St. Clair Hospital HouseCall Vol VI Issue 2
St. Clair Hospital's community newsletter sharing new medical technologies, patient stories and health tips.
C E L E B R AT I N G 60 Y E A R S | 19 5 4 - 2 014 VOLUME VOLUMEVI V ISSUE 2 HouseCall Carpe Noctem HOUSECALL FOLLOWS ST. CLAIR HOSPITAL'S BOARD-CERTIFIED INTENSIVIST YVONNE R. CHAN, M.D. AS SHE AND A TEAM OF FELLOW CLINICIANS CARE FOR PATIENTS ON THE EVENING/OVERNIGHT SHIFT. inside Minimally Invasive Parathyroid Surgery I The Heart Of A Hero I Ask The Doctor History Minute I Summer Swing AROunD-THE-CLOCK CARE “ ” There is acTive healThcare managemenT happening 24/7 aT sT. clair. YVONNE R. CHAN, M.D. INTENSIVIST AND HOSPITALIST Yvonne R. Chan, M.D. 2 I HouseCall I Volume VI Issue 2 EDITOR’S NOTE: THE HIGH QUALITY, COMPREHENSIVE, AND COMPASSIONATE CARE that St. Clair Hospital is well known for doesn’t stop when the sun starts to dip in the western sky and visitors kiss their hospitalized loved ones good night before heading home to their own beds. The Lab continues to do blood work and other tests, Medical Imaging continues to do X-rays and other scans, Emergency Room physicians and specially trained staff continue to treat patients who have been whisked to St. Clair by ambulance or walked in under their own power, pediatric hospitalists continue caring for their young patients, obstetricians continue to deliver babies in the Family Birth Center, nurses continue monitoring and tending to their patients, Hospital pharmacists continue to fill lifesustaining prescriptions, and Nutritional Services continues to prepare healthful meals for hungry patients. Just as importantly, acutely ill patients throughout the Hospital continue to be cared for by experienced, highly trained physicians. One of those elite physicians is Yvonne R. Chan, M.D., a Critical Care Intensivist and Hospitalist who has been caring for patients during the evening/overnight shift since 2005. HouseCall followed Dr. Chan — who splits evening/overnight duties with fellow Critical Care Intensivist and Hospitalist Maxim V. Bocharov, M.D. — through a recent evening/overnight shift to see what she does in the proverbial still of the night. Her shift started at approximately 5:30 p.m. on a Tuesday and concluded just after 7 a.m. Wednesday. The following photo essay captures the spirit of one particular overnight shift as Dr. Chan and other clinicians continued caring for patients while most of us were fast asleep. Meeting patients’ needs around the clock F or most of us, working after midnight is exhausting just thinking about it, let alone actually doing it on a regular basis. But for Dr. Chan, working when most everyone else ‘Seize the night.’ We had a t-shirt with this imprinted in midnight blue on black with the subtitle ‘I do my best work after 2 a.m.’” Dr. Chan, who went on to earn her medical degree at Harvard Medical School, says that she has “always been nocturnal” and relishes the extra challenges and responsibilities she has as one of the Hospital’s Intensivists and Hospitalists after the sun goes down. is asleep is something she learned and mastered back in the early 1990s while she was an undergraduate majoring in biology at the Massachusetts Institute of Technology (MIT) in Boston. “Do you remember the Robin Williams movie, ‘Dead Poets Society,’ in which he told his students, ‘Carpe Diem,’ which is Latin for ‘Seize the day’?” asked Dr. Chan as she began her shift on a recent weeknight this spring where the weather transitioned quickly from sunny to gently falling snowflakes to bone cold at nightfall. “Well, when I was at MIT, the saying was ‘Carpe Noctem,’ Continued on page 4 Volume VI Issue 2 I HouseCall I 3 THE EVENING BEGINS The transition from day to evening/ overnight shift: Yvonne R. Chan, M.D. is thoroughly briefed on each Intensive Care Unit (ICU) patient by Co-Director of Critical Care Gregory Fino, M.D. Critical care: She treats a patient in the ICU. The evening/overnight duties are often fast paced for her and the clinical staff. On the move: In search of: ICU Nurse Amy Carbonara searches online for relatives of a critically ill patient. Continued from page 3 Sporting blue scrubs, black clogs, and a white lab coat, the self-described “nocturnist” bounds from one unit of the Hospital to the next as she explains that it is important for families of hospitalized patients to know that their loved ones are well cared for during the night. “There is active healthcare management happening 24/7 at St. Clair,” she says, adding it is a superior level of care usually