Page 1

VOLUME IX ISSUE 2

HouseCall

THE VALUE OF A

Collaboration between St. Clair and Mayo Clinic yields patient benefits and positive outcomes

inside

New Prostate Cancer Screening Guidelines I Ask The Doctor I Donor Spotlight St. Clair Ranks #1 In The Region I St. Clair Offers Peace Of Mind About Health Care Costs


ST. CLAIR AND MAYO CLINIC

THE VALUE OF A

second

2 I HouseCall I Volume IX Issue 2


opinion Every day across America, physicians make hundreds of thousands of diagnoses in hospitals, medical offices, clinics and nursing homes. They listen to their patients, examine them, ask questions, obtain laboratory and other diagnostic tests, and consider the reports of consultants. Many factors come into play: symptoms, timing and sequence of symptoms, past history, family history, lifestyle, and recent exposure to disease, among them. Physicians synthesize all this information and interpret its meaning as they seek a cause for their patients’ symptoms. Using their senses, intellects, education, and the intuition born of experience, they diagnose.

M

aking a diagnosis is like conducting an

A diagnosis can be many things, but one thing it cannot

investigation, similar to detective work,

be is wrong. The wrong diagnosis can mean delayed,

believes G. Alan Yeasted, M.D., Chief Medical

inappropriate or unnecessary treatment; time lost; complications

Officer at St. Clair Hospital. Mark V. Larson, M.D.,

that cause harm or injury to the patient, and even death. In

a medical director at the Mayo Clinic Care Network,

2015, the Institute of Medicine (IOM) issued a report, Improving

of which St. Clair is a member, describes diagnosis

Diagnosis in Health Care, a continuation of the landmark 2000

in this way: “It’s like a jigsaw puzzle, where the image

study of medical errors, To Err Is Human: Building a Safer System.

is revealed only after all the pieces come together.” Both of these longtime, experienced physicians agree

The new study says that diagnostic errors are a blind spot in health care that has not been adequately addressed,

that diagnosis is both science and art. It is a complex process,

despite the intense industry focus on patient safety and

often painstaking, of narrowing the possibilities through

quality. The IOM estimates that 5 percent of U.S. adults who

a comparative analysis known as a differential diagnosis.

seek outpatient care every year experience a diagnostic error.

Diagnosis determines the course of treatment and informs

Reducing errors is not enough, the report says: the focus

decision-making so that things can move forward, toward

needs to be on improving diagnosis.

a cure, improved health, or the easing of suffering.

Continued on page 4

Volume IX Issue 2 I HouseCall I 3


THE VALUE OF A

second opinion Continued from page 3

That is the goal for all health care providers across the U.S. and the daily quest of Mark L.

and it takes time to get it right.”

Graber, M.D., FACP, Senior Fellow at Research

And yet, physicians do get it right, nearly

Triangle International in North Carolina and the

always. “The United States has the best medical

founder and president of the Society to Improve

care in the world, and the public should trust

Diagnosis in Medicine. Dr. Graber, a leading

their physicians,” says Dr. Graber. “They get it

national expert on diagnosis and diagnostic error,

right at least 90 percent of the time.” Dr. Graber

describes making a diagnosis as one of the greatest

has high praise for a study by Mayo Clinic published

cognitive challenges for human beings. “There

earlier this year in the Journal of Evaluation in

are over 10,000 known disease conditions and only

Clinical Practice, which says that one way to

about 200 total symptoms, and symptoms can be

improve diagnostic accuracy is through referrals

Mark V. Larson, a Medical Director with the Mayo Clinic Care Network, of which St. Clair Hospital is a member.

[MAKING A DIAGNOSIS] IS

LIKE A JIGSAW PUZZLE, WHERE THE IMAGE IS REVEALED ONLY AFTER ALL THE PIECES COME TOGETHER.

MARK V. LARSON, M.D., MEDICAL DIRECTOR, MAYO CLINIC CARE NETWORK

The Pittsburgh Post-Gazette published an editorial about the value of a second opinion in response to a new study by Mayo Clinic.

Copyright ©, Pittsburgh Post-Gazette, 2017, all rights reserved.

4 I HouseCall I Volume IX Issue 2

vague,” he says. “Diagnosis is very, very complicated

Reprinted with permission.


to specialists and second opinions. “Second

of the Mayo Clinic Care Network is the oppor-

opinion may provide the patient and his or her

opinions have a role in improving diagnostic

tunity for St. Clair physicians to connect,

physician with peace of mind,” says Dr. Larson

reliability and I encourage them,” says Dr. Graber.

physician to physician, to discuss diagnostic

of the Mayo Clinic Care Network. “The physician

“Studies in radiology and pathology, where

challenges, rare diagnoses, and difficult clinical

knows that he or she has done everything to

second opinions are the standard, show that

problems. Using electronic connections (please

help the patient, and the patient can appreciate

without a doubt, second opinions are very

see related sidebar on page 11), St. Clair physicians

the physician more because the physician is

valuable. Fresh eyes catch mistakes. Second

can get feedback that enables them to confirm

willing to ask for assistance. A timely second

opinions are a promising way to get us beyond

a diagnosis, validate the treatment plan, fine

opinion reassures both that the diagnosis is

tune a diagnosis or treatment plan, or get

correct and the treatment recommendations

suggestions for ongoing management of the

are appropriate.”

that 90 percent figure.” But getting second opinions is not always a simple matter. Many obstacles exist: will my

patient. Doctors are finding the process easy

insurance cover a second opinion and, if not,

and very useful, and patients are grateful for

their patients, and that includes getting a second

can I afford it? Will my doctor be offended if

the expertise that these consults bring to their

opinion when it is appropriate. At St. Clair,

I request one? How do I go about finding a

respective medical situations. For patients,

the goal is to provide the best care possible.

doctor to give a second opinion?

