VOLUME IX ISSUE 4
IMPROVING MENTAL HEALTH
“Cancer is a disease that wants to kill you; my depression is a disease that makes me want to kill myself. As complex a problem as this poses, the professionals in St. Clair‘s Psychiatry and Mental Health Services were able to look through the kaleidoscope of my illness, and replace it with a telescope, allowing me to see a future I didn‘t think was possible just a few weeks ago.” – JOHN, PATIENT WITH SEVERE DEPRESSION
2 I HouseCall I Volume IX Issue 4
On the FOurth FlOOr OF St. Clair hOSpital, there is a place where the science of medicine meets the art of human relationships: the Department of psychiatry and Mental health Services, a place where anyone who is experiencing mental or emotional distress can ﬁnd the highest quality, state-of-the-art treatment, along with genuine compassion and solid support. St. Clair’s psychiatry Department is staﬀed by a multidisciplinary team of professionals whose commitment to their mission is evidenced by the longevity of their service and the passion with which they speak about their work. they are people whose exemplary professional skill is matched by the depth of their humanity; they are prepared and eager to oﬀer their graceful expertise to those who are struggling and suﬀering with emotional pain, behavioral problems and mental illness. they want to help, they know how to help and they are right here, in the heart of this community.
ental illness is common, treatable and blameless. It is primarily
a medical condition, a disorder of the brain, and it is impacted
by a complex of factors: biological, genetic, emotional, spiritual
and social. It is not the result of a weakness of character. Mental
illness can change one’s thinking, emotions, moods, productivity
and relationships; it can cause enormous distress and prevent people from
American adults experience mental illness requiring treatment in any given year.
fulfilling themselves and fully enjoying their lives. Just like physical illness ranges from the common cold to cancer, mental illness has a range; some conditions are more serious and require higher levels of attention and intervention than others. At some point in their lives, nearly everyone experiences, in themselves or a close family member, a behavioral problem, mental illness or emotional disorder that will benefit from treatment. People from all walks of life and all seasons of life experience mental illness. According to the National Association for the Mentally Ill (NAMI), one in five American adults, or 44 million, will experience mental illness
18% of American adults are affected by anxiety disorders.
severe enough to require treatment in any given year. One in 25 lives with a serious mental illness. Anxiety disorders affect 18 percent of American adults; 7 percent live with major depression; and 2.6 percent live with bipolar disease. Ten million American adults have co-occurring mental illness and addiction disorders. The most common forms of mental illness are depression and anxiety disorders; other types include obsessivecompulsive disorder, bipolar disorder, post-traumatic stress disorder, eating disorders, schizophrenia, psychosis, addiction and substance abuse. Continued on page 4
American adults have co-occurring mental illness and addiction disorders.
Volume IX Issue 4 I HouseCall I 3
IMPROVING MENTAL HEALTH Continued from page 3
“There is a misconception that mental illness is permanent, but the reality is that people generally recover from mental illness,” says Bruce A. Wright, M.D., chair of St. Clair’s Department of Psychiatry. Psychiatric care in 2018 is evidence-based and includes medication, various types of psychotherapy, and electroconvulsive therapy. The psychiatrists who diagnose and treat mental illness are medical doctors who care for the whole person and address both the mental and physical aspects of mental illness, including prescribing medications and monitoring the response to them. Like other physicians, psychiatrists save and improve lives. “People with mental illness don’t always get better quickly, but they generally do get better,” says Dr Wright. “At St. Clair, we strive to provide excellent service with a tremendous, top quality team. Our reputation brings people here from all over the region, beyond the South Hills. St. Clair has always been committed to providing the community with quality psychiatric service.”
THERE IS A MISCONCEPTION THAT MENTAL ILLNESS IS PERMANENT, BUT THE REALITY IS THAT PEOPLE GENERALLY RECOVER FROM MENTAL ILLNESS .
BRUCE A. WRIGHT, M.D., CHAIR, DEPARTMENT OF PSYCHIATRY, ST. CLAIR HOSPITAL
Bruce A. Wright, M.D.
BRUCE A. WRIGHT, M.D. Dr. Wright is Chair of St. Clair’s Department of Psychiatry. He earned his medical degree at the University of Pittsburgh School of Medicine, and completed his residency at UPMC/Western Psychiatric Institute & Clinic. Dr. Wright is board-certified by the American Board of Psychiatry & Neurology-Psychiatry. He practices with Associates in Clinical Psychiatry, PC. To contact Dr. Wright, please call 412.347.0170.
4 I HouseCall I Volume IX Issue 4
the state of psychiatry Despite the pervasiveness of mental illness in the U.S., access to appropriate treatment is often problematic. Bruce Sutor, M.D.,
Dr. Sutor says that the availability of potent illegal drugs adds fuel to the fire. “People expose themselves to whatever is in their environment.
Psychiatrist and Assistant Professor of Psychiatry at Mayo Clinic in
Once it was alcohol; now they have access to drugs that affect their
Rochester, Minn., says that even with high quality psychiatric services,
brain development and functioning.” Lack of parity in mental health
lack of access means that many people are not getting the care they
care is another problem, Dr. Sutor says. “Insurers should pay for mental
need. Dr. Sutor defines quality psychiatric care as “reasonable access
health care just as they pay for cancer care.”
to care in a reasonable period of time.” “Psychiatry is in a critical state,” he explains.
A good interdisciplinary team is essential to quality care, Dr. Sutor says. “A good team has people who can assess individual needs, including
“There’s a lack of preventive services, so people
the need for community support. Support must be included, especially
go to the Emergency Room when they’re in
with chronic mental illness. Support can prevent the drift into poverty
crisis and have not been receiving any preven-
tive or maintenance care. Imagine if the same was true for heart disease, if there was no preventive cardiac care and people only sought care when they were in critical need. Bruce Sutor, M.D.
Many hospitals, especially community and rural hospitals, no longer have psychiatric
services. This compounds the shortage of psychiatric beds that followed the de-institutionalization movement of the 1960s, when President Kennedy initiated efforts to make psychiatric care more communitybased. There is a serious shortage of psychiatrists: the psychiatrists now practicing have a mean age of 55, and medical students in adequate numbers aren’t choosing the specialty.”
psychiatry at St. Clair The dilemma facing psychiatry is that more people than ever need mental health care services, but there are fewer and fewer facilities and providers to care for them. According to the National Alliance on Mental Illness, only 41 percent of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9 percent received mental health services in the past year. St. Clair Hospital is an exception to this trend, as a full-service hospital with multiple levels of care that provide expert help for anyone who is experiencing mental illness. The psychiatric service encompasses a continuum of programs designed with great care to correspond to specific community needs and to complement each other seamlessly, so that transitions are smooth. This includes emergency psychiatric care; inpatient care; outpatient programs; support groups; community outreach; consultation services; suicide prevention; an in-hospital delirium task force; and a program for mothers with postpartum depression. “Mental health is a priority issue at St. Clair,” says Kathe Dvorsak, M.S.N., R.N., Director of Psychiatry and Mental Health Services. “It has been identified as a critical issue in our community. We provide excellent care and we want the community to know that we are here to help anyone who is suffering with mental or emotional problems. You have somewhere to go.” Continued on page 6
Never give up on someone with mental illness. When“I”is replaced by “we” illness becomes wellness. ’ Volume IX Issue 4 I HouseCall I 5
IMPROVING MENTAL HEALTH Continued from page 5
inpatient care Most people with mental illness do not need to be hospitalized, but
Mental health is a priority issue at St. Clair.
