving to provide unique and beautiful smiles to our patients, and we believe that every patient deserves to feel the self-confidence that results from orthodontic treatment.

What about the overall health aspects of orthodontic care?

While there are numerous aesthetic and psychosocial benefits associated with a beautiful smile, one of the fundamental principles of our profession is to create an oral environment that fosters proper function and overall dental health.

It is typically recommended that children begin seeing an orthodontist by the age of 7 to evaluate their growth and overall dental development. Starting at this age, there is a potential for intervention which can help prevent worsening of dental problems. This is also the age during which psychosocial development may be the most impacted.

What are some recent advances in care that the Center for Orthodontic Care can offer?

There have been many exciting developments in the field of orthodontics over the past couple of decades which have helped to broaden the scope of treatment we are able to provide as well as aid in providing faster, more efficient treatment. Advances such as 3D imaging, digital scanners, and the mainstream use of clear aligners are some of the ways in which we can treat a range of complex malocclusions (misalignment of the teeth or bite) that once may have been difficult.

The added benefit of innovation in orthodontics has been improving the ease and accessibility of orthodontic care, which continues to reach a broader spectrum of patients from what was once predominantly children and adolescents to more and more adults seeking orthodontic treatment.

We take pride in staying on the cutting edge of technology and research to provide our patients with the highest standard of orthodontic care possible.

How is it determined if a patient is a candidate for braces (or other orthodontic intervention)?

It starts with a screening examination to determine if the patient would benefit from braces. (There is no charge for this initial examination.)

If we determine the patient would benefit, the next step is a records appointment, where we do imaging work, take models of the teeth, conduct a thorough clinical exam, and review medical history.

From there we come up with a diagnosis and a treatment plan. Sometimes this can include surgical orthodontics first before we can proceed with braces. We then discuss the risks and benefits of the proposed treatment with the patient (and parent, when applicable), answer their questions, and if all are in agreement, we move forward.

What should we know about “invisible” braces?

Traditional braces involve metal or ceramic brackets or bands that are glued to the teeth. A wire runs through each one to gradually move the teeth over time, resulting in a corrected bite and/or smile.

An alternative to traditional braces is a clear-aligner treatment, commonly known as Invisalign. This treatment uses transparent orthodontic devices that are removable, although we recommend leaving them in all the time to get the desired results. As the brand name suggests, the aligners are nearly invisible, which makes this approach very popular. It can be a treatment option in many circumstances.

Learn more about orthodontic care at UConn Health, or call 860-679-2664 for an appointment.

Spotlight on Services: Transport

UConn Health transport aide Howard Fairley brings a patient to his hospital room. “I love the job. I give it all I got. I was hired on Valentine’s Day and fell in love with the job,” he says. (Photo by Kristin Wallace)

Often when patients come to the UConn John Dempsey Hospital, particularly for surgical procedures, the first and last people they encounter during their stay are the transport aides. UConn Health has 25 transport aides: nine full-time staff, 12 part-time staff, and four students. They are a unit within the Office of Logistics Management that works around the clock, and as such, are considered Level 1 (essential) staff.

Describe the role of transport aides and how they fit into our care delivery mission?

“First and foremost, they’re transporting inpatients,” says Alex Schwarz, who supervises the transport aides. “They’re also moving specimens, they’re getting and moving equipment (such as stretchers or wheelchairs) when it’s needed, they’re rounding, they’re responding to Code Blues, Rapid Response Team calls,  in addition to the massive transfusion protocols. Sometimes they’re the first ones to see the patients, and usually they’re the last people the patients talk to before heading home. They can leave a lasting impression of the care we offer here.”

“Even though they’re not treating patients, they play a vital role, in that they get the patients where they need to be for treatment,” says Logistics Management Director Jeff Boyko. “Whether it’s bringing patients down for CT scans or X-rays, or moving specimens and equipment, they focus on getting people and things where they need to go so our doctors and nurses can focus on patient care.”

“People are feeling sick, we’re trying to help them get better, so they can move on,” says Howard Fairley, who, in his third decade in the role, is UConn Health’s most veteran transport aide. “We do whatever we need to do as far as transporting them, and then help the nurse do all that she does, so we can get this patient down to the doctor and it all can run smoothly and safely.”

“Any patient or anything patient-related, we’re here to move,” Schwarz says. “We averaged 169 transports per day in December.”