offered at only the country’s best academic healthcare centers. Drs. Chan and Bocharov are full-time nocturnists, a rare breed of physicians who work exclusive nights. Nocturnists are quickly becoming high in demand as peer-reviewed medical journals, including the New England Journal of Medicine, say that night and weekend coverage by attending physicians greatly enhances patient care. THE COMPREHENSIVE HANDOVER OF PATIENT CARE The 40-year-old Boise, Idaho, native’s shift begins in the Hospital’s Intensive Care Unit where she is thoroughly briefed on each patient by Co-Director of Critical Care Gregory Fino, M.D., who, along with specially trained critical care nurses, has been treating patients there throughout the day. 4 I HouseCall I Volume VI Issue 2 Staying nourished: Mindful of colleagues’ needs too, Dr. Chan orders in food for the ICU staff. Suiting up: In preparation for placing a central line, she creates a sterile environment. Administering critical care: Dr. Chan places a central line in a patient in the ICU. A caring mom checks in: A quick call home to say good night to her two young children. “Each patient in ICU needs to be individually discussed because they are so critically ill,” explains Dr. Chan, as she examines a 38-yearold man who was rushed to St. Clair after being found unresponsive by his roommate. The patient’s initial caregivers first suspected bacterial meningitis, but tests soon ruled out that potentially fatal disease in which a person suffers from acute inflammation of the protective membranes covering the brain and spinal cord. His breathing assisted by a ventilator, the unconscious patient is suffering multipleorgan failure. Attempts to locate the patient’s next-of-kin have proven unsuccessful so far, as all phone calls have gone straight to voicemail. ICU nurse Amy Carbonara begins researching various addresses on her desktop computer to try and find close relatives of the patient to notify them about his condition. ALWAYS CLOSELY MONITORING PATIENTS IN RECOVERY In a flash, Dr. Chan is down the hall, then the stairs, to the Cardiovascular Surgical Unit (CVSU) on the Third Floor to check on patients who had undergone open heart surgery earlier that day. Like her patients in ICU, the patients in CVSU are in need of very intensive, individualized care following surgery. Continued on page 6 Volume VI Issue 2 I HouseCall I 5 Quick change: Cardiology conference: Cardiologist John Girod, D.O., who practices with South Hills Cardiology Associates, part of St. Clair Medical Services, confers with Dr. Chan about a 90-year-old female patient who was transported to the ER after suffering a heart attack and was about to undergo a cardiac catheterization. ER physician Jason Biggs, M.D., and Dr. Chan discuss a patient he is treating in the ER and who is about to be admitted. St. Clair Hospital’s nationally recognized ER is staffed 24/7 by board-certified physicians. Cardiac catheterization team: Left to right, Leah Pence, R.N., and Cardiovascular Technologists Nicole Antle and Rachel Zeh arrive in the ER to prepare a patient for a catheterization in the nearby Cath Lab, just after midnight. Continued from page 5 A CALL TO THE ER Dr. Chan also serves as the Hospital’s admitting physician throughout the evening/night, which means frequent trips to the Emergency Room to consult with ER physicians. Together, they will decide which tests to run before patients are assigned to a unit in the Hospital. One of her trips to the ER this evening is to examine a 39-year-old patient who attempted suicide. Intubated to maintain an open airway, he is later transported to the ICU. There, Dr. Chan consults Micromedex, one of the many medical knowledge databases the Hospital provides to augment physicians’ practice, to determine the toxicology of the medication he had ingested in large quantities. Around midnight, Dr. Chan is back in the ER, conferring with Cardiologist John Girod, D.O., who was called in from home to perform a heart catheterization on a 90-year-old female patient who had suffered a heart attack and was rushed to St. Clair. Dr. Girod is a member of St. Clair’s door-to-balloon team — interventional cardiologists who respond to heart-related emergencies throughout the night. Door-to-balloon refers to the time between when a suspected heart attack victim arrives in the ER and when a tiny balloon is inflated in his or her heart artery to clear blockages that led to the attack. Studies have shown that shorter door-to-balloon time leads to a better recovery. St. Clair cardiologists have long had some of the best door-to-balloon times in the country. 