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HouseCall Uterine Artery Embolization




Combating Antibiotic Resistance I Collaborative Patient Care: Mayo Clinic Care Network Q & A The Ouchless ER: Innovative Pediatric Care I Donor Spotlight I Economic Impact Health Care Costs Made Transparent I Ask The Doctor



Minimally invasive procedure is helping patients suffering from uterine fibroids At St. Clair Hospital, an advanced, high-tech procedure for the treatment of symptomatic uterine fibroid tumors is giving women a safe, effective alternative to hysterectomy, the surgical removal of the uterus, that has long been the traditional treatment. Uterine artery embolization is a minimally invasive procedure that blocks off the blood supply to the fibroids, causing them to shrink. Unlike total hysterectomy, it preserves the uterus and ovaries.

I’m so grateful that this option was given to me... everything happened exactly as they said it would. I had a true team taking care of me.


Interventional Radiologist Richard G. Foster, M.D. performed a uterine artery embolization on patient Maria McCormick.

2 I HouseCall I Volume VIII Issue 4


terine artery embolization is performed in St. Clair’s

feeling of heaviness or fullness throughout the pelvis. These

Interventional Radiology Lab, rather than in a traditional

symptoms can diminish quality of life, and in some instances,

Operating Room, says Richard G. Foster, M.D., a board-

can lead to complications. Occasionally, when fibroids cause

certified Interventional Radiologist who performs the procedure.

heavy bleeding, anemia can result. Although the anemia is usually

Dr. Foster says the procedure has numerous additional advantages

reversible with iron and vitamin supplements, some women will

over hysterectomy: it does not require general anesthesia or large

need blood transfusions.

surgical incisions; there is relatively minimal post-operative pain, no blood loss and no scarring. Uterine artery embolization requires a brief overnight admission to the Hospital and recovery is significantly faster and easier.

Finding relief after diagnosed with fibroids Maria McCormick, 46, leads a busy and fulfilling life centered on her husband, John, and their three children: Michael, 22;

Uterine fibroids are a common condition. It is estimated by the

Kayla, 19; and Megan, 15. Maria lives in Baldwin and works full

Centers for Disease Control and Prevention (CDC) that one in four

time in billing at a medical practice. When she began experiencing

American women will have uterine fibroid tumors at some point in

heavy periods, she suspected it might mean premature menopause.

their lives, usually in the childbearing or early middle years. Most

“I did not have any other symptoms, no pain or cramping,” she

often, she will be unaware of their presence; fibroids tend to be

recalls. “I wasn’t thinking that it could be fibroids. But my gyne-

asymptomatic. Occasionally, they are discovered by a gynecologist

cologist diagnosed fibroids; the bleeding from the fibroids was

during a routine pelvic exam.

so excessive that I became anemic and he sent me to the hospital

Fibroids are benign (non-cancerous) muscular tumors that grow in the wall of the uterus. Also known as leiomyoma, fibroids

for blood transfusions.” In September 2015, Maria sustained an injury that resulted in

can appear as a single tumor or more frequently, as a group of

a blood clot in her arm. She was admitted to St. Clair, under the

several; they vary in size from as small as a seed to as big as a

care of vascular surgeons Samuel T. Simone, M.D., and Thomas

cantaloupe. In severe cases, they can enlarge the uterus to such a

A. Simone, M.D., who performed a thrombectomy, a surgical

degree that the woman appears to be pregnant. There are three

procedure to remove the clot. Post-operatively, Maria received

types of uterine fibroid tumor: a submucosal grows into the uterine

heparin, a blood thinner, to prevent more clots from forming,

cavity; an intramural grows within the wall of the uterus; and a

and she was followed by St. Clair hematologists Robert A.

subserosal fibroid grows on the outside of the uterus. A pedunculated

VanderWeele, M.D. and Vincent E. Reyes, Jr., M.D. All was going

fibroid grows with a stalk, or stem-like structure.

well, and she was recovering nicely — until she got her period.

Most fibroids require no treatment. When fibroids are sympto-

“I already had a problem with heavy periods, but due to

matic, the symptoms will vary according to the type, size and location

the heparin therapy, the bleeding was extreme. It became an

of the fibroid. Pain and cramping are the most common symptoms,

emergency, and I was very scared,” Maria recalls. St. Clair

along with heavier than normal menstrual bleeding. Larger ones

Hospital obstetrician/gynecologist Shannon H. McGranahan, M.D.,

may put pressure on the bladder and/or the rectum, causing

who practices with Advanced Women’s Care of Pittsburgh, was

frequent urination, constipation and rectal pain. Other less common

consulted, and then Dr. Foster was brought in.

symptoms include lower back pain, painful intercourse and a Continued on page 4

FIBROIDS CAN CAUSE PAIN AND DISCOMFORT along with other symptoms that can severely diminish quality of life. Fibroids are almost always benign (non-cancerous).

1in4 WOMEN WILL HAVE UTERINE FIBROIDS at some point in their lives. Most often, they are unaware of their presence.

600,000 HYSTERECTOMIES are performed annually in the U.S. One-third are for the removal of fibroids.

ABOUT THE COVER Interventional Radiologist Richard G. Foster, M.D. shows Maria McCormick imaging scans following her uterine artery embolization procedure. Volume VIII Issue 4 I HouseCall I 3

TREATING FIBROIDS Continued from page 3

Something had to be done immediately. “Dr. Foster


the fibroid; they close the vessel, blocking off the

explained uterine artery embolization to my husband

blood supply. Gradually, the fibroid tissue shrinks and

and me,” Maria says. “He described it as an alternative

dies; the tiny particles remain, but are harmless.

to hysterectomy, which I preferred not to have. The embolization procedure sounded interesting and safe,

Post-procedure, Dr. Foster says, most patients will remain overnight in the hospital and be discharged


and Dr. Foster explained it thoroughly and reassured

the following day. Pain management consists of


me. I liked and trusted Dr. Foster so we agreed to it.

non-steroid anti-inflammatory medication to reduce

I had it done right away and it went very well. A year

swelling and a patient-controlled analgesia pump for

later, I’ve had no recurrence of bleeding; Dr. Foster

self-medication. Patients are instructed to follow-up

totally took care of it. I’m very pleased with the results.”

with their gynecologists. Recovery time following



Interventional Radiologist Richard G. Foster, M.D. in St. Clair Hospital’s new Interventional Radiology Lab.