Mayo Clinic eConsults are effortless: there is

Through advanced technology and a spirit of

no cost, no need to travel, and no inconvenience.

collaboration, St. Clair is bringing Mayo Clinic’s

At St. Clair Hospital, no such obstacles exist. By virtue of its collaboration with

Every patient does not need a second opinion. But when the problems are rare or

opinions from experts in every specialty at the

complex, a referral for a second opinion is an

Rochester, Minnesota-based health system.

essential component of good care and can be,

One of the primary benefits of being a member

in some instances, lifesaving. “A second

expertise to the diagnosis and treatment of patients throughout the region. Please read on for four real-life examples of the value of a second opinion.

s

Mayo Clinic, St. Clair has access to second

Physicians always want to do the best for

MAKING A DIAGNOSIS IS LIKE CONDUCTING AN INVESTIGATION, SIMILAR

TO DETECTIVE WORK. G. ALAN YEASTED, M.D., CHIEF MEDICAL OFFICER,

ST. CLAIR HOSPITAL

G. Alan Yeasted, M.D.

Volume IX Issue 2 I HouseCall I 5


THE VALUE OF A

second opinion KATHY RUMSKI:

Personalized treatment approach improves outcome

M

other’s Day 2017 was a perfect spring day, bright with sunshine, blue skies, and vibrantly hued flowers

Traditions matter to Kathy, who works as an Above the Wing ground operations supervisor for Southwest Airlines at Pittsburgh

among new green foliage. But the color pink was the order of

International Airport. Every year, she and her friend Susan

the day in Schenley Park, and it was everywhere as thousands

schedule their mammograms together, and afterward go out to

of people gathered for the annual Susan G. Komen Race for

lunch. This year, their plans changed when the doctor told her,

the Cure. Among them, for the first time, was Kathy Rumski,

post-mammogram, “We need to do a biopsy.”

48. Mother’s Day has always been special for this Crafton mother of three, and she had been planning to spend it in

Those are always frightening words, and they hit Kathy hard. Her sister, Debbie, who lives in Houston, has Stage 4 breast

a perfect way, with her children Courtney, 24; Megan, 19;

cancer. Debbie has had a double mastectomy and reconstruction,

and William,16; and her own mother. Instead, she broke

and is currently on a course of chemotherapy. “My sister is my

with that tradition and went to the race, and found solidarity

hero,” Kathy says. “She has high spirits no matter what, and

and inspiration there.

she always makes me feel better. But I was scared.”

“ ”

Dr. Grahovac saved my life. KATHY RUMSKI, PATIENT

Kathy Rumski, left, with her daughter, Megan.

6 I HouseCall I Volume IX Issue 2


. . . HAVING ACCESS TO MAYO CLINIC IS SUCH A BENEFIT . .. IT HELPS US TO CUSTOMIZE CARE TO EACH INDIVIDUAL PATIENT.

TARA L. GRAHOVAC, M.D.,

BREAST SURGEON, ST. CLAIR HOSPITAL Tara L. Grahovac, M.D., left, performs breast surgery at St. Clair Hospital. At right is Physician Assistant Alexis Joseph, PA-C.

Kathy had the biopsy on December 6, and on

“I was happy with the availability of a Mayo

breast surgeon, Raye J. Budway, M.D. Kathy had

December 9 learned that she had breast cancer.

Clinic eConsult,” says Dr. Grahovac. “There was

complete confidence in her care. “I was fortunate

She was referred to St. Clair breast surgeon Tara

a quick turn-around. I have found that patients

that I was referred to Dr. Grahovac; she and her

L. Grahovac, M.D., for treatment. “Kathy had

appreciate evidence-based medicine; they are

Physician Assistant Alexis Joseph, PA-C, have

ductal carcinoma in situ, which does not have

often well informed and they use the Internet a

been phenomenal. They treat you with the utmost

the ability to spread outside the breast tissue,”

lot. There are no perfect answers, but having

kindness and respect.”

explains Dr. Grahovac. “However when we did a

access to Mayo Clinic is such a benefit because

Kathy honors those who have surrounded

lumpectomy, the pathology showed invasive triple

it is a great resource and it’s important to speak

her with care and support as heroes: her doctors,

negative breast cancer, which can spread. Often we

with other physicians who are treating this

her children, her sister Debbie, her mother and

add chemo to the treatment plan for that, but she

disease; a Mayo Clinic consult is a meeting of

her friends. But she is truly the hero of her own

had a small focus of invasive cancer and her axil-

the minds. It helps us to customize care to each

life. Kathy is a survivor, and on Mother’s Day she

lary lymph node biopsies were negative. This was

individual patient. Gone are the days when

joined other breast cancer survivors at the Race

a rare case where we could skip chemotherapy;

‘everyone with this condition gets that treatment.’

for the Cure. She was surprised by a gift from her

she was referred directly for radiation therapy.”

When you take each patient as an individual,

daughter, Megan, 19, who had secretly assembled

using your training and the literature plus your

a team for her. “At the event, there is an area that

scan unexpectedly revealed a lymph node under-

personal knowledge of the patient, you get better

is only for survivors. You walk in there alone.

neath the sternum, near her heart, that appeared

outcomes and higher patient satisfaction.”

