St. Clair Hospital HouseCall Vol XII Issue 1

VOLUME XII ISSUE 1

ON THE FOREFRONT OF

CRITICAL

CARE MEDICINE See Page 2

CRITICAL CARE MEDICINE

2 I HouseCall I Volume XII Issue 1

The Intensivists

ON THE FOREFRONT OF CRITICAL CARE When Baldwin Township resident Scott Marshall became deathly ill (please see related story, Page 6), he was rushed to St. Clair, where he received life-saving care in the Emergency Room (ER) and the Intensive Care Unit (ICU). Scott was fortunate: his condition (sepsis) upon admission was grave, but he was in the right place. St. Clair has every resource for the stabilization and care of the critically ill, and every one of those resources was drawn upon to save Scott’s life.

S

t. Clair, says Gregory J. Fino, M.D., Chief of Critical Care

Physicians who specialize in Critical Care are also known as

Medicine at St. Clair, is a tertiary-level hospital, capable

Intensivists. Intensivists are full-time ICU physicians who are

of caring for very sick patients like Scott. “At St. Clair,

trained and certified in Critical Care Medicine. According to the

we have the capability of providing critical care to our

Society for Critical Care Medicine, hospitals that have full-time

region, and we have been doing so at this level for years. Our

intensivists have better patient outcomes and fewer complications.

critical care services match the pace and intensity of those in

At St. Clair, there are seven intensivists who provide 24/7 in-house

larger medical centers.”

coverage to the ICU: Dr. Fino; Maxim V. Bocharov, M.D.; Kevin

Critical Care is for high-acuity patients who have

P. Kane, M.D.; Lauren Rossman, D.O.; Laurie A. Kilkenny, M.D.;

life-threatening conditions and are often unstable; many ICU

Andrew Perez, IV, M.D.; and Patrick G. Reilly, M.D. The Critical

patients require resuscitation and life support, including

Care Department is continuing to grow and expand; Corey

ventilators. Acute cardiac and respiratory problems are the most

Bollinger, M.D., an intensivist currently at George Washington

common diagnoses in the ICU, along with stroke, sepsis, heart

University Hospital in Washington, D.C., will join the staff later

failure, gastrointestinal bleeding, cardiac arrhythmias, and organ

this summer.

failure. These patients have extreme needs: they require highly

“In 2003, we began 24-hour in-house coverage at St. Clair

specialized care and constant attention from doctors, nurses,

and we were one of the first hospitals to have this,” Dr. Fino says.

therapists and other clinicians who have advanced training and

“We are never one minute without intensivist coverage onsite.

skills in monitoring and managing the very complex needs

The intensivists lead our multidisciplinary team, which includes

of these patients.

critical care RNs with extensive experience, respiratory therapists, Continued on Page 4

About The Cover: Gregory J. Fino, M.D., Chief of Critical Care Medicine at St. Clair, rounds on patients in the Intensive Care Unit.

Volume XII Issue 1 I HouseCall I 3

CRITICAL CARE MEDICINE Continued from Page 3

physical and occupational therapists, radiology technicians,

We physicians are all trained in bedside ultrasonography and

pharmacists, dietitians, and CNAs who help the nurses and are

echocardiography which has been shown over the last decade to

essential. In the critical care areas, there is a 1:2 nurse-to-patient

be an invaluable tool in the diagnosis and treatment of patients.”

ratio all of the time. However, some patients, the very sickest ones,

In 1954, when St. Clair Hospital opened its doors, it was the first

require 1:1 care. We also frequently call upon specialists in

hospital in the region to have piped-in oxygen. This major advance

anesthesia, internal medicine, general surgery, cardiology,

obviated the need for the large, awkward, heavy metal cylinders

cardiovascular surgery, neurology, nephrology and other

that had to be wheeled to the bedside and frequently replaced.

specialties as needed. St. Clair provides a full spectrum of

This was state-of-the-art acute care in the 1950s, before the

specialty services and we rely on these physicians for their

development of critical care medicine. Thirteen years later, in 1967,

experience and expertise.”

critical care services began at St. Clair with an ICU and a CICU —

At St. Clair, critical care medicine is not confined to a single

coronary ICU — the precursor of the cardiac care unit. The 1990s

unit. “Critical care encompasses a full range of services: the ICU;

brought open heart surgery to St. Clair, and the establishment of

the coronary care unit (CCU) for patients who have had angioplasty

the Hospital as a cardiac care center. In 2003, 24/7 coverage by

and stenting; the cardiovascular surgery unit (CVSU), where

physician intensivists was initiated, and the ICU was expanded.

patients are admitted after open heart surgery; and the ER,”

The ICU of the 21st century is a complex, high-tech

Dr. Fino explains. “St. Clair has an ER that is known throughout

environment that can be intimidating to those who are unfamiliar

the region for its exceptional quality and high volume of patients.

with it. Brightly lit and buzzing with activity, it is populated by scrub

The ICU has an excellent relationship with the ER; many patients

suited professionals who weave purposefully, among each other,

come to the ICU through the ER. For instance, the ER and ICU have

connecting with colleagues in snippets of jargon-laced dialogue

developed a very aggressive team approach to sepsis among other

while alarms beep and buzz in the background. Sophisticated

diseases. We are often called to the ER and we immediately go and

technological devices abound: infusion pumps, monitors,

assist with care whenever necessary. The intensivist physicians

ventilators, crash carts, dialysis machines and much more, with

also have a consultative role throughout the Hospital; if we are

an intricate assortment of cables, lines and catheters that tether

needed elsewhere, we’re there.”

the patient to the devices. With so much activity, technology and

An example of how critical care services are extended throughout the Hospital can be found in St. Clair’s Nurse Intensivist program. “ICU trained nurses are available to help manage

personnel, the uninitiated can almost miss the patient, lying sedated in the bed.

But the patient is never obscured. The patient is the point,

emergencies on the floors through our rapid response program,”

and the critical care team at St. Clair never blinks. The fluctuating

Dr. Fino says. “They don’t take a patient assignment so they are

condition of the patient demands constant fine-tuning and clinical

free to respond immediately (as part of the Rapid Response Team)

decision-making: increments and decrements, minute to minute,

when there is an airway problem, or a cardiac or respiratory arrest

in oxygen levels, ventilator settings, medication doses and infusion

on one of the floors. A respiratory therapist, hospitalist physician

rates. The nurses constantly monitor the patient’s vital signs

and ICU nurse all respond to these events.

and other parameters, maintain the life support systems, titrate

“Every day, we hold multidisciplinary rounds. In attendance

infusions, administer multiple medications and maintain access

are the ICU physician, the charge nurse, pharmacist and dietitian.

to the blood vessels. They provide pain relief and comfort care,

4 I HouseCall I Volume XII Issue 1

always mindful of the risk of complications such as infection.

to be here and do this work. We work toward the best possible

In constant attendance are the intensivists, directing and

outcomes for all critically ill patients. We offer emotional support

coordinating the care, and the therapists: respiratory therapists

and education to the family.”

who manage the ventilators, making precise, minute adjustments,

For the patient and family, the dedication, expertise and caring

and the physical therapists whose treatments prevent long term

of the entire intensivist team is unforgettable. “The doctors and staff

complications. They are an exemplary team: an exceptional group

of the ICU were taking care of all of us — me, my wife and my kids,”

of highly skilled and deeply engaged professionals who provide

says Scott Marshall, the sepsis patient from Baldwin Township.

intensely attentive care for extremely ill, vulnerable patients using

“To the staff of the ICU, we were all

state-of-the-art technology, and are always cognizant of the human

the patient. Every day, I thank

needs of the patient. The ICU technology is counterbalanced by

God for St. Clair Hospital and

the deep compassion and humanity of the staff.

its ICU.” n

“This is what we do,” says Dr. Fino. “It’s a choice we’ve made

“

OUR CRITICAL CARE SERVICES MATCH THE PACE

AND INTENSITY OF THOSE IN LARGER MEDICAL CENTERS.

