KNEE
PAGE 4
Victor’s story, PAGE 14
St. Clair earns high marks for orthopedic care
Margaret’s story, PAGE 8
SPINE
Kayla’s story,
ORTHOPEDIC EXCELLENCE
HIP
SHOULDER
VOLUME IX ISSUE 3
Kristy’s story,
PAGE 12
ORTHOPEDIC EXCELLENCE
Every day at St. Clair Hospital, expert orthopedic surgeons perform the most advanced, highly specialized surgical procedures, including joint replacements and spine surgery. Using pioneering surgical approaches and the most cutting-edge technology, St. Clair’s orthopedic surgeons are at the forefront of orthopedics advancements. Orthopedic services at St. Clair are distinguished by excellence: the program is consistently ranked at the highest levels for its outstanding quality, safety, clinical outcomes and patient satisfaction, far exceeding regional and national standards. Uniquely focused on the experience of the patient, St. Clair is an ideal setting, offering superior orthopedic care.
2 I HouseCall I Volume IX Issue 3
DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE ST. CLAIR HOSPITAL
L
onger life spans of Americans, aging Baby Boomers, increasing obesity, and the popularity of extreme sports, along with advances in orthopedics and sports medicine, are among the factors driving the nation’s increased demand for orthopedic surgery, according
to the American Association of Orthopedic Surgeons. The number of people having knee replacement has doubled in just 10 years, and younger people are having joint replacements. For those whose lives have been interrupted by injury or diminished by the cruel pain and limitations of arthritis, orthopedic surgery at St. Clair can relieve pain, restore mobility, renew lives and sometimes even transform them. Having major orthopedic surgery is an enormous undertaking for
anyone, and whether one is having hand surgery, a spinal fusion or a knee replacement, every patient is entitled to the best care possible. St. Clair delivers that. For St. Clair’s orthopedic surgery program, excellence is not simply a standard to aspire to — it is everything. There is an ethic of excellence that permeates the entire scope of the service, cascading through every tier of the patient’s experience. It has become the culture. All members of the orthopedic surgery team — the surgeons, the operating room (OR) staff, the nurses and nurse managers, the physical therapists and support staff — are dedicated, consummate professionals who have chosen this specialty and share a passion for their mission. Orthopedic care at St. Clair Hospital is complex, high-tech and meticulously coordinated, but it is also personal. Across a seamless continuum of care, from the first office visit through graduation from rehab, the care is based on solid science and best practices research. With an emphasis on minimizing pain, eliminating complications and individualizing care to the unique needs of each patient, St. Clair delivers impeccable orthopedic surgical care. Continued on page 7
t
St. Clair Hospital has always taken great pride in helping patients get back to the things they love most. On the next pages are just a few of many inspiring orthopedic success stories.
Volume IX Issue 3 I HouseCall I 3
ORTHOPEDIC EXCELLENCE
TORN SHOULDER REPAIR 4 I HouseCall I Volume IX Issue 3
Kayla Smith of Jefferson Hills is back on the court after shoulder surgery.
SHOULDER SURGERY
Kayla’s Story Kayla Smith, 19, of Jefferson Hills, is a superior athlete who threw
throw the javelin. This time, though, the injury — another tear of the
javelin and played volleyball for the Thomas Jefferson High School
labrum — was more complex. According to Dr. Walker, “This was a
Jaguars. Both javelin and volleyball require overhead motion, which
bigger tear, which destabilized the origin of the biceps tendon. The
asks a lot of the shoulder joint. In May of 2015, Kayla suffered an
biceps tendon is attached to the shoulder at the upper part of the
injury, a flap tear in the labrum of her right shoulder, while competing
labrum. Typically, this type of injury afflicts throwing athletes, including
in a WPIAL championship competition. She was referred to Shaka M.
pitchers and javelin throwers, who use overhead motions. Javelin
Walker, M.D., a board-certified orthopedic surgeon and sports medicine
throwers give a super maximum effort. Because it is an elimination
specialist at St. Clair Hospital. Dr. Walker, who operated on Kayla’s
sport, you have to throw as hard as you can, every single time. It sets
shoulder in July 2015, is former Chief of Orthopedic Services at Landstuhl
you up for injury. When you throw a javelin, there’s a deceleration that
Regional Medical Center near Landstuhl, Germany. The Center is
occurs, and upon release, the labrum is getting very forcefully pulled.”
operated by the U.S. Army and the Department of Defense and is
In December 2016, Dr. Walker re-attached the labrum, adding an
the largest military hospital outside of the continental United States.
anchor that holds the repaired tissues in place for healing. Kayla did
It serves as the nearest treatment center for wounded soldiers coming
very well post-op, says her surgeon, and she is able to participate in
from Iraq and Afghanistan. While in Germany, Dr. Walker, who held
any sport now. “For some athletes, there may be diminished rotation
the rank of Major, also served as Director of the Sports Injury Clinic
of the shoulder post-op,” he says. “Some pitchers may be unable to
at the Center, taking care of numerous athletes living in the Kaiser-
throw as fast or as hard.”
slautern Military Community.
