St. Clair Hospital_HouseCall Vol IX Issue 3

KNEE

PAGE 4

Victor’s story, PAGE 14

St. Clair earns high marks for orthopedic care

Margaret’s story, PAGE 8

SPINE

Kayla’s story,

ORTHOPEDIC EXCELLENCE

HIP

SHOULDER

VOLUME IX ISSUE 3

Kristy’s story,

PAGE 12

ORTHOPEDIC EXCELLENCE

Every day at St. Clair Hospital, expert orthopedic surgeons perform the most advanced, highly specialized surgical procedures, including joint replacements and spine surgery. Using pioneering surgical approaches and the most cutting-edge technology, St. Clair’s orthopedic surgeons are at the forefront of orthopedics advancements. Orthopedic services at St. Clair are distinguished by excellence: the program is consistently ranked at the highest levels for its outstanding quality, safety, clinical outcomes and patient satisfaction, far exceeding regional and national standards. Uniquely focused on the experience of the patient, St. Clair is an ideal setting, offering superior orthopedic care.

2 I HouseCall I Volume IX Issue 3

DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE ST. CLAIR HOSPITAL

L

onger life spans of Americans, aging Baby Boomers, increasing obesity, and the popularity of extreme sports, along with advances in orthopedics and sports medicine, are among the factors driving the nation’s increased demand for orthopedic surgery, according

to the American Association of Orthopedic Surgeons. The number of people having knee replacement has doubled in just 10 years, and younger people are having joint replacements. For those whose lives have been interrupted by injury or diminished by the cruel pain and limitations of arthritis, orthopedic surgery at St. Clair can relieve pain, restore mobility, renew lives and sometimes even transform them.

Having major orthopedic surgery is an enormous undertaking for

anyone, and whether one is having hand surgery, a spinal fusion or a knee replacement, every patient is entitled to the best care possible. St. Clair delivers that. For St. Clair’s orthopedic surgery program, excellence is not simply a standard to aspire to — it is everything. There is an ethic of excellence that permeates the entire scope of the service, cascading through every tier of the patient’s experience. It has become the culture. All members of the orthopedic surgery team — the surgeons, the operating room (OR) staff, the nurses and nurse managers, the physical therapists and support staff — are dedicated, consummate professionals who have chosen this specialty and share a passion for their mission.

Orthopedic care at St. Clair Hospital is complex, high-tech and meticulously coordinated, but it is also personal.

Across a seamless continuum of care, from the first office visit through graduation from rehab, the care is based on solid science and best practices research. With an emphasis on minimizing pain, eliminating complications and individualizing care to the unique needs of each patient, St. Clair delivers impeccable orthopedic surgical care.

Continued on page 7

t

St. Clair Hospital has always taken great pride in helping patients get back to the things they love most. On the next pages are just a few of many inspiring orthopedic success stories.

Volume IX Issue 3 I HouseCall I 3

ORTHOPEDIC EXCELLENCE

TORN SHOULDER REPAIR 4 I HouseCall I Volume IX Issue 3

Kayla Smith of Jefferson Hills is back on the court after shoulder surgery.

SHOULDER SURGERY

Kayla’s Story Kayla Smith, 19, of Jefferson Hills, is a superior athlete who threw

throw the javelin. This time, though, the injury — another tear of the

javelin and played volleyball for the Thomas Jefferson High School

labrum — was more complex. According to Dr. Walker, “This was a

Jaguars. Both javelin and volleyball require overhead motion, which

bigger tear, which destabilized the origin of the biceps tendon. The

asks a lot of the shoulder joint. In May of 2015, Kayla suffered an

biceps tendon is attached to the shoulder at the upper part of the

injury, a flap tear in the labrum of her right shoulder, while competing

labrum. Typically, this type of injury afflicts throwing athletes, including

in a WPIAL championship competition. She was referred to Shaka M.

pitchers and javelin throwers, who use overhead motions. Javelin

Walker, M.D., a board-certified orthopedic surgeon and sports medicine

throwers give a super maximum effort. Because it is an elimination

specialist at St. Clair Hospital. Dr. Walker, who operated on Kayla’s

sport, you have to throw as hard as you can, every single time. It sets

shoulder in July 2015, is former Chief of Orthopedic Services at Landstuhl

you up for injury. When you throw a javelin, there’s a deceleration that

Regional Medical Center near Landstuhl, Germany. The Center is

occurs, and upon release, the labrum is getting very forcefully pulled.”

operated by the U.S. Army and the Department of Defense and is

In December 2016, Dr. Walker re-attached the labrum, adding an

the largest military hospital outside of the continental United States.

anchor that holds the repaired tissues in place for healing. Kayla did

It serves as the nearest treatment center for wounded soldiers coming

very well post-op, says her surgeon, and she is able to participate in

from Iraq and Afghanistan. While in Germany, Dr. Walker, who held

any sport now. “For some athletes, there may be diminished rotation

the rank of Major, also served as Director of the Sports Injury Clinic

of the shoulder post-op,” he says. “Some pitchers may be unable to

at the Center, taking care of numerous athletes living in the Kaiser-

throw as fast or as hard.”

slautern Military Community.

Continued on page 6

Dr. Walker describes Kayla’s injury: “Kayla had a tear in the superior labrum. The labrum is a fibrocartilaginous ring that sits on the rim of the glenoid, the socket of the shoulder. It’s a gasket-like structure all the way around the joint, 360 degrees. The stability of the shoulder depends on the labrum and other soft tissues. Kayla’s injury was amenable to debridement. We did the procedure in July so that she would be ready to throw the javelin in the spring.”

Unfortunately, Kayla reinjured the shoulder during the fall 2015 season of volleyball at TJ, but played through the injury during the ensuing track and field season, continuing to

“

WITH ATHLETES LIKE KAYLA, YOU HAVE TO UNDERSTAND THEIR GOALS IN ORDER TO SELECT THE BEST TREATMENT FOR THEM.

”

SHAKA M. WALKER, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL

SHAKA M. WALKER, M.D. Dr. Walker specializes in orthopedic surgery. He earned his medical degree at Georgetown University, Washington, D.C., and completed a residency in orthopedic surgery at University of California, San Francisco, with subspecialty training in Sports Medicine. He later served as Chief of Orthopedic Services and Director of the Sports Injury Clinic at Landstuhl Regional Medical Center, Germany. Dr. Walker is board-certified by the American Board of Orthopaedic Surgery. He practices with St. Clair Orthopedic Associates, a division of St. Clair Medical Services.

To contact Dr. Walker, please call 412.942.7262.

Volume IX Issue 3 I HouseCall I 5

ORTHOPEDIC EXCELLENCE Continued from page 5

“

Dr. Walker helped me through everything and worked with me to get me back in shape.

He made sure I was doing everything right.

He is kind-hearted and takes a personal interest in his patients.

