St. Clair Hospital HouseCall_Volume 5 Issue 2

VOLUME V ISSUE 2

HouseCall The New

Center of Healthcare Expanded Outpatient Center Debuts in Bethel Park Page 2

Restored to

life

South Park resident Tami Mikush was clinically dead for 45 minutes.

St. Clair Hospital doctors, advanced technology, and her determination to live brought her back from the brink.

Her amazing story begins on Page 10.

inside

New Physician Spotlight I Ask The Doctor: Low Testosterone Treatment In The Swing Of Things: Summer Swing Date Announced I In The Community

Continued GroWth

St. Clair Hospital

Outpatient Center at Village Square-Bethel Park

The newly expanded St. Clair Hospital Outpatient Center at Village Square is a response to patient desire to access healthcare services in a way that is convenient and efficient.

2 I HouseCall I Volume V Issue 2

outpatient facility triples in size and makes accessing healthcare services simple and convenient.

ThE CrEATion oF A onE-STop ouTpATiEnT CEnTEr AllowS pATiEnTS To hAvE TESTS, SEE A phySiCiAn, unDErgo ThErApy, AnD EvEn EnJoy A SpECiAlTy CoFFEE. All unDEr onE rooF.

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xtensive renovations at St. Clair Hospital

Grouping these services allows patients to see a

Outpatient Center–Village Square are nearing

number of physicians and obtain healthcare services

full completion, but patients are already

in one day, all under the same roof ― a response to

enjoying a wealth of healthcare services

patient desire to access healthcare services in a way

conveniently located on three floors, all

that is convenient and efficient. Moreover, a new café

in one accessible, easy-to-navigate building across

will soon be added to the Outpatient Center so patients

Fort Couch Road from South Hills Village mall.

can enjoy a specialty coffee and a bite to eat in a warm,

You'll find easy access to a wide range of healthcare services and physicians, including lab, imaging and other

inviting atmosphere.

What follows over the next six pages is a floor-by-floor

diagnostic services, occupational medicine, physical therapy,

breakout of services at the Outpatient Center-Village Square

breast care, pain management, diabetes care, and cardiac

and corresponding contact information for each. We encourage

testing, along with physicians in primary care, endocrinology,

HouseCall readers to save this handy guide for future reference.

ear/nose/throat, orthopedics, cardiology and more. And

Meantime, welcome to the new St. Clair Hospital Outpatient

coming soon: an urgent care center that will be open

Center–Village Square. We look forward to taking care of you

every day of the year, including all major holidays.

and your family.

Continued on page 4

An artist’s rendering of the soon-to-open South Hills Cardiology Associates’ suite on the Third Floor.

Volume V Issue 2 I HouseCall I 3

Continued GroWth Continued from page 3

First Floor A

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diaGnoStiC Center

Café 4 at villaGe Square

Long considered the heart of the overall Outpatient Center, the

CominG Soon!

Diagnostic Center’s easy check-in service and comfortable, spacious

Patients and visitors to the Outpatient Center will be able to sip a cup

waiting area are a gateway to the Center’s many services, such as: • Lab, which includes blood draws and • specimen X-ray collection, and • Imaging, which includes X-ray, CT, MRI, and more.

• MRI • CT scan To contact the Diagnostic Center, please call 412.942.7100.

of specialty coffee and get a bite to eat at the Center’s soon-to-open Café 4 at Village Square. The sit-down café will be offering some of the same popular menu items as its namesake at the Hospital. In addition to its famous coffee, those items will include danish and bagels, baked goods, salads and sandwiches, nuts and dried fruits, and more. A selection of bottled beverages suitable for breakfast and lunch will also be available.

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diaGnoStiC Center

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Café 4

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rehabilitation ServiCeS

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urGent Care

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valet ServiCe

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rehabilitation ServiCeS

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urGent Care

PHYSICAL THERAPY

CominG Soon!

