St. Clair Hospital HouseCall Vol VII Issue 3

VOLUME VII ISSUE 3

HouseCall St. Clair Hospital Spine Surgeons are

inside

Ask The Doctor I Breast Surgeon Enhances St. Clair’s Philosophy Of Patient-Centered Care Advancing Home Healthcare Through New Partnership I Reducing Central Line Infection Rates Scenes From The 2015 Summer Swing

SPINAL CARE

“Oh, my aching back!”

It’s a common lament: nearly all American adults will suffer with

back pain, especially low back pain, at some point in their lives. It occurs at all ages, but is far more common in older adults. Fortunately, most of this pain will resolve with self-care or thoughtful, conservative medical treatment. For those few whose back pain requires surgical intervention, there is reason for optimism: spine surgery is overwhelmingly successful surgery, effective at alleviating pain, restoring function and improving quality of life.

2 I HouseCall I Volume VII Issue 3

AT ST. CLAIR HOSPITAL, SPINE SURGERY IS

CHANGING LIVES At St. Clair Hospital, experienced, expert spine surgeons perform a full range of the most advanced surgical approaches to treating spinal conditions and injuries. St. Clair’s comprehensive spine surgery program includes state-of-the-art diagnostics, cutting-edge surgical technology, specialized nursing care and physical therapy. Among the conditions that St. Clair’s spine surgeons treat are spinal stenosis, herniated discs, scoliosis, spinal arthritis, fractures, congenital conditions, trauma, and tumors of the spine.

S

pine surgery has come a long way from the often time-

reduce post-operative pain. Advances in physical therapy and new

consuming operation that it once was. In the past, spine surgery

medications are all part of the evolution of spine surgery and the

entailed a lengthy operation; a weeklong hospital admission;

care of spinal problems.

a long incision and subsequent scar; bed rest and months of recovery; and, quite often, pain. Today’s spine surgery is far less invasive and

THE MAINSTAY OF THE SKELETON

traumatic; outcomes are excellent and most procedures require one

The human spine is a masterpiece of architecture and engineering.

overnight stay. According to Joseph D. Smucker, M.D., spokesperson

Designed to bear the body’s weight, enable movement and provide

for the Leadership Fellows Program of the American Academy of

strength, flexibility and stability, it is the mainstay of the skeleton.

Orthopaedic Surgeons (AAOS), spine surgery has evolved mightily:

With its long column of 33 individual bones and intricate system of

“Spine surgery is now highly focused and far less invasive. It has

cushioning discs and connective tissue, the spine bears a tremendous

evolved as surgical technology and imaging technology have evolved.

responsibility: it protects the precious, vital spinal cord, which powers

The quality and consistency of MRIs, for instance, have improved

all movement. In the design of the spine, it is what is not there that is

substantially in the past 10 years, so surgeons have excellent pre-op

critically important; the spinal canal, the hollow space that surrounds

imaging and diagnostic precision. Surgeons know exactly what they

the cord, must be preserved. When anything — a tumor, a herniated

are going to find when they operate.”

disc, a protrusion of bone from arthritis or a fracture — intrudes on

Spine surgeons also have many new options for keeping patients

that space and impinges on the cord or a nerve root, the result is

out of the operating room, Dr. Smucker says. “There are many tools, and

pain — most often, severe pain, that will radiate to the part of the

surgery is just one. For instance, there are more focused diagnostic

body served by the nerve root. It is the body’s alarm, signaling that

tools, which help surgeons narrow the indications for surgery, as

the cord is threatened. Nerve pain demands attention; it is pain that

well as expand their options. With selective injection of nerves, for

cannot be ignored. For two of St. Clair’s spine surgeons — Carmen

example, surgeons can medicate around a single nerve root, isolating

Petraglia, M.D., M.S. and Derek J. Thomas, M.D. — each of whom is

it and pinpointing the precise source of pain. This minimizes the

profiled on the following pages, it is the capacity to relieve this terrible

amount of surgery needed. Surgeons have intricate, specially

pain that drives them and forges the powerful, intense and very personal

designed instruments that enable them to make tiny incisions that

bonds that they develop with their patients. ■ Continued on page 4 Volume VII Issue 3 I HouseCall I 3

SPINAL CARE Continued from page 3

Carmen Petraglia,

being an orthopedic spine

making rounds on patients who had herniated discs. “Their pain was

surgeon, and he is exceptionally

unforgettable,” he says. “Nothing helped relieve it. Now I do surgery on

well qualified for this specialty.

people with herniated discs and they are pain-free on the first post-op

M.D., M.S.

He is one of an elite, specialized

night. It’s amazing to be able to help them.”

