St. Clair Hospital HouseCall Vol XII Issue 2 by NFM + Dymun

VOLUME XII ISSUE 2

An insightful Q&A on COVID-19 Please see Page 2

Q &A COVID Q&A

Editor’s note:

The COVID -19 pandemic has greatly affected all of our lives since the first cases surfaced in the United States earlier this year. While the Pittsburgh region, and the world, wait for the development and distribution of an effective vaccine to combat this novel virus, HouseCall magazine asked St. Clair Hospital’s Senior Vice President and Chief Medical Officer John T. Sullivan, M.D., MBA, to pose some of the most pressing questions on COVID-19 to the Hospital’s Chief of Infectious Disease, Stephen M. Colodny, M.D., to help HouseCall readers better understand the virus and the risks it presents to individuals and the community. Information in this Q and A was accurate at the time of its publication. Please check the Centers for Disease Control and Prevention website, cdc.gov, for additional updates on COVID-19.

2 I HouseCall I Volume XII Issue 2

the vaccine is between 40 percent and 70 percent effective). Since there has not been as much variability in the genetic make-up of COVID-19, the hope is the vaccine will be 60 percent or more protective. There are a lot of variables associated with this and they have an effect on the degree of protection and durability (how long it lasts) of that protection.

Ok, so which is likely to come first: An effective vaccine, or effective therapies for treating COVID-19? We already have several therapeutic modalities that are low-tech and have successfully reduced mortality rates in treating COVID-19. These include early steroid administration, anticoagulation and placing the patient in a prone (i.e., face down) position. Other interventions, including convalescent plasma (plasma from a patient who has recovered from COVID-19 and has virus-fighting antibodies) and antiviral medications such as Remdesivir Dr. Colodny, how is this coronavirus, COVID-19, different from the seasonal flu? Well, Dr. Sullivan, COVID-19 is a novel coronavirus,

are being used in the context of ongoing studies at St. Clair and elsewhere. An effective vaccine is likely 6 months or more from being widely available. Some exciting vaccine candidates are now in stage III or final testing.

so no one in the community had immunity to it, and, hence, we are all at risk for infection. COVID-19 is easier to transmit from person-to-person than is influenza and can cause more severe illness, particularly in at-risk individuals. COVID-19 is many times more deadly than the seasonal flu.

If a person has tested positive for COVID-19, has recovered, and then has been shown to have antibodies in their system, how can he or she contribute their plasma to help others still struggling with the virus? If you are a potential donor who has completely

So then, how effective is the eventual vaccine for COVID-19 likely to be, given that the seasonal flu

recovered from COVID-19, please fill out the application at: vitalant.org/COVIDfree.

vaccine is never 100 percent effective? Continued on Page 4

No vaccine is 100 percent effective. The seasonal influenza vaccine efficacy varies from year to year depending on the strains circulating in the community and how well they match to the vaccine strains (usually

Volume XII Issue 2 I HouseCall I 3

COVID Q&A Continued from Page 3

Q &A

Chief of Infectious Disease at St. Clair, Stephen M. Colodny, M.D., left, answers questions on COVID-19 posed to him by St. Clair Senior Vice President and Chief Medical Officer John T. Sullivan, M.D., MBA.

When should I get my seasonal flu vaccine this year to help ensure maximum protection for the longest period of time? We generally suggest mid-October to mid-November as the ideal time for influenza vaccination. The immunity conferred by the vaccine takes 2 weeks to develop and usually lasts 6 months in a healthy person. Influenza generally circulates in our community from mid-December through April. There is no information yet to suggest this year will be different. I encourage everyone to get their flu shot this year. It will help keep the community healthier and decrease the confusion as to whether a febrile (showing symptoms of a fever) respiratory illness is flu or COVID-19. I want to emphasize that people should not be concerned that getting a shot for the seasonal flu will make them more susceptible to contracting COVID-19. It will not.

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Will it be safe to get a seasonal flu vaccine AND a

aerosols (much smaller particles than droplets), but at least,

vaccine for COVID-19, if the latter is available during

as of this time, aerosols seem to be more important in

the approaching seasonal flu season?

closed spaces with decreased air circulation and lots of people in close proximity (such as a crowded bar).

We do not have definite data yet, but these are different kinds of vaccines and should not affect each other, nor

Hand washing continues to be important to prevent self-inoculation by touching one’s mouth, nose or eyes.

should they interact with each other. Am I more likely to contract COVID-19 from close Why are older adults more vulnerable to COVID-19’s

contact with an infected person, or by touching an

most harmful effects?

object that has been tainted?

Older people tend to have more underlying illnesses, so

Much more from an infected person if you’re within 6

they are at higher risk for complications from COVID-19. They also have less clinical strength when they develop

feet and one of you is not masked. Transmission via objects or from surfaces is much less efficient.

respiratory difficulty. Continued on Page 6

Why are children and young adults, for the most part, not contracting the virus in large numbers? Children and young adults are contracting COVID-19, but they have a higher rate of asymptomatic disease. This does not mean they can’t spread it to family members or friends who are higher risk for more severe disease.

Are wearing masks, practicing social distancing, and washing your hands truly effective in preventing COVID-19?

St. Clair Senior Vice President and Chief Medical Officer John T. Sullivan, M.D., MBA

These are the main ways to slow the spread of COVID-19. Masks catch the great majority of droplets we expel when we talk or cough. Droplet spread is by far the major source of new infections. Most if not all droplets fall to the ground within 6 feet, hence the efficacy of social distancing. There is some ongoing discussion about the significance of

JOHN T. SULLIVAN, M.D., MBA Dr. Sullivan specializes in anesthesia. He earned his medical degree at the University of Michigan and completed a residency in anesthesiology at Massachusetts General Hospital, an affiliate of Harvard University Medical School. Dr. Sullivan also earned a master’s in business administration from the Kellogg School of Management at Northwestern University, Evanston, Ill. Prior to joining St. Clair, he served as Associate Chief Medical Officer for Academic Affairs at Northwestern Memorial Hospital and as Professor of Anesthesiology at Northwestern University Feinberg School of Medicine, Chicago, Ill.

Volume XII Issue 2 I HouseCall I 5

COVID Q&A Continued from Page 5

Should I be concerned about contracting COVID-19

Those precautions include extensive and frequent

by going to the Emergency Room, an Urgent Care

cleaning, social distancing in waiting rooms and other

facility, a hospital, or a doctor’s office during this

public spaces, the use of personal protective equipment,

pandemic?

including masks, face shields, gloves and gowns, hand hygiene and more. Moreover, many St. Clair

No! If you are sick, please seek appropriate medical care. Do not delay care out of concern of being exposed to COVID-19 at a hospital or other health care

physicians, primary care and specialist alike, offer telemedicine visits to patients who might not want to physically visit one of our clinical settings.

facility. The risks of delaying that care far outweigh the risks of contracting the virus. Please know that all of St. Clair’s facilities have been taking a plethora of precautions to protect our patients and our caregivers.

Why didn’t COVID-19 practically disappear during the hot summer months much like the seasonal flu does? Seasonal flu doesn’t disappear, but becomes much less prevalent in the summer when we spend more time outside and more people have both new and recalled immunity. There is no recalled immunity to COVID-19 because it is novel and it is more transmissible than influenza, hence the lack of seasonality.

With so many viruses circulating throughout the world, why is COVID-19 so particularly dangerous? It is highly infectious and causes an extreme inflammatory response. COVID-19 also causes hypercoagulability (increased clotting) which causes both large and small blood clots, particularly in the St. Clair Chief of Infectious Disease Stephen M. Colodny, M.D.

lungs, leading to increased respiratory failure.

STEPHEN M. COLODNY, M.D. Dr. Colodny specializes in infectious diseases. He earned his medical degree at New York Medical College in Valhalla, N.Y., completed his residency in Internal Medicine at Bayside Medical Center in Springfield, Mass., and completed a post-doctoral fellowship in infectious disease at Yale-New Haven Hospital in New Haven, Conn. He is board-certified in internal medicine and infectious diseases. Dr. Colodny is Chief of Infectious Disease at St. Clair and practices with Pittsburgh Infectious Diseases, Ltd.

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St. Clair Senior Vice President and Chief Medical Officer John T. Sullivan, M.D., MBA, right, interviews St. Clair Chief of Infectious Disease Stephen M. Colodny, M.D. about COVID-19.

Should I forgo any social interaction until there is a vaccine? Decisions on social interaction are highly personal and need to be made weighing the relative risks to the individual and everyone they subsequently contact.

A virtual town hall with Mayo Clinic and St. Clair doctors

OF SPECIAL NOTE: on the frontline, fighting against Covid-19.

Drs. Sullivan and Colodny, along with What can be done to help prevent more viruses

Family Medicine physician Ruth A.

like COVID-19 from affecting us in the future?

Christoforetti, M.D., as well as two medical experts from Mayo Clinic,

We need vigilant international cooperation on disease

recently presented a virtual town hall

identification and tracking. There have been several

to answer the communityâ&#x20AC;&#x2122;s questions on

high-risk outbreaks in the last decade (SARS; MERS;

COVID-19. To view the town hall, simply visit:

H1N1 influenza) which had the potential to cause pandemics. There have always been outbreaks and there will be more in the future, potentially including influenza H7N1. Hopefully, with the knowledge we are gaining with COVID-19, we may learn new behaviors that will help us, and science will learn new techniques

stclair.org/thefrontlineonline, where it is archived. The virtual town hall coincided with St. Clairâ&#x20AC;&#x2122;s fourth anniversary as a member of the exclusive Mayo Clinic Care Network.

for combating these diseases. n

Volume XII Issue 2 I HouseCall I 7

COVID-19 SURVIVOR

“

COVID-19 wants to knock you out. It took the wind out of me. Before COVID, I thought I was invincible.

”

MICHAEL BAYENS, PATIENT

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MICHAEL BAYENS

The fight of his life Michael “Mike” Bayens has sparred with Roberto Duran

Bayens’ illness began with vague symptoms: loss of appetite,

and Sugar Ray Leonard, and he will never forget the power and

fatigue and restlessness. He had no fever or shortness of breath.

speed that these two formidable athletes possessed. Bayens, of

But his wife worried that it could be COVID-19 and urged him to

Dormont, is a former amateur boxer who fought in the Golden

see their primary care physician. On Monday morning, July 6,

Gloves in 2002 and once won a match in 32 seconds. He is also

she drove her husband to the office of Bora Janicijevic, M.D., who

a boxing coach for the Pittsburgh Boxing Club, the founder

immediately called for an ambulance to take Bayens to St. Clair

of the Brookline Boxing Club, and well known among local

Hospital’s Emergency Room. He was transported to the Intensive

boxing fans. He loves boxing, has expert knowledge of it, and

Care Unit and remained there for the next eight days.

possesses a rather surprising view of it. “Boxing is an art form

In the ER, Mike had stable vital signs and was alert, but he

— it’s the purest form of the martial arts. It’s actually human

required five liters of oxygen to keep his oxygen saturation at

chess at its finest. It isn’t just about throwing punches; it’s a

normal levels. His chest x-ray showed diffuse pneumonia in both

problem-solving sport and a thinking man’s game, just as chess

lungs, and bloodwork indicated that he was already in moderate

is. In boxing and in chess, you have to study your opponent and

kidney failure and had an inflamed liver. “Mike had been self-

calculate every move. It’s one-on-one competition.”

isolating at home, and had no contact with anyone known to have

With his boxing chops, plus his 20 years in the U.S. Marine

COVID-19,” explains Gregory J. Fino, M.D., Chief of Critical Care

Corps, Bayens is one tough guy who is ready to take on any

Medicine at St. Clair. “His symptoms were mild,

opponent. “I’m a fighter. I’ve always had an instinct to fight.

but he was much sicker than he appeared.”