4 I HouseCall I Volume VIII Issue 4

For the uterine artery embolization procedure, the patient is given light sedation, but remains conscious, Dr. Foster explains. He makes a tiny

uterine artery embolization is 3-6 days, as opposed to 60 to 90 days for hysterectomy. Maria has had an excellent outcome, says Dr. Foster,

incision in the groin and threads a thin catheter into

noting that her case was exceptional. “It’s very unusual

the femoral artery. Using state-of-the-art imaging

to have an inpatient emergency like that. Maria had

technology, he is able to advance the catheter to the

had the thrombectomy, which required the use of

uterine artery, and to the smaller “feeder” vessels

heparin (a blood thinner) afterward. Unfortunately,

that serve as the blood supply for the fibroid tumor.

she began to bleed heavily. She had two fibroids;

Tiny bead-like particles called microspores are

we were able to complete the fibroid embolization

delivered through the catheter to the vessel feeding

and get her back on the blood thinner four hours later.”


Uterine artery embolization is becoming an increasingly popular option as women learn more about it. The procedure


got a boost, Dr. Foster says, when Oprah Winfrey devoted a

Uterine Artery Embolization is a non-invasive procedure. It does not require general anesthesia or surgery; there is minimal post-operative pain and no scarring. The procedure has a quick recovery time and only requires a brief overnight stay. Most patients are back to work in a few days. The success rate is high.

program to it. “I get a lot of self-referrals from patients who have done their own research, and we have a good relationship with the gynecologists, who also refer patients. Women like the fact that uterine artery embolization removes the


fibroids but preserves the uterus and preserves their fertility. The success rate is high. A very rare risk is premature menopause; when we embolize, there is the potential for DIAGNOSIS /EVALUATION

connection between the uterine artery and ovarian artery,

Before fibroid embolization, every patient is thoroughly evaluated to ensure the procedure is appropriate for her. This includes a review of medical history and general physical health.

which can be accidentally embolized. But to prevent this, we leave the main uterine artery open and we only occlude the vessels which feed the fibroid.” Dr. Foster says Interventional Radiology is a subspecialty within radiology, and one of the most progressive branches in medicine today. It employs breakthrough guided imagery


technology to visualize and treat numerous conditions

The patient undergoes complete pelvic imaging, either ultrasound or MRI, to measure the size of the uterus and to look for any other conditions that might affect her health.

through “interventions” — minimally invasive, delicate and extremely precise procedures. Interventional radiologists accomplish this by inserting miniature needles and catheters through tiny punctures and threading them through the blood vessels to the organ in need of treatment. Interven-


tional Radiology reduces and even eliminates the need for

An incision the size of a freckle is made in the groin. A tiny catheter is inserted through this incision and into the femoral artery.

many surgical procedures. Fibroids can often be detected during a pelvic exam by a patient’s gynecologist, but a definitive diagnosis requires the use of diagnostic technology, including ultrasound, MRI, CAT scan and other tests. If the fibroids are small and asymptomatic and bleeding is not present or excessive, then no treatment may be needed and the physician will often recommend a “watch and wait” approach. Fibroids don’t usually interfere with fertility or pregnancy, but on rare occasions, especially

Using state-of-the-art imaging technology the doctor locates the arteries which supply blood to each fibroid.


when they are of the submucosal type which protrude into the uterine cavity, they may cause premature labor, placental UTERINE ARTERY

problems or growth restriction in the fetus.


In the United States, two of the most frequently performed major surgeries, Cesarean sections and hysterectomies, involve the same organ: the uterus. The CDC reports that 600,000 hysterectomies are performed in the U.S. every year; by the age of 65, 60 percent of women will have undergone hysterectomy. One-third of those are for the removal of fibroids.



Now, with the availability of uterine artery embolization, more

Tiny bead-like particles called microspores are delivered through the catheter to the vessel feeding the fibroid; these microscopic particles close the vessel, blocking off the blood supply. Without a steady blood supply, the fibroid tissue gradually shrinks and dies.

women may be able to keep their uterus and avoid the major surgical procedure that is hysterectomy. On average, 85-90 percent of women who have uterine artery embolization report significant or complete relief of heavy bleeding and

POST PROCEDURE Recovery time is 3-6 days, and 85-90% of all patients who had the procedure experienced dramatic relief. Recurrence of fibroids is extremely rare.

pain. Recurrence of fibroids is extremely rare. Continued on page 6 Volume VIII Issue 4 I HouseCall I 5

TREATING FIBROIDS Continued from page 5


RISK FACTORS FOR THE DEVELOPMENT OF UTERINE FIBROIDS: In addition to family history, age is a key factor: There is a higher incidence of fibroid development among women who had an early menarche (before age 12), or who are in their 30s and 40s through menopause. Other factors include:

Medical science has not yet pinpointed the cause


of fibroids, but they are associated with a number of factors. Mostly, fibroids are linked with the hormones estrogen and progesterone. In pregnancy, when hormones levels are high, fibroid growth is accelerated,

ETHNICITY African-American women are three times more likely to develop uterine fibroids.

OBESITY Being overweight doubles the risk of developing fibroids.

EATING HABITS Consuming red meat raises the risk of developing fibroids, while consuming green vegetables and fruit lowers the incidence.

but they will shrink or disappear after childbirth. During and after menopause, when hormone levels drop, fibroids typically shrink and cease to grow, as long as the woman is not taking hormone

VITAMIN D DEFICIENCY Inadequate levels of vitamin D increases the risk of uterine fibroids.

replacement therapy.

CONTRACEPTIVES Birth control pills with higher doses of estrogen may increase the growth of fibroids.

