Our Services

Sports Medicine Clinic

Our physicians are experts in musculoskeletal and medical sports conditions and they understand what drives athletes. They will help you recover from injury as quickly and safely as possible and get back in the game!

Our services include (but are not limited to) assessment and treatment of:

  • Acute injuries (strains, sprains, joint pain, fractures)
  • Overuse injuries (tendonitis, stress fractures)
  • Back pain in young athletes
  • Shortness of breath and fatigue in athletes
  • Athletic skin disorders
  • Athletes with illness (mononucleosis, asthma, and diabetes)
  • Sports Concussion (treatment and management)

Athletic Training Services

Cayuga Medical Center has seven certified athletic trainers (ATC) on staff. They are skilled professionals who specialize in athletic health care and work closely with physicians and other allied health personnel as integral members of the sports medicine team.

Cayuga Medical Center’s certified athletic trainers work on site at area high schools, colleges, and with club teams, as well as in the sports medicine clinic at the Island Health Center.

Athletic Training at Area High Schools

Cayuga Medical Center provides athletic training services to ten area high schools: Cortland, Homer, Ithaca, Lansing, Moravia, Newfield, Spencer / Van Etten, Trumansburg, Watkins Glen and Whitney Point. The level of service ranges from full time practice and game coverage to bi-weekly injury clinics. The injury clinics are held in the school nurses office, our athletic trainers work collaboratively with the school nurse to ensure athletes receive the highest level of care and return to play safely. Athletes are given instructions for self care or referred to the appropriate health care professional.

Our athletic trainers are on site at each school to:

  • assess injuries
  • make recommendations for treatment and further care
  • assist with injury rehabilitation
  • modify activity to allow an injury to heal while continuing to practice
  • help with injury prevention
  • design sport-specific strength training programs.

Athletic Training Event Coverage

If you have an event such as a football game, wrestling tournament or 5k race we can provide an athletic trainer to care for your athletes. Our athletic trainers will arrive prior to the event equipped with a fully stocked medical kit to tape and prep your athletes. After the competition is over they will evaluate any injuries and make recommendations for self care or further medical follow up.

If your school does not offer Athletic Training, or you would like to learn more about our Athletic Training services, please contact Margaret Vence, Director of Sports Medicine and Athletic Performance at (607) 252-3580.

Sports Concussion Management

Concussions occur when a blow to the head or neck interrupts brain function. The effects of these concussions vary among individuals, and many mild concussions are undiagnosed and unreported. Most athletes recover completely and can return to play following an appropriate period of recovery. However, it is important to understand that suffering a second blow to the head while recovering from an initial concussion can have catastrophic consequences, including death. Knowing when it is safe to return to play in order to avoid serious brain injury is crucial.

Assessing concussions

At Cayuga Medical Center we believe that all concussions should be properly assessed. Our Sports Concussion Team includes sports medicine doctors, athletic trainers, and physical therapists who specialize in concussion management.

The cornerstone of our management includes ImPACT Neuropsychological Testing. ImPACT testing allows us to evaluate, measure, and document various brain functions such as memory, symptoms, processing speed, and reaction time. Based on this information our physicians are better able to return the athlete to play safely.

Contact sports

Athletes, especially those who participate in contact sports, should take a baseline ImPACT test prior to the start of their athletic season. The baseline test takes approximately 30 minutes and can be performed at one of our participating schools or in our Sports Medicine Clinic. After an athlete has suffered a concussion, we recommend a medical evaluation followed by a post-concussion ImPACT test.

We recommend that schools and athletes participate in ImPACT baseline testing to help in the event of a concussion. If a baseline test is not available, ImPACT has developed norms that can be used to evaluate the recovery process of a concussed athlete. While these norms can be used to monitor recovery, they do not replace the value of an athlete being compared to a baseline test.

Safe return to play

The goal of our program is to make sure athletes who have suffered from a concussion are returned to play safely and on an individual basis.

To schedule an appointment to see one of our sports physicians or to have a baseline concussion ImPACT test please call (607) 252-3580.

Endurance Sports Performance Center

Welcome to the Cayuga Medical Center Endurance Sports Performance Center. In designing our center, we envisioned a place where endurance athletes can go to have all of their performance needs met from testing, to nutrition, to biomechanics, to coaching, and even medical treatment and rehabilitation. Our team has a broad range of expertise within the fields of medicine and exercise. Like you, we too are athletes. We want to help you reach your goals!

VO2 Max Test

A VO2 Max Test is the gold standard for cardiovascular fitness assessment. The data obtained is helpful in designing training programs, establishing heart rate zones, measuring current fitness level, and preventing overtraining syndrome. In our lab, the protocol we most commonly use starts at a relatively easy level and increases intensity in two-minute stages until the subject is no longer able to continue. Total work time is usually 8 -12 minutes. During the test, your nose will be plugged so all gas exchange occurs by breathing through a mouthpiece connected to a metabolic analyzer. You will wear a heart rate monitor or be connected to an ECG machine while you run or walk on the treadmill. You do not need to have this test done in order for us to provide you with good information about your running. However, it can provide useful additional information.

Metabolic Profile Tests and Assessments

Sport Nutrition Assessment and Consultation
Initial Nutrition Consultation and Assessment:
This 1-hour nutrition consultation and assessment is provided by our Board Certified Sports Dietitian. The initial consult determines an athlete’s nutrition needs based on short- and long-term performance goals. Each consultation is unique to the individual athlete and includes specific recommendations to help the athlete reach and maintain peak performance.

Follow-up Nutritional Consultation: As modifying diet for maximal performance is an on-going process, follow-up appointments with the sports dietitian are important. During these ½- hour follow-up appointments, athletes work with the sports dietitian to achieve and fine-tune their diet to maximize sport performance.

Resting Energy Expenditure
Resting Energy Expenditure is used to determine the number of calories an individual needs to consume in order to lose, maintain or gain weight. Since REE accounts for approximately 70% of your caloric uptake, it is a great tool to help regulate one’s desired bodyweight and a critical measure when trying to achieve optimal athletic performance. This test is performed at rest and no exercise is involved. With the nose plugged, you will breathe through a mouthpiece connected to the metabolic analyzer.

Body Fat Analysis
Using calipers and taking readings from various sites on your body we will assess your current body fat content which can then be used to help provide a baseline for weight loss, weight gain and for athletic performance purposes.

Bike Fitting

One of the biggest performance upgrades you can make to your bike is a proper fit. Your bike and its contact points must be selected and positioned in a manner that promotes the 3 key measures of a perfect fit. More Comfort, More Power and More Aerodynamic Speed.

Run Gait Analysis

Biomechanical analysis of gait to optimize your running ability. Individualized attention to running style and ways to optimize running performance.

At Cayuga Medical Center we are proud to offer state of the art surgical techniques to correct a variety of orthopaedic conditions. All our surgeons are board certified in orthopaedic surgery and several have completed additional fellowship training in subspecialties. Our mission is to give our patients the opportunity to make the best recovery possible, right here, close to home.

The surgical procedures we perform include (but are not limited to):


  • Arthroscopic Rotator cuff repair
  • Arthroscopic shoulder stabilization for instability
  • Arthroscopic management of shoulder stiffness
  • Fracture repair
  • Repair of separated and dislocated shoulders
  • Total Shoulder replacements for arthritis
  • Complex revision surgery


  • Fracture fixation
  • Nerve releases and transposition
  • Total Elbow Replacement
  • Tennis Elbow (lateral epicondylitis) debridement
  • Elbow arthroscopy for elbow stiffness, loose bodies, or arthritis
  • Ligament Reconstruction (i.e. “Tommy John” surgery)
  • Biceps tendon repair
  • Complex revision surgery

Wrist and Hand

  • Wrist, hand, and finger fracture fixation
  • Carpal tunnel release
  • Trigger finger release
  • Tendon repairs
  • Nerve repairs
  • Joint replacements and fusions for arthritis
  • Ligament repairs
  • Release of contracted or deformed fingers
  • Wrist arthroscopy
  • Xiaflex injections
  • Complex revision surgery


  • Total hip replacements, including revision surgery
  • Hip fractures
  • Periprosthetic femur fractures


  • Fracture fixation
  • Ligament reconstructions, including ACL
  • Meniscus repairs and debridements
  • Articular cartilage procedures
  • Patella tendon repairs
  • Patella tendon realignment
  • Total knee replacements, including revision surgery

Foot & Ankle

  • Ankle arthroscopy
  • Fracture fixation
  • Tendon repairs, including Achilles
  • Ligament reconstruction and joint stabilization

Joint Solutions Program Overview

Preparing for Surgery
Once you and your surgeon have decided on joint replacement, the surgery is scheduled. At this time, you enroll in a pre-operative education class.

You and a caregiver, who will be your “coach” through your recovery, are invited to class to learn what to expect and how to prepare for the surgery. The class also gives you an opportunity to ask questions and interact with other people preparing for surgery. You’ll learn about the importance of pre-operative exercises in preparation for the surgery and you’ll receive an education guide outlining what to expect before, during, and after the operation.

Your Stay at Cayuga Medical Center
The surgical day involves completion of the surgery and optimal post-operative pain control to help prepare you to begin moving. Orthopedic nurses and physical therapists will teach you about total hip precautions or total knee care. The Joint Solutions team will continue to emphasize these safety factors throughout your hospital stay

The day following surgery physical therapy begins and continues twice a day, each day in the Joint Solutions gym. The therapist works with you to improve strength, range of motion and mobility. Your “coach” is invited to attend therapy group sessions to observe and assist you.