When Dr. Petraglia was a medical student at Temple, he recalls

Dr. Carmen Petraglia loves

Disc herniations occur when there is a tear in the outer portion of

group of surgeons who perform

“revision surgery” — large, complex operations to correct spinal

the disc, formally known as the annulus, and the inner watery tissue,

deformities, such as scoliosis, which may be congenital or acquired.

the nucleus pulposus, extrudes through the tear. There are two kinds

Dr. Petraglia is a graduate of Duquesne University, who had a master’s

of herniated discs: a simple tear, in which the fragments of the tear

degree in biology when he enrolled in medical school at Temple University.

are contiguous, and an extruded herniation, in which fragments have

During his residency in orthopedic surgery at MedStar Union Memorial

broken off and are free, floating around in the spinal canal. “We don’t

Hospital in Baltimore, he completed a rotation with experts in scoliosis

really know why some discs herniate,” Dr. Petraglia says. “They tend

and spinal deformity surgery at The Johns Hopkins Hospital. He then

to be strong in the center and weaker at the outer parts. The typical

completed a fellowship in spine surgery at the Shock Trauma Center at

patient is a young adult whose discs have not yet begun to degenerate.

the University of Maryland Medical Center, one of the nation’s leaders

As you age, the discs dehydrate and shrink, the disc space narrows and

in trauma care, research and training, where he was exposed to the

you are less likely to have a herniation. Factors that contribute to disc

advanced care of spine injuries.

herniation are sedentary lifestyle or work that requires prolonged sitting,

“

such as long distance driving. One might assume that standing and walking put more pressure on the discs, but the opposite is true — the highest pressure occurs

Today we have

when you’re sitting. Those who work with heavy,

‘smarTer spine surgery,’

jarring machinery, like a jackhammer, have a

wiTh beTTer diagnosTic Tools and finely Tuned surgical skills.

”

higher incidence. Smoking is a factor; nicotine constricts the blood vessels and decreases blood supply to the disc.”

Disc herniation typically occurs in the lower L4-L5 and L5-S1 region of the spine, producing pain in the buttocks, thigh, leg and foot. It’s pain that patients describe as feeling like electrical shocks

CARMEN PETRAGLIA, M.D., M.S. ORTHOPEDIC SURGEON ST. CLAIR HOSPITAL

or burning. “The pain is created by both mechanical and chemical means,” Dr. Petraglia says.

“The physical pressure of the herniated tissue

compresses the spinal nerve and the body’s immediate reaction to this is a massive inflammatory response; the body releases inflammatory markers which inflame the nerve root.” Patients may also experience

Spine surgeon Carmen Petraglia, M.D., M.S. prepares to scrub in before surgery.

4 I HouseCall I Volume VII Issue 3

The Spinal Patient Outcomes Research Trial, better known as the SPORT Study, validates the value of discectomy. The SPORT Study is a comprehensive, National Institutes of Health, multi-center study which looked at patients with three types of back conditions, including herniated discs, and compared the effectiveness of surgery with non-surgical alternative treatments. The SPORT Study found that patients improved rapidly with surgery and maintained those gains at four years post-op.

“There are always risks with surgery, even though spine surgery is greatly improved. Most often, we prefer to operate only after patients have exhausted all non-surgical options. Today we have ‘smarter spine surgery,’ with better diagnostic tools and finely tuned surgical skills.

We get right to the root of the problem and we don’t operate solely on the basis of pain. We Spine surgeon Carmen Petraglia, M.D., M.S. (second from left) performs surgery at St. Clair Hospital.

find out what’s generating the pain; we confirm the diagnosis with state-of-the-art imaging, we try non-surgical modalities and perform

weakness, pins and needles sensations,

3-inch incision right over the herniated disc.

less invasive procedures. The patient recovers

numbness, and loss of bowel and bladder control.

“Using small instruments, I excise the

quickly and gets their quality of life back.”

The diagnosis of herniated disc is made

herniated disc and remove any fragments

by patient history, physical exam and imaging

that are present. It takes about 45 minutes.

studies. Dr. Petraglia assesses the patient’s

The patient stays overnight and goes home the

pain, movement, sensation and strength,

next day. They will have pain relief right away.

and does a “straight leg test” — the patient’s

Once the incision is closed and healed, they

affected leg is extended and raised, with the

will begin physical therapy to increase core

patient lying flat on his back. X-rays make sure

strength and range of motion, enabling

that there’s no spinal instability and an MRI

them to return to normal activities.”

Continued on page 6

confirms the diagnosis. Dr. Petraglia says that the surgery — microdiscectomy — is a less invasive procedure that involves a small, 1- to

Spine surgeon Carmen Petraglia, M.D., M.S. (far right) with an OR team, including (from left) registered nurse Casey Steines, physician assistant L’Lee Z Janicki, and surgical tech Andrew Dorich.

Volume VII Issue 3 I HouseCall I 5

SPINAL CARE Continued from page 5

“

i didn’t want to become a person who took pain pills forever.

”

AMY MARTIN PATIENT

AMY MARTIN:

Remembering how to be pain-free Amy Martin’s long, steep odyssey of suffering began in 2010 with shooting pains that traveled from her lower back to her right hip and leg. In the beginning, it was manageable with pain medication, or a change in position. But then it intensified, soon growing into a stabbing, burning sensation that reached deep into her bones. It woke her up at night and never left her during the day. She tried physical therapy, oral steroids, yoga, even injections — but the pain persisted and nothing helped consistently. “I’m a mother; I was trying to cope with the pain because my kids were young. Levi, my son, was 9 when this started; my daughter Chloe was 5. I was diagnosed with a herniated disc at L4-5. My pain worsened to the point that I was in agony 24 hours a day. It was affecting every aspect of my life, even my mood and my thinking.”

The pain exhausted her.