Then you stand with the other survivors, and

As she prepared for radiation therapy, a CT

abnormally large. “It would be unusual for such

Kathy is a satisfied patient. She finished

they have music and speeches. I saw thousands

a tiny cancer to spread that way, and we don’t

four weeks of radiation in April and will have

of people looking at me, cheering for me, and I

usually remove lymph nodes in that area, so close

a mammogram in July. She appreciates that

cried when I spotted my team out there. It was

to the heart, but if the node was found to contain

Dr. Grahovac consulted with Mayo Clinic and

very emotional. The whole day was an incredible

breast cancer it might change our decision regard-

also with Dr. Grahovac’s colleague and fellow

gift, and I plan to make it a tradition.” n

ing chemotherapy. It was a complicated case, without clear guidelines to guide decision-making,

TARA L. GRAHOVAC, M.D.

so I decided to consult Mayo Clinic for an

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

eConsult with breast surgeon David R. Farley, M.D., to see if they had encountered a similar scenario,” says Dr. Grahovac. “Ultimately, we made the decision to remove the lymph node, in part because Kathy had concerns, as she has a sister living with breast cancer. The biopsy on that lymph node was fortunately negative.”

To contact Dr. Grahovac, please call 412.942.7850.

Volume IX Issue 2 I HouseCall I 7


THE VALUE OF A

second opinion RAY ZOFCIN:

Trust and peace of mind lead to a quick recovery

W

hen Ray Zofcin developed back pain last winter, he assumed it was due to a work-related injury;

he’s a foreman in the construction industry, and has known his share of muscle aches. But this felt different, in a vague way, and his usual chiropractic treatment did not ease the pain. As his pain intensified, he saw his primary care physician, Nicolette E. Chiesa, M.D., FACP, who practices with Preferred Primary Care Physicians, Inc. The test she ordered found blood in his urine, so she immediately referred him to urologist Arnold J. Sholder, M.D. of Sholder and Bordeau Urology Associates. “Dr. Sholder ordered a CT scan and my wife Chris and I went to the St. Clair Outpatient Center at Peters Township to have it done,” Ray says. “But I unexpectedly passed out in the changing room and was transported to St. Clair’s Emergency Room, where they gave me pain medication and completed the CT scan. The result was a complete shock: I had a tumor on my right kidney.” It turned out to be a complicated tumor. Ray, who is 50 and lives in Carnegie with Chris and their two children, Zachary and Courtney, also had swelling in his legs, and an ultrasound revealed the presence of multiple blood clots. He was admitted to the Hospital and placed on blood thinners, while undergoing a series of scans. The news grew worse: the tumor had spread to a major blood vessel, the inferior vena cava, and was obstructing the

“ Ray Zofcin

I would not hesitate to go to St. Clair for anything. Having Mayo Clinic as an added resource makes it even better.

RAY ZOFCIN, PATIENT

8 I HouseCall I Volume IX Issue 2


flow of blood returning to the heart from the legs, causing the swelling and clots. Ray needed surgery,

IT’S WONDERFUL

but first he needed to be in optimum condition and that meant a two-week delay while the clots resolved.

TO HAVE THIS ASSET AT ST. CLAIR.

According to Dr. Sholder, “Ray had a large

tumor that had invaded the inferior vena cava, so I consulted two St. Clair vascular surgeons, Dr. Samuel Simone and his son and partner,

ARNOLD J. SHOLDER, M.D.,

Dr. Thomas Simone. We devised a treatment

CHAIR OF SURGERY, ST. CLAIR HOSPITAL

plan for him and decided to obtain a Mayo Clinic eConsult to confirm that it was the right plan and the best plan. Ray liked the idea of a second opinion. We sent the information to Mayo Clinic and within 24 hours we received a complete, concisely written response that validated our plan. The Mayo Clinic urologist, Dr. Stephen A. Boorjian, agreed with everything that we were going to do.” The six-hour procedure in early March was a joint effort involving four surgeons: Dr. Sholder and his partner, Kevin Bordeau, M.D., and the two

Arnold J. Sholder, M.D.

Drs. Simone. It was an intricate operation that removed the entire right kidney and disentangled the tumor from the inferior vena cava. The surgery was performed on a Friday and Ray went

“I had complete trust in my doctors and

my ability to stay positive, and I believe that a

home five days later. He is being followed by

in St. Clair Hospital, but it was great to get

positive attitude helps you heal. The nurse at

Vincent E. Reyes, Jr., M.D., an oncologist/

Mayo Clinic’s opinion. It gave me peace of

Peters Township who was going to do my CT

hematologist. “Dr. Reyes says that right now,

mind when Mayo Clinic experts said that our

scan in Peters came to the Hospital to see how

I am cancer free and there is no need for

plan was exactly what they would do. I knew

I was. That’s the kind of person who works at

chemotherapy or radiation. I’ll have scans

of the reputation of Mayo Clinic, so getting

St. Clair: she didn’t have to do that. All of my

every few months for several years, to monitor

their opinion about my case meant a lot.

doctors — the four surgeons, Dr. Chiesa and

me because there is a risk of recurrence. All

The process was smooth and efficient.”

my oncologist, Dr. Reyes, were unbelievable.

my symptoms are gone and I feel great; I have returned to work.

“The way the staff of St. Clair treated me, with care and compassion, had a lot to do with

The care was superb. We’re fortunate to have this great Hospital right in our backyard. I would not hesitate to go to St. Clair for anything.

ARNOLD J. SHOLDER, M.D. Dr. Sholder serves as Chair of Surgery at St. Clair Hospital and specializes in urological surgery. He earned his medical degree at the University of Illinois College of Medicine and completed his internship, residency and fellowship at Northwestern University, Chicago. Dr. Sholder is board-certified by the American Board of Urology. He practices with Sholder and Bordeau Urologic Associates, a division of St. Clair Medical Services. To contact Dr.Sholder, please call 412.572.6194.