I still go to the gym to hit the punching bag.”

Bayens was admitted to the ICU where,

But a recent opponent took Mike by surprise and had him up

overnight, his condition deteriorated,

against the ropes for a while. That opponent was a microscopic

with his oxygen requirement increasing

but very aggressive fighter by the name of COVID-19, also known

to 15 liters. The intensivist physicians

as the novel coronavirus. “COVID-19 wants to knock you out,”

of the ICU, led by Dr. Fino, knew that

Bayens says. “It took the wind out of me. Before COVID, I thought

Bayens needed mechanical ventilation

I was invincible.”

at that point. They sedated him and

Bayens, 65, is a retired mail carrier for the United States

intubated him, placing a breathing tube

Postal Service who had a mail route in North Versailles for years.

into his airway, and connected it to

He liked his work and all that daily walking helped keep him

a ventilator.

healthy. He goes to the gym, jumps rope and has continued to be

Continued on Page 10

a regular walker. He and his wife Virginia “Ginger” were aware of the COVID-19 pandemic and conscientiously followed the recommended precautions. “I knew that the virus was out there and was very contagious but I didn’t think it would ever affect

Gregory J. Fino, M.D., FCCP

me,” he says. “I have no underlying conditions and I didn’t know anyone who had it. I’m the first person I know who got the virus.”

GREGORY J. FINO, M.D., FCCP Dr. Fino is Chief of Critical Care Medicine at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh School of Medicine, where he also completed a residency and fellowship. Dr. Fino is board-certified by the American Board of Internal Medicine, including in pulmonary disease. He practices with St. Clair Medical Services. To contact Dr. Fino, please call 412.942.2025. Volume XII Issue 2 I HouseCall I 9

COVID-19 SURVIVOR Continued from Page 9

Triple Therapy This was taking place in early July, at a time when intensivists,

• Convalescent plasma: this is plasma collected from COVID-19

pulmonologists and infectious disease specialists across the country

survivors. It is rich with COVID-19 antibodies and is obtained from blood

were eagerly trying various therapies and sharing their experiences as

banks. The U.S. Food and Drug Administration (FDA) issued an

they worked with fierce determination to save lives being threatened by

emergency use authorization for investigational convalescent plasma

COVID-19. Dr. Fino and his St. Clair colleagues, including critical care

for the treatment of COVID-19. St. Clair, a member of the Mayo Clinic

medicine physicians Maxim Valeryerich Bocharov, M.D. and Kevin P.

Care Network, participated in Mayo Clinic’s Expanded Access Program

Kane, M.D., infectious disease physician Amanda M. Michael, D.O.,

for convalescent plasma, which was designed to increase access to

and hospitalists Christopher S. Mizzi, D.O., Chad M. Liber, M.D. and

investigational convalescent plasma and evaluate the safety of this

Christopher P. Lang, D.O., treated Bayens with a “triple therapy” approach

experimental therapy.

based on what was emerging in the medical literature. This consisted of: • Dexamethasone (Decadron): a corticosteroid given intravenously to reduce inflammation. Patients who were requiring oxygen or a ventilator responded well, Dr. Fino says. “There was a remarkable drop in mortality in those patients, but if the person was not on the ventilator and oxygen, it did not change mortality.” •R emdesivir: an antiviral drug which shortens the duration of COVID-19 but does not eliminate it. Dr. Fino reports that Remdesivir decreased

And in This Corner: Ginger Bayens and his wife have known each other since 1969. Their parents were close friends and they grew up together. “Ginger is my world,” Bayens says. “I’m blessed to have her for my wife.” The couple raised a family of five (Katie, Teddy, Danny, Sean, Paul) and are now grandparents to six. Mrs. Bayens was recovering from surgery and had not yet returned to her job at Target when Mike became ill. “Mike is never sick. But he didn’t feel well as July 4th approached,

the number of days of illness by four, with patients recovered in 11 days.

and we canceled our traditional family cookout for that weekend,”

However, there is national undersupply of this drug.

she recalls. “That was the first sign; he was very tired and had no appetite. He looked completely worn out and began to have trouble staying awake.

COVID-19 survivor Michael “Mike” Bayens outside his Dormont home with his wife Virginia “Ginger”.

10 I HouseCall I Volume XII Issue 2

That scared me. When we went to Dr. Janicijevic, I had to stay in the car while Mike saw the doctor. They came out to the car to talk to me, to explain that Mike needed to go to the ER. They said I could not drive him there because he was so sick, that he would probably pass out in the car. His oxygen saturation rate was below 70.” She watched as the EMTs brought Mike to the ambulance. He had an oxygen mask over his face and tried to speak to his wife, but she could not understand him. One of the EMTs told her, “It’s COVID-19. You need to go home and wait because the Hospital won’t let you come in. They’ll call you later.” Bayens called his wife on his cell phone from the ER and confirmed that the doctors said it was COVID-19. That, she recalls, was their last

COVID-19 survivor Michael “Mike” Bayens hits the heavy bag at the Mt. Washington location of Pittsburgh Boxing Club.

conversation until July 14, when he could use a phone again. “It was the longest we have ever gone without talking. If one of us was away from home, we would talk every night.” None of the other members of the Bayens family contracted COVID-19, but Mrs. Bayens says every one of them was deeply affected by his illness. “It was hard on the kids. We have a granddaughter with special needs; she’s Katie’s daughter and has lung disease. My daughter takes great care of her and knows all about lungs — that was a blessing because she knew what questions to ask and she could interpret the medical information for the rest of us. We created a family system with texting to keep everyone informed. The kids have never experienced one of us being so sick. They could not see their Dad or me, because I was in a 14-day quarantine. In my isolation, I became depressed. Paul, my youngest, would stand on the porch to see me through the window. All the kids stepped up and I’m proud of them. I couldn’t see them, but I could feel the love they were sending to me and Mike.” Mrs. Bayens is forthcoming about the depression she experienced. “I encourage people to get counseling if you have a loved one with COVID-19, because this feels like grief. It is as if you have lost the person who has COVID-19 and you start the grieving process, but you still want to hope. There’s nothing to hold on to — you can’t talk to them or see them, to see for yourself how they are. You can’t comfort them. It’s hard to be sitting at home, waiting and wondering. It leaves you feeling paranoid — what next? What if I get it? I tested negative, but I’m susceptible. What if Mike gets it again? Even to go to the store was dangerous. “What helped me cope with seeing my husband so gravely ill? The nurses at St. Clair. They were wonderful; they talked to us every day and gave Mike my messages. They posted get well cards that the grandchildren made. Mike is doing better. His voice is stronger. We go for walks where it’s flat. He walks with a slow pace, but he is walking and he can drive again.”

Dr. Fino attributes Bayens’ recovery to three main factors: the combination of medications; the fact that he was ventilated quickly; and the quality of the care he received from nursing and respiratory therapy professionals. “These nurses and therapists spend a lot of time with their patients and are very dedicated. Mike received care of the highest quality.” Bayens spent a total of 15 days at St. Clair. By the time he was discharged to home on July 20, he was breathing room air again. “At the time of transfer to the COVID-19 unit, Mike was weak, but was no longer very sick,” Dr. Fino says. “His only complaint is leg weakness and numbness, but he is walking and gaining strength.” Bayens believes that his fighting spirit helped him defeat COVID-19. “The nurses told me I was fighting even while I was sedated. I’m still fighting it.” The Heart of a Fighter In the 1940s and ’50s, Pittsburgh became a world boxing mecca: five recognized world boxing champions at one time were from Pittsburgh. They inspired Bayens, who says boxing taught him important life lessons about endurance and adaptation to the unexpected. He passed those lessons on to the young men he trained, and now watches with pride as those boxers train others. It’s his legacy. “I still get requests to come to the gym to help out with special boxers, and I enjoy being involved. But now, as a COVID-19 survivor, I want to be involved in helping to end this pandemic. I hope to donate my plasma to help treat others and to spread the message that this virus needs to be taken very seriously. I wouldn’t want this experience for anyone. Wear the mask, and wear it right — why bother if it’s not covering your nose and mouth completely? We all have to follow the experts and look out for each other.” n

Volume XII Issue 2 I HouseCall I 11

BREAST CARE

DON’T DELAY SCREENING MAMMOGRAPHY Women across the U.S. are not getting their routine screening mammograms for breast cancer in 2020 due to anxiety about contracting COVID-19, and the consequences could be profound.

ealth care professionals who specialize in cancer care are greatly concerned about the negative impact that the COVID-19 pandemic is having on vital cancer screenings, including mammograms. Fear

of exposure to the virus in medical settings has led millions of American women to cancel or delay their routine annual screenings for breast cancer, and this could result in delayed diagnoses and an eventual increase in breast cancer deaths. Early detection is the key to breast cancer survival, and the delayed detection could mean that breast cancers will not be diagnosed until they are in advanced stages, which translates to worse prognoses. Breast cancer is the second most common cancer

“

among women in the U.S., after skin cancer.

SCREENING MAMMOGRAMS SAVE LIVES . . . A DELAY OF EVEN A FEW MONTHS CAN MAKE A DIFFERENCE.

”

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

TARA L. GRAHOVAC, M.D. Dr. Grahovac specializes in breast surgery. She earned her medical degree at the University of Cincinnati College of Medicine, Cincinnati, Ohio. Dr. Grahovac completed her residency in general surgery at Allegheny General Hospital, and a fellowship in breast surgery at UPMC Magee-Womens Hospital. She is board-certified by the American Board of Surgery and is certified as a trained clinical fellow in breast surgical oncology by a Society of Surgical Oncology-accredited program. Along with her partner Raye J. Budway, M.D., FACS, Dr. Grahovac practices with St. Clair Medical Services. To contact Dr. Grahovac, please call 412.942.7850.

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BREAST CANCER BY THE NUMBERS Mammography has helped reduce breast cancer mortality by ONE THIRD in the US since 1990.

In 2020 an estimated

276,480

new cases of breast cancer are expected to be diagnosed in women in the U.S.

For every

100

women who get a screening mammogram:

A woman’s risk of breast cancer nearly doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer.

1out of 8 women

will be told that their mammograms are normal

Breast cancer is the second leading cause of cancer death in women.