Amy Martin

6 I HouseCall I Volume VII Issue 3

In November of last year, it grew suddenly

For Amy, the biggest obstacle

worse and her primary care physician, Kevin

was her fear.” Fear of spine

Kotar, D.O., of St. Clair Hospital, referred her

surgery is normal, Dr. Petraglia

to Dr. Petraglia. “I was reluctant to see a surgeon

says. “Anyone contemplating

because I didn’t feel that I could take the time off

surgery has fear, and the back

for surgery, rehab and recovery. I have to take care

is the core of the body. The key

of my family and work full time in the Community

to helping the patient deal

Planning Office of Upper St. Clair. I never had

with fear is the doctor-patient

surgery, and I was worried about the risks of

relationship.”

surgery in general — the anesthesia, incision, admission to a hospital; when you have young kids who rely on you, you can’t help but worry about things going wrong.”

But Dr. Petraglia explained to Amy, 38, that her MRI showed an enormous, severe herniation. He told her that surgery would bring her relief.

“I no longer remem-

On her first night after

“

i got my life back, and more importantly, my kids got their mother back.

”

the surgery,

AMY’S DIAGNOSIS: HERNIATED DISC AT L4-5 CAUSING PAINFUL PRESSURE ON NERVE

DR. PETRAGLIA’S TREATMENT: REMOVE HERNIATED DISC WITH MICRODISCECTOMY SURGERY

Amy slept through the night. It was the first time in years that

ment that puts you at ease.”

she had been able to do so.

Today, Amy says she feels healed. In late May,

The pain that had been

she went on a five-mile hike in Upper St. Clair’s

her constant and unwanted

Boyce Mayview Park with her children for the

companion for five years

first time in a year. It was a glorious moment for all

was gone.

of them, being outdoors in the air and sunshine

“I had some incisional pain but no nerve pain. I had

on a beautiful day in a beautiful place, enjoying quality time with each other.

an incredible experience:

“We climbed a hill together. It meant so

everyone, the office staff, the

much to me to be there with them, and it meant

want to become a person who took pain pills

nurses, the therapists — could not have been

so much to them to be there with me. Thanks

forever. Dr. Petraglia’s confidence put me at ease.

nicer or more competent. The care felt personal.

to Dr. Petraglia, I got my life back, and more

He was knowledgeable and skilled, and he spoke

St. Clair provides a calm, professional environ-

importantly, my kids got their mother back.” ■

bered how it felt to be pain free,” Amy recalls; “I didn’t

AMY MARTIN PATIENT

to every one of my concerns. I was willing to have the surgery for my kids. They’re active; they love sports and being outdoors. For so long I couldn’t do those things with them. It was heartbreaking for me.”

Dr. Petraglia performed a microdiscectomy on Amy in April at St. Clair Hospital. “Amy was young, in her 30s, and although she had no loss

CARMEN PETRAGLIA, M.D., M.S. Dr. Petraglia earned his medical degree at Temple University School of Medicine. He completed a residency at MedStar Union Memorial Hospital, and a fellowship at the University of Maryland Medical Center. Dr. Petraglia practices with South Hills Orthopaedic Surgery Associates.

To contact Dr. Petraglia, please call 412.283.0260.

of function, her pain was severe,” he says. “We had tried all non-surgical options with her.

Continued on page 8

Volume VII Issue 3 I HouseCall I 7

SPINAL CARE Continued from page 7

Derek “Duke” Thomas, M.D.

Nerve root pain, or radiculopathy, is the worst kind of pain, says Derek

“Duke” Thomas, M.D., a board-certified, fellowship-trained orthopedic spine surgeon. “Nerve pain doesn’t go away on its own,” he explains, “but surgery is not necessarily the answer. Surgery is the last resort.

The vast majority of people with back pain won’t need spine surgery.

If the patient can’t walk and function, or they’re in severe pain, they’re probably good candidates for surgery. Of the many patients I see each day, only three or four will be candidates for surgery.”

Having the capacity to relieve the pain of suffering people is deeply meaningful to Dr. Thomas. As a medical student, he once considered plastic surgery, but chose to follow his brother into orthopedics instead.

He has never regretted it. “I’m able to help 99 percent of the people who walk through my door. I can make a significant improvement in their comfort, day-to-day functioning, and quality of life. I can take away their suffering, which is often severe, and help them get their lives back.

Being able to do that and alleviate terrible pain is deeply gratifying.”

Spine surgery, says Dr. Thomas, should have an immediate effect.

That “instant improvement” aspect of it was a decisive factor in his choice to specialize in spine surgery. “I knew this was what I was going to do. I could make an enormous difference, and do it fairly quickly.

“

my paTienTs are always

saying To me, ‘wow, Thank you — The difference is unbelievable.’

”

DEREK “DUKE” THOMAS, M.D. ORTHOPEDIC SPINE SURGEON ST. CLAIR HOSPITAL

Derek “Duke” Thomas, M.D.

8 I HouseCall I Volume VII Issue 3

It’s the best: my patients are always saying

Most people will have a combination of spinal

to me, ‘Wow, thank you — the difference is

stenosis and spondylolistheses. Patients who

spine surgery, Dr. Thomas says. “There are

unbelievable.’”

have no spine slippage will do fine with a

advantages here: a depth of resources, including

laminectomy, which removes the impinging

state-of-the-art imaging services; excellent

procedures he performs at St. Clair are

bone, Dr. Thomas says, but those who have

ancillary services; and an expert nursing staff.

for spinal stenosis, herniated discs, and

slippage need the additional stabilization

The nursing care is especially impressive:

compression fractures.

offered by a spinal fusion. “When you take the

when I come in to see a patient on the first

Spinal stenosis, which is the narrowing

pressure off with a laminectomy (enlarging

post-operative morning, he or she is always

of spaces in the spine, mostly affects older

the spinal canal),” Dr. Thomas explains, “you

up and active. There is a physical therapy

adults, ages 65-80. Arthritis eventually affects

may destabilize the spine and make things

department right on the orthopedic unit.

the spine in most people and although one

worse if there is spinal slippage.”

