St. Clair Hospital_HouseCall Vol VII Issue 4

VOLUME VII ISSUE 4

HouseCall A Weight Off Her Shoulders A progressive and innovative approach to shoulder care at St. Clair Hospital

inside

Infection Prevention I Neurosurgeon Brings Patients ‘Back To Life’ St. Clair Opens Vein Care Center I Ask The Doctor I Pink Out Champions Breast Care Center Expands To Peters Township

SHOULDER CARE

St. Clair Hospital orthopedic surgeon Patrick J. McMahon, M.D. performs arthroscopic rotator cuff surgery on a female patient.

2 I HouseCall I Volume VII Issue 4

Giving patients

A SHOULDER

to lean on

ST. CLAIR HOSPITAL ORTHOPEDIC SURGEON PATRICK J. MCMAHON, M.D. SPECIALIZES IN RESTORING STRENGTH, FLEXIBILITY AND FUNCTION TO PATIENTS’ AILING SHOULDERS

F

ew people will get through life without a shoulder injury,

of scientific articles to prestigious medical journals and is

says Patrick J. McMahon, M.D. He should know: few

the editor of a forthcoming book, Rotator Cuff Injuries, to

physicians can match his credentials as an expert in

be published in 2016 by Springer. Dr. McMahon is a graduate

the diagnosis and treatment of shoulder conditions and injuries.

of Temple University School of Medicine and completed an

Dr. McMahon is a shoulder specialist, a board-certified ortho-

internship at New York University Medical Center, followed

pedic surgeon who is trained in sports medicine and also treats

by a residency and a fellowship at UPMC and a sports medicine

conditions of the knee and elbow. He is a fellow of the American

fellowship at the Kerlan Jobe Orthopaedic Clinic in California,

Academy of Orthopaedic Surgeons and serves as an adjunct

whose physicians serve as team doctors to a host of professional

professor in the University of Pittsburgh department of bio-

sports teams in the Los Angeles area.

engineering, where he is studying the science of hard-to-heal

An impressive resume. But ask Dr. McMahon’s patients

tissues. Dr. McMahon has an independent medical practice,

about him, and they respond with raves about his other, non-

McMahon Orthopedics & Rehabilitation, and performs surgery

academic credentials: his bedside manner, his attention to

at St. Clair Hospital. In addition, he is an inventor of medical

detail in the clinical setting, his personal warmth and kindness,

devices and a researcher, educator and consultant who has

and his ability to inspire confidence in them. They praise his

earned national recognition for his progressive, innovative

talent for explaining complex concepts and his direct style

approaches to shoulder care. He has been a frequent contributor

of communicating.

Continued on page 4

ABOUT THE COVER Shoulder surgery patient Janiece Newell of Homestead.

Volume VII Issue 4 I HouseCall I 3

SHOULDER CARE Continued from page 3

SHOULDERS: POWERFUL, YET VULNERABLE

The shoulder’s marvelous mobility has a shadow side: it leaves it

Think of all that your shoulders enable you to do: lift a baby, swing a

vulnerable, subject to injury and to wear-and-tear degeneration. Arthritis,

tennis racket, embrace a loved one, put a star atop a Christmas tree or

tendonitis, bursitis, partial and complete tears, and traumatic injuries plague

twirl a Terrible Towel. Shoulders allow us to move our arms in almost

the shoulder joint, which is in almost constant motion during our waking

every direction; we can even reach behind our backs. As the most mobile

hours, as we use our hands and arms for countless activities. Shoulder

and flexible joint in the body, the shoulder has a unique anatomy that

complaints are so common that they are among the top five reasons that

distinguishes it from all the other joints. It’s composed of three bones:

Americans visit their primary care physicians. The Centers for Disease

the humerus, or upper arm bone; the clavicle, or collarbone; and the

Control and Prevention reports that nearly 8 million people will visit

scapula, or shoulder blade. It’s a ball and socket joint, as is the hip, but

emergency rooms each year with shoulder injuries, often related to sports

with a critical difference: the socket into which the head of the humerus

but also the result of common, everyday activities that place stress on

fits is small and shallow, so that the humerus fits into it just partially. It

the shoulder joint.

doesn’t plug snugly into the socket. (Picture the way that a golf ball sits

“The shoulder is easily injured. Rotator cuff injuries especially are

atop the tee, and turn that image on its side). This anatomical arrangement

common after the age of 60,” says Dr. McMahon. “Half of those I see with

facilitates the shoulder’s amazing range of motion that allows us to raise,

shoulder pain don’t even know how they hurt their shoulders; the pain may

lower and rotate or twist our arms, but it also demands more support

come on gradually or they wake up with it, and they can’t pinpoint a specific

from surrounding tissues. That’s where the rotator cuff comes in. The

activity that brought on the pain. Overhead activity is a factor; laborers who

rotator cuff, a group of four tendons and muscles that resemble the cuff

reach their hands above their heads all day to paint, for example, are

of a shirt, stabilizes the shoulder. It has the job of holding those shoulder

prone to shoulder injury. Athletes, especially tennis players, swimmers,

bones together, maintaining the head of the humerus in the socket.

and pitchers are vulnerable. Even yoga can lead to shoulder injury.”

MUSCLE ANATOMY OF A ROTATOR CUFF INJURY The rotator cuff is a group of muscles and tendons

Acromion

Clavicle

TENDON

that surround the ball and socket joint in the

Humeral head

shoulder. The rotator cuff provides stability to the shoulder and allows the shoulder to rotate.

Most commonly, tearing of the rotator cuff occurs where the tendon attaches to the bone.

Scapula TENDON

Humerus

TEAR IN ROTATOR CUFF TENDON MUSCLE

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Sue Clafshenkel, R.N. (foreground) works closely with Orthopedic Surgeon Patrick J. McMahon, M.D. during a recent shoulder surgery.

The evaluation of a rotator cuff injury includes a thorough physical exam, says Dr. McMahon. “I evaluate range of motion and strength, and perform ‘provocative tests’ — moving the arm in various ways to provoke pain, to determine the source of the pain.” Symptoms of rotator cuff injuries include pain, weakness and sometimes decreased joint mobility. Most injuries will heal on their own, he says, and physical

A tiny camera inside the patient’s shoulder projects a live image onto a screen in the operating room.

therapy or a home exercise program can be quite helpful. A minority will require surgery.