UConn Health transport aides (from left): Howard Fairley, Anna Kustra, Brian Schramm, Gabriela Buksza, Sean Reynolds, and Gwen Williams
UConn Health transport aides (from left): Howard Fairley, Anna Kustra, Brian Schramm, Gabriela Buksza, Sean Reynolds, and Gwen Williams (Photo by Alex Schwarz)

What are their qualifications?

“Our transport aides are CPR-certified,” Schwarz says. “They go through crisis prevention intervention (CPI) training, which teaches them to recognize the signs of patients or visitors who may go from exhibiting normal behavior to becoming agitated, then agitated escalating to aggressive, then aggressive to violent; it teaches them what to do to keep themselves safe and to try de-escalate the situation.”

“We also look for people with experience in a hospital or clinical setting, transporting patients, transitioning them from different modes of transport. They also have experience with the equipment, such as patient lifts, and they are trained in safe patient handling and two-step identification to verify they’re moving the correct patient.”

“You try to make the patients feel comfortable in a sick situation,” Fairley says. “You try to feel them out first, to see how you can uplift their spirits, to make them feel that this is going to be OK.”

What are the most rewarding/challenging aspects of the job?

“I really enjoy the patients,” Fairley says. “I try to come across friendly and easy to talk to, and I want them to feel that way, to help them feel more at ease about their medical situation.”

“There was this one older gentleman who had heart surgery, and he was just fretting, saying he was going to die. I spoke to him, I said, ‘Life and death is about your tongue. Speak life, and live!’ Four days later, he was so happy, when I saw him he said, ‘Hi, my friend!’ I get joy out of seeing that. It’s all about the patient. That’s pretty much the way we do it.”

“It can be a challenge when the patient doesn’t really want to be here, but that’s understandable. When a patient’s not nice, you’ve got to find your way around that and not take it personally. They’re sick, they’re hurting, they may be angry, they may receive bad news from the doctor. When someone gets a bad report, or doesn’t make it, those are some of the things you deal with. It weighs on a person to see stuff like that.”

What’s an example of when the transport aides are moving something other than patients?

“When someone’s in the O.R. for a surgery or a mother’s giving birth, if the patient starts losing blood, UConn Health has a massive transfusion protocol,” Schwarz says. “Many departments are notified, including ours. Transport’s role is to go get the requisition for the blood, haul up to the blood bank, get that blood, and run back and forth with the blood, which obviously is a pretty critical component.”

How far back does the role of transport aide go, and what has changed?

“Transport goes back to the start of the hospital and used to be a function of what today we call Facilities Management and Operations,” Schwarz says. “It was under Nursing for a while, and in 2013 it came under Logistics Management.”

“The job has remained pretty much the same over the years in terms of responsibilities. But the way that we log the calls and the way that we track performances have changed throughout the years. When transport moved to logistics, they were logging all the calls that came through. We had someone dedicated to answering the phone, taking all the calls and handwriting all of the calls that came through on a log, and then they were going into Excel after the fact and they were transcribing everything that was written into the log. Then we moved toward having an Excel log, in which they directly entered the information. We had all kinds of formulas set up in the spreadsheet, and we gained some efficiency and reporting capabilities. And now we’ve moved to UConn HealthONE, so we don’t even have that person sitting on the phone anymore. That individual is basically an on-shift lead person who’s actually out there helping with the calls, which I think has proven to be beneficial. On average, 97 percent of the calls are completed within 16 minutes of being requested. Before HealthONE the average would fall between 20 to 23 minutes.”

How do we request a transport?

“Basically anything patient-related that needs to be transported within the hospital should be placed into HealthONE,” Schwarz says. “Everyone should have access to place patient and non-patient transport requests. Our transporters sign in to HealthONE, which assigns them to the calls on a rotating basis, subject to availability.”

Spotlight on Services: UConn NeuroSport

Dr. Anthony Alessi on sideline at Rentschler Field
Dr. Anthony Alessi is director of UConn NeuroSport in Downtown Storrs. (Peter Morenus/UConn Photo)

Whether an athlete suffers a traumatic brain injury (TBI) or a persistent neurologic condition, he or she can turn to UConn NeuroSport for diagnosis, treatment, and rehabilitation. Located in downtown Storrs and part of UConn Health Orthopedics and Sports Medicine, NeuroSport enlists multiple specialties to deliver personalized care. Dr. Anthony Alessi, a neurologist who specializes in sports medicine and neuromuscular disease, is the director of UConn NeuroSport.

