Services

Cardiology

The Cardiology service provides a complete range of diagnostic evaluations and therapeutic options in both inpatient and outpatient settings. Cardiology also has extensive outreach programs with a number of hospitals and communities in the region. The members of the service have expertise in all areas of adult cardiology, including coronary artery disease, valvular heart disease, cardiomyopathy, congenital heart disease in the adult, arrhythmia, preventive cardiology and cardiac rehabilitation.

Diagnostic procedures include cardiac catheterization and angiography, exercise electrocardiography, nuclear cardiology including sestamibi (Cardiolite) imaging during exercise and with pharmacologic stress and radionuclide ventriculography, 2-dimensional and transesophageal echocardiography, and exercise and dobutamine echocardiography.
The Arrhythmia Service offers noninvasive arrhythmia assessment (Holter monitoring, signal averaged high frequency ECGs, event monitors, tilt table evaluation), invasive electrophysiologic testing, permanent pacemakers and implantable antitachycardia devices, and ablation therapy for tachyarrhythmia. Cardiology has extensive experience with catheter-based coronary interventions, including percutaneous coronary angioplasty (PTCA), stents, atherectomy and rotoblators. A member of Cardiology is always available by telephone for discussion and informal consultation about cardiology problems.

Dermatology

The Dermatology Outpatient Clinic provides consultation and therapy for patients with all types of problems of the skin, hair, and nails. Specific research interests include skin cancer, male pattern baldness, acne, leg ulcer therapy, psoriasis, atopic eczema, and skin substitutes in wound healing. In addition, the Clinic offers the following services: UVB and/or UVA phototherapy for psoriasis, Botox therapy, treatment for photo damage, laser surgery for portwine stains, telangiectasias, warts, tattoo removal, laser resurfacing and other cosmetic issues. An outpatient surgery suite is located in our office where Mohs surgery and many dermatologic surgical procedures are performed. Physicians within the Dermatology Clinic are also participating members of the Vermont Laser Center. Pediatric dermatology services are also provided at the Dermatology Outpatient Clinic on the Medical Center Campus.

Endocrinology, Diabetes Mellitus and Metabolism

Endocrinology, Diabetes Mellitus and Metabolism is staffed by attending physicians, nurse practitioners, fellows, diabetes teaching nurses and dieticians. The specialty provides consultation to referring physicians for problems in Endocrinology, Diabetes Mellitus and Metabolism. Areas of expertise within this subspecialty include consultation and diagnostic testing of patients with thyroid and adrenal diseases, hyperlipidemia and problems with nutrition, disorders of hypothalamicpituitary function, calcium metabolic bone disease, gonadal function and abnormalities of growth and development.The Vermont Regional Diabetes Center is a major component of the unit and provides specialized evaluation, education and treatment programs for patients with diabetes mellitus.

Gastroenterology and Hepatology

The Gastroenterology and Hepatology Outpatient Clinic is staffed by Fletcher Allen Health Care/University of Vermont faculty members and fellows providing consultation and treatment of diseases of the liver, biliary tree, pancreas and alimentary tract.

Specialized services include diagnostic and therapeutic endoscopy, enteroscopy, ERCP, endoscopic laser surgery, manometry, 24-hour ambulatory PH monitoring, treatment of variceal and nonvariceal bleeding and the placement of temporary and permanent esophageal and biliary stents.

Primary areas of interest and expertise of our faculty include pancreatico biliary endoscopy, irritable bowel syndrome, gastroesophageal reflux disease, peptic ulcer disease, liver disease, therapeutic endoscopy, motility, and inflammatory bowel disease.

Outreach services are provided by the faculty at various sites in the surrounding community.

Hematology/Oncology

The Hematology/Oncology Outpatient Clinic is staffed by 9 oncologists and 3 hematologists, and welcomes telephone consultations from referring physicians. The Clinic provides comprehensive diagnosis, evaluation and treatment for all forms of cancer, including both solid tumors and hematologic malignancies. Major areas of interest in nonmalignant hematology include anemia, polycythemia, platelet disorders and all forms of coagulation disorders. The Clinic is part of the Vermont Cancer Center, a NCI-designated Comprehensive Cancer Center.

Physicians in the Hematology/Oncology Clinic participate in the Vermont Cancer Center’s coordination of patient care, research and education. A full staff of physicians, fellows, nurses, social workers, nurse practitioners, and clinical psychologists stress a multidisciplinary approach to the patient and family. Physicians also provide a comprehensive Hemophilia Clinic, evaluate peripheral blood smears and bone marrow biopsies, assess immune function and coagulation mechanisms, perform plasma and cytopheresis, and have treatment programs utilizing high dose chemotherapy and stem cell support.

A cancer patient support program is also offered to patients.

Infectious Disease

The Infectious Disease Outpatient Clinic is interested in the diagnosis and management of all types of infectious diseases including bacterial, viral, fungal, chlamydial, protozoal and mycoplasmal disease. In addition, the evaluation of the febrile patient from whatever cause is an area of expertise and interest to the unit members. The Unit provides consultation for patients with infectious diseases or fevers of unknown origin in both hospitalized and ambulatory patients.

