St. Clair Hospital HouseCall Vol VI Issue 1
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 1 2 HouseCall A REVOLUTIONARY APPROACH TO KNEE AND HIP REPLACEMENT Taking the offensive against pain Plus Urgent Care Opens at Village Square Please see page 18 inside Broken Heart Syndrome I From Hospital Gown To Wedding Gown Ask The Doctor I History Minute I Focus On Giving Again Ranked Among The 100 Top Hospitals速 In The Nation Pioneering TreaTmenT Transforming Orthopaedic Surgery Brett C. Perricelli, M.D. specializes in complex hip and knee joint replacement surgery at St. Clair Hospital, spending his days performing total hip arthroplasty (THA) and total knee arthroplasty (TKA). In recent months, he has become a trailblazer in his specialty, pioneering a revolutionary approach to total joint replacement that holds the promise of a new era in the field. His approach to controlling pain after hip and knee surgery represents a dramatic departure from the conventional approach. His protocol is not just innovative; it may be transformative. P ain. It’s a fundamental issue in joint replacement. The pain and disability of osteoarthritis eventually become unbearable, driving people to orthopaedic surgeons in search of relief. of pain and facilitating a faster, gentler and more comfortable postoperative recovery process and more successful rehabilitation. His “Peri-operative Pain Protocol,” is a regimen that is centered on multimodal analgesia — “hitting pain from many angles,” he calls it — and local peri-articular injections, given with exquisite precision into the surgical site. Pain is controlled for up to three days after surgery, with effects that can last much longer. The result is less reliance on narcotics and fewer narcotic-related side effects, which can inhibit recovery and create complications that prolong length of stay, increase patient discomfort and drive up costs. “Joint replacement surgery, and knee replacement in particular, are difficult for patients,” he explains. “They feel agonizing pain that is traditionally treated with narcotic painkillers that leave them groggy and nauseated. In the old paradigm, pain management means narcotics. My goal is to improve pain control throughout the peri-operative period — before, during and after surgery — in order to decrease narcotic use and minimize complications associated with narcotics. It gets patients back on their feet faster.” Joint replacement will bring that relief, or at least significant improvement, but first, there’s the procedure itself — generally considered by surgeons to be among the more painful of all surgeries. Consider what is involved: to accommodate the implant, the surgeon makes multiple cuts in large bones, shaping the ends of the femur and tibia, and cutting out the arthritis to replace it with metal implants. “It’s literally sawing the bone in multiple places,” Dr. Perricelli explains. “There is also dissection of the soft tissue that has multiple nerve endings.” The resulting post-operative pain can actually be an impediment to recovery, when it keeps patients from adhering to their physical therapy (PT) regimen. Dr. Perricelli takes the offensive against this pain, aggressively treating it before he even begins the surgery. His comprehensive approach to analgesia is all about altering the patient’s experience 2 I HouseCall I Volume VI Issue 1 “ ” My goal is to iMprove pain control ... before, during and after surgery ... it gets patients back on their feet faster. BRETT C. PERRICELLI, M.D. ORTHOPAEDIC SURGEON Brett C. Perricelli, M.D. Volume VI Issue 1 I HouseCall I 3 Pioneering TreaTmenT Continued from page 3 no Post-op Pain Laverne Lewis, R.N., a former St. Clair Hospital nurse, and a resident of Upper St. Clair, had TKA surgery November 19. “I was out of bed walking with a walker that night. I had no pain on my first post-op day until I had physical therapy. During rehab, I just took an anti-inflammatory and now, if I have pain, I take Tylenol.” Living in a split level house with three floors, she has a lot of stairs to climb. Thus, she opted to spend three weeks at a rehab facility before heading home. “Having PT and OT (occupational therapy) every day was a big advantage. I also had home PT two or three times a week, and then outpatient PT at St. Clair. They gave me a walker but I don’t use it, and I only use my cane when I go out.” it Didn’t Hurt much at all When Liza Minnelli was asked on a talk show about her knee replacement, she said the pain was so horrific that it left her eyes permanently crossed. She was joking, of course — about her eyes. But the pain can be so severe that sometimes, patients who need to have both knees done will choose not to return for the second procedure. That was the case for Deb Gossic, 61, a retired physical education teacher. “I had knee replacement surgery eight years ago. The pain was worse than labor and lasted much longer. I decided that no matter how bad my other knee got, I would not go through that again.” “ ” i was waiting for the Medication to wear off and the terrible pain to begin. it never did. DEB GOSSIC KNEE REPLACEMENT PATIENT Deb Gossic Her other knee did get worse and she took cortisone shots and endured it, until she heard about Dr. Perricelli. “It was a completely different experience this time,” she raves. “It was like night and day. The first time, I was on Vicodin and morphine and I could not sleep due to the pain. It took me forever just to get dressed for PT.” Her second TKA took place in October. “I didn’t realize I would have almost no pain. I woke up in the Recovery Room and I thought that they had not done the surgery. I asked, ‘What happened? Did you do it?’ I was waiting for the medication to wear off and the terrible pain to begin. It never did.” Gossic recalls that her PT began 15 minutes after she got to her room on the orthopaedic floor. “I had my surgery Tuesday and I was home Friday. I never took the narcotic pain medication; most of the time, I did well with Tylenol. I put off the second surgery for eight years. This time, the experience was amazing. Dr. Perricelli has perfected this, and I’m grateful to him and to St. Clair for the excellent care.” 4 I HouseCall I Volume VI Issue 1 a multimodal approach The old approach to pain management has numerous drawbacks that affect recovery and quality of life. Nerve blocks numb the thigh and knee joint, leading to a decrease in pain but also severe weakness of the quadriceps muscles, the major thigh muscles that rehabilitate the knee. Patients have difficulty getting up and walking, and the resultant immobility can produce many complications, such as falls, blood clots and urinary retention. There is also risk of injury to the nerve itself. Once the nerve block has worn off, usually several hours after surgery, the patient may have severe pain that requires narcotic medications. These can produce drowsiness, nausea and constipation. The multimodal approach employed by Dr. Perricelli relies less on narcotics and blocks, and instead uses multiple short and long lasting pain medications, given in a site-specific, rather than systemic, manner, combined with low doses of oral and intravenous