St. Clair Hospital HouseCall Vol XI Issue 4

VOLUME XI ISSUE 4

A breakthrough in heart valve surgery Please see Page 2

TAVR PROCEDURE

Expanded availability of revolutionary cardiac procedure brings life-changing outcomes to more patients

2 I HouseCall I Volume XI Issue 4

An innovative, minimally-invasive procedure known as transcatheter aortic valve replacement, or TAVR, is transforming the treatment of severe, symptomatic aortic stenosis, a debilitating, progressive form of heart valve disease that afflicts millions of Americans. TAVR relieves the symptoms of severe aortic stenosis, improving health, quality of life, and survival. TAVR was approved in the U.S. by the FDA in November 2011 as an alternative to traditional surgical valve replacement for elderly, frail patients who were at high risk of dying during open heart surgery. Based on the success of the procedure, a new FDA ruling last summer (Please see related story on Heart Team Summit, Pages 12–13) expanded access to the procedure, making it newly available to more patients with severe aortic stenosis, whose only option, until now, has been open heart surgery.

t St. Clair Hospital, cardiothoracic surgeon Andy C. Kiser, M.D., FACS, FACC, FCCP, Chief of Cardiac Surgery, and Ryan W. Zuzek, M.D., FACC, an interventional cardiologist and Medical Director of Interventional Cardiology, have been performing the TAVR procedure since July. Working side by side,

Andy C. Kiser, M.D., FACS, FACC, FCCP

Dr. Kiser and Dr. Zuzek are achieving excellent, life-changing outcomes for patients. “The TAVR procedure isn’t new, but its expanded availability is new, and represents an exciting development in the field,” says Dr. Kiser, who is internationally respected for his pioneering work to improve the treatment of valve disease and atrial fibrillation.

Continued on Page 4

“ ”

... AN EXCITING DEVELOPMENT IN THE

FIELD OF CARDIOTHORACIC SURGERY.

ANDY C. KISER, M.D., FACS, FACC, FCCP, CHIEF OF CARDIAC SURGERY, ST. CLAIR HOSPITAL

About The Cover:

St. Clair Hospital TAVR patient Josephine “Josie” Schultz bags donated items at the St. Vincent DePaul Food Pantry at St. Elizabeth Ann Seton Parish, where she volunteers.

Volume XI Issue 4 I HouseCall I 3

TAVR PROCEDURE Continued from Page 3

AORTIC STENOSIS The heart’s four valves are leaflet-like tissue flaps that function

However, when aortic stenosis worsens and symptoms develop,

as gates between the heart’s chambers. They open and close to

that is an altogether different matter. Severe, symptomatic aortic

regulate the flow of blood and assure that blood is only flowing

stenosis is not only debilitating, interfering with daily living, but

one-way. When they become diseased, due to calcium build-up

also dangerous, as it can lead to heart attack, stroke and death.

on the leaflets, the passage through the valve narrows, a condition

Symptoms of aortic stenosis may include shortness of breath,

known as stenosis. Stenosis compromises the ability of the valves to

irregular heartbeat, swelling of the legs and feet, chest pain, fatigue

perform their job of opening and closing, and the heart has to pump

and dizziness. Aortic stenosis is primarily associated with aging,

harder to propel blood through the thickened valves. Aortic stenosis

but it can be congenital or, on rare occasions, a complication of

specifically means that the passage between the left ventricle and

radiation therapy or a heart infection.

the aorta, the large main conduit from the heart to the body, has narrowed. Aortic stenosis is a fairly common condition, especially in older adults, but they frequently have no symptoms and simply live with it, possibly not even knowing they have it.

THE HEART TEAM At St. Clair, TAVR is a team endeavor. It begins with the primary care physicians and cardiologists who diagnose severe aortic stenosis in the patient and make referrals to St. Clair’s cardiovascular specialists. A multidisciplinary Heart Team comprised of cardiac surgeons, cardiac imaging specialists, interventional cardiologists, cardiac anesthesiologists, nurses, catheterization lab technicians and others convenes to consider the unique needs of the patient and to identify the patient’s surgical risk. Surgical risk means not only the risk of mortality, but also complications during and after surgery.

At St. Clair, the Heart Team bases this risk assessment on the Society of Thoracic Surgeons Predicted Risk of Mortality, which calculates risk based on factors of age, severity of symptoms, co-morbid conditions, previous heart surgery and general frailty.

This information is shared with the patient, explains Dr. Kiser, and the patient’s personal goals and preferences are taken into account.

“We have superb teamwork, with outstanding communication and collaboration,” says Dr. Kiser. “All the physicians gather to

Andy C. Kiser, M.D., FACS, FACC, FCCP

discuss the case and the best option for that patient. We ask, what will give this patient the greatest benefit? We present both options to the patient and discuss risks/benefits to help them reach their decision.”

Continued on Page 6

ANDY C. KISER, M.D., FACS, FACC, FCCP Dr. Kiser is Chief of Cardiac Surgery at St. Clair Hospital. He earned a B.S. in biology with honors and distinction, and a medical degree with honors, from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason-Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser then served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser practices with St. Clair Medical Services.

To contact Dr. Kiser, please call 412.942.5728.

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What is Aortic Stenosis?

Aortic stenosis is a narrowing of the aortic valve opening restricting the blood flow from the left ventricle to the aorta. This narrowing prevents the valve from opening fully, which reduces or blocks blood flow from the heart into the main artery (aorta) to the body.

The heart-weakening effects of aortic valve stenosis may lead to heart failure.

TAVR:

Normal aortic valve

Aortic valve stenosis

closed

closed

open

open

How it works TAVR is a minimally invasive procedure that offers leading-edge treatment for structural heart disease patients.

Benefits of TAVR TAVR provides patients with a quicker recovery, returning home after a shorter hospital stay, than traditional surgery.

What is TAVR?

Patients get back to their normal activities sooner.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a narrowed aortic valve that fails to open and shut properly (aortic valve stenosis).

A small incision is made in the groin.

Using imaging technology, a thin balloon catheter system containing the new valve is guided through the femoral artery to the heart. When placed into position, the new valve pushes aside the diseased valve and acts as the new heart valve.

Once the new valve is in place, it immediately begins the regulation of flow between the heart’s chambers.