St. Clair Hospital’s Outpatient Physical Therapy Department, or PT,

Today’s urgent care centers are designed to take care of patients who

has long been recognized for its highly skilled team of licensed

become ill or are injured, but their conditions are not serious enough

physical therapists. The newly renovated and greatly expanded

to warrant a trip to an Emergency Room. St. Clair Hospital’s Urgent

space at the Outpatient Center has allowed the installation of new

Care center will be a brand new addition to the Outpatient Center,

state-of-the-art equipment and the introduction of enhanced treatment

and will offer on-demand care for minor injuries, colds and flu,

options for patients. Physical therapists use a variety of treatment

physical exams for after-school sports, and vaccinations.

techniques, such as exercise; gait training; balance activities; heat/cold modalities; electrical stimulation; traction; and tissue

The Urgent Care Center will be open 9 a.m. to 9 p.m., seven days a

mobilization/manual therapy techniques to aid patients.

week, 365 days a year and will be staffed by board-certified physicians.

OCCUPATIONAL THERAPY

Patients visiting the Center do not make appointments. They simply

With a personalized plan of care, patients are assisted in resuming

walk in and ask to see a doctor.

Follow-up care will be coordinated with patients’ personal physicians.

activities integral to participation in independent self-care, home and work-related skills, and leisure activities.

SPEECH THERAPY Utilizing comprehensive assessments and therapy materials, the department’s team of specialized healthcare professionals identifies and treats a variety of speech conditions and disorders.

To contact Rehabilitation Services, please call 412.942.7122.

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free valet ServiCe

Free valet parking is available for patients of the Outpatient Center and physician practices. Visitors to other building tenants may also use valet parking for a nominal fee.

Volume V Issue 2 I HouseCall I 5

Continued GroWth Continued from page 5

Second Floor A

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South hillS orthopaediC SurGery aSSoCiateS

preferred primary Care phySiCianS, inC.

South Hills Orthopaedic Surgery Associates is home to a leading team

The office of Preferred Primary Care Physicians (PPCP) at Village

of surgeons who specialize in the care of the musculoskeletal system,

Square is staffed by board-certified physicians who specialize in

with emphasis on the spine, neck, shoulder, elbow, wrist, hand, hip,

family practice. They provide primary care services with an emphasis

knee, foot and ankle. Whether it is repairing a torn ACL (anterior

on wellness and preventative care.

cruciate ligament) in the knee of an athlete, performing intricate hand or shoulder surgery, or completing a joint replacement of a patient's hip,

To contact PPCP, please call 412.831.1522.

the surgeons at South Hills Orthopaedic Associates are committed to helping their patients regain motion and be more active without fear of pain or further injury.

To contact South Hills Orthopaedic Surgery Associates, please call 412.283.0260 or 888.817.2019.

(left to right) Damon B. Combs, D.P.M., Brett C. Perricelli, M.D., Eric D. Nabors, M.D., Derrick J. Fluhme, M.D., and Christopher M. Manning, M.D.

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Kevin G. Kotar, D.O., (l) and John L. Bobby, D.O.

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South hillS orthopaediC SurGery aSSoCiateS

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preferred primary Care phySiCianS, inC.

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oCCupational mediCine Center

diabeteS

D1 Center

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aSSoCiateS in endoCrinoloGy

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South hillS ent aSSoCiation

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oCCupational mediCine Center

D1

diabeteS Center

The Occupational Medicine Center is under the direction of an

The Diabetes Center provides comprehensive, personalized diabetes

experienced certified occupational medicine physician who promotes

care and management, with diabetes educators and registered dietitians

and maintains the health of workers and provides client companies

in one convenient location. The Center’s highly trained staff is very

with personalized, professional and cost-effective healthcare. The

experienced in diabetes care and management, and assists patients

Center also offers medical services for individuals traveling

in managing their condition and understanding how it impacts their lives.

overseas, including vaccinations and immunizations.

As part of its Empowerment Program, Center staff works with patients

To contact Occupational Medicine, please call 412.942.7115.

and their primary care physicians to provide the comprehensive education and support patients need to stay healthy and reduce the risk of complications. Patients receive a personalized plan on blood glucose monitoring, insulin administration, diabetes medications, exercise strategies, meal planning, sick-day management, and more.

To contact the Diabetes Center, please call 412.942.2151.

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aSSoCiateS in endoCrinoloGy

Associates in Endocrinology specializes in the care of diabetes, thyroid disease, osteoporosis, hormonal disorders and metabolism.