”

KAYLA SMITH, LABRAL TEAR SURGERY PATIENT

Treating athletes is especially satisfying because they are so motivated to get better, says Dr. Walker, who played intercollegiate soccer at the Air Force Academy. “Part of what we do as orthopedic surgeons is technical, and that part is interesting, but with athletes like Kayla you have to understand their goals in order to select the best treatment for them. The human connection with the patients helps me know them so that I have a clear understanding of what they want.”

Kayla is a determined young woman who sets ambitious goals for herself in athletics and in academics. She says since graduating from TJ in spring 2016, her days of formally competing in track and field and on the court are behind her, but she still can throw javelin and spike a volleyball with the best of them. Now a sophomore at the University of Pittsburgh, where she is studying Pharmacy, Kayla says, “My shoulder healed correctly and it is as good as it can possibly be.

Two shoulder surgeries in less than two years was an ordeal, but I toughed it out and I had a lot of support, from my mother, my teammates, my friends and my cat, Kiki. Most of all, Dr. Walker helped me through everything and worked with me to get me back in shape. He made sure I was doing everything right. He is kind-hearted and takes a personal interest in his patients.”

The aspiring pharmacist, who is working part-time as a pharmacy technician while a full-time student at Pitt, says her experience with Dr. Walker and the staff at St. Clair Hospital will have a lasting impact on her. She is completing a six-year program that will eventually earn her a doctoral degree. “When I am a full-time health care professional, I will absolutely remember how it feels to be a patient, and I hope to treat people with the kind of respect and compassion that I experienced at St. Clair Hospital.” n

Shoulder surgery has let Kayla Smith throw javelin again.

6 I HouseCall I Volume IX Issue 3

DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE

ST. CLAIR HOSPITAL Continued from page 3

St. Clair’s orthopedic surgeons specialize in

the diagnosis and treatment of nearly every type of injury and condition of the musculoskeletal

system. In addition, some of the surgeons sub-

specialize in joint replacement of the knee and

hip, sports medicine, spine surgery, hand and

pedic program is ranked in the top 1 percent in

national Press Ganey rankings and has maintained that ranking for the past three years. Credit for

that impressive achievement, says Bob, goes to

the staff: “We’re proud of this rating but also

humbled by it. We have a true interdisciplinary

shoulder surgery, and foot surgery. Robert “Bob”

team, including clinical and non-clinical services,

Orthopedics at St. Clair, and a trained physical

have been well cared for here.”

Kovatch, M.P.T., M.B.A., F.A.C.H.E., Director of

therapist, says the department performs 3,500

The orthopedic department has also

attained superlative ratings for clinical quality

“Although we’re a high-volume service, we

op complications and infection. Patient falls, a

treat every patient as a unique individual,” Bob

says. “That is one of our greatest strengths. We

never take our eyes off the ball in terms of quality and patient satisfaction. The effort to achieve

and sustain excellence is constant; we meet and

and patient safety with a low incidence of post-

significant measure of safety, are almost non-

existent among orthopedic surgery patients

prevention is important for all patients, but

invested in it.”

surgical site,” he explains. “It’s a high priority.

St. Clair is well documented. The service is

in damage to the implant or disruption of the

Our fall rate was already low, but we cut it even further with this program. The nursing staff

ranked in the highest echelons by Press Ganey,

practices decentralized documentation, so

evaluator of patient satisfaction. St. Clair’s ortho-

respond immediately to a call.”

the nation’s largest independent, third-party

in patient satisfaction nationally*

* Press Ganey, national database (300- to 449-bed hospitals)

St. Clair orthopedic nursing unit

Patient Fall Rate

0.08%*

National Benchmark is 0.27%

* NDNQI inpatient falls per patient day, 2016 NIH data

called “Call, Don’t Fall.” According to Bob, fall

critical for orthopedic patients. “A fall can result

The superior quality of orthopedic care at

1%

HHHHH TOP

at St. Clair, thanks to a patient education initiative

exceed our quality goals of performing in the top 10 percent nationally. Everyone on the team is

St. Clair’s orthopedic nursing unit is ranked in the

and all of us want our patients to feel that they

surgical procedures every year, of which 1,100

are hip and knee replacements.

ST. CLAIR HOSPITAL ORTHOPEDIC QUALITY METRICS

Average length of stay in hospital Primary hip & knee replacement

2.2 DAYS*

National Benchmark is 2.7 days * Crimson

they are always near the patient rooms and can Continued on page 11

90-Day Readmission Rate Hip, knee or shoulder replacement, and spine surgery

“

4.6%*

National Benchmark is 5.5%

* Crimson, all-cause readmissions, with exclusions

… IN TERMS OF QUALITY AND PATIENT SATISFACTION, THE EFFORT TO ACHIEVE AND SUSTAIN EXCELLENCE

IS CONSTANT.

”

ROBERT KOVATCH, M.P.T., M.B.A., F.A.C.H.E., DIRECTOR OF ORTHOPEDICS, ST. CLAIR HOSPITAL

Complication Rate

Hip, knee, or shoulder replacement, and spine surgery

1.4%*

National Benchmark is 3.7%

St. Clair is in the top 10% nationally ( Top decile is 2.2% )

* Crimson, Complications of Care

Volume IX Issue 3 I HouseCall I 7

HIP REPLACEMENT

ORTHOPEDIC EXCELLENCE

8 I HouseCall I Volume IX Issue 3

Margaret Robertson of Mt. Lebanon is back to walking and running after hip replacement surgery.

DOUBLE HIP REPLACEMENT

Margaret’s Story Margaret Robertson, 72, has been running for 35 years and she is not about to stop anytime soon. The retired Baldwin High School Latin teacher is a familiar sight in every season to local residents who frequent Bower Hill Road, her usual route. Two hip replacements have motivated

need to get up, instead of thinking you can do it by yourself. And when you do call, they come.”

Hip replacement is a major surgical procedure, says Dr. Perricelli.

“We perform a high volume of hip replacements at St. Clair and we

her to keep up the pace and continue to enjoy an activity that she says

have specialized teams of expert clinicians to care for and guide the

enhances her life in countless ways. “I am not an athlete; I run for my

patients at every step. As a result, the patients do very well. Every single

health,” Margaret says. “Running has physical and emotional benefits.

case is unique. No two joints are alike, so every single operation is

It clears my head and keeps me balanced. My husband, Bob, is a

specialized.”

retired professor of exercise physiology and a lifelong runner; it

Hip replacement surgery is technically called a total hip arthroplasty.

became part of my life, too. Running has kept me active; when I can’t

The hip is a ball-and-socket joint, and during the operation, the surgeon

run, I miss it.”

resurfaces the acetabulum, the concave, cup-shaped socket that receives

Margaret’s arthritic right hip was replaced in 2014 by Brett C.

the “ball” — the head of the femur, the thigh bone. A prosthetic femur

Perricelli, M.D., a board-certified orthopedic surgeon and Chief

head made of titanium and plastic is fitted into the bone and the new parts

of Orthopedic Surgery at St. Clair Hospital. When pain in her left

interface smoothly, restoring movement. Essentially, the surgeon recreates

hip caused her to limp earlier this year and to curtail her running,

the joint anatomy. “We carefully take the bone down to the healthy

she knew it was time to see Dr. Perricelli again. “I was not in terrible

tissue, removing the arthritic tissue and cartilage,” Dr. Perricelli says.

pain but I knew I could be better. I had complete confidence in Dr. Perricelli.”