This early activity expedites discharge and

Dr. Thomas says many of the surgical

may be asymptomatic for years, if the arthritis

The surgery, he adds, relieves pain and

produces degenerative changes such as bone

restores function and changes life in a dramatic

spurs, the result will be narrowing of the

way. “Nearly all patients will wake up and feel

spinal canal, compression of the cord and

better right away. Our goal with spinal stenosis

subsequent nerve pain in the back and legs.

surgery is to make you feel better and able

Genetics play a major role, Dr. Thomas says.

to walk for at least 30 minutes.”

“People may attribute their spinal stenosis

Rehab following spinal stenosis

to their work or to being overweight, but it’s

surgery consists primarily of

mostly genetic. Obesity leads to more people

walking. Dr. Thomas encourages

seeking treatment for back pain, but it’s not

his patients to walk as much as

a strong factor in spinal stenosis. Most spinal

tolerated, with pain as their guide,

stenosis occurs in the lower back.”

gradually increasing the time.

The diagnostic workup for spinal stenosis

By four to six weeks after the

includes X-rays to look for spondylolisthesis, a

surgery, he wants his patients

form of spinal instability in which the vertebrae

walking 30 minutes a day.

St. Clair Hospital is an ideal setting for

helps reduce the risk of complications.”

Continued on page 10

“

being able To help my paTienTs geT Their lives back is deeply graTifying.

”

DEREK “DUKE” THOMAS, M.D. ORTHOPEDIC SPINE SURGEON ST. CLAIR HOSPITAL

slips out of place onto another bone; and an MRI, which is diagnostic for spinal stenosis.

Orthopedic spine surgeon Derek “Duke” Thomas, M.D. studies an MRI scan of a patient’s cervical spine.

Volume VII Issue 3 I HouseCall I 9

SPINAL CARE Continued from page 9

MIKE TRUSKOWSKI:

A long and winding road to pain relief In Mike Truskowski’s Ambridge home, a guitar has been sitting unused for the past few years. It’s Mike’s guitar, the one he plays when he performs with his band, Kuzyns. The name is the Polish word for cousins — Mike and his bandmates are all cousins who play rock and roll and specialize in the music he loves most, the music of the Beatles. It’s been two and a half years since Mike has been able to go onstage and perform those songs. The music, and most of his usual life, came to an abrupt halt on December 4, 2012. Mike was at work on an ordinary day, delivering hazardous materials to bridge sites, when things went terribly wrong and he was injured. “I was working on a loading dock and the hydraulics were bad,” he explains. “I felt immediate excruciating pain sear across my lower back and down my leg. I’ve never felt pain like that before.”

“ ”

my only regret is that i waited and suffered unnecessarily.

MIKE TRUSKOWSKI PATIENT

Mike Truskowski

10 I HouseCall I Volume VII Issue 3

The pain was horrendous, and constant.

By the spring of 2015 the

Day and night, there was no escape from it.

suffering was unbearable. He

Sometimes, pain medication helped for a little

saw Dr. Thomas again and they

while, but nothing took the ferocious pain away.

re-scheduled surgery. “If you do

It drastically changed Mike’s life and he feels that

nothing to treat spinal stenosis,

it changed who he was. At the moment it began,

the symptoms will make you

it sliced his life in half, into Before and After.

miserable,” Dr. Thomas com-

Before, at age 50, Mike was an active man with a

ments. “It’s not a heart attack.

demanding job, a family, and regular weekend

You won’t die from spinal

engagements with his band. After, he could no

stenosis, but it never gets better

longer work. Driving was impossible. His three kids

on its own. The level of pain may

drove him where he needed to go, with Mike

fluctuate and you may have

leaning against the passenger door to take

some good days, but it will only

pressure off his left leg. Sometimes, he could not

get worse over time and you will

sit long enough to eat a meal.

become more sedentary.”

MIKE’S DIAGNOSIS: SPINAL STENOSIS

DR. THOMAS’ TREATMENT: LUMBAR FUSION

Dr. Thomas, Mike says, was happy to help him.

“The pain was so severe that I honestly can’t

Mike had a lumbar fusion done at St. Clair

“He’s a great doctor, amiable and kind, and I felt

describe it. I could barely move, sit or stand.

Hospital in May, and as a result he is now, incred-

immediate rapport with him. He knew I needed

Occasionally it even went to my right leg. It

ibly to him, essentially pain-free. “The effect of the

the surgery and told me so, but he didn’t push

forced me to give up my work, my music, and

surgery was amazing. All my symptoms — the

me; he respected me enough to let me try other

my independence. I had to give up practically my

pain, numbness, weakness, tingling — GONE,

things. He listens to you. I can’t say enough about

whole life.”

immediately. Everything happened exactly as

how good he is. He gave me back my life.”