”

GREGORY J. FINO, M.D., CHIEF OF CRITICAL CARE MEDICINE, ST. CLAIR

GREGORY J. FINO, M.D. Dr. Fino specializes in pulmonary diseases and critical care medicine. He earned his medical degree at the University of Pittsburgh School of Medicine, where he also completed a residency and fellowship. Dr. Fino is board-certified by the American Board of Internal Medicine, including pulmonary disease. He practices with St. Clair Medical Services.

To contact Dr. Fino, please call 412.942.2025.

Gregory J. Fino, M.D.

Volume XII Issue 1 I HouseCall I 5

CRITICAL CARE MEDICINE Continued from Page 5

SCOTT MARSHALL: PATIENT PROFILE

Family matters A human voice is like a fingerprint; no two are exactly alike. Voices are so distinct that we can immediately identify others by voice alone. Medical professionals who care for unconscious patients have long believed that these patients can hear sounds in the room, and so they often talk to them while providing care, and encourage families to do the same.

Recent research tells us that hearing a familiar voice can actually help a comatose patient awaken and even lead to a faster recovery.

When Scott Marshall, 68, was in the Intensive Care Unit (ICU) at St. Clair, fighting for his life as sepsis, a life-threatening complication of an infection, ravaged his body, he was incapable of responding to his environment.

Critically ill, sedated, and in shock, he had no perception of his situation.

But as his condition began to stabilize and improve, he became vaguely aware. He had no idea of where he was or what had happened to him; at times he wondered if he was dead or alive. In that state, Scott longed for one thing: to hear the voice of his beloved wife, Pam. “I needed to hear Pam’s voice,” he recalls. “I knew that if I heard her, I was alive, and if she was here, then I was going to be okay. All I wanted was to hear her voice.”

“

I feel indebted to St. Clair and the ICU staff; I would have died without them.

SCOTT MARSHALL, PATIENT

Scott Marshall

6 I HouseCall I Volume XII Issue 1

”

The illness that nearly took Scott’s life had a mild beginning.

A former sales executive, Scott lives in Baldwin Township with Pam,

symptoms and will have them for a few days.”

The ER experience was emotional and frightening for Pam, but

a retired registered nurse, and enjoys the simple daily routines of life

she found enormous comfort in the care and support of the staff.

in retirement: rising early, making coffee, watching the news and

“I’m a nurse and I had worked at St. Clair for years; it’s my professional

catching up with the lives of their three children and four grandchildren.

home. I know some of the ER staff. Their competence and behavior

“I wasn’t very sick,” Scott recalls about the day his life changed.

calmed me. Even though I understood the meaning of the bloodwork,

“Pam, who was still working when this incident occurred, was at

I was there as a wife, not a colleague, and I wanted them to explain to

St. Clair and I was home. It was a normal morning. But in the afternoon,

me what was happening. They understood that. Dr. Fino came to the

I suddenly felt very tired. I wanted to take a nap which is unusual.

ER and spoke to me frankly. He said that Scott was very, very sick;

Things went downhill quickly — I became dizzy and weak, like I was

the bloodwork revealed that he had sepsis. He said they would do

going to pass out, and I began having trouble speaking. I thought

everything possible, but he wasn’t sure Scott would survive.

I was having a stroke. I called Pam at work and she called 911.

I appreciated his honesty.”

The paramedics found me on the floor of the garage. I have no memory of anything after that.”

Pam’s memories, however, are clear and strong. “Scott never calls me at work. I happened to see the caller ID, and I answered because

“All of the staff in the ER made me feel confident that Scott was in good hands; they were the utmost professionals. I believed that if Scott had a chance to live, these people were going to give it to him.”

In the ICU, Scott was a challenging patient for Dr. Fino, his Critical

it was him. All I could hear was him struggling to breathe and trying

Care Medicine colleagues Maxim Bocharov, M.D. and Kevin Kane, M.D.,

to say, ‘Help me.’ I knew something was terribly wrong. I left work and

and Infectious Disease specialists Jeffrey S. Burket, M.D., and Amanda

when I got home, the ambulance was there and I could see that Scott

Michael, D.O. With the critical care team in constant attendance, they

was very sick. That morning, when I left for work, he seemed fine; he

gave him fluids and medications to raise his blood pressure

waved goodbye to me. He didn’t say anything about feeling sick.”

and maintain circulation. They tweaked the ventilator settings and

Upon arrival at St. Clair’s Emergency Room (ER), Scott was in shock

obtained frequent blood gases to monitor the effects. They continued

and respiratory failure. Chest x-rays and bloodwork indicated he had

to administer antibiotics, and they kept Scott sedated in order to

pneumonia. The ER physicians, including ER Medical Director Jason

facilitate management of the ventilator.

M. Biggs, M.D., intubated Scott, placing a breathing tube into his

“For the first few days Scott was very unstable,” Dr. Fino recalls.

airway and giving him extra oxygen. Suspecting that Scott had

“We gave him nutrition through a nasogastric feeding tube and we

developed sepsis, Dr. Biggs summoned Gregory J. Fino, M.D., a

provided vigorous physical therapy. PT in the ICU is important and

pulmonologist and Critical Care Intensivist who is Chief of Critical

improves survival: caring for a patient like Scott in the ICU is not only

Care Medicine at St. Clair, to the ER.

about treating the symptoms and the condition but also preventing

“Scott was a very sick man, in critical condition. He had

complications of treatment. We had many talks with his wife; we had

overwhelming pneumonia due to pneumococcus,” Dr. Fino says.

to let her know how bad this was. The patient is the one in the ICU, but

“This led to Acute Respiratory Distress Syndrome (ARDS), shock and

the family is also experiencing the trauma. We support the family, too.”

multiple organ failure; in addition to severe respiratory failure, he went

The Marshall children — daughters Erin and Christine, and son

into kidney failure and moderate liver failure. He was hyponatremic,

Scott — came to the Hospital every day, as did Scott and Pam’s niece

meaning his blood sodium levels were abnormally low. The chance

Kelly Kyle, R.N., who lives with them and works on St. Clair’s Unit 6E.

of surviving such bad pneumonia depends on the early initiation of

The children brought their Dad’s favorite Frank Sinatra tapes to play

treatment: antibiotics, ventilation, oxygen and fluids. Scott was given

for him. The children were included when Dr. Fino and his colleagues

antibiotics within three hours, which is what we aim for. Scott’s illness

met with Pam. “The ICU staff took time and shared details about the

evolved quickly and was atypical, as he had only had slight shortness

ventilator,” Pam says. “They gave us tremendous emotional support.”

of breath the day before. Most people with pneumonia will have more

Continued on Page 8

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CRITICAL CARE MEDICINE Continued from Page 7

Scott Marshall with wife, Pam.

Scott spent a total of 24 days in the ICU, 14 of them on a

indebted to St. Clair and the ICU doctors and staff; I would

ventilator. “Scott was cared for by our entire team,” Dr. Fino

have died without them. I’m grateful for the support I had from

says. “He was in the ICU the entire time; he never went to the

many people, but mostly from Pam. When I was beginning to

stepdown unit. He developed what we call ICU myopathy —

wake up, hers was the first voice I heard — and all I wanted

muscle mass loss due to illness and inactivity — and was too

was to keep hearing her voice. Pam is more than my wife;

weak to even swallow. After discharge, we transferred him to a

she is my everything.”

high-level rehab facility because he needed ongoing PT and had the potential for long term pulmonary problems.”

That comes as no surprise to Dr. Fino. “Pam’s voice became a lifeline for Scott,” he says. “We don’t know if a patient in a

When Scott finally woke up, he was in the rehab facility,

coma can hear, so we talk to them and encourage the family to

with no recollection of what had brought him there. “All I know

do so. Critical care is more than clinical management; there is

is what Pam told me. I was very weak, and had to learn to walk

a spiritual aspect. Scott’s desire to live and his family’s support

again. I went to PT every day, and did more PT on my own. It took

were as essential to his recovery as the ICU’s medical care.”

longer than I expected, but I was deeply motivated, and my goal was simple: home. My family needed me.”