The left hip replacement took place in March, followed by three months of rehabilitation. Margaret claims that the secret to a great outcome is to follow your surgeon’s

Continued on page 10

“

OUR CARE IS SEAMLESS

instructions to the letter. “Do what they tell

. . . EACH TRANSITION TO

you! If they tell you to go to the classes, go.

THE NEXT GOES SMOOTHLY

Do the exercises, the way they show you.

Remove your throw rugs. Don’t think that you can do more on your own because you feel better; always do things their way.

They know what they’re doing.”

No detail was overlooked in her postoperative care and follow-up, Margaret says.

“Dr. Perricelli stays on top of everything; he even called me at home on the day I was

. . . INCLUDING THE TRANSITION TO HOME.

”

BRETT C. PERRICELLI, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL

discharged. The staff is excellent. St. Clair has a policy known as ’Call, Don’t Fall’ — it means that you call the nurse when you

BRETT C. PERRICELLI, M.D. Dr. Perricelli is Chief of Orthopedic Surgery at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh, and completed residencies in general surgery and orthopedic surgery at UPMC. Dr. Perricelli then completed an Adult Reconstruction Fellow at OrthoCarolina Hip and Knee Center, Charlotte, N.C. He is board-certified by the American Board of Orthopaedic Surgery, and practices with South Hills Orthopaedic Surgery Associates.

To contact Dr. Perricelli, please call 412.283.0260.

Volume IX Issue 3 I HouseCall I 9

ORTHOPEDIC EXCELLENCE Continued from page 9

“The new titanium implant has a liner made of greatly improved plastic. We don’t need to use cement. There is minimal trauma to the muscles and other soft tissues.”

Degenerative changes in the joint due to osteoarthritis is the usual reason for the surgery. Hip arthritis is often the result of an anatomical mismatch, Dr. Perricelli explains, that increases wear and tear on the joint. “Some people are born with a shallow acetabulum; sometimes, the head of the femoral bone is egg-shaped rather than round. If you’ve had a labral tear, you are more at risk to develop osteoarthritis (OA), just as a meniscus tear can set your knee up for it. Obesity is a factor, although it is more significant in the development of knee arthritis.” Many patients present with deep aching pain in the groin, the front of the thigh and even the knee.

Margaret Robertson has regained her stride following double hip replacement surgery.

Sometimes, a hip replacement will relieve this knee pain, but if the patient has OA in both sites, the hips should be replaced before the knees. Preventing arthritis is primarily a matter of staying in shape, managing your weight and using your body, Dr. Perricelli says. He recommends non-impact exercise, including cycling, water sports and using an elliptical machine.

Margaret says that since the surgery, she feels 30 years younger. “I can do just about anything now; I walk up hills, work in my garden, go to the gym, exercise and go to the theatre. I love being retired.” She does much of her running indoors, on a flat surface at the gym, and also exercises in a pool. Her advice to others considering hip replacement is to go ahead and do it. “Don’t wait, get it done. There’s nothing to fear. If you are in pain and you have limited mobility, a hip replacement will change your life for the better. It changed mine.” n

“

... a hip replacement will change your life for the better.

It changed mine.

”

MARGARET ROBERTSON, PATIENT, TOTAL HIP ARTHROPLASTY

10 I HouseCall I Volume IX Issue 3

DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE

ST. CLAIR HOSPITAL Continued from page 7

There are numerous advantages to having

Joint replacement patients are encouraged to

In the post-operative period, the St. Clair

orthopedic surgery at St. Clair. “Our care is

attend pre-op patient education classes offered

advantage begins with a focus on minimizing pain

Orthopedic Surgery at St. Clair, “and we have

by the nursing, therapy and care management

tocol, pioneered by Dr. Perricelli for joint replace-

seamless,” says Brett C. Perricelli, M.D., Chief of every capability here. All the elements are

integrated, so that each transition from one

three times a week. “The classes are presented

staff who will be caring for the patient,” Bob says.

“We urge patients to bring family members. The

and maximizing mobility. A multi-modal pain proment patients, is a highly successful approach to

pain management in which pain is anticipated and

stage to the next goes smoothly for the patient,

agenda covers preparation of the home, the

prevented as much as possible, beginning in the

tied together.”

and home care. It helps the patient know what

on narcotic medications, virtually eliminating the

including the transition to home. Everything is

Pre-operatively, Dr. Perricelli and his colleagues

work with the patients to optimize their general

surgery and post-operative period, rehabilitation

to expect and that reduces anxiety.”

In the OR, seasoned professionals manage

health for surgery, especially for joint replacement.

highly specialized orthopedic surgical technology

risk factors so that there is less chance of compli-

work with the same surgeon; they know every

“The goal pre-operatively is to eliminate reversible cations, such as blood clots, infection or anesthesia problems,” he says. “This may mean helping them to quit or reduce their smoking. We encourage

a nutritious diet to promote healing. If the patient needs to reduce their weight and lower their BMI (body mass index), we have resources to help

within a complex clinical environment. Teams

OR. It provides effective pain relief with less reliance noxious side effects that can inhibit recovery.

The pre-emptive pain regimen complements

another St. Clair standard: early mobilization. Pain

relief means that patients can get moving faster —

a key factor in recovery. “Early mobilization reduces

detail of that surgeon’s procedure and equip-

the risk of complications such as blood clots. We

being and safety, during surgery and in the

ical and occupational therapists who are on the

OR team is implementing a protocol known as

a specialized therapy gym on the unit,” says Bob.

ment needs. Diligent monitoring of patient wellpost-anesthesia recovery area, is a priority. The ERAS (Enhanced Recovery After Surgery), an

have a dedicated team of very experienced physorthopedic unit seven days a week, and we have “On the day of surgery, patients are out of bed

them. If they have a chronic disease, we work

evidence-based, multidisciplinary program to

and walking. Physical therapists and nurses get

patient in the best possible condition for surgery.”

surgery, to further improve the quality of care.

early discharge and improves outcomes.”

to get that under control. Our goal is to get the

Nurses confer on St. Clair’s orthopedic unit, 5A.

facilitate recovery and reduce the stress of

them back on their feet faster; this facilitates

Continued on page 17

Volume IX Issue 3 I HouseCall I 11

SPINAL SURGERY

ORTHOPEDIC EXCELLENCE

12 I HouseCall I Volume IX Issue 3

Kristy Jericho of Belle Vernon is able to enjoy her new kitchen and her dog Charlie.

