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Advancing Care - 2024 | Issue 1


Jennifer Frampton, DO, reviews a patient’s angiograph image to look for signs of coronary artery disease.


When it comes to coronary artery disease, think “prevention”

Coronary artery disease (CAD) is the most common type of heart disease, according to the Centers for Disease Control and Prevention. The good news is many CAD risk factors can be controlled through lifestyle changes and medications. 

In coronary artery disease, also known as ischemic heart disease, at least one of the three coronary arteries that supply blood to the heart has plaque, a buildup of calcium and cholesterol. Plaque can create a blockage in blood flow and lead to angina, heart attack or cardiac arrest. 

“Both men and women* are at risk of coronary disease, but men often present earlier in life when compared with women,” said Jennifer Frampton, DO, an interventional cardiologist with Yale New Haven Health’s Heart and Vascular Center and assistant professor of Medicine at Yale School of Medicine (YSM). 

Learn more about CAD

I’m so dizzy! Should I call my doctor? 

You roll over in bed – and the room starts to spin. Or you stand up from the couch – and you suddenly feel woozy and disoriented. What’s going on? Why are you dizzy?

“Dizziness” is one of the most frequently cited complaints when people seek medical help. According to estimates from the National Institutes of Health, dizziness, vertigo and balance problems affect between 15 - 20 percent of U.S. adults each year, with higher rates seen in people 65 and older. It affects females up to three times more than males.* 

Diagnosing dizziness can be frustrating because dizziness isn’t a disease or a condition– it’s a symptom. Many factors can disrupt your balance. Being hungry or dehydrated can make you feel lightheaded. Some medications can make you feel dizzy. Health problems such as infection, stroke or tumor can affect your inner ear or brain, throwing off your balance. 

To pinpoint the underlying cause, healthcare providers must first identify the type of dizziness a person is experiencing, said Nofrat Schwartz, MD, an otolaryngologist (ear, nose and throat surgeon) at Yale New Haven Health and assistant professor of Otolaryngology at Yale School of Medicine. 

“When a patient complains of dizziness, it can refer to many different sensations,” she said. “It’s important for a provider to figure out what dizziness means to you.” 

“Many types of dizziness are caused by inner ear diseases, so it is important for a patient to accurately describe symptoms,” added Frank Dellacono, MD, section chief of Otorhinolaryngology at Lawrence + Memorial Hospital.  

Types of dizzy sensations

  • Are you lightheaded? Lightheadedness is a feeling of faintness or wooziness, as if you are suddenly about to pass out. You may feel sweaty and nauseous or have trouble hearing or seeing well. This can be related to conditions that affect the heart or blood circulation. You may also feel lightheaded and woozy if you are dehydrated or have low blood sugar. It may also be a side effect of medications.

  • Is it vertigo? Does it feel like the room is spinning and swirling around you, even though you are sitting still? This is called vertigo, and it may be accompanied by nausea, vomiting, sweating or difficulty walking. Vertigo can be associated with many conditions, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Meniere's disease, migraines, concussions from head injuries and motion sickness. 

  • Are you feeling unsteady or off-balance? Balance problems can make you feel dizzy. Losing your balance while walking or standing can result from problems with your inner ear; muscle weakness or nerve damage to your legs (peripheral neuropathy); certain neurological conditions; joint, muscle or vision problems; or as a side effect of medications.

When to call your healthcare provider

Everybody experiences dizziness at some point in their lives, and many cases are mild and go away on their own. But when you should see your healthcare provider? 

“You might occasionally experience vertigo when you have a mild illness, but if it lasts for more than a day, it’s recommended that you see a doctor about what might be causing it,” Dr. Dellacono said.

“See your doctor if you’ve never had dizziness before or if you are experiencing different symptoms than you normally do,” Dr. Schwartz. said. “Also, if you are experiencing significant dizziness or unsteadiness that that is hampering your daily activity, that also warrants further medical evaluation.” 

Tell your healthcare provider when the symptoms occurred, how long they lasted and what triggered them. This will help your provider narrow down the possible cause and determine what’s causing your symptoms. 

According to Dr. Dellacono, a new balance problem can sometimes signal a medical emergency, like a stroke. “If the dizziness is not fleeting or eased by lying down or if your balance is compromised, you should immediately visit the closest emergency department,” he said. 