Scott made it home. Today, he says he is 100 percent

Pam recently telephoned her children and told them to pray for everyone at St. Clair: “An experience like this gives you a new appreciation for life and for all the blessings you have.

recovered and feels great. “I travel, I drive, I do everything;

St. Clair Hospital gave me back my husband of 47 years.

Pam and I watch our grandchildren four days a week. I feel

The ICU has a great reputation and they lived up to it.” n

8 I HouseCall I Volume XII Issue 1

e p o H g n i r i Insp

Schoolgirl writes touching letters of encouragement to patients struggling during COVID-19 pandemic Near the end of his hospitalization at St. Clair,

prism reflecting sunlight in every direction, she

The letter writing project did not come as a

Jim Kauffman was transferred to Unit 6F, Medical

has many facets — creative talents, interests and

surprise to her mother. “Lexie came up with this

Surgical Telemetry, to continue his recovery. (Please

personal qualities — that make her a special person.

idea of personal letters to COVID-19 patients. She

see related story, Page 10.) Barely able to hold a

She loves math but loves the arts equally: she enjoys

creates them on a Chromebook and gives them to

tablet, he was physically weak and emotionally frail.

sketching, designing things, playing the trumpet and

me; I make rounds on my unit every day and when

Jim knew he was fortunate to be alive and he was

writing stories. Like Jim Kauffman, she’s an animal

I encounter a patient who seems especially sad or

grateful, but he was alone, unable to see his wife,

lover, with a cat, Toby, and two dogs, Ryker and

struggling, I give them one. The patients are very

Wendy, or his friends. The separation from Wendy,

Tessa. She loves photography and is considering

appreciative of the letters. I had been talking with

and the effort to cope with his long and terrible

making that her career.

Jim Kauffman and knew that he really missed his wife;

ordeal with COVID-19, were hard to bear.

Lexie recently completed fifth grade in

he had been in the ICU and in the hospital for several

One day, an unexpected gift arrived when Ashley

Washington County, where she and her classmates

Kimmell, R.N., MSN, nurse manager on Unit 6F,

had to make the transition to distance learning

Each letter is unique. “I get ideas,” Lexie says.

handed him a letter, simply saying, “This is for you.”

during the pandemic. With extra time at home, Lexie

“I might tell them about a hobby, or about my pets.

It was a letter reaching out to him with a message of

created her letter writing campaign in early April,

I give each one a special design and use different

hope and encouragement. Written in large letters in

inspired by her mother’s work as a nurse and her

colors of ink; I make sketches on them.”

purple ink, the letter read: “Hey hey there! My name

stepfather’s work as a policeman. Lexie says that she

Being in the hospital is always hard, Lexie

is Lexie! I am 11 years old. Yes, I know about COVID

has a heart like her mother’s. “My mom cares a lot

believes, but COVID-19 has made it much harder

19 but everything is okay! I know you can do this!

about people. If you’re sick, she’ll give you a whole

because of the separation from family. She knows

(Smiley face) You’re strong! Don’t stress at all, your

day to take care of you.”

well the importance of family: she lives in a home filled

doctors are taking very good care of you! Feel better!

Have a good day! (Smiley face) – Lexie Joseph

weeks. I thought a letter would help him.”

At St. Clair, Lexie’s mother Ashley, the nurse

with children, animals, and love. Hers is a blended

manager on Unit 6F, was taking care of people who

family: Mom Ashley and stepfather Garrett; sister

It struck Jim right away that

were recovering from COVID-19, and Lexie thought

Whitnee, 14; stepbrother Matthew, 22; stepsisters

the letter writer was named

about how that must feel for those patients and their

Emily, 17; Megan, 14; and Madeline, 7. “If I was in

Lexie: “That’s the name of

families. “I thought about how it would feel for a

the hospital I would want my family there,” she says.

one of my beloved dogs, a

family with someone in the hospital that they can’t

“You need your family to make you feel safe, but

rescue dog that had been

go and see. I thought about how the patient would

with this virus, you’re alone. I want to make people

abused. That’s a name

feel, all alone, sick and afraid. I decided that my goal

happy when they’re missing their family and other

that means a lot to me. I

was to cheer up their day when they are sad.”

loved ones.”

was very touched by this

Lexie has known quite a lot of sadness in her own

With empathy, creativity and a gift for loving

letter.” He was determined

life. Five years ago, at the age of six, she lost her

kindness, Lexie is doing exactly that, one letter

to tell Lexie how much he

father to cancer. Then her grandmother died, and

at a time, one patient at a time. To Jim Kauffman,

more recently, her uncle. According to her mother,

her thoughtfulness touched him at a vulnerable

appreciated the letter.

Lexie Joseph sparkles.

Lexie’s strength and sensitivity come from her

moment. He has saved and posted the letter on his

It isn’t just her shiny hair,

experiences with loss. “Lexie has known the sadness

refrigerator. He hopes to meet Lexie one day, to

her luminous smile or

of loved ones being in the hospital, and keeping

thank her in person, and, as a lifelong musician with

her upbeat energy;

them company. She knows that being in the hospital

a reggae band, to encourage her to keep practicing

Lexie radiates light

is scary and difficult. She cares about everybody

her trumpet — and writing those letters. n

from within. Like a

and always wants to find ways to make people feel better. She loves to make people smile.”

Lexie Joseph pens a letter of hope to a patient.

Volume XII Issue 1 I HouseCall I 9

CRITICAL CARE MEDICINE Continued from Page 9

“

I had the finest care possible from the most amazing people — the doctors, nurses, therapists, aides and housekeepers. . . . I wish I could remember every single name.

”

JIM KAUFFMAN, PATIENT Jim Kauffman and wife, Wendy.

10 I HouseCall I Volume XII Issue 1

JIM KAUFFMAN: PATIENT PROFILE

It takes a village Jim Kauffman, 62, resides in a Mount Washington neighborhood,

social distancing restrictions had not yet been put into place. A few

but he has a village of his very own. He lives there with his wife,

days after Jim became ill, Wendy developed symptoms: a dry cough,

Wendy, 55, and their two Great Danes, Diesel and Lexie. Many others

aches and pain, loss of taste and smell and a slight fever. She was

— family members, friends, co-workers, neighbors, fellow musicians

fortunate — her symptoms resolved within a few days. But Jim was

— make up the population of Jim’s personal village, and although

getting worse. Wendy was concerned about his breathing: “Jim has

they don’t all know each other, they all know Jim and are linked by

asthma, but he had never been short of breath like this. I tried to

their great love and affection for him. He’s an easy guy to like —

purchase a pulse oximeter on the Internet, but they were sold out.

gregarious, energetic, witty and warm.

Jim’s sister brought us one and when we checked his level, it was

When Jim became ill in March with COVID-19, the villagers circled the wagons around him, and around Wendy, too. They

62 percent. We knew we had to go to the ER.” Wendy’s mother Gail lives in Mt. Lebanon and encouraged Jim

became an army, fighting for a brother who was fighting for his

and Wendy to go to St. Clair. She called the Hospital’s Nurse Triage

life, and their love and support lifted and embraced the Kauffmans

Hotline for COVID-19 and was told Jim needed to come to the ER,

throughout a long, agonizing ordeal. Coupled with brilliant,

right away. Jim recalls watching Wendy pack a bag for him.

painstakingly meticulous care provided by St. Clair Hospital’s health

“That was the last time I saw her, until 19 days later.”

care professionals in the Emergency Room (ER), Intensive Care Unit

A pulse oximeter measures oxygen saturation — the level of

(ICU), and COVID-19 Unit, the effort to save Jim’s life took on grand

oxygen in the bloodstream. A normal reading is 95–100 percent.

proportions. It took a village. And Jim survived COVID-19.

Jim’s 62 percent was dangerously low, a condition known as hypoxia.