SPINAL SURGERY

Kristy’s Story It’s part of a degenerative process in which the disc becomes dehydrated,

One of the most important days in Kristy Jericho’s life was the day that her orthopedic surgeon, Thomas D. Kramer, M.D., gave her something she had

worn and stiff; it subsequently tears. When that happens, enzymes leak

waited a long time for: a diagnosis. Kristy, a critical care nurse at a southwestern

into the surrounding tissue, causing inflammation. It can also be the

Pennsylvania hospital, had endured months of excruciating back pain that

result of trauma. The classic symptom is increased pain upon sitting.

wreaked havoc on her life. She was forced to leave the job she loved and she

Disc pressures are highest when we sit.”

An annular tear can expose nerves, causing the severe pain that Kristy

became essentially bedridden, unable to sit and barely able to stand and walk.

She could no longer do the things she enjoyed, like cooking, driving, going

was enduring. After confirming the diagnosis, it was clear that Kristy needed

out to eat with her husband, Tony, and walking her beloved dog, Charlie.

surgery, quickly. In April, Dr. Kramer performed a posterior lumbar fusion,

Life became an endless cycle of agonizing pain, pain medication and

placing screws into her spine. His goal was to relieve her pain and get her

fruitless visits to medical specialists.

“I had started having back pain at work,” Kristy recalls.

“I took Motrin and kept working for a few months but it worsened to the point that it felt like my back was breaking.

An MRI showed a herniated disc at L4-5 and I was referred to a spine surgeon. Subsequently, I was referred to an

“

off the pain medications. “Sometimes, people with

Dr. Kramer was

a blessing ... All the doctors looked at the

orthopedic surgeon, a pain medicine specialist, a second

same MRI, but he was

spine surgeon and a neurologist. I was told it was muscle

the only one who

spasms and given a muscle relaxer; I was told it was bursitis and was given steroids. The pain just got worse; it was off the charts.”

With worsening pain and still waiting to see a spine specialist, Kristy had to take opioid pain relievers and stay

really listened to me ...

severe back pain do get better with injections and pain management,” he says, “but this was a situation where the patient had a problem that required surgery, and instead she was placed on narcotics. The classic sign of an annular tear was right there; she had increased pain with sitting.”

Kristy is grateful to Dr. Kramer for his surgical expertise, but gives equal credit to his interpersonal skills. “Dr. Kramer was a

That made all the

blessing. He treated me with kindness and

difference.

respect. All the doctors looked at the same

in bed, as that was the only position she could tolerate.

For a woman who is normally very active, who often works 16-hour shifts at a demanding nursing job, this helplessness

”

KRISTY JERICHO, SPINAL SURGERY PATIENT

MRI but he was the only one who really listened to me and paid attention. That made the difference.”

Kristy, 53, always wanted to become a nurse,

was barely tolerable. Kristy had to depend on her husband to do all the

but did not go to nursing school until the age of 40, after she had raised

shopping, housework and cooking. Her father, who resides next door, drove

her two daughters. She says she learned about the importance of listening

her to her appointments. It took an emotional toll. Continuous pain, isolation

in nursing school. “When you give a patient time and attention, you are

and fear created enormous anxiety. Kristy felt let down by the very system that

showing them that you care,” she reflects. “It’s not easy;

she was so proud to be a part of. “I love being a nurse and working in health

you have to learn to be quiet and stop talking.

care; it’s my passion. I felt like I was being dismissed. No one seemed to

Listening isn’t passive; there is skill

understand what I was going through.”

involved.”

Except for Tony. Her husband of 35 years was her rock and, it so happened,

Kristy’s recovery has been long and

the key to her eventual recovery. “Tony is a sales representative for orthopedic

difficult, but she is gradually feeling

surgical products,” she says. “He knew Dr. Kramer and liked and respected him.

better; she can now sit for an hour

He suggested that I see Dr. Kramer.”

Dr. Kramer, a board-certified orthopedic surgeon at St. Clair Hospital, talked to Kristy, examined her and looked at her MRI. He told her that she had an

without pain and stand in her newly renovated kitchen long enough to prepare home-cooked meals. As for

annular tear — the root of the disc at L4-5 was torn and nearly severed. “An

practicing her profession of nursing,

annular tear is in the back part of the annulus, which is the tough outer layer of

one thing is certain: she will be listening

a disc, made of fibrous tissue,” Dr. Kramer explains. “It’s like a hole in a car tire.

attentively to patients. n

THOMAS D. KRAMER, M.D. Dr. Kramer specializes in orthopedic surgery. He earned his medical degree at the University of Pittsburgh, and completed residencies at the University of Alabama Hospitals and Healthsouth Medical Center, Birmingham, Ala. He later completed a fellowship in spine surgery at the University of Maryland Hospitals. Dr. Kramer is board-certified by the American Board of Orthopaedic Surgery. He practices with Greater Pittsburgh Orthopaedic Associates.

To contact Dr. Kramer, please call 412.262.7800.

Volume IX Issue 3 I HouseCall I 13

ORTHOPEDIC EXCELLENCE

Victor Hays of Upper St. Clair is back to coaching elite soccer players.

KNEE SURGERY 14 I HouseCall I Volume IX Issue 1

KNEE SURGERY

Victor’s Story

the knee. The ACL is in the front of the knee and it prevents the tibia bone

Soccer player, soccer coach and all-around avid athlete, Victor Hays

knows the importance of trust. It’s an essential element of teamwork. It’s

from shifting too far forward. Surgeons don’t actually repair a torn ACL,

also a key to the relationship between a physician and patient. When Victor

they reconstruct it using a graft. Victor, who had a previous ACL tear,

realized that he needed to have surgery to repair torn cartilage in his left

needed a revision of an ACL reconstruction. “This was an arthroscopic,

knee, he embarked on a thorough search to find exactly the right surgeon,

outpatient procedure,” says Dr. Gibbons. “Victor also had a torn meniscus.

much like a recruiter seeking the perfect new member for a team. He

When you do a reconstruction with a graft, there are three choices: you can

needed someone he could trust.

“

The right surgeon would be someone who understood what was at stake. Victor, who lives in Upper St. Clair, has been an athlete for his entire life, from his childhood in Peru and Argentina where he grew up playing soccer to his present-day life as a husband, father, soccer coach and environmental engineer in Pittsburgh. A former pro soccer player, he is 56, and remains in outstanding physical condition.

Victor is a volunteer coach for the Upper St. Clair

including his son, Anthony, 13 — is unwavering.

“This age is the critical time for the kids to fine tune

tendons, or an allograft — a cadaver tendon. In Victor’s

I give a lot of credit to Dr. Gibbons ...

He understood my desire to be as athletic as I’ve always been.

