St. Clair HouseCall Vol VIII Issue 1

VOLUME VIII ISSUE 1

HouseCall From diagnosis to emergency intervention, advanced treatment and techniques, to preventive care, St. Clair Hospital is a nationally recognized leader in cardiac care.

inside

Healthcare Costs Made Transparent I A Comprehensive Program For Preventing Patient Falls Community Outreach I Donor Spotlight I Ask The Doctor VII Issue 4 I HouseCall I 2 St. Clair Ranked #1 In Western Pennsylvania For OverallVolume Hospital Care

HEARTSTRONG

ST. CLAIR HOSPITAL IS

TAKING YOUR CARE

to heart ONE IN FOUR ADULTS HAS SOME DEGREE OF CORONARY ARTERY DISEASE

2 I HouseCall I Volume VIII Issue 1

610,000

735,000

PEOPLE DIE EACH YEAR FROM HEART DISEASE

ADULT AMERICANS WILL HAVE A HEART ATTACK ANNUALLY

F

OR DECADES, ST. CLAIR HOSPITAL HAS CARED FOR THE HEARTS OF PITTSBURGH RESIDENTS. EVERY DAY AT ST. CLAIR, HEART ATTACKS ARE HALTED, DAMAGED HEARTS ARE REPAIRED, ARTERIES ARE RE-OPENED, HEART RHYTHMS ARE STABILIZED — AND LIVES ARE SAVED AND RENEWED. THROUGH THE

YEARS, ST. CLAIR’S CARDIAC CARE SERVICES HAVE EXPANDED IN SIZE AND SCOPE AND CONTINUE TO EVOLVE, BRINGING EVERY AVAILABLE RESOURCE, HUMAN AND TECHNOLOGICAL, TO THE CARE OF PATIENTS.

IN THIS ISSUE OF HOUSECALL, readers will get a look at a sampling

Meantime, fellow St. Clair cardiologist Ryan W. Zuzek, M.D. is

of the many heart-related procedures offered at the Heart Center,

also using cardiac stents to treat patients with so-called left main

through the words of a few of the 2,000-plus heart-related patients

coronary artery disease, the most complex and challenging type and

who are treated each year by the Hospital’s outstanding cardiologists,

one that requires extensive planning, measurement and clinical

three of whom are featured in the following pages.

precision. Thanks to Dr. Zuzek and his expertise, patient Mark Bowman of Bethel Park is back to playing golf, doting on his first grandchild,

We begin with patient Zenon “Zen” Piotrowski, whose chest

and making plans to walk his youngest daughter down the aisle.

pain and shortness of breath on a recent business trip led him to the Cardiac Catheterization Lab of St. Clair cardiologist Jeffrey M.

And St. Clair cardiologist Jeffrey C. Liu, M.D., known for his

Friedel, M.D., who made the Upper St. Clair resident part of medical

masterful work in repairing problems with the heart’s electrical

history when he placed the region’s first Synergy cardiac stent in

conduction system, such as atrial fibrillation, is “fixing” AFib patients

Zen, preventing a near certain heart attack and restoring the business

like Brian McCay of Upper St. Clair and Kate Fagan, also of Upper

executive to good health.

St. Clair, in the Hospital’s sophisticated Cardiac Electrophysiology Lab. Continued on page 4

♥ ST. CLAIR HOSPITAL IS RANKED

#1 IN WESTERN PA FOR CORONARY BYPASS SURGERY

ST. CLAIR RANKS ST. CLAIR HOSPITAL WAS AWARDED THE REGION’S ONLY

‘A’ GRADE IN PATIENT SAFETY

1ST IN THE REGION IN DOOR-TO-BALLOON TIME ... AND IS AMONG THE BEST-PERFORMING HOSPITALS IN THE NATION

Volume VIII Issue 1 I HouseCall I 3

HEARTSTRONG Continued from page 3

Jeffrey M. Friedel, M.D.

ZEN, SYNERGY AND HEALING Zenon “Zen” Piotrowski made several trips to Las

I seemed okay. He referred me to cardiologist Jeffrey

Vegas in 2015, but two were especially significant. The

M. Friedel, M.D., who thought my history and diagnostic

first, late last year, was a business trip, one of many

tests suggested coronary artery disease. I had a stress

made by this busy sales executive for IBM Corporation.

test at the Heart Center at St. Clair Hospital. I failed it.

Zen was en route to a conference center, walking a fairly

Next, I had cardiac ultrasound and an EKG, and Dr. Friedel

hefty distance on a warm day, and arrived to find that

said I needed a cardiac catheterization and that he might

the long, long escalators he needed to take to his third

be able to take care of the problem then, with stents.

level destination were out of order. Disheartened but

The other possibility was that I might need coronary artery

determined, the 59-year-old Upper St. Clair resident

bypass surgery. I’m a non-smoker, I’m active and I love

and hiking enthusiast began the steep climb, and by the

the outdoors, but I have stress because I travel so

time he reached the top, he experienced some alarming

much and I’m overweight. Those things were probably

and unfamiliar sensations: a tightness in his chest,

contributing factors.”

accompanied by shortness of breath. It didn’t last long,

According to Dr. Friedel, a board-certified cardiologist

perhaps 90 seconds in all. But Zen was well aware of

with South Hills Cardiology Associates and the chief of

the implications of his symptoms.

the Division of Cardiology at St. Clair, Zen’s clinical

It happened a second time, in a similar manner, a few

presentation was classic. “It was very suspicious for

days later. “When I came home, I called my primary care

coronary artery disease at the outset. As soon as Zen

physician, internist Richard Gobao, M.D., in Scott Township,

exercised, he had chest pain and EKG changes — findings

and asked to see him right away. He examined me and

that are very concerning for a heart blockage. The symptoms

said that my blood pressure was a bit high, but otherwise

went away when he rested. I set things in motion for him to have a cardiac catheterization and instructed him to take it easy. I put him on aspirin, nitroglycerine and metoprolol, a beta blocker.”

Coronary artery disease refers to the narrowing of the blood vessels that supply the heart muscle with blood and oxygen. The condition can be treated with an open-chest surgical procedure known as a coronary artery bypass graft, or CABG, commonly referred to as a bypass, in which blood vessels from other parts of the body are grafted onto the heart to replace the blocked arteries. Since the early ‘90s, cardiologists have also been performing a minimally invasive procedure, percutaneous coronary intervention,

Jeffrey M. Friedel, M.D., Chief of Cardiology, says St. Clair was the first hospital in the region to make the new Synergy stent available to patients.

4 I HouseCall I Volume VIII Issue 1

or PCI, to treat coronary artery disease in selected patients, and placing stents in the diseased arteries.