Medical treatment of a rotator cuff injury is focused on reducing pain and inflammation. It consists of rest, strengthening exercises that are specific for the rotator cuff and oral anti-inflammatory medications, or NSAIDs. If there is no improvement after four to six weeks, a steroid injection may be the next step. People tend to be confused about steroid shots, Dr. McMahon says, and he wants to clarify that confusion. “Steroid shots work as an anti-inflammatory. People may have heard that longterm use of steroids can weaken bones and tendons, but it is not long-

“

Don’t Dismiss aches anD pains,

term use to get a shot. A steroid shot decreases inflammation and that

iF you have a tear . . . without treatment,

can give you long-term pain relief. The benefits far outweigh any risk.”

a cycle oF inFlammation anD re-injury

Rotator cuff injuries can occur at all ages. Tears usually happen at the spot where the tendon enters the bone and can be mild or severe.

A small, mild tear can grow bigger, and inflammation is often the culprit. “Inflammation can lead to a tear in the rotator cuff. We think it probably begins with tendonitis, from trauma such as a fall or heavy

may Develop anD leaD to worse problems Down the roaD.

”

PATRICK J. MCMAHON, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL

Continued on page 6 Volume VII Issue 4 I HouseCall I 5

SHOULDER CARE Continued from page 5

lifting, or from chronicity — no specific event, just gradually worsening tendonitis. You may have a small tear that grows bigger over time.

“

we are FinDing new ways to repair, heal,

If you know you have a rotator cuff injury, you

reconstruct anD

need to monitor your pain and if it gets worse,

regenerate DamageD

come in to be re-evaluated with strength testing and perhaps an MRI. Don’t dismiss aches and pains, if you have a tear and have chosen to not get it fixed, because those symptoms might mean your tear is worsening. Without treatment, a cycle of inflammation and re-injury may develop and lead to worse problems down

anD DiseaseD tissues.

”

PATRICK J. MCMAHON, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL

OSTEOARTHRITIS, SHOULDER INSTABILITY AND FROZEN SHOULDER Other common shoulder conditions include osteoarthritis, shoulder instability and frozen shoulder. Nationally, orthopedic surgeons replace millions of arthritic hips and knees, and although total shoulder replacement is possible, it is far less common. “About 100,000 shoulder replacements are done annually in the U.S.,” Dr. McMahon says. “I myself do about 100. The demand is not that great; shoulder osteoarthritis can usually be treated

the road.”

medically. But the surgery is successful,

With rotator cuff surgery, there is approxi-

with outcomes similar to that of other joint

mately a 75 percent chance that the tendon

replacements: most will last for 20 years.”

will heal, Dr. McMahon explains. “While there

the tear. Post-op, you can’t move your shoulder

are other factors that affect healing, it is

under your own power, and you will most likely

Shoulder instability — the upper arm

higher if the tear is mild and lower if the tear

be using a sling for four to six weeks to support

popping out of the socket — is rare. “When it

is severe. For most people, recovery takes

the joint as it heals. The goal is to restore

does happen, it’s most likely the result of

about six months and depends on the size of

strength, flexibility and function to the shoulder.”

trauma, when the arm is pushed too far back,”

PATRICK J. MCMAHON, M.D.

Optimizing Healing with High-Tech Tissue Engineering Solutions The human body has an immense capacity for self-healing. When there is an injury, a chain of events is set in motion that usually heals, protects, repairs and sometimes restores and rebuilds the injured tissue. This process, which takes place in stages, works perfectly in the vast majority of cases. But sometimes, healing is slow; it may even fail to happen at all.

Some tissues are known to heal poorly and healing can be delayed or complicated by factors including diabetes, hypertension, obesity, vascular insufficiency, immunocompromised states and even smoking, which constricts blood flow, a critical aspect of healing.

Injuries such as these are referred to as “hard-to-heal” injuries, and they present a special challenge for surgeons such as Patrick J. McMahon, M.D. Dr. McMahon, who specializes in orthopedics and operates at St. Clair Hospital, has long had a special interest in “hard- to-heal” injuries, especially to musculoskeletal tissues such as the knee’s anterior cruciate ligament (ACL) and the shoulder’s rotator cuff. ACL rupture and rotator cuff tears are among the orthopedic injuries that have a higher-than-average rate of poor postoperative healing. It matters: a tissue that has not healed or has healed poorly often means chronic pain and poorer function, and it may not return to its pre-injury strength and stability.

6 I HouseCall I Volume VII Issue 4

Dr. McMahon says. “It’s essentially a subluxation, or displacement — the bone doesn’t go all the

PATRICK J. MCMAHON, M.D.

way out.” It is painful and requires emergency

“It’s worse if it happens when you are young.

Dr. McMahon specializes in orthopedic surgery. He earned his medical degree at Temple University School of Medicine, Philadelphia. Dr. McMahon completed his residency at UPMC and fellowships at UPMC and the Kerlan-Jobe Orthopaedic Clinic, Los Angeles. He is board-certified by the American Board of Orthopaedic Surgery. He practices with McMahon Orthopedics & Rehabilitation.

If under 25, you have a 60–90 percent chance

To contact Dr. McMahon, please call 412.431.7342.

treatment, with sedation provided to ease the discomfort of having it pushed back into the socket. An unstable shoulder is likely to recur if the initial event happens when one is young.

of recurrence. Over age 40, it’s 10–15 percent.”

A frozen shoulder is the result of scarring in the joint lining and is most common in women in midlife. This condition begins with another injury or inflammatory process, like

Advances in orthopedic surgical technology,

Patients experiencing shoulder pain and

tendonitis, and is self-limiting. According to

medical science, and diagnostic imaging have

dysfunction can rest assured that there are

Dr. McMahon, “A frozen shoulder will go away

propelled shoulder surgery forward to a new

solutions, both medical and surgical, that will

on its own, eventually, although it may take

era, with innovative, dynamic surgeons like

relieve their pain, improve their strength and

several months or a year. Probably 90 percent

Dr. McMahon leading the way. Improvements

mobility, and restore their quality of life. ■

of patients with a frozen shoulder will never

in pain management and more focused physical

need surgery.”

therapy modalities are part of this progress.