Athletic Association’s Soccer Travel Team and his commitment to the 13-14 year olds on the team —

use the patient’s own patellar tendon, two hamstring

”

case, the latter was the best option; a cadaver tendon gives more flexibility. Rejection is not typically a problem because it is not a living tissue.”

Post-operatively, the patient wears a brace to protect the knee until the quadriceps muscle strength is recovered. Weight bearing is allowed as tolerated, and generally patients use crutches for up to a week.

A continuous motion machine helps to restore full motion initially, followed by physical therapy. It’s a

VICTOR HAYS, KNEE SURGERY PATIENT

fairly long recovery, generally taking four to six months.

Victor’s rehab has gone well. “I give a lot of credit to Dr. Gibbons,” Victor says. “He understood my

the technical aspects of soccer and be prepared to move on to the next

desire to be as athletic as I’ve always been, although I have made some

level,” he says. “It’s important in their development as athletes. The travel

modifications to my workouts, to more aerobic and lower impact activities;

team provides opportunities for some kids to get additional training and

stepping back on the soccer pitch with my teams is my ultimate goal and

playing time, in hopes of later playing at the high school or college level,

has already begun. My whole family is athletic: in addition to Anthony, who

with hard work and dedication.”

Victor, who says he is a very hands-on coach, wore a brace on his

plays for both the USC travel team and the 03 Beadling Elite Cup Team, I have a daughter, Alexandra, 15, who is a gymnast, diver and competitive

injured knee and persevered to the end of the fall season. Specifically, his

cheerleader with one of the top teams in the state. My wife Michelle

injury was a torn anterior cruciate ligament (ACL) — the second one on the

runs and plays tennis.”

same knee — a common injury for athletes. “I needed a surgeon who had

“Athletes like Victor are physiologically young and take very good care

experience in ACL revision surgery and would be aggressive about getting

of themselves,” Dr. Gibbons says. “For them 50 is the new 40, and they

me back in shape and on the field. I did a lot of research.” Victor interviewed

do not want to give up their sports when they

several surgeons before someone pointed him to John M. Gibbons, M.D.,

are injured.” The care of aging athletes

a sports medicine specialist and orthopedic surgeon at St. Clair Hospital.

An ACL tear can be quite painful, says Dr. Gibbons, but it doesn’t always

is a specialty in itself, Dr. Gibbons believes. He works out with a trainer

require surgery. “An ACL reconstruction is a young person’s surgery, for the

and is interested in how exercise

most part. It typically happens to teens and young adults. The ACL gets torn

impacts aging. “I’m concerned with

in sports that involve sudden stops and changes in directions, like soccer.

injury prevention in this group. How

When an ACL tear happens to a person over 40 or 50, it doesn’t necessarily

do we slow aging and maintain

have to be repaired. You don’t always need surgery and you may be able

healthy bones? How do trainers deal

to strengthen and stabilize the knee with physical therapy. But Victor is

differently with the aging athlete?

atypical; he’s active at a very high level and for him to maintain that, he

We want to keep them active but

needed surgery.”

Ligaments are strong rope-like structures that connect bones to other bones. The two cruciate ligaments — “cruciate” because they cross — stabilize

prevent injuries. Of course, if they do get injured, St. Clair

Hospital is the place to go.” n

JOHN M. GIBBONS, M.D. Dr. Gibbons specializes in orthopedic surgery. He earned his medical degree at Columbia University, New York City.

Then Dr. Gibbons completed a residency in orthopedic surgery at Columbia-Presbyterian Medical Center, New York City, and a fellowship in knee reconstruction and sports medicine at Beth Israel Medical Center, New York City. He is boardcertified by the American Board of Orthopaedic Surgery. He practices with Advanced Orthopaedic & Rehabilitation.

To contact Dr. Gibbons, please call 724.225.8657.

Volume IX Issue 3 I HouseCall I 15

ORTHOPEDIC EXCELLENCE

ORTHOPEDIC NURSE NAVIGATOR

Guiding patients from pre-op through rehab At St. Clair Hospital, a new Orthopedic Nurse Navigator service is easing the experience of joint surgery for many

and/or on the orthopedic unit following surgery, when I meet with them and with their family.”

patients. Nurse navigators are registered nurses with in-depth

During their admission to the Hospital, Brigitte sees the

clinical experience and strong teaching and communication

patient. Once the patient has been discharged, she makes

skills who shepherd the patient through their entire journey,

frequent follow-up phone calls to see how things are progress-

from the pre-operative preparation through surgery and

ing at home. She collaborates with the case managers and

rehabilitation. The concept, which originated in oncology, has

the home health care team, to ascertain that the person’s

been very successful as an added resource and layer of

needs are being met. Patients are also welcome to call her

support for patients.

if they have questions or concerns. She is available to them by

“Undergoing major orthopedic surgery can be over-

phone 24/7.

whelming, and a nurse navigator makes the experience more

Brigitte says her relationship with the patient is the key

manageable,” explains Brigitte Easterday, B.S.N., B.S.Ed., R.N.,

to the nurse navigator program. “In nursing, the relationship

C.R.R.N. (pictured below), who began providing the service

with the patient is so important. I’m able to have one-on-one

to hip and knee surgery patients at St. Clair in May. “I transition

relationships with the patients. I can help ease their pain, give

the patient through each phase. Our relationship begins when

them emotional support, and help them obtain the resources

they initially sign up for surgery, through 90 days

they need. They have the comfort of knowing that I am their

post-op. I call the patient after they have

advocate. This kind of consistency is important, but it can be

seen the surgeon. I talk to them about

hard to come by; patients are discharged so quickly and they

their concerns and needs. I tell them

encounter many professionals during their experience. When

what to expect. I answer their ques-

they know there is one person who knows them and knows

tions. I encourage them to attend

their family, they feel less stress. For me, it’s satisfying to be

the pre-op classes provided by the

able to give patients this degree of care and attention.”

multidisciplinary care team on the

With seven years of orthopedic nursing experience and

orthopedic unit. The classes help the

degrees in both nursing and education, Brigitte is ideally

patients and their families know

suited for the position. “It enables me to integrate my teaching

what to expect and help them

skills and nursing skills. And the feedback from the patients

prepare for the surgery and rehab. I don’t teach the

Feedback from the physicians is equally enthusiastic.

classes, but I am there

“The nurse navigator program is a service enhancement that

to meet the patients. I

effectively helps the patients get through the system,” says

become a familiar face. I see them in the pre-op area

16 I HouseCall I Volume IX Issue 3

has been great.”

orthopedic surgeon Shaka M. Walker, M.D. “It’s care coordi-

nation with a single point of contact, and the patients and families appreciate it.” n

DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE

ST. CLAIR HOSPITAL Continued from page 11

Many different facets compose the jewel

make daily rounds to identify problems and

patient, St. Clair’s orthopedic team is guided

that is St. Clair orthopedics, but outstanding

take steps to effectively resolve them. Early

by visionary leaders and supported by an

among them is the top-notch nursing care

mobilization facilitates early discharge, and

administration that provides the resources for

that runs through every phase of the patient

most orthopedic surgery patients are able

them to do their best.