Dr. Anthony Alessi, UConn NeuroSport

What kinds of conditions do you see at UConn NeuroSport?

Although everyone is focused so much on concussion and head injuries, and rightfully so, we also take care of athletes with other neurologic injuries, like migraine headaches, epilepsy, and multiple sclerosis. We’re not limited to high-velocity contact sports. Other athletes – runners, non-contact sports athletes, any of those who they feel have a neurologic problem, whether it be acute or chronic – we’re happy to see, even if it’s just to give them a second opinion. Or people who are getting symptoms, as they’re running they’re starting to develop neurologic symptoms, we’re happy to see them.

Who are your candidates for care?

We see all ages, including high school and younger, from throughout the region, including other states. We have elite athletes who fly in and stay at the hotel out here, at the Nathan Hale Inn, and will stay for several days. We put them through the regime based on what we see and who they’re going to see next in the same day. If we need imaging we get that done quickly – we’re now able to do MRI imaging here. We have everything right here in Storrs, including athletic fields to assess athletes on. It’s exciting because it’s growing pretty fast.

What is UConn NeuroSport’s approach to care?

We are familiar with what medications need to be used that are legal, from the standpoint of performance-enhancing drugs, and we have to modify our treatment based on their performance. Some drugs that we would use typically for, say, migraine or epilepsy, will impair performance. Some will cause patients to gain weight, some to lose weight.

We look at all the neurological aspects of sport. When someone comes here with head injury, we typically look at that, verify the diagnosis, and then try to implement a program of getting them back to their sport, working with athletic trainers. It’s a multidisciplinary approach to getting an athlete back. It’s crucial to all of sports medicine, and neurology is no different. UConn, here in Storrs, is one of the few places where we do that through the Department of Orthopedics and Sports Medicine. We’re a growing of group of subspecialists within neurology who do sports.

Which other specialties are involved?

We work with primary care sports medicine specialists, orthopedic surgeons, physical therapists, and athletic trainers.

Who refers patients to UConn NeuroSport?

We get most of our referrals from athletic trainers. When you’re an athletic trainer for a team, your job is to get that athlete back as quickly and safely as you can. Those are the people who are closest to the action.

Second to them are primary care physicians, who evaluate their patients and then send them to us when appropriate. Anytime a physician is faced with a patient who they’re not able to get back in a timely fashion, or they keep meeting obstacles with, those are the people we want to see.

We have athletes with neurologic conditions who compete at the highest level of sport. Who would even imagine that someone could be playing at the highest level of their competitive sport with a diagnosis of multiple sclerosis? But that is going on.

More information about UConn NeuroSport is available at health.uconn.edu/orthopedics-sports-medicine/specialties/neurosport.

Spotlight on Services: Diabetes Education

UConn Health diabetes educators
From left: UConn Health certified diabetes educators Lori O’Keefe-Fomenko, Rebecca Santiago, Linda York, and Jean Kostak (Photo by Kristin Wallace)

Diabetes educators are an essential part of the care team for people with diabetes. The UConn Health Diabetes Education Program includes nurses and dietitians – some of whom are certified as diabetes educators (CDE) – as well as physicians, nurse practitioners, physician assistants, exercise specialists, social workers, and other health care professionals. All work together to ensure the best care and management of diabetes.

Jean Kostak, diabetes education specialist
Jean Kostak, UConn Health Diabetes Education Program coordinator

Jean Kostak is a diabetes education specialist and the program’s coordinator.

How do CDEs fit into the larger care picture?

CDEs are health professionals who work with providers to support patients’ day-to-day efforts managing their diabetes. We can be registered nurses, registered dietitians like myself, pharmacists, exercise specialists or social workers. We take the time to get to know the patients, help them develop a plan, and give them to the tools to take control of their diabetes. Part of that is, as our name suggests, educating patients about their type of diabetes and how it progresses through their lifetime.

What’s the most common question you get?

“What can I eat?” We probably get that the most. We work with patients to individualize their meal plan to help them meet their blood sugar goals and lose weight if needed. Often times they can still enjoy their favorite foods, in reasonable moderation. If you think about it, it’s really not that different than those don’t have diabetes, because really we all should be careful about what – and how much – we eat.

Rebecca Santiago, diabetes nurse educator
Rebecca Santiago, diabetes nurse educator
Linda York, diabetes nutrition educator
Linda York, diabetes nutrition educator

How do you help with the self-management of diabetes?