Volume XI Issue 4 I HouseCall I 5

TAVR PROCEDURE Continued from Page 4

THE TAVR PROCEDURE As a catheter-based, percutaneous (through the skin) technique,

leaflets. Once the new valve is in place, it begins functioning

TAVR is radically different from traditional, open heart surgical valve

immediately. The surgeons secure it, test it to make sure it is

replacement, which entails general anesthesia, a chest incision,

working exactly as it should, remove the catheter and close the

dividing the sternal bone and stopping the heart to place the patient

tiny femoral incision. This entire process often takes less than

on a heart-lung bypass machine. TAVR is substantially less invasive,

two hours. Post-operatively, the patient is transferred to the

nearly bloodless, almost entirely painless, and leaves the body

Cardiovascular Surgical Unit (CVSU) and likely discharged within

unscarred. Recovery is accelerated: patients are home within a day

the next day or two.

or two and complications are rare.

At St. Clair, Dr. Kiser and Dr. Zuzek perform the TAVR procedure

One of the many advantages of St. Clair’s comprehensive TAVR program is the streamlined process that guides patients and

together. They make a small incision in the femoral fold and, using

families through every step of the TAVR experience. Professional,

x-ray and echocardiography imaging, direct the passage of a thin,

efficient and individualized, this approach emphasizes patient

pliable catheter containing the new prosthetic valve through the

education and emotional support, and creates a smooth flow that

femoral artery to the heart. The valve is delivered to the heart on a

reduces stress and eases the patient and the family through the

balloon system that, when inflated, pushes aside the diseased valve

assessment, preparation, procedure, recovery and follow-up phases.

The TAVR team at St. Clair Hospital includes, left to right, Christopher E. Pray, M.D., FACC; Jamie Roland, R.N.; Ron Partee, ST; Andrew Schwanekamp, R.N.; Ryan W. Zuzek, M.D., FACC; Andy C. Kiser, M.D., FACS, FACC, FCCP; Shawn Balaschak, R.N., BSN, MSM; Ashley Vay, ST; Steve Kretschman, R.N.; Alyse Olah, R.N.; Jessica Ketchum, CRNA; and Carissa Rogers, RT.

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Dr. Zuzek, left, and Dr. Kiser perform a TAVR procedure at St. Clair Hospital.

ST. CLAIR’S VALVE PROGRAM Valve disease is fairly common, with as many as 5 million

Despite numerous advantages, TAVR is not for everyone.

people diagnosed every year. As the U.S. population ages, more

Some aortic stenosis patients may not be good candidates

people are likely to be diagnosed with severe aortic stenosis and

for TAVR due to the size and structure of their hearts or

will be candidates for valve replacement. St. Clair’s comprehensive

because of previous heart surgeries, and will undergo

Valve Clinic, Dr. Zuzek says, has the capabilities to do every kind

the traditional approach, which also results in excellent

of valve procedure, from TAVR to complex valve reconstructions.

outcomes. In the traditional open heart surgical

“We can do pretty much any procedure now that is being done for

replacement of the aortic valve, the diseased valve

valves, and do it extremely well,” he says. “We are a true team,

is entirely removed and replaced with an artificial

deeply experienced, with everyone pulling in the same direction.

one. The patient will typically stay in the CVSU for

We go over every single patient with six or seven physicians. It

approximately a week.

takes a lot of people and a lot of hard work, but it’s wonderful to see the patients when they walk into the office for their follow-up.

To contact the St. Clair Hospital Valve Clinic,

please call 412.942.VALV (8258). n

This is an exciting time in the field of cardiovascular surgery and the expansion of eligibility for TAVR is one of the reasons for that.”

Ryan W. Zuzek, M.D., FACC

RYAN W. ZUZEK, M.D., FACC Dr. Zuzek earned his medical degree at the National University of Ireland in Galway. His postgraduate training includes an internal medicine residency at the Cleveland Clinic, where he was later an attending physician. He then completed cardiology and interventional cardiology fellowships at Brown University hospitals in Providence, R.I. Dr. Zuzek is board-certified in internal medicine, general cardiology, interventional, and nuclear cardiology. He practices with US Heart and Vascular, P.C. To contact Dr. Zuzek, please call 412.429.8840.

Volume XI Issue 4 I HouseCall I 7

TAVR PROCEDURE Continued from Page 7

TAVR is transforming the treatment of aortic stenosis and it has transformed the lives of patients who have undergone the procedure at St. Clair Hospital. They have renewed health and energy; they manage their daily lives with comfort and independence; and they can now enjoy activities that they had given up.

Free of the life-limiting symptoms of aortic stenosis, they can breathe easily again. Two TAVR patients share their stories with HouseCall.

JOHN LIEBERMAN:

A superhero makes a comeback For John Lieberman, 84, of Bridgeville, the spring of 2019 was a period of heartbreak, illness and pain. In March, he lost his beloved

Mark K. Greathouse, M.D., FACC performed the stent placement in late June. The procedure went smoothly and tests indicated that the

wife of 64 years, Mary Ann; he developed near-fatal gastrointestinal

stent was functioning perfectly. So, six weeks later, Dr. Kiser and

bleeding; and he struggled with worsening aortic stenosis that left

interventional cardiologist Ryan W. Zuzek, M.D., FACC performed

him weak and short of breath. A plumbing contractor who has never

John’s TAVR procedure at St. Clair.

quite retired, John could no longer drive, had no appetite and was

Two days later, John Lieberman went home, with a new aortic

barely able to walk. He needed help, but his advanced age and a

valve and a new lease on life. “I had no pain and no complications,”

previous open heart procedure meant that he was not a candidate

he says. “I can breathe again; I can walk and climb the stairs. I can

for surgery.

walk up and down the street for 30 minutes. I feel like I can do

For John’s family, witnessing their father’s decline was excruciating.

anything. I’m so happy that there was a hospital and a team of

His six adult children and 17 grandchildren revere him and call him

doctors who were able to help me. Dr. Kiser and Dr. Zuzek gave

Superman. According to his daughter Amy, who shares a home with

me back my life.”

him in South Fayette, “My Dad is a superhero; he and my mother

It has been an amazing turnaround, says daughter Amy. “Without

gave us a wonderful childhood and a happy home. He had his own

TAVR, my Dad would not be here today. We are grateful to his team

business and was always in demand but he was home for dinner

of doctors: Dr. Kiser, Dr. Zuzek, Dr. Mehta and Dr. Greathouse. They

every night. He was the best father and everything he did was for

were all involved and made the experience as easy as possible for

his family. My mother was everything to my Dad. When he was in

us. Dr. Kiser was so attentive to my Dad but also to the whole family;

the hospital with the bleeding, we thought we were going to lose

Dr. Zuzek took time to explain everything to us and put us at ease.

him too.”