6 I HouseCall I Volume VI Issue 2 Working the phone: A concerned physician consults Dr. Chan about his patient. Bedside: As evening/overnight shift rounds continue, she checks the condition of a patient on Unit 5G from head to toe. Floor by floor: The evening/overnight shift often requires her to hustle between floors, going wherever highly specialized patient care is needed. Code Blue: Dr. Chan checks monitors that have been connected to a patient who suffered a medical emergency in the middle of the night. SOOTHING THE FEARS AND PAIN OF A MOTHER AND BABY Critical Care Intensivists and Hospitalists, the ER physicians, and an in-house anesthesiologist are also ready to assist in emergent issues in the Pediatric Unit, where there is a pediatrician in house 24/7. A quick check of the Pediatric Unit around 1 a.m. finds a mom gently trying to coax her eight-month-old son back to sleep. Down the hall, the boy’s nurse is preparing another round of ear drops for the child who is suffering from infection in both ears and pneumonia in both lungs. Dr. Chan’s own children, Brendan, 6, and Hana, 2, are at home with dad, Jerry, a software engineer. Earlier that evening Dr. Chan snuck in a quick call to wish them all a good night. She acknowledges that her steady evening/ overnight schedule can be tough with little ones at home. “Not seeing my family is the hard part,” she says. CODE BLUE RESPONSE Dr. Chan is also responsible for responding to all Hospital-wide Code Blue response calls, which are medical emergencies that might require resuscitation and advanced life support, as well as Rapid Response calls, in which a team of healthcare providers attempts to prevent respiratory or cardiac arrest in patients in nonintensive care units who are showing early signs of clinical deterioration. Continued on page 8 Volume VI Issue 2 I HouseCall I 7 COORDInATED InPATIEnT CARE As noted in the main story, Drs. Chan and Bocharov are Intensivists and Hospitalists who care for patients in critical care units, as well as other units throughout the Hospital during the evening/overnight shift. During standard daylight hours, patients are cared for in the Intensive Care Unit (ICU) by Co-Directors of Critical Care Gregory Fino, M.D. and Patrick G. Reilly, M.D., as well as by their Intensivist colleagues Laurie A. Kilkenny, M.D., Andrew Perez, IV, M.D., and Zachary T. Young, M.D. St. Clair also uses Hospitalists, i.e., physicians who are trained in internal medicine or family practice and who specialize in the care of acutely ill patients. Hospitalists work closely with patients’ primary care physicians and specialists so Hospital and follow-up care are well coordinated. ST. CLAIR’S HOSPITALISTS INCLUDE: Jose I. Christlieb, M.D., Medical Director Meredith C. Broberg, M.D. Daniel C. Jackson, D.O. Christopher Mizzi, D.O. Catherine M. O’Hara, M.D. Danilo O. Policarpio, M.D. Ansal Shah, M.D. Amy Danner, CRNP Moreover, St. Clair offers 24/7 in-Hospital pediatric care by a team of board-certified pediatricians led by Dayle B. Griffin, M.D., and Sheila Clarke, M.D. Continued from page 7 Full team response: A team of clinicians, including Dr. Chan, treat a patient in the Behavioral Health Unit who has suffered a seizure while walking in a hallway. Once stabilized, the patient is placed on a backboard and her neck is secured in a brace, before she is transported to Medical Imaging for a CT scan, the results of which are negative. Heading to ICU: Following the CT scan, the patient is taken to the ICU for extensive evaluation. INTENSE IS TYPICAL FOR A HOSPITAL INTENSIVIST Although Dr. Chan would later describe this particular shift as relatively “slow,” it was a night of constant activity, as she only sat down to record notes on patients and exchange patient information with Dr. Fino. n 8 I HouseCall I Volume VI Issue 2 Heading home: Dr. Chan leaves the ICU around 7 a.m. She plans to stop for a workout at a gym before heading home to see her family and get some sleep. Ensuring continuity of care: Dr. Chan records patient notes to apprise incoming day shift staff of patient status. Morning debriefing: As her evening/overnight shift comes to an end, she updates Dr. Fino on ICU patients he transferred to her care at the end of his daylight shift, as well as new patients she admitted during the night. THE OVERNIGHT SHIFT ENDS YVONNE R. CHAN, M.D. MAXIM V. BOCHAROV, M.D. Dr. Chan earned her medical degree from Harvard, where she completed a joint program in Health Sciences