when they do, it is usually for the purpose of stabilization, closer monitoring, establishing a diagnosis and devising an appropriate treatment plan. That is what takes place on the Fourth Floor inpatient unit that is one component of St. Clair’s comprehensive mental health service. A bright, warm environment, it is thoughtfully designed to be therapeutic. The department is a deliberate contrast to the outmoded and negative
KATHE DVORSAK, M.S.N., R.N., DIRECTOR OF PSYCHIATRY AND MENTAL HEALTH SERVICES, ST. CLAIR HOSPITAL
images of psychiatric wards depicted in movies; here, one will not find patients clad in hospital pajamas sitting, smoking and watching TV. Instead, patients interact with each other and the staff throughout busy days filled with therapy sessions, group meetings, meals in a community dining room, and activities. It is a purposeful place, and the purpose is healing. In the department, a multidisciplinary team of physicians, nurses, social workers, counselors and therapists collaborate to create and implement an individualized plan of care for each patient. Although the majority of the patients on the inpatient unit have depression or anxiety disorders, some are also being treated for substance abuse, which is strongly associated with mental illness. Most patients receive medication, which Dr. Wright calls one of the important components of psychiatric treatment, along with individual and group therapy and patient/family education. Electroconvulsive Therapy (ECT) is an option for select patients with severe depression (please see sidebar on pages 12-13). The entire team meets daily to discuss and update each patient’s plan of care. Kathe says that the nurses are the core of the inpatient care team. “A good psychiatric nurse has excellent teaching and communication skills, and is an especially skilled listener. Nurses are problem solvers, skilled at recovery planning and crisis management; they are intuitive about psychosocial issues. We have 25 highly experienced nurses and low turnover. We are unique at St. Clair in that our nurses facilitate group therapy along with our therapists. On most psychiatric units, therapists have that role, but we believe that there is an advantage to also having nurses in that role: they look at the patient holistically, which is helpful to patients who also have medical issues and comorbid conditions. We are also unique in the nursing model that we utilize. Each nurse has a primary patient assignment where 1-to-1 interactions can be provided. The assigned nurse works with each patient to develop and monitor their treatment plan and assist them in developing daily goals, which will help the patient toward a successful treatment outcome. Many psychiatric units only use nurses to administer medications and to be in charge. As a psychiatric nurse for 30 years, I see what value psychiatric nurses bring to the inpatient setting;
Kathe Dvorsak, M.S.N., R.N.
6 I HouseCall I Volume IX Issue 4
We never give up on anyone.
DUBA WEINSTEIN, B.S., O.T.R./L. PSYCHIATRIC OCCUPATIONAL THERAPIST, ST. CLAIR HOSPITAL
Duba Weinstein, B.S., O.T.R. /L.
the psychiatric nurses at St. Clair are no exception. They are extremely
Many patients haven’t been living disciplined lives, and we believe that
valuable to our patients.
mental health patients need routines and healthy habits to give structure
Our social work staff is another integral part of the quality of the psychiatric unit. They work hard right from admission to assess the patient’s needs for discharge. The aim is to provide continuity of care with outpatient providers, so that patients have access to the resources
and organization to their days. When it is time for group therapy, the phones and televisions are turned off.” Patients leave St. Clair with new skills, she adds. “Each patient receives an individualized, self-help workbook called WRAP: Wellness
they need to prevent another crisis requiring hospitalization. In addition
Recovery Action Plan, that helps them become more self-aware.
to outpatient treatment, social workers provide resources, plan and/or
WRAP is an evidence-based program that teaches you to recognize
arrange for a variety of social needs the patient may have, from access
your patterns and identify your hot buttons. It’s very creative, but
to care, home care, housing, and drug and alcohol treatment.”
equally practical; it gives you a plan and tools to deal with things, and
Another distinctive aspect of St. Clair’s psychiatric program is the
that is empowering. In the grips of depression or addiction, people feel
presence on the team of a psychiatric occupational therapist and two
powerless. It feels like the disease has the power, but you can learn
recreational therapists who facilitate group therapy and offer a specialized
how to take your power back.”
approach to patient needs according to their educational background and clinical expertise. “It’s unusual now to find an O.T. on a psych unit, but
“I get to see lives transformed here. We have a high quality program and we see people recover. We never give up on anyone.”
O.T. actually has its origins in psychiatry,” Duba Weinstein, B.S., O.T.R. / L.,
Continued on page 8
Psychiatric Occupational Therapist, St. Clair Hospital, says. “I coordinate the therapy group programming committee, which oversees the content and structure of the groups. My colleagues in Recreational Therapy and I have incorporated an art group, music group and exercise group. The art and music are not a time filler — they’re a way to get you out of your head and be expressive.” Duba says that the inpatient unit employs a holistic model of care that includes medications, cognitive behavior therapy and group therapy. “In the past, patients did not have to go to group, but we changed that.
Often it’s the deepest pain which empowers you to grow into your highest self. Volume IX Issue 4 I HouseCall I 7
IMPROVING MENTAL HEALTH Continued from page 7
THESE PROGRAMS CAN BE LIFE-CHANGING.
MINDY HUTCHINSON, M.D., PSYCHIATRIST, ST. CLAIR HOSPITAL
Outpatient care There are two outpatient psychiatric programs offered by St. Clair: the Partial Hospitalization Program (PHP) and the Intensive Outpatient Program (IOP), supervised by Jeannie Conklin-Kauf, R.N. Both programs are short-term: most patients attend for an average of three weeks, during which they participate in highly focused, multifaceted group therapy and education sessions. The PHP program is scheduled for six hours a day, four days a week, and the IOP consists of day or evening sessions of three hours, three times a week. According to Jeannie, the outpatient programs provide a transition from the Hospital, but they can also be an alternative to the Hospital. Patients come to the groups via transfers from the inpatient unit, by referral from physicians and therapists in the community and by self-referral. The groups are diverse, consisting of 6-10 patients with a variety of diagnoses. The entire care team of psychiatrists, nurses, recreational therapist, licensed clinical social worker and a licensed professional counselor work with the groups every day. “Group therapy is very specialized; all of us are trained in group therapy. Our patients become educated and empowered in the groups,” says Jeannie. Psychiatrist Mindy Hutchinson, M.D., works with patients in both the PHP and IOP and says that the outpatient groups are intermediate levels of care that can provide all the treatment one would get in the Hospital. “People can really be struggling, but they don’t necessarily need to be in the Hospital; these programs allow them to work parttime and be home in the evening. Most hospitals have closed their outpatient programs; I’m proud that St. Clair offers them. These programs can be life-changing.” Jeannie adds the outpatient programs provide quality care and therapy, which embraces St. Clair’s culture of excellence. Jeannie says that the groups provide patients with resources that help them manage their symptoms and function more effectively. “They learn coping skills; they learn about cognitive behavior therapy, which helps change their negative thoughts, which in turn, changes their mood and decreases anxiety.
Mindy Hutchinson, M.D.
MINDY HUTCHINSON, M.D.
Dr. Hutchinson specializes in psychiatry. She earned her medical degree at Northwestern University Medical School, completed her residency at George Washington University Hospital, and a fellowship at Children’s National Medical Center, both in Washington, D.C. Dr. Hutchinson is board-certified by the American Board of Psychiatry & Neurology-Psychiatry. She practices with St. Clair Medical Services. To contact Dr. Hutchinson, please call 412.942.4860. 8 I HouseCall I Volume IX Issue 4
In addition to cognitive behavior therapy, the staff are also trained in the WRAP program. So much support is given, and this makes it possible for people to continue to get well after they are out of the group.” “My WRAP action plan is like a toolbox to go,” says Jane, a patient with bipolar depression. “All your resources are in there: a daily maintenance plan, self-care strategies, establishment of a routine, and a plan for dealing with crisis and even for post-crisis. It’s thorough. The daily maintenance plan is the beginning of the action plan and is essential for all the other parts of it. It’s so important to have structure; structure is something that you can count on. I can’t overstate how much that helps. I’m so glad to have this — it’s enormously helpful; it takes away a lot of anxiety.” Most gratifying, Jeannie says, is the cohesiveness that develops among group members. “There is a therapeutic component that the group brings out in all the participants. They develop altruism. When it’s going well, it feels like electricity. The patients build relationships;
Just when the caterpillar thought the world was over, it became a butterfly.