Not just any stent Zen became the first person in western

Stents are tiny, hollow, flexible mesh devices that are

Pennsylvania to receive a new kind of stent that had

placed within the narrowed coronary arteries. Simply

recently been approved for use by the FDA. Known as

stated, a stent holds the artery open and allows blood

the Synergy stent and developed by Boston Scientific,

to flow more freely.

it is a bio-absorbable polymer drug-eluting stent

Zen’s cardiac catheterization took place in St. Clair’s

(BP-DES) and is the only such stent in use in the

state-of-the-art Cardiac Catheterization Lab. “Patients

nation. Groundbreaking in its design and utility, it

are usually sedated but awake for the procedure,

is a paradigm changer that promises faster healing,

which is typically painless,” says Dr. Friedel. “I give

fewer complications and better outcomes.

my patients medication to take the edge off and help

Dr. Friedel says that St. Clair was the first

them relax. I used the right radial artery, near the

hospital in the region to make the new stent

wrist, as the insertion site for the catheter, instead

available to patients. “The BP-DES is the third

of the femoral site. It’s my preference: it’s a smaller

generation of coronary artery stents. The first

artery and there is a lower risk of bleeding. It’s a

generation was the bare metal stent,

better choice for the patient’s comfort, plus they

followed by the drug-eluting stent,

can walk immediately afterwards.”

which delivered a time-release

The cardiac cath revealed that Zen had three

Zenon “Zen” Piotrowski

medication. There were problems

critical blockages; the third vessel had a collateral

with both of those stents, which

vessel, which Dr. Friedel explains is the heart’s own

led to the engineering of the

natural bypass. “With multiple blockages, you

Synergy stent. It’s a major

consider bypass surgery, depending on the nature of

improvement.”

the blockages and their location within the coronary arteries. Zen’s blockages were very localized, making him a good candidate for placement of the stent.”

Continued on page 6

“

I was talking with Dr. Friedel during the procedure … right after, I felt good enough that I wanted to go right home.

”

ZENON “ZEN” PIOTROWSKI, PATIENT

Volume VIII Issue 1 I HouseCall I 5

HEARTSTRONG Continued from page 5

The original bare metal stents provided healing, but the resultant

reliably. These stents reduce the amount of time the patient has

scar tissue led too often to re-stenosis (re-narrowing) of the coronary

to stay on medications; with the faster healing, you don’t always need

artery. According to Dr. Friedel, who has worked with both previous

long-term blood thinners.”

models of stents, the healing that took place was too much of a good

The Synergy stent is a significant technological advance for

thing: “It was a hyperactive kind of healing, similar to a keloid.”

cardiology. Composed of platinum chromium, it is a miniscule device,

As many as one-third of patients developed re-stenosis from the scar

but its architecture provides great strength and capability. Intricately

tissue. That problem seemed to be solved by the development of the

carved by ultra-precise laser-cutting technology, its mesh is very thin

second generation stent, the drug-eluting stent, which included a

and finely detailed in a scaffold pattern, composed of bridges and

scar-preventing medication imbedded within a polymer coating.

struts that render it flexible, expandable and very strong. The BP-DES

The drug, everolimus, is delivered gradually and prevents re-stenosis,

model is coated on one side only with the absorbable polymer —

while the polymer coating remains on the stent. But in some patients,

a significant difference from the drug-eluting stent, which was entirely

the polymer acted as an irritant, and long-term exposure to the polymer

coated. The coating is a mere four microns thick — by comparison,

produced inflammation, which delayed healing and sometimes led

a human hair is 70 microns. The polymer breaks down after the drug

to serious complications, including blood clots.

has been delivered and is fully absorbed in three months.

“This latest stent provides the best of both worlds — it includes a

For Zen, who had two stents placed by Dr. Friedel, the beauty of

medication which prevents scarring and a polymer that is gradually

the Synergy stent is in the renewed health and vitality it has given him:

absorbed by the body and eventually disappears, so the risk of inflam-

“I’m amazed by this entire experience. I was nervous about having the

mation from long-term polymer exposure is eliminated,” Dr. Friedel

cardiac catheterization and stent placement, especially when I learned

says. “It allows the coronary artery to heal more quickly and more

that I would be awake for it. Dr. Friedel gives great explanations and

THE NEW SYNERGY STENT The Synergy stent is a significant technological advance for cardiology. Composed of platinum chromium, it is a miniscule device, but its architecture provides great strength and capability. Intricately carved by ultra-precise, laser-cutting technology, its mesh is very thin and finely detailed in a scaffold pattern, composed of bridges and struts that render it flexible, expandable and very strong.

Dr. Friedel explains the intricacies of the new Synergy stent.

THIN, INTRICATELY CARVED MESH

STRONG AND FLEXIBLE

PLATINUM CHROMIUM COMPOSITION

6 I HouseCall I Volume VIII Issue 1

BIO-ABSORBABLE POLYMER DRUG-ELUTING COATING

tells you what to expect, and that lessened the

“

anxiety a lot. I was talking with Dr. Friedel during the procedure, and I’m still surprised by how comfortable I felt throughout it. The

Dr. Friedel has been

care was excellent, and felt very personal.

awesome and

Right after, I felt good enough that I wanted to go right home.”

St. Clair Hospital

Zen felt well enough to make another

gave me an excellent

trip to Las Vegas at Thanksgiving to visit his mother, who had been ill. “Without these

experience ...

stents, I would have had to go through the

I am very grateful.

entire bypass ordeal, and I would not have been well enough to travel, to see my

”

mother,” he says. “Dr. Friedel cleared me to make the trip. I feel very good now; I’m on aspirin, a beta blocker and a blood thinner, and I might be able to get off the blood thinner

ZENON “ZEN” PIOTROWSKI, PATIENT

soon. At my follow-up appointment with Dr. Friedel, my blood pressure was 117/78.

I love spending time with my family: my wife, Donna, and our two sons, Stefan, 30, and John, 27. I know I’m fortunate; my own father died at age 49 of a heart attack. Dr. Friedel has been awesome and St. Clair Hospital gave me an excellent experience. I’m again enjoying the outdoors; I love sports, especially University of Michigan sports, and I love walking my German shepherd. I am very grateful.”

Dr. Friedel is equally pleased with Zen’s progress. “Zen was an ideal candidate for the Synergy stent, and the stent conformed nicely to the bends in his coronary arteries. It went

Heart patient Zenon ”Zen” Piotrowski is back to playing fetch with his full-bred German Shepherd, Onya, 8.

very well. He was wise to see his primary care doctor quickly when he had symptoms, and to get a referral to our cardiology practice.

JEFFREY FRIEDEL, M.D.

At St. Clair, we have the most advanced tools

Dr. Friedel earned his medical degree at the Pennsylvania State University College of Medicine and completed his internal medicine residency at Allegheny General Hospital. He also completed fellowships in cardiology and interventional cardiology at Allegheny General Hospital. He is board-certified by the American Board of Internal Medicine in cardiovascular diseases and interventional cardiology and board-certified by the American Board of Nuclear Cardiology. Dr. Friedel practices with South Hills Cardiology Associates, a division of St. Clair Medical Services.

to diagnose and treat heart disease, including the most cutting-edge coronary artery stent.

If you have symptoms, as Zen did, don’t hesitate to come to the Emergency Room at St. Clair, so we can make a diagnosis and begin treatment.”

To contact Dr. Friedel, please call 412.942.7900.

Continued on page 8

Volume VIII Issue 1 I HouseCall I 7

HEARTSTRONG Continued from page 7

Ryan W. Zuzek, M.D.