and Technology with the Massachusetts Institute of Technology (MIT). She completed a residency in internal medicine at Mount Auburn Hospital in Cambridge, Massachusetts (part of the Harvard network of teaching hospitals), and a fellowship in pulmonology and critical care medicine at UPMC. She is board-certified in critical care, pulmonology, and internal medicine. She practices with St. Clair Medical Services. Dr. Bocharov earned his medical degree in Saint Petersburg, Russia, his native country. He then completed a residency in internal medicine at Mercy Hospital in Pittsburgh, and a fellowship in critical care medicine at UPMC. He is board-certified in critical care and internal medicine. Dr. Bocharov practices with St. Clair Medical Services. Volume VI Issue 2 I HouseCall I 9 MInIMALLy InVASIVE SuRGERy WHAT IS PARATHyROIDISM? The parathyroid glands are tiny marvels. They are four organs, each no bigger than a grain of rice, which are attached to the back of the thyroid. The parathyroids perform a vitally important function in the human body: regulating calcium metabolism, along with phosphorus and Vitamin D levels. Calcium is essential to every cell; it builds bones and teeth, helps regulate the pumping of the heart and plays a key role in muscle contraction. It helps the nervous system transmit messages and it is a component of the body’s blood clotting process. When the parathyroid glands are healthy, they do their job quietly and efficiently, manufacturing parathyroid hormone and maintaining the body’s delicate balance of calcium in the bloodstream. When things go awry, it is generally because the parathyroid is making too much hormone (hyperparathyroidism) or too little (hypothyroidism). Hyperparathyroidism is more common. It can be primary — meaning that one of the four glands is too large or is overactive, secreting an excess of the hormone; or it may be secondary, resulting from dialysis or illness. Hyperparathyroidism produces hypercalcemia, elevated calcium levels in the blood. While symptoms such as fatigue and weakness sometimes occur, they are vague and common to many conditions. According to St. Clair Hospital thoracic surgeon Richard H. Maley, Jr., M.D., “The body controls calcium in a very tight range. Slight elevations may not be symptomatic, but any elevation is abnormal and the cause has to be determined and treated.” Left untreated, hypercalcemia may lead to kidney stones, bone pain, fractures and heart disease. ROBOTIC-ASSISTED PARATHYROID SURGERY Accessing hard-to-reach places with minimal trace K rista Woodard, a 22-year-old hairstylist from Bethel Park, had no idea that elevated calcium levels were the source of an illness that began bothering her in the fall of 2013. “I was experiencing nausea and stomach pain, and I thought that maybe I had an ulcer. I saw my primary care doctor and he ordered blood work, which showed that my calcium level was abnormally high. He referred me to Wayne Evron, M.D., an endocrinologist at St. Clair. On my scan, they found that one of my parathyroid glands was down in my chest, in my thymus gland, instead of in my neck. Dr. Evron sent me to Dr. (Richard H.) Maley, (Jr.) a chest surgeon at St. Clair, to see about removing it.” Generally, parathyroid surgery is performed by an otolaryngologist, or ENT surgeon. But Krista’s condition was an ectopic parathyroid — a gland that had migrated to the wrong location, underneath the sternum in her chest. Thus, a thoracic surgeon was needed. In addition to being lodged in the thymus, the gland was enlarged. Dr. Maley recognized right away that Krista was an ideal candidate for robotic-assisted surgery, utilizing the da Vinci Surgical System. “For Krista’s condition, robotics is the gold standard. For places that are difficult to access, it’s quite helpful and has many benefits.” Krista Woodard 10 I HouseCall I Volume VI Issue 2 The da Vinci Robotic Surgical System is an advanced surgical technology that uses a high-powered endoscopic camera and robotics to translate the movements of a surgeon's hands into precise movements of surgical instruments. The surgeon sits at a console in the operating room, positioned several feet away from the patient, and works through tiny incisions, as in minimally invasive laparoscopic surgery. Using hand and foot controls, he manipulates a machine with four robotic arms, which is poised over the patient. dures in the least invasive way possible, without large incisions, making recovery faster and easier. The Hospital uses a special robotics surgical team in a