To contact Associates in Endocrinology, please call 412.942.2140.

Bridget Beier, D.O., (l) and Camille Buonocore, M.D.

Christopher G. Maropis, M.D. (r)

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South hillS ent aSSoCiation

The branch of medicine and surgery that specializes in the diagnosis

throat care. The physicians and audiologists at South Hills ENT

and treatment of disorders of the head and neck is called

Association combine compassion, expertise and integrity in the care

Otolaryngology, but most people refer to it simply as ear, nose and

of every patient. Services there include: • Head and neck surgical oncology and reconstructive surgery • Thyroid surgery • Facial plastics • Allergy • Sinus surgery

• Sleep apnea • Snoring • Otologic surgery • Vestibular disorders • Audiology • Hearing aid dispensing

To contact South Hills ENT Association, please call 412.831. 7570. (left to right) David P. DeMarino, M.D., Stephen F. Wawrose, M.D., Brian R. Elford, M.D., and Paul Scolieri, M.D.

Volume V Issue 2 I HouseCall I 7

Continued GroWth Continued from page 7

Third Floor A

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CardiaC diaGnoStiCS

evron endoCrinoloGy aSSoCiateS/ robert t. JohnSton, m.d.

The new Cardiac Diagnostics Center offers patients a full range of diagnostic testing, including EKG, holter monitoring, echocardiology, stress testing, and nuclear cardiology.

Endocrinologist Wayne A. Evron, M.D., and Internal Medicine Physician Robert T. Johnston, M.D., share this suite. Dr. Evron specializes in the care of diabetes, thyroid disease, hormonal disorders, hypertension

To contact Cardiac Diagnostics, please call 412.942.7900.

and osteoporosis. Dr. Johnston offers a full range of internal medicine and primary care services.

Dr. Evron

Dr. Johnston

To contact Dr. Evron, please call 412.942.7295.

To contact Dr. Johnston, please call 412.4 71.3061.

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evron endoCrinoloGy aSSoCiateS/robert t.

JohnSton, m.d.

8 I HouseCall I Volume V Issue 2

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KeyStone pain ConSultantS, ltd.

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South hillS CardioloGy aSSoCiateS

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breaSt Care Center

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ConferenCe room

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KeyStone pain ConSultantS, ltd.

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breaSt Care Center

Staffed by Jorge N. Rivero, M.D., who specializes

St. Clair Hospital launched a new era in women’s healthcare with the

in pharmacologic and interventional management

October 2012 opening of its new, state-of-the-art Breast Care Center at

of pain, Keystone offers a host of acute and chronic

Village Square. Designed with a spa-like ambience, the Center offers

pain services designed to support and speed

the most advanced diagnostic imaging technology in an environment

healing and relieve suffering. Chronic back pain

of comfort, convenience and beauty. The Center also features a new

sufferers, for example, may benefit from epidural

technology called 3D breast tomosynthesis, which has been credited

steroid injections, facet joint injections, neurolytic blocks, spinal cord stimulators and intrathecal

in a recent study with a significant increase in cancer detection rates, Dr. Rivero

particularly for invasive cancers, and a simultaneous decrease in false-

drug delivery system implants. All patients must be referred by their

positive rates, when used with traditional mammography. Patients also

primary care physician, oncologist, or another medical doctor.

have access to stereotactic biopsy, a procedure that uses a computer

To contact Keystone Pain Consultants, LTD., please call 412.942.5786.

and imaging to localize a tumor, or small calcifications, which can be an early sign of breast cancer, and guide the removal of tissue for examination by a pathologist.

D South hillS CardioloGy aSSoCiateS D This seven-physician practice offers a wealth of services that focus

To contact the Breast Care Center, please call 412.942.3177.

on the diagnosis and treatment of conditions and diseases involving the heart and vascular system at large. In addition to providing an array of diagnostic testing, the cardiologists are available 24 hours a day, seven days a week to provide scheduled and emergency cardiac care. The highly trained cardiologists also offer patients undergoing heart catheterizations the option of having a “cath” performed through the radial artery in the wrist instead of the traditional femoral artery in the groin, a procedure that offers several advantages, including less bleeding and faster recovery time.