Jamie Roland, R.N., St. Clair Hospital Valve Clinic Coordinator, took

Cardiologist Harshad R. Mehta, M.D., FACC had been monitoring John’s aortic stenosis for several years and when his symptoms grew more severe, referred John to Andy C. Kiser, M.D., FACS, FACC,

care of every detail and held our hands through it all. The care was excellent and every single person at St. Clair treated us well.”

John is looking forward to playing golf again and enjoying time

FCCP, Chief of Cardiac Surgery at St. Clair. Initially, after an

with the adoring family that is more convinced than ever that he

assessment of John’s condition and history, Dr. Kiser believed that

really is Superman. He still takes calls from customers who trust

John was too high-risk for even the TAVR procedure, which was

him and know the high quality of his work, says Amy; but, as always,

conceived for ‘high-risk’ patients. Later, he offered John an option:

family comes first. “We have a tradition of big celebrations for

have a coronary artery stent placed first, and if the stent worked he would schedule the TAVR procedure. Dr. Mehta’s partner, cardiologist

8 I HouseCall I Volume XI Issue 4

birthdays and holidays and now we have more to celebrate. Dr. Kiser

and Dr. Zuzek have given us back our Superman.” n

“

Dr. Kiser and Dr. Zuzek gave me back my life.

”

JOHN LIEBERMAN, PATIENT

John Lieberman

Volume XI Issue 4 I HouseCall I 9

TAVR PROCEDURE Continued from Page 9

“

I’m healthy and I’m looking forward to being active again.

”

JOSEPHINE SCHULTZ, PATIENT

Josephine Schultz

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Thomas Schultz

JOSEPHINE SCHULTZ:

Mending a kind heart Compassion and kindness flow freely from the heart of Josephine “Josie” Schultz. She is an active 83-year-old retiree who keeps busy caring for her husband Thomas, her expanding family, and her community. Her volunteer activities are never-ending: she volunteers with Thomas at the St. Vincent DePaul Food Pantry at St. Elizabeth Ann Seton Parish in Carnegie twice a week and has been doing so for 18 years. She helps run the bingo program at the senior living community where she and Thomas live. She is a member of the St. Elizabeth Ann Seton Christian Mothers chapter and helps out with the annual Lenten Fish Fry. Wherever there is a need in her community, Josie is likely to be there, eager to help. In 2002, she retired from a longtime job with the Pennsylvania Department of Environmental Protection, but she never slowed down.

In January of last year, however, Josie began to feel a little different.

She could no longer walk the circuit around the mall, and she became short of breath with exertion. She was under the care of cardiologist Robert N. Shogry, M.D. and had had a successful stent placement years ago. She was aware that she had aortic stenosis, and Dr. Shogry kept close tabs on it, monitoring her cardiac health with regular echocardiograms. In June, he informed her that the stenosis had worsened and it was time to intervene. He referred her to Andy C. Kiser, M.D., FACS, FACC, FCCP, Chief of Cardiac Surgery, at St. Clair.

“Dr. Kiser did a lot of tests on me and told me about TAVR; interventional cardiologist Dr. Ryan Zuzek M.D., FACC came in during my tests and introduced himself to me. Dr. Kiser explained that he and Dr. Zuzek and a whole team of doctors would meet to discuss my test results; they were considering whether open heart surgery or TAVR would be best for me. When they told me that I could have the TAVR

Josie exercises on a treadmill in St. Clair Hospital’s Cardiac/Pulmonary Rehabilitation unit.

procedure, I was happy because I had been praying for that. Dr. Kiser said that he and Dr. Zuzek would do it together.”

Josie was designated a ‘low-risk’ patient: she was physically active

Josie feels great; she no longer gets short of breath and she’s enjoying her life again, including the cooking and baking that she loves.

and able to fully perform activities of daily living. She had no serious

She plans to travel to New York and St. Louis to visit her children and

medical conditions that might complicate the procedure. She had the

grandchildren (seven grandchildren and four great-grandchildren)

TAVR procedure on August 8 at St. Clair and was home the following

and to resume her volunteer activities. “I’m grateful to Dr. Kiser and

day, after a pre-discharge echocardiogram and EKG showed that her

Dr. Zuzek for the TAVR procedure. Both are fantastic doctors. Dr. Kiser

new valve was working. “It went quickly and I did well; I felt no pain

told me that I was a very good patient and he was proud of me. Well,

at all. My daughter, Angie, came to stay with me for a few days when

maybe I was a good patient, but he was a good doctor — a very good

I came home. I saw Dr. Kiser two weeks later and he was pleased

doctor. Thanks to him and Dr. Zuzek, I’m healthy and I’m looking

with my recovery.”

forward to being active again.” n

Volume XI Issue 4 I HouseCall I 11

CARDIOVASCULAR CARE

PITTSBURGH HEART TEAM SUMMIT A SYMPOSIUM ON CARDIOVASCULAR ALLIANCES

A WHO’S WHO OF HEART SPECIALISTS CAME TO PITTSBURGH FOR A SYMPOSIUM ON THE MOST RECENT ADVANCES IN CARDIOVASCULAR CARE, ORGANIZED BY ST. CLAIR HOSPITAL. Andy C. Kiser, M.D., FACS, FACC, FCCP, St. Clair’s Chief of Cardiac Surgery, and Christopher E. Pray, M.D., FACC, St. Clair’s Director of Medical Imaging, served as Co-Directors of the Pittsburgh Heart Team Summit, which featured presentations by the country’s foremost experts in cardiology and cardiac surgery leaders. The expert presentations focused on the most progressive medical and surgical interventions for atrial fibrillation, heart valve disease, heart failure, and coronary artery disease, as well as the newest technology in cardiac imaging and other topics. The faculty presented clinical evidence and practical guidelines to enhance teamwork and build alliances to advance excellence in the care of patients with cardiovascular disease.