ALCOHOL Consumption of alcohol, particularly beer, increases the risk of developing uterine fibroids.

Department of Obstetrics and Gynecology at

Women want to keep their bodies intact, as much

question. “I am done having children, but I was

St. Clair, understands these sentiments. She

as possible; we want to leave this world with the

not ready to give up my uterus. At 46, I consider

says that it is not uncommon for women to feel

organs we came with. Procedures such as uterine

myself young, and I felt strongly that an important

a sense of loss and grief after hysterectomy.

artery embolization, which preserve the uterus,

part of me would be taken away.”

“The sense of loss is related to the importance

help a woman to feel whole, and that promotes

of the uterus to a woman’s sense of self.

a feeling of optimal health and well-being.

For Maria, hysterectomy was out of the

Deborah A. Lenart, M.D., Chair of the

“Women are well-informed when they come in to see us,” says Dr. Lenart. “They do DEBORAH A. LENART, M.D. Dr. Lenart specializes in obstetrics and gynecology and is Chair, Department of Obstetrics/Gynecology, at St. Clair Hospital. She earned her medical degree at Wright State University, Dayton, Ohio. Dr. Lenart completed an OB/GYN residency at the Medical School of the University of Texas. She is board-certified by the American Board of Obstetrics and Gynecology. Dr. Lenart practices with Advanced Women’s Care of Pittsburgh, P.C. To contact Dr. Lenart, please call 412.561.5666.

a lot of online exploring and research, and there is so much information. There are lots of non-surgical options, including uterine artery embolization, and we will be seeing more and more with technological advances. Uterine artery embolization works well and I make many referrals for the procedure.” Maria has no regrets. “I’m so grateful that this option was given to me, and that Dr. Foster was the one who did it. My care was done like clockwork; everything happened exactly as

RICHARD G. FOSTER, M.D. Dr. Foster specializes in interventional radiology. He earned his medical degree at SUNY Upstate Medical University Health Science Center, Syracuse, New York. Dr. Foster completed his diagnostic radiology residency at UPMC, and a fellowship in angiography and interventional radiology at The Western Pennsylvania Hospital. He is board-certified in Diagnostic Radiology with subspecialty in Vascular and Interventional Radiology by the American Board of Radiology. Dr. Foster practices with South Hills Radiology Associates. To contact Dr. Foster, please call 412.942.3101.

6 I HouseCall I Volume VIII Issue 4

they said it would. I had a true team taking care of me: the gynecologists, the vascular surgeons, the hematologists and the internal medicine doctors. I have to mention my nurse, Haley Dyczewski, R.N., who got me through it all. I want to thank everyone involved; they were all competent and compassionate; they worked together to solve the problem and help me.” ■



ANTIBIOTIC RESISTANCE St. Clair Hospital clinicians and scientists are fighting to keep patients safe Antibiotics, the first miracle drugs of medicine, are in trouble.

Bacteria are outsmarting antibiotics more and more, fighting back by developing resistance — and surviving. As a result, some antibiotics are no longer effective in treating bacterial infections; instead of dying, the bacteria grow, multiply and spread, and the infection becomes worse. Antibiotic-resistant bacteria are tough to eradicate and costly to treat, and they are a significant cause of death across the globe. It’s one of the most serious, growing and dangerous public health problems in the world. Continued on page 8

Volume VIII Issue 4 I HouseCall I 7

QUALITY HEALTH CARE Continued from page 7


T ST. CLAIR HOSPITAL, ANTIBIOTIC RESISTANCE IS BEING MET HEAD-ON by an exemplary multidisciplinary medical SWAT-like team: the Antibiotic Stewardship Team. Determined, dedicated and intrepid, these physicians, microbiologists, nurses and pharmacists bring their own “weapons and tactics” to the battle, in the form of experience, top-notch skills and a collaborative spirit that melds their diverse capabilities into a cohesive whole. When bacterial infection is suspected, the team is alerted and their meticulous systems are set in motion.

A Wonder Drug … With Global Concerns Initially viewed as miraculous, antibiotics are still wonder drugs,

that threatens our ability to treat and prevent infections.” All over the world, governments and public health agencies including

still a powerful tool in the treatment of infections caused by bacteria,

the World Health Organization are scrambling to find solutions. In the

and still lifesaving. But the use of antibiotics is not a simple matter,

U.S., more than 2 million Americans acquire antibiotic-resistant

and their misuse and overuse have created an urgent global concern

infections every year, and at least 23,000 die as a result, according

as bacteria become increasingly able to withstand the effects of the

to a Centers for Disease Control and Prevention (CDC) report. The report

antibiotics intended to eradicate them.

details the challenges and threats posed by the antibiotic-resistant

Laura A. Morris, M.T. (ASCP), CIC, Senior Infection Preventionist at St. Clair and one of the leaders of the Hospital’s Antibiotic Stewardship Team, says antibiotic resistance is not a new thing, but it is a much

germs that have the most impact on human health and ranks these threats into categories of urgent, serious, and concerning. St. Clair Hospital initiated the Antibiotic Stewardship Team four years

greater threat today. “Certain bacteria, when exposed to an antibiotic,

ago, well ahead of most hospitals. The team is a dynamic and highly

will evolve and adapt very quickly in order to live despite that antibiotic.

organized group whose mission is to improve every aspect of antibiotic

When this happens, the antibiotic is rendered ineffective, so the bacteria

use within the Hospital. To achieve that, they have created processes,

thrive and multiply. Antibiotic resistance is a global public health concern

policies and practices that monitor and manage all patterns of infection, antibiotic use and resistance. In addition to closely following every patient who is given antibiotics, the Antibiotic Stewardship Team issues regular reports to all clinical staff; compiles an annual “antibio-gram” report to the CDC; collaborates with other health care providers in the region; and provides continuing education to keep clinical staff up-to-date on emerging developments. “At St. Clair, we created the Antibiotic Stewardship Team because it was the right thing to do,” Laura states. “It’s another way to assure that our patients are getting the best care possible.” Having a stewardship team has been a recommendation of hospital regulatory agencies, but not a requirement; however, beginning in early 2017, it will be mandated by the Centers for Medicare & Medicaid Services and by the Joint Commission.