experience. St. Clair’s orthopedic unit, Unit 5A,

to go home within 1-3 days. A close working

And while the entire team is pleased to

is staffed by registered nurses who specialize

relationship with home health care agencies

see the high quality and satisfaction ratings

in orthopedics, and with specialization comes

streamlines the transition. Some patients

they have earned, the best feedback some-

expertise. Post-operative care of orthopedic

receive a pre-discharge home assessment

times comes with far less formality. Orthopedic

patients is intense. In addition to managing

to evaluate safety and ease mobility post-op.

surgeon Shaka M. Walker, M.D., cherishes the

pain and mobility, monitoring post-anesthesia stability, caring for complex surgical wounds, providing intravenous fluids and medications, nurses also tend to the psychosocial needs of patients, 24/7. It’s whole-person care and it’s demanding. “The nurses at St. Clair are extremely conscientious and the orthopedic unit is exceptionally well run, clinically and administratively,” says orthopedic surgeon John M. Gibbons, M.D. “The high quality of the nursing care makes the difference.” Adds his colleague, orthopedic surgeon Thomas D. Kramer, M.D., “The superior patient satisfaction at St. Clair is in large part because of the nurses: their focus is on the patient experience, no matter what it takes.”

A new and innovative aspect of that effort is the addition of an Orthopedic Nurse Navigator to the team, another example of St. Clair’s pioneering leadership in orthopedic excellence.

Brigitte Easterday, B.S.N., B.S.Ed., R.N., C.R.R.N., joined the team last spring to help joint replacement patients move seamlessly through the overall surgical process. (Please see related sidebar at left.)

Orthopedic surgery patients at St. Clair benefit from the Hospital’s multidisciplinary team. Physicians, social workers, case managers, nurse managers and physician assistants

moments when he encounters his patients in

A CONSTANT EFFORT TO IMPROVE

someone will often walk up to me and say,

proven record of exceptional quality, the team

great,’ and that is the best reward. It’s a special

Although the orthopedic service has a

does not rest on its laurels. A major advancement will be completed in 2018, when a total renovation of the environment of care is finished. The construction project will give the department all new patient rooms, a re-designed nurses’ station, a new state-ofthe-art therapy gym for both physical therapy and occupational therapy, and upgrading of

the community. “When I am out with my kids, ‘Hey, Dr. Walker, you fixed my knee and it’s reminder of why we all do what we do.” n

“

WHEN I AM OUT WITH MY KIDS, SOMEONE WILL OFTEN

the entire orthopedics unit. “The redesign will

WALK UP TO ME AND SAY,

result in better work flow and greater efficiencies

‘HEY, DR. WALKER, YOU FIXED

of care. It will optimize operations on the entire unit in a more aesthetically pleasing environ-

MY KNEE AND IT’S GREAT,’

ment,” Bob says. “It will further improve the

AND THAT IS THE BEST

patient experience.”

REWARD. IT’S A SPECIAL

At every stage along the spectrum of care, St. Clair’s orthopedic program honors the patients with caregiving measures that affirm and respect them as individuals. All of these measures, taken together, are a seamless whole that promises the patient safety, the highest quality care, and the utmost attention to their comfort. Care is customized to personal need, never delivered in a cookie-cutter fashion.

REMINDER OF WHY WE ALL DO WHAT WE DO.

”

SHAKA M. WALKER, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL

Cohesive, creative and committed to achieving the best outcome and experience for every

Volume IX Issue 3 I HouseCall I 17

YOUR HEALTH

ADULT VACCINES:

MORE IMPORTANT THAN EVER

VACCINATION RATES Vaccinations among U.S. adults are well below the target.

42% Influenza

E

verybody needs vaccinations. Throughout the human lifespan, they are essential to good health.

of self-care, as well as a way of caring for others. Vaccines

The need for childhood vaccinations is widely

not only protect one’s own health, but they also protect

recognized, but adults of all ages need vaccinations, too.

those around you: your loved ones, your co-workers and

An adult’s vaccination needs are more varied and individu-

friends, and your community. Getting vaccinations is a

alized than a child’s, but all adults need at least some

matter of personal responsibility, says Dr. Michael. “I find

vaccinations. Many, however, are not getting the vaccina-

personally that most of my patients understand the

tions they need.

importance of vaccination, not only for themselves, but

It’s a complex issue. Part of the problem is that vaccines

25% Shingles

20% Pneumococcal

20% Tdap

Actual vaccination rates among U.S. adults* *US Department of Labor

18 I HouseCall I Volume IX Issue 3

Getting appropriate and timely vaccinations is a form

also for the protection of loved ones,” she says. “Many of

have worked so well: they have eradicated smallpox

them care for young children whose immune systems are

throughout the world, they have nearly wiped out polio

still maturing, or perhaps for elderly parents who are at a

and other infectious diseases, and they have prevented

much higher risk of becoming very ill should they acquire

untold millions of deaths since the 1950s. “Some people

a vaccine-preventable disease.”

believe that we live in a post-vaccine era, but this is a

Every year, thousands of American adults become ill

misconception,” says Amanda M. Michael, D.O., a board-

and even die from diseases that can be prevented by vacci-

certified Infectious Disease specialist and Chair of the

nations. The Centers for Disease Control and Prevention

Antibiotic Stewardship Committee at St. Clair Hospital.

(CDC) reports that 42,000 adults and 300 children die every

“We are fortunate in this country to have had a respite

year in the U.S. from such diseases, including influenza and

from most vaccine-preventable diseases on a mass scale,

hepatitis. Vaccine-preventable diseases are not benign;

thanks to the intense effort that took years of vaccinating

they can have terrible consequences. For example, measles

and maintaining high rates of vaccination in the general

can cause severe illness and even death; shingles can lead

population. The World Health Organization estimates that

to blindness and lifelong pain. Even those who were fully

between 2 million and 3 million deaths are prevented

immunized as children need vaccination, as that protection

each year due to vaccination.”

can wear off, and there are new, improved versions of

some of those vaccines. Certain vaccines, such as the

resource. If traveling internationally, it can be helpful

shingles vaccine, are specifically for adults, although

to have the input of an infectious disease specialist,

75 percent of Americans over age 60 have not taken

given that various regions of the world have specific

advantage of it.

requirements for vaccination. The presence of mosquito-

The current CDC recommendations are that all adults should receive an annual flu vaccine. In addition, all adults should get Td/Tdap (tetanus-diphtheria,

borne illnesses and other infectious diseases must also be taken into account.”