Continued on page 6
Dr. Walker describes Kayla’s injury: “Kayla had a tear in the superior labrum. The labrum is a fibrocartilaginous ring that sits on the rim of the glenoid, the socket of the shoulder. It’s a gasket-like structure all the way around the joint, 360 degrees. The stability of the shoulder depends on the labrum and other soft tissues. Kayla’s injury was amenable to debridement. We did the procedure in July so that she would be ready to throw the javelin in the spring.” Unfortunately, Kayla reinjured the shoulder during the fall 2015 season of volleyball at TJ, but played through the injury during the ensuing track and field season, continuing to
“
WITH ATHLETES LIKE KAYLA, YOU HAVE TO UNDERSTAND THEIR GOALS IN ORDER TO SELECT THE BEST TREATMENT FOR THEM.
”
SHAKA M. WALKER, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL
SHAKA M. WALKER, M.D. Dr. Walker specializes in orthopedic surgery. He earned his medical degree at Georgetown University, Washington, D.C., and completed a residency in orthopedic surgery at University of California, San Francisco, with subspecialty training in Sports Medicine. He later served as Chief of Orthopedic Services and Director of the Sports Injury Clinic at Landstuhl Regional Medical Center, Germany. Dr. Walker is board-certified by the American Board of Orthopaedic Surgery. He practices with St. Clair Orthopedic Associates, a division of St. Clair Medical Services. To contact Dr. Walker, please call 412.942.7262.
Volume IX Issue 3 I HouseCall I 5
ORTHOPEDIC EXCELLENCE Continued from page 5
“
Dr. Walker helped me through everything and worked with me to get me back in shape. He made sure I was doing everything right. He is kind-hearted and takes a personal interest in his patients.
”
KAYLA SMITH, LABRAL TEAR SURGERY PATIENT
Treating athletes is especially satisfying because they are so motivated to get better, says Dr. Walker, who played intercollegiate soccer at the Air Force Academy. “Part of what we do as orthopedic surgeons is technical, and that part is interesting, but with athletes like Kayla you have to understand their goals in order to select the best treatment for them. The human connection with the patients helps me know them so that I have a clear understanding of what they want.”
Kayla is a determined young woman who sets ambitious goals for herself in athletics and in academics. She says since graduating from TJ in spring 2016, her days of formally competing in track and field and on the court are behind her, but she still can throw javelin and spike a volleyball with the best of them. Now a sophomore at the University of Pittsburgh, where she is studying Pharmacy, Kayla says, “My shoulder healed correctly and it is as good as it can possibly be. Two shoulder surgeries in less than two years was an ordeal, but I toughed it out and I had a lot of support, from my mother, my teammates, my friends and my cat, Kiki. Most of all, Dr. Walker helped me through everything and worked with me to get me back in shape. He made sure I was doing everything right. He is kind-hearted and takes a personal interest in his patients.” The aspiring pharmacist, who is working part-time as a pharmacy technician while a full-time student at Pitt, says her experience with Dr. Walker and the staff at St. Clair Hospital will have a lasting impact on her. She is completing a six-year program that will eventually earn her a doctoral degree. “When I am a full-time health care professional, I will absolutely remember how it feels to be a patient, and I hope to treat people with the kind of respect and compassion that I experienced at St. Clair Hospital.” n
Shoulder surgery has let Kayla Smith throw javelin again.
6 I HouseCall I Volume IX Issue 3
DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE
ST. CLAIR HOSPITAL Continued from page 3
St. Clair’s orthopedic surgeons specialize in
the diagnosis and treatment of nearly every type of injury and condition of the musculoskeletal
system. In addition, some of the surgeons sub-
specialize in joint replacement of the knee and
hip, sports medicine, spine surgery, hand and
pedic program is ranked in the top 1 percent in
national Press Ganey rankings and has maintained that ranking for the past three years. Credit for
that impressive achievement, says Bob, goes to
the staff: “We’re proud of this rating but also
humbled by it. We have a true interdisciplinary
shoulder surgery, and foot surgery. Robert “Bob”
team, including clinical and non-clinical services,
Orthopedics at St. Clair, and a trained physical
have been well cared for here.”