8 I HouseCall I Volume VIII Issue 4

Evidence-based Practices Guide Antibiotic Use

Like so many clinical endeavors at St. Clair,

In these early stages, this is pragmatic treatment, Laura explains. “Initially, a broad-

this system is a true team effort, involving

spectrum antibiotic is ordered because it will

many departments and individuals. Most

antibiotic use is a complex one, with many

most likely cover the relative organism. As we

importantly, it’s a path to wellness for the

essential and very precise steps, Laura explains.

know more, we will modify the order. In the

patient, with constant, ongoing assessment

She describes a typical scenario: “A patient

meantime, the attending physician and nursing

and adjustments, a constant fine-tuning in

comes into the Emergency Room (ER) with

staff are monitoring the patient:

symptoms that suggest a urinary tract infection.

is the patient responding to the

care. In complex cases, the

The ER physician performs a diagnostic work-up:

treatment? Are there new symptoms

Infectious Disease Department

physical examination, bloodwork and urine

that suggest something other than

may be consulted as well. Amanda

culture. Based on these early findings she

a urinary tract infection? Is the

M. Michael, D.O., a bacteriologist

prescribes an antibiotic using an ‘order set’ —

patient tolerating the antibiotic?”

and board-certified Infectious

or clinical pathway — that our pharmacists

In the St. Clair Lab, microbiologists

and infectious disease experts created, based

are using advanced technology to

on evidence-based practices and the latest

detect bacterial growth and identify

science from the Infectious Disease Society

the specific organism.

The process of monitoring and managing

of America. The order set serves as a general guideline, telling the physician what organism

order to provide the highest quality

50% of all antibiotics prescribed in the U.S. are not necessary

“Within 48 hours after admission, the culture reports are complete, identifying

Disease physician specialist, is the Medical Director of the Antibiotic Stewardship Team. She describes the use of antibiotics as a balancing act. “It takes a huge effort behind

the scenes to treat people as needed, but

is the likely cause of the infection, giving her

the specific bacterium causing the infection,”

without misusing antibiotics. The goal is to

options and guiding her to the best antibiotic

Laura says. “Adjustments will be made as

get the patient started on the right antibiotic,

for the immediate phase. The order is sent to

needed by the physician, with Pharmacy

as soon as possible, for the shortest duration,

the Pharmacy, where the dose is re-calculated

review. Very often, the next step is to switch

using the narrowest spectrum possible. A

and the order undergoes a number of checks.

from the broad-spectrum antibiotic to one

broad spectrum antibiotic will kill a lot of bugs,

Is it the most appropriate drug at this point?

with a more narrow range that is tailored

including the good ones. We never take the

Are there any possible drug interactions or

specifically to that bacteria. This will be

administration of antibiotics lightly; there is a

allergies? Is the dose correct? Is the patient’s

more effective and is less likely to lead to

significant downside to getting antibiotics that

kidney function normal?”

antibiotic resistance.”

you do not need.”

What you can do. • When you are ill with an upper respiratory infection, do not automatically expect or demand antibiotics from your physician. Antibiotics fight bacteria, not viral infections, which cause colds and flu. Learn to manage symptoms with over-the-counter products and home remedies; rest and let your body heal you. If your symptoms worsen, contact your physician. • When you are prescribed antibiotics, take them exactly as directed. When you start feeling better, do not skip doses or stop the antibiotic — take the full course, unless otherwise directed by your physician. If you skip or stop on your own, the drug may not kill all the bacteria and the ones that survive can become resistant to the drug you have taken. Plus, you may get sick again.

Continued on page 10

The battle against drug-resistant bacterial infections is everyone’s problem and everyone’s responsibility. Here are some ways that individuals can help prevent the creation and spread of infection and antibiotic resistance. • If you are hospitalized, make sure your caregivers and visitors wash their hands — correctly — before touching you. Keep your own hands very clean. • If you are on antibiotics and you develop diarrhea, tell your physician or nurses right away. • Never take an antibiotic on your own — don’t take anyone else’s prescription or pills from a previous infection that you “saved.” It may be inappropriate for the infection you have, and the wrong antibiotic will not help you get better. • Don’t be afraid to take an antibiotic if your doctor says you have a bacterial infection and you truly need one. • If you have questions about taking an antibiotic, contact your physician or your pharmacist.

REMEMBER: Taking an antibiotic to treat a viral infection: will not cure the infection or make you feel better; will not prevent the spread of the infection to others; may cause harmful side effects; may contribute to the development of antibioticresistant bacteria. In addition, always follow these general guidelines for infection prevention: • Wash your hands after using the restroom, before eating, and when coming home after being in public places. • Keep current on your vaccinations. • Prevent foodborne illness by handwashing before food preparation, keeping a clean kitchen, cooking food to proper temperatures. • Stay home from work or school when you are sick.

Volume VIII Issue 4 I HouseCall I 9

QUALITY HEALTH CARE Continued from page 9

According to the CDC, 50 percent of all antibiotics prescribed in the U.S. are not

as C. diff (please see sidebar below), which is a

today is the way that antibiotics are being used.

big concern in health care.”