Sherri H. Chafin, M.D., and Raye J. Budway, M.D.

To contact South Hills Cardiology Associates, please call 412.851.0279.

additional St. Clair hoSpital phySiCianS at villaGe Square are: Family Practice: John E. Popovich, M.D. To contact Dr. Popovich, please call 412.854.5491.

Hematology/Oncology: Louis Pietragallo, M.D.; Robert Volkin, M.D.; Ronald Fierro, M.D.; Vincent Reyes, M.D.; Robert Vanderweele, M.D. To contact any of the above physicians, please call 412.831.1320.

Internal Medicine: Joel D. Warshaw, M.D. To contact Dr. Warshaw, please call 412.833.2233. (left to right) Mark K. Greathouse, M.D., John P. Girod, D.O., Robert N. Shogry, M.D., James H. MacDougall, M.D., Harshad R. Mehta, M.D., and Jeffrey M. Friedel, M.D. Not pictured, Jeffrey C. Liu, M.D.

Rheumatology: David J. Helfrich, M.D. To contact Dr. Helfrich, please call 412.854.3491.

Volume V Issue 2 I HouseCall I 9

patient profile

FROM DEATH TO

life

Tami Mikush is given a second chance at life after a heart attack throws her heart out of normal rhythm.

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T

amara “Tami” Mikush

inTervenTional cardiologisT James w. marcucci, m.d., remembers Tami crying ouT, “please don’T leT me die,” JusT as she began To lapse in and ouT of consciousness.

(pronounced Mick-ish) remembers that fateful Friday night in late October 2012 like it was yesterday.

But only the first part of the night.

Because later that night … she was

clinically dead.

For 45 minutes.

“I was getting ready for bed around 11 p.m. As soon as I got into bed, I felt something was wrong; something wasn’t

As she was being transferred from the

shock to her heart did not restore it to its

right. It was almost like a panic attack. I felt

ambulance stretcher to a bed in the ER, Tami

natural rhythm.

sweaty and I could feel my heart beating.”

says, “My heart stopped.”

Tami, 53, says she got out of bed and

Her doctors told her later that her heart

Dr. Marcucci and Cath Lab staff declared a Code Blue and immediately began Cardio

sipped on a glass of water in an attempt to

had stopped its normal rhythm and instead

Pulmonary Resuscitation (CPR) to manually

calm herself down. When that failed, she

was in “ventricular fibrillation” (V-fib) in

provide oxygen to the heart, brain and other

woke her husband. “I think we need to call

which it was quivering and no longer sending

vital organs until normal heart and pulmonary

an ambulance,” she told him.

oxygen-rich blood to her heart, brain and

function could be restored.

Seconds later, she felt her left arm

other vital organs.

ER staff quickly used an electrical

go numb.

Paramedics arrived and told her she was having a heart attack.

The ambulance crew rushed her to the Emergency Room (ER) at St. Clair Hospital.

“

The docTors and The enTire sTaff aT The hospiTal were wonderful To me and my family. i feel blessed for everyThing each and every one of Them did in making sure i had a greaT recovery.

”

TAMI MIKUSH

device known as a defibrillator to restore her trembling heart to its normal rhythm.

They then transported Tami to the

Within seconds, some 10 to 12 people were in the room, all part of St. Clair Hospital’s CPR team. In between chest compressions, the team shocked Tami’s heart. Again and again.

adjoining Catheterization Lab where

They worked feverishly on Tami for

Interventional Cardiologist James W.

more than 20 minutes, alternating between

Marcucci, M.D., was preparing to insert

electrical shocks and CPR. Still, her heart

a thin wire through her femoral artery

would not return to a normal rhythm.

into her heart to clear the suspected blockage that caused the heart attack and the V-fib.

“When I got to the Cath Lab, apparently

Dr. Marcucci was bound and determined to not let Tami die, so he and the staff continued CPR and shocking her heart for another 25 minutes. They also administered

my heart stopped again,” Tami relates in a

intravenous amiodarone and lidocane, both

calm, strong voice while relaxing in the living

powerful anti-rhythm drugs, and vasopressin,

room of her South Park home.