they develop a team among themselves and learn to trust each other. They become another support system. People want to get better, and the outpatient group serves as an anchor for them. Hope and positivity are the themes in all that we do. You do not have to suffer. There is hope. There is help and it is right here, nestled in the South Hills at St. Clair Hospital.”
what is delirium? Delirium is a syndrome characterized by a sudden change in an individual’s mental state or behavior. Also called acute confusional state, it can occur in hospitalized patients, who
Continued on page 11
Acute Confusional State
dementia is generally a chronic rather than acute condition. Delirium has many
psychiatrist Bruce A. Wright, M.D. was developed at St. Clair. The task force works to improve the early identification and treatment of patients with
possible causes and can
delirium. Delirium Task Force members include
happen at any age, explains
physicians, nurses, and a pharmacist; they have
Kathe Dvorsak, M.S.N., R.N.,
Director of Psychiatry and Mental
developed a protocol and an education program to assist physicians and nursing staff to recognize
become confused in their thinking and their
Health Services at St. Clair Hospital. These
delirium, including the use of an assessment
perception of their environment.
include infections, such as pneumonia or a
tool known as the CAM (Confusion Assessment
urinary tract infection; imbalances in the blood
Method). In addition, education was provided
appearing within hours or over a few days.
chemistry, as a result of illness or dehydration;
on evidence-based standards of treatment,
Symptoms of delirium may include restlessness,
fever; extreme pain; sleep deprivation; medication
including appropriate medications to alleviate
rambling or illogical speech, inability to focus,
side effects; and drug or alcohol withdrawal.
the patient’s symptoms, hydration and pain
hallucinations, disorientation and personality
Delirium can be worse for those who have
relief, and environmental modifications.
changes, including aggression. Symptoms may
sensory deficits, such as vision or hearing loss.
fluctuate and are frequently worse at night.
For older adults, one of these factors, plus the
includes reversing the conditions that brought
change in environment that hospital admission
it on, the symptoms of delirium may
entails, can trigger symptoms of delirium.
persist after the underlying problem
The onset of delirium is rapid, with symptoms
Delirium can be quite alarming to family members, who are often the first to note the sudden change in the patient. They may be
Since patients with delirium can be very
concerned that their loved one has developed
difficult to care for and their safety is a priority,
dementia, which has similar symptoms. However,
a special Delirium Task Force led by Kathe and
Although medical management of delirium
has been treated. Providing emotional support to the patient and family is paramount. n
Volume IX Issue 4 I HouseCall I 9
IMPROVING MENTAL HEALTH
Mental illness is an illness like any other. Anyone can get an illness, including a mental illness. It ,s important to realize that people live through it and recover. You have to be willing to do whatever it takes and give it time. I have many tools: therapy, a support group, medications and my psychiatrist; I need them all and it can be hard work, but I am living my life. – JANE, PATIENT WITH BIPOLAR DEPRESSION
Help and hope in many forms Snap out of it. You’ll get over it. Tough it out. Suck it up. It will make you stronger. Misunderstandings about mental
and even families. According to National Alliance on Mental Illness,
illness lead people to make comments like these to persons who
treatment, and the stigma is a major factor.
are suffering. St. Clair’s psychiatry professionals address these misconceptions in educational meetings for patients, families and
60 percent of adults with treatable mental illness are not receiving “Secrecy and stigma are an enormous problem,” says Dyan Conaway, R.N. “The stigma of mental illness stops people from getting
community outreach groups. Their message is consistent: mental
the help they need. Because of it, they delay getting help, and then
illness is illness, just like hypertension or diabetes. It can affect
it’s hard to get an appointment, and what began as mild depression
anyone. People get better. Mental health is an integral part of overall
intensifies and becomes suicidal thoughts.”
wellness. If you or someone you care about is suffering from depres-
Duba Weinstein, B.S., O.T.R. / L. says that patients can begin to
sion, anxiety or other forms of mental illness, St. Clair can help you.
believe the stigma. “They feel ashamed and the shame seeps into their sense of self. One of the tools in our WRAP action plan is a section
THE STIGMA OF MENTAL ILLNESS There is a stigma associated with mental illness that persists throughout society, promoting fear and harsh judgment of the mentally ill and causing greater suffering. The stigma, along with misconceptions about mental illness, are impediments to recovery, making people with mental illness feel ashamed and misunderstood. The stigma is a form of discrimination that causes people to be devalued by others in their communities, workplaces
10 I HouseCall I Volume IX Issue 4
on how not to take other people’s uninformed comments personally, even when it is your loved ones saying these things.” While some believe that there has been progress, there is still a long way to go, says psychiatrist Jacob W. McBride, D.O. “Stigma needs to be addressed as a matter of public policy. It’s helpful when celebrities speak out, as former Steelers quarterback Terry Bradshaw did when he spoke about his struggles with depression and became a champion for removing the stigma of mental illness.” Dr. Wright adds, “People don’t talk about mental illness because of the stigma. Unfortunately, people do judge and label those with mental illness. When people are open about mental illness, it helps
erase the stigma and encourages others to seek help.” n
Continued from page 9
Community support Community outreach is an extremely important component of St. Clair’s overall philosophy to ensure that the community is supported regarding mental illness and educated about mental health. St. Clair offers community Mental Health Support Groups, open to everyone, in two locations in the area. These groups are designed to help anyone cope with the challenges of mental illness and emotional problems, including family members of mental health patients. “The support groups address an enormous need,” says Duba Weinstein, B.S., O.T.R./L., Psychiatric Occupational Therapist, St. Clair Hospital. “They’re held twice a month, in Bridgeville and Bethel Park. The groups are inclusive and the focus is on empowerment, through acquiring skills and knowledge. There are 25-35 people in each group, usually; we have regulars and new people come all the time; they are very dynamic groups. We encourage people to bring loved ones.” Mental Health nurse Dyan Conaway, R.N. works with the support groups and says that for many people, a support group is all you need. “St. Clair’s support groups give you tools, education, a safety net of support, socialization and peer support. Mental illness is isolating, and the stigma adds to the loneliness. Support groups are a safe place where you will be treated with great respect. There is great power in groups.” n
FOR A COMPLETE LISTING OF ALL PSYCHIATRY AND MENTAL HEALTH SERVICES AT ST. CLAIR HOSPITAL, PLEASE VISIT STCLAIR.ORG.
St. Clair Psychiatry and Mental Health Services team members, from left to right: Jeannie Conklin-Kauf, R.N., supervisor, PHP and IOP outpatient programs; Lynn McGann, LCSW; Kathe Dvorsak, M.S.N., R.N., Director, Psychiatry and Mental Health Services; and Cathie Kalas, R.N.
Support groups are a safe place where you will be treated with great respect. There is great power in groups.
DYAN CONAWAY, R.N., MENTAL HEALTH NURSE, ST. CLAIR HOSPITAL
Dyan Conaway, R.N.
Volume IX Issue 4 I HouseCall I 11
IMPROVING MENTAL HEALTH
A PATIENT’S STORY:
JANE — TREATING BIPOLAR DEPRESSION WITH ECT. ollywood has given the world a false and frightening image of electroconvulsive therapy (ECT), once known as shock treatments, in movies such as “One Flew Over the Cuckoo’s Nest” and “The Snake Pit.” These inaccurate depictions, says St. Clair Hospital psychiatrist Kenneth von der Porten, M.D., PhD. have done a disservice to psychiatric treatment and to patients who may benefit from ECT. “ECT is one of the best treatment options we have
ECT is a relatively benign procedure that induces a brief,
for severe depression,” he says. “Fortunately people
generalized seizure. The treatment is used by psychiatrists
are more sophisticated today and most know better than
primarily as a treatment for severe, medication-resistant
to believe the movie portrayals. People may be initially
depression; it is also useful, although rarely used, for
resistant to ECT, but when the procedure and the benefits
treatment of mania, Parkinson’s, psychosis and to break
and potential risks are explained, the patient can make
status epilepticus, a dangerous type of prolonged seizure.
an informed decision and most are willing to try it.