state-of-the-art operating room that is utilized by many surgical specialties. “I’ve been using the da Vinci system for in detail, even how the thymus and parathyroids work. He told me what to expect. I agreed to the surgery, and had it done on December 4. I was in St. Clair for three days. Post-op, I was pretty sore at first and it hurt to breathe, but I felt a lot better in seven days. I was back at work, cutting hair at Sport Clips, by December 31. I just have four little holes instead of a scar. Best of all, my calcium and parathyroid levels are normal now and the stomach pain and nausea are gone. I feel great.” Continued on page 12 For KrisTa’s condiTion, roboTics is The gold sTandard. For places ThaT are diFFiculT To access, iT’s quiTe helpFul and has many beneFiTs. “ ” several years. Everything is visual with the da Vinci Surgical System,” Dr. Maley says, adding the da Vinci is perfectly suited to the anterior mediastinal surgery that he often performs. To Krista, roboticassisted surgery sounded “kind of cool.” Dr. Maley RICHARD H. MALEY, JR., M.D. Three of the arms hold miniaturized surgical instruments and the fourth holds the camera. At the console, the surgeon looks through lenses that give him a three-dimensional image and magnification up to ten times beyond normal. The da Vinci system enables surgeons to perform intricate surgical proce- explained to her that with the da Vinci, he would be able enter her chest from the side, between the ribs and behind the sternum, in order to avoid cutting through the sternum. “Dr. Maley told me that the best way to do it was with robotic-assisted surgery. I had never heard about that, but he explained everything Krista with her pet bunny. The Benefits of Robotic-Assisted Surgery D a Vinci surgery is highly regarded as a minimally invasive option, with surgeons only making a few small incisions. The da Vinci Surgical System features a magnified 3D high-definition vision system and tiny wristed instruments that bend and rotate far greater than the human wrist. These features enable surgeons to operate with enhanced vision, precision, dexterity and control. St. Clair Hospital surgeons offer da Vinci roboticassisted procedures for patients in need of thoracic, urologic, gynecologic, colorectal and general surgeries. The potential benefits of da Vinci surgery for all robotic-assisted procedures at St. Clair Hospital include: • Lower rate of complications • Less blood loss • Shorter hospital stay • Less pain • Minimal scarring • Improved quality of life soon after surgery The da Vinci Surgical System console. Volume VI Issue 2 I HouseCall I 11 MInIMALLy InVASIVE SuRGERy Continued from page 11 Too Much of a Good Thing Laureen Cramer also had a parathyroid gland in the wrong place — in her chest. In her case, though, it was not a matter of a migrating gland, but of an extra one. With five parathyroids functioning normally, she had an elevated calcium level. The 64-year-old had no symptoms, and was diagnosed when routine screening blood work revealed hyperkalemia. “My doctor told me to stop taking my calcium supplements. I did, but the level remained high. I went to St. Clair to have scans and my parathyroids lit up when they injected iodine; they could see that there was one in my chest. I saw an ENT surgeon, but he said the site was too low for him; he operates in the neck and head. He referred me to Dr. Maley, who told me this was perfect for robotic surgery. I was surprised. I’ve had previous surgeries and didn’t know what it would be like. “It turned out to be much less painful this way. I had to stay in the hospital for four days, but that’s because it’s your chest.” During the surgery, Dr. Maley deliberately leaves the right lung unventilated so that it is reduced in size and can be secured out of the way. Post-operatively, the patient then requires a chest tube for a day or two to drain blood and re-inflate the lung. “We check parathyroid levels immediately after the procedure, about 20 minutes after the gland is removed. They should be decreased; it happens that fast. We also have to watch that the calcium does not drop too low; the normal parathyroids have had this ‘big kid on the block’ for years and may have gotten lazy. Now with the extra or enlarged one gone, they have to step up and do all the work. We monitor to watch that the calcium doesn’t fall too low. We check levels at one month and six months; if they’re normal, there’s no further follow-up needed.” Laureen says that her calcium levels are perfect now. “They were normal by