In addition to being a clinician, Dr. McMahon is also a researcher studying the science of healing at the University of Pittsburgh, where he is an adjunct associate professor of bioengineering. The Upper St. Clair resident is the

platelets that have the highest concentration of growth factors. This may help to build new tissue.”

The third approach is to study the patient selection process: “Who benefits

editor of two books and, soon, a third one on how to treat rotator cuff

most from surgery? Are there patients who can get better without surgery?

injuries. He is the author of more than 100 scientific articles published in

And, what are the factors that determine this? Not everyone needs surgery.

medical journals and has been an invited speaker at numerous international,

We know that some people can compensate or adapt to injury better than

national and regional meetings.

others. I recently published a study of 151 elite athletes and found that 21

Dr. McMahon is designing and creating techniques and technologies to

percent had a full-thickness rotator cuff tear; this means that a rotator cuff

improve the repair and healing of injured musculoskeletal tissue. “Hard-to-

repair is not needed for participation in sports. We need to do more of these

heal tissue requires a three-pronged approach,” Dr. McMahon explains. “The

studies to tease out through research which factors — age, gender, type of

first is the development of improved surgical repair techniques. For example,

injury, activity level — impact this.”

for the last several decades it was thought the ACL had to be replaced

Finding solutions to the problem of hard-to-heal wounds is one of

because it would not heal. My colleagues and I are developing a technique

Dr. McMahon’s passions — as a surgeon, he seeks the best possible outcomes

for ACL repair using a device that isn’t brittle, so it will not break into shards.

for his patients. He has engaged for 20 years in an exploration of the factors

It’s resorbable, so over time, it falls away and allows the ACL to pick up

that impact post-operative healing. “The goal is to minimize pain and

the load, slowly. It’s comparable to a cast that you don’t remove all at once,

restore function,” Dr. McMahon states. “These new technologies are

but gradually.”

innovations that are going to improve outcomes. We are finding new ways

“The second approach is to use new technologies that optimize the

to repair, heal, replace, reconstruct and regenerate damaged and diseased

healing response. Our ACL repair technique includes a scaffold, which when

tissues. It’s exciting; these advances will help us to more effectively

applied in this innovative manner serves as a matrix to guide and support

treat muscle, bone, ligament and tendon injuries and this may help to

tissue repair following surgery, and platelet-rich plasma; we isolate the

prevent arthritis.” ■

Volume VII Issue 4 I HouseCall I 7

SHOULDER CARE Continued from page 7

“ ”

my results are extraordinary.

JANIECE NEWELL, PATIENT

Janiece Newell 8 I HouseCall I Volume VII Issue 4

JANIECE NEWELL:

Regaining flexibility and strength to return to a productive life

J

aniece Newell, 43, of Homestead, injured her shoulder

manages a convenience store, J and J’s convenience

in a fall. A former Family Intervention and Prevention

store in Munhall. The store is open six days a week and

Specialist, Janiece had surgery on her left shoulder in

caters primarily to the neighborhood children, keeping

2011 to repair a torn muscle and was unable to work for

it well stocked for the after-school crowd. It’s work that

a year; consequently, she lost her job.

entails a good bit of physical labor, including daily lifting,

The 2011 surgery did not heal well, she says, and the

but she has no problems performing her job.

pain and weakness made her more reliant on her “good”

A former Steel Valley High School basketball player,

shoulder, the right one. “I compensated for the weak-

Janiece also finds time to serve the Charlie Batch Foun-

ness and pain on the left by overusing my right shoulder.

dation as head coach for a girls basketball team and

Before long, I had plenty of pain on the right, too.

assistant coach for a boys team. It’s a volunteer position,

My original surgeon referred me to Dr. McMahon for a

but one that rewards her with the satisfaction of giving

second opinion; he said Dr. McMahon was the best

back to her community. “I went to high school with (former

orthopedic surgeon specializing in shoulders.” Upon

Pittsburgh Steelers quarterback and Homestead native)

examination, Dr. McMahon discovered that Janiece had

Charlie Batch and I joined the Foundation at the beginning.

considerable scar tissue in her left shoulder from the

It means a lot to me to give back, and to watch these kids

previous procedure, and a torn rotator cuff on the right.

grow and learn,” she says. “I try to maintain a relationship

In April 2014, he performed an arthroscopic surgical

with the kids throughout the year. Both of my teams went

procedure on her left shoulder to clean up the joint, with

to the Best of the Batch championships this year and the

excellent results. Five months later, in September 2014,

girls won.”

he performed another procedure — repair of her right rotator cuff.

Janiece is still able to play basketball pretty well herself, despite three shoulder surgeries. “I can still

Today, Janiece has no pain and no more stiffness

shoot baskets and do lay-ups. I get tired from the running,

in either joint; both are healthy and fully functional.

but both of my shoulders feel great! I had a wonderful

That’s a great relief to Janiece, who carries a lot on

experience at St. Clair Hospital,” she says. “I recommend

those shoulders. She’s the mother of two teenagers:

St. Clair and Dr. McMahon to anyone who is having a

Christyann, 15, and Elysha, 13; she also owns and

problem with their shoulders.” ■

Volume VII Issue 4 I HouseCall I 9

QUALITY HEALTHCARE

10 I HouseCall I Volume VII Issue 4

AT ST. CLAIR HOSPITAL, INFECTION PREVENTION IS

Everyone’s Job At St. Clair Hospital, every single employee is an Infection Preventionist. Whether the employee works at a desk, an operating table, or a patient’s bedside, he or she is an integral part of a robust and comprehensive effort to prevent infections. At St. Clair, infection prevention is a top priority and the effort is paying off: St. Clair has one of the best infection prevention records among all hospitals in Pennsylvania, and meets or exceeds national benchmarks for hospital-acquired infections. In fact, St. Clair has reduced one type of infection, central line associated bloodstream infections (CLABSI), to zero — a claim that only 10 percent of hospitals in the U.S. can make.

