St. Clair Hospital HouseCall Vol III Issue 2

VOLUMEIII, II,ISSUE ISSUE22 VOLUME

INSIDE

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ISSUE

ASK THE DOCTOR

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da VINCI Si SURGERY PATIENT PROFILE

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ST. CLAIR’S OUTPATIENT LOCATIONS

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ER RANKED AMONG BEST IN U.S.

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COMMUNITY OUTREACH

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SUMMER SWING

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ST. CLAIR DOCTORS RECEIVE TOP RATINGS

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LEADING TEC

NOLOGY

Next generation surgery using the da Vinci Si

CONTINUED GROWT New surgeon bolsters St. Clair’s breast surgery program

R

aye J. Budway, M.D., a 2011

Pittsburgh Magazine “Top Doctor”,

relocated her practice to St. Clair in April.

Dr. Budway specializes in general and breast surgery and will lead St. Clair’s Breast Care Center.

As a participating surgeon in the recent National Surgical Adjuvant Breast and Bowel Project’s (NSABP) clinical trials, her

DRS. ARTHUR THOMAS and KEVIN BORDEAU are among a growing group of surgeons at St. Clair Hospital using the da Vinci Si, the world’s most advanced robotic-assisted surgery system.

work has contributed to changes in the treatment protocols for breast cancer—a disease which affects more than 200,000 women each year. The NSABP, which is supported by the National Cancer Institute, has published studies that have led to the

S

urgeons at St. Clair Hospital are now using state-of-the-art robotic technology, the da Vinci Si, to provide the benefits of minimally invasive surgery to a

growing number of patients.

Named after the famous Italian engineer, mathematician and scientist Leonardo

establishment of lumpectomy with radiation

da Vinci, the da Vinci System uses the most advanced technology to enable surgeons

over radical mastectomy as the standard

to perform delicate and complex operations through a few tiny incisions with

surgical treatment for breast cancer, and

increased vision, precision, dexterity and control.

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Y o u n g

LEADING TEC

b a s e b a l l

a n d

NOLOGY

CONTINUED FROM PAGE 1

The da Vinci is currently being used at St. Clair for urology

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shorter hospital stay, and quicker recovery and return to everyday life. And, in men who have their prostates partially or fully removed, robotic-assisted surgery also can mean a faster

procedures, such as prostatectomies (removal of the prostate

return to urinary continence, lower rates of urinary pain, and

gland, most often due to cancer), but the system is also designed

sustainable erections.

for gynecology, cardiothoracic, head and neck and general

From the surgeon’s perspective, the benefits of robotic-

surgery procedures. Gynecological surgeons at St. Clair are

assisted surgery start with the ability to see inside the human

expected to be the next users of the new system.

body at 10 times magnification. Moreover, the da Vinci Si’s “endo

The da Vinci Si consists of four interactive robotic arms that

wrists” enable the surgeon to sew sutures more precisely than by

are controlled by a surgeon who is seated at a console in the

hand. “Robotic-assisted surgery is more beneficial over traditional

operating room. Three of the arms are for tools, such as a

laparoscopic surgery in anything that requires sewing,” Dr. Thomas

grasper and scissors, the fourth holds an endoscopic camera

says.

with two lenses that give the surgeon a 3-D image (at 10 times

Dr. Bordeau says a key to the success of the robotic-assisted

magnification) during the procedure. The system seamlessly

program at St. Clair is the operating room personnel who have

translates the surgeon’s hand, wrist and finger movements into

undergone extensive training with the da Vinci Si system.

precise, real-time movements of surgical instruments. Every

Several teams have been trained.

surgical maneuver is under the direct control of the surgeon.

Dr. Bordeau says those teams, and he and the other surgeons

Repeated safety checks prevent any independent movement

performing robotic-assisted surgery, will benefit from having “the

of the instruments or robotic arms.

newest and best system and the added advantage of learning

St. Clair urological surgeons, Arthur D. Thomas, M.D. and

from the best practices.”

Please see Patient Profile on Page 4.

Kevin P. Bordeau, M.D., both of whom have years of experience with the da Vinci system, completed the Hospital’s first roboticassisted surgeries in April, performing radical prostatectomies on area men suffering from prostate cancer.