As the exercises become more advanced and walking distances increase, you will become more independent in preparation for discharge. You’ll progress to stair climbing and learn more about total hip precautions or self total knee stretches. The occupational therapist will assist you with activities of daily living and make recommendations regarding assistive devices.

Returning Home
Prior to discharge, our discharge-planning nurse will assist you in obtaining necessary equipment and will help to determine an optimal discharge plan. The discharge plan will determine whether you will qualify for acute rehabilitation or be discharged directly home. When you are ready for discharge to home, the discharge planning nurse will assist in setting-up continued services for home-care physical therapy and nursing if needed. You will work with a therapist on continuing to improve strength, range of motion, and mobility.

Your surgeon may also recommend outpatient physical therapy following home-care to further optimize your recovery. Cayuga Medical Center has two outpatient physical therapy clinics at Physical Therapy & Sports Medicine Island Health and Fitness Center or Cayuga Medical Center’s Brentwood Physical Therapy offices.

Weight Loss

At CCHL, we understand that losing weight can be very challenging. Let us support you on your journey to better health with helpful tools, resources, and ongoing contact. Our trained medical team can help you adopt healthy lifestyle habits in a safe and welcoming environment, in order to:

  • Promote weight loss
  • Increase activity and energy level
  • Improve your overall health by lowering blood pressure, blood sugar, and cholesterol

During our individual counseling sessions we will work together with you to determine which of the following programs, or combination of programs, would best meet your specific weight goals

Medically Supervised Weight Management

Both individual counseling sessions and group classes are offered by our team of medical practitioners, nurses, dietitians, health educators, and exercise physiologists. Clients of all ages are welcome.

Nutrition Counseling

What you eat has a great impact on your health. At CCHL, many people learn to improve their health and manage weight through better nutrition. Healthy eating is discussed at CCHL during medical appointments, in classes, and at individual meetings with our Registered Dietitian/Nutritionists (RDNs).

At a meeting with the RDNs, you can develop specific strategies to address the following health concerns:

  • Obesity/Overweight
  • High blood pressure (hypertension)
  • High cholesterol
  • Diabetes
  • Cardiovascular disease

In addition, the RDNs are experienced with the following concerns:

  • Anemia
  • Cancer
  • Celiac disease
  • Child nutrition
  • Digestive problems (including irritable bowel syndrome, inflammatory bowel disease, Crohn’s disease, GERD, gastritis, and diverticulitis)
  • Food allergies
  • Gestational diabetes
  • Irregular eating patterns and disordered eating
  • Pregnancy
  • Sports nutrition
  • Special diets (such as low oxalate, high potassium, low potassium)
  • Special eating concerns (including swallowing problems and tube feeding)
  • Underweight

HMR® Weight Management

Cayuga Center for Healthy Living (CCHL) offers a supervised weight management program that closely monitors your progress towards better health and well-being. Health Management Resources (HMR) is an intensive weight-loss and lifestyle-change program designed to help you lose weight fast and build healthier routines that last. Our weight loss program works because it offers a different path than traditional weight loss programs by combining supervision, meal replacement with nutrition counseling, accountability, education and support, and lifestyle changes. CCHL and HMR© help you achieve lasting weight loss!

Learn more

Bariatric Surgery

CCHL provides lifestyle support for the Cayuga Center for Metabolic and Bariatric Surgery. If your body mass index (BMI) is greater than 40, or greater than 35 and you have diabetes, high blood pressure, or other weight-related problems, you may be a candidate for weight-loss surgery.

Exercise Transition Program

The Exercise Transition Program at Cayuga Wellness Center is designed to teach you how to safely exercise.  The program provides guidance to those who are new to exercise, have chronic medical conditions or have limited mobility. Classes are led by exercise physiologists from Island Health & Fitness, utilizing cardiovascular equipment, hand-held weights, functional activities, and stretching. Referral with medical clearance from your primary care provider or the providers at CCHL is needed to enroll.

Living Well Classes

Monthly Classes for a Healthier YOU!

Cayuga Center for Healthy Living offers a series of monthly classes starting in January continuing through December each year.  The classes are led by our expert staff of providers, dietitians, nurses and health educators and focus on a variety of topics to help improve overall health, addressing exercise, diet, sleep, stress and how to successfully adopt healthy habits.

Class format:  30-minute presentation, followed by a “hands-on” activity related to the month’s subject with plenty of time for questions.

Who should attend:  Anyone looking for ways to improve their health!  An optional (private) weigh-in is available before each class for those working on weight management.


A growing body of scientific evidence has demonstrated that lifestyle intervention is an essential component in the treatment of chronic disease such as type 2 diabetes. With appropriate changes in your lifestyle, you can go a long way toward turning the tables on type 2 diabetes.

  • Our diabetes team provides outpatient services at CCHL, as well as inpatient support to patients who are hospitalized at Cayuga Medical Center. Our services are comprehensive and our care team is very experienced.
  • We will help you learn to manage your diabetes and prevent or slow its progression, in coordination with the treatment you receive from your primary care provider.

What Can You Expect When You Get Referred to CCHL for Diabetes?

  • A clinical visit with one of our medical providers to discuss your individual lifestyle issues and your history with diabetes
  • Access to American Diabetes Association accredited diabetes education classes
  • A visit with one of our dietitians to assess your dietary goals
  • Information on our programs and classes including, weight loss, tobacco cessation, stress management, and exercise
  • Ongoing support and education based on your goals and needs

Diabetes is a complicated problem. For a thorough explanation of type 2 diabetes you can go to the website of the American Diabetes Association or WebMD.

Diabetes Prevention Program

More than 84 million US adults—that is 1 in 3—have prediabetes.  With prediabetes, blood sugar is higher than normal but not high enough yet to be diagnosed as diabetes.  People with prediabetes are at high risk for Type 2 diabetes (the most common type of diabetes), heart disease, and stroke.  Have you ever been told by your doctor that you:

  • Are at risk for getting diabetes?
  • Have pre-diabetes?
  • Have borderline diabetes?
  • Have high blood sugar or glucose?
  • Had gestational diabetes?

The Diabetes Prevention Program offered by CCHL can help you make a change for life. The program helps you learn how to change your lifestyle to prevent Type 2 diabetes.  This evidence-based program is part of the U.S. Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (NDPP).

Learn more

  • WHAT: Groups meet with a trained Lifestyle Coach for 16 weekly sessions + six monthly follow-up sessions over the course of a year.
  • WHO: Groups are open to all qualifying
  • HOW: Ask your doctor for a recommendation, or contact CCHL at 252-3590

Diabetes Education Classes

Diabetes Self-Management Education (DSME) is recognized by the American Diabetes Association and taught by a Certified Diabetes Educator together with other professional staff. Topics cover an overview of diabetes, complications, exercise, self-monitoring, medications, and nutrition.

Classes meet weekly each month. Call for upcoming dates and times.

Eating and Nutrition

At CCHL, we understand that changing the way you eat can be very challenging, especially if you are the family member who is responsible for preparing meals for everyone. With our assistance you can develop an eating plan that incorporates fruits, veggies, whole grains, beans, lean proteins, and low-fat dairy products to help control diabetes and also effectively lower blood pressure and cholesterol.

The Impact of Exercise

For most people with diabetes, engaging in regular exercise is one of the most important steps you can take to improve your health because physical activity lowers blood glucose. We can help you develop an individual exercise routine that is safe and effective for your specific health concerns. If you are overweight and have high blood pressure and high cholesterol levels, exercise can help to improve those numbers.

Cardiac Rehabilitation Program

The Cardiac Rehabilitation Program at Cayuga Medical Center offers medically monitored exercise and risk management education for people with qualifying cardiac diagnoses. Our program is certified and accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).

Patients are typically referred to our program through a cardiologist or primary care provider and must have one of the diagnoses listed below.

  • myocardial infarction (MI or heart attack)
  • percutaneous coronary intervention (PCI)
  • stable angina
  • congestive heart failure
  • coronary artery bypass graft (CABG)
  • valve repair or replacement
  • heart transplant

The program varies in length depending on the nature of your health care coverage. Additional cardiac diagnoses may be covered. We urge you to check with your insurance provider regarding coverage and co-pays.

Building Confidence with Exercise

Cardiac rehabilitation is an exercise program that includes telemetry monitoring and is administered by a multidisciplinary team of professionals including a supervising physician, registered nurses certified in advanced cardiac life support (ACLS), and exercise physiologists.

  • While class is held in a group format, each participant receives a personal exercise prescription and individual instruction.
  • Once enrolled, patients attend 60-minutes exercise sessions, two times a week, in the attractive and accessible Cayuga Wellness Center.
  • Our cardio equipment is comfortable, well-maintained, and suitable for all levels and abilities. Additional exercise instruction may include resistance exercises, functional fitness, and stretching.
  • Patients who complete the Cardiac Rehabilitation Program have the option of continuing, and building on, their exercise routine in the Transition Exercise Program at Island Health & Fitness.

Lifestyle Modification

There are a number of lifestyle risk factors that contribute to cardiovascular disease. Lifestyle education and disease risk management are essential parts of cardiac rehabilitation.

  • Cardiac rehab patients often have co-existing diagnoses such as high blood pressure, high cholesterol, obesity, and diabetes, which increase the risk for future cardiac problems.
  • Participants in our program have access to individual education and lifestyle counseling sessions provided by the clinical staff at CCHL.
  • Whether the goal is to lose weight, adopt a heart healthy diet, quit tobacco products, or manage stress, we assist people in developing a plan and help them follow it through.