The exact mechanism by which it works is not fully
ECT is a safe and effective treatment for severe
understood, but it can be very effective and it can work
medication-resistant depression and other types of
quickly. It came into use in the late 1930s, before there were
mental illness. It’s not cruel and is never punitive.”
effective psychotropic medications, and was widely used
ECT can save your life, says Jane, a middle aged
in psychiatric hospitals at the time. It fell out of use when
woman with bipolar depression who has been receiving
Thorazine and other medications emerged in the 50s and
ECT treatments for 20 years. Her psychiatrist, Bruce A.
60s, but has made a comeback. In its current form, it is
Wright, M.D., proposed it to Jane after several years
significantly modified from its original form in order to
of anti-depressant medication and therapy were not adequately relieving her depression. Bipolar depression is more challenging to treat, he says,
get maximum benefits with minimal side effects. At St. Clair, patients can view an educational video about ECT. Most often, it is started while the patient is
because the person with bipolar depression also
in the Hospital, which gives them an opportunity to talk
has episodes of mania. “It was a hard decision
with others who have experienced it. After that, ECT is
and I was initially scared,” she recalls. “My husband is very supportive and he encouraged me to try it. Over the years, the procedure
provided in the Outpatient Surgery Department. Dr. von der Porten is one of several St. Clair psychiatrists who perform it there. He initially does an assessment to determine
has changed and it’s easier now. It was
whether the patient has a depression that might respond
a much bigger deal 20 years ago; now
to ECT, since certain types of depression and other factors
may make success less likely. A medical consultant
ECT IS A SAFE AND EFFECTIVE TREATMENT FOR SEVERE MEDICATION-RESISTANT DEPRESSION.
KENNETH VON DER PORTEN, M.D., PhD. PSYCHIATRIST, ST. CLAIR HOSPITAL
KENNETH VON DER PORTEN, M.D., PhD.
Dr. von der Porten specializes in psychiatry. He earned his medical degree at Texas A&M University College of Medicine, College Station, Texas. He did his post-graduate training at UPMC Western Psychiatric Institute & Clinic, where he also completed a fellowship. He is board-certified by the American Board of Psychiatry & NeurologyPsychiatry. Dr. von der Porten practices with Associates in Clinical Psychiatry, PC. To contact Dr. Porten, please call 412.347.0170. 12 I HouseCall I Volume IX Issue 4
assesses any medical risks that would enter into the
Jane receives ECT on a monthly basis. She is doing
decision. The treatments are performed in the Post-
well and she knows that if her symptoms get worse,
Anesthesia Care Unit (PACU) and involve inserting an
she can increase her ECT treatments. She recommends
intravenous line. Electrodes are placed on the patient’s
that persons with depression and other types of mental
scalp as a means of passing the electric current, and
illness approach all treatment, including ECT, with an
vital sign monitors are attached. An anesthesiologist
open mind. “If your doctor recommends ECT, you
gives the patient general anesthesia and a muscle
should definitely give it a try, especially if your meds
relaxant. A small amount of electrical current is
aren’t working well. It’s an option, and to manage
delivered and triggers a seizure, while an EEG (elec-
depression, you need all the tools you can get. ECT is
troencephalogram) records constantly to measure
one part of my treatment; I also participate in the
brain activity and document the seizure. The actual
support groups and I take anti-depressant medication.
seizure takes only about 20 to 60 seconds. The patient
Mental illness is just another illness — you manage it
wakes up in the Recovery Room in about 5 to 10 minutes,
like any chronic illness. St. Clair has given me many
and may be groggy for a few hours. The patient does
resources to do that; the whole program is well thought
not feel the seizure, but may experience a mild
out. For me, St. Clair has been wonderful.” n
headache or mild muscle aches. Jane experienced some memory loss in the early days of her treatments, which eventually resolved. “I didn’t want to lose my memories of my children’s childhoods. The doctors made adjustments to my treatments and my memory improved. There is no pain with ECT; sometimes I get a slight headache and I’m sleepy for a while after a treatment, but that’s all.” Most people need six to eight sessions, three times
“St. Clair Hospital has been wonderful. The staff is supportive; the nurses are kind, caring and giving. Everyone is there for you, and they want you to get well.” – JANE, PATIENT WITH BIPOLAR DEPRESSION
a week, to get results. If that does not produce a good response, Dr. von der Porten says, then treatment can be extended — generally to a maximum of 12, although there is no hard and fast rule. “Occasionally, because major depression tends to be recurrent, a patient may need to be maintained with ECT on a longer term basis.”
Volume IX Issue 4 I HouseCall I 13
IMPROVING MENTAL HEALTH
MENTAL HEALTH LIAISON
A collective effort in treating mental health emergencies “It is perfectly okay to come to the Emergency Room with a mental health problem,” says St. Clair Mental Health nurse Dyan Conaway, R.N. “Mental health emergencies occur just like physical health emergencies.
and more. The common denominator is the need for immediate professional help. Dyan works the evening shift in the ER. “People sometimes come
At St. Clair, our ER is totally prepared to help you or your loved one having
in to the ER at the encouragement of family or friends, but often come
an acute mental health, emotional or behavioral problem.”
of their own accord,” she explains. “We perform both a mental health
The Mental Health Liaison Program is an integral part of St. Clair’s wide-ranging psychiatric service. A team of psychiatrists and registered nurses with
assessment and a medical assessment. Sometimes, psychiatric symptoms are due to a medical problem. With severe depression or anxiety, a person’s decision-
advanced training in the care of persons with mental
IF YOU NEED HELP,
health emergencies comprise the team, which serves
JUST COME TO
the entire Hospital. The nurses work on-site in St. Clair’s
THE ER AND WE’LL
alcohol are part of the picture, it is both a medical and
highly rated ER, in a quiet section where there is a
TAKE CARE OF YOU.
space dedicated to mental health, with three private exam rooms and a mental health office. There, people experiencing acute distress are greeted with the reassuring presence of seasoned, caring professionals who are there specifically to evaluate them, provide care and direct them to appropriate resources.
mental health crisis, you are not yourself. If drugs or
For many Americans, the point of entry into the mental health care system is an ER. The ER serves as a safety net and is the only option for some patients, due to the
DYAN CONAWAY, R.N., MENTAL HEALTH NURSE, ST. CLAIR HOSPITAL
That is immensely important to patients who have come to the ER
making may be impaired; in the full throes of an acute
gaps in services resulting from shortages of psychiatric hospital beds and psychiatrists. For others, the stigma surrounding mental illness is a factor that may have
prevented them from seeking care earlier, before their problems
in crisis, and to the families and friends who have brought them to the
progressed to a critical point. The national Centers for Disease Control
ER. Psychiatric emergencies come in many forms: severe depression;
and Prevention points out that ER visits for mental health care are
threats of suicide; threats of harm to others; psychosis; substance
increasing, and says that a high quality mental health service demands
abuse; extreme anxiety; medical emergencies related to eating disorders;
a system of care that includes emergency mental health care.
The Emergency Room at St.Clair Hospital sees over 1,000 patients a year for mental health issues.
14 I HouseCall I Volume IX Issue 4
Your illness does not define you. Your strength and courage does. “Our Mental Health Liaison team sees over 1,000 patients per year in the ER,” says Kathe Dvorsak, M.S.N., R.N., Director of Psychiatry and
region for the mental health care at St. Clair. In everything that we do — in the ER, in the Hospital and in the community — we are working to help
Mental Health Services. “One of our mental health nurses is always in
people with mental illness get the help they need and also to encourage
the ER, 20 hours a day; the ER doctors ask them to do comprehensive
people to see mental illness differently. Mental illness is just illness;
evaluations on patients and to assist them with stabilizing the patient.
the stigma creates shame and secrecy, and that’s a barrier to care.