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A highlight was the keynote session, “What Does Low-Risk

Robotic Cardiac Surgery, University of Chicago; Jason N. Katz, M.D., MHS,

Transcatheter Aortic Valve Replacement (TAVR) Mean to Cardiologists

Medical Director of Mechanical Support and Cardiovascular Critical Care,

and Surgeons?” presented by Michael Mack, M.D., Medical Director,

University of North Carolina Hospitals, Chapel Hill; Roger Carillo, M.D., MBA,

Cardiovascular Surgery, The Heart Hospital at Baylor Scott and White,

Cardiothoracic Surgery, Tenet Florida Hospitals; John Gorscan III, M.D.,

Plano, Texas. Dr. Mack, the lead author of a groundbreaking study on TAVR,

Director of Clinical Research, Washington University, St. Louis; Andrea Natale,

announced FDA approval of TAVR for low risk patients at the Heart Team

M.D., Executive Medical Director, Texas Cardiac Arrhythmia Institute, Austin;

Summit. The FDA ruling expands the availability of transcatheter aortic valve

and William O’Neill, M.D., Director of Cardiology and Structural Heart

replacement for patients with severe aortic stenosis. (Please see

Disease, Henry Ford Hospital, Detroit. From East Carolina Heart Institute in

related story on TAVR, Pages 2–11). Dr. Kiser and Ryan W. Zuzek, M.D.,

Greenville, North Carolina, J. Paul Mounsey, M.D., PhD, Chief of Electro-

FACC, Medical Director of Interventional Cardiology at St. Clair, offer

physiology, and Blasé Carabello, M.D., Chief, Division of Cardiology, gave

TAVR through the Valve Clinic at the Hospital.

presentations and participated in panel discussions. Western Pennsylvania

Other Summit faculty were James Edgerton, M.D., Senior Clinical

was represented by Stephen Bailey, M.D., Director of Cardiac Transplantation

Scientist, Department of Epidemiology, Baylor, Scott and White, Plano Texas;

and Mechanical Support and Director of Cardiac Surgery, Allegheny Health

Jonathan Piccini, M.D., MHS, Director of EP Clinical Trials, Duke University

Network; David M. Lasorda, D.O., Director of Interventional Cardiology,

Medical Center; Isaac George, M.D., Surgical Director of the Heart Valve

Allegheny Health Network; Erik Schelbert, M.D., MS, Director of Cardiovascular

Center, New York Presbyterian/Columbia University; Matthew E. Wiisanen,

Magnetic Resonance, UPMC; and Anson Jay “Conrad” Smith, M.D., Director

M.D., Director of Structural Heart Disease, Erlanger Heart and Lung Institute,

of the Cardiac Catheterization Labs, UPMC.

Chattanooga; Husam H. Balkhy, M.D., Director of Minimally Invasive and

The 2020 Pittsburgh Heart Team Summit will be conducted July 30-31. n

St. Clair Hospital Chief of Surgery Andy C. Kiser, M.D., FACS, FACC, FCCP (ninth from left) poses with other heart experts at last year’s Pittsburgh Heart Team Summit. Pictured third from right is St. Clair Hospital Director of Medical Imaging Christopher E. Pray, M.D., FACC. Volume XI Issue 4 I HouseCall I 13

BREAST CARE

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WHOLENESS

RESTORED Oncoplastic Surgery is an Excellent Option for Breast Cancer Patients

Breast cancer patients who need to have a lumpectomy along with breast reconstruction might find oncoplastic surgery an excellent option. Oncoplastic surgery is a specialized approach to the treatment of breast cancer that produces the best possible medical outcome, as well as a superior aesthetic result. It combines lumpectomy (surgical removal of a suspected cancerous tumor, or other abnormal tissue, and a small portion of the surrounding tissue) with plastic surgery reconstruction in a way that removes the cancer and conserves the breast, restoring wholeness to the patient and enhancing her long-term recovery. At St. Clair Hospital’s Breast Care Center, breast surgeons and plastic surgeons collaborate in order to provide this option to patients who are good candidates for the procedure.

Continued on Page 16

LUMPECTOMY

BREAST RECONSTRUCTION

Oncoplastic surgery is the term used to describe rearranging breast tissue at the time of lumpectomy to help improve the appearance of the breast after surgery.

ONCOPLASTIC SURGERY Volume XI Issue 4 I HouseCall I 15

BREAST CARE Continued from Page 15

A

traditional lumpectomy can be disfiguring, leaving a patient

that rebuilds the breast and restores it to a normal and natural

with a scar or deformity, says Tara L. Grahovac, M.D., a

appearance. No implant is needed. The opposite breast is also

board-certified breast surgeon at St. Clair’s Breast Care

reshaped, so that the breasts match.”

Center. “In an oncoplastic breast surgery procedure, the surgeon

Edward J. Ruane, Jr., M.D., a board-certified plastic surgeon at

performs the lumpectomy in a way that facilitates breast reconstruction

St. Clair, frequently works with Dr. Grahovac and with Raye J. Budway,

by the plastic surgeon. We do a generous resection (surgical removal

M.D., a breast surgeon and Medical Director of the Breast Care Center.

of tissue or organs) of the tumor, plus extra surrounding tissue, to

“Lumpectomy is a breast-conserving treatment and a good option for

make sure that the margins are clear. We leave enough tissue for the

many women, but it does involve radiation to the remaining tissue.

plastic surgeon to reconfigure in a breast lift and/or breast reduction

Radiated tissue doesn’t heal as well as non-radiated tissue, so there is a chance of healing-related issues. For this reason, the plastic surgery has to precede the radiation. Our approach is to do the lumpectomy, followed by a period of healing of one or two weeks, then the breast reconstruction, and finally radiation a few weeks later,

“

when the surgical wounds have healed. With this approach, all the

OUR PATIENTS

ARE VERY PLEASED

WITH THE RESULTS.

”

EDWARD J. RUANE, JR., M.D. PLASTIC SURGEON, ST. CLAIR HOSPITAL

treatment takes place within a few weeks. We don’t do it all on a single day, because you have to confirm that the margins are negative for cancer before you do the reconstruction and re-arrange the tissue.

There is no deformity after lumpectomy when it is done this way, and the patient gets an aesthetic improvement.”

Oncoplastic surgery has many benefits. One of the most significant is that it can lower the risk of cancer recurrence. “The priority is always treating the cancer first,” says Dr. Ruane. “Dr. Grahovac can remove a wider margin of tissue around the tumor, because she knows that I will be able to fix it, no matter how large the resection is, when I do the reconstruction. She can be as aggressive as she needs

Edward J. Ruane, Jr., M.D.

to be and this can mean a reduced risk of the cancer returning.”

The ideal candidate for oncoplastic surgery is a large-breasted woman who has a large tumor and wants breast conservation, explains Dr. Budway. “Another candidate is a smaller-breasted woman with a regular-sized tumor with the same clinical indicators, so that the cosmetic result is better.” Most women, when presented with this option, are pleased to have it, but the procedure is not for everyone: a woman with small breasts who has a large cancer will not have enough tissue and will need to have a mastectomy and breast reconstruction.