Tobacco Cessation and Heart Disease

Tobacco use is bad news for people with heart disease. Tobacco significantly increases your risks for further health complications, including additional cardiac events and premature death.

Visit the NYS Quit Line for more information.

Stress Management

A certain amount of stress is a good thing. But in our busy, complicated lives, many of us live in a state of constant, low-level stress. Most of us describe this as normal, everyday stress; however, this constant surge of “fight or flight” hormones causes inflammation, which contributes to virtually every kind of disease. Eliminating stress from our lives is an unrealistic goal; it’s our approach to handling our stress that can make the difference.

Scientific research has shown the benefits of stress management for people with chronic health problems, such as heart disease. Our collaborative partners at Island Health & Fitness and Rasa Spa offer various avenues for stress reduction, including:

  • Body work: massage, reflexology, aromatherapy (Rasa Spa)
  • Mindfulness-based stress reduction program (IH&F, Rasa Spa)
  • Meditation (Rasa Spa)
  • Yoga (various approaches) (IH&F)
  • Medical therapeutic yoga (Rasa Spa)
  • Tai Chi (IH&F)

The scope of our pain management services includes both medical and non-medical therapies. In addition to the specific therapeutic approaches offered in the pain center, we work closely with a number of physicians and area health-care practitioners on a referral basis, including specialists in neurology, physical medicine, psychology, physical and occupational therapy, chiropractic, massage, acupuncture, and spiritual healing.

An individual treatment plan is designed for each patient, depending on the patient’s problem and preferences.

We treat patients with a variety of chronic pain problems including:

  • neck and back pain from spinal disorders, herniated disks, and orteoporosis
  • myofascial pain
  • chronic regional pain syndrome
  • post-herpetic neuralgia
  • intractable cancer pain
  • post-operative pain that remains unresolved
  • unresolved migraine

Medical pain management

There are several options for medical pain management in treating chronic pain. Your pain specialist will talk with you about what those options are, their benefits and drawbacks, given your individual situation. We may also recommend referrals for physical therapy or aqua therapy, which can be very effective tools for pain management. Appropriate exercise done correctly can help build tolerance and reduce pain over time. TENS (transcutaneous electrical nerve stimulation) therapy is another treatment modality that has proven effective in helping certain patients manage their pain.

Interventional approaches

There are many different interventional approaches to pain management. Each intervention has its own specific purpose, associated risks, and benefits. Your doctor will recommend a course of treatment depending on your individual assessment.

Fluoroscopy-guided epidural steroid injections

Fluoroscopy-guided epidural steroid injections are often recommended to manage low back and/or leg pain caused by sciatica. Typically these injections comprise a fast-acting local anesthetic for temporary pain relief and cortisone (a steroid) to reduce chronic inflammation for longer lasting pain relief. The injection is administered with live imaging guidance, which accurately guides the doctor to the epidural space.

Radiofrequency ablation

Radiofrequency ablation can be used to provide pain relief for patients suffering from chronic back and neck pain caused by degenerative changes in the spine due to arthritis. This minimally invasive procedure uses a radio wave to heat a small area of nerve tissue, which decreases its ability to transmit pain impulses. Radiofrequency ablation is performed with fluoroscopic (live imaging) guidance.

Nerve blocks

Nerve blocks involve the injection of a nerve-numbing medication and may be recommended for either diagnosing or managing pain that is caused by a group of nerves, called a plexus or ganglion. Diagnostic nerve blocks can be used to locate the source of pain, while therapeutic nerve blocks can be used to control acute pain.

Trigger point injections

Trigger point injections can provide relief from painful focal areas of muscle spasm called trigger points. The peripheral nerve pain from trigger points often responds well to the injection of an anesthetic or combination of anesthetic and cortisone.



The Department of Imaging Services at Cayuga Medical Center is the most comprehensive in the region and has a reputation for remaining at the forefront of this critically important field of diagnostic medicine. We are technologically equal to the country’s premier medical centers. Our board-certified neuroradiologist works closely with an experienced team of registered radiological technologists who have earned additional certifications in specialty areas, including CT, MRI, nuclear medicine, and PET (Positron Emission Tomography) scan.

A leading edge computerized picture archiving communication system (PACS) captures digital images and maintains them electronically, eliminating the need to print and store film. With connectivity to our PACS through a secure network, our physicians can review their patients’ imaging studies and radiologists’ reports as soon as they are completed. This system also facilitates physician consultations and patient referrals to the University of Rochester Medical Center (and other tertiary care centers), which provides a very high level of integrated care.

Neurodiagnostics Clinic

Our newly renovated neurodiagnostics clinic comprises three testing rooms and is located on the medical center’s third floor, offering a view of Cayuga Lake. The clinic provides EEG (electroencephalogram) and EMG (electromyogram), which are the two principal neurological testing modalities used to confirm or to rule out several different diagnoses.

Patients can be referred to the clinic by primary care providers and by physician specialists. Testing is performed under the direction of our department supervisor, a board-registered EEG technologist with 25 years of experience in the field. Test results are interpreted by members of our team of board-certified neurologists, all of whom have subspecialty training within the field of neurology including pediatric neurology, dementia, neuromuscular disease, epilepsy, and stroke.

  • EEG is used in the diagnosis of conditions such as epilepsy, syncope (fainting, loss of consciousness), memory disorders, stroke, headache, and altered mental status. For additional information on EEG testing.
  • EMG is used to determine the cause of neck and back pain, numbness and tingling, neuropathy, carpal tunnel syndrome, and peripheral pain, such as a burning sensation in the feet or hands. For additional information on EMG testing.


Adult and Pediatric Neurology

Neurologists diagnose and treat disorders of the central nervous system, which includes the brain, spine, and peripheral nervous system and muscles. The Department of Neurology, a subspecialty of internal medicine, was established at Cayuga Medical Center in the mid-1980s. Our team includes both adult and pediatric neurologists.

There are many types of medical diseases of the central nervous system. Among the most common neurologic conditions we treat are:

  • Parkinson’s disease and other movement disorders
  • Multiple sclerosis (MS)
  • Stroke
  • Epilepsy
  • Dementia
  • Migraines and other headache disorders


Epilepsy is a neurological disorder that causes a person to have recurrent, unprovoked seizures. These seizures occur when the electrical activity in the nerve cells of the brain are disrupted. Seizures vary from person to person and can involve staring, abnormal movements and loss of consciousness. Epilepsy can occur at any time of life; however, it has the highest incidence in the very young and in the elderly. Among people with epilepsy, two-thirds are able to satisfactorily control their seizures and lead a normal life. However, one-third of those with epilepsy are still coping with uncontrolled or poorly controlled seizures.

There are two basic categories of epilepsy: generalized seizures and focal seizures.

  • Generalized seizures involve all areas of the brain at once and cause loss of awareness and often loss of consciousness. This type of epilepsy is most commonly diagnosed in children.
  • Focal (or partial) seizures begin in one part of the brain and may only impact the part of the body controlled by that specific area of the brain. The onset of focal seizures can begin at any time of life. Within each of those basic categories there are several different types of seizures.

At Cayuga Medical Center we treat pediatric and adult epilepsy, employing various types of treatment.

Cayuga Epilepsy Center

Epileptologist Dr. Deana Bonno, supervises the epilepsy monitoring unit on the third floor of Cayuga Medical Center. The unit allows her to evaluate electroencephalograms of brain waves and videotapes of patients’ body movements on a 24-hour basis. She uses this data to determine the type of epilepsy a patient has and the type of treatment to recommend.


Treatment of Conditions of the Brain and the Spinal Cord

Neurosurgeons specialize in the surgical treatment of conditions of the brain and the spinal cord. They use the most advanced computer and imaging technology in the diagnosis of neurologic problems and in the operating room during surgery. Our neurosurgeons manage the surgical treatment of patients with cerebrovascular hemorrhage and aneurysms, head injuries, spinal problems, tumors of the central nervous system, and congenital abnormalities.

Cayuga Medical Center launched its neurosurgery program in 1996. In 2013, after nearly two decades of steady growth, we became clinically connected with the University of Rochester Medical Center (URMC) Department of Neurosurgery. This important relationship has increased regional access to advanced neurosurgery.

  • Area residents have the advantages of excellent local neurosurgery and a direct link to one of the most highly rated neurosciences programs in the nation.
  • Patients who can be treated in Ithaca stay here and receive their care locally.
  • Patients with more complicated brain and spinal cord injuries or aneurisms that require highly specialized care are referred to URMC.
  • This tiered system is a very effective model of care that avoids unnecessary transfers of patients who are best served at Cayuga Medical Center.

Comprehensive Services

Comprehensive medical center services support the work of our neurosurgeons:

  • Cayuga Neurologic Services of Cayuga Medical Associates, comprising a very experienced team of board-certified neurologists
  • Outstanding neurological imaging provided by the region’s most comprehensive Department of Imaging Services and the experienced specialists at Radiology Associates of Ithaca, including a fellowship trained neuroradiologist
  • A talented team of intensive-care medicine specialists and hospitalists
  • One of the most consistently highly rated inpatient Physical Medicine Rehabilitation Units in the country
  • The most extensive outpatient physical therapy programs in the region, including practitioners with experience and training in neurologic conditions and musculoskeletal problems of the neck and spine
  • The Ithaca Center for Pain Management, staffed by physicians who are board certified in physical medicine, anesthesiology and pain management

Pain Management

Chronic Pain Problems

Our caregivers treat patients with a variety of chronic pain problems including:

  • neck and back pain from spinal disorders, herniated disks, and osteoporosis
  • myofascial pain
  • chronic regional pain syndrome
  • post-herpetic neuralgia
  • intractable cancer pain
  • post-operative pain that remains unresolved.