Dr. Thomas says that in the last two years, robotic-assisted laparoscopic radical prostatectomies have become the No. 1 treatment choice for localized prostate cancer, supplanting open surgery and various radiation options. The benefits of this minimally invasive surgery include less pain and blood loss, a

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Kevin P. Bordeau, M.D. earned his medical degree at Tufts University School of Medicine in Boston and completed a residency in urology at the Eastern Virginia Medical School. Dr. Bordeau is board certified by the American Board of Urology and practices as part of Sholder & Bordeau Urologic Associates.

Arthur D. Thomas, M.D. earned his medical degree at the University of Pennsylvania School of Medicine and completed a residency in urology at the Hospital of the University of Pennsylvania. Dr. Thomas is board certified by the American Board of Urology and practices as part of The Center for Urologic Care, P.C.

m o r e

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i m p r o p e r

t e c h n i q u e .

ASK THE DOCTOR Q: I’m hearing more stories of young

of the shoulder

baseball and softball pitchers suffering shoulder and elbow injuries. What is causing this jump in injuries?

sliding out.

A:

or days after

Achy pain that persists for several hours

Travel and instructional teams have recently become

throwing is

popular in baseball and softball. In addition to their school

common. The

and summer teams, some boys and girls are playing more

medial collateral

baseball and softball than ever. More play may result in

ligament (MCL)

better performance. But for some, more play means more

of the elbow

injuries, especially at the shoulder and elbow.

can also be

Pitch count is very important. Most professional starting

DR. PATRICK MCMAHON

injured from throwing. This

pitchers throw only 100 balls a game, then rest for five days.

ligament is on the inside of the elbow and injury initially results

But some Little Leaguers throw many more, especially if they

in pain with hard throws. Pitch velocity is lost. A pop with

are the “best” pitchers on their respective teams. And while the

immediate sharp pain is felt on the inside of the elbow if the

windmill pitch used in softball may be somewhat safer than

MCL tears. Fortunately, this is uncommon and most patients

the overhead baseball pitch, I am seeing more girls with injuries

have mild shoulder and elbow injuries. Then, a proper

after pitching several games in a week.

rehabilitation program and rest for a few weeks to a few

Many don’t know that pitching effectiveness comes from

months is often effective as first

pitch placement and variation in pitch speed as much as simply

treatment. If this does not

“bringing the heat.” Effective starting pitchers in the big

work, their evaluation by

leagues rarely throw as hard as they can. Pitching mechanics

an orthopedic surgeon

are also very important to minimizing injury and several hours

with expertise in shoulder

with a good pitching instructor is often time well spent in

and elbow problems is the

effectiveness and in avoiding or limiting injury.

next best step.

Throwing a ball causes huge forces at the shoulder and elbow that can easily cause injury. Anterior instability is the

Please see Dr. McMahon’s biography on Page 8.

ball of the shoulder sliding out the front from its normal position. It can occur when the shoulder is placed beyond the limit of its normal range of motion. This may occur when a ball player “reaches back” to throw really hard. Throwers with anterior instability will report pain and sometimes a sensation 3

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St. Clair Hospital OUTPATIENT SERVICES

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Occupational Therapy

Occupational Medicine

OB Ultrasound

MRA/MRI

LAB

IVP

Infusion Center

GI

EKG

Echocardiogram

Diabetes Center

CT/CTA

Computer Aided Detection (CAD) Mammogram

Cardiac Rehabilitation

Breast MRI Guided Biopsy

Breast MRI

LOCATION OF SERVICES

Bone Densitometry

t. Clair Hospital is committed to offering exceptional, high quality outpatient health care services in four convenient locations. Highly skilled teams of board-certified physicians, registered nurses, physical therapists, technologists and technicians collaborate to provide compassionate, personalized care for a wide range of outpatient medical services. The accompanying chart lists the wealth of available services at the Hospital’s main campus in Mt. Lebanon, as well as at three satellite facilities in surrounding communities.