The nurses consult with the psychiatrist on call about admissions, the need
It keeps people in a place of suffering.”
for detoxification, disposition and referrals to drug and alcohol centers.” The most common mental health diagnoses in the ER are severe
Jacob W. McBride, D.O., a psychiatrist and a member of the Mental Health Liaison Team at St. Clair, has words of wisdom for anyone who
depression and threatened or attempted suicide; thus, one of the most
is concerned about a loved one’s mental health. “To be helpful, be a
important responsibilities of the Mental Health nurses is to assess suicide
friend and be kind. Learn about mental illness; there are many good
risk. “We don’t ask just yes and no questions,” Dyan says. “We do a
resources. If your friend has taken steps to harm himself, that is an
thorough assessment. A patient may feel overwhelmed and unable to
emergency and you should call 911 or bring him to the ER. Another
cope; they may be suffering and want to kill themselves, but can’t do it
great resource is re:solve, the Allegheny County 24-hour emergency
because of their religion or because they won’t do that to their family.
mental health service.”
Others say, ‘I don’t want to die, but I can’t bear my life.’ It’s never a black and white thing; it’s complicated.” The Mental Health Liaison Team is a valuable resource to the ER staff and throughout the Hospital. Every day, they also provide mental
To anyone who is struggling alone, Dyan extends an invitation: “You deserve better, and there is emergency care for you, right here. In the ER we can
health consultations on the patient units as needed, for medical patients
defuse a mental health crisis, reassure
deemed to have mental health needs or those identified as a suicide risk
you, create a plan, including treatment
(please see sidebar on suicide prevention, pages 18-19). It is not uncommon
and a safety plan, always, and get you
for persons with life-limiting illnesses or chronic, complex diseases to
to the right resources. If you need help,
have emotional difficulties. “The work of our Mental Health nurses is
just come to the ER and we’ll take
very specialized, and they do an excellent job,” says Bruce A. Wright, M.D.,
care of you. You do not have to
Chair of the Department of Psychiatry. “They see children as well as
continue to suffer.” n
adults. The nurses have a lot of experience.” St. Clair Hospital Psychiatrist Fred Radfar, M.D. adds, “I have found our Mental Health nurses to be very caring and very knowledgeable, true patient advocates.” Dyan also leads one of St. Clair’s community outreach support groups
Jacob W. McBride, D.O.
and manages Baby Steps, a program for women with post-partum depression that is jointly run by Psychiatry and the Family Birth Center. She loves her work and is proud of the sustained excellence of St. Clair’s Psychiatry and Mental Health Services. “People come from all over the
JACOB W. MCBRIDE, D.O.
Dr. McBride specializes in psychiatry. He earned his medical degree at Philadelphia College of Osteopathic Medicine, and completed his residency at University Hospitals, Cleveland. He then completed a fellowship at Western Psychiatric Institute and Clinic of UPMC. Dr. McBride is board-certified by the American Board of Psychiatry & Neurology-Psychiatry. He practices with St. Clair Medical Services. To contact Dr. McBride, please call 412.942.4800.
Volume IX Issue 4 I HouseCall I 15
IMPROVING MENTAL HEALTH
A PATIENT’S STORY:
JOHN – OVERCOMING SEVERE DEPRESSION. or John, mornings used to begin with the cheery sounds of his little daughter awakening and bounding down the hall to greet the day and her parents. It was a daily, joyful ritual that gave each day an upbeat beginning, and John looked forward to it. But when he began falling into a deep depression, and his days became dark and difficult, those sounds took on a different meaning and he found himself dreading them. Another day meant facing more pain and anguish, trying to function, and feeling hopeless.
because of cancer or for surgery, no one would expect a quick rebound. I hope I can help someone by telling my story.” John completed the IOP program and is doing better now. He says the right mix of medications and the group meetings of the IOP
“Getting up in the morning became a
and they were extremely nice, caring and
played key roles in his improvement, but most
bad thing,” he says. “I had no energy; I cried
responsive. I went three days a week, plus
of all he attributes his healing to the IOP staff.
constantly. I had had depression before,
I had homework assignments. I was glad I was
“I felt cared for on a personal level. The staff
but this kept getting worse, to the point that
doing something and I began to feel a little
pays attention to everything you say; they are
I could not work, eat or sleep. I was spiraling
better. Gradually, I began to talk in the group.
excellent listeners and they remember what you
down and it became unbearable. When my
We also had training sessions and cognitive
have said before. I was treated as an individual,
wife said, ‘Let’s go to the hospital,’ I agreed.”
behavioral therapy, and we saw our psychia-
and I was encouraged to be my own advocate.
trists once a week. We were taught all about
They assisted me with administrative matters and
Jack Mannheimer, M.D., increased his anti-
depression and mental illness; we learned
paperwork — something not to be discounted
depressant medication and added a sleep
about our biochemistry and the mind-body
under the debilitating effects of depression and
medication. He told John about St. Clair’s
connection, which is amazing. Depression
anxiety. The doctors, nurses and other staff of
Intensive Outpatient Program, or IOP. At first
is a complex disease and unfortunately,
the IOP literally saved my life.”
John was reluctant, having had a previously
most people don’t understand that. I was
unfavorable experience with group therapy.
lucky in that my wife is very supportive and
to take his medication and see a therapist.
But his situation was dire and he was willing
my family gets it.”
Although he worries about the impact of his ill-
At St. Clair Hospital, John’s psychiatrist,
to do anything to get better.
John says that the issue of the stigma
He has returned to work, and he continues
ness on his children, he focuses on the positive
around mental illness was a daunting problem.
life lesson they received, of seeing him seek
the IOP group,” he recalls. “I was still feeling
“People are uninformed about mental illness
help and get better. He is getting his life back
negative about it. The group consisted of local
and this needs to change. The stigma was
and best of all, he is able to once again appreci-
people, people like me. There were teachers,
actually the main topic in the group; everyone
ate the ordinary miracle of happy little feet,
attorneys, pilots, doctors, college students and
was worried about it. The thought of returning
bouncing along a hall, announcing the start of
homemakers. I met with the professional staff
to work was stressful; if you had been off
“On the first day, I did not participate in
a new, and brighter, day. n
“I was amazed to discover that there was a place so close where I could get this kind of help. The doctors, nurses and others literally saved my life. I felt cared for on a personal level; I was treated as an individual. We have a hidden gem in St. Clair ,s psychiatry department and the people who work there. Right here, right in your backyard.” – JOHN, PATIENT WITH SEVERE DEPRESSION
16 I HouseCall I Volume IX Issue 4
The Power of Partnerships
providing an effective network of mental health care St. Clair Hospital is part of a network of area organizations and agencies that share our values and aspire to help those in need. Highlighted are two partner agencies whose staff are experts and advocates in psychiatry and mental health. Our relationship with these community partners is based on a belief in each other’s missions. They are resources that provide invaluable feedback to the Hospital and collaborate with us, providing daily services to people whose care we often share. When we join forces, we are far more effective in meeting the needs of our patients.
Over the last 40 years, Outreach Teen & Family Services has evolved into a community
hartiers Center is celebrating
ment and a number of services and
counseling agency that is effective,
50 years of service to the com-
housing supports for people who are
responsive, and dedicated to promoting
munity throughout 2018. Providing
homeless. Individuals who have an
mental wellness throughout the community.
treatment and support to consumers
intellectual and developmental disability
with behavioral health needs has
can be served in one of the Center’s
with the Mt. Lebanon Municipality, the
been, and will continue to be the
two-day programs in Dormont.