Kovatch, M.P.T., M.B.A., F.A.C.H.E., Director of
therapist, says the department performs 3,500
The orthopedic department has also
attained superlative ratings for clinical quality
“Although we’re a high-volume service, we
op complications and infection. Patient falls, a
treat every patient as a unique individual,” Bob
says. “That is one of our greatest strengths. We
never take our eyes off the ball in terms of quality and patient satisfaction. The effort to achieve
and sustain excellence is constant; we meet and
and patient safety with a low incidence of post-
significant measure of safety, are almost non-
existent among orthopedic surgery patients
prevention is important for all patients, but
invested in it.”
surgical site,” he explains. “It’s a high priority.
St. Clair is well documented. The service is
in damage to the implant or disruption of the
Our fall rate was already low, but we cut it even further with this program. The nursing staff
ranked in the highest echelons by Press Ganey,
practices decentralized documentation, so
evaluator of patient satisfaction. St. Clair’s ortho-
respond immediately to a call.”
the nation’s largest independent, third-party
in patient satisfaction nationally*
* Press Ganey, national database (300- to 449-bed hospitals)
St. Clair orthopedic nursing unit
Patient Fall Rate
0.08%*
National Benchmark is 0.27%
* NDNQI inpatient falls per patient day, 2016 NIH data
called “Call, Don’t Fall.” According to Bob, fall
critical for orthopedic patients. “A fall can result
The superior quality of orthopedic care at
1%
HHHHH TOP
at St. Clair, thanks to a patient education initiative
exceed our quality goals of performing in the top 10 percent nationally. Everyone on the team is
St. Clair’s orthopedic nursing unit is ranked in the
and all of us want our patients to feel that they
surgical procedures every year, of which 1,100
are hip and knee replacements.
ST. CLAIR HOSPITAL ORTHOPEDIC QUALITY METRICS
Average length of stay in hospital Primary hip & knee replacement
2.2 DAYS*
National Benchmark is 2.7 days * Crimson
they are always near the patient rooms and can Continued on page 11
90-Day Readmission Rate Hip, knee or shoulder replacement, and spine surgery
“
4.6%*
National Benchmark is 5.5%
* Crimson, all-cause readmissions, with exclusions
… IN TERMS OF QUALITY AND PATIENT SATISFACTION, THE EFFORT TO ACHIEVE AND SUSTAIN EXCELLENCE
IS CONSTANT.
”
ROBERT KOVATCH, M.P.T., M.B.A., F.A.C.H.E., DIRECTOR OF ORTHOPEDICS, ST. CLAIR HOSPITAL
Complication Rate
Hip, knee, or shoulder replacement, and spine surgery
1.4%*
National Benchmark is 3.7%
St. Clair is in the top 10% nationally ( Top decile is 2.2% )
* Crimson, Complications of Care
Volume IX Issue 3 I HouseCall I 7
HIP REPLACEMENT
ORTHOPEDIC EXCELLENCE
8 I HouseCall I Volume IX Issue 3
Margaret Robertson of Mt. Lebanon is back to walking and running after hip replacement surgery.
DOUBLE HIP REPLACEMENT
Margaret’s Story Margaret Robertson, 72, has been running for 35 years and she is not about to stop anytime soon. The retired Baldwin High School Latin teacher is a familiar sight in every season to local residents who frequent Bower Hill Road, her usual route. Two hip replacements have motivated
need to get up, instead of thinking you can do it by yourself. And when you do call, they come.” Hip replacement is a major surgical procedure, says Dr. Perricelli. “We perform a high volume of hip replacements at St. Clair and we
her to keep up the pace and continue to enjoy an activity that she says
have specialized teams of expert clinicians to care for and guide the
enhances her life in countless ways. “I am not an athlete; I run for my
patients at every step. As a result, the patients do very well. Every single
health,” Margaret says. “Running has physical and emotional benefits.
case is unique. No two joints are alike, so every single operation is
It clears my head and keeps me balanced. My husband, Bob, is a
specialized.”
retired professor of exercise physiology and a lifelong runner; it
Hip replacement surgery is technically called a total hip arthroplasty.
became part of my life, too. Running has kept me active; when I can’t
The hip is a ball-and-socket joint, and during the operation, the surgeon
run, I miss it.”
resurfaces the acetabulum, the concave, cup-shaped socket that receives
Margaret’s arthritic right hip was replaced in 2014 by Brett C.
the “ball” — the head of the femur, the thigh bone. A prosthetic femur
Perricelli, M.D., a board-certified orthopedic surgeon and Chief
head made of titanium and plastic is fitted into the bone and the new parts
of Orthopedic Surgery at St. Clair Hospital. When pain in her left
interface smoothly, restoring movement. Essentially, the surgeon recreates
hip caused her to limp earlier this year and to curtail her running,
the joint anatomy. “We carefully take the bone down to the healthy
she knew it was time to see Dr. Perricelli again. “I was not in terrible
tissue, removing the arthritic tissue and cartilage,” Dr. Perricelli says.
pain but I knew I could be better. I had complete confidence in Dr. Perricelli.” The left hip replacement took place in March, followed by three months of rehabilitation. Margaret claims that the secret to a great outcome is to follow your surgeon’s
Continued on page 10
“
OUR CARE IS SEAMLESS
instructions to the letter. “Do what they tell
. . . EACH TRANSITION TO
you! If they tell you to go to the classes, go.