I

t’s a hard-won achievement and an endeavor that

As Senior Infection Preventionist, Laura, along with St. Clair

demands constant vigilance and commitment. According

Hospital Infection Preventionist Julie Fitzpatrick, MSN, RN, CIC,

to Laura Morris, M.T. (ASCP), CIC, St. Clair’s Senior

perform data collection in real time. This monitoring enables

Infection Preventionist and the leader of the infection

the department to identify trends and problems and intervene

prevention program, the key is teamwork. “Hospital

immediately with proven, evidence-based strategies. The

associated infections are a major issue in the healthcare

Infection Preventionist educates the staff, elicits their input,

industry and a major threat to patient safety, but they are

monitors the effects of the intervention and provides feedback.

often preventable. St. Clair’s good rates are a reflection

Along with Stephen M. Colodny, M.D., Chief of Infectious

of the quality of this organization and of everyone’s

Diseases, Laura leads the Infection Prevention Committee,

contribution to infection prevention. At this hospital,

which meets regularly and includes representatives from

infection prevention is a team effort that involves the

nursing, medical staff, laboratory services, pharmacy, nutritional

entire staff at every level. Our goal is to not only reduce

services, perioperative services, environmental services,

but eliminate the infections that threaten our patients.”

and administration.

Continued on page 12

Volume VII Issue 4 I HouseCall I 11

QUALITY HEALTHCARE Continued from page 11

“Hospital- or healthcare-associated

Laura Morris, M.T. (ASCP), CIC

additional infection prevention education and serve as resource persons

infections result in an estimated

and role models for their units. “The liaison team members are charged

1.7 million infections each year

with sharing the latest information with their co-workers,” explains Laura.

across the country,” says Dr. Colodny,

“The liaison is a unit-level, front line expert and extremely valuable to our

who practices with Pittsburgh

efforts. For fiscal year 2015, St. Clair had its lowest overall healthcare-

Infectious Diseases, Ltd. "St. Clair

associated infection rate yet.”

has been very effective at reducing

Laura and the Infection Prevention teams work to improve practices and

serious hospital-acquired infections

procedures not only in clinical areas, but throughout Hospital operations.

over the years. With the help of

“It’s a three-pronged effort: the clinical, education and environment,”

a very dedicated staff and our

she says. “Education is ongoing; things are always changing and we have

patients and their families we

to keep the staff informed. “Huddles” are held on the units, with front

are committed to doing our part

line staff. Pharmacy plays a critical role, providing stewardship of antibiotic

to overcome the barriers and

use. Environment is critical — some resistant organisms can live on

challenges to preventing these

surfaces for months. We have a meter that detects bioburden — the degree

infections." Dr. Colodny adds that

of microbial contamination on a surface. It gives feedback to the staff and

subcommittees individually address the five major types of hospital-

is a teaching tool. There are actions that have to become hard-wired in

associated infections: ventilator associated pneumonia; surgical site

one’s behavior. They become a part of you, second nature. These include

infection; catheter-associated urinary tract infection; C. diff infection;

hand hygiene; compliance with isolation precautions; staying home when

and central line-associated bloodstream infections. In addition, there

you are ill; and getting immunizations.”

is a team of Infection Prevention liaisons consisting of staff members

It has to become a culture, Laura says — not simply a program

from each of the clinical units and the ancillary services of escort, dietary,

or department, but a culture that engages the entire organization.

laboratory, respiratory therapy, plant operations, and environmental

“At St. Clair, everyone wants to do the right thing. There is a genuine

services. “All of our Environmental/Support Services staff are dedicated

commitment, at every level. We never forget that all those statistics

and passionate about maintaining a clean, safe and germ-free environment

represent real people, members of families, who come to St. Clair

for our patients, visitors and staff,” says Ed Virbitsky, Director, Environ-

to get care and get well. It’s our job to keep them safe, and infection

mental/Support Services at St. Clair. Liaison team members receive

prevention is a critical piece.” ■

A

12 I HouseCall I Volume VII Issue 4

A LEAP ABOVE St. Clair Hospital is once again awarded the region’s only ‘A’ grade IN PATIENT SAFETY

COMMUNITY CHAMPIONS

PINK OUT CHAMPIONS Area students join St. Clair in fight against breast cancer

I

n what has quickly become an October tradition, eight area school districts teamed with the St. Clair Hospital Foundation to raise funds

South Park High School

for the Hospital’s Breast Care centers during Breast Cancer Awareness

Month. Students at Bethel Park, Chartiers Valley, Keystone Oaks, Mt. Lebanon, Montour, Peters Township, South Park and Upper St. Clair sold signature St. Clair Hospital pink bandannas at “Pink Out” football games, bake sales and throughout their respective districts, raising money to support St. Clair Hospital’s Breast Care centers. 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. Each school was presented with a Pink Out Champions plaque as a thank you for the students’ generosity and hard work. ■

Mt. Lebanon High School

Montour High School

Keystone Oaks High School Volume VII Issue 4 I HouseCall I 13

NEUROSURGERY

Combining Form and Function Neurosurgeon Michael Y. Oh, M.D., F.A.A.N.S. Practices at St. Clair Hospital

T

here are many people who use their lives to make the world a better place. Perhaps they provide a service, teach and open minds, ease pain and heal the sick, invent life-changing new

technologies, or solve complex problems. It’s a rare person who makes the world a better place by doing all of those things.

MICHAEL Y. OH, M.D., F.A.A.N.S., is one such person. The physician, neurosurgeon, researcher, teacher, author and pioneering inventor demonstrates his exemplary surgical skill, professionalism, and warm, compassionate presence at St. Clair Hospital every day.

Born in Korea, Dr. Oh grew up in California and attended the University of California. He later earned his medical degree at the University of Southern California. He came to Pittsburgh for a neurosurgery residency at Allegheny General Hospital, and then completed a fellowship in stereotactic (CT-guided) surgery at the University of Toronto. He then joined the Division of Neurosurgery at the University of Missouri as an assistant professor, but then came back to Pittsburgh in 2005 to practice his specialty.