Mt. Lebanon Police Department, and other
organization’s top priority. The Center offers a range of services
Treatment can begin as a “walk-in” or an individual might be referred
Outreach continues its strong partnership
community resources, including St. Clair Hospital. Its efforts also extend to
from a hospital. The Center’s team
students in Washington County and
based recovery, including Behavioral
works closely with St. Clair Hospital
Pittsburgh area post-secondary schools.
Health Outpatient, Substance Use
and other health care providers to
Outreach continues to provide vitally
Treatment Outpatient and Intensive
jointly develop a plan of care that best
needed mental health counseling to
Outpatient Services, as well as
suits each patient’s clinical and
young people and their parents throughout
school-based treatment in the
psycho-social needs. To learn more
Allegheny and Washington counties.
Chartiers Valley, South Fayette and
about Chartiers Center, its programs
intended to promote a community-
Keystone Oaks school districts. It also offers specialized case manage-
and services, visit chartierscenter.org or call 412.221.3302. n
Whether Outreach’s young clients are struggling with depression or anxiety, stress, family and school issues, anger, or drugs and alcohol, its professional counselors meet their needs with empathetic, personal, accessible, and affordable mental health counseling. To learn more about Outreach, its programs and services, visit outreachteen.org or call 412.561.5405. n
Volume IX Issue 4 I HouseCall I 17
IMPROVING MENTAL HEALTH
SUICIDE PREVENTION: WHAT YOU SHOULD KNOW People commit suicide when they are having unbearable
Screening is a critically important tool in suicide prevention,
emotional pain and distress and they feel hopeless, helpless
because very rarely will a person come right out and state,
and alone. People who commit suicide, or contemplate
‘I want to kill myself.’ But if they are asked about it directly by
committing suicide, are not weak, selfish or vindictive;
a health care professional, they are far more likely to
they are desperate.
respond that yes, they are thinking about it, have tried it or
At St. Clair Hospital, suicide prevention is a priority, says Kathe Dvorsak, M.S.N., R.N., Director of Psychiatry and Mental Health Services. “Everything we do in the psychiatry
intend to do it. Every year, approximately 1,800 patients commit suicide in American hospitals, according to the Joint Commission.
service is a form of suicide prevention. St. Clair has made it
Staff education is essential, as is modifying the hospital
an integral part of our care, across the entire spectrum of
environment to minimize opportunities for suicide. St. Clair’s
patient care services.” The Hospital has implemented a
Mental Health Consultation-Liaison Team is available to
vigorous and comprehensive suicide screening program that
evaluate any patient on any unit in the Hospital, if there are
assesses every single patient for suicide risk. All patients
concerns about suicidal or other dangerous behaviors.
are screened by a health care professional upon admission,
IF YOU ARE WORRIED
ABOUT SOMEONE, STEP FORWARD TO
Suicide is the tenth leading cause of death across all ages
whether they are admitted to the
in the United States, and is a major public health problem.
Hospital or in the ER. The purpose,
It accounts for the loss of more than 41,000 American lives
says Kathe, is to identify persons
each year, more than twice the number of lives lost to homicide;
at risk and get them into treatment
among young people aged 15-34, it is the second leading
immediately. “Suicide prevention is a constant
cause of death. In 2013, over 494,000 people were treated in U.S. emergency departments with serious self-inflicted
at the Hospital,” Kathe says. “We
injuries from suicide attempts, according to the national
assess every patient for their potential
Centers for Disease Control and Prevention (CDC).
DON’T HESITATE ...
to harm themselves, as well as others.
ORDINARY PEOPLE CAN PREVENT SUICIDE.
MINDY HUTCHINSON, M.D., PSYCHIATRIST, ST. CLAIR HOSPITAL
18 I HouseCall I Volume IX Issue 4
As alarming as these numbers may be, they significantly
We never assume that only psychiatry
understate the extent of the problem: many people who feel
patients are a suicide risk; people
suicidal or make suicide attempts do not seek help. In addi-
come to this Hospital with many kinds
tion, many who feel very depressed will go to the ER seeking
of problems; they are often in
help for a physical complaint, when their primary problem
personal crisis and may be thinking
is a mental health one. There is no single cause of suicide,
of ending their lives. We ask every
but factors that increase the risk include previous suicide
patient, ‘Have you thought about
attempts; history of depression or other mental illness;
substance abuse; family history of suicide; physical illness;
always finding hope
poverty and extreme loneliness. According to the CDC, certain populations have a higher risk: veterans, the elderly, those with substance abuse disorders, prisoners and the homeless. St. Clair psychiatrist Mindy Hutchinson, M.D. says that suicide is a concern with many mental health and medical diagnoses: “If a
WARNING SIGNS: Seek help as soon as possible if you or someone you know exhibits any of these signs:
person has suicidal thoughts that they may act on, the person may need to be admitted.” She also cautions that unexplained physical symptoms can be a sign of mental illness. “If you are worried about
Threatening or talking about wanting to hurt or kill oneself
someone, step forward to help them. Don’t hesitate if you see
Looking for ways to kill oneself with firearms, pills, etc.
someone struggling emotionally; asking about suicidal feelings
Having no sense of purpose in life or a reason for living
does not ‘plant’ the idea. Ordinary people can prevent suicide.”
Feeling hopeless, desperate or trapped
Signs that someone may be thinking of suicide include: making threats to hurt or kill oneself; looking for ways to kill oneself, seeking
firearms or pills; talking or writing about death, dying or suicide;
Increased aggression, uncontrolled anger, seeking revenge
expressing feelings of hopelessness; acting reckless or engaging in risky behaviors; and withdrawal from friends, family or society. If there is any concern that you, or someone you know, may be at risk for suicide, it is imperative to seek help immediately. Call your/their therapist or psychiatrist if already involved in treatment, or call 911 — they respond to mental health emergencies — or bring the person to the St. Clair Hospital ER. n
Increased alcohol or drug use Withdrawal from friends, family, and society Feeling anxious or agitated Change in sleep or eating habits Dramatic mood changes
FOR MORE EMERGENCY HELP:
If you live in Allegheny County: re:solve Crisis Network — 24-hour hotline 1.888.7.YOUCAN (1.888.796.8226) Allegheny County Peer Support Warmline Network 1.866.661.WARM (1.866.661.9276)
SUICIDE IS THE
In Washington County: 24-hour Crisis Hotline — 1.877.225.3567
Washington County Peer Support Warmline Network
(7 days/week, 6-9 p.m.)
LEADING CAUSE OF DEATH IN THE U.S.
1.800.MHA.2466 (1.800.642.2466) For anyone: National Suicide Prevention Lifeline — 1.800.273.TALK St. Clair Hospital, Psychiatric Unit — 412.942.4800
Help & INtervention
SUICIDE IS THE
LIVES EACH YEAR IN THE U.S. (more than twice the number of lives lost to homicide).
2ND LEADING CAUSE OF DEATH AMONG PEOPLE AGED 15-34.
If you, or someone you know, exhibits signs of suicide risk, you don’t have to be an expert to listen. Ordinary people can prevent suicide.
Asking about suicidal feelings does not ‘plant’ the idea.
Show them you are interested in their well being.
ENCOURAGE Acknowledge their emotions.
TAKE ACTION Contact help.
Volume IX Issue 4 I HouseCall I 19
A MERITORIOUS LEGACY
G. ALAN YEASTED, M.D., FACP
Respected Chief Medical Officer stepping down after leading the Hospital through significant growth and achievement “Emeritus” is a symbolic title usually bestowed on the former holder of a position, intended to convey the respect and esteem in which that person is held. Keeping one’s title, with the word emeritus added, is a mark of distinguished service and is an honor reserved for only the most deserving.
G. Alan Yeasted, M.D., FACP
Milestones: 1977 Started private practice after graduating University of Pittsburgh School of Medicine. Board-certified in internal medicine.