Patient services

The scope of pain management includes both medical and non-medical therapies. Our pain management specialists treat pain with medication, nerve blocks, and implanted technologies (such as dorsal column stimulators). The pain management team also works closely with a number of physicians and area health-care practitioners on a referral basis, including specialists in neurology, physiatry (physical medicine specialists), psychology, physical and occupational therapy, chiropractic, massage, acupuncture, and spiritual healing. An individual treatment plan is designed for each patient, depending on the patient’s problem and preferences.


Designated Stroke Center

Cayuga Medical Center is designated as a Stroke Center by the New York State Department of Health. This designation process is part of a statewide initiative to raise diagnostic and treatment standards and improve access to high quality care for patients with a diagnosis of stroke, which is the fifth leading cause of death in the United States and the leading cause of adult disability. Studies published in the Journal of the American Medical Association have shown that patients treated at hospitals with a Stroke Center have reduced mortality and morbidity, fewer complications, improved long-term outcomes, and increased patient satisfaction.

Stroke, also known as “brain attack,” is a medical emergency requiring swift transportation to the nearest medical center and immediate medical treatment by the stroke team. This is a multidisciplinary group including emergency physicians and nurses, neurologists, radiologists, neurosurgeons, vascular surgeons, and rehabilitation specialists. Team members are available to respond 24/7 in the Emergency Department for the evaluation and treatment of stroke patients.

Code Gray

In the management of acute stroke, the pressing issue is time. A Code Gray calls the stroke response team into action and things happen very quickly. The timely administration of thrombolytic agents to dissolve a possible clot blocking blood flow to the brain, is vital to save brain cells.

  • The EMS responders start the process with their assessment of the patient in the field.
  • As soon as the ambulance calls in, the response begins. CT imaging techs are in the hospital 24-hours a day so they can immediately prepare the CT scanner and call the radiologist for stand-by alert.
  • Other stroke team members go to the Emergency Department where they are ready and waiting at the door to receive the patient.
  • Our neurologists collaborate closely with the stroke neurologists at the University of Rochester Medical Center, who direct the care of patients arriving with symptoms of stroke.

There are two types of stroke: Ischemic (caused by a clot or vessel narrowing that blocks the flow of blood in the brain) and hemorrhagic (caused by bleeding into the brain or an aneurysm that leaks or ruptures). By examining a CT scan of the brain, a radiologist can determine if the patient has had a stroke and which type of stroke it is. If diagnosed in time, ischemic strokes can be treated with thrombolytic (“clot-busting”) medication to dissolve the clot and restore blood flow in the brain.

As soon as the initial CT images are taken, they are transmitted to the radiologist for interpretation. Additional brain imaging studies can be helpful, as well, to determine the extent of the impact the stroke has had on the brain. These images are also available to our colleagues at the University of Rochester Medical Center.

How to Recognize a Stroke

Signs and symptoms of stroke usually occur suddenly and may include:

  • Numbness or weakness of the face, arm, or leg on one side of the body
  • Confusion, trouble speaking or understanding
  • Trouble seeing from one or both eyes
  • Trouble walking, dizziness, or loss of balance or coordination
  • Severe, unexplained headache, especially of sudden onset

If you have any of these symptoms, call 911 immediately. Do not try to drive yourself to the hospital – your symptoms could get worse while you’re driving.

Risk factors for stroke you can change with your doctor’s help

  • High blood pressure
  • Tobacco use
  • Diabetes
  • Carotid and other artery disease
  • Irregular heart rhythm
  • Illegal drug use
  • Transient ischemic attacks
  • Certain blood disorders
  • High blood cholesterol
  • Physical inactivity and obesity
  • Excessive alcohol use

Medical Rehabilitation

Who We Can Help

Before anyone is admitted to our medical rehabilitation unit, our multidisciplinary care team conducts a thorough patient assessment to determine if our approach to care and level of intensity is appropriate for the individual. To be admitted to the unit, you must be determined to have the stamina necessary to participate in three hours per day of active therapy. We will only accept you into the program if we believe we can truly help.

Our Philosophy of Care

Each patient who comes to us for help is an individual with specific challenges to overcome. Our goal is to help you recover abilities, regain confidence, and return home with the skills needed to live life to the fullest.

You will work hard and so will our care team. We focus our efforts and our attention on your progress; we celebrate your successes and help you plan for the future. Families and friends are an integral part of the rehabilitation process, and we teach them how to reinforce the gains made through therapy. The work you and family do here prepares you to cope with changes in lifestyle following your trauma or illness.

Ours is a full-service Laboratory comprising several labs that focus on different specialties within the field of laboratory medicine. We provide testing in all major areas of clinical laboratory including chemistry, special chemistry, cytology, and molecular microbiology, pathology, urinalysis, hematology, coagulation, and blood banking. We offer a robust menu of tests, with seamless ordering capabilities and test results.

Our lab works in collaboration with the Mayo Medical Laboratories, which serves as the official reference laboratory for Cayuga Medical Center Laboratory. Mayo Medical Laboratories are considered world leaders in both the quality and scope of services of services they provide.

The Cayuga Medical Center Laboratory is licensed by the New York State Department of Health to perform testing in the following categories, in accordance with the Public Health Law:

  • Andrology (limited to semen analysis)
  • Bacteriology Comprehensive
  • Blood pH and Gases
  • Blood Services Transfusion
  • Cellular Immunology Malignant Leukocyte Immunophenotyping (for interpretation of results only)
  • Clinical Chemistry
  • Cytopathology Gynecological Testing Non-gynecological Testing
  • Diagnosis Immunology Diagnostic Services Serology
  • Endocrinology
  • Forensic Pathology
  • Hematology Cellular Hematology Coagulation Cytohematology Diagnostic
  • Histopathology (general)
  • Immunohematology
  • Molecular Microbiology
  • Mycobacteriology Restricted
  • Mycology Restricted
  • Oncology Human Papillomavirus (HPV) Testing Soluble Tumor Markers
  • Parasitology Comprehensive Toxicology
  • Clinical Toxicology-Initial Testing Only Forensic Toxicology-Initial Testing Only (for breath alcohol testing
  • Ther. Sub. Mon./Quant. Tox.
  • Urinalysis
  • Urine Pregnancy Testing
  • Virology

Extended Services

To better serve our patients we provide certain extended services. The following special services are available to patients with a doctor’s order:

FNA Center
Fine needle aspiration (FNA) to determine whether a cyst or lump is cancerous or benign, performed by cytopathologist Dr. Daniel Sudilovsky, who is a national expert in FNA. This method for acquiring a tissue sample provides the greatest accuracy rate and is less invasive than other biopsy procedures such as core needle biopsy or surgical biopsy.

Home Phlebotomy Service
Convenient home specimen collection for patients who require blood work but who are unable to travel to one of our five different Laboratory patient service centers in Ithaca, Dryden, Cortland, and Montour Falls. With a physician order our Laboratory provides phlebotomy services for homebound patients.

Nursing Home Phlebotomy Service
On-site collection of blood samples and specimens for residents in area nursing homes.

Informational brochures to help patients understand certain lab tests ordered by their doctors and what preparation, if any, is necessary prior to specimen collection are available in local doctors’ offices.

To better serve our doctors we provide:

  • Swift, accurate lab test results available for viewing in physician offices.
  • Responsive client service staff members, whose jobs are to answer phone calls and questions coming into the Laboratory from our clients. When physicians contact us by phone, we answer those calls in person.
  • Client service representatives working directly with physician offices to ensure that the physicians and their office staff have what they need on site. This includes working closely with physicians’ offices, the student health centers at Cornell University and Ithaca College, and local nursing homes.
  • A direct link to the Cayuga Lab Test Catalog.
  • Daily courier service from physician practices to our Laboratory to ensure prompt test results for patient specimens collected during physician office visits.
  • Continuing growth in local testing capabilities, including diagnostic and prognostic testing for molecular markers for different cancers.
  • The ability to view slides with a pathologist upon request.
  • The most advanced laboratory technology in the Southern Tier of New York State, including rapid flu, strep, MRSA testing and bacterial identification using MALDI-TOF/Mass Spectraphotometry.

For more information or to set up services, please contact:

Deborah Mansfield, BSMT 
Manager of Laboratory Outreach 
(607) 274-4474 or

Brian Porter 
Laboratory Outreach Supervisor 
(607) 274-4474 or

Common Gastrointestinal Disorders

The experienced team of gastrointestinal specialists at Cayuga Medical Center treats the array of disorders relating to the digestive system. The following disorders are among the most common problems we diagnose and treat.

Barrett's esophagus

Barrett’s esophagus is a serious complication of gastroesophageal reflux disease (GERD) that occurs when the tissue in the esophagus (swallowing tube) becomes altered due to constant inflammation. About 10 percent of people with chronic symptoms of GERD develop Barrett’s esophagus. This condition increases the risk of developing esophageal adenocarcinoma, which is a rare but very serious, potentially fatal form of cancer.