Mike saw spine surgeon Dr. Thomas, who

Dr. Thomas said it would, and I had exceptional

Mike’s advice? “Listen to your doctor, espe-

told him he needed a lumbar fusion. The surgery

care at St. Clair. I can sit, stand, drive and walk

cially if it’s Dr. Thomas. I encourage people who

was scheduled for March 2013, but some well-

without pain. I’m doing things I never thought I

have back pain to see him and don’t do what I did

meaning members of his extended family who

would be able to do again. You take the ability to

— don’t be afraid and don’t wait. My only regret is

had had back surgery convinced him not to have

do these things for granted. Now, it’s meaningful

that I waited and suffered unnecessarily.”

it. “They warned me that back surgery could

to me to be able to sit and relax and enjoy a meal.

Before the surgery, in the pre-op holding

make things worse; they encouraged me to give

I have a little post-op muscle pain, and it will take

area, he told Dr. Thomas, “Doc, get me back on

it time to heal and to try physical therapy first.

me longer to heal because my injury was un-

stage again.” Although that has not happened

I cancelled the surgery, although Dr. Thomas

treated for so long. I’m doing physical therapy,

yet, that is Mike’s goal. He can hardly wait to

warned me that the pain was not going to go

weaning from pain medication, and slowly getting

pick up his guitar and start playing Lennon-

away on its own. He gave me steroid shots that

my strength back.”

McCartney tunes again. ■

helped a little, but the pain didn’t improve much.

I went to a pain clinic, and they gave me medication, but did not tell me I needed the surgery.

For two years, I tried my best to cope. I did a lot

DEREK “DUKE” THOMAS, M.D.

of physical therapy; I walked as much as I could.

Dr. Thomas earned his medical degree at Virginia Commonwealth University School of Medicine. He completed his residency at the Medical University of South Carolina, and a fellowship at Stanford University/St. Mary’s Medical Center. Dr. Thomas is board-certified by the American Board of Orthopedic Surgery.

He practices with Greater Pittsburgh Orthopaedic Associates.

I tried to be positive. But it took a toll emotionally and eventually I became depressed. No one will ever understand the pain I was enduring.”

To contact Dr. Thomas, please call 412.262.7800.

Volume VII Issue 3 I HouseCall I 11

PATIENT-CENTERED BREAST CARE

BREAST SURGEON TARA L. GRAHOVAC, M.D.

Enhancing St. Clair Hospital’s Philosophy of Patient-Centered Care

“

iT’s crucial To reassure

The paTienT and convey To her ThaT we are going To Take care of This … we give The paTienT a plan, and ThaT plan gives a sense of order ThaT helps To calm her fears.

”

TARA L. GRAHOVAC, M.D. BREAST SURGEON ST. CLAIR HOSPITAL

12 I HouseCall I Volume VII Issue 3

“You have breast cancer.” Those four words have the power to stop time. For the woman to whom they are addressed, they represent the start of a journey that she hoped she would never have to take. For every

woman with breast cancer, the road to survival is an individual journey, but it is never a solitary one. Along

the way, she will likely encounter companions for the journey, offering help and support beyond anything she

could have imagined. Some of that will come from family and friends, and some from volunteers, other

patients and organizations dedicated to helping. Much of it will come from healthcare professionals who have chosen to make the care of women with breast cancer their life’s work.

A

t St. Clair Hospital Breast Care Center, where the care of

and very frightened. They have a diagnosis but they don’t know yet

women with breast cancer is both art and science, a team

what to expect. In that first encounter, it’s crucial to reassure the

of top, multidisciplinary specialists provides excellent,

patient and convey to her that we are going to take care of this.

personalized care that recognizes the complex medical and emotional

We have so many ‘weapons’ in our armamentarium. Before we even

needs of women with breast cancer. Led by board-certified breast

perform the surgery, we explain all the treatment options to her,

surgeon Raye J. Budway, M.D., St. Clair’s comprehensive breast care

and tell her precisely what to expect in terms of the surgery and

program brings together pathologists, radiologists, oncologists, plastic

aftermath. We discuss what will come next, after surgery. We give

surgeons, nurse navigators and others, dedicated to offering the

the patient a plan, and that plan gives a sense of order that helps

most advanced, integrated diagnostics and treatment. That team

to calm her fears.”

has been advanced by the recent addition of Tara L. Grahovac, M.D.,

It is also the beginning of a process of empowerment that Dr. Grahovac

a breast surgeon with exceptional qualifications in education, clinical

says is essential. “Knowledge is power, for me, but also for my patients.

training and research. Dr. Grahovac has chosen to practice at St. Clair

Breast cancer is a dynamic, complicated field and there is so much

in partnership with Dr. Budway because, she says, she shares

going on — advances in treatment, surgery, technology and drugs are

Dr. Budway’s vision: “Raye Budway has a wonderful vision of truly

emerging all the time. It’s an evidence-based field, and we work hard

comprehensive breast care that is personal and patient-centered,

to stay on top of it all. For me, that’s one of the factors that drive me,

and I share and support that vision. She is a team player whose

because I want to share my knowledge with my patients. It’s my job

focus is always on the patient; her practice is pure in that sense.

to have the latest knowledge and to educate my patients. They’re

Our mission is to give patients confidence that they are getting

empowered by knowledge; it helps turn things around for them.”

the best breast care possible, and to provide that care in a way

The unique and intimate relationship that exists between the

that is streamlined and organized.”

breast surgeon and her patient is, for Dr. Grahovac, the most gratifying

A PLAN TO CALM FEARS

aspect of her work. “The doctor-patient relationship in the care of

From the moment when a woman first learns she has breast

to this specialty,” she says. “I did a breast surgery fellowship last

cancer until she finds herself face-to-face with a surgeon, there

year that solidified this for me. My patients give me so much: they

women with breast cancer is one of the main factors that drew me

is an interval of time. In that interim period, says Dr. Grahovac, the

teach me, too, and they give back. This work can be emotionally

patient is likely thinking the worst. “The first visit with the surgeon

exhausting, but my relationships with my patients are emotionally

is critical,” she says. “When patients first come in, they are in shock

replenishing. They are so appreciative.”