20 I HouseCall I Volume IX Issue 4
Began career at St. Clair at just 24 years old.
Named Chairman of the Department of Medicine.
1993 Joined the St. Clair Hospital Board of Directors.
G. Alan Yeasted, M.D., FACP, is certainly deserving and,
hard and we’ve been extremely successful in the clinical
for his many contributions to St. Clair Hospital as Chief Medical
arena, with sound financial footing. We will continue to excel.”
Officer since 2000, he will assume the new title of Senior Vice
Dr. Yeasted is continuing the primary care practice
President and Chief Medical Officer Emeritus. As Chief
he started in 1977 and is working closely with the St. Clair
Medical Officer, Dr. Yeasted has played a key role in leading
Hospital Foundation. He is also responsible for a number
the Hospital through unprecedented growth and achievement.
of special projects. He is looking forward to St. Clair’s
He is stepping down from that position, but he will
continued success under new medical leadership. “It’s time
remain deeply involved in the Hospital. Dr. Yeasted’s goal for St. Clair has
for me to make this change, and St. Clair will be announcing an extremely strong, well
always been the pursuit of excellence,
DR. YEASTED HAS BEEN
and St. Clair’s unprecedented growth
THE LEADER OF A
and achievements during his tenure are
a testament to that. “When I came to
OF PHYSICIANS WHO HAVE
to provide the South Hills community with
MADE ST. CLAIR A NATIONAL
university-quality medicine within a warm,
St. Clair, my goal was to provide university-quality care,” he says. “We have achieved that. St. Clair is nationally rated for quality, safety and patient satisfaction; we have achieved national recognition as a leader in
LEADER IN QUALITY. ... ALAN’S ‘TRUE NORTH’ HAS ALWAYS BEEN QUALITY, ALWAYS BEEN THE PATIENT, AND ALWAYS BEEN
quality health care. This is due in no
small part to the superb doctors and nurses we have here. When you have a core of excellent people, others will want to work here, too, and so we have been able to recruit top-notch professionals. Additionally, we have an exceptionally
and energy in the Hospital.”
as my successor.” “My legacy is that we have been able
caring environment, and we built our medical staff into a highly qualified, top-notch one. Seventeen years ago, people asked me, why are you taking this job? This is why: in my practice, I see one patient at a time and hopefully have a positive impact on that patient. As CMO, I have a much larger impact, an impact that is still very important to the individual
JAMES M. COLLINS, PRESIDENT AND CHIEF EXECUTIVE OFFICER, ST. CLAIR HOSPITAL
fine board of directors who invest enormous time
educated, high quality chief medical officer
patient, but encompasses the entire community. I can improve the health and the health care of the entire community.”
Dr. Yeasted, a Mt. Lebanon resident, is the recipient of numerous honors and awards. In December, he received
St. Clair’s selection as a member of the Mayo Clinic
the Laureate Award from the Pennsylvania American
Care Network is especially satisfying, Dr. Yeasted says.
College of Physicians. It is the highest honor given by
“It’s an honor that we were in a position to be chosen by
that organization. n
an organization that is so highly selective. We’ve worked
Named Chief Medical Officer and Senior Vice President, St. Clair Hospital.
Elected President, Allegheny County Medical Society.
Named Governor, Western Pennsylvania American College of Physicians.
Received Laureate Award, the highest honor given by the Pennsylvania American College of Physicians.
Volume IX Issue 4 I HouseCall I 21
GETTING TO THE
HEARTOF THE MATTER
Rapid advancements in technology are transforming the diagnosis of heart disease with cardiac MRI.
t. Clair now offers a cutting-edge test for the diagnosis and treatment of heart disease that was previously available
only at university hospitals, thanks to the addition of a
remarkable new cardiac imaging technology and an exceptionally qualified cardiac imaging specialist, Christopher Pray, M.D., FACC. Cardiac MRI is revolutionizing the field of cardiology, and Dr. Pray is specially trained to deliver the benefits and advantages of that Christopher Pray, M.D., FACC
transformation to patients in St. Clair Hospital’s service area. “Cardiac MRI is a new imaging technology that combines the best aspects of echocardiology and nuclear cardiology,” Dr. Pray explains. “It’s a fantastic tool; it uses radio waves, magnets and computer technology to create detailed images of the heart and precise measurements of heart size and function, including the size and functioning of the valves and blood vessels in the chest. It’s as easy for the patient as an x-ray, and is safer than an x-ray, as it does not use any radiation.” According to Dr. Pray, cardiac MRI allows cardiac imaging specialists like himself to visualize any scarring of the heart muscle that might indicate a prior heart attack or other condition. Cardiac muscle can be scarred not only by heart attacks, but also by viral infections, infiltrative diseases, or autoimmune
CHRISTOPHER PRAY, M.D., FACC
Dr. Pray specializes in cardiology. He earned his medical degree at SUNY Upstate Medical University, Syracuse, N.Y. and completed his residency at UPMC. He also completed fellowships in cardiology and cardiac MRI at UPMC. Dr. Pray is board-certified by the American Board of Internal Medicine in internal medicine, cardiology and echocardiography. He practices with South Hills Cardiology Associates, a division of St. Clair Medical Services. To contact Dr. Pray please call 412.942.7900. 22 I HouseCall I Volume IX Issue 4
diseases that can attack the heart. Cardiac MRI is now the preferred diagnostic study for the identification of congenital heart disease and for hypertrophic cardiomyopathy, the condition that causes thickening of the heart muscle that can lead to heart failure and sudden cardiac arrest. “Before we had cardiac MRI, the only way to acquire this kind of information was by doing a biopsy of the heart muscle, an invasive procedure with greater risk,” Dr. Pray says. “When you have a cardiac MRI, you’ll have an IV, but we don’t use any radiation and we don’t use CT contrast, so there is no risk of injury to the kidney.” Cardiac MRI can also detect heart failure, coronary artery disease, and heart aneurysms. Cardiac MRI imaging is conducted at St. Clair’s Outpatient Center in Peters Township, where the Hospital’s MRI scanner has been specially equipped to perform it. The hour-long test is an interactive test, meaning that the patient is awake and responding to directions from the MRI technologist. “A regular MRI requires that there be no patient movement. The challenge with MRI is that the heart is always
A view of a heart taken with cardiac MRI software.
in motion: it’s beating all the time, and the chest is moving with breathing. This made it challenging to do heart MRIs in the past. New technology plus the patient/technologist interaction make it possible now; the tech
see damage to the heart muscle as soon as a coronary artery is
blocked; the cardiac MRI can even show the edema (fluid infiltrate)
IT’S AS EASY FOR THE PATIENT
of the injured muscle.
AS AN X-RAY, AND IS SAFER.
simply tells you when to hold your breath, and when to breathe again.” Many cardiac conditions can be missed by standard diagnostic tests, notes Dr. Pray, but cardiac MRI provides remarkable detail. He can
Cardiac MRI has such tremendous value to patients, and to their physicians, that the demand for it is expected to increase rapidly. “At St. Clair, we are in on the early stages of this revolutionary development in the diagnosis of heart disease; the indications for cardiac MRI are constantly expanding. Currently, we get referrals from primary care
IT’S A FANTASTIC TOOL . . .