1 in 38

women will die of breast cancer.

will develop breast cancer during their lifetime.

85% of women diagnosed with breast cancer have

no family history

will be asked to return for an additional mammogram or ultrasound

40 is the age women should begin

will be recommended for a biopsy

annual mammograms.

SOURCE: www.breastcancer.org

Tara L. Grahovac, M.D., a board-certified breast surgeon at St. Clair

CDC and the Pennsylvania Department of Health. St. Clair’s Breast

Hospital, says that at this point, no one knows exactly what the full

Care Center has the most advanced diagnostic imaging technology and

impact will be. “It’s a difficult thing to predict, but the National Cancer

women can feel confident they will receive care that is sensitive,

Institute does prediction modeling, and they estimate that there will be

personal and of the highest quality.

10,000 additional deaths from breast and colorectal cancer over the next

Cancer screenings are elective procedures, but they are also critically

10 years, as a result of the COVID-19 pandemic.” Fewer cancers are

important to the early detection and treatment of cancer. The timing

being diagnosed, but the incidence of cancer has not decreased, according

of diagnosis and the start of treatment greatly impact prognosis: the

to the NCI report; in fact, these estimates may be conservative.

earlier the cancer is detected, the better the odds of survival.

Dr. Grahovac says that breast cancer screenings, which includes

“Screening mammography saves lives,” Dr. Grahovac says. “They

mammograms, breast MRIs and breast ultrasounds, have plunged by

reduce cancer mortality by one-third. A delay of even a few months

nearly 50 percent in some parts of the country since the beginning of

can make a difference.” n

the pandemic; at St. Clair, it was closer to one-third between February and May/June. At first this was due to the restrictions that government officials placed on hospitals when the virus began to spread. But when hospitals resumed operations, with strict, comprehensive safety precautions in place to protect patients from exposure, many women still opted to cancel their appointments or delay scheduling them. At St. Clair, breast cancer screenings are available in a safe

SCHEDULE YOUR SCREENING

Full imaging services are available at the Breast Care Center at St. Clair Hospital’s Outpatient centers in Bethel Park and Peters Township. To schedule your appointment, please call 412.942.8150.

environment, with all necessary protections as recommended by the

Volume XII Issue 2 I HouseCall I 13

ADVANCED CARDIAC CARE

ST. CLAIR: A HISTORY OF OUTSTANDING

Cardiovascular Care The evolution of cardiac care at St. Clair Hospital is a story of the pursuit of excellence in order to serve the needs of the region. The commitment to excellence is of long duration, but has been invigorated in recent years by transformative leadership and innovative change that have made St. Clair one of this area’s top centers for cardiac care. St. Clair’s highly respected and nationally recognized program has attracted leading specialists in cardiology and cardiothoracic surgery who have made it possible for St. Clair to offer the most progressive new technologies and procedures. St. Clair now offers complete cardiac care: a full spectrum of first-rate services for the diagnosis and treatment of every form of heart disease. Continued on Page 16

Pictured at right are St. Clair Medical Services cardiologists Ryan W. Zuzek, M.D., FACC; Christopher Pray, M.D., FACC; Jeffrey C. Liu, M.D., FHRS; Andy C. Kiser, M.D., FACS, FACC, FCCP, MBA; James W. Marcucci, M.D., FACC; and John P. Girod, D.O., FACC. 14 I HouseCall I Volume XII Issue 2

St. Clair has long been a leader in cardiovascular care. Outstanding elements of St Clair’s Cardiac Care program include: • An expansive, first-rate, 24-hour cardiac catheterization lab; • Cardiac MRI, the most advanced, groundbreaking imaging technology for diagnosing heart disease and assessing the heart’s pumping function; • A cardiac electrophysiology lab that provides the most progressive care for the diagnosis and treatment of problems in the heart’s electrical conduction system, such as atrial fibrillation (A Fib); • Interventional cardiology, in which specially trained cardiologists perform minimally invasive, catheter-based procedures, such as angioplasty and stenting; • Complex open-heart surgical procedures, including coronary artery bypass grafts and valve replacement; • Innovative procedures including TAVR — transcatheter aortic valve replacement — an alternative to open-heart valve surgery for aortic stenosis; • Comprehensive cardiac rehab and follow-up care; • Advanced emergency care for heart attacks and other cardiac emergencies, seamlessly integrated with regional responder services; and • One of the nation’s best “door to treatment” times, measuring the efficiency with which heart attack victims receive lifesaving care. This is cutting-edge, tertiary-level care, provided by impeccably skilled and credentialed clinicians trained at the nation’s leading medical centers. St. Clair is distinctive for having a hospital culture that is consistently patient-centered, where the caring is genuine and personal. That unique culture, in combination with the cardiac services, makes St. Clair’s heart care program a rare gem: a program that provides the most advanced technology and interventions within an environment of amity, respect and compassion. It is truly the best of both worlds.

Volume XII Issue 2 I HouseCall I 15

ADVANCED CARDIAC CARE Continued from Page 14

Transitions and Transformation: Improving care at St. Clair

t. Clair’s cardiology program has evolved in ways that would not

The years 2000–2010 were the era of stents, the tiny, hollow tubes

have been imagined even 10 years ago. James W. Marcucci, M.D.,

that hold open blood vessels, including coronary arteries. Stents

has been a cardiologist at St. Clair since 1984 and is enthusiastic

represented a major advance for cardiology and throughout the decade,

about the advances taking place. “Physicians today have much better

four generations of stents were produced, with each one an improvement

treatment for heart disease; the new medications have made a big

that meant better and better outcomes for people with coronary artery

difference, as have drug-coated stents. There is a push now for treating

disease. St. Clair’s cardiologists recognized they needed to identify

structural heart disease, like valve problems, with minimally invasive

gaps in services and begin offering new programs. “By 2010

procedures, and we can now offer the procedures to older patients.

interventional cardiology was taking off,” explains cardiologist Ryan W.

It minimizes their down time and is much safer for them.”

Zuzek, M.D. “We wanted to meet the community’s needs with the

In 1979, following a major hospital expansion and in response to the high incidence of heart disease in the community, St. Clair launched

latest and most innovative care.” St. Clair began recruiting cardiology specialists, including Jeffrey C.

a cardiology service. The ’70s were a threshold era in cardiac care

Liu, M.D., cardiac electrophysiologist, and Christopher Pray, M.D.,

nationally, when surgeons began to perform the coronary artery

cardiac imaging specialist. The cardiac cath lab was expanded and

bypass graft (CABG) procedure, an open-heart surgery that revolutionized

a new electrophysiology lab was opened. New diagnostic and

cardiac care and became the standard of care for treating and

treatment possibilities were offered, and each step forward triggered

preventing heart attacks. Throughout the ’80s, CABG surgery was

additional growth and improvement.

improved, and the ’90s brought balloon angioplasty — a technique that opened blocked coronary arteries without open-heart surgery. This was another leap forward.

16 I HouseCall I Volume XII Issue 2

Continued on Page 18

PROFILES IN CARDIAC CARE AT ST. CLAIR

JAMES W. MARCUCCI, M.D., FACC

Experienced and patient-centered James W. Marcucci, M.D. remembers the days when a patient

so this is our hospital, too. We want a cardiac program that is equal

who was over 65 and had a heart attack was admitted to a regular

to any. St. Clair is an excellent hospital, known for its warm, more

medical floor and given morphine. It’s a far cry from the efficient,

personal culture. The community has confidence in us. When we

evidence-based, emergency care that is standard today, and he feels

were developing the TAVR (transcatheter aortic valve replacement)

great satisfaction in the tremendous progress that has taken place

program, patients said to me, ‘I need this, but I am waiting for

in the treatment of heart disease, including coronary artery disease.

St. Clair to do it.’

Dr. Marcucci, who trained at George Washington University

“It’s important for St. Clair to offer such high level heart care.

Hospital, has been practicing cardiology at St. Clair since 1981,

A lot of elderly residents live in the region. They are more comfortable

when G. Frederick Woelfel, M.D., now retired, and Ross DiMarco, M.D.,

staying in their local community. Because of all that we offer a

began to do cardiac catheterizations and open-heart, coronary

St. Clair, they don’t have to travel to get the highest quality care.”

artery bypass operations. “They were excellent physicians and they

Dr. Marcucci is a runner who lives a heart-healthy lifestyle.

brought the heart program to a higher level,” he says. “Now the

“I have patients who live on my street, so I have to be a role model.

same thing is happening; we’ve acquired tremendous new

I run; I put it in my schedule to make time for it. I don’t feel as well

technology and excellent, well-trained physicians with expertise in

mentally if I don’t run.” n

this technology. We’re doing procedures that we did not offer in the past. We have Chief of Cardiac Surgery Andy Kiser, whose impact at St. Clair has been tremendous. His contributions are outstanding, and he is enthusiastic about driving the program forward. The mix of experienced cardiologists and younger cardiologists who have new knowledge and technology is a winning combination, and we interact to bring about the best results for patients. We teach each other. It’s essential to be on the cutting-edge of technology, and to have cardiologists in every subspecialty.” One of St. Clair’s best assets, says Dr. Marcucci, is excellent nursing. “Nursing is first line in importance. It’s the nursing care that the patients remember. We would not have a heart program of such quality if we did not have a team of nurses, therapists, technicians and other professionals who provide the highest quality care.”

James W. Marcucci, M.D., FACC

St. Clair is not only the hospital where Dr. Marcucci has worked throughout his career, but is also his personal choice for his own medical care and that of his family. He has five children, all of whom were born at St. Clair. “A lot of the physicians live in this community,

JAMES W. MARCUCCI, M.D., FACC Dr. Marcucci specializes in interventional cardiology at St. Clair. 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 St. Clair Medical Services. To contact Dr. Marcucci, please call 412.429.8840. Volume XII Issue 2 I HouseCall I 17

ADVANCED CARDIAC CARE Continued from Page 16

St. Clair’s Heart Team: On the forefront of cardiovascular care In 2018, Andy C. Kiser, M.D., FACS, FACC, FCCP, joined St. Clair as

appendage clips, to decrease the risk of stroke from A Fib. All this

Chief of Cardiac Surgery. An internationally recognized and vastly

innovation is intended to meet the expectations of the region. We are

experienced surgeon, Dr. Kiser is a pioneer whose innovative

providing the level of care that the region needs, and to do that we’ve had

approaches to valve disease and A Fib have contributed to the advancement

to transition to a far more advanced program.”

of treatment for these conditions. He developed the convergent

St. Clair’s sterling reputation has attracted top-notch, highly trained

hybrid ablation procedure for A Fib and has designed numerous medical

and experienced physicians. Recently, three new specialists have come

devices. With Dr. Kiser, St. Clair was able to offer procedures and

on board: Muhammad Salman, M.D., a cardiothoracic surgeon; George

interventions that had not previously been available, including TAVR.