A CHALLENGING CONDITION

“

In its infinite wisdom, the human body vigilantly

St. Clair Hospital. According to Dr. Zuzek, treatment for

protects its most vital organ, the heart. Shielded by the

coronary artery disease keeps improving, and St. Clair

armor of the sternum and rib cage, the heart carries out

Hospital is on the cutting edge of the latest breakthroughs

its ceaseless work, nurturing every tissue in every organ

in technologies and approaches to treatment. This

system. It’s the toughest and hardest working muscle

includes the treatment of left main coronary artery

in the body, and it requires some special sustenance of

disease, the most complex and challenging type. Left

its own. That is provided by the coronary arteries, the

main coronary artery disease is treated at St. Clair by

network of blood vessels that supply the heart muscle with

Dr. Zuzek and other interventional cardiologists with

The coronary arteries are

percutaneous coronary intervention, or PCI ― the

delicate-looking vessels

arteries through small incisions in the groin or the wrist.

ARTERY DISEASE KEEPS

that snake across the

This includes balloon angioplasty and the placement of

IMPROVING, AND ST. CLAIR IS

outer surface of the

stents, all of which take place in St. Clair’s Cardiac

heart. Like long, thin

Catheterization Lab.

richly oxygenated blood.

TREATMENT FOR CORONARY

ON THE CUTTING EDGE OF

fingers, they appear to

THE LATEST BREAKTHROUGHS

cup the heart and gently

IN TECHNOLOGIES AND

hold it. Their fragile

APPROACHES TO TREATMENT.

”

RYAN W. ZUZEK, M.D., INTERVENTIONAL CARDIOLOGIST, ST. CLAIR HOSPITAL

non-surgical, minimally invasive treatment of coronary

A patient in dire need It was about one year ago, on a Sunday night, when

appearance belies their

Mark Bowman, 56, sat down after dinner to watch a

significance: they are

Steelers game at his home in Bethel Park, and suffered

the heart’s own personal

a massive heart attack. As a pharmaceutical sales

circulatory system, as

representative who specializes in cholesterol-lowering

vital to the heart as the

drugs, Mark knew enough about heart disease to

heart is to the body.

immediately recognize that the “incredible pain” in

Taken together, the

his chest and upper arms was a heart attack. He took

three coronary arteries are merely inches in length — but

some aspirin, laid down on the floor and instructed

they are some of the most critically important inches in

his wife to call 911. Then he waited. And prayed.

the entire body. If there are deposits of plaque within a

When the paramedics arrived, Mark was unconscious

coronary artery or one of its branches,it may become

and going in and out of ventricular tachycardia, an

stenotic (narrow) or even occluded (closed), reducing the

abnormal heart rhythm that can be fatal. He was taken

flow of blood to the heart, a condition called ischemia.

the short distance to St. Clair Hospital’s Emergency

Ischemia causes the chest pain known as angina and can

Department, where clinicians awaited his arrival. In the

be clinically catastrophic; if the ischemia is not reversed,

Cardiac Catheterization Lab, in cardiogenic shock with

the affected tissue is starved of oxygen and dies. That is

his heart failing, he was placed in the care of Dr. Zuzek,

essentially what happens in a myocardial infarction,

who diagnosed a 100 percent occlusion of the left main

more commonly known as a heart attack.

coronary artery, leaving the two major arteries on

Treating coronary artery disease by maintaining or

the left side of his heart without any blood flow. The

restoring the flow of blood through the coronary arteries

blockage was initially treated with balloon angioplasty

to the heart muscle is the clinical focus of Ryan W. Zuzek,

to resume some blood flow and help stabilize him.

M.D., a highly credentialed interventional cardiologist at

Because of the high risk of operative mortality Continued on page 10

8 I HouseCall I Volume VIII Issue 1

Erin Maclay, an exercise specialist in St. Clair Hospital’s Cardiac/Pulmonary Rehabilitation Department, checks the blood pressure of heart patient Mark Bowman before he begins exercising.

Volume VIII Issue 1 I HouseCall I 9

HEARTSTRONG Continued from page 8

Dr. Zuzek, left, in St. Clair’s state-of-the-art Cardiac Catheterization Lab.

associated with his condition, Mark was not

Mark is looking forward to playing golf this

I heard tremendous things about it, and it

a candidate for cardiac surgery. So, Dr. Zuzek

spring. To build his strength and tolerance for

was exactly the place I needed to go.”

placed a stent (a small mesh tube designed to

activity, Mark attends the Cardiac/Pulmonary

hold open a blocked coronary artery) in Mark’s

Rehabilitation program at St. Clair three

and he is looking forward to next fall, when

left main coronary artery, extending into the

times a week. He says it has been a godsend.

he will walk his youngest daughter down

left anterior descending, and positioned an

“Cardiac rehab has benefitted me greatly.

the aisle at her wedding.

intra-aortic balloon pump to help keep his

I chose St. Clair’s rehab program because

He is excited to be a first-time grandfather,

blood pressure stabilized. The stent propped open the vessel, allowing blood to flow again to Mark’s severely injured heart muscle.

Dr. Zuzek knew that, given the extent of the

RYAN W. ZUZEK, M.D.

damage, the situation was grave. “Mark had

Dr. Zuzek earned his medical degree at the National University of Ireland in Galway. His postgraduate training includes an internal medicine residency at the Cleveland Clinic, where he was later an attending physician. He completed cardiology and interventional cardiology fellowships at Brown University hospitals in Providence, R.I. Dr. Zuzek is board certified in internal medicine, general cardiology, interventional, and nuclear cardiology. He practices with US Heart and Vascular, P.C.

an acute left main occlusion and a massive myocardial infarction,” Dr. Zuzek says. “I have only seen this a few times, and he is the only patient I have seen who survived that kind of severe event. He was in critical condition.”

Today, thanks to Dr. Zuzek’s skills and Mark’s dogged determination to recover,

10 I HouseCall I Volume VIII Issue 1

To contact Dr. Zuzek, please call 412.429.8840.

CORONARY ARTERY DISEASE:

The Evolution of Treatment Dr. Zuzek’s treatment of Mark’s heart disease

national standards. In fact, St. Clair ranks first

Re-stenosis is a complex physiologic process,

is a prime example of how treatment of coronary

in the Pittsburgh region in its door-to-balloon

involving many elements, and it was found that

artery disease has evolved substantially in the

time rate and is among the best-performing

the obstructive tissue in the bare metal stents

last half-century, and it continues to progress.

hospitals in the nation in this metric. This proce-

was fibrous; it was not composed of plaque.

The 1970s were a time of game-changing

dure, and the CABG procedure, saved thousands

It was the result of the body’s inflammatory

progress, when cardiac surgeons began restoring

of lives and prevented countless first and second

response to the presence of a foreign body.

blood flow to ischemic heart muscle by replacing

heart attacks.

But, blockage is blockage, no matter what the

diseased coronary arteries with blood vessels

The next breakthrough came with the

grafted from other parts of the body. This proce-

development of stents, the tiny hollow tubes

composition.”