THE NEXT GOES SMOOTHLY
Do the exercises, the way they show you. Remove your throw rugs. Don’t think that you can do more on your own because you feel better; always do things their way. They know what they’re doing.” No detail was overlooked in her postoperative care and follow-up, Margaret says. “Dr. Perricelli stays on top of everything; he even called me at home on the day I was
. . . INCLUDING THE TRANSITION TO HOME.
”
BRETT C. PERRICELLI, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL
discharged. The staff is excellent. St. Clair has a policy known as ’Call, Don’t Fall’ — it means that you call the nurse when you
BRETT C. PERRICELLI, M.D. Dr. Perricelli is Chief of Orthopedic Surgery at St. Clair Hospital. He earned his medical degree at the University of Pittsburgh, and completed residencies in general surgery and orthopedic surgery at UPMC. Dr. Perricelli then completed an Adult Reconstruction Fellow at OrthoCarolina Hip and Knee Center, Charlotte, N.C. He is board-certified by the American Board of Orthopaedic Surgery, and practices with South Hills Orthopaedic Surgery Associates. To contact Dr. Perricelli, please call 412.283.0260. Volume IX Issue 3 I HouseCall I 9
ORTHOPEDIC EXCELLENCE Continued from page 9
“The new titanium implant has a liner made of greatly improved plastic. We don’t need to use cement. There is minimal trauma to the muscles and other soft tissues.” Degenerative changes in the joint due to osteoarthritis is the usual reason for the surgery. Hip arthritis is often the result of an anatomical mismatch, Dr. Perricelli explains, that increases wear and tear on the joint. “Some people are born with a shallow acetabulum; sometimes, the head of the femoral bone is egg-shaped rather than round. If you’ve had a labral tear, you are more at risk to develop osteoarthritis (OA), just as a meniscus tear can set your knee up for it. Obesity is a factor, although it is more significant in the development of knee arthritis.” Many patients present with deep aching pain in the groin, the front of the thigh and even the knee. Margaret Robertson has regained her stride following double hip replacement surgery.
Sometimes, a hip replacement will relieve this knee pain, but if the patient has OA in both sites, the hips should be replaced before the knees. Preventing arthritis is primarily a matter of staying in shape, managing your weight and using your body, Dr. Perricelli says. He recommends non-impact exercise, including cycling, water sports and using an elliptical machine. Margaret says that since the surgery, she feels 30 years younger. “I can do just about anything now; I walk up hills, work in my garden, go to the gym, exercise and go to the theatre. I love being retired.” She does much of her running indoors, on a flat surface at the gym, and also exercises in a pool. Her advice to others considering hip replacement is to go ahead and do it. “Don’t wait, get it done. There’s nothing to fear. If you are in pain and you have limited mobility, a hip replacement will change your life for the better. It changed mine.” n
“
... a hip replacement will change your life for the better. It changed mine.
”
MARGARET ROBERTSON, PATIENT, TOTAL HIP ARTHROPLASTY
10 I HouseCall I Volume IX Issue 3
DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE
ST. CLAIR HOSPITAL Continued from page 7
There are numerous advantages to having
Joint replacement patients are encouraged to
In the post-operative period, the St. Clair
orthopedic surgery at St. Clair. “Our care is
attend pre-op patient education classes offered
advantage begins with a focus on minimizing pain
Orthopedic Surgery at St. Clair, “and we have
by the nursing, therapy and care management
tocol, pioneered by Dr. Perricelli for joint replace-
seamless,” says Brett C. Perricelli, M.D., Chief of every capability here. All the elements are
integrated, so that each transition from one
three times a week. “The classes are presented
staff who will be caring for the patient,” Bob says.
“We urge patients to bring family members. The
and maximizing mobility. A multi-modal pain proment patients, is a highly successful approach to
pain management in which pain is anticipated and
stage to the next goes smoothly for the patient,
agenda covers preparation of the home, the
prevented as much as possible, beginning in the
tied together.”
and home care. It helps the patient know what
on narcotic medications, virtually eliminating the
including the transition to home. Everything is
Pre-operatively, Dr. Perricelli and his colleagues
work with the patients to optimize their general
surgery and post-operative period, rehabilitation
to expect and that reduces anxiety.”