It’s important to get symptoms checked out as soon as possible. Seek medical attention immediately if you have any of the following symptoms:

  • Dizziness after a head injury
  • High fever
  • Stiff neck 
  • Sudden or severe headache
  • Sudden change and complete loss of hearing
  • Convulsions or ongoing vomiting
  • Chest pain, heart palpitations, shortness of breath, inability to move an arm or leg
  • Change in vision or speech
  • Fainting and/or loss of consciousness 
  • Weakness or numbness in your face, leg or arm

Positional vertigo: What it is and what to do about it

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sensation that the room is spinning or swaying around you. It’s triggered when tiny calcium carbonate crystals found inside your inner ear become dislodged and fall into one of the balance canals — an area where they don’t belong. This leads to a sensation of vertigo when you move your head, especially when you look up at a high cabinet, roll over in bed or sit up. It may also cause nausea and a feeling of being unbalanced. BPPV can affect people of all ages but is most common in people over the age of 60. 

The classic symptoms of BPPV are characterized by brief episodes of dizziness lasting less than a minute; however, they can recur over the span of days or even a month until completely resolving. A visit to your primary care provider is the first step to rule out other reasons for your dizziness. Diagnosing BPPV involves taking a detailed health history and performing a diagnostic test called the Dix-Hallpike maneuver to look for certain eye movements. 

If you are diagnosed with BBPV, your doctor can refer you to a vestibular therapist who specializes in treating vertigo with special repositioning exercises that will help move the tiny pieces of calcium back into their correct place, according to Corie Sigan, DPT, a physical and vestibular therapist who treats patients at Lawrence + Memorial Hospital’s Outpatient Rehabilitation Services in Waterford. Patients seeking vestibular therapy for vertigo can also be treated at Flanders Health Center in East Lyme and Pequot Health Center in Groton. 

“Once diagnosed with BPPV, a canalith repositioning maneuver can be performed to resolve symptoms,” Sigan said. The most common repositing procedure is called the Epley maneuver, which involves a series of movements of the head, neck and body that are performed in a specific order to move the crystals that are trapped in your ear’s semicircular canal. The maneuver can be completed in office with your physical therapist and takes about five to 10 minutes. Sigan said patients often find relief of BPPV symptoms within one to two visits when the correct maneuver is performed. 

Can you treat BPPV symptoms by yourself? While there are videos online that explain the Epley maneuver, it’s best to talk to your healthcare provider before trying any do-it-yourself procedures, because if the Epley maneuver isn’t done correctly it can make the vertigo symptoms worse and possibly make it more difficult to treat in the long run. 

“After your first visit, your therapist will give you additional information about BPPV, and if indicated, may have you complete the maneuver at home,” Sigan said. 

Learn more about Rehabilitation Services at Lawrence + Memorial Hospital.

Free wellness classes in New London and Westerly 

Lawrence + Memorial Hospital and Westerly Hospital offer a series of free wellness programs that cover a variety of health topics.

There is no charge for these programs; however, in-person attendance is limited. Classes start at 5 pm and are held at either L+ M Hospital (365 Montauk Ave., New London) or Westerly Hospital (25 Wells St., Westerly). Registration is required; follow the links here to register. For details, call 1-800-562-2537 (L+M classes) or 1-800-636-2824 (WH classes).

Registration Open for Smilow “Beyond Beauty Program” Workshops

The Beyond Beauty Program is a free service for Smilow Cancer Hospital patients, provided by our licensed cosmetologists, certified hair and wig specialists and The Cingari Family Boutique. It is created for current Smilow patients who are undergoing chemotherapy and radiation treatment and experiencing temporary visual changes to their hair, skin and nails. 

If you are a current Smilow patient, you may register for an interactive workshop being held on March 20 from 2 - 4 pm at Smilow Cancer Hospital — 230 Waterford Parkway South, Waterford. You must pre-register to receive your makeup toolkit on the day of the class. Sign up for the Beyond Beauty Program by calling the Cingari Family Boutique at 203-200-2273 (CARE), sending an email to [email protected] or asking your social worker or nurse for details. 

Additional workshops are available at Smilow Cancer Hospital locations in Guilford, North Haven, Waterbury, Stamford, Torrington and Derby. Call or email for details on dates and times.

Find a provider at L+M or Westerly Hospital 

Are you looking for a physician? Call 833-346-3637 or visit our “Find a Doctor” feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience. 

Billing questions? 

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