It started with a birthday party in early March, an ordinary family

Hypoxia can cause damage to the body’s organs, including the brain.

event to honor the 80th birthday of Wendy’s mother, Gail. Family

Upon arrival in the ER, Jim was placed on oxygen immediately. Chest

members came from out of town to celebrate and everyone had

x-rays revealed that he had severe pneumonia. His condition was

a good time. A week later, Jim, who works for PNC Bank, began

so grave that he was sedated, intubated and rushed to the ICU.

feeling ill. “I felt like I was getting the flu but it got really bad,

Gregory J. Fino, M.D. is the Chief of Critical Care Medicine at

quickly. I developed a fever, loss of appetite, shortness of breath

St. Clair. Dr. Fino guided Jim’s care, from those first critical moments

and exhaustion. My thinking became fuzzy. I got out of breath just

in the ER through his entire hospitalization. “Jim was extremely sick at

climbing the stairs. My fever spiked to 103 for several days. We

admission, with a very abnormal chest x-ray, and he got much sicker.

called our primary care physician (PCP) and spoke to his nurse who

He was placed on mechanical ventilation right away, on high amounts

said we were doing everything right. My fever started coming down,

of oxygen. The ventilator delivers oxygen directly to the lungs by way of

to 101, but my breathing and fatigue were worsening. My PCP saw

a plastic tube called an endotracheal tube — when we say we intubate

me via telemedicine, but I don’t think he realized how drained and

a patient, that’s what we are referring to. The tube is connected to

exhausted I was. I was just so sick.”

the ventilator, which we set to deliver a specific mix of air and oxygen,

The COVID-19 pandemic was still in the beginning stages in the U.S. at that point. There was little information about it, and the

at a specific rate per minute, under pressure, to force open the tiny airways in the lungs and oxygenate the patient.”

Continued on Page 12

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CRITICAL CARE MEDICINE Continued from Page 11

While Jim was in the ICU, Wendy was at home, isolated and

DAY 3:

scared, facing two weeks of quarantine with only her dogs for company.

Wendy Kauffman March 28 2020

She was able to take time off from her position as a business analyst for a health insurance company, with strong support from her employer. “Help began to come from everywhere,” she recalls.

“Due to COVID, there wasn’t much that people could do for me, but they gave me tremendous love and support. People reached out to me — my family, friends and employer. The information from the

Jim has COVID-19. He is still on the ventilator on high amounts of oxygen.

DAY 8:

Hospital kept me going and I kept everyone up to date on social

Wendy Kauffman April 2 2020

media. The response was unbelievable.”

WENDY’S FACEBOOK POST: Wendy Kauffman March 26 2020

Jim is in St. Clair Hospital, in the ICU on a ventilator. They won’t know the test results until Saturday, but they are treating him as if he has COVID-19. He will be on the ventilator for a few days and could be in the hospital a few more days. I’ll keep everyone updated.

LATER THAT DAY: Wendy Kauffman March 26 2020

Jim’s ICU nurse called me. His name is Michael and he is an angel. He gave me a lot of information. Technical details. It made me feel that I knew what was going on. He was warm, kind and helpful. Dr. Kane, one of the ICU doctors, also called me with updates several times. He was great. He volunteered all the information he could.

To ventilate him effectively, Jim was heavily sedated and temporarily paralyzed with medications. The purpose of this was to keep him from “fighting” the ventilator. “Sedation allows the ventilator to do its job. Otherwise, the patient feels like they can’t

Jim is not doing as well as hoped after they stopped the paralyzing drug, so they are putting him in the prone position.

They do this with the sickest of the sick, which is what he is right now. He is on high amounts of oxygen and now another antibiotic.

For days, the ICU team gave Jim aggressive ventilator support, through two modalities: 1) an approach to ventilation known as APRV — airway pressure release ventilation, a form of continuous positive airway pressure with two levels that cycles intermittently to release some of the pressure on the lungs; and 2) proning — a strategy that positions the patient on his stomach, because that allows for improved expansion of the lungs. Proning worked: after 24 hours of prone positioning, Jim’s lung function finally began to improve. In addition to the ventilator management, the ICU team also administered corticosteroids to Jim. DAY 9: Wendy Kauffman April 3 2020

It’s very touch-and-go. They are doing everything that they can for him. Hopefully he is not feeling any of this. His vital signs are all over the place and they are constantly adjusting the ventilator settings to help him. I’m hanging in there; I have my good and bad moments. It’s my birthday. A bittersweet day. I received a lot of love from everyone. Thank you all so much.

breathe and they struggle,” Dr. Fino says. With the patient still and sedated, the ICU doctors, nurses, and respiratory therapists are better able to monitor his status and treat him. With state-of-the-art technology, they constantly track his vital signs, blood gases, fluid and electrolyte balance and the functioning of the heart, kidneys and liver. They administer medications: antibiotics, vasopressors, steroids — and they watch closely to assess the effectiveness of

Eventually, the combination of APRV, proning and steroids made the critical difference, Dr. Fino says. “Those things really turned him around, finally. He spent 13 days on a ventilator and that is a long time. His asthma was a co-morbid factor for him. We were able to extubate Jim on April 7.”

DAY 13:

every intervention. These things must be constantly adjusted and tweaked for a patient as sick and unstable as Jim was. There were complications: Jim’s blood pressure skyrocketed and his blood sugar levels were erratic.

12 I HouseCall I Volume XII Issue 1

Wendy Kauffman April 7 2020

THE BREATHING TUBE IS OUT!!!!!!!!!!

Jim began having physical therapy to restore his muscle

“I don’t think the public realizes how much health care professionals

strength and learn to use a cane and walker. He continued to require

care. We take them for granted and assume they’ll be there when we

supplemental oxygen, delivered by a nasal cannula. He had no

need them. They care about you personally and treat you accordingly.

memory of the ventilator; he needed the nurses to tell him where he

My experience at St. Clair was entirely positive.”

was and why he was there. He had vivid dreams that seemed real

“Wendy and I are blessed to have family and friends. I have a village

to him — a common occurrence in the aftermath of a critical illness

around me and Wendy is the queen. Everyone rose to the occasion and

and medically-induced coma. Gradually, the amount of oxygen was

their support was inspirational. I know I have a long recovery ahead, but

decreased until he had been weaned back to room air. His oxygen

I am a little better each day. I still get out of breath on the stairs but my

saturation normalized and his chest x-ray cleared. He spent another

pulse ox is 95 percent. Not everyone with COVID-19 is as lucky as me.

few days in the Hospital, gaining strength and beginning to eat solid

My advice to people is to stay home and stop fighting. If you need care,

food. Although Wendy was still unable to visit, Jim called her. He

don’t procrastinate. Pay attention to early symptoms. Listen to the

continued to improve, and his spirits rose as his strength slowly

doctors and trust your instincts.”

returned. It was finally time to go home.

Jim’s village continues to rally around him as he recovers. He and Wendy are grateful for the support and care they received from family,

DAY 20:

friends and a team of dedicated and expert caregivers at St. Clair.

Wendy Kauffman April 14 2020

Home sweet home.

Jim is here and doing great. Just want to send out lots of love and thanks to all of you for your prayers, love and support. It has been priceless. This has been a horrendous and scary time, and you have all helped boost my strength and Jim’s. Thank you, thank you, thank you!

Sometimes, it does “take a village,” a phrase that usually refers to raising children but has a broader meaning. It’s really about needing each other, and about how the help and involvement of many is sometimes needed to reach a goal. Jim may have been in isolation as he struggled to survive, but he was never alone. n

Jim looks back on his COVID-19 experience with many emotions, but mostly with gratitude. “This was my first long hospitalization and I had the finest care possible from the most amazing people — the doctors, nurses, therapists, aides and housekeepers. At St. Clair, everyone is kind. When you can’t do things for yourself, you depend on others and that staff never let me lose my dignity. I wish I could remember every single name: Hannah, Clare, Bob, Matt and especially Rachel, the night nurse who was so quiet and effective, like an angel caring for me. Even the people who brought the (meal) trays were wonderful.