Good lifestyle choices go a long way in managing diabetes, and the cases of people who have prediabetes, good lifestyle choices can slow down or even prevent progression to type 2 diabetes. This includes of course exercise. We work with patients to teach them how to fit physical activity and exercise into their daily routine regardless of their restrictions. We educate them about their medication and how to take it correctly. And we can assist with choosing the right blood glucose testing monitor and show them how to use it and interpret the results.


Why is this an effective care model?

Lori O'Keefe-Fomenko, diabetes nurse educator
Lori O’Keefe-Fomenko, diabetes nurse educator

Managing diabetes can be stressful. Adding to that stress is, if not managed properly, diabetes can lead to other complications. When you have someone to work closely with as you face these challenges, you can build confidence in you ability to self-manage you diabetes. And that can help you feel your best. We have an ongoing relationship with our patients. They don’t have to go through it alone, which can make a big difference in not letting their diabetes get in the way of leading a full, healthy life.

What are the qualifications of a certified diabetes educator?

We must prove our knowledge and skill in diabetes self-management education by completing at least 1,000 hours of patient education and pass a challenging certification exam. Patients can be sure that when they’re working with someone with CDE credentials, they’re in good hands.

November is Diabetes Awareness Month, and this year, National Diabetes Education Week is Nov. 4-10.

Learn more about diabetes care at UConn Health at health.uconn.edu/diabetes.

Spotlight on Services: Sports Cardiology

(Getty images)

Sports cardiology is an emerging subspecialty with a focus on highly active people. It’s now available at the Pat and Jim Calhoun Cardiology Center, where Drs. Kai Chen and Peter Schulman are among those trained in this discipline, supporting not only UConn athletics but also the Connecticut Sun professional women’s basketball team and the New England Black Wolves professional lacrosse team.

What is sports cardiology?

Dr. Kai Chen, Calhoun Cardiology Center
Dr. Kai Chen, Calhoun Cardiology Center

Chen: Sports cardiology is cardiology related to sports and exercise, an entity incorporating all ages, from childhood to the senior population, and all forms of exercise activity, including professional, recreational, and occupational. Starting with the care of competitive athletes, sports cardiology has expanded to include the general population in the prevention and management of cardiac conditions during exercise.

Who is a candidate to see a sports cardiologist?

Chen: Sports cardiology takes care of athletes and anyone who exercises. Candidates for a sports cardiology evaluation include:

  • Healthy people with a family history of cardiac condition before participation in sports or exercise.
  • Anyone with new symptoms during exercise or sports participation such as lightheadedness, palpitation, shortness of breath, chest discomfort, or unexplained drop in exercise tolerance.
  • Patients with known cardiovascular disease who want to return to exercise and stay active.

How does this discipline fit in with the service as team physicians to the UConn athletic programs?

Schulman: UConn Health physicians serve as the team physicians for UConn athletes, and this is part of sports cardiology. For example, we screen the UConn athletes as they prepare for the upcoming season. Sports injuries and other medical conditions are handled by the UConn infirmary and UConn Health providers in Storrs. Between these two services, UConn athletes have all of their health needs served.

What’s the difference between athletic heart syndrome and hypertrophic cardiomyopathy?

Dr. Peter Schulman, Calhoun Cardiology Center

Schulman: Due to increased metabolic demands of athletic performance, the athlete’s heart adapts to the enhanced metabolic needs by undergoing structural changes to increase the ability of the heart to pump blood. These changes include “bulking up” or hypertrophy of the heart muscle and increasing the size of the heart chambers to handle the increased blood flow. These changes are part of the “athletic heart syndrome.”  On the other hand, there are some diseases of the heart muscle such as hypertrophic cardiomyopathy (HCM) that can cause adverse structural changes of the heart. HCM can appear superficially similar to the normal adaptation of the heart from athletics. Fortunately, in most instances, testing can distinguish most patients with HCM from the athletic heart.

What steps can be taken to reduce the likelihood of a problem on the practice field?

Schulman: There is a screening process that can distinguish many, but not all, conditions that could be dangerous to athletic participation. The athlete (or the parent) must be vigilant and report any untoward symptom promptly that could signal a cardiac problem. The symptoms may include untoward weakness, dizziness, loss of consciousness or chest pain around the time of sports participation. A family history of premature death or sudden cardiac death may also be a warning sign.

More information about the sports cardiology program at UConn Health is available at health.uconn.edu/cardiology/clinical-services/sports-cardiology.