In the OR, seasoned professionals manage
health for surgery, especially for joint replacement.
highly specialized orthopedic surgical technology
risk factors so that there is less chance of compli-
work with the same surgeon; they know every
“The goal pre-operatively is to eliminate reversible cations, such as blood clots, infection or anesthesia problems,” he says. “This may mean helping them to quit or reduce their smoking. We encourage
a nutritious diet to promote healing. If the patient needs to reduce their weight and lower their BMI (body mass index), we have resources to help
within a complex clinical environment. Teams
OR. It provides effective pain relief with less reliance noxious side effects that can inhibit recovery.
The pre-emptive pain regimen complements
another St. Clair standard: early mobilization. Pain
relief means that patients can get moving faster —
a key factor in recovery. “Early mobilization reduces
detail of that surgeon’s procedure and equip-
the risk of complications such as blood clots. We
being and safety, during surgery and in the
ical and occupational therapists who are on the
OR team is implementing a protocol known as
a specialized therapy gym on the unit,” says Bob.
ment needs. Diligent monitoring of patient wellpost-anesthesia recovery area, is a priority. The ERAS (Enhanced Recovery After Surgery), an
have a dedicated team of very experienced physorthopedic unit seven days a week, and we have “On the day of surgery, patients are out of bed
them. If they have a chronic disease, we work
evidence-based, multidisciplinary program to
and walking. Physical therapists and nurses get
patient in the best possible condition for surgery.”
surgery, to further improve the quality of care.
early discharge and improves outcomes.”
to get that under control. Our goal is to get the
Nurses confer on St. Clair’s orthopedic unit, 5A.
facilitate recovery and reduce the stress of
them back on their feet faster; this facilitates
Continued on page 17
Volume IX Issue 3 I HouseCall I 11
SPINAL SURGERY
ORTHOPEDIC EXCELLENCE
12 I HouseCall I Volume IX Issue 3
Kristy Jericho of Belle Vernon is able to enjoy her new kitchen and her dog Charlie.
SPINAL SURGERY
Kristy’s Story It’s part of a degenerative process in which the disc becomes dehydrated,
One of the most important days in Kristy Jericho’s life was the day that her orthopedic surgeon, Thomas D. Kramer, M.D., gave her something she had
worn and stiff; it subsequently tears. When that happens, enzymes leak
waited a long time for: a diagnosis. Kristy, a critical care nurse at a southwestern
into the surrounding tissue, causing inflammation. It can also be the
Pennsylvania hospital, had endured months of excruciating back pain that
result of trauma. The classic symptom is increased pain upon sitting.
wreaked havoc on her life. She was forced to leave the job she loved and she
Disc pressures are highest when we sit.” An annular tear can expose nerves, causing the severe pain that Kristy
became essentially bedridden, unable to sit and barely able to stand and walk. She could no longer do the things she enjoyed, like cooking, driving, going
was enduring. After confirming the diagnosis, it was clear that Kristy needed
out to eat with her husband, Tony, and walking her beloved dog, Charlie.
surgery, quickly. In April, Dr. Kramer performed a posterior lumbar fusion,
Life became an endless cycle of agonizing pain, pain medication and
placing screws into her spine. His goal was to relieve her pain and get her
fruitless visits to medical specialists. “I had started having back pain at work,” Kristy recalls. “I took Motrin and kept working for a few months but it worsened to the point that it felt like my back was breaking. An MRI showed a herniated disc at L4-5 and I was referred to a spine surgeon. Subsequently, I was referred to an
“
off the pain medications. “Sometimes, people with
Dr. Kramer was
a blessing ... All the doctors looked at the
orthopedic surgeon, a pain medicine specialist, a second
same MRI, but he was
spine surgeon and a neurologist. I was told it was muscle
the only one who
spasms and given a muscle relaxer; I was told it was bursitis and was given steroids. The pain just got worse; it was off the charts.” With worsening pain and still waiting to see a spine specialist, Kristy had to take opioid pain relievers and stay
really listened to me ...
severe back pain do get better with injections and pain management,” he says, “but this was a situation where the patient had a problem that required surgery, and instead she was placed on narcotics. The classic sign of an annular tear was right there; she had increased pain with sitting.” Kristy is grateful to Dr. Kramer for his surgical expertise, but gives equal credit to his interpersonal skills. “Dr. Kramer was a
That made all the
blessing. He treated me with kindness and
difference.
