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procedures," says David E. Rivadeneira, M.D., FACS, FASCRS, Chief of Colon and Rectal Surgery, Director of the Colon and Rectal Program at St. Catherine of Siena Medical Center and a colon and rectal surgeon at St. Charles Hospital. "There really was a lack of specialization in the area for the minimally invasive approaches we offer. We have filled the void nicely, resulting in a tremendous benefit for patients, their families and their referring doctors." More Than One System Although cancer is commonly treated through the program, Dr. Rivadeneira and his colleague Jill C. Genua, M.D., FACS, FASCRS, also address conditions such as anal fissures, fecal incontinence, Crohn's disease, constipation, diver- ticulitis, hemorrhoids, polyps of the colon and rectum, pelvic floor dysfunction, rectal prolapse and ulcerative colitis. The colorectal program works closely with counterparts in gastroenterology, oncology and radiology, as well as nursing support. The program's care is further complemented by physical therapists, nutritionists and wound specialist nurses specializing in ostomy care and education. The multidisciplinary approach not only provides Drs. Rivadeneira and Genua a wealth of therapeutic options with which to build a comprehensive treatment plan, but also offers invaluable diagnostic information that allows the program to address health concerns beyond those of the colon and rectum. "When a patient comes to us, we're looking at the entire patient, not just a single problem," says Dr. Rivadeneira. "We want to positively impact patients' overall health, which is why we use a multidisciplinary team effort." When first evaluating a patient, Dr. Rivadeneira explains, gathering in-depth medical and family histories is crucial. Particularly for patients with a cancer diagnosis, information about genetic and environmental factors can help tailor the ultimate course of treatment. The colorectal program offers state-of-the-art diagnostic tests in Dr. Genua, performing transanal endoscopic microsurgery for a rectal tumor, with the assistance of nurse Bernadette Kaminsky. Dr. Genua has a particular interest in treating women with pelvic floor disorders such as rectal and pelvic floor prolapse, rectocele, enterocele and fecal incontinence. their offices, including genetic analysis for colorectal cancer patients and their family members. They also provide specialized analysis of tumor markers and responsiveness to chemotherapy agents and work closely with their oncol- ogy colleagues to tailor a customized chemotherapy regimen. The information alerts Drs. Rivadeneira and Genua to the degree of responsiveness the cancer will have, which in turn helps them select the most effective drug without putting the patient through an undue trial-and- error process. Patients also undergo the most current and comprehensive imaging modalities, including 64-slice computed tomography (CT) scans, endorectal ultrasound, magnetic resonance imaging (MRI) and whole-body positron emission tomog- raphy (PET). Before shifting from a diagnostic investigation to a treatment path, the patient meets with the mul- tidisciplinary team for an educational discussion about the surgical options best suited for the patient's case. From the Lab to the Bedside "Pelvic floor disorders" is a term that refers to a broad scope of conditions, including constipation, incontinence, pelvic or anorectal pain, pelvic and rectal MDNEWS.COM ■ MD NEWS Long Island | 7 prolapse, and rectocele. The group of con- ditions has recently garnered increased attention, and Dr. Genua explains that this is due to multiple factors, from heightened awareness to an attitude shift within the area of patient care. "Because these disorders involve condi- tions that are typically embarrassing for the patient, in the past, physicians would hesitate to ask about them, and the patient would not initiate the conversa- tion or report his or her complaints. We now know that these issues have been present for a long time and in greater numbers than was previously recog- nized," Dr. Genua says. "Patients are also more empowered and educated. They are Close-up view of the specialized equipment needed for the transanal endoscopic microsurgery approach