Spotlight on Services: Day in the Life of a Dispatcher

Buildings and Grounds Patrol Officer Kevin Cabelus answers a call. (Kristin Wallace/UConn Health Photo)
Buildings and Grounds Patrol Officer Kevin Cabelus answers a call. (Kristin Wallace/UConn Health)

Our UConn Health dispatchers answer hundreds of calls each day – some of them routine – such as vehicle jumpstarts or door unlocks – others are a matter of life and death. One recent incident called special attention to the great work they do when Buildings and Grounds Patrol Officer Kevin Cabelus kept a distraught, suicidal former patient on the phone talking while dispatcher Stephen Ferraro figured out his identity and location. They contacted local police who rushed to the man’s home and found him clinging to life. Their fast action is credited with saving the man’s life.

Buildings and Grounds Patrol Officer Kevin Cabelus answers a call.
Buildings and Grounds Patrol Officer Kevin Cabelus and dispatcher Stephen Ferraro. (Kristin Wallace/UConn Health)

The Pulse wanted to learn more about our dispatch services here at UConn Health so we asked Stephen and Kevin to answer a few questions about the important service they provide.

How many dispatchers work at UConn Health?
UConn Health currently has five full-time dispatchers. There are 10 Buildings and Grounds Patrol Officers (BGPO) in the department who are also trained in dispatch to fill in absences on any shift as needed. There is always someone on duty – whether it is a dispatcher or a BGPO – our emergency and routine lines are always monitored by trained staff on campus.

What kind of training does it require?
The full-time dispatchers are sent to the same training course that municipalities send their dispatchers. We also take a course to be certified in COLLECT which is the Connecticut database for accessing everything from driver and license plate information, to stolen cars and wanted or missing persons nationwide. Additionally, dispatchers have specialized training opportunities in active shooter, crisis intervention, self-defense, and radiation. We are also CPR certified.

What types of calls do you receive?
Typical emergencies, such as medical/injury calls, car accidents, thefts, and personnel disputes and routine calls, such as people needing directions or escorts, vandalism, door unlocks, vehicle jumpstarts, wildlife reports, or just anything that people need to know and don’t know who else to ask. Though we strive to help everyone as soon as they call, you may be put on hold for an answer to your routine question when something of an emergency nature is on the other line. We appreciate your patience!

What is the most common call you receive?
This will vary by shift, but because I work at night we do a lot of unlocks in the building and escorts for employees after shuttle service stops. We also have a lot of calls for patients who are disruptive or combative. I send BGPO’s and police officers there to mitigate and isolate these threats and keep staff and the other patients safe and comfortable.

How is it different working here versus a town or city police dispatch?
Basically all the same things that occur in a town can and do occur here on campus at some point. The biggest technical difference is that we do not answer 911. While we have our in-house emergency line, only so many 911 centers are authorized by the state. Since we’re located in Farmington, 911 calls go there initially. If a call is pertaining to our campus, it will be transferred back to us when necessary. In terms of call handling, a big difference is that we are customer service oriented. Whether it’s a call from an employee or one of our many patients and visitors – we are here for everyone, to keep them safe and do what we can to help while they learn, teach, work, heal, grieve, or celebrate life.

Why did you want to become a dispatcher?
Stephen:
Being a dispatcher is a great way to help people, which I enjoy being able to do as a career. What led me to this position was a background in volunteer firefighting, giving me experience on the other side of the radio. I had already worked at UConn Health in Nursing Transportation so when this position became available I was very eager to jump at the opportunity to do something I love at a place I’d grown to love as well.

Kevin: I chose public service because I knew at a young age this is what I wanted to do. There are a lot of police officers in my family so it felt natural to get my college degree in criminal justice. Helping people is what I enjoy and there’s no better way to do that than with this career. When you go into any type of law enforcement or public service you build a bond with co-workers that is very strong because you depend on each other every day. For example, the call that Steve and I had, we’ve worked together for a little over 3 years now so when that call came in we knew what the other person needed to make that call successful. When you work with people like Steve and you mesh well together, it makes your shift and career a lot easier.

Any calls that really stand out for you and the dept.?
Collectively all of our dispatchers do great work handling serious calls, they’ve had accidents, they’ve had casualties, they’ve had people running around with weapons or being aggressive on drugs, they’ve had fires and gas leaks… It’s our job as dispatchers to quickly bring about resolution and minimize the impact these incidents have on those involved and the rest of the important things that go on here at UConn Health. Doing so, alongside our excellent team of firefighters, paramedics, police officers and BGPO’s, has been as much of an honor as it has been working with the other dispatchers here at UConn Health.