Celiac disease

Celiac disease is an allergic reaction to gluten, which is a protein found in specific grains: wheat, barley, rye, and possibly oats. Why allergic reaction occurs in certain people and not others remains unclear. When a person with celiac disease consumes gluten, it breaks down during digestion and causes painful inflammation, which damages the inside of the small intestine. This makes it difficult to absorb the nutrients from food and can lead to other chronic problems, such as anemia and osteoporosis.

Crohn's disease

Crohn’s disease is a chronic inflammatory disease of the digestive tract. Symptoms include severe abdominal pain, profuse diarrhea, bleeding in the intestinal tract, and weight loss. There is no one test to determine if a person has Crohn’s disease, as it has many symptoms that are the same as those of other health problems. To make a diagnosis of Crohn’s disease, your doctor will probably gather information from a combination of exams, lab tests, and imaging studies.

Chronic constipation

This is a common condition that is characterized by difficult, infrequent, or incomplete evacuation of bowel movements, or the inability to pass stool. The prevalence of chronic constipation increases with age and is more common in women than men. There are many causes of chronic constipation, including lesions or narrowing of the colon, medical conditions such as diabetes, thyroid disorders, or Parkinson’s disease, or it may be due to certain medications. In people over 50, the cause may be a serious bowel disease so it is important to see your doctor to rule this out.


The medical term for difficulty swallowing is called dysphagia. This can be caused by problems of the brain or nervous system (that prevent the throat and esophagus from working properly) and by conditions such as GERD.

Fatty liver disease

Fatty liver disease is also called nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH). This condition, which occurs when fat (adipose) cells infiltrate normal liver cells, is the most common cause of liver disease in the United States. If it is controlled, fatty liver disease is usually benign; however, if left uncontrolled it can lead to permanent scarring of the liver that requires a liver transplant.

GERD (gastroesophageal reflux disease)

Heartburn is an irritation of the esophagus that occurs when acid comes up into the swallowing tube (esophagus) from the stomach. This is called acid reflux. When heartburn symptoms occur frequently, it may be a sign of the more serious problem called GERD. Left untreated, GERD can cause several different problems, among them esophagitis (chronic inflammation of the esophagus), ulcers, hoarseness, and Barrett’s esophagus.

Hepatitis C

Hepatitis C is a virus that affects the liver. An estimated 3.2 million people in the United States have hepatitis C, but because it causes very few symptoms over the course of several years, most people don’t know they have it. However, this is a virus that often does not disappear on its own. Typically if you have acquired hepatitis C, it will infect your liver for the span of your life and may progress to liver cancer or cirrhosis of the liver if not successfully treated. Hepatitis C is the most common cause of liver failure.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is the most common disorder of the digestive tract treated by gastroenterologists. This disorder does not shorten a person’s life, nor does it lead to serious illness or increase the risk for developing cancer. It is chronic, however, and causes very distressing symptoms that can have a significant impact on quality of life. IBS is called a disorder because it occurs in gastrointestinal tracts that appear healthy and have no signs of disease, such as inflammation, infection, or cancer. Nevertheless, people with IBS suffer from gastrointestinal dysfunction in the way matter moves through their digestive tracts and this abnormal function causes a variety of uncomfortable symptoms.


Peptic (or gastric) ulcers are very common in this country. Ulcers are holes in the protective lining of the stomach and the upper part of the small intestine. These are the areas in the digestive tract that come into direct contact with stomach acids and enzymes. Less common are esophageal ulcers that form in the swallowing tube. Historically it was believed that ulcers resulted from stress; however, we now know that the vast majority of ulcers are caused by a specific bacterium. Ulcers can be exacerbated, and in some cases caused, by overuse of over-the-counter painkillers, heavy alcohol use, and smoking.

Diagnostic Tests and Treatments

Endoscopy is a nonsurgical approach to examining the digestive tract. Using an endoscope (a thin, flexible tube with a tiny light source and camera attached to it) your gastroenterologist can view images of your digestive tract on a color monitor. Endoscopic exams, many of which are performed with light sedation to keep patients comfortable, are typically very well tolerated.

  • Endoscopy is used to: detect the presence of disease; remove precancerous polyps that can become cancerous over time; collect small tissue samples for further examination by a pathologist; stop bleeding in the digestive tract; remove foreign objects; and treat certain other problems such as difficulty swallowing.
  • During an upper endoscopy procedure, the endoscope is gently passed through the mouth and throat into the swallowing tube, enabling the gastroenterologist to see the esophagus, stomach, and upper part of the small intestine.
  • In an examination of the lower gastrointestinal tract the gastroenterologist passes an endoscope through the rectum into the large intestine (or colon). This procedure is called a colonoscopy.

Some of the more common procedures and treatments performed by our gastroenterology team are described below.

Upper Gastrointestinal Tract

The EGD (esophagealgastroduodenoscopy)

The EGD (esophagealgastroduodenoscopy) examines the esophagus, the stomach, and the duodenum (the first section of the small bowel. During this procedure, the gastroenterologist examines the linings of the upper GI tract and can perform treatments as needed. Biopsies and tissue samples may be obtained.

Stricture Dilation and Stenting

Stricture Dilation and Stenting may be performed if the esophagus is narrowed and swallowing food is difficult. Narrowing of the esophagus may occur for a number of reasons, such as tumors, the presence of scar tissue, or muscle spasms. The esophagus may be opened using different methods, and occasionally a stent may be placed to keep the esophagus open.

Barrett's Esophagus/GERD Monitoring

Barrett’s Esophagus/GERD Monitoring is recommended on a regular basis for people with these conditions to ensure that no cancer is developing. Gastroesophageal reflux disease (GERD) occurs when stomach acid goes back up into the esophagus, damaging its lining over time. Barrett’s esophagus is a complication of long-term GERD and may increase the risk of esophageal cancer.

Esophageal pH Monitoring

Esophageal pH Monitoring is performed by placing a capsule in the esophagus during an EGD. The pH capsule contains a small radio that transmits data to small receiver worn on the patient’s belt or waistband, similar to a pager or mobile phone. Over 24 to 48 hours, data is collected that is analyzed by the gastroenterologist and used to develop a treatment plan.

Esophageal Manometry

Esophageal Manometry shows the contractions of the esophagus during swallowing. A small, highly sensitive probe is passed through the nose to the end of the esophagus. Pressures can then be measured and analyzed to assist the gastroenterologist in developing a treatment plan.

Botulinum Toxin Injection

Botulinum Toxin Injection is used to treat achalasia, an esophageal mobility disorder in which the muscles in the swallowing tube and the lower sphincter do not contract and relax the way they should to move food from the mouth to the stomach.

Foreign Body Removal

Foreign Body Removal is performed during an EGD procedure to remove food or a foreign object that has become lodged in the swallowing tube.

Percutaneous Endoscopic Gastrostomy Tube (PEG Tube)

Percutaneous Endoscopic Gastrostomy Tube (PEG Tube) can help when someone is having ongoing and serious trouble swallowing and cannot consume enough food or liquid by mouth. A PEG tube is a feeding tube placed directly into the stomach through the skin, allowing the intake of food and calories while bypassing the mouth and esophagus.

Small Bowel or Small Intestine

Small Bowel Enteroscopy

Small Bowel Enteroscopy is a procedure that places a tube through the mouth and throughout the small bowel. This may be used to assist in diagnosing irritable bowel diseases, such as Crohn’s disease or celiac disease.

Capsule Endoscopy

Capsule Endoscopy is a procedure in which the patient swallows a small capsule containing a tiny camera that takes multiple images of the esophagus, stomach, and small bowel as it travels through the digestive tract. The images are collected by a small receiver worn on the patient’s belt and then downloaded into a computer. The gastroenterologist uses these pictures to help with the diagnosis and treatment plan. The capsule passes through the digestive tract into the toilet, where it is flushed away

Large Bowel or Lower Gastrointestinal Tract


Colonoscopy is a procedure that looks at the entire large bowel (colon) with a thin, flexible tube called a colonoscope. Pictures are taken and treatments may be performed through the colonoscope. Biopsies may be taken and polyps may be removed during this exam. Polyps have the potential to become cancerous and are therefore removed to help prevent colon cancer from starting. Screening colonoscopies are the number one way to prevent colon cancer and save lives. This procedure may also be performed through a stoma, if a patient has had a colostomy.


Sigmoidoscopy is a procedure that looks only at the sigmoid colon, which is the part of the large intestine that is closest to the rectum. Biopsies can be performed and polyps can be removed during this procedure.

Medical Oncology

The medical oncologists on staff at Cayuga Medical Center completed their oncology fellowship training at three of the country’s top universities (University of Massachusetts, Duke University, and Columbia University) and are board certified in oncology and internal medicine. They collaborate regularly with colleagues at several national cancer research institutes and are on the teaching faculty of the Roswell Park Cancer Institute, one of the nation’s leading cancer treatment and research centers.

Our experienced team of cancer physicians and nurses provides the newest treatment protocols in chemotherapy, immunotherapy, and hormone therapy for cancer patients, including participation in clinical trials. We have two sites for chemotherapy. Cancer patients undergo chemotherapy in a beautiful, comfortable outpatient suite at Cayuga Hematology Oncology Associates, overlooking Cayuga Lake and directly adjacent to Cayuga Medical Center and on the east side of Cayuga Lake at Convenient Care at Ithaca.

Radiation Oncology

The Cayuga Medical Center Department of Radiation Medicine is accredited by the American College of Radiology. This certification verifies that our program meets or exceeds national standards of care in radiation medicine.

