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Around 18 million people in the United States are affected by a potentially deadly disease: obstructive sleep apnea (OSA).
With cases of OSA on the rise—and a suspected 80 percent of Americans going undiagnosed—diagnosis and treatment are critical. Dr. Todd Falcone ’09 (MED), an otolaryngologist at UConn Health, and Dr. Lauren Mentasti ’09 (DENT), a general dentist in Avon, exemplify the kind of interdisciplinary approach that ensures patients have the happiest outcomes with this disease.
The common symptoms of OSA are snoring, daytime sleepiness, and restless, disrupted sleep—unsurprising, since the disease is characterized by repeated episodes of decreased or complete blockage in air flow during sleep. OSA is often due to collapse of the upper airways, including the soft tissues of the nose, mouth, or throat, and patients are often unaware that they literally stop breathing during the night. “During these ‘apneic’ episodes, a patient’s blood oxygen level can decrease, stressing the entire body—most notably the cardiovascular and respiratory systems,” Dr. Falcone explained. “And witnessing these breath-holding episodes is often quite disturbing to patients’ bed partners.”
Dr. Mentasti noted the devastating effects of OSA: “Left untreated, sleep apnea can lead to long-term problems such as hypertension, heart attack or failure, stroke, depression, cognitive impairment, and sexual dysfunction.”
Drs. Falcone and Mentasti met while attending UConn’s Medical and Dental Programs. At the completion of their training, they both settled in the Farmington Valley and reconnected professionally to help care for mutual patients with sleep apnea. Both are involved with the initial screening and diagnosis of OSA, but have different approaches to management of the disease depending on the patient’s specific disease profile and treatment wishes.
For patients suspected to be suffering from sleep apnea, Dr. Falcone first orders a sleep study, which can be performed either at home or in a certified sleep center. The overnight monitoring yields important data, measuring breathing, heart rate, limb movements, oxygen levels, and breath-holding episodes. The gold standard for treating OSA is continuous positive airway pressure (CPAP). When using CPAP, a patient wears a custom-fitted mask over their nose, mouth, or both while sleeping. The mask is attached to a machine that utilizes pressure to keep the airways open, thus preventing soft tissue collapse.
Dr. Falcone treats many patients with CPAP, but also specializes in surgery of the nose, mouth, and throat that may improve a patient’s sleep apnea depending on their unique anatomy. “Surgeries to improve nasal breathing include septoplasty, turbinate reduction, and sinus surgery,” he said. Other surgeries aim to increase the size of the airway in the mouth or throat, such as tonsillectomy, adenoidectomy, uvulectomy or uvulopalatopharyngoplasty (UPPP), during which both the tonsils and uvula are removed.
Dental professionals, like Dr. Mentasti, are part of an OSA patient’s healthcare team because they have a unique opportunity to screen for the disease, and can then collaborate with their medical colleagues on providing effective treatment. In addition to considering medical conditions and medications often associated with sleep apnea, a dentist may ask questions about snoring, daytime sleepiness, or quality of sleep to help determine whether a patient is at increased risk for this serious condition. “During a routine dental cleaning or exam, a dental professional is trained to evaluate the soft tissue architecture of the airway – including the neck, tongue, soft palate, tonsils, and uvula,” Dr. Mentasti said. “Dentists are also trained to look for other oral signs of OSA, such as teeth grinding and acid erosion.”
While CPAP is usually well tolerated and often curative for patients, those with mild or moderate OSA may receive best results with a non-invasive oral appliance. Fabricated by an experienced dentist, Dr. Mentasti noted, it is an acceptable first-line treatment, and may be an alternative option for those intolerant to CPAP. “The appliance repositions the lower jaw down and forward, opening the soft tissues of the airway, preventing airway collapse during sleep, and allowing for air to pass more freely,” Dr. Mentasti said, adding that patients must work closely with a dental professional to adjust the appliance. Proper fitting and titration of the device can maximize its effectiveness in treating the airway issue, while minimizing potential side effects to the temporomandibular joint (TMJ).
Untreated sleep apnea dramatically affects patients’ quality of life, can reduce life expectancy, and can be dangerous when chronically sleep-deprived people are behind the wheel. OSA increases patients’ risk for hypertension, heart disease, hormone imbalances, weight gain, and depression.
“As members of the healthcare community, we all have a responsibility to educate ourselves on obstructive sleep apnea so that we can effectively screen our patients and provide them with resources to seek the help that they need,” Dr. Mentasti said.