Having Mayo Clinic as an added resource makes it even better.” For Dr. Sholder, the Mayo Clinic eConsult was a highly positive experience. “It’s wonderful to have this asset at St. Clair,” he says. “The process is straightforward and easy; the consult itself is concise and totally on point — not only the clinical portion but the report itself — and it is presented so well.” n

Volume IX Issue 2 I HouseCall I 9


THE VALUE OF A

second opinion JOHN:

Feeling fine and fortunate after complex cancer journey

I am very pleased with the care I received and the skill of my doctors in Pittsburgh, all of which was borne out by the confirmation we received from Mayo Clinic.

JOHN, PATIENT

Jeffrey C. Liu, M.D., Electrophysiologist, St. Clair Hospital

10 I HouseCall I Volume IX Issue 2

J

ohn (a pseudonym, as he requested anonymity)

John’s journey began when an ultrasound

is a South Hills resident who lives an active,

ordered by his PCP showed spots on his liver.

fulfilling life, balancing the demands of his profession

A biopsy of the liver revealed carcinoid, a rare

with family time. He works full time and has enjoyed

form of cancer, which had originated in the small

vibrant health throughout his life. That changed

intestine. With the diagnosis established, John was

recently, though, when the findings of a routine

ready for the next steps: interventional radiology

annual physical examination by his primary care

procedures to shrink the liver cancer, followed by

physician propelled him on a long, labyrinthine

surgery to remove the primary tumor. “My PCP

journey through cancer and its complications. His

coordinated all of this,” John says. “I call him the

problems were complex, and his treatment was

quarterback. My wife and I could not have done

arduous, but he and his physicians drew upon many

this without him.”

excellent resources and specialists in the Pittsburgh

John says during surgery his heart rate

area, including those at St. Clair Hospital and Mayo

accelerated and became erratic. Told it was atrial

Clinic, thanks to St. Clair’s membership in the Mayo

flutter, John was referred to Jeffrey C. Liu, M.D.,

Clinic Care Network. After multiple surgeries and

a specialist in cardiac electrophysiology at St. Clair.

treatments, John is feeling fine and fortunate,

“Dr. Liu performed an ablation procedure, which

and he is back at work.

took care of the atrial flutter very effectively.”


eConsults and eTumor Boards provide easy access to Mayo Clinic experts St. Clair Hospital’s clinical collaboration with Mayo Clinic means that

consult request is triaged to the most appropriate expert specialist. That

physicians are able to call upon a vast network of experts to help them solve

physician may elect to bring in other experts as she/he sees fit, to review

complex diagnostic and treatment challenges, at no additional cost to patients.

and comment on the case. The Mayo Clinic physician writes a response

Any of St. Clair’s physicians can initiate an eConsult or present a patient’s

that typically includes an analysis of the information, confirmation or

case at a live eTumor Board with Mayo Clinic specialists. The process is direct,

refinement of the diagnosis and/or treatment plan, or suggestions for

efficient and simple, and logistics are efficiently coordinated by St. Clair’s

treatment options. The information is presented in a concise, organized

Quality Improvement Department. Ashley Butler, R.N., MHA, Manager of

summary and, when appropriate, is followed up with a telephone conver-

Quality Improvement at St. Clair, says there have been dozens of Mayo Clinic

sation between physicians. The entire process often takes place in 24 to

eConsults, across a wide range of medical and surgical specialties, initiated

48 hours, but is guaranteed to occur within 2 to 4 days after a request and

by St. Clair physicians since the Hospital became a member of the Mayo Clinic

relevant medical data have been submitted.

Care Network approximately one year ago. Most have been sought in order

A physician who wants to discuss the case of a patient suffering from

to confirm a diagnosis, validate a treatment plan, or identify additional options

a cancerous tumor with the Mayo Clinic eTumor Board submits a request,

for treatment.

with relevant information, including pathology reports, to Mayo. At a

An eConsult — four of which are detailed in this issue of HouseCall —

scheduled time, St. Clair physicians and their counterparts at Mayo, along

begins with the requesting physician’s submission of relevant medical

with physicians from more than 40 other health systems across the U.S.

records, along with a consult request, to the Quality Department. The

and abroad that are part of the Mayo Clinic Care Network, conduct a live,

records, plus imaging studies and lab findings, are sent electronically.

interactive group discussion about the patient’s case. St. Clair’s dedicated

Clinical Integration Specialists Joanna Hughes, RN, BSN, MSHSA and

eTumor suite is outfitted with cameras, microphones and wall-sized

Victoria Andromalos-Dale, RN, BSN, PCCN organize the information and

monitors to facilitate the discussion with Mayo’s experts.

transmit it through a secure web portal to Mayo Clinic. At Mayo Clinic, the

Any St. Clair physician can attend the eTumor Boards.

But there were other cardiac-related complica-

because of any lack of confidence in my own

the advice I would have received had I gone to

tions. According to Dr. Liu, a carcinoid tumor

local doctors. I was completely satisfied with

Mayo Clinic in Minnesota.” Although John’s journey is not over yet, as

secretes serotonin, which affects the tricuspid

the quality of their care. The Mayo Clinic consult

heart valve. “The valve becomes thickened and

was a comfort. Physicians there confirmed the

he still has the valve replacement surgery down

leaks, causing blood to back up and the heart

impact of the carcinoid cancer and the recom-

the road, he is feeling relieved and confident.

to enlarge,” says Dr. Liu. “It’s called tricuspid

mended treatment for my heart condition.