EDWARD J. RUANE, JR., M.D. Dr. Ruane specializes in all aspects of plastic surgery, ranging from reconstructive to cosmetic. He earned his medical degree at Duke University School of Medicine and completed a residency in Plastic Surgery at UPMC, where he served as Administrative Chief Resident in the Department of Plastic Surgery. Dr. Ruane is board-certified by the American Board of Plastic Surgery. Along with his partner Robert W. Bragdon, M.D., FACS, Dr. Ruane practices with St. Clair Medical Services.

To contact Dr. Ruane, please call 412.942.5725.

16 I HouseCall I Volume XI Issue 4

Oncoplastic surgery represents a new effort in breast cancer treatment that emphasizes how a woman feels about her breasts and herself after surgery, says Dr. Grahovac. “Removing a breast can have a negative impact on a woman’s psychosocial and sexual health, so breast conservation is a huge benefit. Oncoplastic surgery is a specialized technique that is not performed in every center, but we are doing it frequently here. St. Clair is giving patients in this region a full set of options, especially unique surgical approaches such as oncoplastic surgery.” n

Edward J. Ruane, Jr., M.D., plastic surgeon, and breast surgeon Tara L. Grahovac, M.D. perform surgery at St. Clair Hospital.

“Oncoplastic surgery is the epitome of individualized care for surgery,” says Dr. Grahovac. “This approach delivers an excellent medical outcome, conserves the breast and does that in a way that gives the woman an

Tara L. Grahovac, M.D.

aesthetic improvement. We know that this can positively impact her self-image, sense of well-being and quality of life, and enhance her recovery. It’s a creative approach.”

Breast reconstruction is a safe, outpatient procedure; it does not increase the risk of cancer recurrence, or the risk of missing a recurrence.

“Women should be aware that at St. Clair we can treat their cancer and give them breast lifts; they can have a lumpectomy and no deformity,” Dr. Ruane says. “Our patients are very pleased with the results. Any woman who needs a lumpectomy and radiation therapy should ask her surgeons about this option.” Dr. Ruane and his board-certified partner Robert W. Bragdon, M.D., FACS offer the full range of breast reconstruction options, including implants and tissue-based reconstruction for women who require mastectomy.

TARA L. GRAHOVAC, M.D. Dr. Grahovac specializes in breast surgery. She earned her medical degree at the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Grahovac completed her residency in general surgery at Allegheny General Hospital, and a fellowship in breast surgery at UPMC Magee-Womens Hospital. She is board-certified by the American Board of Surgery and is certified as a trained clinical fellow in breast surgical oncology by a Society of Surgical Oncology-accredited program. Along with her partner Raye J. Budway, M.D., FACS, Dr. Grahovac practices with St. Clair Medical Services.

To contact Dr. Grahovac, please call 412.942.7850.

Volume XI Issue 4 I HouseCall I 17

BREAST CARE Continued from Page 17

“

I just wanted the cancer to be gone. Thankfully, my doctors were looking at the big picture and wanted more for me.

”

REYNE MITCHELL, PATIENT

Reyne Mitchell

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REYNE MITCHELL:

Positive long-term benefits Oncoplastic breast surgery is a compassionate and innovative

Reyne’s lumpectomy was performed at the end of January 2019,

approach to breast cancer that considers the whole woman, beyond the

followed by reconstruction surgery two weeks later. “If I didn’t have the

cancer diagnosis, with an eye to her total well-being and long-term

second cancer, I might have been able to have just lumpectomy and

recovery. Reyne Mitchell, 57, of South Fayette, had oncoplastic surgery

radiation,” she recalls, “but because of the second cancer I needed a

in January 2019 and she is grateful that her St. Clair Hospital physicians

much larger lumpectomy. They removed an entire quadrant, but I had

were always cognizant of the broader, lifelong impact of her experience.

enough tissue for a breast lift. Dr. Ruane lifted tissue into the void left by

“I just wanted the cancer to be gone,” she says. “Thankfully, my doctors

the lumpectomy. I also had a breast reduction on the right at the same

were looking at the big picture and wanted more for me. They wanted to

time, so my breasts would be symmetrical. Both surgeons, Dr. Grahovac

give me an outcome that would truly put the cancer behind me in a more

and Dr. Ruane, worked together for the best possible outcome.”

complete way. They didn’t simply treat me, they healed me because they saw me as a person, with life ahead of me.”

Reyne was diagnosed with breast cancer in December 2018,

Six weeks of post-operative healing gave Reyne time to prepare for radiation therapy. She went back to work as a hair stylist at the McMurray Styling Center — a job that demands stamina; but she believed that

following a routine screening mammogram on her 56th birthday.

work was essential to her healing, not just from the surgeries but from

“My mammogram showed abnormalities in my left breast that required

the entire ordeal of cancer. “It was a lot to go through, but I kept getting

further testing, including a biopsy. It came as a complete shock; I had

positive news along the way. I prayed, kept going and maintained my

no symptoms. I’ll never forget that birthday or the moment when I

life as normally as I could. I tried to stay positive, as hard as that

learned I might have breast cancer.”

sometimes was.

There was a second surprise in store for Reyne. A breast MRI

“Cancer is a journey of unpredictability. You make choices and hope

revealed that there was another tumor, also in the left breast. St. Clair

that they are the right ones. I was fortunate to have caring doctors:

Hospital breast surgeon Tara L. Grahovac, M.D. informed Reyne that she

Dr. Grahovac; Dr. Ruane; my oncologist, Dr. Vincent Reyes; and my radiation

would need surgery and radiation therapy. “I was incredibly scared, but

oncologist Dr. Robert Werner. I had tremendous support from my

after I saw Dr. Grahovac, she calmed my fears, because we discussed

husband Mark and my adult daughters, Maggie and Micaela. Mark

my treatment in detail and made a plan. Dr. Grahovac explained that

went through everything with me. I will be forever grateful to my

every cancer is unique, so every woman needs an individual plan. She

doctors, and to St. Clair, for their excellent care.”

told me what the options were, and we decided together that a lumpectomy

Dr. Ruane says Reyne’s surgeries went well. “There was concern

plus plastic surgery reconstruction was right for me. My St. Clair plastic

that she could have been left with a significant divot after lumpectomy,

surgeon, Dr. (Edward J.) Ruane, agreed that this was a good option.