“It is essential for physicians and dentists alike to effectively communicate and collaborate for the benefit of our mutual patients,” Dr. Falcone added. “Our patients’ lives may depend on it.”
How does someone prepare for a career that can include a morning meeting with a foreign minister, followed by an afternoon investigation inside a cave full of bats?
The Career. The Preparation
For Paige Armstrong ’11 (MED), her degree from UConn School of Medicine launched a career in public health that would take her across the globe to identify and stop deadly diseases.
Armstrong found her interest in public health early on, discovering a passion for science in grade school and finding a role model in her father, an emergency medical technician. “Caring for people has always been in my life,” she said.
Her father’s work, as well as a service trip she took as a teenager with Amigos de las Américas working to build latrines and stoves in Guanajuato, Mexico, led her to think about public health and the course her life could take. “When I returned from Mexico, I had my sights set on medicine,” said Armstrong.
She says UConn was a critical part of her plans to become a public health officer specializing in deadly fungal diseases. Before entering UConn School of Medicine, Armstrong earned a Master of Health Sciences (M.H.S.) degree, as well as a B.A. from Johns Hopkins University. “I wanted to make sure I got that foundation in public health and understood what kind of projects I should work on during my time in medical school and my residency at George Washington University,” said Armstrong.
“I have to give UConn School of Medicine a lot of credit for the way they structure their medical education,” she said. “It was a rigorous, intense four years of my life, but UConn was always supportive of developing and trying new things.” For example, Armstrong and some classmates sought and earned the support of the Dean to create a medical Spanish interest group.
Because of the strong interest in this group, the Dean also approved their request to create an elective focused on the communications needs and cultural considerations of Spanish-speaking populations. “We actually taught that elective and brought in guest lecturers,” said Armstrong. “This openness and willingness to let us take an idea and run with it allowed me to continue fostering my interests in public health. It gave me experiences I continue to use.”
Today, Armstrong applies her education and experiences in emergency medicine and public health to her role as an Epidemic Intelligence Service (EIS) officer in the Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC). In her role, she investigates and analyzes outbreaks fungal diseases including Histoplasmosis, Coccidioidomycosis, Aspergillosis, Mucormycosis, Scedosporiosis in collaboration with international and domestic colleagues and government officials.
In recent years, Armstrong assisted in the Emergency Operations Center at the CDC on the Zika response, and worked alongside the Ministries of Health in El Salvador and Nicaragua to evaluate their national surveillance systems.
She also led two outbreak investigations, one of which focused on the outbreak of Histoplasmosis in tunnel workers in the Dominican Republic. The outbreak response focused on providing diagnostic support to confirm the diagnosis of Histoplasmosis and investigating and providing additional occupational and environmental recommendations.
A team of 35 men had the unenviable job of cleaning out bat guano from tunnels that allow access to a hydroelectric dam. Many of these men developed the respiratory form of the disease. Histoplasma capsulatum spores exist in bat guano, and when inhaled, can cause this respiratory disease that results in sickness and, in some cases, death. (In this case, 27 of the 30 men who became ill survived.)
The second investigation Armstrong led focused on Candida auris, a multi-drug resistant yeast, in Colombia. Armstrong co-authored the results of this research on this fungus that acts like a superbug bacteria and is difficult to identify.
While there are inherent challenges and potential risks in a field investigation, the CDC provides comprehensive resources. “We have amazing support systems that provide everything we need, from radios for our use in remote areas to mosquito repellant.”
When they arrive in a country, their teams are also supported locally by a ministry or hospital that devotes a group of staff to support their efforts. “We sit down with leadership to understand the significance of the event that’s occurring in the community,” says Armstrong. “You appreciate the gravity of the situation and want to make sure you are taking the steps necessary to identify the concern, address it, and relay the appropriate recommendations to the leadership to ensure they are implemented.”
The local staff and government officials are supportive and critical to their success. “Every interaction with them is constructive,” said Armstrong. “Our work wouldn’t be possible without them.”
It’s also true that this work would not be possible without those, like Armstrong, who possess the combined passions of medicine and public health. “Sometime during my residency, I realized that when I was able to work in a position that combined my UConn medical education with my passion for public health, I could a make a large-scale difference and affect the lives of a lot of people.”