In 2003, a third generation of stents was

dure, called coronary artery bypass graft or

that are placed in coronary arteries to hold them

introduced, with dramatic results. Drug-eluting

CABG, is an open-chest surgical procedure and

open. This alternative procedure, however, was

stents are made of metal and are coated with a

was the standard of care until the ‘90s, when

problematic, as re-stenosis (renarrowing) of the

polymer that contains and elutes (delivers)

balloon angioplasty was developed. Balloon

artery was common within just six to nine

timed-release drugs to the walls of the

angioplasty, the insertion and inflation of a

months. In the late ‘90s a significant advance-

coronary artery, which tricks the body into

balloon-like device, enabled cardiologists to

ment was achieved with the advent of bare

thinking that the stent is not a foreign presence.

re-establish blood flow to the heart muscle

metal stents made of chromium, titanium or

“The effect is cytosuppressive, meaning that

without surgery. St. Clair’s door-to-balloon time

cobalt. “Bare metal stents inhibited re-stenosis,”

the cells don’t proliferate,” Dr. Zuzek says.

— the period of time from arrival in the Emer-

Dr. Zuzek explains. “They were better than

“Just as chemotherapy drugs inhibit the

gency Room (ER) to completion of artery-opening

balloons but still 35 percent of patients would

growth of cancer cells, drug-eluting stents

balloon angioplasty — is consistently above

return with another narrowing within that stent.

inhibit the development of fibrous tissue in the Continued on page 12

BALLOON ANGIOPLASTY WITH STENT

THE HUMAN HEART

PULMONARY ARTERY

LEFT MAIN CORONARY ARTERY

2

1

Build-up of cholesterol, partially blocking blood flow through the artery.

Stent with balloon inserted into the partially blocked artery.

LEFT MARGINAL ARTERY RIGHT CORONARY ARTERY DIAGONAL ARTERIES

RIGHT MARGINAL ARTERY

3

4

Balloon inflated to expand the stent.

Balloon removed, leaving the expanded stent.

Volume VIII Issue 1 I HouseCall I 11

HEARTSTRONG Continued from page 11

CORONARY ARTERY DISEASE:

The Evolution of Treatment (continued) stent. These are much better stents, far less

new drug-eluting stents, the left main is now

ment, as it demands absolute clinical

likely to develop stenosis. They represent

an acceptable site for stenting in select

precision. Patients are admitted to the

the most important development since the

patients. Drug-eluting stents are producing

Cardiac Care Unit after the procedure and

advent of balloon angioplasty. Drug-eluting

excellent outcomes that are similar to out-

may remain hospitalized for several days.

stents have greatly reduced the incidence of

comes achieved with open-heart surgery.

Patients who have stents in their coronary

re-narrowing, from 35 percent to just 5-8

They’ve become more popular as a viable

arteries have an increased risk of developing

percent, and have saved many lives.”

option as the technology and equipment have

blood clots and are consequently placed on

improved.”

anti-clotting therapy for a year or more.

The left main coronary artery is unique and presents special challenges for cardi-

Drug-eluting stents are not for everyone,

“Dual anti-platelet therapy means a combi-

ologists. “The left main is like the trunk of a

however, and are not a replacement for CABG

nation of aspirin plus another anti-clotting

tree,” explains Dr. Zuzek; “It’s wider and

for those who truly need it. For patients who

medication, such as Plavix, to prevent stent

shorter than the other coronary arteries

are relatively healthy, CABG is still recom-

thrombosis,” Dr. Zuzek says. In addition,

and branches off into two tributaries. These

mended and remains the gold standard. Drug-

patients must make lifestyle choices to

arteries supply 80 percent of the blood to

eluting stents represent a major advancement

prevent coronary artery disease. “That means

the heart. Fortunately a blockage at this site

for patients who have unprotected left main

no smoking; taking your medicine exactly

has not been treated ― and are unable to

as prescribed; exercising four times per week and following a heart-healthy diet.”

have the CABG surgery because they have

Coronary artery disease is the most

is not a common event, as the left main is the largest of the coronary arteries, but it is associated with high mortality.”

disease ― advanced left main stenosis that

Traditionally, the treatment of left main

existing co-morbid conditions, such as

common form of heart disease in the U.S.,

disease has been CABG surgery. “A blockage

chronic obstructive pulmonary disease or

according to the Centers for Disease

of 50 to 60 percent in the left main coronary

COPD, that make them poor candidates for

Control and Prevention, claiming 610,000

artery always resulted in a recommendation

such an extensive surgical procedure. Others

lives annually. One in four adult Americans

for CABG,” says Dr. Zuzek. “It has been the

may simply prefer not to undergo the bypass

have some degree of coronary artery

preferred approach, really the only approach,

surgery. For these patients, drug-eluting

disease, and 735,000 of them will have

to revascularize the left main coronary

stents are an option.

a heart attack. For most, it will be their

artery and restore perfusion to the heart.

The placement of a drug-eluting stent in

The left main was considered a ‘no-fly zone’

the left main is a complex procedure that

first ― and the heart attack itself may be

for stenting. But with the availability of the

requires extensive planning and measure-

happened with Dr. Zuzek’s patient, Mark.

ACCORDING TO THE NATIONAL HEART, BLOOD AND LUNG INSTITUTE

An 82% reduction in heart risk is possible

12 I HouseCall I Volume VIII Issue 1

their first symptom of heart disease, as

When you do these four simple things:

AVOID SMOKING

STAY PHYSICALLY ACTIVE

EAT A BALANCED DIET

MAINTAIN A HEALTHY WEIGHT

Jeffrey C. Liu, M.D.

RESTORING RHYTHM Shortly after joining St. Clair Hospital’s highly regarded cardiology program, board-certified cardiac electrophysiologist Jeffrey C. Liu, M.D. helped to expand the Hospital’s Cardiac Electrophysiology program and to develop a fully equipped, state-of-the-art, comprehensive Cardiac Electrophysiology Lab for the treatment of cardiac rhythm disorders, or arrhythmias — abnormal patterns in the heartbeat that are the result of problems in the heart’s electrical conduction system.

Cardiac electrophysiology is a subspecialty within cardiology, and Dr. Liu is one of relatively few cardiac electrophysiologists in the region. Dr. Liu specializes in complex cardiac ablation; at St. Clair, he performs one of the most advanced forms of ablation, cardiac cryoballoon ablation, which was developed specifically to treat atrial fibrillation, a common arrhythmia.

Cryoballoon ablation is a truly cutting-edge medical technology, Dr. Liu says, and the Cardiac Electrophysiology Lab at St. Clair is generating excellent outcomes with this and other procedures.

Most importantly, cryoballoon ablation is changing the lives of patients, restoring not only their normal heart rhythms, but also their quality of life.

Continued on page 14

NORMAL

Jeffrey C. Liu, M.D.

ATRIAL FIBRILLATION

This medical illustration of a patient’s EKG shows a normal heart rhythm and one in atrial fibrillation.