Dr. Marcucci remembers Tami crying out, “Please don’t let me die,” just as she began to lose consciousness.

As in the ER, Tami’s heart had gone into V-fib. But unlike the first time, an electrical

which stimulates contraction of muscles of capillaries and arteries.

It was the 25th shock, and what was probably going to be the final shock that Tami would receive, that restarted her heart and returned it to a normal rhythm.

Continued on page 12

Volume V Issue 2 I HouseCall I 11

patient profile Continued from page 11

dr. marcucci acknowledges …

ThaT in 30 years of pracTicing cardiology, he has never seen a paTienT be clinically dead for 45 minuTes and noT suffer any ill effecTs.

James W. Marcucci, M.D.

In fact, Tami believes she remembers feeling

a temporary pacemaker and intra-aortic

the sensation of that last shock to her heart.

balloon pump inserted to support her blood

Dr. Marcucci then proceeded with the

pressure. She also was placed in a medically

emergency catheterization, which revealed

induced coma. CVSU doctors pumped

that Tami’s dominant right artery was 100

refrigerated intravenous fluids through her

percent blocked. Dr. Marcucci performed

veins and also placed cooling blankets

a balloon angioplasty to restore blood flow

underneath and on top of her to keep her body

through the artery.

temperature at approximately 92 degrees

Tami’s chest was black and blue and

iT was The 25Th shock, and whaT was probably going To be The final shock ThaT Tami would receive, ThaT resTarTed her hearT and reTurned iT To a normal rhyThm.

for 24 hours. (Normal body temperature is

what she would later describe as very sore,

98.6). The cooling blankets are body-sized

but, amazingly, she did not suffer any broken

plastic coverings filled with extremely cold

two adult daughters, gathered at Tami’s

ribs, despite 45 minutes of continuous

water that is supplied by a portable pump.

bedside, staff in the CVSU prepared them for

CPR, a nod to the skill and dexterity of the

The chilling effect of the cold fluids and the

the worst. Given her heart attack and the fact

As her husband and family, which includes

cooling blankets is designed to lower a

she was “clinically dead” for 45 minutes in

patient’s body temperature, reducing brain

the Cath Lab, it was possible Tami would die,

was taken to the Hospital’s Cardiovascular

swelling and the formation of dangerous

or, she would be severely impaired mentally

Surgical Unit (CVSU), where, still critically

chemicals that result from inflammation.

and physically because of the suspected lack

ill, she was placed on a ventilator and had

It also preserves other vital organs.

of oxygenated blood to her brain.

CPR team.

Following her catheterization, Tami

12 I HouseCall I Volume V Issue 2

But 12 days later, Tami was discharged from the Hospital with no neurological or other impairment. She recognized everyone and could talk, walk, and eat without assistance.

She believes it is a miracle that she survived and did so in full possession of all her faculties. “I’m still here because there is a purpose for me in this world,” Tami

Twelve days laTer, Tami was discharged from The hospiTal wiTh no neurological or oTher impairmenT. she recognized everyone and could walk, Talk, and eaT wiThouT assisTance.

says. “It wasn’t my time.” And, she adds, “I was lucky Dr. Marcucci shocked me one more time.”

Tami’s heart attack in October was

Tami says she is very grateful for the care

Dr. Marcucci largely credits Tami’s

actually her second. She suffered her first

she received at St. Clair Hospital. “The doctors

miraculous recovery to the efforts of the CPR

attack in 1990, an event that resulted in a

and the entire staff at the Hospital were

team, who kept precious blood coursing

14-day hospital stay.

wonderful to me and my family. I feel blessed

through her arteries, and the organpreserving cooling blanket.