For those who have chronic conditions, such as

“

PRIMARY CARE PHYSICIANS ARE MAJOR STEWARDS OF

tetanus-diphtheria-pertussis) if they are unvaccinated

diabetes, heart disease or lung disease, vaccinations

or if their vaccine history is unknown. Td boosters are

are especially important, as these conditions, even

PUBLIC HEALTH AND

recommended every 10 years and sometimes in the

when well-managed, make one more vulnerable to

TERRIFIC RESOURCES

event of a wound. Beyond those, individual needs are

complications of vaccine-preventable diseases that

determined by a host of factors: age; lifestyle; occupa-

can result in hospitalization and even death.

tion; existing health conditions; previous vaccination

Vaccination is one of the safest and most cost-

history; and travel habits. Every year, the CDC updates

effective preventive medical procedures in existence.

their recommendations and this information is easily

There may be minor side effects after receiving a vaccine

accessed on the website, www.cdc.gov.

injection — a sore arm and low fever are the most

The best source of information about one’s vaccine

common — but these are mild and of short duration.

needs is the primary care physician, says Dr. Michael:

True adverse effects, such as an allergic reaction,

“Primary care physicians are major stewards of public

are rare. Dr. Michael says that there is less than one

health and terrific resources for people to learn about

severe allergic reaction per 1 million doses of vaccine.

their individual vaccination needs. If there is a particu-

The CDC and FDA monitor adverse events closely and

larly difficult scenario, PCPs may involve infectious

encourage the reporting of them.

disease specialists, but by and large PCPs are the best

FOR PEOPLE TO LEARN ABOUT THEIR INDIVIDUAL VACCINATION NEEDS.

”

AMANDA M. MICHAEL, D.O., INFECTIOUS DISEASE SPECIALIST, ST. CLAIR HOSPITAL

Continued on page 20

Recommended Immunizations for Adults: By Age If you are this age, talk to your healthcare professional about these vaccines Flu Influenza

Td/Tdap Tetanus, diphthera, pertussis

Shingles Zoster

You should get a Td booster every 10 years. You also need 1 dose of Tdap. Women should get Tdap vaccine during every pregnancy.

You should get shingles vaccine even if you have had shingles before.

Pneumococcal PCV13

PPV23

Meningococcal MenACWY or MPSV4

MenB

MMR Measles, mumps, rubella

HPV Chickenpox Hepatitis A Hib Human papillomavirus Varicella Hepatitis B Haemophilus influenzae type b for women for men

19-21 22-26 27-59 60-64 65+ More information:

You should get flu vaccine every year.

Recomended For You: This vaccine is recommended for you unless your health care professional tells you that you do not need it or should not get it.

You should get 1 dose of PCV13 and at least 1 dose of PPSV23 depending on your age and health condition.

May Be Recomended For You: This vaccine is recommended for you if you have certain risk factors due to your health condition. Talk to your health care professional to see if you need this vaccine.

You should get this vaccine if you did not get it when you were a child.

You should get HPV vaccine if you are a woman through age 26 years or a man through age 21 years and did not already complete the series.

Source: U.S. Department of Health and Human Services Centers for Disease Control and Prevention www.cdc.gov/vaccines

Volume IX Issue 3 I HouseCall I 19

YOUR HEALTH Continued from page 19

Misleading information about vaccine safety has unfortunately produced resistance to vaccination among some people. Dr. Michael approaches this

about vaccination and is the author of numerous books and research studies.

According to Dr. Offit, vaccines are underutilized

“This is even more important as we are in an era where antibiotics are becoming less useful. We are likely to lean on vaccines more heavily than

with a direct and substantive conversation. “I tell

because people no longer fear the diseases that

ever going forward. Vaccines are the safest they

people about the history of vaccines, how they are

vaccines prevent. “Our parents witnessed the

have ever been in this country, and studies are

produced now, and about vaccine-preventable

devastation of these diseases. They knew children

ongoing to assess guidelines for adult vaccine

illnesses. I discuss the many large studies that

with polio; they saw teenagers die with diphtheria.

recommendations. Vaccines are an incredibly

have been done on vaccines. As with everything

But most people alive today have never seen

important part of the arsenal against disease,

when caring for patients, it’s important to explain

the diseases. They don’t understand the threat.

for adults as much as for children.”

why you want to do a particular thing, whether

Unfortunately, people are more compelled to act

it’s starting a new medication, ordering a test or

by fear than by reason. They may ask, ‘Why give

giving a vaccine, so that you establish a trusting

polio vaccine when no one gets polio anymore?’

partnership regarding their health.”

The answer is that these diseases still exist and

VACCINES ARE

cause much suffering and death. There can be

AN INCREDIBLY

“Vaccines are victims of their own success,” says Paul A. Offit, M.D., a leading international

an outbreak at any time. People could be walking

expert on vaccines, viruses and immunization.

through airports shedding polio virus, and if you

Dr. Offit is the Director of the Vaccine Education

are not vaccinated against polio, you could

Center and professor of pediatrics in the Division

contract the disease and spread it to others.”

of Infectious Diseases at Children’s Hospital of

Unfortunately, vaccines are too often perceived

Philadelphia. He is a member of the Institute of

as something for children, Dr. Offit says. “Many

Medicine of the National Academy of Sciences

people don’t feel that they are affected. Adults go

and has served as a member of the Advisory

to the doctor when they’re sick, but they’re not

Committee on Immunization Practices for the

very good about ‘well’ care and preventive care.”

CDC. He has written and spoken extensively

As a consequence of the anti-vaccine movement, there have been outbreaks of vaccinepreventable diseases in communities across the U.S. in recent years. “In 2015, there was an out-

“

IMPORTANT PART OF THE ARSENAL AGAINST DISEASE, FOR ADULTS AS MUCH AS FOR CHILDREN.

”

AMANDA M. MICHAEL, D.O., INFECTIOUS DISEASE SPECIALIST, ST. CLAIR HOSPITAL

break of measles that was traced to Disneyland,” Dr. Offit says. “It infected 189 people in 25 states

Vaccines are the best defense against serious,

and created a lot of fear. In 2014, an outbreak in

preventable, contagious and potentially deadly

an Amish community in Ohio infected 680 people.

infectious diseases. They are safe, effective and

But a study of vaccination rates for elementary

readily available. Vaccination rates among

school children in upper income communities in

American adults, although low, are improving,

California revealed that less than 50 percent were

says the CDC, especially among those who

vaccinated — which is worse than vaccination

have a regular provider and health insurance.

rates for South Sudan.”

At every PCP visit, the CDC says, vaccination

According to Dr. Michael, there are more vaccines in development for a variety of illnesses.

status should be reviewed and appropriate

vaccination should be offered then and there. n

AMANDA M. MICHAEL, D.O. Dr. Michael specializes in infectious diseases. She earned her medical degree at the Philadelphia College of Osteopathic Medicine. Dr. Michael then completed an internal medicine residency, as well as a fellowship in infectious diseases, at Drexel Medicine/Hahnemann University Hospital, Philadelphia. She is board-certified by the American Board of Internal Medicine. Dr. Michael practices with Pittsburgh Infectious Diseases, Ltd. To contact Dr. Michael, please call 412.347.0057.