Continued on page 14

Tara L. Grahovac, M.D.

Volume VII Issue 3 I HouseCall I 13

PATIENT-CENTERED BREAST CARE Continued from page 13

Dr. Grahovac is a Pittsburgh native who grew up in Brookline and

During her residency at Allegheny General Hospital, Dr. Grahovac

the South Hills and graduated from Thomas Jefferson High School.

received an exceptional honor: the Joseph C. Young Award for Outstanding

She knew at an early age that she wanted a career in medicine. “I always

Surgical Resident of the Year, given by the Department of Surgery to

knew I would become a surgeon,” she recalls. “It was not really a

a resident who demonstrates outstanding patient care and surgical

conscious decision, just a good fit for me. I love the culture of surgery.”

technique. What made the honor especially meaningful is that she was

She majored in pre-medical studies at Ohio University, where she

just a second year resident, receiving an award normally given to a more

met her now husband, and then attended the University of Cincinnati

senior level resident.

College of Medicine.

Despite knowing that surgery was going to be her specialty, Dr. Grahovac

Dr. Grahovac took time off from her surgical residency to pursue her other professional passion: research. She completed a research

did not initially find a lot of support for her choice. “Everyone was telling

fellowship in regenerative medicine. With a special interest in soft tissue

me that surgery was very difficult for women because of the long hours

reconstruction, she studied the application of adipose (fat) stem cells in

and all. But I had a great mentor in medical school who encouraged me.

tissue engineering. Known as “fat grafting,” it’s an emerging technology

I returned to Pittsburgh to complete a residency in general surgery.

that uses the patient’s own tissue as a scaffold and holds promise as

During my residency, all my attendings (physician mentors), especially

an advancement in wound healing.

the female ones, and that includes Dr. Budway, were encouraging. I got

Through this research, Dr. Grahovac developed an interest in soft tissue

to know Dr. Budway during that time; she was easy to work with and I

oncology, particularly in breast cancer. In 2014, she was awarded a

liked her style of caring for patients. She has been a role model for me

prestigious breast fellowship, where she gained proficiency in the most

since then.”

advanced breast cancer diagnostics and innovative approaches to treatment.

“

our breasT care program

achieves excellenT ouTcomes, and wiTh dr. grahovac on board, we’re able To offer The highesT QualiTy services To even more women.

RAYE J. BUDWAY, M.D. BREAST CARE CENTER DIRECTOR ST. CLAIR HOSPITAL

Tara L. Grahovac, M.D. (left) and Raye J. Budway, M.D.

14 I HouseCall I Volume VII Issue 3

”

She also learned, she says, that breast surgery is all about teamwork. “I love the fact that this field is multidisciplinary,” she says. “Many surgical specialties are isolated, but in breast surgery we are constantly collaborating, with radiologists, medical oncologists, counselors and psychologists, and others. I’ve learned so much from the medical oncologists and the

TARA L. GRAHOVAC, M.D. Dr. Grahovac specializes in breast surgery. She earned her medical degree at the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Grahovac completed her residency in general surgery at Allegheny General Hospital, and a fellowship in breast surgery at Magee Womens Hospital of UPMC. To contact Dr. Grahovac, please call 412.942.7850.

psychologists about the resilience of women.

I’ve learned so much from women themselves.

We don’t know how strong we are until that strength is called upon, by something like a

RAYE J. BUDWAY, M.D.

cancer diagnosis.”

Dr. Budway 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.

Surgeon, physician, researcher, humanitarian, wife and mother of two, Dr. Grahovac is set apart by her scholarship, her first class training and her extensive research background. But what sets her apart even more is her passion for her patients and her self-chosen role as their advocate and educator. More than any other

To contact Dr. Budway, please call 412.942.7850.

cancer, Dr. Grahovac says, breast cancer is unique to each woman who has it. “Everyone is different, and the journey to survivorship is an

Center since its opening. “She has excellent

individual one for each patient. I respect that.

clinical training in the specialty of breast surgery

Adds Dr. Grahovac: “I’m excited to be at

We treat a wide range of patients, including

and is a great asset to our breast care program

St. Clair Hospital, a hospital that I know well,

pre-menopausal women, and I have to know

at St. Clair. Her presence will enable us to

and I’m grateful for the opportunity to work with

my patient in order to individualize her care

continue to expand and evolve our services to

Dr. Budway and to continue to learn from her.

and treatment. I’m fascinated by how women

meet the needs of the women of this community.

We are planning to expand our vision for

find their power, and how they are changed

At St. Clair, our breast care program achieves

an environment of care where our patient-

by their experience with breast cancer. Millions

excellent outcomes, and with Dr. Grahovac on

centered philosophy is always evident,

of women are surviving breast cancer today;

board, we’re able to offer the highest quality

in everything we do.” ■

services to even more women.”

it’s a treatable disease.”