He acknowledges, though, that in 30 years

She readily admits that years of smoking about a pack of cigarettes a day likely

for everything each and every one of them did in making sure I had a great recovery.”

contributed to both heart attacks. She had

Feeling better each day, Tami has

of practicing cardiology, he has never seen

smoked for about 10 years until her first

returned to work, part-time for now, in the

a patient be clinically dead for 45 minutes

heart attack in 1990. She then stopped

office of a South Hills podiatrist.

and not suffer any ill effects.

smoking for 11 years, before resuming the

Before she left the Hospital, Tami was

habit about 12 years ago, smoking right up

One of the requirements for her job as a medical receptionist there: being certified

fitted with a Zoll LifeVest, a wearable

until the night of the second attack. She had

in CPR. As she heads to the kitchen to

defibrillator that is designed to detect any

no serious health problems between the

prepare lunch for her husband and one of

abnormal heart rhythms and then deliver

two attacks. “I have not started to smoke

her daughters, Tami smiles when she offers,

a treatment shock if necessary. She had to

again,” says Tami, “and very desperately

“I definitely feel everyone should be trained

wear the LifeVest 24 hours a day. The only

am hoping that I never do again.”

in CPR.” n

time she could take it off was for showering or bathing, and then, she had to have a family member nearby in the event of another

JAMES W. MARCUCCI, M.D.

implantable cardioverter defibrillator by

Dr. Marcucci specializes in interventional cardiology at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh School of Medicine and completed an internship at Temple University Hospital, an internal medicine residency at UPMC Mercy Hospital of Pittsburgh, and a cardiology fellowship at George Washington University Hospital. Dr. Marcucci is board-certified in interventional cardiology and cardiovascular disease by the American Board of Internal Medicine. He practices with US Heart and Vascular, P.C.

an electrophysiologist.

To contact Dr. Marcucci, please call 412.429.8840.

heart-related emergency.

The LifeVest, which was featured in a previous issue of HouseCall, is often used by patients until they are fitted with an

(Editor’s note: Tami’s cardioverter defibrillator was implanted by St. Clair Hospital Electrophysiologist/Cardiologist

PUVALAI M. VIJAYKUMAR, M.D.

Puvalai M. Vijaykumar, M.D., in March.)

Dr. Vijaykumar specializes in electrophysiology and cardiology at St. Clair Hospital. He earned his medical degree at Stanley Medical College and completed his medical training at Madras Medical College, both in India.

He completed an internship at Cabrini Medical Center in Manhattan, and fellowships at Coney Island Hospital in Brooklyn and Deborah Heart and Lung Center in Browns Mills, New Jersey. Dr. Vijaykumar is board-certified in cardiology and electrophysiology. He practices with Pittsburgh Cardiac Electrophysiology Associates, P.C.

About four weeks following the October heart attack, Tami began to experience chest pains and returned to St. Clair’s Cath Lab, where Dr. Marcucci cleared two more blockages in her heart and placed stents in two arteries to prop them open and ensure good blood flow.

To contact Dr. Vijaykumar, please call 412.687.8838.

Volume V Issue 2 I HouseCall I 13

aSK the doCtor

Ask the Doctor ArnoLD­j.­SHoLDEr,­M.D.­ CAMiLLE­M.­BUonoCorE,­M.D.

Q A

i keep hearing the term “low T” being bandied about. what is it and should i be concerned?

The­phrase­“Low­T’­has­become­part­of­the­ American­lexicon,­thanks­to­a­wealth­of­TV­and­ print­advertisements­for­medications­to­treat­low testosterone­in­men.­Having­Low­T­is­something that­can­be­a­significant­problem­for­men.­Low testosterone­could­place­a­man­at­a­higher­risk­for developing­illnesses­such­as­diabetes,­osteoporosis and­heart disease,­as­well­as­causing­lack­of­energy and­low­libido.­ Testosterone­is­the­hormone­created by­men’s­testicles­that­give­them­male characteristics,­both­physical­and emotional.­At­the­low­end­of­normal, men’s­total­testosterone­count is­about­300,­while­the­high­end is­around­900.­ “Men­in­their­20s through­40s­may­have a­normal­range­of around­500,”

14 I HouseCall I Volume V Issue 2

notes­Arnold J. Sholder, M.D.,­a­urological­surgeon­at St.­Clair­Hospital­who­practices­with­Sholder­&­Bordeau Urologic­Associates.­“As­men­age,­there­is­a­gradual decline­in­testosterone,­so­many­men­in­their­70s and­80s­will­have­a­level­at­the­low­range­of­normal or­slightly­below.”