St. Clair Hospital Mt. Lebanon St. Clair Hospital Outpatient Center Village Square St. Clair Hospital MRI Center

St. Clair Hospital Outpatient Lab Chartiers Valley Shopping Center

FOUR CONVENIENT LOCATIONS

ST. CLAIR HOSPITAL OUTPATIENT CENTER VILLAGE SQUARE 2000 Oxford Drive Bethel Park, PA 15102

ST. CLAIR HOSPITAL MT. LEBANON 1000 Bower Hill Road Pittsburgh, PA 15243

ST. CLAIR HOSPITAL MRI CENTER (WIDE B 350 Broughton Road Bethel Park, PA 15102

Robotic-Assisted Surgery PATIENT PROFILE: Ron Obremski he field of robotics not only fueled Ron Obremski’s passion for teaching, it also may have saved his life. Ron, 57, is a retired welding and robotics teacher from McKeesport Area High School and the proud father of two daughters. And thanks to physicians from The Center for Urologic Care at St. Clair Hospital, he’s also a prostate cancer survivor.

To combat prostate cancer, surgeons at St. Clair Hospital have a new sophisticated tool among their arsenal—the da Vinci Si (Please see main story on Page 1) which provides the benefits of robotic-assisted, minimally invasive surgery to prostate cancer patients like Ron. In April, the North Huntingdon resident became the first patient to undergo a robotic-assisted radical prostatectomy at St. Clair Hospital.

A sudden spike in Ron’s PSA (prostate-specific antigen) levels from 15 to 24 caused his primary care physician to refer him to The Center for Urologic Care in early January. The first step in the process was to undergo a biopsy.

“This process was a real shock to me,” Ron admits. Two weeks later at his next appointment, Ron learned that the biopsy came back positive for prostate cancer. “It felt like a punch in the face,” he recalls.

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Based on Ron’s biopsy pathology, PSA numbers, relatively young age and overall good health, he was advised to have his prostate removed.

A bone scan and da Vinci Si patient, RON OBREMSKI CT scan were next.

“These processes were necessary to tell if the cancer was spreading,” he says. “After receiving an IV, I reported to the Radiology Department where they gave me a drink which tasted like a soapy Gatorade. It took an hour for the drink to be absorbed into my system, at which point I was inserted into a cylindrical device that looked like a time travel machine.”

The CT scan only took about 15 minutes. A bone scan took about an hour.

A week later, the test results confirmed that the cancer hadn’t spread, but surgery was still necessary. Prostate cancer is one of the few cancers where

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GENERAL INFORMATION: 412.942.4000 MEDICAL IMAGING SCHEDULING: 412.942.8150

BORE)

X-Ray

Wound Healing Center

Ultrasound

Sleep Disorders Center

Screening & Digital Screening Mammogram

Physical Therapy

PET CT

Osteoporosis Center

WWW.STCLAIR.ORG

ST. CLAIR HOSPITAL OUTPATIENT LAB CHARTIERS VALLEY SHOPPING CENTER 1025 Washington Pike Bridgeville, PA 15017

St. Clair Hospital Outpatient Lab Chartiers Valley Shopping Center

COURTESY VAN SERVICE St. Clair Hospital offers a free transportation service to patients having difficulty accessing health services at our facilities. This need-based service can be arranged by calling 412.942.6157.

Please call at least 24 hours in advance of your appointment.

patients can choose their treatment options. Ron conducted extensive research online, including through YouTube, but still wanted other opinions.

“Knowing that my PSA was unusually high, I knew I was headed for surgery,” he says.“I chose the da Vinci Si. Part of my program at McKeesport Area High School involved robotics so I had an understanding of the process. The main part of any robot is the end effector—what’s on the end of the robot. Most are what’s called pick and place. The end effectors on the da Vinci Si are small laparoscopic arms that perform the operation while being guided by the doctor several feet away.”

The da Vinci Si System uses the most advanced technology to enable surgeons to perform delicate and complex operations through a few tiny incisions with increased vision, precision, dexterity and control.

It consists of four interactive robotic arms that are controlled by a surgeon who is positioned at a console in the operating room. Three of the arms are for tools, such as a grasper and scissors; the fourth holds an endoscopic camera with two lenses that give the surgeon a 3-D image at 10 times magnification during the procedure. The system seamlessly translates the surgeon’s hand, wrist and finger movements into precise, real-time movements of surgical instruments. Every surgical maneuver is under the direct control of the surgeon.

With the da Vinci System, patients have less pain and blood loss, a shorter hospital stay, and quicker recovery and return to everyday life, compared to traditional open surgery.