Hello medical alumni,
We have had another exciting year at UConn School of Medicine. We have launched a new curriculum with emphasis on active and interactive learning as well as earlier integration of clinical medicine with basic science during the preclinical stage. A new classroom named the Academic Rotunda has been built, enabling a new pedagogy-team based learning while lectures in the traditional sense are no longer offered. Class of 2020 was the first class that the student number is at 100. We aim to increase to 110 students per class in the not too distant future. We had a near perfect MATCH for the class of 2017 with 99% matched during the NRMP and 81 percent getting one of top 3 choices. Our students do extremely well with acceptance to some of the top programs in the country, not different from the performance of medical students at some of the most visible, prestigious medical schools.
I am also pleased to inform you that UConn SOM is listed among top medical schools by the current U.S. News and World Report in both research and primary care categories. Our ranking in the research category went from #63 to #56 with 25 public schools ahead of us. The SOM ranked #34 in the primary care category, improving from the # 50 spot last year. Twenty-two public schools were ahead of us with many trailing on the list of top primary care schools.
While we are hitting our strides, we still have much to accomplish in doing the good work and the right things in innovation, discoveries, education, and clinical, community services. We thank our faculty, staff, and alums for all of the efforts. We will continue to strive for excellence.
Bruce T. Liang, MD | Dean, School of Medicine
Director of Pat and Jim Calhoun Cardiovascular Center
Ray Neag Distinguished Professor of Cardiovascular Biology and Medicine
When she was in high school, Carolina Giraldo ’95 DMD would drag race boys in her lime-green VW Rabbit after school at Seaside Park in Bridgeport, Conn.
“I was a sight to see. You barely could see my head. But I would win. That is the car that inspired me, if you could believe it. I knew if I could win in that thing, I had some kind of talent.”
Dr. Giraldo, who is all of 4-foot-10, is all about perseverance. Born in Bogota, Colombia and raised in Bridgeport, she put herself through college and UConn School of Dentistry.
She opened her own dental practice 21 years ago and now wants to help other students like her. So she recently started a scholarship with an initial gift of $10,000 to the UConn dental school for students from underrepresented groups.
“I want the minority population to grow in the field,” she said. “I want a bigger presence of women, of minorities, to get into the field and make a difference.”
Dr. Giraldo wants to give back to help make the path easier than hers was. She and her older sister, Diana, had to grow up quickly. While their parents each worked three jobs, the sisters practically ran the home front and raised their youngest brother, Randy. Dr. Giraldo remembers cooking dinner for the first time when she was only seven.
“We cooked, we ironed, we cleaned. We pretty much raised ourselves,” she said.
She always knew that if she wanted to have an education past high school, she’d have to do it on her own. So she juggled work and books and put herself through college—then dental school.
Scholarships like the one Dr. Giraldo is giving really make a difference in the lives of dental students, said Sarita Arteaga ’99 DMD, MA, MAGD, the school’s associate dean.
“It’s not just help with tuition,” she said. “I get comments back that it also helps them with the little things so they don’t have to take out another loan. It also helps them to know that someone is investing in them. They say, ‘Wow, I can’t believe somebody was in this position and not only wants to give back to the school, but wants to do the same thing for me’.”
Dr. Giraldo’s dental practice, All Smiles, in Norwalk, is like her, vibrant and welcoming. She designed the industrial-chic medical suite herself and decorated it with original artwork.
She remembers first becoming interested in dentistry as a child when she would watch customers visiting her father’s deli in Yonkers, N.Y.
“I would always look at people’s teeth. I don’t know why,” she said. “Whenever they spoke, I would see how their teeth met and I would try to figure it out—this tooth doesn’t belong there, I’d move it over this way. It was really like art mixed with medicine, so it was perfect. I love the art aspect of it. I still get to move teeth and design a smile just like I did behind the counter.”
These days, she lives in Redding, Conn., with her children, Enzo, 17, and Savannah, 16, her fiancé, Hernan, and his son, Alejandro, 18.
And she still likes driving fast. She even tried her hand at hand at Indy-style racing at the Mario Andretti Racing School in Las Vegas, Nev. recently. Her short stature made it challenging and a bit painful.
“I couldn’t reach the pedal. It was pitiful. They put seven cushions around me,” she said, chuckling.
The g-forces slammed her head up against the side of the car and made it difficult to move. Even so, she pushed through and made it up to 149 miles per hour.
Dr. Giraldo’s scholarship supports the UConn Foundation’s ongoing Transform Lives initiative to raise $150 million for student scholarships. You can support future dentists with a gift to the UConn School of Dentistry or contribute directly to Dr. Giraldo’s scholarship for underserved dental students.