Dr. Ruane put me at ease because he was meticulous.”

so we did a breast reconstruction and lift for her. Post-op, it went

smoothly, with no complications.” n

Volume XI Issue 4 I HouseCall I 19

BREAST CARE Continued from Page 19

St. Clair Hospital Breast Care Center radiologists offer world-class diagnostic skill, respect and sensitivity A woman’s breast cancer journey often begins with the radiologist, says Andrea M. Sanfilippo, M.D., a board-certified radiologist at

it can set the tone for the woman’s entire experience, right from the start. At the Breast Care Center, a team of radiologists provide

St. Clair Hospital’s Breast Care Center. The radiologist, who reads

this level of excellence every day, to every patient. They are part

and interprets the breast imaging studies (mammograms,

of a strongly-integrated, passionately dedicated multidisciplinary

ultrasound, MRI), informs the woman of the findings and makes

team that shares a vision of personalized, empowering care,

recommendations based on those findings, including referral to

combined with the most advanced diagnostics and treatments.

a breast surgeon if indicated. It is the radiologists, in conjunction with pathologists, who help diagnose breast cancer and initiate

Dr. Sanfilippo has been with the Breast Care Center for seven years and loves her work. “We work closely with the breast

the patient’s treatment and recovery. It’s the diagnosis that women

surgeons, pathologists, oncologists, radiation oncologists, plastic

dread, but when it is delivered with skill, respect and sensitivity,

surgeons, nurses, technologists and other staff.

“

WE UNDERSTAND THAT BREAST CANCER IS SCARY AND OUR APPROACH IS TO MAKE IT LESS SO.

”

ANDREA M. SANFILIPPO, M.D. DIRECTOR OF BREAST IMAGING, ST. CLAIR HOSPITAL

Andrea M. Sanfilippo, M.D.

20 I HouseCall I Volume XI Issue 4

Bibianna A. Klepchick, M.D.

Dr. Sanfilippo agrees that the interaction with patients is the heart of the radiologist’s work. “We interact with patients throughout the day and we’ll see any patient at any time. We answer questions, relieve fears, and explain procedures. When we find an abnormality after a call-back mammogram, we sit down with the patient and tell her, ‘You need to have a biopsy.’ We’re the first to tell her, and it’s very emotional — there is shock, fear and disbelief, but we give her tremendous support. Our nurse stays with the patient the entire time, literally holding her hand before, during and after the biopsy. She also calls the patient with the biopsy result once it has been received from pathology and reviewed by the radiologist.”

Making the diagnosis of breast cancer and steering the patient to the care and treatment she needs is the most rewarding aspect, both physicians agree. “Seeing patients thrive years after diagnosis and treatment makes all our hard work worthwhile. It’s a privilege to have a career that Radiologist Andrea M. Sanfilippo, M.D. reads breast imaging studies.

allows me the opportunity to help so many people,” says Dr. Klepchick.

According to Tara L. Grahovac, M.D., a board-certified breast

Our highly skilled Breast Care Center technologists work hard every day to obtain excellent imaging and provide the best patient experience. The Breast Care Center has the latest equipment, including a new stereotactic biopsy machine, so we’re able to detect small cancers, catch cancer early and get good outcomes. We understand that breast cancer is scary and our approach is to make it less so; we have amazing

surgeon at St. Clair’s Breast Care Center, the key to excellent outcomes for patients with breast cancer is the teamwork among the radiologists, surgeons, oncologists and pathologists. “Here at the St. Clair Breast Care Center, our radiology team leads that charge. We communicate daily to discuss complex cases and develop customized imaging plans for

patients. The care they provide to my patients is truly world class.” n

technology that enables us to make sure we’re not missing anything.

St. Clair has first rate breast care services.”

Bibianna A. Klepchick, M.D., a board-certified radiologist who was inspired by her father, Fernando L. Arevalo, M.D., a retired radiologist, describes her daily work as challenging and fulfilling. The Breast Care Center has a team of six radiologists. “Two radiologists work at the Breast Care Center each day and there are two alternating rotations,” Dr. Klepchick says. “The ‘diagnostic’ radiologist works up patients who present with a breast complaint or who have been recalled for an abnormality detected on screening mammography.

“The ‘procedure’ radiologist performs all of the procedures, including biopsies (stereotactic, ultrasound-guided or MRI-guided) and pre-surgical radioactive seed localizations. Both radiologists also read screening mammograms and breast MRIs throughout the day. So between reading lots of cases, doing procedures and seeing patients, we’re very busy.”

The idea that radiologists sit alone in a darkened room, staring at a

Radiologist Bibianna A. Klepchick, M.D. chats with patient Diane Welsh of Bethel Park at the St. Clair Hospital Breast Care Center.

computer and never interacting with patients, is a misconception, says Dr. Klepchick. “Radiology can involve a great deal of patient contact and this is especially true in breast imaging, which is why so many radiologists choose the subspecialty. We have the best of both worlds — lots of

The St. Clair Hospital Breast Care Center offers two locations: St. Clair Hospital Outpatient Center–Village Square, 2000 Oxford Drive, Suite 301, Bethel Park; and St. Clair Hospital Outpatient Center–Peters Township,

interesting technology, procedures and images, mixed with very

3928 Washington Road, Suite 100, McMurray. To schedule an appointment

rewarding clinical work.”

at either location, please call 412.942.7800.

Volume XI Issue 4 I HouseCall I 21

DONOR SPOTLIGHT

___ WHY I ___

GIVE Eunice Nasri – A Personal Legacy of Giving

W

hen Eunice Nasri first walked through the doors of St. Clair Hospital as a young

“I want to help make sure that St. Clair always stays

nurse in 1966, she knew right away that

here, and remains an independent hospital.”

she was home. She began her St. Clair career as a staff

One of Eunice’s strongest incentives for donating to

nurse; but her outstanding abilities led to a series of

St. Clair has been her own experience as a patient, plus

promotions, and eventually she was appointed Director

witnessing the care her late husband William received

of Nursing, a prestigious and demanding role that

when he was ill. “The care was excellent and everyone

called for leadership, pragmatism and a firm commit-

received the same high quality of care. I saw firsthand

ment to the ideals of the nursing profession. As Director

how the Hospital’s growth was benefitting people.”

of Nursing, Eunice guided St. Clair’s nursing staff in the

Eunice is especially excited to be able to support

delivery of the highest quality professional care and

the construction of the Dunlap Family Outpatient

provided a work environment in which they could grow,

Center, which is scheduled to open in February 2021.

learn and excel.

“St. Clair benefits the community in so many ways.

“I absolutely loved my work at St. Clair,” she says.