medications. Dr. Perricelli describes his three-step program. “I begin treating pain and nausea before I start the surgery. We know it’s going to happen, so why not get a head start on treatment? The pre-op protocol consists of giving the anti-inflammatories and an antinausea skin patch in the pre-op holding area. Dr. Perricelli, at far right, injects anesthetics and anti-inflammatory agents directly into the surgical site during knee replacement surgery to reduce or prevent the pain during recovery. The second, intra-operative part of the protocol is more complicated. The patient is given spinal anesthesia, then IV Tylenol for pain, IV anti-nausea medication, an anti-bleeding medication, and steroids to prevent inflammation, which is a huge factor in pain. I give the two workhorses — the injections — right into the operative site. The drug Exparel is suspended in bubbles of fat, which slowly break down and release the medicine over 72 hours. I then inject other anesthetics, anti-inflammatory agents and epinephrine into the knee at any point where I think I’m going to cause pain. This is hitting the pain right where it happens. It’s a painstaking process and adds time to the procedure, but it’s worth it.” The third step is the post-operative care of the patient. Once on the patient care floor, the patient receives intravenous Tylenol, oral Celebrex, Pepcid and Tramadol, a non-narcotic pain medication. “If the patient needs opioid pain medication, it’s available,” says Dr. Perricelli. “Many of my patients don’t need it. They also don’t need the pain medication pumps for IV morphine.” Patients are discharged to home with Celebrex and Tramadol, plus oxycodone if they need it. Joint replacement is not pain-free surgery, Dr. Perricelli emphasizes, but it is far more comfortable when done in this manner. “The absence of pain and inflammation is the key. When you control the immediate pain and inflammation, the effects are longer lasting. It’s not like it wears off and then the patient is miserable. Seeing my patients looking comfortable after surgery is the most amazing experience. One was up and making his own bed when I went in to his room the day after a hip replacement. I could hardly believe my eyes.” Continued on page 6 Volume VI Issue 1 I HouseCall I 5 Dr. Perricelli’s Pain managemenT Program Has sHown remarkable resulTs. His THree-sTeP, mulTimoDal aPProacH incluDes Pre- anD PosT-oP oral , PaTcH anD inTravenous meDicaTions, Plus mulTiPle injecTions aT THe oPeraTive siTe. Pioneering TreaTmenT Continued from page 5 up and walking shortly after Hip replacement That patient was Roger Kurtz, 60, from Bethel Park, a retired automotive interior repair specialist who spent his workdays outdoors, on his feet and often in contorted positions that led to osteoarthritis in his hips. Kurtz had his left hip replaced one year ago, using conventional methods, and he had the right one done in early November; both were done by Dr. Perricelli. “I went in with a list of 25 questions and he answered every one without ever looking at his watch. After my first operation, I came out of the O.R. with a drain in my hip, a catheter, IVs and morphine. I was in bed all day and in the hospital for four days. I went home on crutches. The surgery in November was nothing like that. I was out of bed that evening and walking. I had PT the next day and I never needed any morphine. I went home in two days with just a cane; I took oxycodone for three days and then switched to Tylenol. orthopaedic surgeon who just happened to be on-call, she needed a new hip joint. “He’s a great person and a great surgeon; he told me I was his star patient. I was lucky that he was on call. He gave me a new hip and I was only in the Hospital for a day and a half. I went to rehab for a week and came home on Christmas Day. I had almost no pain and I never took anything but Tylenol.” Sasser came home with a walker but used a cane instead, for just a few days. She has already finished her physical therapy and is eager to get back to her activities. changing old Procedures Implementation of the multimodal pain protocol was an enormous endeavor for Dr. Perricelli, involving more than six months of design, development and research. It required not only a change in procedures, but also a shift in beliefs and attitudes. He conducted several in-service trainings for staff, educating the nurses, aides and physical therapists about the protocol and helping them view pain management in a new “ ” Roger Kurtz way. “We had to change the way people think,” he says. “In the past, pain management meant major narcotics like opioids and then managing all their adverse effects; what I am doing is counter to everything the nurses and I have been doing for years. I wanted the staff to understand the process and embrace this. The staff grabbed the concept and ran with it. They’re with the patients 24/7 and they taught me a lot about how to make the entire protocol better.” ROGER KURTZ HIP REPLACEMENT PATIENT i was out of bed that evening and walking, and had physical therapy the next day. “It took some getting used to,” says Sandy Stanley, BSN, MS, a charge nurse for St. Clair’s Center of Orthopaedics, “but the nurses like it and think it’s working well. It’s been amazing. We’re used to giving narcotic pain medications, but Dr. Perricelli’s patients don’t even use the word ‘pain.’ Instead they might say that the knee aches,” she says. Dr. Perricelli’s patients are getting up and walking on the day of surgery, and going home one day earlier, in general, she says. “I give him a lot of credit for preparing his patients so well, too; when the patient knows what to expect, they experience less stress.” Cindy Crock, R.N., has been a Recovery Room nurse at St. Clair Hospital since 2008. She has cared for hundreds of joint replacement patients and she’s enthusiastic about Dr. Perricelli’s pain regimen. “It’s wonderful; it solves and prevents problems. Typically, after TKA, when the spinal anesthesia wears off, the patient needs a femoral nerve block in the Recovery Room. It takes away some of the pain and lasts a few hours. They also need a pain pump. This can be hard on the patient.” Dr. Perricelli's patients do not need either and they are stable enough to leave recovery in under an hour, while the norm is 90 minutes. David Mayer, CRNP, has worked in orthopaedics for 33 years. As the nurse practitioner with Dr. Perricelli’s practice, South Hills Orthopaedic Surgery Associates, he makes daily post-op rounds on knee and hip replacement patients. “I’ve never seen anything like this,” he says. In rehab, my PT told me that I was three or four weeks ahead of schedule with my walking. I can tie my own shoes again! My advice to people who need joint replacement is this: first, don’t be afraid; second, don’t put it off too long; and third, go to Dr. Perricelli. He said to me, ‘Roger, I can take care of you.’ And he did.” Tylenol was all she Took Barbara Sasser never planned to have joint replacement surgery. At 77, with an active social life, she had no known history of arthritis or osteoporosis. But in the wee hours of a Sunday in December, she found herself in the Emergency Department of St. Clair Hospital with a fractured hip. She had fallen during the night and, according to Dr. Perricelli, the 6 I HouseCall I Volume VI Issue 1 “ ” this pain regiMen solves and prevents probleMs that can be hard on patients. CINDY CROCK, R.N. RECOVERY ROOM NURSE Cindy Crock, R.N. It’s making an enormous difference for patients. I was at St. Clair when they started doing joint replacement in the 70s, so I have seen all the advances over the years. It’s wonderful to see patients who are not writhing in pain or taking narcotics, especially the elderly patients. They don’t have a glazed, groggy look. Patients now want to go home earlier. Most are discharged in one or two days.” Mayer says Dr. Perricelli is an exceptional surgeon. “He has an incredible knowledge of the knee. He has great surgical technique and takes his time. He calls every patient on the night before surgery to see if they feel ready and to answer last minute questions. Patients appreciate that.” Dr. Perricelli is a Pittsburgh native who graduated from the University of Pittsburgh School of Medicine. He completed three years of a general surgery residency at UPMC, followed by a complete orthopaedic surgery residency there, under Freddie Fu, M.D. He served as chief orthopaedic resident in 2009–2010, then completed a fellowship in hip and knee replacement at OrthoCarolina Hip and Knee Center in Charlotte, N.C., under Thomas K. Fehring, M.D. He serves as a reviewer of research for the Journal of Arthroplasty and was recently selected by the American Academy of Hip and Knee Surgeons for a national leadership program. Through his training and travels, he has encountered orthopaedic surgeon colleagues across the country; they share information about evolving pain control techniques and review the literature, and put it all together to create and enhance this multimodal protocol. “It has a cumulative effect; it’s synergistic,” he says. “I’m stunned at how well the protocol solves problems associated with conventional pain management. It’s fun for me because my patients are ecstatic. This approach produces happy patients, good outcomes, shorter stays and lower costs. It has surpassed my hopes and expectations, and it feels awesome to me as a surgeon. Part of being a physician is to keep learning, to know and apply the research and stay on top of things.” Apparently, it sometimes means choosing to be an agent of change, a gentle and caring revolutionary, who brings in new concepts and practices, and illuminates the path toward a new direction. “The suffering that patients were experiencing was unacceptable,” Dr. Perricelli says. “We needed a new paradigm for joint replacement surgery.” BRETT C. PERRICELLI, M.D. Dr. Perricelli earned his medical degree at the University of Pittsburgh School of Medicine. He completed his residency in orthopaedic surgery at the University of Pittsburgh Medical Center. Dr. Perricelli then completed a fellowship in hip and knee replacement at OrthoCarolina Hip and Knee Center, Charlotte, N.C. He practices with South Hills Orthopaedic Surgery Associates, P.C. To contact Dr. Perricelli, please call 412. 283 .0260. Volume VI Issue 1 I HouseCall I 7 sTress carDiomyoPaTHy Accurate diagnosis is key to HealingBroken Hearts THROUGHOUT THE AGES , poets have given metaphorical meaning to the human heart. The heart, they say, holds the essence of a person; a kind person is softhearted, and a brave one, lionhearted. The heart aches when one suffers a loss, and it sings with joy when something wonderful happens. Every human emotion seems to find expression through the heart. Modern medical science has told us something different. The heart, we have learned, is simply an organ, a muscle composed of soft tissue. It is nevertheless a vital organ, simple in structure but complex, even wondrous, in function. The healthy heart is a workhorse, an engine that never rests, its chambers and valves pumping life-sustaining blood throughout the body in a constant, rhythmic choreography. The heart is so essential that we ascertain the presence of life by the presence of the heartbeat. Encasing it within a bony cage of ribs, vertebrae and sternum, the body protects the heart, in an acknowledgement of this importance, and also vulnerability. Hearts, cardiologists tell us, do not break. They weaken, they fail, their rhythms go awry and they become damaged when their own blood supply is compromised. But hearts donâ€™t actually break. Or do they? 8 I HouseCall I Volume VI Issue 1 A ccording to Jeffrey Friedel, M.D., Chief of Cardiology at St. Clair Hospital, there is in fact a clinical condition known as Broken Heart Syndrome, or Takotsubo Cardiomyopathy. First described suffering the loss of a beloved Pet Janet Ghise, 70, a resident of Bethel Park, knows all too well that Broken Heart Syndrome is real. She and her husband, Cornell, traveled to Cooperstown, N.Y., last summer to see their grandson play in a baseball tournament, and left their beloved 14-year-old Peekapoo, Maggie, in the care of a kennel. It was tough to leave Maggie behind, Janet recalls. “Maggie cried so much when we left her. We weren’t worried, though. Despite her age, she was healthy and had been to the vet for a check-up recently. She was fine.” At the tournament, they enjoyed seeing their grandson hit three home runs. As they were leaving the park, both Janet and Cornell found messages on their cell phones from the kennel. “As I was reading the message —‘please call right away’ — I overheard my husband, on his phone, say, ‘She’s dead?’ Our dear little Maggie had died suddenly at the kennel. They didn’t know what happened to her, but they could not revive her.” For Janet, the unexpected death of her precious pet was a profound loss, shocking and deeply felt. “Maggie was special, a good little dog; all the neighbors loved her. It was also a terrible loss for my husband, but he handled it differently; Maggie went to work with him every day and was a constant companion.” Janet had experienced other losses in her life but this one, she says, felt different. “I cried all the time; I couldn’t seem to stop. I just could not bear it. I couldn’t talk about her without crying. I wasn’t myself; Continued on page 10 in Japan almost 20 years ago, it is caused by extreme, sudden emotional trauma or distress, and it causes damage to the heart, sometimes permanently. “In Broken Heart Syndrome, there is a characteristic pattern of damage to the heart muscle,” Dr. Friedel says. “The patients who experience this are predominantly women, over age 65, who present with symptoms similar to those of a heart attack: sudden chest pain, shortness of breath, lightheadedness, and sometimes an irregular heartbeat. An EKG will most often be abnormal, with a pattern that looks like a heart attack, and cardiac enzymes will be elevated, indicating the injury to the muscle. A cardiac catheterization will show no blockages, but a ventriculogram (a diagnostic test in which the heart is filled with dye so it can be visualized on X-ray as it contracts) will show that the apex of the heart (the bottom front of the muscle) is enlarged and ballooned out. It doesn’t move, so it cannot pump effectively, but other parts