20 I HouseCall I Volume IX Issue 3

ASK THE DOCTOR

Ask the Doctor RAMY KHALIL, M.D.

Q A

I have a history of gastroesophageal reflux disease (GERD) and am taking a Proton-pump inhibitor (PPI), but I’ve heard that these medications can be dangerous. Is this true? Should I stop taking it?

Proton-pump inhibitors (PPIs, such as Nexium® and Prilosec®)

First, have a conversation with your primary care physician

have been used for the treatment of GERD since the 1980s.

or a stomach specialist like a gastroenterologist. Make sure you

They work by blocking the production of stomach acid, which

understand why a PPI was prescribed in the first place, when it

makes for less irritation caused by stomach juices that leak into

was prescribed, and how long you should be on it. While PPIs

the esophagus. In the past decade, PPI use has exploded thanks

are most commonly used for the treatment of GERD, the

to cheaper generic alternatives and over-the-counter availability.

duration of therapy may vary. Most people do not need long-

There are now an overwhelming number of Americans — about

term PPI therapy, and it can be stopped after a few months of

15 million — on long-term PPI therapy.

use. Other people with more complicated medical problems

PPIs have gotten a lot of bad press lately. They have been

may need to be on PPI therapy for longer periods of time.

implicated in a handful of negative health effects, including an

Second, if you and your doctor decide to stop PPI therapy, be

increased risk for bone fractures, increased risk for pneumonia

sure to do so gradually. Stopping a PPI “cold turkey” after having

and bacterial diarrheal illness, a decrease in the body’s vitamin

been on it for a long time can cause serious worsening of your

B12 and magnesium stores, and, most recently, an increased risk

original GERD symptoms. Transitioning to other, less aggressive

for kidney disease and dementia.

acid blockers like histamine-2 (H2) blockers (e.g., Pepcid® or

At first glance, that’s a scary list. Before you label PPIs as

Zantac®) is also safe and effective. Dietary modifications and most

unsafe altogether, it’s important to know which of these

importantly, weight loss, are also hugely important and can possibly

associations are truly significant. The risk of decreased vitamin

reverse your GERD altogether, obviating the need for PPI therapy.

B12 and magnesium stores is valid, but fortunately it is an easy

It’s important to be educated about medication side effects,

issue to address. Repletion of vitamins and minerals with

but before you throw your PPI supply away, know that the latest

supplements is both safe and simple. The increased risk of

reports on PPIs are not black and white, nor are they compelling

fracture or infection is also valid, though researchers found that

enough to recommend wholly against PPI use. PPIs are, for most

only people who are already at risk for fractures or infections

people, safe and effective when taken appropriately. They can also

for other medical reasons are the ones who are most affected,

be positively life-changing — they can relieve GERD symptoms

and even then, the increased risk is small.

better than any other medication on the

The association with kidney disease and memory loss has been less clear and far more controversial. The research studies that explored these risks were retrospective observational

market and can protect against more serious complications of GERD. Whether you’re about to start

studies, meaning the researchers could not, by nature of

taking a PPI or have been taking one

the experiment’s design, prove a direct cause-and-effect

for years, I recommend all patients talk

relationship. It is not clear if PPIs are truly a cause of kidney

to their doctor about their individual

disease and dementia, or if this is simply an association that is

risks and how long they need to stay

explained by a different reason altogether (in technical terms,

on a PPI. Despite being available

a confounding variable). More research studies on this topic are

over-the-counter, PPIs should not

on the way, which may bring some answers, but until then, what

be used any less seriously than

should you do?

other prescription drugs. n

RAMY KHALIL, M.D. Dr. Khalil earned his medical degree from the George Washington University School of Medicine and Health Sciences in Washington, D.C. He then completed a residency in Internal Medicine at the University of Pittsburgh Medical Center. Dr. Khalil practices as an internist with Mt. Lebanon Internal Medicine, a division of St. Clair Medical Services.

To contact Dr. Khalil, please call 412.942.8500.

Volume IX Issue 3 I HouseCall I 21

FOUNDATION FUNDRAISER

The 2017 version of Summer Swing — dubbed

some of her favorite songs from her performances in

Broadway on the Green — attracted a record 650

musical blockbusters, such as The Lion King, Book of

people and raised more than $340,000 to help

Mormon and The Color Purple. When guests weren’t

ensure St. Clair Hospital can continue to grow

being entertained by Ms. Webb, they were mingling

and provide the most advanced medical care in

and chatting inside and on the patio of St. Clair

state-of-the-art facilities. This year’s Summer Swing —

Country Club, whose chef provided a wealth of

the 20th — was conducted Friday, July 14 and

food stations that were inspired by iconic New York

featured Broadway veteran Rema Webb, who shared

22 I HouseCall I Volume IX Issue 3

City restaurants. n

Tricia & Bob Hammel

Beth & Wayne A. Evron, M.D.

Drs. Brett C. Perricelli & Felicia Snead

Tim Pitschke & Annie Guarino

Mark & Vicki McKenna

Drs. Nina Fatigati & Christopher Pray

Kristen Merck, Dr. Shaka M. Walker, Denise Walker, Gina Florez & Dr. Gerson Florez

David & Sharon Heilman

Volume IX Issue 3 I HouseCall I 23

1000 Bower Hill Road Pittsburgh, PA 15243 www.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 MAKE SURE ST. CLAIR HOSPITAL IS IN YOUR HEALTH INSURANCE NETWORK.

St. Clair participates with every major insurer in almost every product. That means ST. CLAIR IS AN IN-NETWORK PROVIDER for these insurers and products. And, if you have a health insurance product (like a high-deductible health plan) that requires you to share in the cost of paying for services, you’ll be pleased to know that ST. CLAIR IS OFTEN THE LOWEST COST PROVIDER. For more information, please call Customer Service at 412.344.3408 to speak to a St. Clair representative. For a complete list of insurers currently contracted with St. Clair to provide IN-NETWORK services to their members, please visit WWW.STCLAIR.ORG.

St. Clair Hospital marks its one-year anniversary of clinical collaboration with Mayo Clinic Care Network St. Clair Hospital is proud to be a member of Mayo Clinic Care Network. This clinical collaboration with Mayo Clinic — unique in western Pennsylvania — gives St. Clair physicians direct access to the expertise of Mayo Clinic to assist with challenging medical cases, at no additional cost to patients.

By virtue of this collaboration, St. Clair has access to second opinions from experts in every specialty at the Rochester, Minnesota-based health system. Through eConsults, St. Clair physicians can get feedback that enables them to confirm a diagnosis or treatment plan, fine-tune a diagnosis or treatment plan, or get suggestions for ongoing management of their patients. The process is direct, efficient and simple.

Together, St. Clair Hospital and Mayo Clinic are building a healthier community, a community that starts with a healthier you.

Working Together.

For a ealthier You.

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.

@StClairHospital