Ron met with St. Clair urological surgeon, Arthur D. Thomas, M.D., who performed the operation.

“He was great,” says Ron. “He gave me all the details about my surgery and let me know that I would be the first patient at St. Clair on the new da Vinci Si.” Today, Ron is doing great. He’s back to enjoying some of his hobbies such as fishing and working in his yard. “Here it is, a little over three weeks after surgery, and although I’m still supposed to take it easy, I feel like I can do almost all of my normal activities,” Ron says. “Five days after the surgery, I was up out of bed, feeling healthy. I only had to use the catheter for a week, and the scarring is very minimal. All in all my recuperation has been just wonderful.” Even throughout this entire ordeal, it didn’t take long for the teacher in Ron to emerge. He remained focused by chronicling this experience for the benefit of educating others. He kept an online journal detailing his experiences from the time he was diagnosed through his recovery.

“I’m doing this so that this might help someone else, to ease their fears, just as I had with the uncertainty of the process,” he says.

Appreciative of the surgeon who skillfully performed the roboticassisted, minimally invasive surgery, Ron is also grateful to his friends and family who helped him get through this experience.

“Some men find this embarrassing and keep it to themselves, which is a mistake, because of the power of the support that you will receive from people closest to you,” he says.

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ER Consistently Among Nation’s Best

St. Clair Hospital’s Emergency Room (ER) is ranked among the top ERs in the country for patient satisfaction, according to Press Ganey, an independent national research firm. In fact, March 31 marked a two-year period in which St. Clair has consistently been ranked above the 98th percentile in patient satisfaction, an achievement that has earned it the No. 1 ranking in the nation.

Press Ganey’s research indicates patients are particularly impressed with how fast they are taken to an exam room and seen by one of our physicians, all of whom are board certified in emergency medicine.

Patients also cite the compassion of St. Clair’s doctors, nurses and other health care providers, as well as the amenities, including valet parking.

COMMUNITY OUTREAC n May 5th, St. Clair Hospital sponsored a Wellness Day at South

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Hills Interfaith Ministries (SHIM), a non-profit social service agency

that meets the needs of individuals and families in the South Hills who are struggling to make ends meet.

Nurses and other clinical staff from the Hospital conducted a host of free health screenings, including glucose, cholesterol, body mass index, blood pressure, and carbon monoxide levels, while Antonio M. Riccelli, M.D. and Robert J. Pagano, M.D. staffed an “Ask The Doctor” table to help educate families and distribute important health care information. Hospital representatives also talked to participants about quitting smoking and healthful eating habits to avoid or combat diabetes.

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s u c h

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c o m m u n i t i e s .

As a surgeon, Dr. Budway is a proponent of a less invasive

CONTINUED GROWT

surgical approach to breast cancer, and sees herself as an

CONTINUED FROM PAGE 1

educator and partner in her patient’s treatment. One of her most important roles, she says, is to guide her patients through the

was the first to demonstrate the preventive effects of the drug

unfamiliar and often upending journey of breast cancer diagnosis

Tamoxifen in breast cancer.

Recently, NSABP studies revealed that more aggressive breast surgery, including removal of lymph node tissue, was no longer necessary for successful surgical outcomes in breast cancer patients.

"Surgeons historically observed the rules of Halstedian theory (named after Dr. William Halsted, who performed the first radical mastectomy early in the

“

I am there to help them

through the process of understanding the treatment options before them.

”

It’s one decision at a time.

20th century) which said

Raye J. Budway, M.D.

that the more tissue you remove, the better the patient outcome would

and surgery, step by step. “I am there to help them through the

be,” explains Dr. Budway.

process of understanding the treatment options before them.

“The thinking then was

There is so much information that you have to help them get

that cancer first spread

through. It’s one decision at a time.”

locally, then systemically.