of the heart move normally.” If detected in time and treated appropriately, this damage will most likely heal, although Dr. Friedel says that a small percentage of patients will have permanent damage to their hearts and may require more specialized, ongoing treatment. “We treat this like we treat congestive heart failure, with ace inhibitors, beta blockers and diuretics. The patient will be admitted to the hospital, probably for several days in the ICU or CCU (Coronary Care Unit), until the EKG is normal and symptoms are improved.” of the stress hormones adrenaline, epinephrine and norepinephrine. “These cause spasms of the arterial blood vessels of the heart, which cause the damage to the heart muscle,” Dr. Friedel explains. “Any sudden and intense emotional upset or shock can cause this surge of stress hormones. The classic event is the sudden death of a spouse, but it can also be triggered by the death of any loved one.” It can be brought on by extreme rage or fear as well. A heated argument, domestic abuse, a home invasion, a car accident — even a surprise party — can be the triggering event. But most often, it is brought on by the sudden, unbearable loss of a loved one. Janet Ghise Broken Heart Syndrome is believed to be the result of a sudden surge “ now i know that a broken heart is real . . . broken hearts can also be healed. JANET GHISE BROKEN HEART SYNDROME PATIENT ” Volume VI Issue 1 I HouseCall I 9 sTress carDiomyoPaTHy Continued from page 9 “ broken heart syndroMe is a legitiMate clinical diagnosis widely accepted aMong physicians . . . the heart actually changes shape. ” JEFFREY FRIEDEL, M.D. I was worried that people would think I was crazy to grieve like this over a pet, but now I know that lots of people do. I decided to tell my story because it might help someone else and even save another life. People need to know about this.” Broken heart syndrome is a legitimate clinical diagnosis, Dr. Friedel says. “This is not junk science. It’s well described in the literature and Cardiologist Jeffrey Friedel shows what a broken heart looks like. widely accepted among physicians. Doctors are more aware of the condition, but it’s probably underdiagnosed. You have to know what you are looking for and once you see it, there is no mistaking it. The heart actually changes shape.” That characteristic change in the heart — the apical ballooning — is the source of the name Takotsubo, which means “octopus trap” in Japanese. The affected heart closely resembles the trap that Japanese fishermen use to catch octopuses. Broken heart syndrome should be taken seriously and treated as an emergency. People who have the classic symptoms — chest pain, shortness of breath, weakness — should call 911. Although Broken Heart Syndrome is not a heart attack, the symptoms are similar and the condition can lead to sudden cardiac arrest. I felt very tired.” It happened that Janet already had an appointment scheduled with Dr. Friedel. She had had a stent placed in her artery following a heart attack in the past, and he was her regular cardiologist. “I had missed my July appointment and rescheduled for August, and that turned out to be a good thing. If I had gone to the July appointment, before Maggie died, I may not have been diagnosed and I could have died.” Dr. Friedel did an EKG in the office, but he knew as soon as he saw her that Janet was in trouble. “She is normally energetic and smiling, but she was ashen and sweating. I sent her directly to the Emergency Room at St. Clair. A cardiac catheterization showed that her stent looked fine and there was no blockage. But the bottom of her heart muscle was destroyed, in a classic Takotsubo presentation.” Janet is receiving close follow-up care from Dr. Friedel and her heart is almost back to normal. “Dr. Friedel told me that my heart was healing itself, but I know that he is healing me, too. I told him about Maggie, and he understood; he said I lost a family member when I lost Maggie. NORMAL HEART an emotional malady Broken heart syndrome is so similar in presentation to a heart attack that it’s often initially misdiagnosed. That was the case for Rose Corrado, 72, of Mt. Washington, a semi-retired electrologist whose symptoms developed after an intense emotional upset. “I was in the shower afterwards and I felt a twinge in my chest that hit me really hard. I wasn’t afraid; I thought I had the world’s worst case of indigestion. But I cancelled my clients and drove myself to an urgent care center, where they immediately called an ambulance and sent me right to St. Clair Hospital. I was taken LEFT VENTRICLE Tako-tsubo Tako tsubo [noun, Japanese] fishing pot for trapping octopus. “BROKEN” HEART to the Cath Lab and they told me that if there was a blockage I would either get a stent or have open heart surgery.” As it turned out, Rose did not have a heart attack, and did not need a stent or surgery. Instead, she learned that she had Broken Heart Syndrome. “Dr. Friedel told me that my heart was only working at 30 percent capacity, as though it was frozen, nearly standing still. He gave me medication to strengthen my heart and encouraged me to quit working. But I felt okay and wanted to go back to work; I like to be around people. I have clients who depend on me.” Rose says that she has learned an important life lesson from her experience. “It wasn’t like me to get that upset and now I know that it is not worth it. Nothing is worth dying over. I’m trying to stay mellow, because if it happens again, I could die. I like to stay busy with my husband In Takotsubo cardiomyopathy, also known as Broken Heart Syndrome, the heart, affected by acute or sudden distress or loss, results in apical ballooning. The shape closely resembles the trap that Japanese fishermen use to catch (TAKO TSUBO) OCTOPUS TRAP octopuses. Broken Heart Syndrome should be taken seriously and treated as an emergency. 10 I HouseCall I Volume VI Issue 1 Anthony, my four kids and seven grandkids, but I have less energy now. I have to stop to sit and rest. I am working part-time and I make jewelry.” Dr. Friedel says that Rose is recovering well. Like Janet Ghise, she was already his patient, being treated for an aortic valve problem. “Rose’s underlying heart disease made it easy to assume at first that she was having a heart attack,” Dr. Friedel says. “Her enzymes were elevated and she had EKG changes, but it was from extreme stress and not a blockage. “Stress is a direct trigger of a lot of serious problems. We know now that severe physical or emotional stress, even in the absence of significant plaque, can cause a heart attack through this same mechanism. That surge of catecholamines (adrenaline hormones) raises the blood pressure and can cause plaque to rupture and act like a blood clot. We’ve changed our thinking about heart attacks over the past 10 years. It is not that the plaque grows and becomes an obstruction, but that it ruptures.” This has implications for diagnosing heart disease, Dr. Friedel says. A stress test will not reveal the presence of plaque build-up, so cardiologists are not relying on them as in the past. Instead, they prefer a cardiac CT scan or calcium scoring, which looks at plaque within