discharge, and are still normal. I had a very positive experience at St. Clair.” Laureen is enjoying an active retirement at her 100-acre farm in Taylorstown. Formerly of Upper St. Clair, she says that she and her husband Fred moved to the country for the sake of their dogs and cats. “It’s a lot of work to take care of this property, but it keeps us healthy. I believe in living a healthy lifestyle and I encourage everyone to get the recommended health screenings. If I had not had routine blood tests, my high “ ” i believe in living a healThy liFesTyle and i encourage everyone To geT The recommended healTh screenings. LAUREEN CRAMER Laureen Cramer selects some spring flowers at Pete Donati and Sons Inc. Florist-Greenhouse in Bethel Park. 12 I HouseCall I Volume VI Issue 2 St. Clair Endocrinologists Who Diagnose and Treat Glandular Diseases CAMILLE M. BUONOCORE, M.D. Dr. Buonocore earned her medical degree at State University of New York. She completed her internship and residency, and a fellowship, at University of Pittsburgh. She is board-certified by the American Board of Internal Medicine. Dr. Buonocore practices with Associates in Endocrinology, P.C. To contact Dr. Buonocore, please call 412.942.2140. D iagnosing problems with patients’ parathyroid glands is just one of many skills of endocrinologists, specially trained physicians who diagnose and treat diseases related to the glands. In addition to hyperparathyroidism, hypothyroidism and other thyroidrelated diseases, endocrinologists also treat patients suffering from: • Diabetes • Metabolic disorders • Menopause-related issues • Osteoporosis • Hypertension • Cancers of the endocrine glands • Cholesterol disorders • Infertility • Over- or under-production of hormones • Lack of growth WAYNE A. EVRON, M.D. Dr. Evron earned his medical degree at University of Pennsylvania. He completed his internship at University of Florida, his residency at Presbyterian Hospital, and a fellowship at University of Pittsburgh. Dr. Evron is boardcertified by the American Board of Internal Medicine. He practices with Evron Endocrinology Associates, a division of St. Clair Medical Servies. To contact Dr. Evron, please call 412.942.7295 JANN M. JOHNSTON, M.D. Dr. Johnston earned her medical degree at Pennsylvania State University. She completed her internship, residency, and a fellowship at University of Pittsburgh. She is boardcertified by the American Board of Internal Medicine. Dr. Johnston practices with Associates in Endocrinology, P.C. To contact Dr. Johnston, please call 412.942.2140. St. Clair Hospital Endocrinologists include: BRIDGET K. BEIER, D.O. Dr. Beier earned her medical degree at Lake Erie College of Osteopathic Medicine. She completed her internship and residency at University of Connecticut, and a fellowship at Virginia Commonwealth University. She is boardcertified in Internal Medicine and Endocrinology. Dr. Beier practices with Associates in Endocrinology, P.C. To contact Dr. Beier, please call 412.942.2140. DOUHA SAFAR, M.D. Dr. Safar earned her medical degree at University of Aleppo, Aleppo, Syria. She completed her internship at Pennsylvania State University and a fellowship at University of Pittsburgh. She is board-certified by the American Board of Internal Medicine. Dr. Safar practices with Associates in Endocrinology, P.C. To contact Dr. Safar, please call 412.942.2140. calcium would have gone undetected and might have done some damage.” To his patients Krista Woodard and Laureen Cramer, Dr. Maley is a great surgeon whose skill cured their hyperparathyroidism. “I really liked Dr. Maley,” enthuses Laureen. “He’s not only a great surgeon but also a very good doctor. He’s caring and never rushes, and I appreciated that.” n RICHARD H. MALEY, JR., M.D. Dr. Maley earned his medical degree at Hahnemann University in Philadelphia, now affiliated with Drexel University, and completed his residency in general surgery at the University of Kentucky. He also completed a fellowship in trauma/ critical care at the University of Kentucky. Dr. Maley also completed a residency in cardiothoracic surgery at the University of Pittsburgh, and a fellowship in thoracic surgery at Memorial Sloan-Kettering Cancer Center, New York City. He is boardcertified in thoracic surgery. Dr. Maley practices with St. Clair Medical Services. To contact Dr. Maley, please call 412.942.5710. Volume VI Issue 2 I HouseCall I 13 PATIEnT PROFILE At 96, Joe Zimbicki is an inspiration THE HEART OF A HERO J oe Zimbicki has a remarkable heart, and over the course of his long, full, good