respect. All the doctors looked at the same
in bed, as that was the only position she could tolerate. For a woman who is normally very active, who often works 16-hour shifts at a demanding nursing job, this helplessness
”
KRISTY JERICHO, SPINAL SURGERY PATIENT
MRI but he was the only one who really listened to me and paid attention. That made the difference.” Kristy, 53, always wanted to become a nurse,
was barely tolerable. Kristy had to depend on her husband to do all the
but did not go to nursing school until the age of 40, after she had raised
shopping, housework and cooking. Her father, who resides next door, drove
her two daughters. She says she learned about the importance of listening
her to her appointments. It took an emotional toll. Continuous pain, isolation
in nursing school. “When you give a patient time and attention, you are
and fear created enormous anxiety. Kristy felt let down by the very system that
showing them that you care,” she reflects. “It’s not easy;
she was so proud to be a part of. “I love being a nurse and working in health
you have to learn to be quiet and stop talking.
care; it’s my passion. I felt like I was being dismissed. No one seemed to
Listening isn’t passive; there is skill
understand what I was going through.”
involved.”
Except for Tony. Her husband of 35 years was her rock and, it so happened,
Kristy’s recovery has been long and
the key to her eventual recovery. “Tony is a sales representative for orthopedic
difficult, but she is gradually feeling
surgical products,” she says. “He knew Dr. Kramer and liked and respected him.
better; she can now sit for an hour
He suggested that I see Dr. Kramer.” Dr. Kramer, a board-certified orthopedic surgeon at St. Clair Hospital, talked to Kristy, examined her and looked at her MRI. He told her that she had an
without pain and stand in her newly renovated kitchen long enough to prepare home-cooked meals. As for
annular tear — the root of the disc at L4-5 was torn and nearly severed. “An
practicing her profession of nursing,
annular tear is in the back part of the annulus, which is the tough outer layer of
one thing is certain: she will be listening
a disc, made of fibrous tissue,” Dr. Kramer explains. “It’s like a hole in a car tire.
attentively to patients. n
THOMAS D. KRAMER, M.D. Dr. Kramer specializes in orthopedic surgery. He earned his medical degree at the University of Pittsburgh, and completed residencies at the University of Alabama Hospitals and Healthsouth Medical Center, Birmingham, Ala. He later completed a fellowship in spine surgery at the University of Maryland Hospitals. Dr. Kramer is board-certified by the American Board of Orthopaedic Surgery. He practices with Greater Pittsburgh Orthopaedic Associates. To contact Dr. Kramer, please call 412.262.7800. Volume IX Issue 3 I HouseCall I 13
ORTHOPEDIC EXCELLENCE
Victor Hays of Upper St. Clair is back to coaching elite soccer players.
KNEE SURGERY 14 I HouseCall I Volume IX Issue 1
KNEE SURGERY
Victor’s Story
the knee. The ACL is in the front of the knee and it prevents the tibia bone
Soccer player, soccer coach and all-around avid athlete, Victor Hays
knows the importance of trust. It’s an essential element of teamwork. It’s
from shifting too far forward. Surgeons don’t actually repair a torn ACL,
also a key to the relationship between a physician and patient. When Victor
they reconstruct it using a graft. Victor, who had a previous ACL tear,
realized that he needed to have surgery to repair torn cartilage in his left
needed a revision of an ACL reconstruction. “This was an arthroscopic,
knee, he embarked on a thorough search to find exactly the right surgeon,
outpatient procedure,” says Dr. Gibbons. “Victor also had a torn meniscus.
much like a recruiter seeking the perfect new member for a team. He
When you do a reconstruction with a graft, there are three choices: you can
needed someone he could trust.
“
The right surgeon would be someone who understood what was at stake. Victor, who lives in Upper St. Clair, has been an athlete for his entire life, from his childhood in Peru and Argentina where he grew up playing soccer to his present-day life as a husband, father, soccer coach and environmental engineer in Pittsburgh. A former pro soccer player, he is 56, and remains in outstanding physical condition. Victor is a volunteer coach for the Upper St. Clair
including his son, Anthony, 13 — is unwavering. “This age is the critical time for the kids to fine tune
tendons, or an allograft — a cadaver tendon. In Victor’s
I give a lot of credit to Dr. Gibbons ... He understood my desire to be as athletic as I’ve always been.