Cater, M.D., imaging specialist; and Kyle Buchanan, M.D., an

His enthusiasm about the quality of care at St. Clair and the potential

interventionist who specializes in complex structural problems of the

for growth and improvement galvanized the entire team. Under his

heart. “Our ability to recruit physicians of this caliber is remarkable and

leadership, the expansion of the cardiac care program has been

sends a message to the community of our investment in the cardiac

accelerated, producing many advances and growth in breadth

program,” Dr. Kiser says. “It validates the quality of the program.”

and volume. “Other than transplantation, there isn’t anything we don’t do here at

The cardiac care team has a tremendous resource in the deeply experienced and extensively credentialed support staff: cardiac nurses,

St. Clair,” Dr. Kiser says. “We are doing a greater variety of interventions,

cath lab technicians, imaging technicians, respiratory therapists

including complex surgeries like TAVR. Dr. Liu is doing more complex

anesthesiologists and anesthetists, OR technicians, perfusionists, physician

ablations; he has a skill level that few have and that is bringing more

assistants and others. “A multidisciplinary team means better care for

patients to St. Clair, enabling us to expand. TAVR is a complex cardiac

our patients,” Dr. Kiser says. “This staff is outstanding. They’re totally

surgery and we do it frequently, along with pacemaker lead extractions,

invested; the entire team provides the best care possible.”

for pacemaker wires that fail or become infected. We’re doing left atrial

Three exceptional new specialists have recently joined the St. Clair Heart Team From left to right: interventional cardiologist, Kyle Buchanan, M.D., FACC, RPVI; cardiothoracic surgeon, Muhammad Salman, M.D., FACS; and non-invasive cardiologist and cardiac imaging specialist, George Cater, M.D., MSE, FACC.

18 I HouseCall I Volume XII Issue 2

Continued on Page 20

PROFILES IN CARDIAC CARE AT ST. CLAIR

ANDY C. KISER, M.D., FACS, FACC, FCCP, MBA

A pioneering heart surgeon Andy C. Kiser, M.D. relocated to Pittsburgh in 2018 to become

“This warm, caring culture existed long before I came. There is a

the Chief of Cardiac Surgery at St. Clair Hospital. A scholar and

humanitarian instinct that already exists in everyone here, and that

inventor as well as a gifted clinician, Dr. Kiser had spent much of

is fostered by the culture and values of this Hospital. It’s in everyone.

his career in academic settings with large, research-oriented

At St. Clair, everyone asks, “How can I contribute to making you feel

programs. From 2011 to 2016, he served as the Chief of the Division

better?” Everyone at St. Clair, including the Environmental Services

of Cardiothoracic Surgery at University of North Carolina-Chapel

staff, cares about the patients; they will greet and speak to them.

Hill, where he was also the Byah Thomason-Sanford Doxey

Patients feel valued by them as much as by me.

Distinguished Professor of Surgery. Prior to being named Chief of

“This culture is embodied by the nurses. If you are a nurse at

Cardiac Surgery at St. Clair, Dr. Kiser served as Chief of Cardiac

St. Clair, you are likely to stay here for the life of your career. You’ve

Surgery and Director of Cardiovascular Surgical Services at East

made an investment in the care of your community. The nurses

Carolina University Heart Institute in Greenville, N.C. He is a Fellow

make a personal investment in each patient; they truly care about

of the American College of Surgeons, the American College of

them. It takes a lot of energy to care in this way, and nursing is hard

Cardiology and the American College of Chest Physicians.

work, 24/7, but at the end of the day, when you go home, you should

“I never thought I would move to Pittsburgh,” Dr. Kiser says,

feel great.”

“although my wife, Heather, is from Peters Township and I knew

“St. Clair is sitting on a wave,” Dr. Kiser says. “This Hospital is

about St. Clair Hospital. When I visited St. Clair, I was extremely

becoming the place where everyone will want to go for care. We have

impressed with the culture and the quality of the Hospital.”

so many assets, including an outstanding

Two years later, Dr. Kiser is deeply satisfied with his decision

administration that supports our program.

to come to St. Clair. “It’s been an exciting two years. We have

We have a clinical relationship with Mayo

accomplished so much and advanced our program significantly,” he

Clinic, rated as the best hospital in the

says. “We have an outstanding team of cardiologists, sub-specialists

nation. We have a relationship between

and staff, and we are providing an exceptional level of care. Few

the Hospital and the community that is

hospitals are capable of providing this quality, but St. Clair is unique.

ideal. St. Clair is simply a great place

The staff has extensive experience and expertise, confidence and

and I’m happy to be here.” n

a commitment to excellence that is unparalleled. Everyone is professional and reliable; they are always prepared. They are eager to keep learning. There is a culture of caring at this Hospital that makes every patient feel special. Andy C. Kiser, M.D., FACS, FACC, FCCP, MBA

ANDY C. KISER, M.D., FACS, FACC, FCCP, MBA Dr. Kiser specializes in cardiac and thoracic surgery. He earned a B.S. in biology with honors and distinction, and a medical degree with honors from the University of North Carolina at Chapel Hill. He subsequently completed a residency in general surgery there, as well as fellowships in cardiac and thoracic surgery. From 2011 to 2016, he served as the Chief of the Division of Cardiothoracic Surgery at the University of North Carolina at Chapel Hill, where he was also the Byah Thomason-Sanford Doxey Distinguished Professor of Surgery. Dr. Kiser served as the J. Mark Williams Distinguished Professor in Cardiac Surgery, Chief of Cardiac Surgery, and the Director of Cardiovascular Surgical Services at East Carolina University Heart Institute, which is affiliated with East Carolina University, in Greenville, North Carolina. In May, 2018, Dr. Kiser earned an MBA degree from the Kenan-Flagler Business School, also part of the University of North Carolina at Chapel Hill. Dr. Kiser practices with St. Clair Medical Services. To contact Dr. Kiser, please call 412.942.5728. Volume XII Issue 2 I HouseCall I 19

ADVANCED CARDIAC CARE Continued from Page 18

Forging the Future The future is bright and the residents of the region can expect continued

Dr. Pray has developed for St. Clair. For all the satisfaction that Dr. Pray

growth and excellence in cardiac care. Interventional cardiology will

derives from providing the highest level cardiac imaging services, it is the

continue to grow, with more treatments for structural heart disease, such

care of patients with severe, complex congestive heart failure that is the

as valve problems. Prevention of heart disease will get more emphasis,

most personally rewarding for him, and he has created a cutting edge,

and a new effort to educate the public will take the form of small summits

comprehensive approach to their care. “These are often very frail

with physician speakers.

patients,” he says. “We’re able to diagnose and manage heart failure

St. Clair’s cardiac care program has evolved into a full slate of heart care services, distinguished by its excellent outcomes, ability to attract the top physicians in the field, and by a spirit of innovation and openness

patients in an innovative and very humane way that has a profound impact on their care.” (Please see related story, Page 22.) John T. Sullivan, M.D., Senior Vice President and Chief Medical Officer

to progressive ways of thinking and doing. As a result, St. Clair offers new

at St. Clair, agrees. “Dr. Pray’s vision for a heart failure program, with

and better solutions to heart problems and improvements in care, in an

meticulous care and support, is St. Clair at its best. It’s challenging, but

environment of humane and personal care.

it’s something we need to do for the region, so we have committed to it

An illustration of this can be found in a new program that

and are proud to offer it.” n

THE HEART TEAM The Heart Team in St. Clair Medical Services is, left to right: James H. MacDougall, M.D.; Muhammed Salman, M.D., FACS; Robert N. Shogry, M.D.; Mark K. Greathouse, M.D.; Adil Waheed, D.O., FSCAI; Christopher Pray, M.D., FACC; Jeffrey C. Liu, M.D., FHRS; Andy C. Kiser, M.D., FACS, FACC, FCCP, MBA; Ryan W. Zuzek, M.D., FACC; James W. Marcucci, M.D., FACC; George Cater, M.D., MSE, FACS; Kyle Buchanan, M.D., FACC, RPVI; John P. Girod, D.O., FACC; and David J. Burkey, M.D., FACC.

20 I HouseCall I Volume XII Issue 2

PROFILES IN CARDIAC CARE AT ST. CLAIR

RYAN W. ZUZEK, M.D., FACC

A highly trained, well respected cardiologist Ryan W. Zuzek, M.D. arrived at St. Clair Hospital 10 years ago, in

One of the best aspects of the cardiology program, says

a homecoming of sorts. A Pittsburgh native, he acquired his medical

Dr. Zuzek, is the collegiality that exists within the team. “We work

education and training in Ireland, Cleveland and Rhode Island, but

very well together, and we have a common goal: to deliver the very

always had the intention of returning to Pittsburgh to practice. At

best care. There’s a lot of positive energy. Dr. Kiser has had a huge

St. Clair, he found the perfect setting: his exceptional credentials in

impact, bringing a new skill set and new procedures that we had not

cardiovascular medicine were a hand-in-glove fit for this Hospital

been offering. He has expertise in ablation, from a surgeon’s point

that was on the precipice of a new era in cardiac care.

of view; he is pushing the structural heart program (for problems

Dr. Zuzek is an interventional cardiologist and Director of

inside the heart such as valve disease) and we plan to do more high

Interventional Cardiology. He is board-certified in five specialties:

level interventions in the cath lab. We still do traditional open-heart

internal medicine, cardiology, interventional cardiology, nuclear

surgery, but we also do a lot of minimally invasive surgery.

cardiology and vascular medicine. With Andy C. Kiser, M.D.,

“On the horizon, we will expand our structural heart disease

Dr. Zuzek performs a catheter-based procedure known as TAVR —

program (care of valve problems)

transcatheter aortic valve replacement — that replaces open-chest

and will offer new procedures.

surgical valve replacement for the treatment of aortic stenosis. TAVR

Major outreach education

was originally intended for frail patients for whom major surgery is

efforts, with an emphasis

too risky. Now it has been made available to lower-risk patients, and

on preventive care, will

Drs. Kiser and Zuzek are performing the procedure regularly and are

be provided to the region.

achieving excellent, life-changing outcomes for patients.

This is a golden period

“We just completed our first year of TAVR,” Dr. Zuzek says.

for cardiology, with great

“I did four of them today, and that was a great day. It’s wonderful to

technological advances

offer these advanced procedures to the patients. I couldn’t be more

ahead. The future is bright,

pleased with how things are going.”

and it’s a great time to be

Dr. Zuzek has played a key role in the evolution of St. Clair’s cardiology program, by envisioning an expansion of technological

a cardiologist at St. Clair Hospital.” n

capabilities, expertise and options for patients. He advocated for the recruitment of cardiac specialists, and that in turn led to the development of the new services and procedures. “It may have

Ryan W. Zuzek, M.D., FACC

seemed a little ambitious at the time,” he recalls. “But the Hospital administrators and the cardiologists wanted to exceed any limits.”

