VOLUME IX ISSUE 2
THE VALUE OF A
Collaboration between St. Clair and Mayo Clinic yields patient benefits and positive outcomes
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
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.
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
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.
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
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
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,
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.
Jeffrey C. Liu, M.D., Electrophysiologist, St. Clair Hospital
10 I HouseCall I Volume IX Issue 2
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,
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
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
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
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
Checking the Facts Over
estimated new cases of prostate cancer are diagnosed every year in the U.S.
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.
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
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.
The risk of being diagnosed with prostate cancer increases with age. AGE
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
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
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
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
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
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
when it involves children,” she says. “I love children.
Mark and I were among the first couples in this region to adopt children from Russia. My children,
Vicki McKenna: A Heart for Giving
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
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
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
in the region
VALUE AND COST
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
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
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.
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.