A­primary­reason­that­men’s­testosterone­levels decline­as­they­age­is­because­their­testicles­are­not as­active­in­producing­testosterone.­According­to Dr.­Sholder,­95­percent­of­the­testosterone­comes from­the­testicles­and­about­5­percent­comes­from the­adrenal­glands,­which­are­located­above­the kidneys.­Dr.­Sholder­stresses­that­it’s­normal­for men’s­testosterone­to­decline­as­they­get­older­and, for­the­most­part,­it­is­nothing­to­be­too concerned­about­—­as­long­as­a­man’s testosterone­level­remains­in­the­range for­his­age­group.­ Dr.­Sholder­and­St.­Clair­Hospital Endocrinologist­Camille M. Buonocore, M.D., say­they­are­seeing­a­growing number­of­patients­seeking­answers about­Low­T,­many­of­them­prompted to­call­after­seeing­the­ubiquitous advertisements.

The­doctors­say­a­simple­blood­test is­used to­determine­testosterone­levels.

Typically,­the­best­time­to­have­blood drawn­for­testosterone levels­is­early morning.­ The­most­common­symptoms of­low­testosterone­are­a­lack of­energy­and­a­lack­of­interest in­sex.­ When­a­younger­man­is displaying­these­symptoms, a­testosterone­level should­be­done,­says

Arnold J. Sholder, M.D., with Robin Pavlik, Medical Assistant

Dr.­Sholder,­since­this­could­be­a­sign­of­low­testosterone.

For­a­patient­in­his­80s,­it’s­just­a­normal­part­of­aging.­­ Sometimes,­the­symptoms­of­low­testosterone­can be confused­with­suffering­from­stress­at­work­or­home, being overworked,­or­just­not­getting­enough­rest.­ Dr.­Buonocore,­whose­Low­T­patients­range­in­age­from 30­to­70,­says­she­believes­testosterone­levels­are­declining earlier­in­men­due­to­the­rising­incidence­of­obesity.­She notes­that­testosterone­levels­in­obese­patients­often improve­with­weight­loss.­

TesTosTerone supplemenTaTion can be of greaT benefiT for men wiTh low T and significanT sympToms. reTurning The TesTosTerone level To The normal range can resulT in a noTiceable increase in energy and resToraTion of normal libido. iT can also pose hazards for older men wiTh low normal TesTosTerone levels who have minimal chance of benefiTing from a higher TesTosTerone level.

Drs.­Buonocore­and­Sholder­say­there­are­many­treatments available­for­men­suffering­from­Low­T.­Following­a­prostate exam­and­PSA­level­to­rule­out­any­other­problems,­some urologists­and­endocrinologists­will­recommend­an inter-muscular­shot­every­two­weeks.­There­is­also­a pellet­that­is­implanted­under­the­skin­and­slowly releases­testosterone.

Drs.­Sholder­and­Buonocore­often­opt­for­one­of­four topical­gels­that­are­applied­to­the­skin­on­a­daily­basis­and can­be­quite­effective.­ “The­gels­work­so­well­that­to­be­given­a­shot­or­an­injection really­doesn’t­make­a­lot­of­sense­when­you­can­just­apply­a gel­after­your­shower­every­morning,”­says­Dr.­Sholder.

“Men­who­truly­have­low­testosterone­levels­are­the­ones who­can­truly­benefit­from­testosterone­supplementation.”

Following­supplementation,­with­restoration­of­normal testosterone­levels,­men­usually­have­more­energy,­more interest­in­sex,­gain­more­muscle­mass,­and­even­lose­body fat,­according­to­research­by­the­American­Endocrine­Society.­ A­controversy­about­testosterone­supplementation occurs­in­men­with­borderline­low­levels­of­testosterone­and in­elderly­men­who­have­physiological­low­testosterone based­on­their­age.­ “Although­the­decline­in­testosterone­with­age­may­have several­adverse­consequences,­the­impact­of­testosterone

replacement­in­older­men­with­low­normal­serum­testosterone remains­unclear,”­says­Dr.­Sholder.­“The­Committee­of­the institute­of­Medicine­of­the­national­Academy­of­Sciences reviewed­available­studies­and­concluded­that­no­beneficial effects­of­administering­testosterone­have­been­well established­in­this­age­group.”