Jim Kauffman Volume XII Issue 1 I HouseCall I 13

PHARMACOGENOMICS

Mayo Clinic individualized medicine comes to St. Clair St. Clair Hospital has teamed with Mayo Clinic in a new program that will help St. Clair physicians choose the best possible medication for their patients given each patient’s unique genetic makeup.

St. Clair becomes the first to collaborate with Mayo Clinic in a pharmacogenomics (PGx) program, through the Mayo Clinic Center for Individualized Medicine. ”Pharmacogenomics is a branch of individualized (or

at Mayo Clinic. The test result revealed a genetic change that

‘precision’) medicine, specifically about understanding how

identified the patient as a fast metabolizer of common heartburn

an individual’s genetics can affect their response to various

medications. In other words, the patient’s body was clearing

medications,” says Kaitlin Shotsberger, R.N., MSN, CNL,

the medications too quickly, before they had a chance to work.

Executive Director of Quality and Care Management at St. Clair,

With this information, the boy’s physician team, led by Imad Absah,

and the leader of a multidisciplinary task force that is bringing

M.D., a pediatric gastroenterologist at Mayo Clinic, was able to

this cutting edge program to St. Clair. “And, Mayo has one of

change the patient’s medications, resulting in an improvement in

the world’s leading programs in individualized medicine.

his symptoms. “By utilizing the patient’s pharmacogenomics test

“PGx testing is a powerful new tool that enables doctors

result and genetic profile, we determined the right drug at the

to better understand your unique response to the medications

right dose,” Dr. Absah stated. “The concerns of the patient

you are taking, giving you the greatest possible clinical

and his parents were resolved.”

benefits, while also protecting you from adverse reactions,”

Sarah Nelson, R.Ph., Pharm.D., a clinical pharmacy specialist

says Ms. Shotsberger. “With PGx testing, we will transition

at St. Clair, is the lead pharmacist for the St. Clair PGx program.

from a ‘one size fits all’ traditional approach to prescribing

She completed the Clinical Application in Pharmacogenomics

to a highly individualized one that takes one’s genetic makeup

training at Mayo Clinic, and is certified to interpret PGx testing

into consideration.”

for doctors and patients. “PGx testing begins with a physician

A recent Mayo Clinic case substantiates the advantages

order for bloodwork,” she explains. “A blood sample is taken

of PGx testing for patients. Prior to coming to Mayo Clinic,

at one of St. Clair’s Outpatient Centers, or the Hospital, or at

a 16-year-old boy was seen at several institutions for

a St. Clair Medical Services office, and sent to Mayo Clinic, where

uncontrollable heartburn, with no relief from medications.

an analysis is performed. Next, an extensive genetic report

After an extensive medical workup, PGx testing was performed

specific to the individual patient is issued to the pharmacist,

What is Pharmacogenomics?

Pharmacogenomics is the study of the role of the genome in drug response. Its name reflects its combining of pharmacology and genomics. Pharmacogenomics is a field of research that studies how a person’s genes affect how he or she responds to medications. Its long-term goal is to help doctors select the drugs and doses best suited for each person.

14 I HouseCall I Volume XII Issue 1

Sarah Nelson, R.Ph., Pharm.D.

who reviews the results in

including anti-depressants. “At this point, we do not have

the context of the individual

guidelines for all medications, but the research is ongoing,”

patient’s medication list,

Dr. Nelson says. “More drugs will be added, and as more and

including past medications

more people get PGx testing, we will collect more information.

that may or may not have

PGx testing will continue to evolve. This will be extremely helpful,

worked. My role is to present

especially for those with complex, multiple conditions. Once

and interpret the PGx results

you have been tested, you will have this information forever

to the doctor, and to provide

and you can take it to all of your doctors. It applies to your

additional education to the

current medications and to those that you may take in the

physicians about all the

future. It’s basically your genetic profile.”

components of PGx testing,”

Patients should always tell their doctors if they are not

Dr. Nelson says. “It’s exciting

getting the expected result from a medication, or if they are

to me as a pharmacist to be able to use a patient’s genetics to

experiencing bothersome side effects, Dr. Nelson advises.

understand their body’s response to and its interactions with

“Never make medication changes on your own. Talk to your

medications. It’s a whole new level of knowledge and we are

doctor. Plus, you can request PGx testing now.”

participating in it just as it is emerging. Although PGx testing

Dr. Nelson states that PGx testing is an exceptional

does not tell us everything, it provides the genetic piece that we

opportunity to provide more personalized, precise care. “It’s

did not have in the past. It provides another level of reassurance

a new frontier that emphasizes the uniqueness of the person.

that we will be able to specify the correct medication for you.

In the future, everyone will have a personal medication guide,

A second appointment will then take place with the patient

specific to their genetics, and this will be part of routine

and their physician to review the findings.”

care. That is the ultimate goal. It’s exciting that St. Clair is

Dr. Nelson describes the Personalized Medication Guidance

collaborating with Mayo Clinic to bring this very advanced

as essentially a medication management plan for the patient.

program to our community.” Eric

It provides additional decision-making support that guides a

Matey, R.Ph., Pharm.D., Clinical

physician through the many questions surrounding medication

Pharmacogenomics Pharmacist, at

prescribing: is this the right drug or is there a better alternative?

Mayo Clinic, agrees. “I am happy

Is this dose the most efficacious one for this patient? How safe

to be partnering with St. Clair

is this drug for this patient? Is there a risk of toxicity or side

physicians and pharmacists as they

effects? The decisions about changes in medications are made

develop a pharmacogenomics

mutually by the physician and patient.

program. From my own

In this initial phase, St. Clair’s PGx program is utilizing two

experience, it’s been gratifying

testing panels: one that includes commonly prescribed cardiac

talking to patients who have

medications, blood thinners, gastric reflux medications, and

benefitted from this

pain relievers, and a second panel for psychotropic medications,

testing.”

Continued on Page 16

“

PGX TESTING IS A POWERFUL

NEW TOOL THAT ENABLES DOCTORS TO BETTER UNDERSTAND YOUR UNIQUE RESPONSE TO THE MEDICATIONS YOU ARE TAKING.

”

KAITLIN SHOTSBERGER, R.N., MSN, CNL, ST. CLAIR HOSPITAL Kaitlin Shotsberger, R.N., MSN, CNL Volume XII Issue 1 I HouseCall I 15

PHARMACOGENOMICS Continued from Page 15

Precision Medicine and Pharmacogenomics Every year, physicians across the United States write more than

their functions), and it focuses on how one’s genes affect the

4 million prescriptions for medications. These medications are intended

body’s response to specific medications. PGx recognizes that individual

to treat countless diseases and medical conditions, and most of the

genetic variation is a factor in determining how a medication works in

time, they do exactly that.

the body: your DNA can determine whether or not a particular drug will

When doctors prescribe a medication, they balance two things:

be effective for treatment of your medical condition. It can help physicians

efficacy and toxicity. Efficacy means the ability to produce the desired

determine the most accurate dosage for you, and it can determine

effect, while toxicity is the possibility that the medication may do harm.

whether or not a medication is likely to cause adverse effects. It helps

They also take into consideration factors such as age, body size, gender,

doctors tailor prescriptions more precisely for their patients.

and liver and kidney function, and select the drug that they believe

“PGx is about the body’s unique response to medication; it means

will elicit the best therapeutic response. It’s often a matter of trial and

that your DNA can affect whether or not a drug will be beneficial to you,”

error — of waiting to see how the patient responds, watching for

explains Karl E. Bushman, M.D., an internist with St. Clair Medical Services

adverse reactions and side effects, and possibly adjusting the dose.

and the lead physician on the multidisciplinary team working with Mayo

This process takes time.