It provides access to excellent health care, and this new

“I was happy to go to work. The nurses were held in high

facility will make that access even easier. The new

regard. St. Clair was a patient-oriented hospital, and it

outpatient facility is absolutely important for the many

still is. As Director of Nursing, I gave a lot to St. Clair,

outpatient procedures and tests that are performed

but St. Clair was very good to me. The administrators

today. It will provide stability and sustainability for years

treated me with respect, always, and empowered me

to come.”

to solve problems and take the extra step. They gave

For Eunice, there are personal benefits as well.

me many opportunities to learn and I did the same with

“I live in this community; this is my hospital. When you

the nurses, empowering them to take the initiative and

live here, donating to support St. Clair is even more

keep learning.”

important — you can be a benefactor, but you are also

Eunice, 87, of Green Tree, retired in 1998. She maintains a full and fulfilling life with her family (two

a beneficiary.”

“When I donate, I am helping to make sure that

children and six grandchildren) and friends, and she is

St. Clair will always be there, for me, my family and all

involved in many church volunteer activities; but she is

the families of the community. Giving is so important.

still providing care for the patients at St. Clair, just in a different way: as a donor. This is important to her, she

22 I HouseCall I Volume XI Issue 4

says, because St. Clair is essential to the community.

It saves lives, because it helps the Hospital to serve

patients better.” n

GROUNDBREAKING

PROGRESS Help us continue to build on our commitment to the community At St. Clair Hospital, we are committed to providing excellent health care and an exceptional patient experience. As medicine continues to evolve, we too are growing with it. Our Dunlap Family Outpatient Center — scheduled to be completed in early 2021 — is the Hospital’s largest expansion project in 40 years and a response to 130 percent growth in outpatient volume.

As we enter the final stretch of our Groundbreaking Growth campaign, we urge you to join the thousands of community members who are supporting our new outpatient center.

Please consider using the enclosed envelope to make a donation to help ensure St. Clair Hospital remains a leader in health care. Every gift helps us better serve the needs of our community, now, and for generations to come.

THE NEW SIX-STORY, 280,000 SQ. FT. OUTPATIENT CENTER WILL OFFER: • Outpatient surgery with 10 operating rooms • 51 pre- & post-surgical rooms • Laboratory • Medical imaging • Cardiodiagnostics • Physical & occupational therapy • Infusion center

SAVE

• Endoscopy (GI) suite

ST. CLAIR HOSPITAL

SAVE THE DATE FRIDAY, JULY 17, 2020 ST. CLAIR COUNTRY CLUB, UPPER ST. CLAIR

Summer Swing is St. Clair Hospital’s largest annual fundraiser.

For information on tickets or sponsorships, please call 412.942.2465 or email schfoundation@stclair.org. All proceeds support the continued growth of the Hospital.

Volume XI Issue 4 I HouseCall I 23

COMMUNITY OUTREACH

Hidden in Plain Sight:

A Novel and Interactive Approach to Substance Abuse Prevention and Education

T

parents will get to spend five minutes in the trailer to look for evidence of drugs, alcohol

of the trailer that shows the teen bedroom

perfectly innocuous objects. But look a little

and vaping, and write down what they find.

and the Hidden in Plain Sight logo. The

closer. There is something disturbing.

After all the parents have searched the

Hospital also sponsored the printing of tip

trailer, a Mt. Lebanon police officer will point

sheets created by Outreach Teen & Family

he inside of the trailer looks like a typical teenager’s bedroom, with a desk, computer, guitar, and other

What looks like lip gloss is actually a tiny

During the presentation, small groups of

you have to have that hard conversation.”

St. Clair paid for illustrating the exterior

container hiding a stash of marijuana. That

out any signs they may have overlooked,

Services. PNC Charitable Trust awarded a

little rubber bouncy ball has a slit that

such as a secret compartment in a pair of

grant for the trailer.

opens into a pouch of more drugs. Instead

shoes. Then counselors from Outreach will

The tip sheet advises parents who discover

of UV protection, that bottle of sunscreen

offer tips for parents on talking to their kids

drugs and alcohol not to panic, but to clearly

offers cover for kids sneaking alcohol into

about drugs, alcohol and vaping.

their rooms.

The traveling exhibit is called Hidden in Plain Sight, a collaboration between St. Clair Hospital, Mt. Lebanon Police Department and Outreach Teen & Family Services. The program is a way to educate parents, guardians and

St. Clair Hospital internal medicine

Youth who believe their parents will be upset by illegal drugs or drinking are 43 percent less likely to do it.

other adults on the detection of

state their concerns to their children. Youth who believe their parents will be upset by

physician Karl E. Bushman, M.D.,

illegal drugs or drinking are 43 percent less

who serves on the Community

likely to do it. Outreach counselors also

Benefit Committee of the St. Clair

advise parents to have open and frequent

Hospital Board of Directors, said

discussions with their children about what

the Hospital supports the program

is going on in their lives.

to further its goal of preventing

Parents also learn about possible

drug and alcohol abuse. As

warning signs of drug and alcohol use —

a physician, he has seen the

declining grades, abrupt changes in friend

drugs, alcohol and vaping, and how to

devastation caused by fatal overdoses and

groups, new eating and sleeping patterns

broach the subject with their children.

drug addiction. “Drug use can tear a family

and others.

The Mt. Lebanon Police Department,

apart,” he said. “The idea here is prevention

which owns the trailer, takes it on the road

and early intervention, so young people don’t

so parents and teachers can learn to

get deeply into addiction and opioid use.”

recognize new forms of drugs that might be hiding right under their noses.

24 I HouseCall I Volume XI Issue 4

“Will your kids get mad at you? Yes, they might,” Dr. Bushman said. “But sometimes

“This is not a gotcha thing,” said Mary D. Birks, executive director of Outreach Teen & Family Services. “It is an opportunity for parents to see what is out there and how they deal with it in the best interests of their

family. Being an informed parent, you are

— or about 3 million— reported vaping in 2018,

from vaping were most likely caused by tissue

coming from a position of knowledge. You are

almost double the rate of the previous year.

damage from noxious chemical fumes, not

less likely to lose your cool, and instead have a conversation with your kids.”

Mt. Lebanon Police Chief Aaron Lauth said

Encouraging parents to talk to their kids

oil accumulation. The researchers studied

about the still-emerging health risks of

the lung biopsies of 17 patients believed to

vaping is another aim of the Hidden in Plain

have had lung injury from vaping.

underage drug arrests have not spiked in

Sight program. “If you showed a kid a cigarette,

recent years. If anything, there are hints of

they would wrinkle up their nose,” Ms. Birks

for the Mt. Lebanon PTA and has done

improvement, with teen drug arrests going

said. Yet they view candy-flavored vape

presentations for other groups of adults in

from 22 in 2017 to 15 in 2018 and five through

products as innocuous.

the community. The trailer will also travel to

September in 2019. Underage drinking

Mayo Clinic, which has a clinical

arrests have gone down, too, from 13 in 2017

collaboration with St. Clair, released a

to four in 2018.

study last fall that showed lung injuries

Hidden in Plain Sight had a soft opening

surrounding communities in the South Hills.