However,­men­who­have­significantly­low­levels­of testosterone­definitely­do­benefit­from­testosterone supplementation.­ “i­see­elderly­men­who­are­using­testosterone supplementation­who­have­borderline­low­levels,­which­is normal­for­their­age­group,”­says­Dr.­Sholder.­“The­problem with­supplementation­in­these­elderly­men­is­that­there­are­a host­of­other­problems­that­could­arise.­For­example,­if­you have­sleep­apnea,­it­can­make­it­worse.­Men­with­an­enlarged prostate­can­have­prostatic­growth­and­an­increase­in urinary­symptoms.­if­a­man­has­undiagnosed­prostate cancer,­there­is­a­risk­that­they­could­be­feeding­testosterone to­the­cancer,­which­makes­prostate­cancer­grow.”

For­patients­undergoing­testosterone­supplementation, Drs.­Sholder­and­Buonocore­say­they­test­their­patients’ testosterone­levels,­liver­function­and­blood­count,­and monitor­them­for­any­urinary­problems.­n

ARNOLD J. SHOLDER, M.D. Dr. Sholder specializes in urological surgery.

He earned his medical degree at the University of Illinois College of Medicine and completed his internship, residency and fellowship at Northwestern University-affiliated hospitals in Chicago.

Dr. Sholder is board-certified by the American Board of Urology. He practices with Sholder & Bordeau Urologic Associates.

To contact Dr. Sholder, please call 412.572.6194.

CAMILLE M. BUONOCORE, M.D. Dr. Buonocore specializes in endocrinology. She earned her medical degree at State University of New York College of Medicine and completed her internship, residency and a fellowship at the University of Pittsburgh. Dr. Buonocore is boardcertified in endocrinology, diabetes and metabolism by the American Board of Internal Medicine. She practices with Associates in Endocrinology, P.C. To contact Dr. Buonocore, please call 412.942.2140.

Volume V Issue 2 I HouseCall I 15

St.Clair Hospital 1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org

General & Patient Information 412.942.4000

HouseCall

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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.

Medical Imaging Scheduling 412.942.8150

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­Summer­Swing to benefit St. Clair hoSpital

Friday, July 19 – Benefit Dinner – St. Clair Country Club Food Station Dining l Cocktails l Silent Auction l Entertainment For more information regarding reservations, sponsorships, or underwriting opportunities, please contact St. Clair Hospital Foundation at 412.942.2465 or schfoundation@stclair.org, or visit us online at www.stclair.org/82/foundation. Thank you!

New Physician SPOTLIGHT ENDOCRINOLOGIST WAYNE A. EVRON, M.D. WAYNE A. EVRON, M.D., a 10-time Pittsburgh Magazine “Top Doctor” who has been elected by his peers for inclusion in “Best Doctors in America” for 14 years, specializes in the care of diabetes, thyroid disease, hormonal disorders, hypertension and osteoporosis. He earned his medical degree at the University of Pennsylvania School of Medicine, completed an internal medicine internship at the University of Florida-Shands Hospital, and an internal medicine residency, and endocrine and metabolism fellowship at UPMC-Presbyterian Hospital. Dr. Evron is board-certified in internal medicine and endocrinology by the American Board of Medicine.

Previously, he served as Medical Director of the Joslin Diabetes Center at The Western Pennsylvania Hospital, and as Clinical Assistant Professor for the Temple University School of Medicine.

To contact Dr. Evron, please call 412.942.7295.

In the Community s part of its commitment to the community, St. Clair Hospital is supporting area community organizations.

The Hospital highlights the good works of these non-profit partners in HouseCall. In this issue, we feature Pittsburgh Action Against Rape.

The Pittsburgh Action Against Rape (PAAR) mission is to respond, advocate and educate to end sexual violence through counseling victims and their families and supporting them through the medical and legal systems. PAAR is one of the oldest, and largest rape crisis centers in the country. Additionally, PAAR remains the only organization in Allegheny County dedicated exclusively to victims of sexual violence.

PAAR has a 24-hour free and confidential hotline for anyone who needs help: 1.866.END.RAPE. To learn more about PAAR, please visit http://paar.net.