RYAN W. ZUZEK, M.D., FACC Dr. Zuzek specializes in cardiovascular disease and interventional cardiology. He earned his medical degree at the University of Ireland in Galway. His postgraduate training includes an internal medicine residency at Cleveland Clinic, where he was later an attending physician. He completed cardiology and interventional cardiology fellowships at Brown University-affiliated hospitals in Providence, R.I. Dr. Zuzek is board-certified in internal medicine, cardiology, interventional and nuclear cardiology and vascular medicine. He practices with St. Clair Medical Services. To contact Dr. Zuzek, please call 412.429.8840. Volume XII Issue 2 I HouseCall I 21

ADVANCED CARDIAC CARE Continued from Page 21

Comprehensive Heart Failure Program at St. Clair offers advanced treatment and therapies

eart failure is a serious and complex disease that makes

represents a significant advancement in the way we care for

enormous demands on those who have it, and on those

patients with heart failure.”

who care for them. It is characterized by progressive,

In the past, patients with heart failure could be admitted to

sometimes severe symptoms and limitations that can be

any unit in the Hospital. Now, all patients with a diagnosis of heart

overwhelming, altering life in many significant ways. Heart failure

failure will be admitted to the new, dedicated unit, making it easier

can take away one’s health, breath, energy and mobility, but at

for Dr. Pray and the special heart failure team to hone in on the

St. Clair Hospital, it cannot take away hope.

problems patients are experiencing. They will make daily

A new patient unit for the care of patients with heart failure

collaborative patient rounds and will be able to devote more

has opened at St. Clair, bringing a fresh and all-encompassing

time to each patient. Patient education will be a priority: learning

approach to the management of this common, debilitating

self-management strategies, such as daily weight checks, is a key

condition. Christopher Pray, M.D. is the leader of the Heart Failure

to preventing complications.

program, and he brings a new philosophy to the effort. “My vision

Patients with heart failure present at all ages. “We see a lot of

is to simplify and consolidate all services for heart failure patients

younger patients who were healthy until they suffered a viral infection

into a single unit where an expertly trained, experienced, multi-

or myocardial infarction, and then developed heart failure as a

disciplinary team will provide the highest quality care. Our goal

result. We fear we may soon see a rise in the number of patients

is to improve the quality and longevity of our patients’ lives through

with heart failure following COVID-19 infection. Fortunately we are

cutting-edge therapies, meticulous symptom management, and

well-equipped to make these challenging diagnoses with our

support services at home.”

advanced cardiac imaging program at St. Clair, which is a tremendous

Dr. Pray believes that the Heart Failure team will accomplish several important goals: improved quality of life for patients;

complement for our Heart Failure program.” Heart failure is a complex syndrome that exacts a heavy toll

delayed progression of disease; symptom relief; and reduction of

on patients and their families. Patients may struggle with

hospital admissions and emergency room visits. Often, heart failure

shortness of breath, fluid retention, weight loss or gain, fatigue,

patients with very complex disease require re-admissions due to

and exercise intolerance. Dr. Pray is sensitive to all of these problems

worsening symptoms.

and their impact on the lives of his patients. Throughout his time

Dr. Pray says that this can be traumatic for the patient and can lead to further debilitation due to inactivity during hospitalization.

as a cardiologist and Director of Non-Invasive Cardiology at St. Clair, Dr. Pray has cared for many patients with complex heart

“Our integrated, collaborative team manages admissions

failure and recognized the need for a special program. “We care

efficiently and effectively, with a seamless transition to home, so

for a very large number of patients with heart failure at St. Clair,

that the patient can thrive at home. This requires that we address

many of whom have complex cases and travel long distances to

every facet of heart failure, and engage every member of our team:

St. Clair for the quality of our cardiac care. I embrace these

nurses, nurse practitioners, physical and occupational therapists,

challenging and complicated medical scenarios, but am always

dietitians, pharmacists, case managers, respiratory therapists,

asking myself, ‘What can we do differently to help these patients?’

cardiac rehabilitation specialists and others. My colleagues in

This is our answer: a team of very talented and experienced health

the heart failure unit, Dr. James Marcucci and Dr. George Cater,

care professionals coming together to solve a complicated

and the patients’ primary care physicians, will all be tremendous

problem by offering our very best. We’ve been planning and preparing

partners in this endeavor. The team is excited and every one of us

for this program for over one year, and we are ready and highly

wants this to succeed. We believe that having this special unit

motivated to improve the lives of heart failure patients.” To contact the Heart Failure program, please call 412.942.7900.

22 I HouseCall I Volume XII Issue 2

PROFILES IN CARDIAC CARE AT ST. CLAIR

CHRISTOPHER PRAY, M.D., FACC

Revolutionizing cardiac care at St. Clair CHRISTOPHER PRAY, M.D. is a cardiologist whose sub-specialty,

Dr. Pray, who trained at UPMC, is justifiably proud of the cardiac

cardiac imaging, is revolutionizing the diagnosis and treatment of heart

MRI program and its exceptionally well-qualified team. “Our cardiac

disease. At St. Clair Hospital, Dr. Pray has established a cutting-edge

MRI technologists are phenomenal and it’s a privilege to work with

cardiac MRI program that uses state-of-the-art imaging technology that

them. George Cater, M.D., has recently joined our team and is a

provides remarkably informative images of the heart, facilitating the

world-class cardiologist who also has advanced imaging expertise.

diagnosis of complex problems. “I’ve been at St. Clair for three years

Dr. Cater will be a tremendous partner as we grow our program.”

now and in that span I’ve seen dramatic advances in how we provide

The evolution of St. Clair’s cardiovascular program is

care to heart patients. It’s tremendously exciting. I was fortunate to be

exhilarating for Dr. Pray. “I’m excited about how far we have come,

put in a leadership position early on in my career, as Director of Cardiac

and passionate about continuing to improve the quality of our care.

Imaging, which gave me the opportunity to advance our capabilities

We have a team of young and exceptionally well-trained

in cardiac diagnostics. Within our cardiac MRI, echocardiography and

cardiologists who chose to come to St. Clair and intend to stay here,

nuclear cardiology labs, we now recognize complex cardiac problems

to continue building this program. We have attracted renowned

faster and with greater precision. Our imaging technology enables us to

cardiologists and cardiac surgeons like Andy Kiser, M.D. and

address a broader array of pathology. Now, we offer advanced solutions

Muhammad Salman, M.D. Our reputation for excellence is growing.

to our patients with complex problems right here at St. Clair.”

We now routinely see patients referred to St. Clair for specialized diagnostic tests and for care of complex heart problems. Some of these patients are traveling considerable distances. With our technology and level of skill, we routinely diagnose under-recognized causes of heart failure, such as amyloidosis, a disease in which proteins accumulate in the heart. We have made this diagnosis in several patients who had previously been cared for at other hospitals, yet the condition was missed.” n

Christopher Pray, M.D., FACC

CHRISTOPHER PRAY, M.D., FACC Dr. Pray specializes in cardiovascular disease and cardiac imaging. He earned his medical degree at SUNY Upstate Medical University, Syracuse, N.Y. and completed his residency at UPMC. He also completed fellowships in cardiology and cardiac MRI at UPMC. Dr. Pray is board-certified by the American Board of Internal Medicine in internal medicine, cardiology and echocardiography. He practices with St. Clair Medical Services. To contact Dr. Pray, please call 412.942.7900. Volume XII Issue 2 I HouseCall I 23

ADVANCED CARDIAC CARE Continued from Page 23

St. Clair’s EP lab provides state-of-the-art diagnosis and treatment of heart rhythm disorders

t may come as a surprise to learn that the heart relies on

I interpret the information from the electrodes to identify the areas

electricity to do its vital job of pumping blood to every tissue

to ablate.” Although all invasive procedures entail risk, EP studies

in the body. It’s a form of natural energy that is created by ions

and ablation carry just a 2 percent to 4 percent risk of any

that flow within the heart muscle and create electrical impulses.

complication, Dr. Liu says, and the most common one is minor

These impulses drive the heart’s contractions, which propel blood

bleeding at the catheter insertion site at the groin.

through the chambers and create the heartbeat. In a healthy heart,

September was Atrial Fibrillation Awareness Month in the U.S.,

the impulses travel in a regular, strong, rhythmic pattern, but this

notes Dr. Liu. “The incidence of atrial fibrillation is increasing

pattern can be disrupted, resulting in an erratic, rapid or irregular

explosively, due primarily to the aging of the population, especially

pattern known as an arrhythmia.

the Baby Boomers, and to the fact that Americans are living longer

The branch of cardiology that deals with the heart’s electrical

lives. As the heart ages, it manifests its age. But we are seeing

system is electrophysiology (EP), a relatively new subspecialty that

atrial fibrillation in younger adults in their 50s; contributing factors

is rapidly growing. “Electrophysiology is a dynamic field,” says

such as obesity and high blood pressure overlap with unhealthy

Jeffrey C. Liu, M.D., a cardiologist and electrophysiologist who is

lifestyles and the arrhythmia can be the result.”

the director of St. Clair’s EP Lab. “Traditionally, people tend to think

St. Clair has the most advanced EP technology for treating

of heart problems as blockages and heart attacks, so many are

arrhythmias and for the implantation of devices such as pacemakers.

surprised to learn that this field even exists. But disturbances in the

Dr. Liu says that the EP program is a great service for the region.

heart’s rhythm are common.”

“Many people in this area have A Fib and other arrhythmias, so the

Dr. Liu arrived at St. Clair Hospital in 2013 to direct the

need is great and we have a very successful program. There is an

Hospital’s new Electrophysiology Lab, where he performs diagnostic

advantage in being able to come to St. Clair, not only because of

and therapeutic procedures to treat atrial fibrillation, the most

the proximity to home but also because you will see the same EP

common arrhythmia, as well as various forms of tachycardia (rapid

physician every time — me. At larger institutions, it may be more

heartbeat), and other electrical conduction system disorders.

difficult to see the same doctor on multiple occasions. This is

“We’ve made tremendous progress advancing the EP program

important because you can build a relationship, and that familiarity

at St. Clair. We are doing ablations, a procedure in which we place

can be a comfort to the patient.”

special catheters into the heart through the large blood vessels

To contact Dr. Liu, please call 412.942.7900.

in the groin, so that we can study the heart’s electrical patterns, identify the source of any abnormal heart rhythms and make an accurate diagnosis. We then deliver targeted burns to a tiny area of the heart tissue to create a controlled scar that acts as an impediment to the erratic signals that produce atrial fibrillation. Today we are doing complex ablations, the most advanced form, using equipment that we didn’t have back then.” An EP study may be ordered by one’s cardiologist or primary care physician and is an outpatient procedure that is performed in St. Clair’s EP lab. With the patient intubated and under general anesthesia to assure their immobilization during the delicate procedure, Dr. Liu threads a very thin catheter with electrodes on the tip into the femoral vein and directs it to the heart. “The electrodes record the electrical activity of the heart,” he explains. “They detect electrical activity wherever they touch, revealing patterns. This is called cardiac mapping and it’s very precise; it tells me where the arrhythmia is originating. 24 I HouseCall I Volume XII Issue 2

Jeffrey C. Liu, M.D., FHRS

PROFILES IN CARDIAC CARE AT ST. CLAIR

JEFFREY C. LIU, M.D., FHRS

A highly specialized director of Cardiac Electrophysiology For Jeffrey C. Liu, M.D., coming to St. Clair Hospital was a

The community needs the Hospital to provide this high level of

matter of perfect timing. He was just finishing fellowships in

cardiac services, Dr. Liu says. “The need is there. Heart disease is

cardiology and cardiac electrophysiology, a highly specialized

not going away; it remains the #1 cause of death in this country.

field, when he learned from colleague John Girod, D.O., that

With the plagues of obesity and diabetes, many people will develop

St. Clair was expanding its cardiology program and enhancing its

heart disease. Almost every kind of heart disease can be treated

electrophysiology program to treat cardiac arrhythmias (disorders

here. The future of heart care at St. Clair is very bright. There are

of the heart beat). Liu was exceptionally well qualified to direct the

new technologies coming in electrophysiology, plus new pacemakers

program, and with him at the helm for the past seven years,

and innovative procedures to improve outcomes for people with

St. Clair has developed a robust, state-of-the-art Cardiac

A Fib. There will also be more emphasis on preventive cardiology

Electrophysiology program.

in the future.”