CHRISTOPHER PRAY, M.D., FACC, CARDIAC IMAGING SPECIALIST, ST. CLAIR HOSPITAL
physicians and cardiologists, mostly, and also from pulmonologists and oncologists. Lung disease can lead to heart disease, and chemotherapy medications can injure and scar the heart. Eventually, cardiac MRI technology is expected to serve as an alternative to nuclear stress tests.” The availability of cardiac MRI further distinguishes St. Clair among the region’s hospitals, says Dr. Pray, who is “Level III” trained, the highest certification. “It’s exceptional to be able to offer this remarkable technology, so close to home. It’s an important advance, and it’s exciting that we are able to provide it here. St. Clair is uniquely situated to provide this service.” n
Volume IX Issue 4 I HouseCall I 23
ONE YEAR ANNIVERSARY
St. Clair Hospital Celebrates its Clinical Collaboration with Mayo Clinic
t. Clair recently marked its one-year anniversary as a member of the Mayo Clinic Care Network with a week-long series of meetings with Mayo Clinic officials and medical grand rounds. Experts from Mayo Clinic presented to
St. Clair’s physicians and allied health staff on a wealth of clinical topics, ranging from pharmacogenomics (i.e., individualizing the prescribing of medications based
on genetics data), to regenerative medicine, to non-opioid treatments for pain, and more. In addition, at a celebratory dinner with community leaders, David L. Hayes, M.D., Professor of Medicine at the Mayo Clinic College of Medicine and Science, and Medical Director of the Mayo Clinic Care Network, presented on the future of medicine in a talk entitled “Can Emerging Technologies Deliver Medical Miracles? ” Officials from St. Clair and Mayo Clinic also conducted a retreat to plan enhancements to the relationship between the two organizations for the coming year. As a member of the Mayo Clinic Care Network, St. Clair has brought a variety of benefits to the community, including free second opinions from Mayo Clinic experts.n
Pictured after a Mayo Clinic presentation on the future of medicine are, left to right: G. Alan Yeasted, M.D., Senior Vice President and Chief Medical Officer Emeritus, St. Clair Hospital; Michael Flanagan, Senior Vice President and Chief Operating Officer, St. Clair Hospital; Georg von Bormann, Operations Administrator, Mayo Clinic Care Network; Lenae Barkey, Administrative Chair, Mayo Clinic Care Network; David L. Hayes, M.D., Medical Director, Mayo Clinic Care Network; Becky Pautz, Operations Manager, Mayo Clinic Care Network; Richard Chesnos, Senior Vice President and Chief Financial Officer, St. Clair Hospital; and James M. Collins, President and Chief Executive Officer, St. Clair Hospital.
24 I HouseCall I Volume IX Issue 4
IN THE COMMUNITY
Area students and businesses join St. Clair in fight against breast cancer
CH MPS I
PETERS TOWNSHIP MIDDLE SCHOOL
BREWS BROTHERS SIX-PACK EMPORIUM
n a generous October tradition, eight area school districts and two area businesses teamed with the St. Clair Hospital Foundation to raise funds for St. Clair Hospital’s Breast Care centers during Breast Cancer Awareness Month. Students at Brownsville, Chartiers Valley, Keystone Oaks, Mt. Lebanon, Montour, Peters Township, South Park and Upper St. Clair sold signature St. Clair Hospital pink bandannas to raise money to support Breast Cancer awareness efforts. Additionally, Brews Brothers Six-Pack Emporium and Curves of Mt. Lebanon hosted special events to support the Hospital’s Breast Care centers in Bethel Park and Peters Township. The centers offer education, early detection, 3D mammography, treatment and surgical services. The funds support charitable programs and services for women in our community, including free mammograms for the uninsured. St. Clair presented each organization with a Pink Out Champions plaque as a thank you. n
SOUTH PARK MIDDLE SCHOOL
SOUTH PARK SENIOR HIGH SCHOOL
MT. LEBANON MELLON MIDDLE SCHOOL
CURVES OF MT. LEBANON
KEYSTONE OAKS HIGH SCHOOL Volume IX Issue 4 I HouseCall I 25
FIND YOUR PRIMARY CARE DOCTOR AT STCLAIR.ORG New Year’s resolution not quite working out? Whether your goal was to lose a few pounds or lower your cholesterol, talk to one of our Primary Care physicians. St. Clair — a national leader in quality care, patient safety, patient satisfaction, and value — offers a wealth of experienced, board-certified Primary Care physicians to help you maintain a healthy lifestyle.
26 I HouseCall I Volume IX Issue 4
ASK THE DOCTOR
Ask the Doctor GENE M. BATTISTELLA, D.O. AND MICHAEL A. NOTTE, M.D.
How can a primary care physician help patients navigate appointments with specialists, subspecialists, surgeons and others?
The complexity of a healthy, well-functioning human
about what is likely to take place and what will be expected.
body is astounding. Thus, its dysfunction, which manifests
The PCP and his staff can schedule appointments and provide
as disease, is equally complex. As medical science has
written instructions, or provide information so the patient can
advanced in knowledge and understanding of normal and
do so independently. This demands clear communication with
abnormal human physiology, the diagnosis, treatment and
the patient and family, including feedback from them about
prevention of disease have grown as well, and there exists
any concerns or misunderstandings.
a vast amount of information related to both. This can
Ideally, the PCP, the staff and the patient and family
be daunting to patients when they are facing a new
function as a team, with the PCP as team leader. The
problem or having symptoms that need to be investigated,
relationship between the PCP and the patient is a partnership
eventually leading to diagnosis and treatment. Com-
in which both have roles to play; patients should participate
pounding this is the fact that the health care system itself
actively and make their wishes known to the PCP so
can, at times, be complex and overwhelming to patients
that treatment can be as individualized as possible. Additionally, patients are responsible to follow through
and their families. Fortunately, patients are not expected to navigate this
with the recommendations of the PCP, including keeping
on their own. The primary care physician (PCP) plays a key
appointments. Often, the PCP and the patient have an
role, guiding the patient through the entire process. The
established relationship, which facilitates this process. In some
PCP is usually the first person to see the patient when he
situations, others, such as caregivers, family members, case
or she presents with new symptoms or medical issues,
managers and social workers, are brought into this team effort.
so the PCP initiates the diagnostic process. This may entail the scheduling of tests, bloodwork, and referral
In addition, the team includes the specialists. Depending on the problem, and the
to specialists and other health care providers whose
existence of other medical conditions,
expertise will help lead to the correct diagnosis and,
there may be multiple specialists and
subsequently, to the most appropriate treatment.
subspecialists involved. It is the role of the
Throughout the process, the PCP takes the lead,
PCP to coordinate all of the reports and
receiving all the information from the consultants,
recommendations once the consults and
and then interpreting it to the patient and family in terms they understand. It is essential that this diagnostic process be expedited so that treatment can begin in the timeliest manner. That requires attention to the practical matters of scheduling appointments, providing directions and instructions, and educating the patient and family
diagnostic tests are completed. The PCP will present the findings and the proposed plan of care and answer questions when the patient returns for follow-up care. At any point, if the patient has concerns that are not being addressed by the specialists, they can contact their PCP for
additional guidance. n
GENE M. BATTISTELLA, D.O.
MICHAEL A. NOTTE, M.D.
Dr. Battistella earned his medical degree at the Philadelphia College of Osteopathic Medicine, Philadelphia, and completed his residency in internal medicine at Mercy Hospital of Pittsburgh. He is board-certified by the American Board of Internal Medicine. Dr. Battistella practices with the West Hills Medical division of St. Clair Medical Services.
Dr. Notte earned his medical degree at Hahnemann University School of Medicine, Philadelphia, and completed his residency in internal medicine at Mercy Hospital of Pittsburgh. He is board-certified by the American Board of Internal Medicine. Dr. Notte practices with the West Hills Medical division of St. Clair Medical Services.
To contact Dr. Battistella, please call 412.777.4319.
To contact Dr. Notte, please call 412.777.4319. Volume IX Issue 4 I HouseCall I 27
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
THE IN HOSPITAL PATIENT
For over 5 consecutive years, St. Clair has received an “A” grade for patient safety, placing St. Clair in the top 3% in the nation. The grades are determined by The Leapfrog Group, a national, independent, patient safety watchdog, and reflect how well hospitals across the nation protect patients from preventable medical errors, injuries, and infections. To learn more about our Hospital Safety Score, or St. Clair’s performance as a national leader in quality and patient satisfaction, please visit stclair.org.
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.
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