St. Clair Hospital’s breast care program is centered at the Breast Care Center in Bethel Park, an outpatient facility that offers 3-D mammograms and diagnostics, including breast MRI, breast ultrasound, and biopsies, in a convenient, spalike setting. The Breast Care Center opened two

ST. CLAIR HOSPITAL BREAST CARE CENTER offers a team of top, multidisciplinary specialists providing excellent, personalized care that recognizes the complex medical and emotional needs of women with breast cancer.

years ago, and the response of the community has been so strongly positive that it became necessary to expand, by adding Dr. Grahovac to the staff. “We’re so pleased and fortunate to have Dr. Grahovac joining our practice,” says Dr. Budway, who has headed the Breast Care

St. Clair Hospital Breast Care Center St. Clair Hospital Outpatient Center–Village Square Suite 301, 2000 Oxford Drive, Bethel Park, PA 15102 412.942.3177 • www.stclair.org

Volume VII Issue 3 I HouseCall I 15

QUALITY HEALTHCARE

St. Clair advances home healthcare through new partnership

S

t. Clair Hospital recently formed a joint

monitoring equipment. Moreover, Concordia’s disease

venture with Concordia Visiting Nurses

management services are available to those afflicted

and three other hospital systems to provide

with congestive heart failure, chronic obstructive pulmonary disease and diabetes.

home healthcare to patients throughout

“St. Clair Hospital and Concordia Visiting

southwestern Pennsylvania. The strategic relationship is designed

Nurses share the same mission and values

to promote seamless transition

for ensuring that our patients receive the

of care from the Hospital to the

highest quality of care following discharge

home, thereby improving quality

from the hospital,” said G. Alan Yeasted, M.D.,

and cost effectiveness.

Chief Medical Officer of St. Clair Hospital.

“This joint venture provides the right care, in the right

The partnership’s home health services include skilled, wound, and mental health nursing; physical,

setting, at the right time, and will prove extremely

occupational and speech therapy; medical social

beneficial to the men and women who entrust us with

services; and home health aides. The partnership

their health. By integrating with one another and

also offers specialty services in palliative care,

having our clinicians work side-by-side, we are

spiritual care, and telehealth-technology health-

enhancing the care provided to our patients.” ■

ADVANCED EALTHCARE. QUALITY OUTCOMES. Best Practices Reduce Central Line Infection Rates

ST. CLAIR’S CENTRAL LINE BLOODSTREAM INFECTION RATE IS AMONG THE BEST IN THE NATION PER 1,000 LINE DAYS (lower is better*)

St. Clair Hospital has reduced Central Line Associated Bloodstream Infections (CLABSI) to zero, an accomplishment that only 10 percent of hospitals in the nation have been able to achieve. These best-in-the-nation results are attributable to the daily efforts of a team of healthcare professionals providing care to patients with central line catheters, also called central

.5%

.457%

venous catheters. (A central line is a long, thin, flexible tube used to give medicines, fluids, nutrients or blood products over a long period of time

NATIONAL AVERAGE

.4% .6

to hospitalized patients. The catheter is often inserted into a large vein in the arm or chest.) The team attained the results by following a best

.3%

practice “bundle.” A bundle is a group of practices that, when performed collectively, reliably, and continuously, have been proven to improve patient

.4

.2%

outcomes. St. Clair’s central line bundle includes the washing of hands prior to touching a central line, the use of maximum barriers (gowns, gloves, caps and masks) by clinicians inserting central lines, cleansing

.1%

ST. CLAIR HOSPITAL*

a patient’s skin with antiseptics prior to inserting a central line, “scrubbing the hub” of central lines with alcohol prior to accessing it, and removing central lines as soon as they are no longer medically necessary. ■

0.0%

0%

.2

0

2015

St. Clair Hospital Intensivist Yvonne R. Chan, M.D. places a central line in a patient.

16 I HouseCall I Volume VII Issue 3

ASK THE DOCTOR

Ask the Doctor Q A

EDWARD C. KETYER, M.D.

What should parents do to protect a newborn baby until she or he can get vaccines?

Until your baby is old enough to receive

Beginning with the birth dose of

vaccines, the single best thing you can

Hepatitis B vaccine and ending with the

do to protect her or him is to wash your

booster doses for diphtheria-tetanus-

hands frequently with soap and water —

pertussis, polio, measles, mumps, rubella

and insist that all those who handle your

(MMR), and chickenpox, your child won’t

baby do the same. Keeping your newborn

receive a full complement of kindergarten-

away from children and adults who are

required vaccines until four years of age.

exhibiting symptoms of acute illnesses is

That is why it is important to expect other

also advisable to protect her or him from

adults, including parents with their own

contagious infections. Breastfeeding

kids, to protect your still-vulnerable child

allows infection-fighting antibodies to

by making sure their kids are immunized.

be transferred from mother to baby —

Since your child will not receive a first

protection that commercial infant formulas

influenza vaccine until six-months-old

cannot provide. Finally, avoiding exposure

(she or he will need two shots against this

to secondhand tobacco smoke and other

virus in the first year, spaced one month

forms of air pollution will help your baby’s

apart), it is important that everyone

natural defenses work normally to

else around your baby receives an

prevent sickness.