Parents have been very receptive to date,

according to Chief Lauth. n

But what has changed is the form of drugs teenagers are using. Chief Lauth got the idea for the trailer after talking to police departments in other states that have instituted similar programs with a mock bedroom.

Many parents think of marijuana as a leafy substance with a distinctive odor. But a teenager today may be more inclined to use an extract or concentrate in an e-cigarette or vape pen. “There is a new way of doing drugs,” he said. It comes as a surprise when parents discover that what looks like a USB stick next to their child’s bed is in fact a vape pen.

Chief Lauth said it is easy for teens to find clever ways to hide drugs and alcohol, thanks to the internet. “We went on the internet and bought all this stuff without age verification.

Any kid who has access to his mom and dad’s credit card and access to the internet can buy it and hide drugs.”

The rise in vaping among teens, and the recent spate of illnesses and deaths, is another cause for concern. The Centers for Disease Control and Prevention reported that more than 20 percent of high school students

Posing in front of the Hidden in Plain Sight trailer are, left to right, Tom Wright; G. Alan Yeasted, M.D.; Dan Long; Laura Friedman; Joseph B. Smith; Karl Bushman, M.D.; Mary D. Birks; and Aaron Lauth.

Volume XI Issue 4 I HouseCall I 25

ASK THE DOCTOR

Ask the Doctor STEPHEN F. WAWROSE, M.D.

Q A

My sinuses have been bothering me.

Should I see a specialist?

Almost everyone at one time or another has experienced problems with their sinuses. In fact, one out of every eight adults is affected by sinusitis every year. Sinus disease is a common problem that can be treated successfully in a number of ways.

Symptoms will vary in severity, but many sinus sufferers will have most of the following symptoms at one time or another: 1. nasal stuffiness, such as difficulty breathing through the nose during the day or only at night; 2. facial pain or pressure, headaches in the forehead, below or behind the eyes; 3. nasal discharge, thick mucous that is persistent or intermittent, or an odor from the nose and sinus areas; 4. unexplained fever or chills or night sweats; and 5. frequent, recurrent sneezing, accompanied by watery discharge.

Symptoms that resolve within two weeks are likely to be caused by a viral upper respiratory illness. “Colds� can be treated with over the counter medications (OTC)

Stephen F. Wawrose, M.D.

and nasal rinses. Your primary care physician can evaluate symptoms lasting longer than two weeks. He or she might recommend OTC medications in combination with antibiotics, steroid sprays, oral steroids, or montelukast (better known as the brand name Singulair).

Referral to a specialist can occur at any time when symptoms are persistent, severe or not responding to treatment. Some patients will seek out a specialist without a referral if they have ongoing severe or troublesome symptoms that are not getting better with medication.

Continued on Page 27

STEPHEN F. WAWROSE, M.D. Dr. Wawrose specializes in otolaryngology. He earned his medical degree at Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, and completed residencies in otolaryngology and general surgery at University of California, San Francisco. Dr. Wawrose previously served as Chief, Otolaryngology, at the 375th Medical Group at Scott Air Force Base, Illinois. He is board-certified by the American Board of Otolaryngology. Dr. Wawrose practices with South Hills E.N.T. Association.

To contact Dr. Wawrose, please call 412.831.7570.

26 I HouseCall I Volume XI Issue 4

Continued from Page 26

Sinusitis Symptoms Sinusitus, commonly known as a sinus infection, occurs when mucus buildup causes inflammation.

It can be triggered by a virus, like the common cold, allergies, asthma, or bacteria. If any of these symptoms linger you should seek treatment.

Headaches or facial pain

Frequent sneezing

Fever

Nasal stuffiness and discharge

Chills

Fatigue

Source: Stephen F. Wawrose, M.D.

An ear, nose and throat (ENT) specialist (also known as

the nose and sinuses and nasal polyps can block the sinus

an otolaryngologist) will make a complete assessment of your

drainage ports. Nasal polyps are non-cancerous growths

problem by asking about your symptoms, including factors

in the sinus areas that expand slowly, blocking both nasal

that have triggered the problem and the length of time the

breathing and sinus drainage.

problem has been present.

This is followed by a focused exam of the nose and sinuses, including placing a thin fiber optic scope into the

Surgery may be recommended for patients with multiple infections that do not respond to medication, or for symptoms lasting longer than three months. Sinus surgery

nose, if needed, to evaluate for a troublesome blockage

is an outpatient, minimally invasive procedure using a variety

of the nose or sinus drainage areas. In addition, evaluation

of techniques. A tiny telescope is placed into the nose, and

with allergy testing, culture of nasal discharge, and a CT

small instruments and surgical balloons open the sinuses.

(computed tomography) scan can be helpful to identify the

This improves breathing and prevents future sinus infections.

cause of the problem. Treatment is tailored to each patient’s

Most people can expect to get back to work and full activity

condition.

within one week of surgery.

Allergies are a reaction to environmental factors (pollen, dust, pets, mold, and irritants/pollution) that causes localized

A new treatment for severe recurrent polyps that do not improve with surgery and oral medications is available

swelling in the nose and sinuses. This can lead to decreased

as an injection taken twice a month. Medication like this is

ability to breathe through the nose, decreased sense of smell and

costly and requires special insurance approval.

increased pressure, pain or infection in the sinus areas. Allergy

In summary, specialty consultation with an ENT is

desensitization injections can be helpful in treating severe

recommended when symptoms of sinusitis are recurrent

allergic symptoms that respond poorly to medications alone.

after antibiotic treatment or persistent for greater than

Recurrent sinus infections are caused when sinus drainage

three months. n

is blocked. Allergic reactions, viral infections, unusual shape of

Volume XI Issue 4 I HouseCall I 27

1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org

> To find a doctor, please visit stclair.org.

General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400

POWERING UP!

A

new Central Utility Building (pictured top and inset) located at the rear of St. Clair Hospital is complete.

It modernizes the infrastructure for the entire Hospital campus, including the new Dunlap Family Outpatient Center (pictured at left) which is being constructed adjacent to the Hospital. St. Clair officials recently conducted a beam-signing ceremony to mark the final steel beam being lifted into place at the six-story, 280,000 square foot building. The Center is slated to open in February 2021.

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.

@StClairHospital