“My case is very rare and complex. I am very

insufficiency. The valve needs to be replaced

I had the chance to see the written consult and

pleased with the care I received and the skill

eventually, sooner rather than later. We requested

I was impressed by how thorough the consult

of my doctors in Pittsburgh, all of which was

an eConsult with Mayo Clinic, which is well known

was. It was not a quick look, but an in-depth

borne out by the confirmation we received

for its expertise in valvular heart disease. Mayo

consult. In my opinion, it was comparable to

from Mayo Clinic.” n

Clinic cardiologist Vuyisile T. Nkomo, M.D., MPH, a subspecialist in structural heart diagnosis, agreed with our findings.” John says he and his wife were eager to take advantage of the opportunity to consult with physicians at Mayo Clinic. “We initiated the consult because we assumed that Mayo Clinic had probably seen a lot more cases of impact on the heart from a rare cancer like this,” he recalls. “I did not seek the consult

JEFFREY C. LIU, M.D. Dr. Liu earned his medical degree at Jefferson Medical College, Philadelphia. He completed a residency in internal medicine at the University of Maryland Medical Center, served as Chief Resident at the Baltimore VA Medical Center, and completed fellowships in Cardiovascular Medicine and Cardiac Electrophysiology at UPMC. Dr. Liu is board-certified in cardiovascular diseases, cardiology, cardiac electro-physiology and internal medicine by the American Board of Internal Medicine. He practices with South Hills Cardiology Associates, a division of St. Clair Medical Services. To contact Dr. Liu, please call 412.942.7900.

Volume IX Issue 2 I HouseCall I 11


THE VALUE OF A

second opinion RICHARD KAPUSTA:

A sight-saving procedure

I

t could be said that Upper St. Clair resident Richard Kapusta, Ph.D., is a man of exceptional vision. As a child psychologist,

The procedure at a Pittsburgh-based surgery center went well. But one week later, he awakened to find a gray area in his vision;

he sees the hurts and fears of troubled children and helps them

by the end of that day, he had undergone a procedure to repair five

find their way. As a teacher in the graduate schools at Duquesne

retinal tears and two detachments. In Richard’s case, it was an

University and California University of Pennsylvania, he helps

emergency procedure to avoid losing his vision. The repair procedure,

students envision their future careers. When the school year ended

vitrectomy, involves draining vitreous fluid (the gel-like substance

in the summer of 2016 for Bethel Park School District, where

in the eye) to make space for the insertion of an air bubble that

Richard worked as a school psychologist, he took the opportunity

presses against the retina to hold it in place while it heals and

to schedule cataract surgery. Cataract surgery is one of the most

re-attaches. The procedure itself is usually well-tolerated, but the

common operations performed in the U. S., and according to the

post-operative recovery is extremely challenging. In the eye, the air

National Institutes for Health, it is also one of the safest and most

bubble rises to the top, but the retina is at the back of the eye; to get

effective. Richard, 67, anticipated that he would sail smoothly

the bubble to float into place and stay there, holding the retina,

through the experience.

a nearly constant face-down posture is necessary. “I had to be

... my vision was saved by these doctors and institutions collaborating. RICHARD KAPUSTA, PH.D.,

PATIENT Richard Kapusta, Ph.D.

12 I HouseCall I Volume IX Issue 2


positioned sitting fully face down all day, with 10-15 minute breaks only,” Richard recalls. “I

KARL E. BUSHMAN, M.D., FACP

had to sleep on one side. I had to do everything

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 Mt. Lebanon Internal Medicine, a division of St. Clair Medical Services.

face down, including eating, for two weeks. I could barely do anything; I got through it with books on tape and listening to baseball.”

To contact Dr. Bushman, please call 412.942.8500.

After 30 days, his retina seemed stable and he was released from care. But a new retinal detachment in August — his third — meant going through the entire ordeal all over again.

Mayo Clinic provided exactly that. Sophie

having to leave home, have any further tests

“This time, the doctors placed a ‘scleral buckle’

J. Bakri, M.D., Mayo Clinic retinal specialist,

or assessments, without having to spend a

in my eye to hold the retina in place,” he says.

responded with a concise and specific consult

dime of my own money or have it billed to my

that validated the treatment plan in Pittsburgh.

health insurance. It's almost unbelievable.

“The Mayo Clinic consult puts a horizon in front

I'm so impressed that St. Clair has made this

says he got through the ordeal both times only

of you,” says Dr. Bushman, “so that you can

possible for the people of our community.

because of the unwavering support of his wife,

see everything laid out, all the possibilities that

“I still had to do the face-down positioning.” It was frustrating and tedious, and Richard

“Dr. Bushman and his staff took care of

Sue. Through her efforts, Richard acquired a

lie ahead. They validated the treatment and

every detail and I cannot say enough about

vitrectomy recovery chair, with flexible body

made suggestions about potential problems.

their competence and professionalism. It’s

supports and adjustable mirrors that made TV

They also consulted another specialist, who

been a long process, but hopefully the edema

viewing possible. “My wife focused completely

further confirmed that we were giving the

will be fully resolved soon. My vision is 20/20

on my care and recovery, and did everything

correct treatment.”

she could to help me; I was basically helpless.”