Parents should also make sure their own immunizations are up-to-date. It is now recommended that mothers be immunized with the tetanus-diphtheria-

influenza vaccine during the cold and flu season in order to “cocoon” and protect her or him.

It takes a concerted effort from everyone in your family

pertussis (TdaP) vaccine with each

and community to protect

pregnancy. Fathers should also make

your precious newborn

sure they have received this important

baby. We all need to do

vaccine within the last 10 years. Other

our part in keeping other

family members, including siblings,

people healthy until your

grandparents, and other relatives and

baby is old enough to

friends who come in contact with your

receive all of her or his

baby should be up-to-date with all the

childhood vaccinations. ■

vaccines, including TdaP.

Edward C. Ketyer, M.D.

EDWARD C. KETYER, M.D. Dr. Ketyer specializes in pediatrics. He earned his medical degree at Northwestern University Medical School, Chicago. He is board-certified by the American Board of Pediatrics, and practices with Pediatric Alliance, Chartiers/McMurray Division.

To contact Dr. Ketyer, please call 412.221.0160.

Volume VII Issue 3 I HouseCall I 17

SUMMER SWING

TwilighT in The Tropics scenes from sT. clair hospiTal foundaTion’s 2015 summer swing evenT Some 600 guests joined in the fun as St. Clair Hospital Foundation conducted its 18th Annual Summer Swing at St. Clair Country Club, Upper St. Clair. One of the premier charitable events in western Pennsylvania, this year’s guests — who set a new record for attendance — were greeted with the rhythmic sounds of a conga drummer and were surrounded by gently swaying palm trees and tropical flowers under the theme of “Twilight in the Tropics.” The island atmosphere continued inside and on the patio where guests decked out in summer cocktail attire enjoyed foods from the Caribbean-inspired menu, while listening and dancing to live music, directed and performed by Billy Hartung and his band. St. Clair Hospital Foundation raised more than $300,000 at this year’s Summer Swing event, helping ensure the award-winning Hospital will continue to provide the highest level of advanced, quality care to patients throughout southwestern Pennsylvania. ■

Summer Swing event chair Vicki McKenna, center, and committeewoman Karen Woelfel with conga player Noel Quintana.

Beth Evans and Michael Blehar.

18 I HouseCall I Volume VII Issue 3

Jerry and Susan Dioguardi. Jerry was representing Aetna, the 2015 Gold Level sponsor of Summer Swing.

Erik and Tara Grahovac, M.D.

Lucas, Jack and Marcus Piatt. Jack is a member of the St. Clair Hospital Foundation Board of Directors.

st. clair hospital foundation thanks members of the 18th annual summer swing committee for their generous time and contributions: Vicki McKenna, Chair Robert Bragdon, M.D. and Bunny Bragdon Sam and Anne Zacharias, along with Kim and Bo Edvardsson.

Kim is a member of the St. Clair Hospital Board of Directors.

Susan Bradley Brown Dan and Katie Caste Nicolette Chiesa, M.D. Wayne Evron, M.D. and Beth Evron Rose Kutsenkow Carol Showalter Myron, M.D. Brett Perricelli, M.D. and Julie Perricelli Matthew Pesacreta, M.D. and Rosie Pesacreta Robert N. Shogry, M.D. and Marilynn Shogry Rich and Suzy Sieber Andrew and Gail Vater Karen Woelfel G. Alan Yeasted, M.D. and JoEllen Yeasted

Enjoying the tropical atmosphere on the patio are, standing left to right, Jack Shirey, Andy Rodgers, Jack Duckloe, Dorene Berteotti, and Bob Nell.

Seated are, left to right, Brenda Shirey, Janice States, Pat Rodgers, and Jan Zomber Nell. Andy is a member of the St. Clair Hospital Foundation Board of Directors.

Sam and Anne Zacharias Volume VII Issue 3 I HouseCall I 19

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.

FLU SHOTS NOW AVAILABLE Just walk in.

Open daily 9 a.m. to 9 p.m.* MAJOR INSURANCE PROVIDERS ACCEPTED

COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY:

Your Opinion Counts

S

t. Clair Hospital is reaching out to area

community officials and a series of smaller

residents seeking their opinions on

meetings and focus groups.

which health needs they deem most

Once the assessment is complete, the

important for their respective communities.

health needs identified in which St. Clair can

You can submit your opinion via the Hospital’s

have the greatest impact will be addressed

website where you will be directed to a series

through new or redesigned programs. ■

of questions that help identify the health issues most important to area residents.

Topics cover the types of experiences ST. CLAIR HOSPITAL OUTPATIENT CENTER–VILLAGE SQUARE 2000 OXFORD DRIVE, BETHEL PARK, PA 15102 • 412.942.8800 * OPEN 9 A.M.– 5 P.M. ON MAJOR HOLIDAYS

encountered when trying to obtain healthcare,

To access the online St. Clair Hospital health needs survey, please visit www.stclair.org.

satisfaction with services in the community, barriers to local services, and identification of major health issues facing the community.

Other aspects of the outreach assessment

United Way Contributions Benefit St. Clair Hospital

include conducting one-on-one meetings with

To make a gift to the St. Clair Hospital Foundation via the United Way, please use the code 13441 to contribute to the St. Clair Hospital Fund.

Gifts to the St. Clair Hospital Fund are allocated to the Hospital’s highest priorities. Thank you for your support!

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.

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