Spotlight on Services: Colon Cancer Prevention Program

UConn Health started its Colon Cancer Prevention Program a decade ago. Dr. Joel Levine, one of the co-founders, describes how what started as a novel approach to the disease is becoming a mainstream concept.

Dr. Joel Levine
Dr. Joel Levine is a co-founding director of the UConn Health Colon Cancer Prevention Program. (Photo by Janine Gelineau)

What makes the Colon Cancer Prevention Program successful?

The idea of prevention is what’s novel. There aren’t any other prevention programs that do what we do. If you Google “colon cancer prevention program,” we come out as the top listed patient centered resource.

Our process is very longitudinal. It’s not a one and done. We follow more than 6,000 people who return, at least annually, for both the latest information and for modulating their level of risk. Lowering risk is what we, the patient and Program, do. We are always learning how to do that more effectively. Indeed, we have not seen a colon cancer develop in someone who has been in the Program in about eight years. Put another way, if you come to us without colon cancer, we start by identifying risk and, then, follow you accordingly. If we reduce whatever risk level you have, we have not had a patient develop colon cancer on our watch.

The exceptions, so important to us, are patients who, on first visit, we find have colon cancer. Many patients are referred because of a positive FIT test (fecal immunochemical test). We introduced the quantitative FIT test to UConn Health and continue to study the test, over time, as an early marker for polyps or cancer. We work with the wonderful genetics group to identify those patients and families with inherited risk. Very few patients who have colon cancer in the family have actual inheritable risk (3 percent) but they are important to identify. These patients are followed closely, expecting them to develop colon cancer as a risk of their disease. We cannot as of yet prevent it in those inherited risk families, but we still can take steps to reduce risk by about half.

Prevention chose our program to feature in its “Guide to Preventing Disease” in its April issue. What do you see as the implications of that?

This is one of the largest magazine readerships in the world. The increasing recognition of a program dedicated to prevention is encouraging. Therefore we are at the tip of that spear and grateful to the Neag Comprehensive Cancer Center for supporting us from the outset.

We have a program whose purpose is to think about the disease. We are migrating from just doing colonoscopy, which is still important, to what do you do before and after the colonoscopy—how you define risk and  how you then modulate the risk—and that’s prevention. In recent conversations with Dr. Dorado Brooks, who leads the colon cancer division of the national American Cancer Society, we plan to forward this more broad-based and lifelong strategy to lower the frequency and mortality of this disease. The evidence is emerging and our approach that combines the latest in scientific thought to patient care is shaping how we see the problem and solution.

What’s happening on the academic side?

We are publishing and hoping to influence thought. I just co-wrote an editorial for a leading GI journal with Dr. Joseph Anderson [former UConn Health colleague, now at Dartmouth] in which we discuss a particular type of colon cancer pathway. The emphasis is on how long it takes for that pathway to go from one level of risk to another. Young people can have polyps in that pathway but do not commonly develop colon cancer; it is only when they are much older do you see the colon cancers appear, so you have a long period of time in which the disease evolves. There are even specific risks, because this pathway involves DNA methylation, a biologic process that can silence key genes. This occurs progressively as you get older but can be increased cigarette smoking, a behavior we really fuss about. Dr. Anderson’s study of smoking risk, begun here, is very well recognized and regarded.

How has the approach to mitigating colon cancer prevention evolved over the program’s 10 years?

It’s really colonoscopy-plus, with super-sensitive blood stool testing, better understanding of the colon’s microbiome, and an ever-growing knowledge of modifiable risk factors. In this regard, Dr. Ethan Bortniker, who directs new approaches in clinical research, studies how other lifestyle factors (cardiovascular health, metabolic fat in the liver) influence colon polyps and cancer. Our patients know this and are proactive participants in their own well-being. They fastidiously stick with the program.

Overall the colon cancer attack rate is still low. If you have a 5 percent attack rate in a disease, your anxiety says, “Show me I don’t have the disease.” We hope to focus more on those who are likely the 5 percent. Early prediction of biologic and then clinical risk is the name of the game. Dr. Dan Rosenberg, who is the director of our basic research, is a leading authority and invaluable to our clinical approach. We hope to be able to understand the biology of early cancer risk and keep it from becoming a clinical reality. So far, we are making progress.