Volume VIII Issue 1 I HouseCall I 13

HEARTSTRONG Continued from page 13

Relieving the burden of AFib Upper St. Clair resident Brian McCay recently dug an

Dr. Robert Shogry of South Hills Cardiology Associates,

eight-foot by five-foot ditch, and the 51-year-old contractor

(a division of St. Clair Medical Services). I spent two days

could not have been happier. Earlier this year, that kind of

on a Holter monitor; I had a stress test; and I had a cardiac

strenuous work would have been impossible for him. Atrial

catheterization, which showed that my heart was basically

fibrillation had made his life miserable, rendering him

healthy. Dr. Shogry recommended that I see an electro-

breathless and exhausted.

physiologist. Dr. Liu tried several medications, but they

“My heart was beating so fast, as high as 170, and it kept

didn’t help. I had to either live with atrial fibrillation or get

getting progressively worse,” Brian recalls. “In the beginning,

the cryoballoon procedure done. I knew I couldn’t continue

I had episodes about once a month; soon though, they were

to live the way I was.” Dr. Liu says that atrial fibrillation is

happening once a week, and then it became daily. I couldn’t

different for everyone, and for some people, it can be disabling.

breathe or climb stairs; I was exhausted. All I could manage

Brian had a rapid progression of disease, and his episodes

to do was work and sleep.“ Unfortunately, Brian experienced a phenomenon that is

all too common for people with atrial fibrillation ― difficulty

in getting the condition diagnosed. Due to its usually

were severe enough that he felt like he might die. “Some people with atrial fibrillation can’t feel it, while others are very symptomatic, as Brian was. He had a lot of palpitations and he felt so poorly,” Dr. Liu says. “He had no energy. When people

paroxysmal or spasmodic nature, episodes may not coincide

are very symptomatic, we try medication first. Sometimes

with visits to the doctor or the emergency room. Often,

they are very effective, but they had the opposite effect on

patients are told that they are having panic attacks and may

Brian and actually made him worse. This is not unheard of,

go for years without an accurate diagnosis ― and treatment.

“I never had an episode when I was in my PCP’s office.

He told me to go right to the ER when it happened the next

as these medications are designed to alter electrical activity in the heart. We can’t always predict what they will do.”

Dr. Liu talked with Brian about the cryoballoon ablation

time,” Brian says. “I did that several times, and finally the

procedure, explaining the procedure in detail. “I offered Brian

diagnosis was confirmed by an EKG and I was referred to

the ablation procedure in order to decrease the burden of

WHAT IS CRYOBALLOON ATRIAL ABLATION? In many patients atrial fibrillation is triggered

DISORGANIZED ELECTRICAL SIGNALS

by abnormal electrical impulses firing from the pulmonary vein. Cryoballoon ablation is a procedure in which a balloon within the catheter is inflated and filled with an extremely cold gas that slightly “wounds” a specific, targeted area of tissue in the heart. The wound creates a scar that acts as a barrier, blocking the abnormal electrical signals that trigger atrial fibrillation.

14 I HouseCall I Volume VIII Issue 1

CATHETER

ABLATES AT THE POINT OF BALLOON CONTACT

Dr. Liu uses a sophisticated, high-tech mapping system to perform cryoballoon ablation at St. Clair.

atrial fibrillation for him. That’s what it is intended to do.

For those patients who experience paroxysmal

He is young to have the condition. I never twist any arms;

atrial fibrillation, Dr. Liu says, cryoballoon ablation has

I explain the options to the patient. Atrial fibrillation or

a success rate of approximately 80 percent; for those

“

Afib is not life threatening, but many people find the

who are in atrial fibrillation all the time, the rate is

VILLAGE TO DO

symptoms unbearable and they want to have this done.

about 60 percent.

A CRYOBALLOON

This is a safe procedure; people do well with it.”

Cardiac cryoballoon ablation utilizes intense cold to

IT TAKES A

Brian had the procedure at St. Clair and spent two

ABLATION. LOTS

days in the Hospital. Although the cryoballoon ablation

target and destroy a precisely pinpointed area of tissue

itself only takes a few hours, extensive and meticulous

OF VERY SKILLED

in the heart muscle to create a controlled scar to block

advance preparation is required because of the need for

PEOPLE AND

aberrant electrical signals that trigger episodes of atrial

absolute precision. “It takes a village to do a cryoballoon

fibrillation, thus restoring a normal heart rhythm. Regular

ablation,” Dr. Liu says. “Lots of very skilled people and

A LOT OF VERY

cardiac ablation burns or cauterizes the tissue to create

a lot of very special tools play a part. A special cardiac

SPECIAL TOOLS

a scar, while cryoballoon ablation uses freezing technology.

CT scan is done first in Medical Imaging. It gives

PLAY A PART.

During the procedure, a thin pliable catheter is threaded

awesome, high quality pictures — a 3D reconstruction

through the large femoral vein in the leg and up into the

of the veins and what we’re working on. This is

”

heart through a trans-septal puncture. A balloon within

meticulously made and very helpful. We take the

the catheter is inflated and filled with a cold gas that

raw data, process it and incorporate it into a mapping

slightly “wounds” the tissue in order to create a scar.

system. It literally gives me a road map of the patient’s

The tissue is targeted so specifically that the surrounding,

heart ahead of the procedure. As a result, I know exactly

healthy tissue is unaffected.

where I’m going. In addition, we use intracardiac

“Cryoballoon ablation is safer and faster than the old

JEFFREY C. LIU, M.D., ELECTROPHYSIOLOGIST, ST. CLAIR HOSPITAL

echocardiography, which provides high quality pictures

targeted burn technique; it’s easier on the patient,” says

of cardiac structures in real time. We create a scar

Dr. Liu. “It all adds up to a better experience for properly

to isolate the four blood vessels, the pulmonary veins

selected patients.”

that feed blood into the left atrium.”

Continued on page 16 Volume VIII Issue 1 I HouseCall I 15

HEART STRONG Continued from page 15

“

This was life-changing for me. My quality of life is vastly improved.

My experience with Dr. Liu and his whole practice was excellent; his skill is matched by his compassion.

”

KATE FAGAN, PATIENT

Special technology freezes out AFib “It feels like a crazy bird is loose inside your chest, wildly flapping around. It’s not painful but

wasn’t disabling for me; I kept working, although

it feels awful. You can’t relax or sleep and you

it wasn’t easy to be in court with my heart racing.

can’t get anything done because it’s so distracting.

Finally, I was put on a different monitor that

You can’t think; you can hear it and feel it. It’s

I wore for two weeks. On the basis of the data

very disruptive.”

from that monitor, I was referred to Jeffrey

That is attorney Kate Fagan’s vivid description

Friedel, M.D. of South Hills Cardiology Associates.

of how atrial fibrillation can feel. For Kate,

Dr. Friedel explained to me that I was in atrial

the condition began with occasional episodes

fibrillation.”

of rapid and irregular heartbeats. Her journey

Kate, 64, is a civil trial attorney with Wayman,

to diagnosis mirrors that of Dr. Liu’s patient,

Irvin & McAuley, LLC in Three Gateway Center.