The EP Lab is a bright light within St. Clair’s cardiology program.

Dr. Liu is one of relatively few cardiac electrophysiologists in

Dr. Liu and his team, using cutting-edge technology, perform

the region. He graduated from Jefferson Medical College in

complex ablation procedures to treat atrial fibrillation, the most

Philadelphia and completed his residency at the University of

common arrhythmia, and other disorders. “This service had not

Maryland Medical Center. He then went on to complete fellow-

been offered in the past at St. Clair; patients who needed complex

ships in cardiology and cardiac electrophysiology at UPMC, and is

ablations were referred to academic medical centers. Today, it’s

board-certified in both cardiology and cardiac electrophysiology.

rare for us to refer a patient; we’ve grown the program substantially

Dr. Liu specializes in complex cardiac ablation, and at St. Clair,

and we do many ablations. When the volume is high, outcomes are

he performs ablation for AF with the novel cardiac cryoballoon, as

better. The demand for this is great and in order to offer it, you have

well as radiofrequency ablation. With

to have all the resources to back it up: the critical care services and

Dr. Kiser, he performs convergent

supports. Not every hospital can provide this, and it’s exceptional to

hybrid ablation, a pioneering

find a high quality EP Lab outside of the city. St. Clair was one of the

procedure developed by Dr. Kiser

first hospitals in the region to offer this highly specialized service.”

that combines electrophysiology

Dr. Liu says that St. Clair’s multidisciplinary team of cardiologists, cardiac surgeons, other specialists and support staff is unrivaled.

and cardiothoracic surgery to treat severe A Fib. n

“We’re growing profoundly and it’s an exciting time. We have a group of young talented doctors pushing forward. The staff, in the Hospital and the offices, are very skilled and caring. Our team collaborates and communicates very well, with lots of discussion

Jeffrey C. Liu, M.D., FHRS

and sharing. This translates to better care for patients.”

JEFFREY C. LIU, M.D., FHRS Dr. Liu specializes in cardiovascular diseases, interventional cardiology and cardiac electrophysiology. He 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 fellowships in Cardiovascular Medicine and 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 St. Clair Medical Services. To contact Dr. Liu, please call 412.942.7900. Volume XII Issue 2 I HouseCall I 25

ADVANCED CARDIAC CARE Continued from Page 25

The New Heart Valve Clinic at St. Clair provides a multidisciplinary approach to diagnosing and treating heart valve disease

new Heart Valve Clinic has opened at St. Clair Hospital,

through the heart’s four chambers and out to the body. If the valve

offering options and solutions along with very specialized

opening has become too narrow, a condition called stenosis, the

care to persons who have been diagnosed with this

heart muscle is forced to pump harder to propel the blood; this is a

common form of heart disease.

compensatory mechanism, but it will eventually fail. If the valve has

“Our valve program has been growing and we now offer

weakened and fails to close properly, the blood may backflow, a

advanced therapies for complex valve disease and heart failure

condition called regurgitation. Valve disease can be asymptomatic,

at St. Clair,” says the Hospital’s Chief of Cardiac Surgery

but if it worsens, symptoms will develop: shortness of breath, low

Andy C. Kiser, M.D. “The Valve Clinic is a multidisciplinary

energy, and loss of stamina are common. The greatest concern is

program to treat people with any form of valve disease.

that valve disease can lead to heart failure, which can be fatal.

We’re excited to be able to offer the most advanced options for valve treatment to the community.”

“We work in concert with your primary care physician to initiate valve disease treatment,” explains Dr. Kiser. “Referrals

When Dr. Kiser became the Chief of Cardiac Surgery at

to the Valve Clinic come from other cardiologists as well as from

St. Clair two years ago, he envisioned a comprehensive program

primary care physicians. Diagnosing valve disease involves an

for advancing the diagnosis and treatment of heart valve disease.

echocardiogram, cardiac MRI, and sometimes a cardiac catheter-

Dr. Kiser is an internationally recognized expert in this form of

ization or CT scan. It’s very individualized, and not everyone needs

heart disease: he pioneered minimally invasive technology used

surgery. These studies tell us how advanced the valve disease is.

for the repair and replacement of heart valves, including

If your echocardiogram test is abnormal, we establish you in our

transcatheter aortic valve replacement, or TAVR. TAVR has made

program and we monitor you. We deliver guideline-based

it possible for Dr. Kiser and other cardiothoracic surgeons to avoid

treatment and we have a multidisciplinary team conference every

the traditional open chest approach to valve surgery, offering many

week to discuss our valve patients in detail.”

patients a significantly easier experience, a faster recovery and minimal scarring.

Christopher Pray, M.D., St. Clair’s Director of Cardiac Imaging, is an expert in cardiac MRI and, with Dr. Kiser, is coordinating

Over 5 million people are diagnosed with heart valve disease

the Valve Clinic. “Our Heart Team, consisting of an interventional

every year in the U.S., according to the American Heart Association,

cardiologist, imaging specialist and surgeon, meet at length every

and that number is rising due largely to the aging of the population

week in order to discuss all patients with complex heart valve

and increasing longevity. Valve disease can be acquired or congenital.

disease who are referred to us for advanced treatment,” Dr. Pray

When it is acquired, it is most likely the result of other heart

says. “We present each case and consider all possible treatment.

conditions, such as high blood pressure,

We give special attention to those patients who have the highest

infection, and lifestyle-related issues

need for our intervention. We communicate with each other about

like smoking.

these patients constantly, even between the weekly conferences.”

Heart valve disease means that one

The Valve Clinic expedites the care of patients with valve

or more of the heart’s valves are not

disease and enables the Heart Team to provide care that is

functioning normally. The heart has

patient-centered, highly individualized and efficient. “We can

four valves, each with tissue flaps that open and close with

get patients in to be seen very quickly; there are no delays now that there is a dedicated clinic,” Dr. Pray says. “Valve disease is

each heartbeat. These

increasing and we see quite a bit of it, but our valve program is

flaps make certain

growing and provides state-of-the-art care. At St. Clair we offer

that blood flows in the right direction,

solutions, and that is great news for patients.” To contact the Valve Clinic, please call 412.942.5728.

Andy C. Kiser, M.D., FACS, FACC, FCCP, MBA

26 I HouseCall I Volume XII Issue 2

PROFILES IN CARDIAC CARE AT ST. CLAIR

JOHN P. GIROD, D.O., FACC

A staunch advocate of preventing heart disease Cardiovascular disease is the leading cause of death and

New technologies for noninvasive cardiac diagnostics are changing

disability among American adults. It kills more people every year

the future of heart care; we are ramping that up and it will be

than all other causes of death combined. On an average day, 3,000

fantastic for both patients and the Hospital.”

Americans will die of cardiovascular disease. It causes great suffering,

For the region, the expansion of cardiac services means access

costs the nation billions, affects nearly every American family and

to the most advanced care, close to home. Dr. Girod explains that

may result in life-altering disability. But cardiovascular disease is

this is more than a matter of convenience and comfort — it can be

mostly preventable, says John P. Girod, D.O., an interventional

a matter of life or death. “A lot of heart treatment is time-based,

cardiologist at St. Clair Hospital. Dr. Girod is a staunch advocate

so you are better off if you can get the treatment you need without

of prevention, which he says is often a matter of managing

having to travel a distance. We have an excellent, busy ER with a

cholesterol. “Cardiologists are managing heart disease better,

lot of experience treating people with myocardial infarctions, or

before it is symptomatic and there is a need for intervention. People

heart attacks.

with high cholesterol, and a family history of heart disease, need

Treating a patient who is having a myocardial infarction (MI), a

to have preventive care early. The key to helping people with heart

life-threatening event, is deeply satisfying, Dr. Girod says. “There’s

disease is getting it under control aggressively, with medication,

nothing like that feeling, when you have intervened and guided the

healthful eating and exercise. I practice what I preach — I’m diligent

person through an MI, possibly saving their life. My Dad died of an

about diet and I’m a runner.”

MI, which inspired my decision to become

Those who have heart disease will find complete cardiac care at

a cardiologist.” n

St. Clair, Dr. Girod says. “Our cardiac care services are outstanding, whether you have coronary artery disease, atrial fibrillation or another problem. We have exceptional patient safety and excellent outcomes. Our cardiologists, cardiac specialists and cardiac surgeons are seasoned professionals with enormous experience. We have an outstanding, busy cardiac catheterization lab with an excellent staff. Our Electrophysiology Lab is state-of-the-art. The nursing care is excellent.” During his 11 years at St. Clair, he has witnessed changes that have catalyzed the growth of the cardiac care program. “We have become very forward thinking; we don’t simply accept the status

John P. Girod, D.O., FACC

quo. We keep seeking new and better ways to deliver the best care possible and to offer the community truly complete cardiac services.