Radiation therapy is available through Cayuga Medical Center Radiation Therapy, which is located in a state-of-the-art facility adjacent to the medical center. Leading-edge technology (such as respiratory gating for patients with lung and breast cancer), clinical trials, and our affiliation with Roswell Park Cancer Institute ensure that radiation therapy patients have access to the latest radiation therapy protocols. The Cayuga Cancer Center also participates in the Radiation Therapy Oncology Group (RTOG), which is a national clinical cooperative funded by the National Cancer Institute. The mission of RTOG is to improve the quality of life of patients diagnosed with cancer. The radiation oncologist at Cayuga Medical Center is a Roswell Park physician.

Oncology Nurse Navigators

Oncology nurse navigation is associated with higher patient satisfaction and improved rates of screening and follow-up among cancer patients, which can result in earlier identification of new or recurring cancers. The oncology nurse navigators are registered nurses whose clinical expertise guides patients through the cancer continuum of care. This is done by working in partnership with multidisciplinary team members to provide timely screening, diagnosis, treatment, and supportive services. The oncology nurse navigators are here to help patient by assisting to remove barriers to health care.

Our oncology nurse navigator:

  • Acts an interpreter and educator about cancers for you and your family
  • Helps patients and families navigate the medical system, from the time of diagnosis and through the continuum of your care
  • Serves as a liaison between you, your doctors, and the medical center departments involved in your care
  • Helps patients and families connect with community resources

Imaging Services and Breast Health Care

Cancer detection and diagnosis are critical components of successful treatment. The Imaging Services Department at Cayuga Medical Center offers the most comprehensive range of radiologic and imaging technology in the region. We are continuously evaluating, updating, and enhancing our technology and skills to stay at the front of current developments. The modalities we offer enable physicians to detect disease early, when it is most responsive to treatment:

  • Magnetic resonance imaging (MRI) including standard, open, and wide-bore scanners
  • Computerized axial tomography (CT scanning)
  • Most advanced 3D mammography
  • Positron emission tomography (PET scan) and nuclear medicine
  • Digital ultrasound
  • SPECT/CT (hybrid nuclear medicine/CT scan)
  • Sentinel node biopsy for breast cancer and malignant melanoma
  • Stereotactic and MR-guided or ultrasound-guided biopsy

For more information on Imaging Services at Cayuga Medical Center click here.
For more information on the Convenient Care Centers in Ithaca and Cortland click here.

Breast Health Care

We understand women at Cayuga Medical Center. We know that mammograms make women anxious and that waiting for exam results is stressful. We know that safety, comfort, and leading-edge technology are patient-care essentials. And we know that women want individualized, personal care.

Our Breast Health Care program at Cayuga Medical Center provides this and more.


  • State-of-the-art digital mammography, ultrasound, and MRI.
  • Mammography and Imaging Services in three locations: Cayuga Medical Center and our Convenient Care Centers in Ithaca and Cortland.
  • Immediate mammography exam results before each woman leaves the department.
  • When additional views or testing are required, such as ultrasound, these exams are performed during the same appointment.


  • A staff of expert, empathetic professionals who specialize in breast care and are genuinely concerned about the experience of each and every one of their patients.
  • Only radiologic technologists who are women and are certified in mammography, ultrasound, and MRI perform exams.
  • Immediate access to the radiologist who reviews the exam when patients have questions or concerns.
  • Separate and discreet mammography suites at all three Imaging Services sites, for privacy and comfort.


  • The full scope of services, including screening for prevention and early detection of disease, prompt and accurate diagnosis of breast disease, access to the very latest treatment protocols, educational programs, and emotional support.
  • Accreditation by the American College of Radiology of all breast care facilities.
  • Board certified radiologists and mammography, ultrasound, and MRI technologists.
  • A Cancer Care Program that is certified by the American College of Surgeons Commission on Cancer
  • An active network of community services

Laboratory and Pathology

The Cayuga Medical Center Laboratories are under the direction of a nationally recognized specialist in cytopathology, which is the study and diagnosis of disease at the cellular level and plays an essential role in the identification and staging of cancer. Laboratory work is critical in cancer care and Cayuga Medical Center has a higher level of expertise in specialty care than many other hospitals in the region. Additionally, our pathologists are directly involved with patient care and make themselves available if a patient wants to talk with a pathologist about test findings. This is not true at many hospitals.

Our Laboratory is affiliated with the renowned Mayo Medical Laboratories, which serves as Cayuga Medical Center’s official reference laboratory. Mayo Medical Laboratories are recognized as a world leader in esoteric tests for clinics and hospitals, and have the highest standards in quality and service. Through this collaboration, Cayuga Medical Center provides timely, accurate, cancer specific testing and diagnosis for even the most unusual types of cancer.


Surgery for cancer diagnosis and treatment is performed by board certified surgeons who are trained in the diagnosis and removal of tumors. A number of our surgeons specialize in certain types of cancer surgery, such as head and neck surgery, thoracic (chest) surgery, colorectal surgery, tissue-preserving breast cancer surgery, and plastic reconstructive surgery to improve physical function and to minimize disfigurement or scarring resulting from cancer or surgery for cancer.

Multidisciplinary Thyroid Nodule Clinic

Approximately eight percent of all thyroid nodules are cancerous, and yet, in typical medical communities, completing the diagnostic work-up can take weeks. Under the leadership of endocrinologist Dr. Adam Law, Cayuga Medical Center has established the Multidisciplinary Thyroid Nodule Clinic, which meets twice a month. In one visit, the team provides patients with a complete pathological work-up, the diagnosis, and the complete treatment plan before they leave the clinic.

Palliative Care

We offer comprehensive Palliative Care Services to our patients to relieve suffering and to improve the quality of their lives at any stage of their illness, even at times they are undergoing treatment for advanced, chronic, or multiple illnesses. Because many of our palliative care patients move between Cayuga Medical Center and Hospicare and Palliative Care Services of Tompkins County, our Palliative Care Team includes professionals from both organizations. We have medical expertise in pain and symptom control, and we can offer patients and families help through counseling, social work, and spiritual care to address the psychosocial and spiritual issues that are part of chronic and terminal illness.

Drawing up a birth plan, in advance, that reflects your own health care, cultural, ethnic, and spiritual preferences can be an extremely helpful process for families. When a mother, her partner or support person, and her caregiver discuss the various choices and decisions relating to labor, delivery, postpartum and newborn care, the result can be a very individualized, satisfying childbirth experience. Your local obstetrician or nurse midwife will give you a comprehensive binder of information from the Cayuga Birthplace to help you create your birth plan.

While it may not be possible to anticipate and plan for every single contingency as you draw up your individual birth plan, putting your preferences down in writing can help you consider important choices ahead of time.

As you prepare for the arrival of your new family member, we encourage you to take a tour of our new Cayuga Birthplace. You can schedule a tour by calling (607) 274-4408.

Patient Accommodations

The rooms in the Cayuga Birthplace reflect your input. They are appropriately equipped and beautifully appointed for expectant mothers and their families to enjoy all private accommodations. All of the rooms where births happen are equipped with a lovely, spa-like bathroom and most feature a deep whirlpool tub for relief of labor pain.

Family-Centered Care

At Cayuga Medical Center, we believe in family-centered care. Our physicians and nurses encourage mothers to be actively involved in all decision making about your own birth experience and the care of your newborn. For example, most women in labor find that having one or two support people with them works well. Some families want to include the baby’s siblings in the birth, as well. Women are encouraged to talk to their care provider prior to labor about this option.

Our family-centered philosophy also means that under typical circumstances, the mother and baby are cared for together in the mother’s room. All of the patient rooms have a comfortable space for the mother’s partner (or other adult helper) to sleep.

This provides a great chance for the parents to get acquainted with their new son or daughter and to have the support of our staff while learning to care for their newborn.

What if I Need a Caesarean?

A Caesarean or a “C-section” is typically planned in advance, usually for medical reasons. These are known as elective or planned. C-sections carried out at short notice, usually during labor are known as emergency caesareans. A C-section may be recommended at any point in pregnancy and labor. Although it is generally considered to be a safe operation, it is still major abdominal surgery and there are some risks to both you and your baby.

For your well-being, the Cayuga Birthplace has a state-of-the-art Caesarean surgical operating room right within the new Labor and Delivery Suite.

Availability of VBAC (Vaginal Birth After Cesarean Section)

Although VBAC is now considered to be a safe childbirth choice for many mothers, not all hospitals offer expectant mothers this service. Providing a stand-by OR team and anesthesiologist is an added expense that many hospitals are not willing to incur.

Our care providers are committed to offering a wide variety of birthing options to the community we serve and do whatever we can to accommodate individual requests. Women who have had a previous C-section have a thorough discussion with their care provider about the risks and benefits of a VBAC delivery in their particular situation and together plan for a VBAC or for a scheduled repeat C-section. The OB physician works closely with the anesthesiology and operating room staff to assure the availability of needed services during the time a mother is laboring with a VBAC.

Pain Relief Options and Analgesia

Because the birth experience is different for every woman, it is a good idea to explore in advance with your doctor or nurse midwife the availability of analgesia for labor.

The Birthplace provides a wide variety of options for pain management during labor, including breathing and relaxation techniques, intravenous medications, self-administered nitrous oxide (“laughing gas”) as well as epidural and spinal medications. Almost all C-Sections are done with spinal medication so that the mom is fully awake and can even see the baby as it emerges (via a sterile drape with a clear “window”).