Dr. Oh’s practice is divided between intracranial (brain) surgery and spine surgery. In his intracranial practice, Dr. Oh specializes in functional neurosurgery, which uses deep brain stimulation technology to treat complex symptoms of disorders such as Parkinson’s disease.

While there are 3,500 neurosurgeons in the country, only a hundred or so are trained as functional neurosurgeons. Their focus currently is on movement disorders, such as Parkinson’s and dystonia, as well as chronic pain, epilepsy, spasticity and trigeminal neuralgia, but the subspecialty holds enormous promise as an innovative approach to some of medicine’s most perplexing conditions. Dr. Oh and his colleagues are exploring myriad possibilities for the application of the technology. It’s a unique, even revolutionary perspective — a fresh way of looking at problems and helping patients.

“The appeal of functional neurosurgery is in how we are able to improve and alter the human central nervous system, with electrodes, pumps, and other advanced technologies, to improve symptoms and decrease suffering,” Dr. Oh says. “Functional neurosurgery has been around in some form since the early days of the

Michael Y. Oh, M.D., F.A.A.N.S. 14 I HouseCall I Volume VII Issue 4

specialty, but in the last 20 years the technology has improved

it doesn’t move much; most back surgeons therefore thought it could

tremendously. The success of deep brain stimulation in treating

not be that important as a source of low back pain. Apparently, however,

movement disorders has led to it being adapted to other problems —

it has just enough movement to create inflammation in some people.

chronic obesity, depression and obsessive compulsive disorder, to

Two recently published papers have demonstrated this. I myself was

name a few. The technology has caught up with our understanding

initially skeptical, but once I began looking for it, I found a significant

of the brain and we can actually modulate brain processes that

amount of SI joint degeneration among my own patients. Now, I’m a

cause these disorders.”

convert and in general, we spine surgeons are much more aware of the SI joint. SI joint injections are valuable as both a diagnostic and therapeutic measure.”

GETTING PATIENTS ‘BACK TO LIFE’ Dr. Oh has been changing lives at St. Clair Hospital by performing

Spine surgery is always advancing, and Dr. Oh says that while all the

spine surgery to relieve pain and restore functioning for patients

improvements and successes are great, there are always challenges.

suffering from herniated discs, spinal stenosis, arthritis and other

“The back is complex, and we are always learning. On the horizon, the

conditions of the spine. Back pain, Dr. Oh says, can be life limiting.

combination of navigation, minimally invasive technologies and advances

A person’s work, social life, family life and general health are

in biologic technologies — harvesting one’s own tissues — will one day

adversely affected, he says, and some will become dependent on

enable us to rebuild the spine and replace discs. We aren’t there yet,

alcohol or narcotic medication to cope with it. “That’s a conversation

but it’s around the corner.”

that I often have with my chronic pain patients: long-term use of

Dr. Oh says spine surgery has many personal rewards for him.

narcotics can cause complications, reduce the pain threshold, and

“Every time I operate on a spine,” he says, “I get to see and touch the

create depression, all of which may worsen pain. I believe that a

amazing, complex structure that is the human spine. I’m able to see

patient needs to get a broad perspective from a surgeon. There are

this beautiful organization of structures, which so perfectly combines

often multiple ways to achieve the same outcome and, in order to

form and function.”

identify the best approach for each individual, you have to spend

Being a neurosurgeon is very demanding, Dr. Oh says, but well

time with the patient. Most back pain does not require surgery, and

worth it. “For me it’s a joy because I absolutely love what I do and I’m

I rarely recommend surgery on the first visit.”

excited about it. Neurosurgery is a huge field. It’s so much more than

Dr. Oh says neurosurgeons perform back surgery primarily to treat

what you see on television. We work on the entire central nervous

leg pain, which actually has only a few causes. “Back pain is more

system; we become quite invested in our patients. The problems we

difficult to treat than leg pain, because it can have many causes,” he

treat are not simple ones; they are complex diagnoses, and we have to

says. “Sometimes there is clear injury or trauma, but more often the

rule out many possibilities in arriving at a diagnosis. The surgery that

pain is due to degenerative changes. Other factors such as body weight,

we perform is highly technical and intricate. We need to have a deep

weak core muscles and poor posture may contribute. Success rate for

understanding of the entire human anatomy, because we treat the

surgery is around 90 percent when you define success as relief of pain.”

entire body. To be a neurosurgeon, you have to know a lot of science,

According to Dr. Oh, the role of the sacroiliac (SI) joint in back and

technology, and technique and you have to continually learn, because

leg pain is a relatively recent development. The SI joint is the place where the sacrum, the five fused bones at the base of the spine, meets the pelvis, joining the upper body to the lower body. The sacrum sits between the pelvic bones. “Up to 25 percent of people with low back pain have an SI condition as a factor. This is a recent revelation in medical science and has been a bit controversial. The SI joint is one of the largest joints in the body but

“

new information is emerging constantly.” ■

every time i operate, i get to see anD touch the amazing, complex structure that is the human spine. i’m able to see this beautiFul organization oF structures, which so perFectly combines Form anD Function .

”

MICHAEL Y. OH, M.D., F.A.A.N.S. NEUROSURGEON, ST. CLAIR HOSPITAL

Volume VII Issue 4 I HouseCall I 15

NEUROSURGERY Continued from page 15

JULIE WAGNER:

A three-year journey to instant relief Julie Wagner, of Johnstown, Cambria

fusion at L4-5. Unexpected insurance issues

first six weeks require limited 50-percent

County, is a human dynamo who has never

delayed treatment, but eventually she made

weight bearing, and that means crutches

let anything stop her from reaching her goals

her way to Dr. Oh at St. Clair.

or canes. Julie had all the hallmarks of a

or fully engaging with life. A wife and mother

Dr. Oh’s examination revealed surprising

person who would do very well, and she has.”

of two young adults, she is a retired Army

news. The problem, he believed, was not in

captain who served six years of active duty

her lumbar spine at all, but in the sacroiliac

as a Russian translator, followed by 13 years

joint. “Dr. Oh was so thorough with me,”

in the Army Reserves. She also served as a

Julie says. “He did a lot of movement testing

he totally fixed me. I have had no pain,

police officer for 17 years and is currently

and I did well on those; he then tested me

numbness or weakness since then. I had

an instructor at a police academy at Indiana

with a Lidocaine injection, and that brought

six weeks of physical therapy, mostly for

University of Pennsylvania, as well as an

relief for three days. Apparently, problems in

strength, and that helped a lot. Six weeks

adjunct faculty member in criminal justice

the SI joint can mimic lumbar back pain.”

after my surgery, I went hiking in the

at the University of Pittsburgh-Johnstown.