Clinic’s Center for Individualized Medicine. (St. Clair is a member of the

It’s the standard approach, based on clinical research, and ultimately,

Mayo Clinic Care Network and, therefore, enjoys a clinical collaboration

many patients with the same condition will get the same medication

with Mayo Clinic.) “For some patients, the standard dose of a medication

and dose. But medical science now tells us that not everyone responds

may not work, or it may cause an adverse reaction, and this can be due

to a medication in the same way.

to your genes. PGx looks specifically at the genes that control liver

There is no one exactly like you. You are one-of-a-kind, and the

enzymes; the liver metabolizes, or breaks down, the medications

singularity that makes you YOU is the basis for precision medicine, an

we take. PGx enables us to look at certain common

emerging medical discipline that uses a person’s own genetic information

medications to determine how your body will

to individualize and guide their treatment with unprecedented accuracy,

metabolize them. This information helps the

optimizing care and outcomes. Precision medicine, sometimes referred to

doctor determine what will work best for

as individualized medicine, is relatively new and is having a tremendous

the individual — the usual dose, a higher

impact on many aspects of medicine, including pharmacology, oncology,

dose, or a lower dose?”

infectious disease and other specialties. That impact is expected to

When a person takes a medication, it

encompass all of medicine one day, and to make it possible to not only

interacts with the body in complex ways. In

diagnose and treat patients with precisely customized care, but to also

order to gain the benefits of the medication,

predict and prevent disease.

the body must absorb and metabolize it,

A subset of precision medicine, pharmacogenomics (PGx) is

deliver the medication to the tissue that

changing the way that doctors prescribe medications. PGx is a blend

needs it in a process called uptake,

of pharmacology, medical science and genomics (the study of genes and

and excrete the drug. DNA can

KARL E. BUSHMAN, M.D., FACP Dr. Bushman earned his medical degree at Albert Einstein College of Medicine, New York City, and completed his residency at University of Pittsburgh-affiliated hospitals. He is board-certified by the American Board of Internal Medicine. He practices with St. Clair Medical Services.

To contact Dr. Bushman, please call 412.942.8500.

Karl E. Bushman, M.D. 16 I HouseCall I Volume XII Issue 1

William’s medications were having adverse effects on his liver. “When you take a lot of medications, you know they’re doing good things for you, but you wonder if they are doing any harm. It’s good to confirm that my medications are safe for me. It gave me peace of mind.”

A list of 100 drugs has been developed for PGx testing and includes blood thinners, medications for high cholesterol, pain medications, antidepressants and other medications used for behavioral health, and more. The testing produces a personal genetic profile for the individual patient that can be shared among all of the patient’s physicians.

“People may think that the availability of PGx testing means that everyone should get tested, but that isn’t necessary,” Dr. Bushman says.

“The testing is complicated. Mostly, PGx testing affirms that you are on the right drug or that you need a modification of the dose. It’s most useful for people taking multiple medications, having adverse effects from a medication or taking medication that we know has genetic influences.

If you and your physician have concerns about how you are responding to a medication, PGx testing can help.”

Carl Hug at his home in Mt. Lebanon.

play a significant role in all of these processes. For example, if your DNA determines that your body has decreased uptake of a drug you are taking, then that drug will not work well for you and may build up in other parts of the body, creating new problems.

That is what happened to Carl Hug, 86, a retired commercial artist who lives in Mt. Lebanon and enjoys doing stained glass work. He had open heart surgery five years ago and takes multiple cardiac medications. “Most of the time, I feel pretty good,” he says. “Dr. Bushman, my PCP, has been keeping me alive with his excellent care. He asked me to participate in the PGx study, so I gave a blood sample and it was sent to Mayo Clinic for testing. After that, I met with him and he had a huge pile of printouts from Mayo Clinic on his desk. We tested all of my medications and found out that one of the drugs I was taking, generic Lipitor, can cause a side effect of muscle aches and pains. I take it at night, and every morning I was waking up with aching arms and shoulders. I attend cardiac rehab at St. Clair and I just assumed I was achy from exercising. But it was the medication.

Based on the testing, Dr. Bushman cut my dose in half. It made a difference: within the month, I had less pain and aching. It was easy to be in the study,

William Cook outside his Mt. Lebanon home.

and it made a difference for me. I think it’s a great idea.”

William Cook, 74, of Mt. Lebanon, is taking multiple medications to

PGx testing is the beginning of precision medicine, says Dr. Bushman.

treat high blood pressure and high cholesterol. “I was on six different

“This is very new, sophisticated science which has not been previously

medications and Dr. Bushman told me that five of them could potentially

available, and we are bringing it to our patients and to the St. Clair

harm my liver,” he says. “He wanted to find out if these drugs were safe

community. Eventually, it will be offered point-of-care; and one day there

for me to keep taking, so he asked me to take the gene test. It was simple;

will be a database so that the information is available to all patients.”

he gave me a prescription for it and they just took a blood sample in the St. Clair Hospital lab.” Fortunately, the PGx test revealed that none of

For more information about PGx testing at St. Clair, please email: mayo.inquiries@stclair.org n

Volume XII Issue 1 I HouseCall I 17

TECHNOLOGICAL INNOVATION

AngioVac A VERSATILE NEW DEVICE BENEFITS P A T I E N T S W I T H A N O N-S U R G I C A L EXTRACTION OF BLOOD CLOTS

A

n alternative way of treating large blood

treatments have some disadvantages. “Thrombolytics

clots in the chest is making it possible for

such as Streptokinase can break up the clot but there

patients to avoid the ordeal of open heart

is a high risk of bleeding and the leftover pieces are not

surgery. At St. Clair, Andy C. Kiser, M.D., FACS, FACC,

removed,” says Dr. Kiser. “These remain in the lung

FCCP, Chief of Cardiac Surgery, uses a sophisticated

and can lead to pulmonary hypertension, a chronic and

device called an AngioVac to safely remove not only

disabling condition which causes shortness of breath

blood clots, but also tumors and infectious material

and loss of energy. When there is an acute event, and

from the heart and blood vessels without major

the blood clot travels from the leg to the lungs or

surgery. The minimally invasive new procedure, called

heart, it can become wedged in a pulmonary artery,

aspiration thrombectomy, is an important advance in

obstructing it, and blocking oxygen from reaching the

the treatment of deep vein thrombosis (DVT), a serious

tissues. It’s like a heart attack — the tissue will die.”

condition in which blood clots form in the deep veins

Dr. Kiser uses the AngioVac to remove the clot,

of the legs and pelvis. A clot can become free and

plus any remaining debris, so that there is minimal risk

travel through the blood vessels to the lungs, where it

of the person developing pulmonary hypertension. “It’s

is known as a pulmonary embolism, a potentially life-

a suction device that pulls material out of the heart and

threatening situation.

blood vessels,” Dr. Kiser explains. “It can remove blood

Established approaches to treatment for DVT

clots, tumors and ‘cardiac vegetation’, which refers

and pulmonary embolism include thrombolytic

to infectious clumps of tissue that can develop in the

medications, which break up clots, but these

heart, usually attached to pacemaker leads.

ANDY C. KISER, M.D., FACS, FACC, FCCP

ANDY C. KISER, M.D., FACS, FACC, FCCP Dr. Kiser earned his 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 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.