the coronary arteries. Broken Heart Syndrome can be treated and is usually reversible. Heart disease in general is far easier to prevent than to treat, says Dr. Friedel. He encourages everyone to live a healthful lifestyle, learn to manage stress, and become aware of the symptoms of heart disease. And, if you have an experience of extreme emotional distress and you don’t feel right afterwards, seek medical attention. “At St. Clair, we have all the most advanced tools to treat heart disease. If you have symptoms, don’t hesitate to come to the Emergency Room so we can make a diagnosis and begin treatment.” It may well be that the poets who have found love, courage and character in the heart were not wrong after all. We are complex beings, and research into the mind-body connection, a new frontier in medicine, is fascinating in its possibilities and implications. Before her appointment with Dr. Friedel, Janet Ghise told her husband Cornell that she hoped her cardiologist could fix her broken heart. It was, she thought then, just an expression. “Now I know that a broken heart is real, and it was actually a relief to know that. It’s real, and it can be life threatening. But broken hearts can also be healed.” JEFFREY FRIEDEL, M.D. Dr. Friedel earned his medical degree at the Pennsylvania State University College of Medicine and completed his residency at Allegheny General Hospital in Pittsburgh. He also completed fellowships in cardiology and interventional cardiology at Allegheny General Hospital. He is board-certified and practices with South Hills Cardiology Associates, a division of St. Clair Medical Services. To contact Dr. Friedel, please call 412.942.7900. “ My heart was only working at 30 percent . . . as though it was frozen, nearly standing still. ROSE CORRADO BROKEN HEART SYNDROME PATIENT ” Rose Corrado Volume VI Issue 1 I HouseCall I 11 minimally invasive surgery From Hospital Gown toWedding Gown in 48 hours Jacki Fury Hennon was a beautiful, beaming bride on October 2, 2010. Escorted by her parents, and preceded by a procession of seven bridesmaids, Jacki walked slowly down the aisle toward her waiting fiancĂŠ, Christopher Hennon. It was a remarkable sight â€” not just because Jacki was a beautiful bride, but because just 48 hours before, she was wearing a very different kind of gown: a hospital gown, as she lay intubated and under general anesthesia on the operating table of a St. Clair Hospital surgical suite, in the capable hands of St. Clair Hospital Obstetrician/Gynecologist Douglas H. MacKay, M.D. 12 I HouseCall I Volume VI Issue 1 J acki’s fantasy wedding almost obstetrician/gynecologist who practices in Mt. Lebanon and Peters Township with Advanced Women’s Care of Pittsburgh, P.C. “Dr. MacKay was on-call, and was called in for consultation,” Jacki recalls, “and everything changed for the better when he arrived. He reviewed all my tests and labs and told me I needed surgery; he warned me that I might lose my left ovary. But I felt hopeful; I knew I was in good hands. I had immediate confidence in Dr. MacKay. He told me that he would do the procedure using minimally invasive techniques and I would still have my beautiful wedding.” Jacki went into surgery almost immediately. The procedure that Dr. MacKay performed was a “salpingo-oopherectomy” — the removal of the ovary and fallopian tube. Unfortunately, Jacki’s ovarian cyst had twisted tightly around the ovary. “Sometimes, we’re able to twist the vessels back and then observe to see if there is perfusion (blood flow) to the ovary,” Dr. MacKay explains. “It’s similar to a heart attack, in that the blood supply to the organ is cut off, causing the tissue to die. In Jacki’s case, the ovary and tube could not be saved.” On Thursday evening, while her guests enjoyed the rehearsal dinner, sans the bride, Jacki recovered at St. Clair. “I woke up in the recovery room to a different world,” she says. “Despite pain from the surgery, my four days of agony were over.” Her mother and Chris went to the dinner, but Jacki was not alone; bridesmaid Marlene Hedberg sent her own mother, Cheryl Rieland, to St. Clair to sit with Jacki. “I was so grateful. Afterwards, Chris, my sister, bridal party members and my cousins all came to see me.” Cancelling the wedding was not an option for Jacki. “I was going forward with my wedding, even if it meant being pushed down the aisle in a wheelchair with an IV. My gown was strapless; an IV would be no problem! I spent 18 months planning my wedding and I had 200 people coming. Dr. MacKay told me I could do it, and I had no doubts. I was a bride.” Continued on page 14 didn’t happen. A project administrator/financial analyst for Bayer Corporation in Robinson Township, with a side business as a floral designer, Jacki was a detail-oriented young woman who knew how to make things happen. She spent 18 months meticulously planning every detail of the wedding of her dreams. The reception was planned for Jacki’s favorite Pittsburgh place: PNC Park. She did not overlook a single detail, and as the wedding date approached, she felt confident, excited and very happy. Things were going perfectly. Until wedding week. On the Saturday before the wedding, as Jacki was running last minute errands with her mother, Maribeth Fury, she began to feel sick, with nausea and stomach pain. She stayed home all weekend, hoping to feel better with rest. No such luck — her condition grew worse, and on Sunday night, a worried Chris took her to the Emergency Room at St. Clair Hospital. By then, Jacki had a fever and her abdominal pain was severe. “The pain was agonizing, beyond anything in my experience,” Jacki recalls. An ultrasound showed that Jacki had an ovarian cyst and was advised to see her gynecologist about the cyst as soon as possible. Jacki felt increasingly anxious; the wedding was now just days away, and her rehearsal dinner was scheduled for Thursday — a choice she made so that she could spend Friday creating bouquets of flowers. On Wednesday, she and her mother returned to the ER. Doctors there ordered a CT scan and another ultrasound. These tests showed that the ovarian cyst was so large within Jacki’s pelvis that it had created a rare, extremely painful and potentially lifethreatening condition known as ovarian torsion. Ovarian torsion occurs when the ovary and the fallopian tube become twisted, cutting off blood flow to the ovary itself. It can be a surgical emergency. And so, early Thursday morning, with less than 72 hours to go until the wedding, Jacki and Chris met Dr. MacKay, a board-certified i always try to do this laparoscopically, for the sake of the patient. recovery is faster and there’s less post-op pain. “ DOUGLAS H. MACKAY, M.D. OBSTETRICIAN/GYNECOLOGIST ” Douglas H. MacKay, M.D. Volume VI Issue 1 I HouseCall I 13 minimally invasive surgery Continued from page 13 She got through it, she says, with adrenaline, teamwork, strength and a lot of love. “I left the hospital on Friday and went immediately to have a pedicure. I spent that afternoon on my patio, surrounded by relatives and hundreds of flowers and ribbons. I pointed to the flowers I needed, and they handed them to me. I made all my bouquets, just as planned.” Jacki and Chris definitely wanted a family, and she became pregnant the following May. “It was reassuring to us that I became pregnant so easily. We were thrilled. But then I miscarried in July, and we kept trying, but had no luck for over a year. We had testing done and we were preparing for me to start Clomid (a prescription medication that stimulates ovulation). We had an appointment with Dr. MacKay to discuss that, and when he walked into the room, he greeted us by in sickness anD in HealTH On wedding day, Jacki had some anxious moments as she donned her gown. Would it still fit over her three incisions and sore, swollen belly? “There was a moment of panic, as the dress was tight, Christopher and Jacki Hennon with daughter Madelyn. saying, ‘Congratulations.’ We were confused — he’s congratulating us for deciding to go on Clomid? But then he said, ‘You’re pregnant!’” That was December 14, 2012. Eight months later, Madelyn Hennon was born, on August 16, at St. Clair Hospital. She was delivered by Dr. MacKay, and she is a happy, healthy baby. “For the past three years, Dr. MacKay has just happened to be on call every time I needed him, even though there are six doctors in his practice,” says Jacki. “He’s an excellent surgeon, and he has a kind, warm bedside manner. He’s been there for me through every step of this journey. I’m so grateful to him, and my family loves him. Dr. MacKay is my hero.” but it fit. My hair and makeup were done at the house and everyone helped me. When I walked down the aisle, my parents were pretty much holding me up. During the ceremony, there was a lighthearted moment when we got to the words ‘… in sickness and in health.’ Everybody in the church laughed.” Fortuitously, Jacki and Chris, an asset integration technician at Crown Castle International in Southpointe, had planned a delayed honeymoon. “I could not have gotten on a plane, so it worked out. And yes, I danced at my wedding! Just not much!” Jacki’s experience illustrates the beauty of minimally invasive surgery, says Dr. MacKay. “The cyst was so large that I might have done a large abdominal incision, but I always try to do this laparoscopically, for the sake of the patient. Recovery is faster and there’s less post-op pain. Pain is related to the length of the incision. With a large, open incision, Jacki could not have had her wedding. This was a challenging diagnosis because often, with ovarian torsion, the torsion is intermittent. It comes and goes, twisting and untwisting, and the ultrasound may actually have been normal when they looked. It’s best to be conservative with a young woman and not rush to operate, because she is in her child-bearing years.” DOUGLAS H. MACKAY, M.D. Dr. MacKay earned his medical degree at the Ohio State University School of Medicine and completed his residency in obstetrics and gynecology at West Penn Hospital, Pittsburgh. Dr. MacKay is board-certified by the American Board of Obstetrics and Gynecology. He practices with Advanced Women’s Care of Pittsburgh, P.C. To contact Dr. MacKay, please call 724 .941.1866 or 412 . 561.5666. 14 I HouseCall I Volume VI Issue 1 ask THe DocTor Ask the Doctor Q A Is it a sign of something serious if I notice blood while using the bathroom? SCoTT A. HolEkAMP, M.D. Bleeding is a common reason why patients visit a colorectal surgeon’s ofﬁce. Patients may experience signiﬁcant blood in the toilet bowl; it may be mixed in their stool, they may pass blood clots, or they may notice it on toilet paper. Some have bleeding that is not obvious, otherwise known as occult. In these cases, a primary care physician discovers it with simple blood or stool tests. Bleeding may accompany constipation, diarrhea, or be spread throughout the day; and it may or may not be associated with pain. Although common causes of rectal bleeding include benign conditions such as hemorrhoids and ﬁssures, we must always be vigilant for risk factors of colon polyps or cancer, which can also cause bleeding. The gold standard for examining the entire colon is the colonoscopy. Although the American Cancer Society recommends a screening colonoscopy starting at age 50 for the general population, the risk of having a polyp or cancer is inﬂuenced by age, medical history, and family history. We consider these factors when determining at what age patients should undergo their ﬁrst and subsequent colonoscopies. After ruling out more serious causes, a simple history and physical will diagnose the majority of rectal bleeding. Internal hemorrhoids tend to bleed painlessly and have bright red blood. Anal ﬁssures can also have bright red bleeding, but are generally accompanied by excruciating pain with bowel movements. External hemorrhoids generally present with pain instead of bleeding. Dietary and bowel habits signiﬁcantly affect the incidence of hemorrhoids and ﬁssures. Making sure that the patient’s stools are soft and regular is key to successful symptom management. In addition, medical therapies can help reduce the inﬂammation and muscle spasm that exacerbate symptoms. For internal hemorrhoids, painless ofﬁce procedures such as banding or infrared coagulation can act as an adjunct to medical and dietary therapy. Finally, surgical therapy is an option for patients who have continued symptoms despite dietary, medical and ofﬁce treatment. By looking for and addressing the underlying cause of a patient’s symptoms, we are able to offer a more durable solution. As with any medical condition, it is important to talk to your doctor if you are having any of these symptoms, including bleeding or changes in bowel habits. SCOTT A. HOLEKAMP, M.D. Dr. Holekamp specializes in colorectal surgery. He earned his medical degree at the University of Cincinnati College of Medicine. He completed his residency in general surgery at the Beth Israel Medical Center, New York City, and a fellowship in colon and rectal surgery at the University of Miami/Jackson Memorial Hospital. Dr. Holekamp practices with Colorectal Surgical Associates, a division of St. Clair Medical Services. To contact Dr. Holekamp, please call 412 .572. 6192. Scott A. Holekamp, M.D. Volume VI Issue 1 I HouseCall I 15 CELEBRATING HisTory Focus onminuTe giving YEARS 1954-2014 F jack boguT: THe making oF an icon or decades, Jack Bogut has graced the radio airwaves of southwestern Pennsylvania with humor, creativity and an Hospital logo. Bogut explains how this came about. “I was invited to join the board of directors at St. Clair in 1976, during the period when the size of the Hospital was being doubled. I was chairman of the Public Relations Committee, and we were seeking a strong, clear identity for the Hospital within the community. The board was concerned that doubling the size of the Hospital could compromise the quality of care, especially as the construction took place and created inconvenience for staff, patients and visitors. I felt that we needed to send a message of a caring hospital. I thought about how medicine is the “laying on of hands” and that patients come to St. Clair and place themselves in the hands of the staff. So the image of a pair of hands came to me.” It was a stroke of genius. The simplicity of the image — those caring