life, he has always put that heart to excellent use. Adult patients of all ages and fitness levels, from self-admitted “couch potatoes” to triathletes, come to Cardiac/Pulmonary Rehab on the Hospital’s First Floor, where as many as 300 patients are enrolled at any time. New patients participate in a 12-week early rehab program, followed by a maintenance program. The rehab environment definitely has a social aspect, David explains, that becomes part of recovery. To Joe, Cardiac/Pulmonary Rehab is a warm, friendly place. He still drives short distances and gets himself to St. Clair on his own. “Exercise does me a lot of good,” he says. “I exercise at home for 40 minutes before breakfast. I eat a breakfast of oatmeal, a banana, bagel and tea, and then I go to St. Clair. I work out on the treadmill, recumbent bike, regular bike and stair climber, and I lift weights. The staff is wonderful.” Julie Senchak, Joe’s granddaughter, recently penned a biography of him, “The Many Hats of Joe Zimbicki.” She believes that the Cardiac/ Pulmonary Rehab program is a major factor in her beloved grandfather’s longevity. “It keeps him going. The people there are like a second family; they even gave him a surprise party for his 96th birthday. He loves going there.” n It is the heart of a hero who understood and accepted duty, whether that meant helping raise his nine younger siblings or going off and was twice wounded. He came home to marry a beautiful bride, Alma, to World War II, where he landed at Utah Beach in Normandy in June 1944 and together they had two daughters, Beverly and Becky. He has lost both Alma and Beverly, but he has a loving family and a very active life. He gardens, cooks, volunteers, shops, attends church, and takes part in races and walks for good causes. And he is 96 years old. His generous, heroic heart remains strong, due in large part to a healthful lifestyle and regular sessions at St. Clair Hospital’s Cardiac/ Pulmonary Rehabilitation Center. Since 2000, when he underwent quadruple bypass surgery at St. Clair, Joe has been a fixture at 96-year-old Joe Zimbicki pumps some iron. Cardiac/Pulmonary Rehab, never missing his Monday, Wednesday and Friday workouts. To David DeCarlucci, MS, CES, a clinical exercise specialist and the Supervisor of Cardiac/Pulmonary Rehabilitation at St. Clair, Joe is an inspiration, not only to the other patients, but also to the staff. “Joe has a robust spirit and is a natural leader. He has a quiet strength and leads by example. He’s a thoughtful listener who remembers what people tell him. He’s been through a lot in his life, but he’s always focused on others.” David says that when new patients begin Cardiac/ Pulmonary Rehab following a heart attack, stent placement, or heart surgery to bypass blocked arteries or repair a valve, they’re understandably anxious. “Then they see Joe. They hear his story and learn that he developed heart disease in his 80s, had bypass surgery, and learned to make adjustments in his life. They see him exercising three times a week and hear that he’s been faithfully doing it for 14 years. It makes an impression.” Paula Wagner, R.N., a staff nurse in Cardiac/Pulmonary Rehab, does a blood pressure check on Joe Zimbicki as he exercises. 14 I HouseCall I Volume VI Issue 2 ASK THE DOCTOR Ask the Doctor Q A JOHN P. BROSIOUS, M.D. People often equate plastic surgery with cosmetic surgery. But aren’t there many clinical uses for plastic surgery, as well? restore another. Plastic surgeons do a great deal of cancer reconstruction surgery; the most common is breast reconstruction after mastectomy, but we also do a lot of reconstructive surgery for head and neck cancer. Some plastic surgeons specialize in wound care. This involves the treatment of difﬁcult wounds such as pressure sores, which are common in paraplegics, quadriplegics, and the bedridden elderly. Wound care represents about one-fourth of my practice. And ﬁnally, there is the treatment of skin cancer, which often requires the skill and experience of a plastic surgeon. We remove skin cancer and other skin lesions, and we repair lacerations and scars, in a way that minimizes scarring. It’s a great ﬁeld. I love plastic surgery and I embrace all of it. Working with the different age groups and all the parts of the body is challenging and satisfying. What we do provides both a functional and visible difference for our patients, and as surgeons we experience instant gratiﬁcation in the operating room. There is no single solution in plastic surgery, no cookie-cutter approach. Each