The Infectious Disease Clinic coordinates the Comprehensive Care Clinic for the outpatient management of all infectious diseases. This clinic is the state referral center for HIV/AIDS. The physicians, nurses, and social worker of the clinic work as a team for the patient’s medical psychosocial and economic health issues. The clinic works closely with primary care physicians, state agencies and regional AIDS service organizations to provide state-of-the-art care for people with HIV/AIDS. The clinic also coordinates the state’s International Travel Medicine service. Health-related issues regarding international travel including all vaccinations, prophylactic therapies, and traveler education is provided, and follow-up care for infection-related problems can be coordinated by the clinic. The clinic also coordinates home intravenous therapy including full consultative evaluation, insertion of central catheters, first antibiotic dosing, coordination with visiting nurses and primary providers, follow-up of drug levels and management of the central catheters.

The Clinic is able to provide specialized diagnostic studies for diseases caused by infectious agents utilizing the facilities of the Fletcher Allen Health Care laboratories as well as those of the Vermont State Department of Health and the Centers for Disease Control in Atlanta.

Nephrology

The Nephrology Outpatient Clinic is staffed by attending physicians, physician assistants, fellows and by specially trained dialysis and transplantation support staff. The Clinic provides consultation to referring physicians for patients with renal disease, glomerulonephritis, acute and chronic renal failure, systemic vascular and autoimmune disease, hypertension, acid base and electrolyte disorders, and diabetic nephropathy. In conjunction with the Departments of Surgery and Radiology, the Nephrology Clinic provides a program for the comprehensive diagnosis and management services for all forms of difficult to manage hypertension.

Nephrology provides complete diagnostic and management services for patients with acute and chronic renal failure or with end stage renal disease, including hemodialysis, peritoneal dialysis and with continuous renal replacement therapies such as continuous venovenous hemofiltration. The Clinic also provides plasmapheresis services for patients with systemic diseases involving the kidney. In conjunction with the Department of Surgery, Nephrology provides support services for kidney and kidney/pancreas transplantation. The Clinic has an extensive outreach program with dialysis units in Berlin, Rutland, St.Albans, South Burlington, and Newport. We visit these units regularly and are available for both onsite inpatient and outpatient consultation in Berlin, Rutland, St. Albans, and Newport.

Osteoporosis Center

The Osteoporosis Center offers both bone measurement and consultative services for evaluation and management of individuals with metabolic bone diseases, especially osteoporosis. Bone density measurements are performed by Dual Energy Xray Absorptiometry (DEXA) or by Quantitative Ultrasonography (QUS). DEXA is recommended for screening, for evaluation of patients at high risk for fracture or for following changes in bone mass. QUS is better suited for the screening of women with few other risk factors for osteoporotic fractures. All evaluations include a copy of the densitometry report as well as a letter outlining assessed risks and treatment recommendations. The metabolic bone clinic offers expertise for patients with suspected systemic bone diseases.

Pulmonary Disease and Critical Care Medicine

The Pulmonary Disease and Critical Care Medicine service is staffed by fourteen attending physicians, six fellows, and a nurse practitioner. The service works with referring physicians accepting consultation and management of patients with chronic and acute respiratory problems, both inpatient and outpatient. Major areas of interest include chronic obstructive pulmonary disease, asthma, lung cancer evaluation, pulmonary fibrosis, sarcoidosis and other chronic diffuse interstitial lung diseases, pulmonary embolic disease, adult cystic fibrosis, occupational lung diseases, pleural diseases, tuberculosis and other chronic pulmonary infections. Critical Care Medicine is a specialized program area, including management of the Medical Intensive Care Unit and care of patients with acute medical problems requiring intensive care.

The Pulmonary Ambulatory Center located in the Gartman Medicine Clinic on the Medical Center Campus provides evaluation and continuing care by pulmonary subspecialists for the full range of outpatient pulmonary problems. To provide efficient and convenient assessment of our patients, a complete pulmonary function laboratory is part of the outpatient facility. Other services provided are flexible fiberoptic bronchoscopy, transbronchial lung biopsy, provocative inhalation challenge testing for asthma, home oxygen therapy, disability evaluations, thoracentesis, and pleural biopsy.

Rheumatology and Clinical Immunology

Rheumatology and Clinical Immunology is staffed by six board certified rheumatologists. We provide consultations and treatment services for patients with arthritis and related disorders. The following is a partial list of the conditions appropriate for referral: rheumatoid arthritis, psoriatic arthritis and all inflammatory joint problems; systemic lupus erythematosus, scleroderma  and all connective tissue diseases; osteoarthritis, tendonitis and regional musculoskeletal problems; polymyalgia rheumatica, vasculitis and other systemic inflammatory conditions.

Older patients with osteoarthritis or musculoskeletal problems that limit activities of daily living, and patients with chronic pain and fibromyalgia are welcome. Consultation services for patients with diagnostic problems or abnormal immunology laboratory studies are also provided.

The Rheumatology staff emphasizes comprehensive care for the arthritis patient. This includes instruction in appropriate exercises/ fitness programs, physical therapy techniques and psychological support.

Facilities include an onsite intravenous Immunotherapy Center for the administration of antiTNF agents and other newly released intravenous therapies. Clinical studies to evaluate the efficacy of biologic agents in development are available.

The Osteoporosis Center provides the most uptodate analysis of bone loss in this area. Equipped with two DXA bone densitometers, the Center can precisely determine an individual’s bone density, and from that, his or her risk of sustaining a fracture.