Dr. Oh performed a diagnostic SI block

At long last, success — Julie claims that Dr. Oh gave her instant pain relief.

“My surgery with Dr. Oh was very successful;

redwood forest using a cane. I have been

She fills in as a substitute teacher for John-

on Julie to find out how much pain was

to Europe three times since my surgery.

stown area high schools, plus she is a full-

coming from that joint. “If the injection of

These were active trips, with lots of walking.

time doctoral candidate at Walden University.

an anesthetic relieves the pain, then you

I had no trouble sitting on a plane for

In other words, Julie leads an active, busy life.

have identified the source of the pain. I

long periods.

When Julie developed pain and weak-

performed a fusion and placed three screws

“Dr. Oh was wonderful and I recommend

ness in her right leg several years ago, she

into Julie’s SI joint. This is a “less invasive”

him highly. The care at St. Clair was the best

sought help immediately, but her efforts

surgery, not a minimally invasive one. It

I have ever experienced; I felt like I was at

were an exercise in futility. A chiropractor

takes less than an hour and the patient

the Hilton. The entire team was attentive,

helped some, but she didn’t experience

has one overnight stay. It takes about three

caring and competent. It’s incredible to

substantial improvement. An MRI ordered

months to recover from a SI fusion; the

finally be pain-free.” ■

by her primary care physician revealed the presence of a herniated disc at the L4-5 level, as well as spinal stenosis, and she was

MICHAEL Y. OH, M.D.

referred to a neurosurgeon.

Problem solved? Not just yet — within four

Dr. Oh, chief of neurosurgery at St. Clair Hospital, earned his medical degree at the Keck School of Medicine of the University of Southern California. He completed his neurosurgery residency at Allegheny General Hospital and a fellowship in stereotactic surgery at the University of Toronto. Dr. Oh is board-certified by the American Board of Neurological Surgery. He practices with Allegheny Clinic.

months, Julie says, she was dragging her

To contact Dr. Oh, please call 412.942.5790.

He performed surgery to clean up lumbar arthritis and open up the stenosis, but told Julie that the disc appeared to be normal.

leg again and learned that she needed a

16 I HouseCall I Volume VII Issue 4

“

it’s incredible to finally be pain-free.

”

JULIE WAGNER, PATIENT

Spine surgery patient Julie Wagner on the observation deck of The Johnstown Inclined Plane, above downtown Johnstown.

Volume VII Issue 4 I HouseCall I 17

VEIN CARE

varicose veins:

not a normal part of aging NEW VEIN CARE CENTER OFFERS A RANGE OF PROCEDURES

e

arlier this year, St. Clair Hospital opened a state-of-the-art Vein Care Center in its Outpatient Center in Peters Township. The Vein Care Center is designed to provide the region with the most advanced diagnostic and

therapeutic care for common venous conditions, such as varicose veins and spider

veins, in an outpatient setting that is comfortable, convenient and patient centered.

The initiative is living up to its promise, says Vein Care Center Medical Director Jason M. Andrus, M.D., with a growing number of people seeking to improve their health, comfort and mobility through the Center’s streamlined, expert level treatment.

The concept for the Center was developed by Dr. Andrus, a board-certified interventional radiologist at St. Clair. Dr. Andrus performs a range of endovascular procedures, but the primary procedure offered at the Center is percutaneous endovenous ablation, or vein ablation, a minimally invasive, outpatient treatment for varicose veins that is done with local anesthesia. “The Vein Care Center is a natural progression for St. Clair Hospital,” explains Dr. Andrus, who is a graduate of Chicago Medical School and completed his residency and fellowship at Allegheny General Hospital. “I’m trained in vein ablation and worked in a vein clinic during my fellowship. We have great resources: the most advanced technology and equipment and an experienced, highly trained staff.”

That staff is led by Mandy Kooser, B.S., R.D.M.S., R.T.R., Supervisor of Medical Imaging for Ultrasound at St. Clair. Mandy and her team of licensed vascular sonographers perform the diagnostic ultrasound studies of the legs that detect venous insufficiency. “At St. Clair we were already performing a high volume of venous insufficiency ultrasound studies,” Mandy says. “The data indicated that the number of people needing treatment for venous disease and complications will likely grow as the senior population ages. Venous disease is prevalent in older adults and this Center is meeting the needs of the community with the highest quality diagnostics and treatment available.”

Jason M. Andrus, M.D.

18 I HouseCall I Volume VII Issue 4

A NURSE BECOMES A PATIENT

Care at the Vein Care Center begins with a thorough diagnostic

Amy Aiello, R.N., BSN, loves her position as charge nurse in the

assessment, including ultrasound studies and an examination by

St. Clair Hospital Cardiovascular Surgery Unit. She has worked in this

Dr. Andrus. For Amy, the results were surprising; Dr. Andrus found five

unit for 14 years and finds enormous satisfaction caring for patients.

varicose veins in her legs and recommended a series of vein ablations.

“We care for patients recovering from cardiovascular surgery and patients on balloon pumps. We care for our patients from surgery to discharge; it’s one of the many things I love about my work.”