For Richard, the consult was everything he

now; I can read, drive and work again, and I love my work. Vision is precious, and my vision

had hoped for. "I was able to obtain a consult

was saved by these doctors and institutions

specialists here in Pittsburgh who saved his

from a cutting-edge institution with a global

collaborating. In my situation, the art and

vision. The scleral buckle they placed last

reputation for excellence in clinical expertise and

summer has been effective, but swelling in the

research, and I was able to have that without

Richard also gives credit to the skilled retinal

science of medicine came together, and

I’m grateful.” n

retina has persisted. So, when Sue reminded him that St. Clair Hospital was a member of the Mayo Clinic Care Network, and suggested he pursue a clinical eConsult with a Mayo Clinic specialist, he agreed that it was a great idea. He approached his primary care physician, Karl E. Bushman, M.D., FACP, an internist with the Mt. Lebanon Internal Medicine division of St. Clair Medical Services, about pursuing an eConsult. The issue, Dr. Bushman says, was: which medications were best for treating persistent macular edema after multiple retinal detach-

THIS WAS NOT

A CASE THAT YOU WOULD SEE IN A TEXTBOOK.

KARL E. BUSHMAN, M.D., FACP, INTERNIST, ST. CLAIR HOSPITAL

ment surgeries? This was not a case that you would see in a textbook; we needed an expert retinal specialist with a lot of experience.

Karl E. Bushman, M.D., FACP, Internist, St. Clair Hospital Volume IX Issue 2 I HouseCall I 13


MEN’S HEALTH

PROSTATE CANCER SCREENING

BRINGING CLARITY TO COMPLEX ISSUES If you have been confused by conflicting information in recent years regarding

New guidelines . . . recommend individualized rather than universal screening with the PSA blood test for men ages 55 through 69.

the need for prostate cancer screening, you are not alone. In 2012, a task force of medical experts advised against routine prostate cancer screening with the protein-specific antigen (PSA) blood test, because of the imprecise nature of the test. As a consequence, many physicians stopped ordering the test routinely, creating confusion among an American public that has been educated to believe in early detection of cancer through screening tests. Fortunately, new guidelines for PSA testing from the U.S. Preventive Services Task Force, released in April 2017, are bringing some clarity to this complex issue. They recommend individualized rather than universal screening with the PSA blood test for men ages 55 through 69.

Continued on page 16

THE MESSAGE TO EVERY AMERICAN MAN IS TO HAVE

A GOOD CONVERSATION WITH THEIR PRIMARY CARE PHYSICIAN ABOUT PSA SCREENING. SHAILEN S. SEHGAL,, M.D., UROLOGIST, ST. CLAIR HOSPITAL

14 I HouseCall I Volume IX Issue 2


PROSTATE CANCER:

Checking the Facts Over

220,800

estimated new cases of prostate cancer are diagnosed every year in the U.S.

RISK FACTORS:

1in7

FAMILY HISTORY:

The American Cancer Society estimates about one in seven American men will receive a diagnosis of prostate cancer in their lifetime.

Men with an immediate blood relative who has been diagnosed with prostate cancer are twice as likely to develop the disease.

RISK FACTORS:

PROSTATE CANCER IS THE SECOND MOST COMMON CANCER IN MEN IN THE UNITED STATES

2.5 MILLION MEN ALIVE IN THE UNITED STATES TODAY HAVE BEEN DIAGNOSED WITH PROSTATE CANCER

22%

DIET: A diet high in saturated fat as well as obesity, increases the risk of prostate cancer.

One in 36 men will die from prostate cancer, accounting for 22% of all male deaths from cancer.

RISK FACTORS:

The risk of being diagnosed with prostate cancer increases with age. AGE

30

40

50

60

70

Source: https://www.cancer.org/cancer/prostate-cancer.html

Is a PSA blood test screening for prostate cancer right for you? Consult your PCP.

Volume IX Issue 2 I HouseCall I 15


MEN’S HEALTH Continued from page 14

The PSA blood test measures a protein,

According to Shailen S. Sehgal, M.D., a

normally produced by the prostate, which can

board-certified urologist at St. Clair, active

be elevated in the presence of prostate cancer.

surveillance versus intervention for a non-

It is a non-specific test, however, that can also

aggressive prostate cancer can be a difficult

indicate infection, inflammation or benign

choice for patients. “The cancer may be

prostate enlargement. Detecting an elevated

insignificant and in need of only monitoring

PSA often leads to biopsy, and that in turn may

rather than treatment, but the idea of living

OFTEN ORDER THE PSA

be followed by surgery or radiation, which may be

with cancer is hard for many people. It’s

INITIALLY, AND THEY

unnecessary and may result in unwanted side

important to educate the patient and have the discussion of risks versus benefits of

SHOULD HAVE A DISCUSSION

effects, including impotence and incontinence. “The new guidelines walk back the previous guidelines, which discouraged PSA testing. This is a more neutral stance, and it encour-

treatment with surgery or radiation. It may be best to elect active surveillance.” Dr. Sehgal says the new guidelines for

ages a much more individualized decision,”

prostate cancer screening are aimed at

says Kevin P. Bordeau, M.D., a board-certified

primary care physicians and are in alignment

urologist at St. Clair Hospital. “Primary Care

with the clinical practice guidelines from the

Physicians often order the PSA initially and

American Urological Association. Above all,

they should have a discussion with their

the message to every American man is to

patients aged 55-69 about risks versus

have a good conversation with their primary

benefits. In my opinion, the first PSA should

care physician about PSA screening in order

be at age 50, but those with a family history

to receive the most appropriate level of

or those who are African-American should

PRIMARY CARE PHYSICIANS

WITH THEIR PATIENTS AGED 55-69 ABOUT RISKS VERSUS BENEFITS.