JOHN P. GIROD, D.O., FACC Dr. Girod specializes in cardiovascular diseases and interventional cardiology. He earned his medical degree at the Philadelphia College of Osteopathic Medicine. Dr. Girod completed an internal medicine residency at the Cleveland Clinic, as well as a cardiovascular medicine fellowship and an interventional cardiology fellowship at the University of Pittsburgh Medical Center. He is board-certified in interventional and general cardiology. Dr. Girod practices with St. Clair Medical Services. To contact Dr. Girod, please call 412.942.7900. Volume XII Issue 2 I HouseCall I 27

COLON CANCER CARE

Sharp Rise in Colorectal Cancer Rates Among Young Adults When actor Chadwick Boseman died last summer at age 43 from colon cancer, it came as a shock to many. Boseman was a rising star, in demand and very popular with young fans of his megahit, â&#x20AC;&#x153;Black Panther.â&#x20AC;? Few were aware that he had

olorectal cancer is the third leading cause of cancer deaths in the U.S., and the third most common cancer in men and women. The incidence of colorectal cancer diagnoses has dropped

overall, but is rising in young age groups. In 2020, approximately 12 percent of colorectal cancer cases will be diagnosed in people under age 50; rates have been rising since the mid-1980s in adults age 20-39, and since the mid-1990s in adults age 40-54, according to the American Cancer Society (ACS). New cases of colorectal cancer in adults under 55 have increased

been diagnosed with Stage III colon

almost 2 percent every year since the mid-90s and death rates in this

cancer in 2016. Bosemanâ&#x20AC;&#x2122;s tragic death

in 1990 have twice the risk of colon cancer and four times the risk of

unfortunately fits an emerging pattern

uncertain of exactly what is driving this increased incidence of colorectal

group are also rising. A study by the ACS in 2017 found that adults born rectal cancer compared to those born around 1950. Researchers are

of colorectal cancer incidence among

cancer in young adults, and some studies have shown that younger

younger people.

diagnosed at Stage 3 or 4. It may be that the cancer is diagnosed later

adults have more aggressive cancer and worse prognoses when in younger people, since the symptoms are less likely to be recognized as signs of colon cancer. One thing that is certain is that a colonoscopy remains the gold standard for early detection of colorectal cancer. Consult with your primary care physician or gastroenterologist to determine if your age, family history, or symptoms warrant testing. Continued on Page 30

28 I HouseCall I Volume XII Issue 2

WHAT YOU NEED TO KNOW ABOUT

COLORECTAL CANCER

MORE THAN

140,000 50

AMERICANS ARE DIAGNOSED EACH YEAR WITH COLORECTAL CANCER

50,000

90%

LEADING CAUSE OF CANCER DEATHS IN THE U.S.

will die from the disease every year 50 in the U.S.

SCREENING IS KEY

will get colon cancer in their lifetime

SURVIVAL

RATE

WHEN CANCER IS FOUND

AND TREATED EARLY

1in 20

IS THE RECOMMENDED SCREENING AGE

YET

1in3

ADULTS AGED 50+ ARE NOT BEING SCREENED

05 Volume XII Issue 2 I HouseCall I 29

COLON CANCER CARE Continued from Page 28

TOM SINTON

On the road again For Tom Sinton, 45, of South Fayette, the diagnosis of rectal cancer came as a complete surprise. A software developer, Virginia Tech graduate and husband of 19 years to Amanda and the father of three (Nate, 15; Emily, 14; and Luke, 12), Sinton was living a fulfilling life, with work he enjoyed and a thriving family. His cancer journey began with subtle changes in his bowel habits, in the spring of 2019. “It was just a change in frequency, not a big deal at all,” he recalls. “Then I saw blood in August. I had a colonoscopy which revealed a tumor in my colon.” It was a shock, Sinton says. “When you see blood, you know it could mean cancer but you tell yourself it’s probably not, especially when you are young. I never expected to hear the word “cancer,” even though my father had a brain tumor during my childhood. It’s a very emotional experience, to be told that you have cancer. Amanda and I wanted to get going right away to fix it, to find the right people to take care of it.” They did — they found Leigh H. Nadler, M.D., Chief of Colon and Rectal Surgery at St Clair Hospital. Dr. Nadler is an experienced and highly respected colorectal surgeon, and was recommended to the Sintons by a friend. Dr. Nadler assessed the tumor and referred Sinton to medical and radiation oncology for preoperative treatment. Following a five-week course of radiation and chemotherapy to decrease the size of Sinton’s tumor Dr. Nadler performed a successful robotic-assisted low anterior rectal resection of Sinton’s rectal cancer. Fortunately, the preoperative treatment down-staged the tumor and 40 lymph nodes removed were found to be normal. Sinton was discharged after three days of hospitalization and had an excellent recovery. A vascular port was placed by Dr. Nadler for additional postoperative intravenous chemotherapy. Tom Sinton dribbles a soccer ball in his backyard in South Fayette.

30 I HouseCall I Volume XII Issue 2

Colorectal surgeons can choose among different approaches

anything and he will give you a clear explanation. He walked me through

depending on the nature of the condition and the needs of the individual.

this entire experience in a personal way. I would recommend him to

At St. Clair, Dr. Nadler says, those options include traditional open

anyone. The second thing is that the care at St. Clair was amazing. My

surgery, laparoscopic surgery, robotic-assisted surgery, as Traditional open surgery involves a longer incision associated with more postoperative pain, slower return of bowel

operations took place five months apart, but when I was

“

well as transanal endoscopic microsurgery (TEMS).

admitted for the second surgery the nurses remembered me — all of them. They gave me excellent care and a lot of

function and a longer hospital stay. “Most colorectal

...the care at

conditions can be addressed with minimally invasive

St. Clair was

laparoscopic or robotic-assisted surgery,” Dr. Nadler says. “Robotic-assisted surgery provides a significant advantage

amazing.

for the patient, since we can see structures more clearly, which means that there is less risk of an injury, especially to nerves and blood vessels.” Dr. Nadler, his partner Scott A. Holekamp, M.D., and

”

emotional support. My second surgery took place during the COVID-19 pandemic, so I was alone in the Hospital. But the care was so great that I almost didn’t miss my family,” he says with a laugh. “At St. Clair, everyone is professional, but personally caring.” Sinton is still recovering but improving every day and

TOM SINTON, PATIENT

other surgeons at St. Clair use the da Vinci XI, the most

drawing strength from his Christian faith. He received a major boost in his spirits when he decided to take a trip with his daughter Emily to Cincinnati, where she was playing in a Club soccer game. “I had not done much driving, and I was nervous

advanced robotic surgical system available. “Robotic-assisted surgery

about it, but I wanted to do this for my daughter and myself. It was an

is really laparoscopic plus robotic surgery; the robot is simply a tool,”

awesome experience for us: the road trip, the game and the hotel were

explains Dr. Nadler, who has over 10 years of experience with robotic

wonderful. It gave me back my confidence and a wonderful memory with

surgery. “We control the movements of the robot. Through several small

Emily. I want to live a long life and always be there for my kids.” n

incisions, we insert thin instruments and a camera that enables us to see in 3D. My hands move the instruments and they respond immediately, moving exactly like my hands and wrists. I can view high-definition, 3D, magnified images from the robotic camera on a video screen. Robotic-assisted surgery is especially good for pelvic surgery an provides a significant advantage for treating rectal cancer, in that it allows to you to operate deep into the pelvis, since the instruments are longer and the camera is thinner. The da Vinci is especially helpful in men with a very narrow pelvis, since there is limited working space for a surgeon.” Following the resection, Sinton was given a second course of chemotherapy from March through June, and Dr. Nadler removed the chemo port and reversed the temporary ileostomy in July. “Tom has had a great outcome,” Dr. Nadler says. “His prognosis is excellent: 40 lymph nodes were removed during the surgery and all were clear. His postoperative bowel function is back to normal.”

Leigh H. Nadler, M.D.

Although it has been a rough year, there were aspects of his experience that Sinton cherishes. “I felt that I was in good hands with Dr. Nadler; he was always very open and easy to talk to. You can ask him

LEIGH H. NADLER, M.D. Dr. Nadler specializes in colon and rectal surgery. He earned his medical degree at Rosalind Franklin University of Medicine & Science (Chicago Medical School). He completed a residency and internship at Beth Israel Medical Center Mount Sinai School of Medicine, New York, N.Y., as well as a fellowship in colon and rectal surgery at the University of Illinois - Carle Foundation Hospital, Urbana, Ill. He is board-certified by the American Board of Colon and Rectal Surgery and the American Board of Surgery, and practices with St. Clair Medical Services. To contact Dr. Nadler, please call 412.572.6192. Volume XII Issue 2 I HouseCall I 31

COLON CANCER CARE Continued from Page 31

CHRISTOPHER BABIRAD

Back on patrol Christopher Babirad, 49, is a strong and athletic man who has served

have robotic-assisted surgery, but that plan was altered. Dr. Holekamp

as a Pennsylvania State Trooper for 21 years. A former college football

explains: “We didn’t need the robotic system. The chemo and radiation

star at Washington and Jefferson College and a father of three (Ryan, 26;

were done upfront and were so effective that his tumor was almost

Alex 23; and Noah, 18), Babirad lives in McDonald. He is attentive to his

entirely gone at the time of surgery, and what was there was accessible

health and fitness, so it was a bit out of character for him when he delayed

with laparoscopy. Chris is one of the 25 percent of people who have

telling his primary care physician that he was passing blood with bowel

such a great response to medical treatment. The lymph nodes were all

movements. “At first it was just occasionally, but it became more consistent,”

negative for cancer, so we got the tumor out completely. It was the best

he recalls. “I was worried: I knew it might mean cancer, but I kept looking

possible outcome.”

for other explanations. I did a lot of Internet research – maybe it’s this

Dr. Holekamp performed a specialized procedure known as a total

condition or that one. It was nearly a year before I finally told my PCP. His

mesorectal excision, or TME. The mesorectum is a thin membrane that

physician assistant ordered a colonoscopy and when I woke up in recovery

consists of the tissues that surround the rectum, including the lymph

they told me I had a mass the size of a lemon right at the bottom of my

nodes. Using meticulous surgical technique to remove the mesorectum

colon. The gastroenterologist, Nicholas A. Bellicini, D.O., said it’s most

without tearing or perforating it, Dr. Holekamp resected the rectum plus

likely cancer and then the pathology confirmed that. This happened last

a margin of healthy tissue. “TME is a surgery that you might not expect

year on Christmas Eve.”

to find at a hospital outside the city,” Dr. Holekamp says. “The quality

Babirad was referred to Dr. Holekamp at St. Clair and also to

of this surgery was perfect, and as a result we can maximize Chris

Robert A. VanderWeele, M.D., an oncologist and hematologist, for medical

Babirad’s longevity without the cancer recurring and with minimal

treatment of the cancer. “I was scheduled to have the surgery but I had

side effects.”

a repeat colonoscopy the day before and based on that, the doctors decided to hold off on the surgery and give me medical treatment first,” he says. “I started six weeks of chemotherapy and radiation.

It was a long ordeal for Babirad, and it coincided with the beginning of the COVID-19 pandemic, but he says that his doctors made the whole process easier. “My doctors, including Felicia E. Snead, M.D., my radiation oncologist, were great and St. Clair gave me excellent care.

I took chemo pills twice a day but it was

I felt safe and comfortable there and I was always treated well. The

the radiation that beat me up the most:

radiation oncology department at St. Clair Hospital Cancer Center is great.”

28 treatments, Monday through Friday. I had side effects and couldn’t work. I had to wait eight weeks for the radiation to clear before finally having the surgery.” In May, Babirad underwent a rectal resection, performed by

Babirad feels healthy now and has gone back to work full time. He says the cancer journey makes you face your mortality and he offers the wisdom he gained through his experience: “At the first sign of a problem, see your doctor. Don’t delay. I tried to tell myself it was something else, but it was cancer. What helped me through it was the positive attitudes of my doctors, Holekamp, VanderWeele and Snead, who were informative and supportive. My girlfriend, Elaine McMullen, is an emergency room

Dr. Holekamp. Their

tech so she was very helpful, too. I felt lucky that I had been referred

original plan was

to the very best physicians and received care at the very best hospital,

for Babirad to

St. Clair.” n

Scott A. Holekamp, M.D.