Earlier this year, Amy, 50, found herself feeling unusually exhausted after work. “My legs were so tired and my feet throbbed with pain. I was unable to do anything after work. I love to garden, cook

“

once my patients have haD vein ablation Done,

Vein ablation, he explains, is a heat-directed process that uses radio frequency waves to close off and eliminate blood vessels: “We make a tiny cut near the varicose vein and insert a small catheter into the vein. The tip of the catheter heats up, but the patient does not feel that. The heat shuts the vein down, it scleroses, or hardens, and the body absorbs the dead

and have dinner guests at my home in Bridgeville,

they can harDly

but I could no longer do these things. I knew I had

believe the

30 minutes and does not require sedation or

DiFFerence.

about two hours from start to finish and are

varicose veins but I did not associate this pain and fatigue with them. I thought it was due to getting older and working long hours. When I learned about Dr. Andrus and the new Vein Care Center, I thought that I should go there and get checked out. I’m glad that I did. Dr. Andrus and the staff took great care of me and gave me back my vitality and quality of life.”

”

JASON M. ANDRUS, M.D. VEIN CARE CENTER MEDICAL DIRECTOR, ST. CLAIR HOSPITAL

vessel.” Vein ablation is painless, takes about anesthesia. Patients remain at the Center for able to walk immediately afterward.

“I’ve had three vein ablations so far, with one more to go, and already the pain and fatigue in my legs is gone. I’m back at work and I can do things after work again. My life has improved immensely,” Amy says.

Continued on page 20

Dr. Andrus uses an ultrasound monitor operated

by St. Clair Hospital Ultrasonographer Brandy Graf to perform a vein ablation on patient Amy Aiello at the new Vein Care Center in Peters Township.

Volume VII Issue 4 I HouseCall I 19

VEIN ABLATION Continued from page 19

VARICOSE VEINS ARE A DISEASE PROCESS More than 40 million Americans have varicose veins,

Risk factors for chronic venous insufficiency include

according to the federal Centers for Disease Control and

heredity, age, gender and pregnancy. Obesity is not an

Prevention. Despite being so common, the condition is

etiologic factor, according to Dr. Andrus, although it

paradoxically underdiagnosed and undertreated, and

exacerbates the condition. Pregnancy is a risk factor

Dr. Andrus says that a complex of factors contributes to

because of progesterone, he says; It’s a hormonal problem,

this. Contrary to what many people believe, varicose and

not the weight of the fetus pressing on the veins of the

spider veins are not simply a cosmetic problem. Rather,

lower extremities. Family history may be the strongest

they are a symptom of an underlying disease known as

factor; as many as 70 percent of people with varicose

chronic venous insufficiency, or CVI. “Chronic venous

veins have a parent who had them, Dr. Andrus says.

insufficiency is misunderstood. It is a disease process,”

There is also a cultural component, Dr. Andrus adds.

Dr. Andrus emphasizes. “It is not a normal part of aging,

“Since most people view this as cosmetic rather than

nor is it benign. It can lead to severe swelling, skin ulcers

medical, they don’t complain about it to their doctors and

and infections and can make walking difficult. I often find

they don’t begin treatment early enough. Men, especially,

that people are willing to tolerate it and live with it because

dismiss it, viewing it as a female problem. It’s true that

they believe it is inevitable. Spider veins can be the tip of

women are diagnosed with chronic venous insufficiency

the iceberg and should not be ignored or dismissed.”

three times more often than men, but I believe this is largely due to it being underdiagnosed in men. Many people fail to realize that their symptoms, such as heavi-

Getting A Leg Up On A Growing Problem If you suffer from varicose veins, you’re a member of a very large group. Over 40 million Americans face a daily struggle with the swollen veins that can cause throbbing leg pain, severe swelling, and heavy, tired legs. Half of all Americans over 50, and two-thirds of women over 60, have the condition.

Risk factors include heredity, age, gender and pregnancy. Also your lifestyle is a major factor. People whose jobs require them to stand for long periods of time — such as nurses, teachers, waitresses — all have a higher-than-average risk of venous disease.

Once it appears, venous reflux disease never goes away by itself — it's a condition that only worsens unless treated.

ness in the legs, itching, cramping, swelling, restless legs and pain are actually due to varicose veins. You have to battle that disease process early, before complications like skin ulcers develop. If your legs are keeping you from walking, standing or doing normal daily activities, you need to see your physician. Once my patients have had vein ablation done, they can hardly believe the difference.”

Preventative measures include walking, use of compression hose and elevating one’s legs, especially if engaged in an occupation that demands prolonged sitting or standing. “Walking is an effective way to keep the leg veins healthy,” Dr. Andrus says. “When you walk, you work the ‘calf muscle unit,’ compressing and squeezing the veins that go through those muscles. This sends blood back to the right side of the heart.” Compression stockings can keep pooling of blood and subsequent swelling to a minimum, but to be truly effective, one has to wear the thigh-high hose rather than socks. Compression hose have a down side, as they can be hot, uncomfortable

20 I HouseCall I Volume VII Issue 4

and difficult to put on. More importantly, warns Dr. Andrus, compression stockings can keep people from dealing with

JASON M. ANDRUS, M.D.

the disease. “Compression hose have their benefits, but

Dr. Andrus specializes in interventional radiology, radiology, and vein ablation. He earned his medical degree at Chicago Medical School. Dr. Andrus completed a radiology residency and an interventional radiology fellowship at Allegheny General Hospital, Pittsburgh.

He is board-certified by the American Board of Radiology.

He practices with South Hills Radiology Associates.

they help you manage the symptoms and that may lead you to delay seeking treatment.”

In addition to vein ablation, the St. Clair Hospital Vein Care Center offers two additional procedures, micro-phlebectomy and sclerotherapy. Micro-phlebectomy is a procedure in

To contact Dr. Andrus, please call 412.942.2628.

which a 1-2 millimeter incision is made in the leg and a tiny hook device is utilized to tease out small varicosities and reticular veins, veins that form a lattice-like structure.