KEVIN P. BORDEAU, M.D.,

UROLOGIST, ST. CLAIR HOSPITAL

treatment for their individual situation.” n

have it earlier, at 40-45. The earlier people get prostate cancer, the more likely they are to die from the disease. If the patient is symptomatic, it should be done regardless of age.” Prostate cancer, the most common cancer in American men, is a single type of cancer, but with a continuum of aggressiveness, Dr. Bordeau explains. “When cancer is confirmed by biopsy, the aggressiveness

KEVIN P. BORDEAU, M.D. Dr. Bordeau 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. He practices with Sholder and Bordeau Urologic Associates, a division of St. Clair Medical Services. To contact Dr. Bordeau, please call 412.572.6194.

of the cancer is rated on the Gleason scale from 2 to 10, with 10 being the most aggressive. We don’t have to treat them all; we try to find the most aggressive cancers. Some men with

SHAILEN S. SEHGAL, M.D.

low-risk disease are candidates for active

Dr. Sehgal earned his medical degree at Cornell University and completed his urology residency training at the University of Pennsylvania. He completed a research fellowship at the National Institutes of Health and a robotic surgery fellowship at the University of Pennsylvania. Dr. Sehgal is board-certified by the American Board of Urology. He practices with the Center for Urologic Care.

surveillance, meaning that we check PSAs and do digital rectal exams every three months and treat only if there are signs of progression. The treatment is much better now; we do a lot of robotic urologic surgery at St. Clair and our patients do extremely well with that.”

16 I HouseCall I Volume IX Issue 2

To contact Dr.Sehgal, please call 412.833.3000.


ASK THE DOCTOR

Ask the Doctor WILLIAM T. DeCARBO, DPM, FACFAS

Q A

Do lateral ankle sprains need medical treatment?

Lateral ankle sprains are very common injuries in the

needed. For more severe injuries, an ankle brace or even a

general population, as well as in athletes. It has been

walking boot may be necessary to protect and “off load”

reported that 10 percent of all emergency room visits are

the ankle. Usually this is needed for just a few weeks. If

for this injury, with a reported 23,000 ankle sprains per day

there is residual pain and/or a lack of function, physical

in the United States. Forty percent of these injuries are

therapy is often offered to rehab the ankle back to a

athletic injuries. Even with the large number of reported

functional state.

ankle sprains, 55 percent of people experiencing a sprain

Sometimes lateral ankle sprains lead to chronic lateral

do not seek medical treatment. It is also reported that 29

ankle instability that needs further medical treatment and

percent to 42 percent of patients with a lateral ankle

evaluation. Often an MRI is necessary to evaluate the lateral

sprain will develop long term instability.

ligaments if a sprain does not respond to conservative

The lateral ankle is comprised of three ligaments that

treatment within a few weeks or months. When patients

collectively are called the “lateral collateral ligaments.” The

with a lateral ankle sprain are not able to return to normal

ligament “most anterior” is always injured with a sprain.

activity or sport after appropriate treatment for a

Based on the severity, the other two may be injured as well.

reasonable timeframe, surgical stabilization of the lateral

It’s important to note that a “sprain” is a partial tear of the

ankle may be necessary. (Surgical

structure. This is one reason that sprains that don’t get

stabilization involves repairing

better within a few days should be examined by a medical

the torn ligaments.) This is

professional.

patient-dependent and based

The main purpose of the lateral ankle ligaments is to limit abnormal motion and maintain joint integrity and stability. When the ligaments are sprained or partially torn

on patients’ specific needs, expectations and lifestyles. It is always a good idea to

due to injury, the joint stability is thrown off. This causes pain

seek medical advice for these

and a lack of function due to the injured ligament. With

injuries to ensure proper

appropriate treatment, including support and rest, about

healing and to return to

70 percent of these injuries get better within a couple of

everyday living and/

days to weeks. Appropriate treatment depends of the

or sport as soon

severity of the injury. Protected weight bearing (e.g., use of

as possible. n

crutches), rest, ice, compression and elevation, or the “PRICE” principle, is often applied first. If the injured ankle feels better in a couple of days, this is often all that’s

William T. DeCarbo, DPM, FACFAS

WILLIAM T. DeCARBO, DPM, FACFAS Dr. DeCarbo earned his Doctor of Podiatric Medicine at Ohio College of Podiatric Medicine, Cleveland. He completed his residency at Grant Medical Center, Columbus, and a surgical fellowship in foot and ankle at Orthopedic Foot and Ankle Center, Inc., Columbus. Dr. DeCarbo completed a traveling fellowship, learning advanced techniques in foot and ankle surgery nationally and internationally. He is board-certified by the American Board of Foot & Ankle Surgery in Foot, Reconstructive Rearfoot and Ankle Surgery. Dr. DeCarbo practices with St. Clair Orthopedic Associates, a division of St. Clair Medical Services. To contact Dr. DeCarbo, please call 412.942.7262.

Volume IX Issue 2 I HouseCall I 17


DONOR SPOTLIGHT

with children at Family Links or heading to a disaster-ravaged neighborhood toting buckets and brooms to clean houses, as she and her husband, Mark, an attorney in Pittsburgh, did after a devas-

___ WHY I ___

tating flood in Carnegie. She helped to create and still serves as Director of Fundraising for Upper

GIVE

St. Clair Veteran’s Park. And for all that she does in the community, Vicki was honored in late spring by the Crohn’s and Colitis Foundation of Western Pennsylvania as a Woman of Distinction. “My preference is to be hands-on, especially

Vicki McKenna

when it involves children,” she says. “I love children.

Donor

Mark and I were among the first couples in this region to adopt children from Russia. My children,

Vicki McKenna: A Heart for Giving

W

Andrew, 24, and Kylie, 23, are my greatest blessing. When they were in school, I became involved in the Upper St. Clair School District, serving

hen Vicki McKenna was a young girl growing up in Whitehall,

as PTA president and on the school board. When the kids graduated from

she was strongly impressed by the humanity of her father,

high school I graduated, too. It was time for me to go on to other things.”