hands, upright and open, facing each other like parentheses — conveys much. The hands represent the caregivers who lay their skilled hands upon the ill, the suffering and the vulnerable, offering sublime care and compassion. They are the hands of surgeons, nurses, therapists and many others. The logo color (originally a subtle shade of brown), has come to be known as “St. Clair blue,” suggesting the hope and optimism of a sunny, cloudless sky. Distinctive and memorable, the logo has endured, and is readily recognizable throughout the community. It greets visitors who enter the Hospital through the front doors, where the door handles are shaped like the two sides of the logo. “Every time the door closes behind someone, the hands come back together,” Jack says. His love for St. Clair is personal. “My mother was a nurse, so I was always around medical people growing up, and I love nurses, who are the heart and soul of the Hospital. My wife Joanie and I have been patients at St. Clair, and we received excellent care. There’s very little waiting at the Emergency Department, and the people are warm and friendly. St. Clair’s growth has been amazing, and people in the South Hills choose to go to St. Clair Hospital, with good reason — it’s the best.” Jack’s original logotype has evolved over the years into a major brand icon. exceptional talent for storytelling. Highly honored, Jack is a Pittsburgh institution, familiar and beloved to legions of fans. Raconteur, interviewer, host, speaker and author, the versatile radio man is the recipient of numerous prestigious awards: he was inducted in 2011 to the Broadcasters Hall of Fame; he was given the Pittsburgh Radio and Television Club’s Lifetime Achievement Award; and he was honored by the March of Dimes with their AIR (Achievement in Radio) Lifetime Achievement Award. And in 2014, he has received yet another honor, this one from the hospital that he fondly calls “St. Care Hospital.” Jack is serving as a member of St. Clair Hospital’s 60th Anniversary Honorary Committee, and he is delighted to do so. There is a story about this renowned storyteller, this very public man, which may come as a surprise to Pittsburghers. Jack has had a long and happy relationship with St. Clair Hospital — almost as Photo courtesy of John Altdorfer/Mt. Lebanon Magazine. Iconic radio personality Jack Bogut, host of the “Bogut in The Morning Show,” heard on WJAS 1320 AM. Jack is the designer of the original St. Clair Hospital logo. Medicine is the ‘laying on of hands’ . . . patients coMe to st. clair and place theMselves in the hands of the staff. so the iMage of a pair of hands caMe to Me. “ long as his radio career, which, of course, included his long-running morning drive-time show on KDKA-Radio. He has had a lasting impact on the Hospital, as a longtime member of the board of directors, donor, vocal cheerleader for the Hospital, and, perhaps unexpectedly, as the designer of the iconic St. Clair JACK BOGUT ” Original St. Clair Hospital logo created by Pittsburgh radio personality Jack Bogut in the 1970s. 16 I HouseCall I Volume VI Issue 1 wHy i give C making a Personal connection onrad Rossetti is a Washington County resident and an avid fly fisherman for whom the sport is restorative and relaxing. So, while improvement store and donation center that sells new and gently used furniture, accessories, building materials and appliances to the public at a fraction of the retail cost. When St. Clair began demolition on the site of the Peters Outpatient Center they donated the salvage and recyclable items from the previous structure to the Habitat for Humanity store. As someone who spent so much time on that site, overseeing the salvage operation and literally watching the Hospital’s vision for the Outpatient Center come to life, I wanted to ‘pay it forward’ by sponsoring the Canonsburg Lake photograph.” Family is important to the Rossettis, whose children and grandchildren all live within five miles of their home. Sponsoring artwork at the Outpatient Center creates a legacy for the close family and, for Conrad, is a way of honoring his marriage to Gerrie. “This is a special year — we’ve planned a year-long series of trips and activities to celebrate our 50th wedding anniversary. Sponsoring the photograph is part of that; it’s a nice feeling to know that something lasting exists to honor my marriage and family.” CREATE YOUR OWN LEGACY Support the continued growth of St. Clair Hospital by sponsoring one of 13 picturesque scenes of our local community displayed in the St. Clair Hospital Outpatient Center-Peters Township. Sponsors will be recognized with a plaque placed near the selected artwork. For information about sponsoring artwork, please contact the St. Clair Hospital Foundation at 412.942.2465 or at email@example.com. at St. Clair Hospital’s Outpatient Center in Peters Township, he saw the framed photograph of fishermen on Canonsburg Lake hanging behind the reception desk, it resonated with him. “I was inspired when I saw that photograph,” he explains. “I’m passionate about fly fishing. My wife Gerrie and I love the outdoors and anything to do with water and boats. I saw myself in the picture.” The Rossettis decided to make a donation to sponsor the colorful photograph, one of a collection of 13 created by regional artist Leroy G. Pettis and hanging in prominent locations throughout the Center. The photographs feature 12 Washington County sites, plus a picture of St. Clair Hospital that adorns the Center’s Community Room. They are all available for sponsorship through the St. Clair Hospital Foundation. Small plaques bearing the donor’s name will be placed beside each photograph. The Rossettis were moved to donate by the quality of the photograph and their high regard for St. Clair Hospital. “Gerrie and I were impressed by the Outpatient Center,” Rossetti says. “It exceeded our expectations: the advanced technology, the convenience and location of all the departments, and the addition of the café. It’s well thought-out and beautiful.” Conrad Rossetti’s relationship with St. Clair Hospital grew out of his volunteer involvement with the Washington affiliate of Habitat for Humanity. Following a 44-year career in industrial sales and marketing, Rossetti retired to his Nottingham County home in 2005 and was eager to find a new purpose. “I wanted to remain active and give back. I’ve been blessed with good health, a good life and good family. I read a story about Habitat for Humanity seeking to establish a “ReStore” for Washington County. A ReStore is a non-profit home Washington Courthouse Henry Covered Bridge Bednar’s Farm & Greenhouse Conrad Rossetti Volume VI Issue 1 I HouseCall I 17 conTinueD growTH Continuity of Care DISTINGUISHES ST. CLAIR URGENT CARE the care provided at urgent care is designed to integrate with our priMary care and specialty networks. “S ” t. Clair Hospital is bringing the same innovative processes that helped make its Emergency Department number one in the nation to urgent care. The new St. Clair Urgent Care, located on the ground floor of the St. Clair Hospital Outpatient Center–Village Square in Bethel Park, is providing care to people in need of immediate but