The Birthplace is proud to consistently have one of the highest breastfeeding rates in the state, usually above ninety percent. Our staff are well trained to help new moms and babies establish a successful breastfeeding pattern, starting right at the time of birth, wherever that occurs. Should difficulties arise, a member of our breastfeeding support team will assist as needed. Our providers are very supportive of the importance of exclusive breastfeeding for both the baby and the mom and work together with our staff to address any issues that come up.

Our Cayuga Birthplace experts offer monthly workshops to the public on a variety of important topics:

Expectant Parent Workshop
Signs and symptoms of labor, the first hour with your baby, newborn infant care and safety and a Cayuga Birthplace tour. Fee $100 per family.

Siblings are Special
For children ages three to eight years who are about to become big brothers and sisters.

Breastfeeding: Plan for Success
For new and experienced moms and their partners.

Infant Care and Safety
On the basics of care, feeding, and safety of your baby in the first few weeks.

Spinning Babies – Parent Class
Spinning Babies® is unique and innovative approach to birth designed to create more comfort in pregnancy and ease in childbirth.

For more information call (607) 274-4408. Fees are $15 per family unless otherwise indicated.

For a calendar of classes, click here.

Computer Connectivity with Area Physicians

Imaging studies performed at Cayuga Medical Center facilities are digital and appear on a computer monitor (instead of film). Immediately after imaging studies are completed, they are sent directly to our PACS (picture archival and communication system) and a radiologist receives electronic notification that the study is ready for review. The result is fast, comprehensive care. For patients awaiting potentially worrisome news, faster care is more compassionate care.

Here’s how it works.

  • Our radiologists use a state-of-the-art voice recognition system, which is extremely efficient and eliminates the need for transcription. This enables them to view patients’ images right away and dictate their reports, which appear on the screen next to the images
  • Depending on the particular imaging study, referring doctors may receive test results the same day, usually within two to four hours of when the study is done.
  • Via a secure Internet connection, our referring doctors can view their patients’ imaging studies and the radiologist reports in their offices.

Electronic Consultation

You can request that copies of your imaging study be sent elsewhere, in the event you are relocating or you are seeking a second opinion from one of our affiliates or other major medical center. Your studies can be sent electronically or can be provided to you on a CD to carry with you.

Diagnostic Imaging Services: Offering the Full Spectrum

Cayuga Medical Center offers the most comprehensive array of imaging technology in the region. The following is a summary of our imaging capabilities, including a brief explanation of what each imaging method is and when it is recommended.

You can also obtain detailed information on specific imaging exams, what to expect, and how to prepare for your own imaging exam by clicking on Patient Information on Imaging Exams.

CT Scan (computed tomography scan)

CT Scan is a powerful diagnostic tool that utilizes x-ray and a state-of-the-art computer to create both cross-sectional and 3-D images of the body’s muscles, bones, and organs.

Imaging Services at Cayuga Medical Center has expanded CT scanning capabilities with five accredited scanners across our three facilities. These include a 64-slice CT scanner at the main campus, a 32-slice CT scanner in the Emergency Department (ED), and 16-slice scanners at the main campus and at both Convenient Care Centers in Ithaca and Cortland. The additional scanner in the ED enables physicians to quickly rule out life-threatening problems, such as pulmonary embolism in patients with chest pain, which is one of the most frequent causes of death in the US and requires emergency treatment.

  • All of our CT scanners feature Real Exposure Control, which reduces the patient dose of radiation up to 40 percent based on patient anatomy.
    Our CT tables can support up to 450 pounds. Unlike most systems, our tables can be lowered to 12 inches from the ground, making it easier for patients in wheelchairs to transfer to the exam table.
  • All of our CT scanners have large openings, extra wide tables, and are equipped for scanning tall patients.
  • The large-bore scanner at Cayuga Medical Center is one of three CT scanners at the main campus. This particular scanner is used for special procedures and has respiratory gaiting for oncology treatment planning.
  • As a Designated Stroke Treatment Center, Cayuga Medical Center’s CT depart- ment complies with all of the time and image requirements for mergent diagnosis of stroke.
  • All of our full-time CT technologists are nationally registered in CT or are newly eligible for the exam.

CTA (Computed Tomography Angiography)

CTA provides radiologists with a way to view the anatomy of the blood vessels in the body to help diagnose problems such as a narrowing or blockage in the vessel. This imaging technology is often used to look for narrowing of the carotid arteries, which indicates increased risk for stroke.

CTA has surpassed diagnostic catheter angiography in terms of speed and accuracy. Unlike catheter angiography, CTA is not invasive; it requires only an IV injection. 3-D workstations for CTA enable our neuroradiologist to view all of the arteries and veins in the body. He can locate the specific area of interest in a matter of only a few minutes. In the brain, our imaging system is capable of producing images so clear that the diagnostic interpretations are 98 to 100 percent sensitive and specific. This enables us to identify aneurysms as small as 3 mm, as well as differentiate true aneurysms from small focal dilations occasionally seen at the origins of arteries, even in patients experiencing a significant intracranial sub-arachnoid hemorrhage.

DEXA Scan (Dual-Energy X-ray Absorptiometry)

DEXA Scan is the most advanced technique available for measuring bone-mineral density (bone mass) precisely and safely, using a very low exposure to radiation. DEXA scanners at Cayuga Medical Center measure the bone density in the lumbar spine and both hips, whereas most centers typically measure only one hip.

DEXA is considered to be the gold standard for measuring bone mineral density. It is most often performed on the lower spine, hips, and wrists. In children and some adults, the entire body may be scanned. DEXA uses only a small dose of ionizing radiation.

Bone density testing is strongly recommended if you:

  • are a post-menopausal woman who is not taking hormone replacement therapy
  • have a personal or family history of hip fracture or osteoporosis
  • are a current smoker or have a history of smoking
  • are a woman who is tall (68 inches) or thin (less than 125 pounds)
  • use medications such as corticosteroids, antiseizure medications, or thyroid replacement drugs that are associated with bone loss
  • have type 1 (juvenile or insulin-dependent) diabetes), liver disease, or kidney disease
  • have hyperthyroidism or hyperparathyroidism
  • have experienced a fracture as a result of mild trauma

DEXA test results show two scores:
T Score is the number that shows the amount of bone you have compared with a young adult of the same gender with peak bone mass. A score above -1 is considered to be normal. A score between -1 and -2.5 is classified as osteopenia (low bone mass). A score below -2.5 is indicates osteoporosis. The T score is used to estimate your risk of developing a fracture.

Z Score reflects the amount of bone you have compared with other people in your age group who are the same size and gender. If this score is unusually high or low, your doctor may recommend further medical tests.

Diagnostic x-ray

Diagnostic x-ray is the most common exam ordered. As with all of our imaging modalities, x-rays performed at Cayuga Medical Center are digital.

MRI (Magnetic Resonance Imaging)

MRI (Magnetic Resonance Imaging) is one of the most advanced, non-invasive techniques available for examining the human body. A valuable diagnostic tool, MRI creates detailed images of anatomic structures by using a strong magnetic field, radio waves, and computers. At Cayuga Medical Center’s three Imaging Services sites we offer the most advanced technology on the market today. Our short bore MRI scanners comfortably accommodate people of all sizes and feature music systems, enhanced lighting and airflow for patient comfort.

CMC is proud to offer premier MRI capabilities at all three campuses.

All three MRIs are accredited by the American College of Radiology and all of our MRI technologists are nationally registered in MRI and certified for injections.

The main campus and our Cortland campus have identical new 1.5 Tesla MRIs. These systems offer excellent general imaging as well as the ability to image and biopsy those breast patients that cannot be completed in the 3T due to contraindications.

The 3T MRI is located at our East campus and provides exquisite detail for small parts including neuro cases for cranial nerves and musculoskeletal cases including the ligaments of the hands, wrists, feet and ankles. Breast imaging is also available on the 3T with the Sentinel breast imaging coil and biopsy system.

  • All three sites feature state-of-the-art GE MRI systems which include the new GEM coil package which enhances image quality and reduces examination time.
  • All feature short, wide-bore architecture to mitigate claustrophobia:
    • Designed to reduce patient anxiety by providing more space inside the bore.
    • Able to perform more exams with the patient’s head outside of the magnet.
  • Music systems, enhanced lighting, and increased airflow all increase patient comfort.
  • Accommodate all body shapes up to 500 pounds.
  • The MRI at Convenient Care Cortland is now permanent and is housed in a new addition to the Cortland Convenient Care Center.

When a patient or physician’s office calls to schedule an MRI, the patient will first be scheduled for a screening phone interview with a member of the MRI staff. This is very much like a pre-admission-testing phone call for surgery patients. This screening phone call will include:

  • A review of the patient’s medical history
  • Patient education about the requested exam
  • A determination of whether lab work is required
  • A determination of which scanner is appropriate, based on the exam ordered and the patient’s history
  • An overview of our locations

After the scheduled phone screening is completed, the MRI staff member will transfer the call to scheduling and will notify both the scheduler and the patient about which scanner/site the patient is cleared for. The scheduler and the patient will then pick a date and time for that site.


Mammography is an x-ray examination of the breasts. For patient convenience, digital mammography is available at our three Imaging Services sites in Ithaca and Cortland. Mammography exam results are available to every patient before she leaves her appointment. If additional mammography views or an ultrasound are needed, those studies are performed during the same visit.

Same-day Mammogram Results
Cayuga Medical Center was the first hospital in the area to provide same day mammogram results. Each patient has the option to see one of our board certified radiologists following her mammogram and receive her test results.

Digital Mammography
Ours was also one of the first imaging centers in the area to offer full-field digital mammography, which provides many significant advantages over analog (film) mammography.