Louis Anania. “My Dad was an inspiration,” she recalls. “I always

That led her to St. Clair Hospital. A friend who knew of her volunteer

saw him helping others. If he heard of a friend, neighbor or family member

activities recruited her to work on the annual Summer Swing, the Hospital’s

in need, he was the first to step in. He showed me how to have a heart.”

largest fundraising event. She also joined the St. Clair Hospital Foundation

Vicki learned the lesson well. She has a heart that is tireless, generous and overflowing with loving kindness. Her father’s legacy of compassion and altruism formed deep roots in his daughter, and the fruits of that legacy can be found throughout the region, in the numerous non-profits, organizations

board of directors and, for the past seven years, has

chaired Summer Swing. “Summer Swing has grown to become one of the premier events in Pittsburgh,

We support St. Clair because there has been

with attendance and revenue growing annually,” she says. “Mark and I are proud to support St. Clair,

and communities that Vicki has helped, including

such tremendous growth,

an independent and thriving hospital. My husband

St. Clair Hospital. She has graced these groups with

and we want to see

was one of the first babies born at St. Clair and our

her dynamic and charismatic presence and her formidable gifts as a leader, advocate, volunteer, planner and philanthropist. Vicki’s life of service to the Pittsburgh region began in Point State Park. A few decades ago, she

that continue.

entire family benefits from its services. We support St. Clair because there has been such tremendous growth, and we want to see that continue. Mark and I have confidence in the physicians and admin-

VICKI McKENNA, DONOR

istrators at St. Clair, and we encourage everyone

attended a Make-a-Wish fundraiser hot-air balloon

in the community to donate and volunteer. We have

event there. For the crowd of children, families and

a jewel of a hospital right here in our backyard;

volunteers, it was a delightful spectacle, but for Vicki, it was transformative.

it’s a nationally recognized health care facility and a source of pride for

As the colorful balloons lifted off into the blue summer skies over

the community.”

Pittsburgh’s three rivers, something extraordinary was ignited in Vicki:

Vicki plans to step down as chairperson after this year’s Summer

an overwhelming passion to get involved, to serve and to give. She imme-

Swing, but she will remain involved. “We all have so much to give.

diately signed on as a volunteer for Make-a-Wish, the first step in a lifetime

You don’t have to donate money; you can give your time, your skills, your

of giving to that organization.

creativity or talents.” Propelled by gratitude for the gifts and blessings

For nearly 30 years, Vicki has been on the front lines, helping others

she has received, she firmly believes in giving back. Those values —

wherever there is human need. Her giving is often direct, hands-on and

gratitude and giving — are the themes of her life, and service is her

personal. Although she is renowned for her expertise in planning gala

mission. “You do what you can. I volunteer because it’s my passion; it’s in

fundraising events, she is also well known for getting on the floor to play

18 I HouseCall I Volume IX Issue 2

my heart.” n


1

#

in the region

QUALITY

CARE

PATIENT

SAFETY

PATIENT SATISFACTION

VALUE AND COST

TRANSPARENCY

PROVIDING THE HIGHEST LEVEL OF CARE TO OUR PATIENTS IS OUR GREATEST REWARD St. Clair Hospital is consistently rated as the market leader for quality, patient safety, patient satisfaction, value, and cost transparency. These accomplishments reflect St. Clair’s culture of continuous improvement, one that has been recognized by a host of independent third-party evaluators. It’s patient-focused care that is propelling us to not only be the best regionally, but among the best in the nation as well. It’s all part of our pledge to provide the best health care to our patients. Sources: Comparion Medical Analytics; The Leapfrog Group; Press Ganey; CMS

1000 BOWER HILL ROAD

.

M T. L E B A N O N , P E N N S Y LV A N I A 1 5 2 4 3

.

412.942.4000

.

STCLAIR.ORG

Volume IX Issue 2 I HouseCall I 19


1000 Bower Hill Road Pittsburgh, PA 15243 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. Clair offers peace of mind about health care costs

A

T ST. CLAIR HOSPITAL, patients can enjoy the peace of mind that comes from knowing that

St. Clair also provides patients with an online cost transparency tool so they can learn ahead of time what

the high quality health care services they are receiving

their estimated out-of-pocket costs will be for services

are likely to be covered by their health insurance plan.

provided by the Hospital or its Outpatient centers, such

At St. Clair, all major health insurance plans are accepted; St. Clair participates with every major insurer in nearly every insurance product. Not only is St. Clair

as diagnostic tests and procedures. Called Patient Estimates, it is a user-friendly, interactive tool available 24/7 on the Hospital’s website. If you are planning to obtain a health insurance plan,

an in-network provider for

through your job, or independently, make sure St. Clair

these plans, it is frequently the

will be in your provider network. To view a complete list

lowest-cost provider, so those

of insurers who are currently contracted with St. Clair

who have plans that require

to provide services to their members, please visit

cost-sharing, through high deductibles or co-payments, are likely get the most costeffective care in the region at St. Clair.

www.stclair.org. For more information about whether your health insurance plan gives you access to St. Clair’s highly rated, nationally-recognized services at in-network rates, call 412.344.3408 to speak to a Hospital representative.

The online St. Clair Patient Estimates tool takes the mystery out of health care costs.

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.

All major health insurance plans are accepted at St. Clair.

@StClairHospital

St. Clair Hospital_HouseCall Vol IX Issue 2  

St. Clair Hospital's community newsletter sharing new medical technologies, patient stories and health tips.

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