Brian McCay. “I went to my primary care physician,

She is also an eight-year survivor of breast

who ordered a Holter monitor for me to wear,”

cancer, with a lot of first-hand experience in

Kate says. “It showed nothing, but the episodes

the healthcare system. Initially, her atrial

continued and increased in both frequency and

fibrillation was treated with medication. It worked

duration. They were becoming more and more

for a while, but then her episodes returned and

Kate Fagan, patient

16 I HouseCall I Volume VIII Issue 1

unpleasant, although I never passed out. It

worsened. She was referred to Dr. Liu. “Dr. Liu spent a lot of time with me and gave me the opportunity to ask a lot of questions. He was

Cardiovascular screening saves lives

never pushy about having this done. He explained

Cardiovascular disease remains the number one killer of adults

to me what he could do, and told me to think it

in this country. But more important than treating someone with

over. I did a lot of reading and learned as much

a heart attack, is to prevent it from ever happening in the first

as I could about it. I felt that I understood it very well. When my episodes worsened, I knew it was what I wanted to do. I had great confidence in

place. Fortunately, today, medicine has advanced capabilities to identify those who are at greatest risk of dying from a heart attack. Many people have no cardiovascular symptoms, but carry with them an increased risk of heart disease. These include patients with no medical problems, but a strong family history of cardiovascular

Dr. Liu and his team, and I knew I could count

disease. Other patients at risk include diabetics, smokers, those with high blood pressure

on St. Clair Hospital.”

or high cholesterol, sedentary individuals, and people who are overweight.

Kate had cryoballoon ablation done in early November. “The procedure took four hours, and when I woke up, Dr. Liu was right there,” she says.

“He told me it had gone perfectly. I had no need for pain medication afterwards. At first, I did have a few episodes of atrial fibrillation, but I was prepared that this might happen so I didn’t panic.

Those episodes were far shorter and less intense — and they’re completely gone now.

“This was life-changing for me. My quality of life is vastly improved. My experience with Dr. Liu and his whole practice was excellent; his skill is

FOR THOSE WHO MIGHT BE AT RISK FOR HEART DISEASE ST. CLAIR HOSPITAL OFFERS THE FOLLOWING PREVENTIVE SERVICES: ♥ A comprehensive exam by a cardiologist to assess overall cardiovascular risk.

♥ Cardiac CAT scans.

♥ Analysis of cholesterol and abnormalities of the blood known to be markers of heart disease.

♥ Echocardiograms.

♥ A Calcium Score — a noninvasive way to measure plaque in the arteries of the heart. This has been shown to be a powerful predictor of cardiovascular events including heart attack and stroke.

♥ Stress testing. ♥ Cardiac catheterization. ♥ Fitness evaluations — including a comprehensive cardiac rehabilitation program. ♥ Nutritional counseling with an emphasis on heart healthy diets.

matched by his compassion.”

“Cryoballoon ablation is cutting edge, and it distinguishes St. Clair Hospital,” says Dr. Liu. “These procedures have a firm endpoint. I see how the patients do in the long term, and that leads to a better understanding of what we can accomplish. We’re able to get many people off medication and that alone is an incentive to have the procedure. The patients are pleased and doing well. It’s life changing for them, and that’s rewarding for me. It’s a winner in every way.” ■

JEFFREY C. LIU, M.D. Dr. Liu earned his medical degree at Jefferson Medical College, Philadelphia. He completed a residency in internal medicine at the University of Maryland Medical Center, served as Chief Resident at the Baltimore VA Medical Center, and completed a fellowship in Cardiovascular Medicine and a fellowship in Cardiac Electrophysiology at UPMC. Dr. Liu is board-certified in cardiovascular diseases, cardiology, cardiac electrophysiology and internal medicine by the American Board of Internal Medicine. He practices with South Hills Cardiology Associates, a division of St. Clair Medical Services.

To contact Dr. Liu, please call 412.942.7900.

Volume VIII Issue 1 I HouseCall I 17

HEALTHCARE PRICE TRANSPARENCY

EALTHCARE COSTS MADE

18 I HouseCall I Volume VIII Issue 1

ST. CLAIR LAUNCHES A VALUABLE NEW ONLINE FINANCIAL TOOL FOR PATIENTS

S

t. Clair Hospital recently launched a new online tool that promises to further help patients have the best possible healthcare experience. Called

Patient Estimates, it is a cost transparency tool that

patients may freely access on the Hospital’s website, www.stclair.org, in order to learn what their estimated out-of-pocket costs will be for services at the Hospital or its Outpatient Centers prior to the delivery of those services. St. Clair is the first hospital in the region to offer this new cost estimate service, which — given today’s higher deductibles and co-payments — makes St. Clair’s new service especially valuable and meaningful.

“St. Clair Hospital is committed to being a leader in high-value healthcare,” says Richard C. Chesnos, Senior Vice President & Chief Financial Officer. “In addition to our award-winning patient safety and clinical outcomes, and nation-leading patient satisfaction, St. Clair provides very cost-effective services, and we want our patients to feel secure knowing, upfront, how much their care will cost them.”

Continued on page 20

Volume VIII Issue 1 I HouseCall I 19

HEALTHCARE PRICE TRANSPARENCY Continued from page 19

Patient Estimates is a product developed by Experian Health.

Patient Estimates is not a list of charges, but an interactive, user-friendly tool that provides information that is highly specific to the individual. It is simple to use and convenient, accessible 24/7, and available to all. A patient simply visits the Hospital website, www.stclair.org, and selects the option “Financial Tools” on the home page. After selecting the Patient Estimates block on the landing page, a patient then enters their insurance information, selects one of the listed clinical services, and chooses the specific diagnostic test, procedure or treatment.

The tool then provides a customized estimate of what their out-of-pocket costs are likely to be. Traditionally, patients have not had access to cost information. Nearly always, a patient only learns about out-of-pocket costs weeks after a procedure or test via their Explanation of Benefits (EOB). Patient Estimates provides the EOB before services are delivered.

St. Clair’s financial services staff conducted research to determine which clinical services to include. They range from delivery room costs to lab tests and imaging studies. “We chose over 100 of the most frequently ordered services, in 15 categories,” says Rick. “People can come to the website to learn what their financial responsibility will be for that test or procedure. Our tool gives you true out-of-pocket costs, whether you have insurance or not.”

Cost transparency is a growing trend in healthcare. Driven in part by higher deductibles and the Internet, consumers in 2016 are far better informed about their health, quality care and healthcare costs. “Today’s healthcare consumers are educated and informed,” says Rick. “They’re thinking as consumers and demanding more. They want the information so that they can manage their healthcare budget and make the best choices for their circumstances and needs.” ■

20 I HouseCall I Volume VIII Issue 1

NEWSWORTHY The Pittsburgh Tribune-Review and Pittsburgh Post-Gazette published Op-Ed pieces saluting St. Clair’s new Patient Estimates tool just days after its unveiling.

Reprinted with permission.

Copyright Š, Pittsburgh Post-Gazette, 2016, all rights reserved. Reprinted with permission.