Overuse promotes resistance, as does misuse, such as prescribing an antibiotic to treat a viral

necessary or are inappropriate for the infection being treated. This misuse leads to “superbugs” — multidrug resistant organisms, like MRSA (methicillin-resistant staph aureus) — that

Outsmarting ‘Smart’ Bacteria is an Ongoing Challenge Bacteria become resistant to an antibiotic

infection. For example, most sore throats are caused by viruses, but it is not uncommon for patients to request and receive an antibiotic

resist many classes of antibiotics. The conse-

when they evolve in a way that protects them

from their physicians. When one takes an anti-

quence, says Dr. Michael, is that illnesses

from the drug. They can expel it, neutralize it,

biotic for a viral infection, the antibiotic may

that were once easily treatable are far more

or change their own structure through genetic

attack the healthy beneficial bacteria in the

challenging, and in some situations, there are

mutation, so that the antibiotic cannot attach

body. This can promote antibiotic-resistance

no longer any options. “It can be frightening

to it and kill it. When a bacterium survives

properties in harmless bacteria, and those

when we don’t have the appropriate weapons

antibiotic treatment, it can then grow, reproduce

bacteria may share it. Every time bacteria

in our arsenal, but it’s a rare occasion when

and pass on its resistant properties to its

outsmart an antibiotic, treatment options

we have no options at all. More often, giving

offspring. And, some bacteria are altruistic —

grow more limited, infections are prolonged,

an antibiotic is like a puzzle — we try to match

they share their drug-resistant properties

suffering is worse and costs are higher.

the right antibiotic to the infection. Misuse can

with other bacteria.

Amy Georgulis, Pharm. D., a Clinical Pharmacist Specialist, is one of several Hospital

result in distortion of your normal flora, which

The development of antibiotic resistance

leaves a person vulnerable to superbugs such

is normal; all living organisms fight to preserve

pharmacists who serve on the Stewardship

as Clostridium difficile, commonly referred to

their lives and multiply. But what is different

Team. “We have always treated infections, and


Fighting off a dangerous infection with pre-emptive strikes Misuse of antibiotics leads to the development of multidrug resistance and also creates conditions that allow the spread of infections such as Clostridium difficile (C. diff), a bacterium that is one of the most dangerous infections. Every year in the U.S., about 500,000 people become infected with it, according to the Centers for Disease Control and Prevention (CDC), and of those, 15,000 will die. C. diff infection is an intestinal infection that occurs primarily in people who have been recently on antibiotics, especially if they are hospitalized or in long-term care facilities; those at greatest risk are the elderly and those who are immunocompromised. C. diff causes colitis — inflammation of the colon — with severe diarrhea, nausea and dehydration. The C. diff bacteria are shed in the feces and are easily spread by direct contact with contaminated hands, items and surfaces. Anything that may have fecal contamination can be a source of transmission: toilets, sinks or door handles, bed rails, table tops, for example. If you touch contaminated items or surfaces, or are touched by contaminated hands, and then you touch your face or mouth, you can become infected. C. diff bacteria can live in spore form on surfaces for months. When a person takes antibiotics, the drug will target and hopefully kill the bacteria that are causing the infection. But it may also kill the “good” bacteria, the normal flora, which live in the gut and help protect

10 I HouseCall I Volume VIII Issue 4

the body from infection. This is especially true when a broad-spectrum antibiotic is administered. When these good bacteria die off, it leaves an opportunity for pathogens — disease-causing germs — to thrive and multiply, creating illness. C. diff proliferates when antibiotics are not prescribed correctly or monitored closely; this is why an antibiotic stewardship program like St. Clair’s is so vital. According to St. Clair Hospital Infectious Disease specialist Amanda M. Michael, D.O., C. diff is shifting from a predominantly hospital-based infection to a community-based one, as well. It is occurring more frequently, is more virulent and more difficult to treat. There are increasing cases among young healthy people who are not on antibiotics, not in health care facilities and not immunocompromised. “Many healthy adults and infants are colonized with C. diff; it lives in their guts normally, but they are not ill,” she says. “They don’t know they carry it, until they get their intestinal flora wiped out by an antibiotic and suddenly C. diff is the only soldier left standing on the battlefield. Now it has no competition, so it gets the entire food supply.” Ironically, C. diff is treatable with antibiotics, but can be difficult to treat. St. Clair combats C. diff with a comprehensive protocol that consists of five-pillars: 1) hand hygiene; 2) contact precautions, meaning pre-emptive patient isolation (when C. diff is suspected, but before culture results are known) and the wearing of protective gowns and gloves; 3) environmental measures taken by two groups of staff — the environmental services staff, who use sporicidals to disinfect surfaces, and the clinical staff, who disinfect shared medical equipment between patients and also clean surfaces in patient areas; 4) the Antibiotic Stewardship Team; and 5) education for staff, patients, visitors and community health care providers.

we will continue to treat infections, but now we try to do so in ways that will reduce side effects and minimize the development of superbugs. Sometimes, this means stopping the antibiotic a little earlier than the usual 10-14 days. A shorter duration, of five days perhaps, will sometimes

What you need to know about


Antibiotic resistance arises when bacteria change to protect themselves against an antibiotic. Resistance is increasing and the number of effective antibiotics is decreasing. This means that one day no antibiotics may be left to fight life-threatening diseases.

do the job. If this is feasible, it means that fewer bacteria will be exposed, thus there is less chance of developing resistance to an infection

In the last


like C. diff.” Amy reassures that there are still effective

YEARS no new antibiotics have been developed.

and safe antibiotics available. “The situation is concerning because more bacteria are showing up resistant, nationwide, but we do have antibiotics that work.” Both Amy and Dr. Michael say that the development of new antibiotics is critical but many pharmaceutical companies are hesitant

What do antibiotics do? Antibiotics are medicines used to treat infections caused by bacteria such as tuberculosis, blood stream infections and pneumonia. They kill the bacteria or stop them from growing.

to do so. “New drugs are in development, but not nearly enough,” says Dr. Michael. “Drug companies are more invested in drugs that are taken over a long period of time. The World Health Organization is giving priority attention to antibiotic resistance and encouraging the

Antibiotics kill bacteria, not viruses. Take antibiotics only when prescribed by a doctor for bacterial infections. Do not take them for illnesses caused by viruses such as colds and flu. They will not work.

> 20

Antibiotics and vaccinations have added




9 TIMES OUT OF a sore throat is caused by a virus, not bacteria.

pharmaceutical industry to work on developing new products.” Although misuse and overuse of antibiotics is the major cause of antibiotic resistance, other factors play a role, explains Dr. Michael. Globalization and international travel are part of the picture; in many countries, anyone can buy antibiotics over the counter.” “At St. Clair, we educate our patients and their families about taking antibiotics appropriately,” says Laura. “We look at the big picture: the Hospital plus the community, including

Why does it matter?