  • One of the major benefits of digital mammography is speed. Because the images are digital there is no waiting time while films are processed and reviewed. Images are available to the technologist and radiologist within seconds, allowing quick review of the images by the radiologist and rapid determination regarding additional images or studies needed.
  • Digital mammography exposes patients to a reduced dose of radiation.
  • Digital mammography features digital storage and transmission of images, eliminating lost studies and eventually eliminating the need for a film library. Images can be sent electronically to several treating physicians or given to the patient without a loss of quality. This is an important improvement in patient care, particularly for newly diagnosed patients with breast cancer.
  • There is virtually complete elimination of film artifacts.
  • Each mammogram is read by an experienced radiologist and is also sent through our computer-aided detection (CAD) system, which enables our radiologists to be more effective in their interpretation
  • Referring physicians have the ability to view your mammogram on their office computer via a secure Internet connection.
  • Our mammography technologists are all NYS licensed and registered and are certified by the American Registry of Radiologic Technology. They participate in continuing education every year and are held to the highest standards with additional FDA certification in compliance with the Federal Mammography Quality Standards Act.

Nuclear Imaging

Nuclear Imaging is used to evaluate the function of a body organ, as well as its anatomy. It has both diagnostic capabilities and valuable therapeutic applications.

Cayuga Medical Center has two hybrid nuclear medicine/CT cameras in our Imaging Services Department, which combine single photon emission computed tomography (SPECT) with CT imaging. The systems integrate nuclear medicine studies (which measure function and metabolic abnormalities) with CT images that show detailed anatomy. By registering both images in a complete picture during a single exam, we can identify precisely where a detected hot spot is located.

The new SPECT/CT technology produces more accurate studies with crisper images. And because these cameras work faster, the procedures are completed more quickly and our patients spend less time on the table.

Nuclear Cardiac Stress Test

In this particular type of cardiac stress test radioactive materials called tracers are used to capture images of the heart functioning.

To get your heart muscle working hard, you may be asked to exercise on a treadmill for several minutes. When you cannot exercise any more, a tiny amount of tracer will be introduced into your body through an intravenous (IV) line in your arm. You will then wait 30 minutes before scanning. As the tracer travels through your heart, a special imaging camera (called a Gamma camera) detects the material and captures images of the blood flow in your heart muscle. If you are unable to exercise, you may be administered a drug to get your heart muscle working hard.

PET/CT Scan (Positive Emission Tomography)

PET/CT Scan uses small amounts of radioactive tracers that are attracted to specific organs, bones, or tissues in the body and is used to diagnose and treat disease. This technology combines CT and nuclear scanning to create 3-D images of the body’s organs while they function.

Ultrasound (also called Sonography)

Ultrasound like MRI, this test examines the human body without radiation and uses high frequency sound waves to produce dynamic visual images of internal organs, tissues, and blood vessels. It is also used as a noninvasive method to further evaluate and visualize suspicious mammogram findings.

Cayuga Medical Center has eight ultrasound systems among our three imaging locations at the main campus and the east and Cortland campuses. These state-of-the art systems are fully digital, which results in extremely clear images. One of our ultrasound systems is portable. This enables us to provide bedside imaging for inpatients too sick to be transported, which increases patient safety and helps to improve outcomes.

Additional benefits include:

  • Our three locations are accredited by the American College of Radiology (ACR). ACR accreditation ensures that our patients receive high quality ultrasound and vascular imaging.
  • All of our sonographers are registered by the American Registry for Diagnostic Medical Sonography (ARDMS). This assures the public that they are having their exams performed by competent sonographers who have passed rigorous examinations that document their excellence in ultrasound and vascular imaging.

Women’s Imaging

Premier Service

We understand women at Cayuga Medical Center. We know that mammograms make women anxious and that waiting for exam results is stressful. We know that safety, comfort, and leading-edge technology are patient-care essentials. And we know that women want individualized, personal care.

All women having mammograms at Cayuga Medical Center, east campus and Cortland campus learn the results of their mammograms before the end of their imaging appointment. We have been providing this high level of service for many years.

State-of-the-Art Women's Imaging Center

Cayuga Medical Center provides women’s imaging services at all three campuses, including the main campus, east campus and Cortland campus. Our centers were designed with the special needs and desires of women in mind. Access is easy, the setting is private, and all of the imaging modalities necessary for women’s health care are located there.

In 2012 services at the Women’s Imaging Center were enhanced with the addition of a new powerful 3.0 Tesla MRI, which has special capabilities for both breast imaging and performing MRI-guided breast biopsies.

Spectrum of Care

Cayuga Medical Center’s Women’s Imaging Services provide the full spectrum of care. Our services are cutting-edge, compassionate, and comprehensive.

  • State-of-the-art digital mammography, ultrasound, and DEXA scan
  • 3.0 Tesla MRI (magnetic resonance imaging), which enhances breast-imaging capabilities by providing more detailed images to help differentiate breast tumors from surrounding normal tissues. This MRI is so spacious the radiologists are able to do MR-guided breast biopsies right inside the bore of the magnet.
  • A staff of expert, empathetic professionals who specialize in breast care and who are genuinely concerned about the experience of each and every one of their patients. Only radiologic technologists who are women and who are certified in mammography perform mammograms.
  • Immediate access to the board certified radiologist who reviewed the exam when patients have questions or concerns.
  • Separate and discreet mammography suites at all three Imaging Services sites, for privacy and comfort.
  • The full scope of services, including screening for prevention and early detection of problems, prompt and accurate diagnosis of health issues such as breast disease, osteoporosis, and other women’s health issues; access to the very latest treatment protocols, educational programs, and emotional support.
  • Accreditation by the American College of Radiology of all breast care facilities.
  • Board certified radiologists and mammography, ultrasound, and MRI technologists
  • A Cancer Care Program that is certified by the American College of Surgeons Commission on Cancer
  • An active network of community services

Interventional Care

Interventional care comprises exams that require either the introduction of a contrast medium into the bloodstream or an invasive procedure that requires a brief recuperation period. These studies highlight blood vessels, various body organs, and the spinal cord and canal. Image-guided biopsies guide the radiologist or surgeon quickly and accurately to the tissue in question. Our Philips Digital Interventional Angiography Suite features real-time 3-D modeling capabilities, giving us several significant advantages in manipulating catheters to sites of pathology.

Interventional Modalities


Arthrography is an imaging modality that visualizes joints in motion, using a special form of x-ray called fluoroscopy. Arthrography may be performed using x-ray, MRI, or CT.

Arthrography is used to evaluate abnormalities in the joints and to diagnose unexplained pain or malfunction. These images help doctors determine the cause of the pain and how best to treat it.

Image-guided Breast Biopsy

Image-guided Breast Biopsy is a nonsurgical method of collecting breast tissue for microscopic analysis. Image guidance is also used to drain certain types of abscesses.

This type of biopsy is usually recommended to evaluate a finding on a mammogram.

Radiologists at Cayuga Medical Center use a variety of imaging modalities to pinpoint the exact location of the biopsy site, including stereotactic (low-dose x-ray) guidance, MR imaging, and ultrasound. Each of these approaches has difference advantages, depending on the individual patient’s circumstances and preferences.


Myelography examines the spinal cord and canal for injury or disease. This imaging method uses a special camera called a fluoroscope.

A myleogram may be performed to identify a herniated disk, tumor, infection, or narrowing of the spinal canal caused by arthritis.

Virtual Colonoscopy

Virtual Colonoscopy uses CT scanning to visualize the large intestine (colon). This diagnostic procedure enables a medical specialist to examine the lining of the large intestine for any abnormalities.

Virtual colonoscopy is an important screening exam for colon cancer. In examining the lining of the colon, doctors can detect precancerous nodules that, left untreated, can develop into colon cancer. It is important to note that a virtual colonoscopy is performed only when a standard diagnostic colonoscopy has failed.

Vascular (Blood Flow)

Vascular (Blood Flow) studies are noninvasive tests performed with duplex ultrasound. Harmless high-frequency sound waves bounce off the body’s internal structures and are processed electronically to yield information about blood flow and the condition of the arteries and veins.

This test is used to diagnose suspected artery disease and other blood vessel problems. Our vascular technologists perform both arterial and venous testing.

Multidisciplinary Thyroid Nodule Clinic

Approximately eight percent of all thyroid nodules are cancerous, and yet, in typical medical communities, completing the diagnostic work-up can take weeks. Under the leadership of endocrinologist Dr. Adam Law, Cayuga Medical Center has established the Multidisciplinary Thyroid Nodule Clinic, which meets twice a month.

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About Cayuga Medical Center

We are a not-for-profit, acute-care medical center bringing state-of-the-art diagnostic and treatment services to the residents of Tompkins, Cortland, Seneca, and Tioga counties. And a century after our founding, we remain intrinsically tied to those we serve: our corporate membership includes representatives from over 100 community organizations. At Cayuga Medical Center, we believe that hospitals are shaped by the people they serve


Cayuga Health welcomes their new Chief Diversity Officer, Herb Alexander. Click the link below to learn more:
- Wednesday Jul 28 - 3:07pm

Dr. David Maldow, a new Interventional Radiologist with Cayuga Health says what he's most passionate about with Int…
- Tuesday Jul 27 - 12:45pm

Cayuga Health welcomes Dr. Sol Lissette Rodriguez Medina to our Psychiatry team. Welcome!
- Thursday Jul 22 - 12:47pm

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