SCOTT A. HOLEKAMP, M.D. Dr. Holekamp specializes in colon and rectal surgery. He earned his medical degree at University of Cincinnati College of Medicine, and completed a residency in general surgery at Beth Israel Medical Center in New York City. He then completed a fellowship in colon and rectal surgery at the University of Miami/Jackson Memorial Hospital. He is board-certified by the American Board of Colon and Rectal Surgery and the American Board of Surgery. Dr. Holekamp practices with St. Clair Medical Services. To contact Dr. Holekamp, please call 412.572.6192. 32 I HouseCall I Volume XII Issue 2

Christopher Babirad

“

I felt lucky that I had been referred to the very best physicians and received care at the very best hospital, St. Clair.

”

CHRISTOPHER BABIRAD, PATIENT

Volume XII Issue 2 I HouseCall I 33

NATIONAL LEADER IN QUALITY

AT ST. CLAIR, CULTURE DRIVES QUALITY The highest quality care, in the safest environment: this is the hospital experience that every patient hopes to have, and it is the experience that St. Clair Hospital delivers

t. Clair’s culture is distinctive for its commitment to patient-

patient — to design their work in the best way possible for quality,

centered care and constant improvement. Putting what is

safety, and high reliability.

best for the patient first at all times, the staff provides care

Staff members, especially those on the front lines who interact

that is clinically excellent, individualized, safe and compassionate.

directly with patients, are encouraged

“At St. Clair, there is a culture of listening and learning,” says Tania

to identify problems and offer

Lyon, Ph.D., Director of Organizational Performance Improvement.

solutions that will improve

“The staff is open and willing to keep learning, making changes and

processes, advance

corrections as needed in order to improve.”

patient safety and

Over 12 years ago, St. Clair committed to using a proven

optimize the patient

methodology for organizational improvement: lean engineering.

experience. Managers

Lean — pioneered locally by Alcoa under the leadership of former

are supportive and

CEO Paul O’Neill, Sr., who, sadly, passed away last April, and then

the work environment

by the Pittsburgh Regional Health Initiative under the leadership

is structured to empower

of O’Neill and Dr. Karen Wolk Feinstein — is a systems approach

staff members, rather

to reducing unnecessary variability in processes (which can waste

than restrict them, so

resources and create opportunities for error), thus improving quality

they feel comfortable

for the patient and reducing cost at the same time. With Lean, the

giving input.

laser focus is first on understanding patient need and then on how to fulfill that need as perfectly and effortlessly as possible. With perfection always out of reach, Lean demands a culture of striving, questioning, learning, and constantly improving. In health care, this translates into training care providers to be scientific experimenters as they focus on getting every patient high quality, needed care with no mistakes or delay. It helps align the silos of health care into flexible, responsive, connected, seamless pathways of care. It empowers those on the frontline — closest to the

34 I HouseCall I Volume XII Issue 2

Tania Lyon, Ph.D.

Diane L. Puccetti, R.N., BSN, MS, Vice President and Chief Nursing

2012, including the last three years,

Officer, says nurses in this environment feel comfortable speaking out,

a distinction that only 32 hospitals

and they get results. There is no better example of this than nursing’s

across the country, and none in western

Professional Practice Council, says Puccetti. “Our Professional

Pennsylvania, can claim. IBM® Watson

Practice Council is composed of representatives from every nursing

Health™ evaluates all acute care

unit. They are frontline staff who continuously work toward improving

hospitals in the U.S., assessing

the outcomes of their nursing practice, most recently redesigning

their patient safety, quality of

the admission profile to enhance the patient’s plan of care while

care, patient satisfaction, and

hospitalized. The frontline nursing staff knows what they need and

efficiency of operations. Ekta S. Punwani,

they know how to solve problems.”

the 100 Top Hospitals®

“

program leader at IBM®

The best hospitals, like St. Clair, create a strong foundation and culture of quality.

”

EKTA S. PUNWANI 100 TOP HOSPITALS® PROGRAM LEADER, IBM® WATSON HEALTH™

Watson Health™, says being a repeat winner means a hospital is a high reliability organization. “The best hospitals, like St. Clair, create a strong foundation and culture of quality. Patients are looking for this: a hospital that has strengths, including quality

“The staff on the front lines know what is needed,” confirms Dr. Lyon. “They are the experts and their feedback is critical. They are uniquely connected to the patients and the families, and they are

in both the delivery of care and in hospital operations.”

Diane Puccetti, R.N., BSN, MS Vice President and Chief Nursing Officer, St. Clair Hospital

A patient-centered culture

always listening. Listening well is a significant part of our care; it

prioritizes patient safety, and St. Clair excels in providing an

enables us to understand the patient experience. Quality care is the

environment of care that protects patients from harm. “Patients and

foundational building block of patient satisfaction. And we measure

families can trust St. Clair Hospital,” says Anne Mitchell, R.N., BSN,

everything to improve care, systems, processes and outcomes. At

MS, CPHQ, CPPS, Director of Patient Safety, at St. Clair. “Their health

St. Clair, this effort is a constant.”

outcomes matter deeply to us and we are continually working to

That effort has earned St. Clair a number of prestigious national honors, including two recent ones that validate the exceptional quality of care provided to patients: being ranked among the 100 Top

provide the safest possible environment for the patients we serve.” St. Clair has created a comprehensive patient safety program. In recognition of its outstanding commitment to patient safety,

Hospitals in the nation, and receiving its 16th consecutive ‘A’ patient

St. Clair received another ‘A’ grade from the Leapfrog Group, a

safety grade, a performance which is among the best 2 percent in

national patient safety watchdog. Hospitals are graded twice a year,

America.

in spring and fall. St. Clair is the only hospital in the region to achieve

St. Clair was ranked as of the 100 Top Hospitals® for 2020 by IBM®

the highest possible rating continuously for eight consecutive years.

Watson Health™ in its 28th annual empirical evaluation of America’s

Leapfrog safety grades range from ‘A’ through ‘F’ and are assigned on

hospitals. St. Clair has been on the prestigious list six times since

the basis of a hospital’s results in 27 indicators of patient safety, such as infections, falls, medical errors, injuries and accidents. Founded in

THE 4 Cs OF PATIENT-CENTERED CARE

the year 2000 by leading researchers and academics, as well as large employers and other purchasers of health care, the Leapfrog Group was created to promote “giant leaps forward” in the quality and safety of American health care. John T. Sullivan, M.D. MBA, Chief Medical Officer at St. Clair, says, “At a time when great health care has never been more

CULTURE

CARE

COMMUNICATION

COLLABORATION

important, we’re proud of the health care heroes who’ve made St. Clair one of the nation’s highest quality hospitals.” n

Volume XII Issue 2 I HouseCall I 35

1000 Bower Hill Road Pittsburgh, PA 15243 stclair.org

> To find a doctor, please visit 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

GROWING A VISION IN A ROOFTOP GARDEN

o improve the health and well-being of the communities they serve, hospitals have to reach beyond their walls. This entails listening to community leaders and partnering with organizations to solve problems and improve quality of life for residents. A greater focus on prevention of illness holds the promise of enormous community benefit, and although that is a departure from a hospital’s traditional role of treating illness, it is essential for community health, says G. Alan Yeasted, M.D., FACP, Chief Medical Officer Emeritus at St. Clair Hospital. “At St. Clair we do more than provide medical care; we care for the community through health promotion and disease prevention,” Dr. Yeasted says. “Preventing illness rather than treating it after it develops makes sense. We offer programs for smoking cessation, diabetes education, mental health, and health fairs where people can get health screenings and information. We know that social determinants of health need to be integrated into the work of the Hospital, and nutrition is a major social determinant of health.” Dr. Yeasted’s focus on nutrition and health includes the addition of a colorful rooftop vegetable garden at St. Clair. The garden, which Dr. Yeasted helped tend this growing season, is serving multiple purposes: it provides direct help for those who struggle with food insecurity; it adds a touch of whimsy to a clinical environment; it makes a statement of care for the community, and it will eventually serve as an educational tool, to teach the community about the importance of healthful eating. “We’re aware that many in our community have nutritional and economic needs that have been made worse by the pandemic, and we grew this produce to help them,” explains Dr. Yeasted. “It was important to find the right site for the garden, and the right outlet for distribution. South Hills Interfaith Movement (SHIM) Executive Director James Guffey gave a presentation about the crisis of food insecurity to the Community Benefit Committee of our Board of Directors. We felt that SHIM was an ideal initial partner for us. SHIM has 15 community gardens at churches and schools throughout the region, and has a master gardener on its staff: Becky Henninger, who was very helpful to us in planning the garden. SHIM has three food pantries and runs them like grocery stores, so that clients feel comfortable there.” Joseph Smith chairs the Hospital’s Community Benefit Committee, which conducts a community needs assessment every three years and seeks to provide and improve services that address unmet needs in the community.

HouseCall

“

MY HOPE IS THAT THE GARDEN WILL BECOME A THERAPEUTIC ENVIRONMENT AND A PATHWAY TO NUTRITION EDUCATION AND IMPROVED HEALTH.

”

G. ALAN YEASTED, M.D. FACP CHIEF MEDICAL OFFICER EMERITUS, ST. CLAIR HOSPITAL

“The Community Benefit Committee is open to ideas and always wants to do more to help,” Smith says. “We know there are many needs out there and we bring in our experts to help us extend the Hospital’s resources to the community. When Dr. Yeasted brought this proposal to the Committee, he noted that SHIM is an organization that helps everybody. Giving back with food, with sustenance, seemed like a good fit and the committee wholeheartedly endorsed the roof top garden project.” There are enormous — and growing — unmet nutritional needs throughout the community, says Guffey, and these needs are mostly silent. “Community gardens and food pantries play an important role in meeting the needs, but feeding people isn’t enough,” he says. “We want to help people eat more healthful food and learn more about the relationship between health and diet. It’s not easy for everyone to get fresh vegetables, which are essential, and the pandemic has made this harder. Half of the clients coming to our food pantries are new.” SHIM is a non-profit that works with volunteers, donors and partners to reduce the effects of suburban poverty throughout the South Hills. SHIM helps support the most vulnerable residents of the community: the working poor, the unemployed, single parents, seniors, the disabled, refugee families, veterans and others. SHIM provides direct help with food, clothing and services, and also offers an array of programs that teach self-sufficiency. Guffey believes that SHIM is a fitting partner for St. Clair in this endeavor. “We have strong ties to the Hospital, and a longstanding relationship; this project is a natural progression of that. Dr. Yeasted is a member of our board of directors and he was aware of our garden program. This is an excellent stewardship model and we’re pleased to join St. Clair in this program.” n

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