What can you do?

Taking an antibiotic unnecessarily decreases its effectiveness against bacterial infections, so it might not work when really needed. Always check with your doctor before using an antibiotic.

• Use antibiotics only when prescribed by a doctor, and ensure your family does so. • Take the full prescription, even if you are feeling better. • Never share antibiotics with others or use leftover prescriptions. Source: World Health Organization Regional Office for Europe,

nursing homes and other hospitals. We share patients, so we must work together. We also do a lot of outreach, sending our infectious


disease physicians to these other facilities.

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

It’s not a single-hospital issue, it’s a community one, and it’s a challenge. But at St. Clair we are very much on top of the problem of antibiotic resistance. St. Clair Hospital is always driven by quality, and that is what drives the Antibiotic Stewardship Team.” ■

To contact Dr. Michael, please call 412.347.0057.

Volume VIII Issue 4 I HouseCall I 11



Working Together. For a ealthier You. Q & A with the Medical Director

of the Mayo Clinic Care Network


n late August of this year, St. Clair Hospital joined the

Mayo Clinic Care Network. The network allows select high-performing organizations to collaborate with the

renowned Mayo Clinic to promote best practice and advance

medical practice. Recently, HouseCall sat down with David L. Hayes, M.D., medical director of the Mayo Clinic Care Network, to discuss what St. Clair patients can expect from this collaboration.

12 I HouseCall I Volume VIII Issue 4

Q: A:

What are the benefits of membership to St. Clair Hospital? The benefits to St. Clair include a number of clinical tools that Mayo Clinic developed for its own use and extends

The Network seeks organizations that are like-minded and culturally similar. Before inviting a health care organization to join the Network,

through the Network relationship. In addition, based on

Mayo Clinic conducts a comprehensive evaluation based on a

feedback within the Network, the clinical resources keep

rigorous set of clinical excellence criteria: patient care, quality,

evolving. Right now, we offer electronic consults that

safety and service efforts. Also, an exploration of the Hospital’s

help physicians to connect and discuss specific cases;

culture and values determines if the organization is philosophically

a repository of the Mayo-vetted medical information, called

compatible with Mayo Clinic, which places great emphasis on

AskMayoExpert; and access to our best practices, which

whole-person, patient-centered care. The bottom line is, the

we call Health Care Consulting, though it’s really an

member organization is patient-centric and delivers high quality care.

exchange of best practices, innovation and training.

And we found all of that at St. Clair.

By sharing what we’ve learned, members can avoid having to re-create the wheel when they are facing a new challenge in health care.

Q: A:

Q: A:

Why did Mayo Clinic choose St. Clair for participation in the Network?

How does St. Clair’s membership in the Network benefit St. Clair patients?

Q: A:

What is the goal of Mayo Clinic Care Network? The overall goal of Mayo Clinic Care Network is to establish relationships with regional health care organizations to enhance patient care in their communities. By working together — by extending Mayo Clinic knowledge and sharing expertise — we can make certain

St. Clair patients benefit from this relationship because

that patients get the right care at the right place and the right time.

we are focused on enhancing the care experience through

With the right physician. It’s about what’s best for the patient. ■

shared knowledge. In addition to the trusted care of their St. Clair physicians, patients will have access to Mayo Clinic expertise. This can help patients who are facing important medical decisions by giving them peace of mind. For example, if physicians want input on a complex case or another opinion to reassure their patients, they can request an


electronic consultation from one of Mayo’s more than 4,000


physicians and scientists. The request is then scheduled


with the most appropriate Mayo subspecialist. A review of pertinent records and a formal response can be completed in a matter of days and delivered to the requesting physician. All at no additional cost to the patient.


DAVID L. HAYES, M.D. Dr. Hayes is the Medical Director of Mayo Clinic Provider Relations and the Mayo Clinic Care Network, as well as a member of Mayo Clinic’s Management Team. He also is a Professor of Medicine at Mayo Medical School, Mayo Clinic, Rochester, Minn. Dr. Hayes earned his medical degree at the University of Missouri School of Medicine, Kansas City, Mo. and completed his residency in internal medicine, as well as a residency in Cardiovascular Disease, at the Mayo Graduate School of Medicine, Rochester. He also completed training in cardiac pacing at Montefiore Medical Center, New York City, and training in nuclear cardiology at Cornell University Medical Center, New York. Dr. Hayes has lectured worldwide and has published 301 manuscripts and 459 abstracts.

David L. Hayes, M.D. Volume VIII Issue 4 I HouseCall I 13


Taking an OUCH New techniques in St. Clair Hospital’s ER take the pain out of laceration repair for children


t St. Clair Hospital, a novel procedure for treating lacerations in children is changing the experience of going to the Emergency Room (ER).

Going to the ER to have a laceration repaired is a common experience,

but for children it can be a traumatic one. Imagine it from the viewpoint of a child: you’re injured and bleeding, you’re in pain, and you’re rushed to a hospital ER, a place with bright lights and sometimes scarey sights. You get a shot, a doctor approaches you with an odd-looking needle and thread, and a group of adults come in and hold you down, in order to make sure you stay still for suturing. It’s terrifying, and for many children the ER experience is far more distressing than the original injury, potentially leaving long-lasting psychological scars.

St. Clair Hospital Emergency Room physician Emily L. Brown, M.D. demonstrates an ‘ouchless’ approach to treating lacerations in children.