case is unique, so my approach is highly individualized to each patient’s situation and needs. n Plastic surgery is actually one of the broadest ﬁelds in medicine. We are the only surgeons who operate on every body part from head to toe. We operate on every type of tissue: skin, bone, muscle, nerves, blood vessels and fat; and we operate on every age group, from newborns to the very elderly. The perception that cosmetic surgery is our primary focus is a mistaken one; it’s rooted in television shows like “Nip and Tuck” and “Extreme Makeover,” and in all the advertising for cosmetic surgery. These things have given the public a somewhat skewed view of plastic surgery. The fact is, cosmetic surgery is just a fraction of what plastic surgeons do. It’s one of many subspecialties within plastic surgery. Plastic surgery encompasses a wide range of subspecialties. Craniofacial surgery is the treatment of facial trauma, usually due to accidents and injuries, but also including the correction of congenital facial deformities such as cleft lip and palate. Treatment of burns is a major aspect of plastic surgery; we perform burn reconstructions, both acute and delayed, when there is a need for scar revision. Plastic surgeons perform many kinds of hand surgery; this is a very specialized ﬁeld in which we strengthen and restore function in hands that have lost functionality due to fractures, tendon tears, carpal tunnel syndrome, arthritis, and other conditions of the hand. There is also a subspecialty known as extremity salvage. This refers to the repair of arms and legs that have sustained severe trauma, such as open fractures and crushing injuries that damage soft tissue. We perform microsurgery or free tissue transfer; this means taking tissue from one body part and using it to repair and JOHN P. BROSIOUS, M.D. Dr. Brosious earned his medical degree at Indiana University School of Medicine, Indianapolis, Indiana. He completed an integrated residency in plastic surgery at University of Nevada, Las Vegas. He practices with Bragdon-Stofman Plastic Surgery Group, P.C. To contact Dr. Brosious, please call 412.572.6164. John P. Brosious, M.D. Volume VI Issue 2 I HouseCall I 15 St.Clair Hospital 1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org General & Patient Information: 412.942.4000 Outpatient Center–Village Square: 412.942.7100 Physician Referral Service: 412.942.6560 Urgent Care–Village Square: 412.942.8800 Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Peters Township: 412.942.8400 Follow us on twitter at: www.twitter.com/stclairhospital HouseCall is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician. HISTORy MInuTE St. Clair Hospital’s 60th Anniversary July 18 & 21, 2014 S t. Clair Hospital continues celebrating its 60th Anniversary in July with a specially themed Summer Swing. Summer Swing — the Hospital’s biggest fundraiser of the year — will be conducted Friday, July 18 at the prestigious St. Clair Country Club with a decidedly early-’50s theme to recognize the Hospital’s opening in February 1954. Guests will groove to the sounds of a band dressed for the period and crooning yesterday’s and today’s hits into vintage mics. The beneﬁt dinner will feature high-end food stations, live entertainment, and a silent auction with electronic bidding. Then on Monday, July 21, the 2014 version of Summer Swing will wrap up with the Donald J. Hastings Golf Classic at St. Clair Country Club. Both the dinner and the golf classic are open to the public with advance purchases. For tickets or sponsorship opportunities, A 1950s newspaper clipping from Mt. Lebanon News. please contact the St. Clair Hospital Foundation at 412.942.2465. APPEAL FOR ST. CLAIR HOSPITAL MEMORABILIA T o help mark its 60th Anniversary and celebrate its legacy, St. Clair Hospital is preparing a Wall of History and is looking for Hospital- related photographs and artifacts to possibly include in the future display, which will be located on the Fourth Floor. Do you, or someone you know, have photographs taken during the planning/fundraising process or construction of the Hospital? Or perhaps have a St. Clair Hospital nurse’s uniform from the mid to late 1950s? Maybe a patch that adorned an old uniform? What about a doctor’s little black bag? Or old Hospital signage? Any photos of, or artifacts from, St. Clair Hospital through the years is of interest and we would love to hear from you. Please let us know about your St. Clair Hospital treasure by calling Matt Hiser at 412.942.2611 or 412.942.2465, or emailing email@example.com.