A Pittsburgh native and former director of the surgical breast

In the 1970s, Dr. Bernard

disease program and surgical ICU at The Western Pennsylvania

Fisher of Pittsburgh

Hospital, Dr. Budway attended medical school at Hahnemann

launched the theory that

University College of Medicine in Philadelphia. Although her

breast cancer is a

interest in medicine was rooted in childhood, she pursued a

systemic disease, right

bachelor’s degree in chemical engineering from Grove City College

from the start,” she

as a career backup plan, she says. (Her father was an engineer.)

continues. (Note: Dr. Fisher was the principal

One of Dr. Budway’s patients, a mother of five, recently RAYE J. BUDWAY, M.D.

expressed gratitude for the doctor’s thorough, compassionate

author of a study published in 1993 by The New England Journal

approach during her cancer diagnosis and surgery. “I was a deer

of Medicine that showed a form of breast cancer, intraductal

in the headlights. I was just in a great big fog,” she told Dr. Budway in

carcinoma, which had often been treated by full mastectomies,

a follow-up visit. “But you gave me the baby steps I needed. Now,

could safely be treated less invasively with lumpectomy and

I have a friend who’s been diagnosed with cancer, and I’m able to

radiation therapy.) “Now, the results of this new NSABP study

help her get through those baby steps, too.”

indicate that removing much less of the lymphatic tissue results in better surgical outcomes. It’s a choice. With a

Dr. Budway's office is in the St. Clair Hospital Professional Office Building. Her telephone number is 412.942.5600.

mastectomy, you don’t need radiation afterwards; but with a lumpectomy, you need radiation.”

Please see Dr. Budway’s biography on Page 8.

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ST. CLAIR HOSPITAL 1000 Bower Hill Road Pittsburgh, PA 15243 VOLUME II, ISSUE 2

Join us for the

14th ANNUAL

Benefiting St. Clair Hospital’s newest Cardiac Catheterization Lab.

Friday, July 15 5:30 p.m. ‘til the dancing ends Cocktails, Dinner, Silent Auction and Entertainment

ST. CLAIR HOSPITAL General & Patient Information 412.942.4000

Hilton Garden Inn, Southpointe $125 per person

Physician Referral Service 412.942.6560 Outpatient Center—Village Square 412.942.7100

Monday, July 18 —Golf Classic

Medical Imaging Scheduling 412.942.8150

Valley Brook Country Club Registration 10:00 a.m., Shotgun start at noon

www.stclair.org Follow us on twitter at: www.twitter.com/stclairhospital

$700 per person (price includes two tickets to Friday night dinner)

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.

CONGRATULATIONS to St. Clair Hospital’s ‘Top Doctors’

Raye J. Budway, M.D. earned her medical degree at Hahnemann University in Philadelphia. She completed her residency training in general surgery at The Western Pennsylvania Hospital and additional training in surgical critical care at the University of Pittsburgh Medical Center.

She served as the Site Surgical Clerkship Program Director for Temple University Medical School, Site Program Director for the Allegheny General Hospital General Surgery Residency program and Director of the Surgical Breast Disease Program and Surgical Intensive Care at The Western Pennsylvania Hospital.

She is board certified in surgical critical care and general surgery.

She is a Fellow of the American College of Surgeons and serves on the Fellowship's Commission on Cancer.

Patrick J. McMahon, M.D. earned his medical degree at Temple University School of Medicine in Philadelphia and completed his residency in orthopaedic surgery at the University of Pittsburgh Medical Center. He also completed fellowships at UPMC and Kerlan-Jobe Orthopaedic Clinic in Los Angeles. Dr. McMahon is board certified by the American Board of Orthopaedic Surgery.

Donald M. Whiting, M.D. earned his medical degree at Jefferson Medical College in Philadelphia and completed his graduate training in general surgery at Geisinger Medical Center in Danville, Pa., and in neurosurgery at the Cleveland Clinic. Dr. Whiting also completed a fellowship in neurotrauma at Allegheny General Hospital. He is board certified by the American Board of Neurological Surgery.

Patrick G. Reilly, M.D. earned his medical degree at the Royal College of Surgeons in Dublin, Ireland, and completed his residency in internal medicine at Mercy Hospital of Pittsburgh. Dr. Reilly completed a fellowship in critical care medicine at the University of Pittsburgh Medical Center.

He is board certified by the American Board of Internal Medicine.

To contact one of these “Top Doctors” or any of the more than 500 exceptional physicians on our staff, please visit www.stclair.org.

Jay A. Lutins, M.D. earned his medical degree at the Medical College of Virginia. He completed his residency training in urology at the University of Pittsburgh Medical Center and he is board certified by the American Board of Urology.