14 I HouseCall I Volume VIII Issue 4

less approach lacerations and fractures and for imaging

staff to develop the protocol and reformulate

physicians have decreased the likelihood of

procedures, and we’ve had excellent results.

topical Lidocaine for this purpose, as well as

this scenario by implementing an innovative

Many times, it allows the child to lie still,

Dr. Raymond D. Pitetti, associate chief of

and painless approach to the treatment

and that makes it easier for the staff to

emergency medicine at Children’s Hospital

of certain acute injuries in children. Safe,

complete the suturing.”

of Pittsburgh of UPMC, an expert in pediatric

At St. Clair Hospital, emergency medicine

effective, and compassionate, the new method

Dr. Brown describes the procedure:

sedation, who shared his knowledge and

employs nasal inhalation to administer

“ER nurses apply topical Lidocaine, an

experience with the technique with St. Clair’s ER physicians.

medication that calms and quiets children

anesthetizing agent, to the skin upon the

so they can be treated. St. Clair emergency

child’s arrival. This numbs the area and

medicine physician Emily L. Brown, M.D.,

eases any pain. Once it takes effect, we

gives the method rave reviews. “It can be

use a nasal atomizer to deliver a carefully

terrifying for a child to be held down by

calibrated dose of anti-anxiety medication

adults. We’re pleased that we can now give a child a better experience. We use it primarily for treating

into each nostril. The child is monitored


throughout, with nurses keeping track of


vital signs and oxygen saturation. After


10 minutes, the child is usually sufficiently


calm. The effect lasts for 30–40 minutes


and is well tolerated by the children.

“No needles, no restraining, no IV, no pain — this is an ideal way to treat


lacerations in children. For small and simple lacerations, instead of being sedated with IV medications or held down on a table, the child can quietly sit on a parent’s lap.

“This is a wonderful service for the

Most often we treat children in our Fast Track room. We see lots of active, healthy

community; parents can count on being

kids who get injured; they can be treated

in-and-out of the ER quickly,” says Dr. Brown.

here compassionately and effectively.”

“As an emergency medicine physician,

Dr. Brown commends St. Clair’s Pharmacy Department, which worked closely with ER

and as a mother, I know the value of this new approach.” ■

EMILY L. BROWN, M.D. Dr. Brown is board-certified in emergency medicine and serves as Vice Chair of Emergency Medicine at St. Clair Hospital. She earned her medical degree at the University of Pittsburgh School of Medicine, and completed the Harvard-Affiliated Emergency Medicine Residency at Massachusetts General Hospital, and Brigham and Women’s Hospital in Boston, Massachusetts. She is employed by Emergency Resources Management, Inc.

Volume VIII Issue 4 I HouseCall I 15


Highlands Council, Boy Scouts of America; Extra Mile Education Foundation and many additional organizations. He has been the recipient of numerous honors, including three honorary doctorates. His community involvement is greatly rewarding,

___ WHY I ___

he says, and he cites his involvement with the


development of the Regional Asset District as one of the satisfying experiences. He is also a founder of DINAMO, a non-profit, multi-state organization designed to secure financing for the lock and dam infrastructure of the upper Ohio inland waterway

Charles J. Queenan, Jr. Chairman Emeritus, K&L Gates LLP


system and its tributaries.

people who are doing the right thing for the right

Part of being alive is

was born in the river town of Coraopolis,

reasons, like (President and CEO) Jim Collins and

along the Ohio, just a few miles from Pitts-

Dr. Yeasted at St. Clair,” he says. “They have focused

seeking what you can do to

burgh’s iconic Point. Growing up along the river

on excellence in health care services. St. Clair has

harles J. Queenan, Jr. (aka Chuck Queenan)

make life better for others.

undoubtedly shaped his childhood, and he has

a remarkable story. The Hospital provides outstand-

remained devoted to his hometown. That devotion

ing clinical services, and it is a leader in hospital

has been all-embracing and extraordinarily fruit-

safety. St. Clair adopted a strategy to eliminate

ful for Pittsburgh, as Chuck has played a primary

medical errors and hospital-acquired infections,

role in shaping much of the region’s growth and

and it has been successful. Some hospitals pay lip

Now retired, Chuck enjoys playing golf, espe-

revitalization. Through countless professional,

service to these goals, but at St. Clair there is a

cially with his grandsons. “I am married to my

philanthropic and civic endeavors, he has touched

culture of meaningful compliance that has been

childhood sweetheart and blessed with a wonderful

and shaped Pittsburgh with an impact that few

developed under their leadership.”

family,” he says. He continues to work with non-


can match. Just as Pittsburgh’s three rivers have

A legend among lawyers, Chuck is known for

profits and encourages others to volunteer their

shaped the contours of the region’s environment,

his exemplary leadership, mentoring and brilliant

time and talents to hospitals, arts organizations and

economy and culture, Chuck Queenan has influ-

legal mind. In 2014, he was honored by The American

other non-profits. “My first organization was the

enced nearly every major institution and organi-

Lawyer journal with the Lifetime Achievement

Mt. Lebanon Civic League; my volunteer activity

zation in the region — including St. Clair Hospital.

Award. He served as Chairman of the global law

grew from there. What I bring to cultural and civic

Supporting St. Clair, says Chuck, is a matter

firm K&L Gates LLP for decades, guiding the firm

organizations is institutional memory — ‘the wisdom

of “enlightened self-interest” and community spirit.

through expansions that have made it one of the

of the ages’ — and knowledge of leadership and

“We reside at Providence Point, Scott Township,”

largest and most respected law firms in the world.

how to engineer change in public policy. If you can

he explains, “and my wife JoAnn and I have both

He was named Chairman Emeritus of the firm in

convince people that they’re supporting a winner,

received excellent care in St. Clair’s Emergency

2013. K&L Gates represents multinational corpo-

like St. Clair Hospital, you can get them on board.”

Room. St. Clair is a first class hospital, close to our

rations, growth companies, academic institutions

home, and our primary care physician is St. Clair’s

and philanthropic organizations.

Chuck is committed to serving others and improving communities by being a force for good,

Dr. Alan Yeasted. Ours is a community known for

In addition to his leadership in law, Chuck has

its beautiful homes and neighborhoods, with excel-

served numerous organizations through director-

some way. “We are only on this spinning ball we call

lent schools, athletic facilities and churches, great

ships. He has served as Chairman of the Board of

Earth for 70 or 80 years,” he says, “and during that

shopping and thriving local businesses. In short,

Directors for the Allegheny Conference on Commu-

period we have an opportunity to leave this spin-

St. Clair Hospital enhances the community and

nity Development and Chairman of the Board for

ning ball better than we found it. I believe that part

raises home values; it is a jewel of the community.”