18 I HouseCall I Volume XII Issue 1

Diagram of AngioVac system for removal of blood clots

Saline Bag

Filter

Centrifugal Pump Console

AngioVac Circuit Source: www.angiovac.com

Cardiac vegetation is also associated with heart

will be discharged in a day or two, unless there are

infections, IV drug use, dialysis, and use of immuno-

underlying conditions that require monitoring for a

suppressive medication. The AngioVac captures this

bit longer.

debris and keeps it from traveling to the lungs.�

The procedure takes place in an operating room

With the AngioVac procedure, the patient avoids a big operation and gets better treatment, too, says

under general anesthesia and requires just two small

Dr. Kiser. That was certainly true for Barbara Wilson, 80,

incisions, in the femoral or jugular veins, for access.

a retired bank teller and private secretary who enjoys

The technology includes the aspiration device, plus

fitness walking, golf, and cooking healthful meals for

an external bypass circuit with a pump that creates a

herself and her husband David. She and David have

vacuum. Using ultrasound imaging, surgeons visualize

two sons, David, Jr. and Duane, and have lived in their

the clot, tumor or vegetation and aspirate it; filter out

Bethel Park home for more than 50 years. Barbara is

any debris through the external circuit; and return

a 12-year cancer survivor who has endured melanoma

the clean, filtered blood to the patient. Most patients

treatment, the removal of a lung, brain surgery and Continued on Page 20

Volume XII Issue 1 I HouseCall I 19

TECHNOLOGICAL INNOVATION Continued from Page 19

pacemaker implantation. She was experiencing fluctuations in her

“With Barbara, we were able to use the AngioVac and avoid a big

blood pressure and monitoring it with both her primary care physician

operation,” Dr. Kiser explained. “We accessed her heart through

and her cardiologist, Mark K. Greathouse, M.D. When she began to

two small punctures in her femoral vessels. Barbara had a history

feel pain in the left side of her chest, her first thought was not about

of cancer and a previous pacemaker infection; the mass in her heart

her heart — she thought that it might mean breast cancer, and she

could have been either a blood clot or vegetation from the infection

expected to have a mammogram. Instead, her PCP recommended

and pacemaker leads. We were able to aspirate the mass from her

she see Dr. Greathouse, who ordered an echocardiogram.

heart; it turned out to be a benign tumor. After the procedure, she

“Dr. Greathouse told me I had a mass in my heart and that the mass could be a clot, a tumor or both, and he was very concerned.

He told me that it could go to my lungs. He referred me to Dr. Kiser

was cared for in our Cardiovascular Surgery Unit and did very well; she was able to go home in two days.”

Barbara says she healed rapidly. Her blood pressure has stabilized

at St. Clair, because this would require surgery, and not an everyday

and she feels great. “I’ll be able to resume my walking again soon;

kind of surgery.”

I also enjoy golf and hope to get back to that. I will see Dr. Kiser again

When she heard the name Kiser, Barbara says, she immediately

in his office, but can call him anytime. One of the things I like about

relaxed. “I had read about Dr. Kiser in St. Clair’s HouseCall magazine

him is that if you call him, he calls back right away. He’s very kind

and I thought, ‘If I ever have a major heart problem, I want him.’ All the

and concerned for his patients.”

doctors at St. Clair are very good, but my problem was specialized and

With her extensive medical history, Barbara has learned a lot

it needed a special doctor. I knew that was Dr. Kiser. Being referred

about living a healthful lifestyle and coping with illness. “You have to

to him was an answered prayer.”

help yourself,” she states. “Find the right doctor and then work with

Dr. Kiser explained to Barbara and her husband that open heart

that doctor as a partner. I’m fortunate that Dr. Kiser was able to help

surgery might be necessary, but he hoped he would be able to remove

me with this new procedure; I was confident that I was in very good

the mass in a minimally invasive procedure using new technology.

hands. The care at St. Clair was fantastic.” n

Mark K. Greathouse, M.D.

MARK K. GREATHOUSE, M.D. Dr. Greathouse specializes in cardiology. He earned his medical degree at West Virginia University, completed a residency in internal medicine at UPMC Mercy, and a fellowship in cardiovascular disease at Allegheny General Hospital. Dr. Greathouse is board-certified in internal medicinecardiovascular disease. He practices with St. Clair Medical Services.

To contact Dr. Greathouse, please call 412.942.7900.

20 I HouseCall I Volume XII Issue 1

“

I’m fortunate that Dr. Kiser was able to help me with this new procedure. I was confident that I was in very good hands.

”

BARBARA WILSON, PATIENT

Barbara Wilson with her husband, David, outside their home in Bethel Park.

Volume XII Issue 1 I HouseCall I 21

TELEMEDICINE

Remote technologies bring telemedicine into a new light

How are you feeling today?

“

TELEMEDICINE . . .

IT’S CONVENIENT AND SAFE. . . . IT SAVES TIME,

H

“

ouse call” is a phrase that has taken on a new meaning in American health care. Call it telemedicine, telehealth, virtual visit or electronic visit — there’s no doubt that

“seeing” your doctor, face-to-face, on an electronic screen in

THERE IS NO WAITING,

your own home or office, instead of in an exam room in a doctor’s

WE SEE THE PATIENT

office, is a growing trend in health care.

WITHIN MINUTES.

physician electronically, via a two-way, audio/video conferencing

”

Telemedicine means connecting and communicating with your platform similar to Skype, Zoom or Facetime. Outpatient appointments can take place in your home, workplace or other

NICOLETTE E. CHIESA, M.D., ASSOCIATE CHIEF MEDICAL OFFICER, ST. CLAIR HOSPITAL

location — even when you are on vacation. In the comfort and convenience of your familiar home environment, you and your doctor can see each other on a screen and converse. Your doctor can question you about the problem you’re having, visualize it, evaluate your symptoms, and discuss treatment — just like in

Nicolette E. Chiesa, M.D.

the office. All it takes is a smart phone, laptop, tablet or desktop computer with an Internet connection, a camera and a microphone.

NICOLETTE E. CHIESA, M.D. Dr. Chiesa is Associate Chief Medical Officer at St. Clair Hospital. She earned her medical degree at Jefferson Medical College in Philadelphia, and completed residencies at both UPMC and Conemaugh Health System in Johnstown. She is board-certified in internal medicine.

Dr. Chiesa practices with Preferred Primary Care Physicians.

To contact Dr. Chiesa, please call 412.257.2050.

22 I HouseCall I Volume XII Issue 1

Although telemedicine is not new, COVID-19, the respiratory infection caused by the novel coronavirus, has accelerated its use.

Nicolette E. Chiesa, M.D., a primary care physician and Associate Chief Medical Officer at St. Clair Hospital, believes that technology can be a blessing or a curse, but in the case of telemedicine, it’s definitely a blessing. “Telemedicine is mostly a good thing,” she says. “It’s convenient and safe. You can see your doctor from the comfort of your home. It saves time: the check-in is fast and there is no waiting — we see the patient within minutes.

We write prescriptions and make follow-up plans and referrals as usual. Telemedicine has cost savings for patients — they don’t need to worry about paying for gas and parking.”

Patient satisfaction with telemedicine is high, Dr. Chiesa has

Dr. Fatigati demonstrates a telemedicine appointment.

found that it’s best for dealing with specific medical issues. Another

found. “The only minus is that elderly patients may not have the

application of it is for ongoing care after a medical problem has been

technology, or they have it but aren’t sure how to use it,” she says.

diagnosed and treatment started. Telemedicine works well in that

“They might need a family member or friend to help them. But

situation for following up with the patient to see how the treatment is

they like the idea of not having to travel. If they are disabled or

working out. It also can serve as a useful tool in managing the care

have mobility challenges, going to a doctor’s appointment can

of those who are very ill at home, such as the patient with congestive

be an ordeal.”

heart failure who is getting home health care. We can follow those

Electronic visits, says Dr. Chiesa, work best for issues such as upper respiratory infections, urinary tract infections, rashes, and

patients along with the homecare provider.”