Athletic Association’s Soccer Travel Team and his commitment to the 13-14 year olds on the team —
use the patient’s own patellar tendon, two hamstring
”
case, the latter was the best option; a cadaver tendon gives more flexibility. Rejection is not typically a problem because it is not a living tissue.” Post-operatively, the patient wears a brace to protect the knee until the quadriceps muscle strength is recovered. Weight bearing is allowed as tolerated, and generally patients use crutches for up to a week. A continuous motion machine helps to restore full motion initially, followed by physical therapy. It’s a
VICTOR HAYS, KNEE SURGERY PATIENT
fairly long recovery, generally taking four to six months. Victor’s rehab has gone well. “I give a lot of credit to Dr. Gibbons,” Victor says. “He understood my
the technical aspects of soccer and be prepared to move on to the next
desire to be as athletic as I’ve always been, although I have made some
level,” he says. “It’s important in their development as athletes. The travel
modifications to my workouts, to more aerobic and lower impact activities;
team provides opportunities for some kids to get additional training and
stepping back on the soccer pitch with my teams is my ultimate goal and
playing time, in hopes of later playing at the high school or college level,
has already begun. My whole family is athletic: in addition to Anthony, who
with hard work and dedication.” Victor, who says he is a very hands-on coach, wore a brace on his
plays for both the USC travel team and the 03 Beadling Elite Cup Team, I have a daughter, Alexandra, 15, who is a gymnast, diver and competitive
injured knee and persevered to the end of the fall season. Specifically, his
cheerleader with one of the top teams in the state. My wife Michelle
injury was a torn anterior cruciate ligament (ACL) — the second one on the
runs and plays tennis.”
same knee — a common injury for athletes. “I needed a surgeon who had
“Athletes like Victor are physiologically young and take very good care
experience in ACL revision surgery and would be aggressive about getting
of themselves,” Dr. Gibbons says. “For them 50 is the new 40, and they
me back in shape and on the field. I did a lot of research.” Victor interviewed
do not want to give up their sports when they
several surgeons before someone pointed him to John M. Gibbons, M.D.,
are injured.” The care of aging athletes
a sports medicine specialist and orthopedic surgeon at St. Clair Hospital. An ACL tear can be quite painful, says Dr. Gibbons, but it doesn’t always
is a specialty in itself, Dr. Gibbons believes. He works out with a trainer
require surgery. “An ACL reconstruction is a young person’s surgery, for the
and is interested in how exercise
most part. It typically happens to teens and young adults. The ACL gets torn
impacts aging. “I’m concerned with
in sports that involve sudden stops and changes in directions, like soccer.
injury prevention in this group. How
When an ACL tear happens to a person over 40 or 50, it doesn’t necessarily
do we slow aging and maintain
have to be repaired. You don’t always need surgery and you may be able
healthy bones? How do trainers deal
to strengthen and stabilize the knee with physical therapy. But Victor is
differently with the aging athlete?
atypical; he’s active at a very high level and for him to maintain that, he
We want to keep them active but
needed surgery.” Ligaments are strong rope-like structures that connect bones to other bones. The two cruciate ligaments — “cruciate” because they cross — stabilize
prevent injuries. Of course, if they do get injured, St. Clair
Hospital is the place to go.” n
JOHN M. GIBBONS, M.D. Dr. Gibbons specializes in orthopedic surgery. He earned his medical degree at Columbia University, New York City. Then Dr. Gibbons completed a residency in orthopedic surgery at Columbia-Presbyterian Medical Center, New York City, and a fellowship in knee reconstruction and sports medicine at Beth Israel Medical Center, New York City. He is boardcertified by the American Board of Orthopaedic Surgery. He practices with Advanced Orthopaedic & Rehabilitation. To contact Dr. Gibbons, please call 724.225.8657. Volume IX Issue 3 I HouseCall I 15
ORTHOPEDIC EXCELLENCE
ORTHOPEDIC NURSE NAVIGATOR
Guiding patients from pre-op through rehab At St. Clair Hospital, a new Orthopedic Nurse Navigator service is easing the experience of joint surgery for many
and/or on the orthopedic unit following surgery, when I meet with them and with their family.”
patients. Nurse navigators are registered nurses with in-depth
During their admission to the Hospital, Brigitte sees the
clinical experience and strong teaching and communication
patient. Once the patient has been discharged, she makes
skills who shepherd the patient through their entire journey,
frequent follow-up phone calls to see how things are progress-
from the pre-operative preparation through surgery and
ing at home. She collaborates with the case managers and
rehabilitation. The concept, which originated in oncology, has
the home health care team, to ascertain that the person’s
been very successful as an added resource and layer of
needs are being met. Patients are also welcome to call her
support for patients.
if they have questions or concerns. She is available to them by
“Undergoing major orthopedic surgery can be over-
phone 24/7.