Carnegie Mellon University. He has served as a

of being alive is seeking what you can do to make

Chuck extols the Hospital’s leadership — and

Director for The Pittsburgh Cultural Trust; United

life better for others. Find out what appeals to you

he is an expert on leadership. “I admire smart

Way of Allegheny County; St. Vincent College, Laurel

and get involved. The rewards are tremendous.” ■

16 I HouseCall I Volume VIII Issue 4

and he believes that everyone can contribute in


Our economic impact on the region St. Clair Hospital plays a pivotal role in the economic health and vitality of the community. Below is a snapshot of the direct and indirect impact on the area’s economy in 2015, the most recent year available.



Hospital employment Hospital spending Emergency Department capacity Regional vitality Community health

Non-Hospital employment Regional spending State and local tax revenues State economic development support











$504.3 MILLION

COMMUNITY BENEFIT PROGRAMS • Community Health Improvement Services & Community Benefit Operations • Health Professions Education • Subsidized Health Services • Cash and In-Kind Contributions • Community Support • Community Health Improvement Advocacy

$ 3.68 MILLION




CHARITY, DISCOUNTED AND UNCOMPENSATED CARE • Charity Care • Discounts to Uninsured/ Underinsured • Unpaid Patient Expenses • Unreimbursed Medicare • Unreimbursed Medical Assistance

$162.5 MILLION

Source: The Hospital and Healthsystem Association of Pennsylvania


$43.23 MILLION

$46.91 MILLION

Volume VIII Issue 4 I HouseCall I 17


Patient Estimates tool takes the mystery out of health care costs In an era of increasingly higher deductibles, patients want to take control of their medical costs. Typically, you learn about your out-ofpocket hospital costs weeks after your test or procedure. So, to help you navigate the pricing landscape, St. Clair Hospital created

Patient Estimates, the nation’s first pricing transparency tool for hospitals. Based on information provided by each patient’s specific health benefit plan,

Patient Estimates instantly produces highly accurate cost estimates for services at St. Clair Hospital and its Outpatient centers. A national leader in quality and patient satisfaction, you’ll also find St. Clair is often the lowest cost provider. To access Patient Estimates, please visit and click on Financial Tools.



18 I HouseCall I Volume VIII Issue 4


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






Enlarged Prostate is a Common Problem



I wake up multiple times a night to urinate, and I have to urinate frequently during the day. I was told I that I have an enlarged prostate. What are my options? As men get older, their prostates increase in size. This is a normal aging process. As the prostate gets larger, it can make emptying of the bladder difficult, which can result in frequent urination, slowing of the urinary stream, waking up at night to urinate, and urinary urgency (voiding dysfunction). Not all men with voiding dysfunction have a large prostate; many men with normal sized prostates can also have problems urinating. Enlargement of the prostate is a very common problem. It is estimated that 210 million men worldwide have benign prostatic enlargement, affecting one quarter of men in their 50s, one third of men in their 60s, and half of men 80 years or older. There are a number of different treatments that can be used to improve the quality of life of men suffering from voiding dysfunction due to an enlarged prostate. Some of these are behavioral. For example, a simple measure that helps many men is to restrict fluid intake at nighttime, which can markedly improve the number of times they have to wake up to urinate. Other options include medications that can either relax the muscle within the prostate, or shrink the prostate. Some of these medications can work as quickly as 48 to 72 hours after beginning treatment. Finally, there is a wide spectrum of surgeries that can be done to decrease the size of the prostate. Often, men think that these surgeries involve removal of the entire prostate, as is done for prostate cancer. In reality, most of the surgeries done for benign prostate enlargement do not require removal of the entire prostate and are done in an outpatient setting. These surgeries range from minimally invasive office procedures to laser vaporization of the prostate to endoscopic surgery that removes only the obstructive portion of the prostate. Only in select patients do we resort to more radical surgery via robotic and/or open surgical techniques.

Many men fear that voiding dysfunction is a worrisome sign. Most of the time this is not the case. Voiding dysfunction is infrequently linked to prostate cancer and is usually not related to damage to the urinary system. However, there are circumstances when incomplete bladder emptying can cause urinary tract infection, development of bladder stones, and kidney damage. Therefore, it is important to bring up voiding dysfunction with your health care provider because there are a few quick assessments that can confirm that your symptoms are not representative of a more significant problem. A common misconception is that if a man experiences voiding dysfunction, it is attributable to prostate enlargement alone. This is often, but not always, the case. For instance, men, similar to women, can develop an overactive bladder. Oftentimes in men, the prostate obstructing the bladder over time causes an overactive bladder. In addition, voiding dysfunction in men may be related to inflammatory or infectious conditions of the lower urinary tract, neurologic problems, or scar tissue in the urinary tract. Voiding dysfunction in men can result in significant impairment in an individual’s quality of life, and in certain circumstances be a sign of other health problems. There are a number of easy interventions that can be done to restore a man’s quality of life if he is suffering from voiding dysfunction. Please let your health care provider know if you have this very common problem. ■

Shailen S. Sehgal, M.D.

SHAILEN S. SEHGAL, M.D. Dr. Sehgal earned his medical degree at Cornell University and completed his urology residency training at the University of Pennsylvania. He completed a research fellowship at the National Institutes of Health and a robotic surgery fellowship at the University of Pennsylvania. Dr. Sehgal is board-certified by the American Board of Urology. He practices with the Center for Urologic Care. To contact Dr. Sehgal, please call 412.833.3000. Volume VIII Issue 4 I HouseCall I 19

1000 Bower Hill Road Pittsburgh, PA 15243

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


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.


THE REGION’S LEADING OSPITAL IN PATIENT SAFETY St. Clair is the only hospital in the region to receive 8 consecutive ’A’ grades for Hospital Safety.


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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St. Clair Hospital HouseCall Vol VIII Issue 4  

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

St. Clair Hospital HouseCall Vol VIII Issue 4  

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