In general, Dr. Fatigati believes that telemedicine will become part

minor wounds. The downside is that she cannot touch or palpate

of a complete program for primary and specialty care, although it will

the patient, listen to the heart and lungs, or check weight and blood

not replace hands-on care. “It will not become the norm, but

pressure. Dr. Chiesa says she also misses being able to touch her

it will have a role. It’s an additional option for seeing

patients. “I’m old school; I like to give my patients a hug and chat

patients. Younger people who are very busy with

with them about non-medical things. It’s important that I can still

their jobs may prefer telemedicine, but most

have a good doctor-patient relationship.”

patients prefer to come in, and as a physician

Gene Hollingsworth, 72, of Bridgeville, recently had his first

I need to see and examine the patient most of

“virtual visit” with Dr. Chiesa, his primary care doctor, and it worked

the time. The physical examination and the

out perfectly. “I found it to be an easy and positive experience,”

patient interview are the art of medicine and

Gene recalls. “I needed to see Dr. Chiesa. Her staff suggested a

that cannot and should not be replaced.”

telemedicine appointment. I had some initial difficulty in setting it up,

A telemedicine appointment is private,

but my daughter helped me. Once that was done, I was able to show

personal and secure. At St. Clair,

Dr. Chiesa my problem on the screen. She diagnosed me correctly

telemedicine visits are available for

and changed my treatment, and as a result, my condition improved.

a number of primary care and

It went so well that I decided to have another electronic appointment

specialty care practices.

with my pulmonologist, Stephen G. Basheda, D.O., and that one

If you’d like to have an

also went smoothly. I recommend that others give it a try.”

electronic visit, call your

Telemedicine will definitely be part of the health care future, says

participating doctor’s office

Mario J. Fatigati, M.D., FACP, CMD, an internist and Associate Chief

and the staff will help

Medical Officer at St. Clair Medical Services, the Hospital’s affiliated

arrange it for you and

multispecialty group. “Telemedicine fills a niche and as we use it,

provide instructions

we are discovering the places where it can be most useful. I have

on how to do it. n

MARIO J. FATIGATI, M.D. , FACP, CMD Dr. Fatigati earned his medical degree at the University of Rome, Italy. He completed his residency in internal medicine at the former St. Francis Medical Center, Pittsburgh, where he later served as chief resident in internal medicine.

He is board-certified in internal medicine and holds specialty certification in Geriatric Medicine. He is a certified medical director in long-term care. In 2018, the American College of Physicians presented him with a Clinical Practice Award.

Dr. Fatigati practices with St. Clair Medical Services, where he also serves as Associate Chief Medical Officer.

To contact Dr. Fatigati, please call 412.343.1770.

Mario J. Fatigati, M.D., FACP, CMD

Volume XII Issue 1 I HouseCall I 23

THANK YOU

THANK YOU

to ALL our Health Care Heroes The COVID-19 pandemic shone a light on the health care heroes on whom our communities count for guidance, comfort, and care. Indeed, it is our medical staff, employees, and volunteers who have made St. Clair nationally acclaimed for patient safety and quality.

Pictured are just a few of those who make us proud.

24 I HouseCall I Volume XII Issue 1

and THANK YOU donors for your support!

We wish to express our deep gratitude to everyone in our region who supported St. Clair during the COVID-19 spring outbreak. Whether it be a restaurant which donated meals to our nursing units, an organization which furnished life-saving personal protective equipment, a community member who sewed handmade masks, or someone who donated to St. Clair Hospital Foundation to support our employees in need of personal assistance, we say ‘thank you’. For these and all other generous acts of kindness, we also applaud you.

For it is in times like these we are reminded that, above all, we aim to be worthy of the communities we so proudly serve.

For a listing of organizations, community members and donors who helped St. Clair throughout this health care crisis, please visit stclair.org/thank-you

Volume XII Issue 1 I HouseCall I 25

ASK THE DOCTOR

Ask the Doctor AARON S. WANG, M.D.

Q A

When do I need cataract surgery?

What are my options if I do?

A cataract is the clouding of the natural lens within the eye.

Virtually all of us will get cataracts as we age. Cataract formation is usually a gradual process and vision changes can be subtle.

Common symptoms include blurred or dim vision, sensitivity to light with glare, seeing halos, difficulty with night vision, and needing brighter light for reading. Often, the prescription of your glasses change frequently, with diminishing improvements with each change.

Ophthalmologists recommend a comprehensive eye exam to have your visual acuity measured and your eyes (pupils) dilated.

A special microscope called a slit lamp is utilized to view and grade your cataract. You will be evaluated for other eye diseases, such as glaucoma or macular degeneration as well.

The decision to proceed with cataract surgery is based on how much the cataract interferes with your vision and daily activities.

There is usually no rush, but the surgery can become more urgent if, for example, you fail to have adequate vision for driving.

Fortunately, cataract surgery is one of the safest and most effective procedures. Typically, it is an outpatient procedure done under light intravenous (IV) sedation. Through microscopic incisions, your cloudy natural lens is emulsified with ultrasonic energy and is replaced with a clear artificial lens. This artificial lens is called an intraocular lens (IOL). Your vision should significantly improve over the next few days as long as you use your prescribed postsurgical eye drops.

There are different surgical options, including upgrades that can be associated with out-of-pocket expenses.

Standard cataract surgery with a basic IOL is covered by insurance. It is a fine option if you are comfortable wearing glasses for both distance and near vision after surgery. Upgraded options leverage the latest technologies, including laser-assisted cataract surgery, intra-operative aberrometry, and premium

IOLs (toric and/or multifocal IOLs). These technologies deliver customized surgery, address optical irregularities of your eyes, such as astigmatism, and minimize spectacle dependence. You can choose to reduce your need for glasses for distance vision or near vision or both.

An ophthalmologist will meet with you for a cataract evaluation, with the intention of learning your individual visual needs, answering all of your questions, and guiding you toward the most appropriate option for which you may qualify. In addition to the options mentioned, an ophthalmologist can also offer “dropless” cataract surgery if you have difficulty instilling eye drops.

Typically, regardless of which CATARACT SURGERY surgical option is chosen, the Diamond knife surgery takes minutes, you leave without a stitch or patch, Posterior capsule and the improvement is lifeLens changing.

A corneal sub-specialist, Small incision such as myself, can also perform a number of treatments Phacoemulsification concurrently with your cataract needle surgery if you have other co-existing eye diseases. An example includes the latest in corneal transplantation (DSAEK, DMEK) for Fuchs’ Ultrasonic emulsification and aspiration of lens nucleus Corneal Dystrophy. Another example is minimally invasive glaucoma surgery (MIGS) to lower your eye pressure.

IOL Combined surgery, when needed, provides convenience Implantation of new, and the quickest route to your foldable lens best possible vision. n SOURCE: www.nature.com/articles/nrdp201514/

Aaron S. Wang, M.D.

AARON S. WANG, M.D. Dr. Wang specializes in ophthalmology. He earned his medical degree at Stanford University School of Medicine, and completed his residency at Johns Hopkins Hospital Wilmer Eye Institute. He subsequently completed a fellowship at Shiley Eye Center, UC San Diego Health. Dr. Wang practices with Glaucoma-Cataract Consultants, Inc. To contact Dr. Wang, please call 412.5 72 .6121.

26 I HouseCall I Volume XII Issue 1

In critical moments,

excellence matters THE REGION’S ONLY HOSPITAL WITH 16 STRAIGHT As IN PATIENT SAFETY

The Leapfrog Group, a national, independent, patient safety watchdog,

NATIONALLY RECOGNIZED

awarded St. Clair special recognition for the 16th consecutive period, making St. Clair the region’s only hospital to earn an ‘A’ grade for patient safety for 8 years running. The grades rate how well hospitals protect patients from preventable harm, like infections, falls, and medical errors. To learn more about our Hospital Safety Score, or St. Clair’s performance as a national leader in quality and patient satisfaction, please visit stclair.org.

1 0 0 0 B OW E R H I L L R OA D

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M T. L E B A N O N , P E N N SY LVA N I A 1 5 2 4 3

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412.942.4000

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S TC L A I R . O R G

Volume XII Issue 1 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 ST. C L AIR D U NL A P F A M I LY O U TP A TI E N T C E N TE R

TAKING

SHAPE

The photo below, shot by a camera-equipped drone in mid-April, shows continuing construction on St. Clair’s 280,000-squarefoot, six-story Dunlap Family Outpatient Center, which is being built adjacent to the Hospital. The architect’s rendering, at right, illustrates what the outpatient center will look like when completed and welcoming patients in the spring of 2021. Funding for the outpatient center is being supported by tax-exempt bonds, accumulated funds and philanthropy. To donate, please visit: stclair.org/giving/groundbreaking-growth/

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