Volume VIII Issue 1 I HouseCall I 21

QUALITY & PATIENT SAFETY

ST. CLAIR SAFETY INITIATIVE

Preventing Patient Falls FALLING IS ONE OF THE LEADING CAUSES OF INJURIES TO HOSPITALIZED PATIENTS. It is the most common adverse event reported by hospitals, according to the Institute for Healthcare Improvement, and half of all hospital falls result in injury. Falls are not always unavoidable, however, and a strong fall prevention program is an essential element of quality care at any hospital. At St. Clair Hospital, patient safety is a priority, and an important effort that is being formally recognized by such renowned national organizations as the Leapfrog Group, which recently awarded St. Clair the region’s only ‘A’ grade in patient safety.

S

t. Clair has implemented a vigorous and comprehensive

There are two major aspects of risk, Joan says. “We look at fall

fall prevention program that is producing outstanding

risk and harm risk as two separate issues. Does the patient

results. At St. Clair, vulnerable patients are protected

have a history of falls? Is the patient at greater risk for a fall

by an extensive system of well-defined and well-executed initiatives that have resulted in a fall rate that is well below the national average, and is continuing to improve.

Joan Massella, R.N., M.Ed., M.B.A., Administrative Vice President & Chief Nursing Officer at St. Clair, says that a fall is formally defined as “an unplanned and unexpected descent to the floor.” Not all falls are traumatic, she

because of pre-existing conditions? Does the patient use an assistive device like a cane or walker? Those issues raise the risk of falling. The risk of harm to the patient from a fall increases when there is advanced age, bone disease, such as osteoporosis, the use of anticoagulant therapy (blood thinners) or recent major surgery.”

In a hospital environment, there are numerous factors that raise the risk of falling. Contributing factors for patients include: cognitive changes secondary to illness or the side effects of medication; muscle weakness and fatigue;

explains, and not all falls lead to injury.

disorientation in an unfamiliar environment; changes in gait,

But when injuries do occur, she says, they

balance or posture; and sensory changes, including pain.

can be severe: “Falls can result in fractures, especially hip

Something as simple as not wearing shoes or being unable to locate one’s eyeglasses can contribute to a fall. In many

fractures and head

instances, the interplay of multiple factors results in a fall.

injuries. A fall can also cause

While not all of these factors are modifiable, awareness of

a patient to be fearful and

them leads to careful monitoring and interventions that

more tentative about their

mitigate risk and help prevent falls.

daily routine, which can

Fall prevention is primarily the responsibility of nursing

tend to make a person

and at St. Clair, the nursing staff meets the challenge of

more reclusive. A fall can

fall prevention with diligence and determination, utilizing

change a life; it can be

a multifaceted approach that both reduces the risk of falling

the beginning of a cascade

and minimizes the risk of harm from falls. From adherence,

of complications and lead

to the most time-honored fundamentals of nursing practice,

to immobility as well as

to use of evidence-based guidelines and national best

to a loss of independence

practice interventions, to the utilization of high-tech safety

and reduced quality

equipment and electronic monitoring, St. Clair nurses

of life.”

view fall prevention as imperative.

Continued on page 24

Joan Massella, R.N., M.Ed., M.B.A., Administrative Vice President & Chief Nursing Officer, St. Clair Hospital 22 I HouseCall I Volume VIII Issue 1

Patients wearing red socks are deemed at risk of falling and are carefully monitored and attended to around the clock.

“

At St. Clair, the staff pays enormous attention to quality care and patient safety.

ELIZABETH PITTMAN, VICE PRESIDENT OF OPERATIONS, ST. CLAIR HOSPITAL

”

Volume VIII Issue 1 I HouseCall I 23

QUALITY & PATIENT SAFETY Continued from page 22

Barbara Girod, B.S.N., M.B.A., R.N., Director of Nursing Quality at St. Clair, says nursing interventions at the

The presence of family members can be highly beneficial in fall prevention, and the nursing staff welcomes them.

Hospital are both universal and individualized. “At St. Clair,

“Families provide essential information to the staff, information

we apply universal precautions and safeguards for every

the patient may not share,” Barb explains.

patient, including call bells, a uncluttered floor and adequate

Nursing, in

lighting. We set up the patient environment to minimize risk.

large part, centers

A key preventive step is the initial assessment of the patient,

on communication

to identify risk factors, using a standardized risk-assessment

and analysis of

form. Other interventions are visual cues: red ID bands

risk. Hand-off communication

information to all staff that the patient is a fall risk.”

at shift changes

FALLS PER 10,000 PATIENT DAYS 2.75 1.96

ST CLAIR HOSPITAL

NATIONAL AVERAGE

235 200 _ 172

and red non-slip socks that immediately provide visual “We use protective devices,

includes fall- and

164

150 _

137 120

100 _

such as a slip guard on the chair

harm-risk information

to prevent sliding,” Barb adds.

for patients who are

“For frail patients with arthritic hips,

transferred about the

osteoporosis or a body mass index

Hospital for testing or treatment. St. Clair

(BMI) below 20, we have padded hip

staff performs approximately 300 audits

protectors: high tech pads, which

each week using a software program

50 FY ’11

cushion the hips in case of a fall.

called Qualaris. Data are entered into

Low beds, eight inches from the floor,

an electronic dashboard, from which

are an option. We also have “landing

the team can monitor trends and

mats” — soft pads placed next to

identify opportunities for improvement.

the bed, to provide a cushioned surface on which to fall.”

’12

Qualaris furnishes the nursing department

Technology plays a key role in fall prevention at St. Clair.

with a summary that reveals

The Hospital has a video monitoring system in place to keep

trends and allows comparison

a constant eye on selected patients whose risk is especially

to previous years.

high. A pilot program demonstrated that staff can respond

A multidisciplinary fall

very quickly when they are alerted that a patient is about to fall

prevention committee meets

or is in a precarious situation that may lead to a fall. Although

monthly; they review every

every patient room has camera capabilities, the monitoring

fall event, identify all the

system is used selectively and only with the consent of the

contributing elements, and

patient and family.

make recommendations.

“

RED ID BANDS AND RED NON-SLIP SOCKS IMMEDIATELY PROVIDE VISUAL INFORMATION TO ALL STAFF THAT THE PATIENT IS A FALL RISK.

”

BARBARA GIROD, B.S.N., M.B.A., R.N., DIRECTOR OF NURSING QUALITY, ST. CLAIR HOSPITAL

24 I HouseCall I Volume VII Issue 4

ST. CLAIR ACUTE INPATIENT FALLS

250 _

Barbara Girod, B.S.N., M.B.A., R.N.

’13

’14

’15

Since 2012, when St. Clair began to track falls, the fall rate at the Hospital has dropped.

metrics

per 10,000 patient days, which compares very

used by the

favorably with the national rate of 2.75 falls

“We measure by patient days, in accordance

Leapfrog

per 10,000 patient days, as tracked by NDNQI,”

with the system used by the National

Group, a

Elizabeth says. “Our fall prevention program

Database of Nursing Quality Indicators

national organization that focuses on patient

is quite effective. It is actually preventing

F (NDNQI),” says Joan. “We compare quite

safety. St. Clair has consistently had an

as many as five falls per month.”

favorably with the national rate.”

‘A’ rating from Leapfrog.

