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VOLUME IX ISSUE 4

HouseCall


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

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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.

M

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

1IN5

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

10

MILLION

American adults have co-occurring mental illness and addiction disorders.

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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.

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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-

and homelessness.”

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.

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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

it’s routine.”

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.

psychiatric crisis.”

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

C

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

HELP THEM.

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;

harming yourself?’”

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

Reckless behavior

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:

SHOCKING REALITY

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

1Oth

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 CLAIMS

SUICIDE IS THE

41,OOO

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.

ASK

LISTEN

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

1978

1986

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

REMARKABLE GENERATION

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

THE COMMUNITY.

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

2001

2003

2012

2017

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


ADVANCED TECHNOLOGY

GETTING TO THE

HEARTOF THE MATTER

Rapid advancements in technology are transforming the diagnosis of heart disease with cardiac MRI.

S

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

S

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

PINK OUT

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.

STCLAIR.ORG

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.

Q A

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

SAFETY

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.

HouseCall

is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.

2013-2017

@StClairHospital

St. Clair Hospital_HouseCall Vol IX Issue 4  

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

St. Clair Hospital_HouseCall Vol IX Issue 4  

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

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