not emergency care, says Rachel L. Schroer, D.O., Medical Director at Urgent Care. “In urgent care, we treat people who come in with a focused problem that we are able to fix. The most common problems that we treat are upper respiratory infections, flu and sore throats; cuts requiring sutures; sprains and uncomplicated fractures; and skin infections. We can do X-rays and point-of-care lab testing on-site for blood sugar, strep throat, mononucleosis and urinary tract infections. Urgent care is not a mini-emergency department; we take care of urgent illnesses and injuries. If a patient is more critically ill or needs higher level testing or monitoring, such as with chest pain or abdominal pain, they need to be evaluated in our Emergency Room.” Dr. Schroer transitioned into urgent care after five years in private practice. She finds urgent care challenging and satisfying. “It’s wonderful to be able to see a patient quickly and resolve the problem right away. There is always a lot of variety. This facility is a great work setting; we have top-of-the-line technology and beautiful aesthetics. All the physicians who work here are board-certified. Patients love the facility, the excellent care and the convenience.” David Kish, R.N., Director of Emergency Services and Patient Logistics for St. Clair Hospital, manages St. Clair Urgent Care. To Dave, urgent care has many benefits. “St. Clair has a great network of primary care physicians. But if patients need to be seen after hours, urgent care is here to fulfill that need. Staffed by board-certified physicians, registered nurses and radiology technologists, St. Clair Urgent Care at Village Square welcomes patients seven days a week, 365 days a year. DAVID KISH, R.N. DIRECTOR OF EMERGENCY SERVICES AND PATIENT LOGISTICS Urgent Care provides quick, convenient, quality care close to home. 18 I HouseCall I Volume VI Issue 1 “St. Clair Urgent Care is open seven days a week and is staffed by a physician, registered nurse, X-ray technologist and patient registrars. The staff is cross-trained to provide support to each other. Urgent Care’s goal is to examine and treat each patient in less than an hour. Our current average is 56 minutes.” St. Clair Urgent Care also facilitates continuity of care, Dave explains. “The care provided at Urgent Care is designed to be seamless. For example, St. Clair Urgent Care has treated patients with orthopedic injuries who were referred and seen immediately by orthopedic surgeons whose practices are in the same building. In a similar fashion, several patients who did not have a primary care physician were able to be connected with PCPs and seen very quickly. Urgent Care’s location inside the Outpatient Center is ideal, since patients using our lab and diagnostic imaging center can also benefit from Urgent Care services.” Both Dr. Schroer and Dave say the key to a smooth continuum of care is communication, via the electronic health record, or EHR. “A summary of a patient’s visit to St. Clair Urgent Care is easily accessed electronically by physicians and facilitates communication between the primary care physician and the staff at Urgent Care.” St. Clair Hospital has a commitment to serve the community, says Dr. Schroer, and St. Clair Urgent Care exemplifies that commitment. “Patients appreciate the quality and immediacy of the services. People in the St. Clair communities are accustomed to top-notch care; they expect a high quality of care. St. Clair Urgent Care is unique because it's integrated. We offer streamlined care, excellent communication with your own physician, and a convenient, comfortable location.” URGENT CARE STAFF AND SERVICES St. Clair Urgent Care, which opened January 13 in the St. Clair Hospital Outpatient Center–Village Square in Bethel Park, is staffed by board-certified physicians, registered nurses, radiology technologists, and patient registrars. It is open 9 a.m. to 9 p.m. (9 a.m. to 5 p.m. on major holidays) seven days a week, 365 days a year, no appointment necessary. There are six examination rooms, two procedure rooms, and an X-ray room. St. Clair Urgent Care also has a lab offering, among other things, urine analysis and rapid strep testing. St. Clair Urgent Care treats minor injuries and illnesses. Below is a list of some of the common ailments and conditions treated there: • Allergies and asthma • Colds, pneumonia and flu • Coughs and sore throats • Cuts requiring stitches • Dehydration • Earaches • Eye infections • Fever • Fractures and minor broken bones • Skin rashes/infections • Stomach ailments • Urinary tract infections Also available: • Flu shots • Sports physicals St. Clair Urgent Care accepts most major health insurances and can fill selected prescriptions on-site. CONVENIENTLY LOCATED FO RT Norman Center D RD. HIGHLAN RD FO OX CO UC H RACHEL L. SCHROER, D.O., MEDICAL DIRECTOR Dr. Schroer earned her medical degree from Lake Erie College of Osteopathic Medicine (LECOM). She completed her residency at UPMC–St. Margaret. Dr. Schroer is board-certified by the American Board of Family Medicine. RD . Giant Eagle Market District . DR H AS W ON GT IN . RD St. Clair Urgent Care Home Depot . DR T-line RD UCH T CO FOR South Hills Village Mall RD FO OX . St. Thomas More Church MATTHEW S. COOPER, D.O. Dr. Cooper earned his medical degree from Lake Erie College of Osteopathic Medicine (LECOM). He completed his residency at UPMC-Shadyside. Dr. Cooper is board-certified by the American Board of Family Medicine. T-line Eat’n Park EL TH E B CH UR H C . RD EDIRI A. MONTOYA, M.D. Dr. Montoya earned her medical degree from the University of Pittsburgh School of Medicine. She completed her residency at Washington Hospital. Dr. Montoya is board-certified by the American Board of Family Medicine. VILLAGE SQUARE 2000 OXFORD DRIVE BETHEL PARK, PA 15102 412.942.8800 • 365 DAYS A YEAR • 9 A.M. TO 9 P.M. (9 A.M. TO 5 P.M. ON MAJOR HOLIDAYS) • NO APPOINTMENT NECESSARY Volume VI Issue 1 I HouseCall I 19 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. n i a g A ^ RANKED AMONG THE 100 TOP OSPITALS IN THE NATION. ® St. Clair Hospital has again been named one of the nation’s 100 Top Hospitals® . The annual award — now in its 21st year — is given by Truven Health Analytics (formerly a division of Thomson Reuters) based on an objective analysis of patient safety, clinical outcomes, patient satisfaction, and value. Hospitals do not apply, nor do they pay, for this honor. Jean Chenowith, senior vice president of Truven, noted that the winners are “hospitals that deliver higher quality, higher satisfaction, and lower cost.” Among the other notable honorees in 2014 are Duke University Hospital (Durham, NC) and Vanderbilt University Medical Center (Nashville, TN). Truven calculates that if all Medicare inpatients had received the same level of care as those treated in the award-winning hospitals: • More than 165,000 additional lives could be saved; • Nearly 90,000 additional patients could have avoided medical complications; • And $5.4 billion could have been saved. St. Clair salutes its outstanding physicians and employees for this prestigious achievement. To learn more about this honor, visit our website at www.stclair.org.