Sclerotherapy is a similar treatment for spider veins,

to treat venous insufficiency. “Varicose veins keep people

although it can result in pigmentation changes in the skin.

from walking,” Dr. Andrus explains. “The pain and swelling

“We’re getting very good outcomes treating venous

keep you sedentary and once those problems are resolved

insufficiency at the vein clinic, but this is a lifelong disease,”

after treatment, you naturally begin walking more and

says Dr. Andrus. “For this reason, it’s essential for patients

burning calories. The ability to walk is critical to health

to take preventive measures after treatment, including

and well-being, to aging well, and to overall quality of life,

walking.” Many patients find that they lose weight, without

so having vein ablation is likely to positively impact your

dieting, after undergoing vein ablation and other procedures

general health.” ■

“

my life has improved immensely.

Vein ablation patient Amy Aiello, R.N., BSN shares a moment with St. Clair Hospital heart surgeon G. Frederick Woelfel, M.D. in the Hospital’s Cardiovascular Surgery Unit, where Amy works as a charge nurse and cares for many of Dr. Woelfel’s patients following open heart surgery.

”

AMY AIELLO, R.N., BSN, CARDIOVASCULAR SURGERY UNIT CHARGE NURSE, ST. CLAIR HOSPITAL, AND VEIN ABLATION PATIENT

Volume VII Issue 4 I HouseCall I 21

ASK THE DOCTOR

Ask the Doctor MICHELLE L. HARVISON, M.D.

Q A

My husband and I are planning to start a family in 2016.

What preparations should I be making in order to ensure a healthful pregnancy?

The majority of pregnancies result in favorable outcomes for both moms and babies. However, there are still adverse outcomes that can occur.

The key to a successful pregnancy is to optimize your health prior to conception.

Scheduling an appointment with your obstetrician/gynecologist (OB/GYN) prior to conception will allow a thorough review of your medical history.

Your OB/GYN can review all medications you are taking to ensure they are safe for pregnancy and, if not, make any necessary changes. Also, any chronic medical problems that you may have, such as diabetes or hypertension, should be under tight control.

It is also important to initiate folic acid supplementation at

least one month prior to conceiving to decrease the risk of neural tube defects in the fetus. You should ensure that you are up-to-date on all necessary immunizations, because contracting some infections such as chicken pox or rubella can be detrimental to your pregnancy.

Other considerations to discuss with your doctor would be any possible work or environmental exposures that you may encounter throughout your pregnancy. You and your doctor can also discuss appropriate nutrition prior to and during pregnancy. Another topic to discuss with your OB/GYN is genetic testing. You should know of any genetic diseases that may run in your family or your spouse's family. There are many inheritable diseases that can be tested for now, such as cystic fibrosis.

These are some of the topics you can discuss with your OB/GYN prior to conception to ensure the best possible outcome for you and your baby. â–

Michelle L. Harvison, M.D.

MICHELLE L. HARVISON, M.D. Dr. Harvison specializes in obstetrics and gynecology. She earned her medical degree at the Joan C. Edwards School of Medicine at Marshall University, Huntington, W.Va. Dr. Harvison then completed an OB/GYN residency at Riverside Methodist Hospital, Columbus, Ohio. She practices with Advanced Women’s Care of Pittsburgh, P.C., which has offices in Mt. Lebanon and Peters Township.

To contact Dr. Harvison, please call 412.942.1866.

22 I HouseCall I Volume VII Issue 4

ADVANCED EALTHCARE. QUALITY OUTCOMES.

St. Clair Hospital is a highly honored, independent, acute-care medical center with 550 leading physicians, offering advanced, high-quality care in multiple specialties, including heart, vascular, oncology, orthopedics, spine, mental health, women’s and children’s services, stroke care, and more. Consistently rated by independent evaluators as one of the country’s 100 Top Hospitals® , St. Clair is a proven leader in patient safety, clinical outcomes, patient satisfaction, and value. Driven by a culture of continuous

ST. CLAIR ACCEPTS ALL MAJOR INSURANCES 1 0 0 0 B OW E R H I L L R OA D

.

improvement, St. Clair earned the region’s only “A” grade in patient safety, and ranks in the top 2 percent in the nation in patient satisfaction.

M T. L E B A N O N , P E N N SY LVA N I A 1 5 2 4 3

.

412 .942 .4000

.

W W W. S TC L A I R . O R G

Sources: Truven Health Analytics; CareChex; Press Ganey; Leapfrog Group

St.Clair Hospital 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 BREAST CARE CENTER IS

Expanding Our Healing Touch to Peters Township

Sherri H. Chafin, M.D.

BREAST SURGERY

•

Raye J. Budway, M.D.

3-D MAMMOGRAPHY

•

Tara L. Grahovac, M.D.

BREAST ULTRASOUND

•

BREAST MRI

The area’s only comprehensive Breast Care Center is expanding its expertise to Peters Township. Located within the St. Clair Hospital Outpatient Center, our team of breast surgeons, diagnostic radiologists, medical and radiation oncologists, nurse navigators, and plastic and reconstructive surgeons helps guide patient care every step of the way. As one of the nation’s 100 Top Hospitals,® St. Clair continues to invest in the healthcare of our communities with exceptional physicians, technologies and processes to deliver superior outcomes.

St. Clair Hospital Outpatient Center–Peters, 3928 Washington Road, Suite 100, McMurray, PA 15317 • 412.942.7800 St. Clair Hospital Outpatient Center–Village Square, 2000 Oxford Drive, Suite 301, Bethel Park, PA 15102 • 412.942.7800 Sherri H. Chafin, M.D. specializes in diagnostic radiology at St. Clair Hospital, where she is Vice Chair of Medical Imaging.

She earned her medical degree at the Penn State Hershey Medical Center and completed her residency at Allegheny General Hospital. Dr. Chafin is board-certified by the American Board of Radiology. She practices with South Hills Radiology Associates.

HouseCall

Raye J. Budway, M.D. earned her medical degree at Hahnemann University in Philadelphia. She completed her residency training in general surgery at The Western Pennsylvania Hospital and a fellowship in surgical critical care at UPMC. She previously served as the Site Program Director for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital. She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer.

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.

Tara L. Grahovac, M.D. specializes in breast surgery. She earned her medical degree at the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Grahovac completed her residency in general surgery at Allegheny General Hospital, and a fellowship in breast surgery at Magee Womens Hospital of UPMC.

WWW.STCLAIR.ORG

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