Elizabeth Pittman, Vice President of

Zero falls, says Elizabeth, is the ultimate,

The fall prevention team drives efforts

though formidable, goal. “At St. Clair, the

Operations at St. Clair, says that fall rates are

with data collection, data analysis, bench-

staff pays enormous attention to quality care

considered a significant quality indicator by

marking and trending. “For fiscal year 2015,

and patient safety. They truly care about the

the entire healthcare industry and are publicly

St. Clair had 152 falls in 776,500 patient

well-being of all those in our care and they

reported. Hospital fall rate is one of the

days. This gives St. Clair a fall rate of 1.96

are doing an outstanding job.” ■

PREVENTING FALLS

Falls are usually caused by a combination of several risk factors, including problems with balance, slow reflexes, poor eyesight and medications.

STEP STEP

Patients who fall while in the hospital have a 60 percent higher likelihood of falling at home. To help prevent falls at home, St. Clair Hospital provides patients and families with the following fall prevention guidelines at discharge.

BY

PROTECT YOURSELF

MAKE YOUR HOME SAFE Use grab bars and non-slip adhesive strips or a mat in the shower or tub.

Ensure proper lighting, especially on stairs.

Review your medications with your doctor.

Some drugs can make you drowsy, dizzy and unsteady.

If dizzy or lightheaded, sit down until your head clears, then get up slowly.

Have your sight and hearing tested.

Consider a bench or stool in the shower and an elevated toilet seat.

Perform regular exercise to improve strength, flexibility and balance.

First verify with your doctor that exercise is okay.

Keep electrical and telephone cords out of pathways.

Use a cane or walker when walking, if you have been advised to use one or both.

Wear nonslip, low-heeled shoes or slippers. Avoid walking in stocking feet.

Remove clutter.

Remove throw rugs or runners that can be a tripping hazard.

Always use handrails on stairs.

Never stand on a chair to reach things.

Volume VII Issue 4 I HouseCall I 25

IN THE COMMUNITY

COMMUNITY OUTREAC YOUTH MENTORING Karen Alberts, R.N. (top photo, far right), of St. Clair Hospital's Sipe Infusion Center, explains to high school-aged students with the Bethel Park-based human services organization SHIM (South Hills Interfaith Movement) one of her duties at the infusion center during a recent job shadowing/career night at the Hospital. More than 15 students from SHIM — all of whom are refugees — spoke with professionals in Pharmacy, Occupational Therapy, Medical Records, Medical Imaging and Nursing during the event. ■

DONOR SPOTLIG

T

Jennifer A. Totten, M.D.

GRANT TO FUND COURTESY TRANSPORTATION Venard Campbell (third from left), Pre-Hospital Coordinator at St. Clair Hospital, accepts a $1,000 grant from Joseph King, (second from left) President of the Mt. Lebanon Community Endowment to support the Hospital’s Courtesy Van Transportation Program. The program, funded entirely with generous donations from the community, shuttles individuals who do not have access to transportation to their medical appointments. Pictured with Venard and Joseph and one of the Foundation-sponsored Courtesy vans are, left to right: Audrey Bode, Executive Director of the Endowment; Mike Blehar, a Board Member of the Endowment; Rick Lerach, Vice President of the Endowment, and Kristen Beattie, Manager, Organizational Advancement, St. Clair Hospital Foundation. ■

26 I HouseCall I Volume VIII Issue 1

Volume VIII Issue 1 I HouseCall I 26

ASK THE DOCTOR

Ask the Doctor JENNIFER A. TOTTEN, M.D.

Q A

I have been having abdominal pain and indigestion. Could I have irritable bowel syndrome? What is the treatment?

Irritable bowel syndrome (IBS) is a very common

doctor. By working with your physician, you can

gastrointestinal disorder. Up to 20 percent of Americans

determine if you have specific symptom triggers, such

have symptoms consistent with IBS. In fact, IBS is the

as stress, lifestyle habits or specific foods that exacerbate

most common diagnosis seen in gastroenterology practices.

your symptoms. Then, eliminate or attempt to minimize

Women are twice as likely to be diagnosed with IBS

those triggers.

as men.

Patients with IBS often suffer from diarrhea,

Certain foods, such as milk-containing products, legumes and cruciferous vegetables, may aggravate IBS

constipation, or alternating diarrhea and constipation.

symptoms in certain patients by promoting gas and

Abdominal pain must also accompany these bowel changes

bloating. It is reasonable to eliminate these foods

for a patient to be diagnosed with IBS. Other symptoms

for two weeks to see if your symptoms improve.

seen with IBS include bloating, gas and belching.

There is not one specific diagnostic test for IBS,

There are several medications available to control IBS symptoms and specific therapies targeted to the individual

however, there are formal criteria that physicians use for

symptoms. Pharmacologic treatment strategies include

diagnosis. After taking a medical history and performing

medications for constipation and diarrhea,

a physical exam, your doctor may recommend certain

probiotics, low-dose anti-depressants,

tests to exclude other gastrointestinal conditions as well.

antispasmodics and certain

In order to establish a diagnosis, patients must have

antibiotics.

recurrent abdominal pain and/or discomfort for at least

It is also important to eat

three days per month during the last three months. The

a balanced diet, drink plenty

symptom onset must have been six months or more prior

of water and to exercise

to the diagnosis, and patients must have at least two of

regularly to help keep your

the following three symptoms: symptom improvement

digestive tract regulated.

with a bowel movement; onset associated with a change

The goal is to establish a

in stool frequency; or onset associated with a change in

lifestyle plan that gives you

stool appearance or form.

maximum control over

Although IBS is thought to be a chronic disorder,

your symptoms. â–

there are many options available for treatment. First and foremost is to establish a good relationship with your

Jennifer A. Totten, M.D.

JENNIFER A. TOTTEN, M.D. Dr. Totten specializes in gastroenterology. She earned her medical degree at the University of Rochester School of Medicine. Dr. Totten completed her residency in internal medicine at the University of Pittsburgh Medical Center, and a fellowship in gastroenterology at Allegheny General Hospital. She is board-certified in internal medicine and gastroenterology by the American Board of Internal Medicine.

Dr. Totten practices with Southwest Gastroenterology Associates.

To contact Dr. Totten, please call 724.941.3020.

Volume VIII Issue 1 I HouseCall I 27

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

General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400

MAKE SURE ST. CLAIR HOSPITAL IS IN YOUR HEALTH INSURANCE NETWORK.

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

1 in Western Pennsylvania for Overall Hospital Care

#

National accolades for St. Clair Hospital’s quality continue.

The latest to recognize St. Clair as a national leader in patient safety and quality is Comparion Medical Analytics, one of the nation’s largest privately held healthcare information services companies. Using its proprietary CareChex® quality rating system, Comparion rates St. Clair #1 in western Pennsylvania and in the top 2 percent in the country for “Overall Hospital Care.” Comparion also rates St. Clair as best in the region for eight different specialties.

ST. CLAIR HOSPITAL IS RANKED #1 IN WESTERN PENNSYLVANIA FOR: General Surgery

Coronary Bypass Surgery

Orthopedic Care

Overall Surgical Care

Overall Hospital Care

Gastrointestinal Care

Cancer Care

Neurological Care

Major Bowel Procedures

HouseCall

is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.

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