whelming, and a nurse navigator makes the experience more
Brigitte says her relationship with the patient is the key
manageable,” explains Brigitte Easterday, B.S.N., B.S.Ed., R.N.,
to the nurse navigator program. “In nursing, the relationship
C.R.R.N. (pictured below), who began providing the service
with the patient is so important. I’m able to have one-on-one
to hip and knee surgery patients at St. Clair in May. “I transition
relationships with the patients. I can help ease their pain, give
the patient through each phase. Our relationship begins when
them emotional support, and help them obtain the resources
they initially sign up for surgery, through 90 days
they need. They have the comfort of knowing that I am their
post-op. I call the patient after they have
advocate. This kind of consistency is important, but it can be
seen the surgeon. I talk to them about
hard to come by; patients are discharged so quickly and they
their concerns and needs. I tell them
encounter many professionals during their experience. When
what to expect. I answer their ques-
they know there is one person who knows them and knows
tions. I encourage them to attend
their family, they feel less stress. For me, it’s satisfying to be
the pre-op classes provided by the
able to give patients this degree of care and attention.”
multidisciplinary care team on the
With seven years of orthopedic nursing experience and
orthopedic unit. The classes help the
degrees in both nursing and education, Brigitte is ideally
patients and their families know
suited for the position. “It enables me to integrate my teaching
what to expect and help them
skills and nursing skills. And the feedback from the patients
prepare for the surgery and rehab. I don’t teach the
Feedback from the physicians is equally enthusiastic.
classes, but I am there
“The nurse navigator program is a service enhancement that
to meet the patients. I
effectively helps the patients get through the system,” says
become a familiar face. I see them in the pre-op area
16 I HouseCall I Volume IX Issue 3
has been great.”
orthopedic surgeon Shaka M. Walker, M.D. “It’s care coordi-
nation with a single point of contact, and the patients and families appreciate it.” n
DELIVERING THE HIGHEST LEVEL OF ORTHOPEDIC CARE
ST. CLAIR HOSPITAL Continued from page 11
Many different facets compose the jewel
make daily rounds to identify problems and
patient, St. Clair’s orthopedic team is guided
that is St. Clair orthopedics, but outstanding
take steps to effectively resolve them. Early
by visionary leaders and supported by an
among them is the top-notch nursing care
mobilization facilitates early discharge, and
administration that provides the resources for
that runs through every phase of the patient
most orthopedic surgery patients are able
them to do their best.
experience. St. Clair’s orthopedic unit, Unit 5A,
to go home within 1-3 days. A close working
And while the entire team is pleased to
is staffed by registered nurses who specialize
relationship with home health care agencies
see the high quality and satisfaction ratings
in orthopedics, and with specialization comes
streamlines the transition. Some patients
they have earned, the best feedback some-
expertise. Post-operative care of orthopedic
receive a pre-discharge home assessment
times comes with far less formality. Orthopedic
patients is intense. In addition to managing
to evaluate safety and ease mobility post-op.
surgeon Shaka M. Walker, M.D., cherishes the
pain and mobility, monitoring post-anesthesia stability, caring for complex surgical wounds, providing intravenous fluids and medications, nurses also tend to the psychosocial needs of patients, 24/7. It’s whole-person care and it’s demanding. “The nurses at St. Clair are extremely conscientious and the orthopedic unit is exceptionally well run, clinically and administratively,” says orthopedic surgeon John M. Gibbons, M.D. “The high quality of the nursing care makes the difference.” Adds his colleague, orthopedic surgeon Thomas D. Kramer, M.D., “The superior patient satisfaction at St. Clair is in large part because of the nurses: their focus is on the patient experience, no matter what it takes.” A new and innovative aspect of that effort is the addition of an Orthopedic Nurse Navigator to the team, another example of St. Clair’s pioneering leadership in orthopedic excellence. Brigitte Easterday, B.S.N., B.S.Ed., R.N., C.R.R.N., joined the team last spring to help joint replacement patients move seamlessly through the overall surgical process. (Please see related sidebar at left.) Orthopedic surgery patients at St. Clair benefit from the Hospital’s multidisciplinary team. Physicians, social workers, case managers, nurse managers and physician assistants
moments when he encounters his patients in
A CONSTANT EFFORT TO IMPROVE
someone will often walk up to me and say,
proven record of exceptional quality, the team
great,’ and that is the best reward. It’s a special
Although the orthopedic service has a
does not rest on its laurels. A major advancement will be completed in 2018, when a total renovation of the environment of care is finished. The construction project will give the department all new patient rooms, a re-designed nurses’ station, a new state-ofthe-art therapy gym for both physical therapy and occupational therapy, and upgrading of
the community. “When I am out with my kids, ‘Hey, Dr. Walker, you fixed my knee and it’s reminder of why we all do what we do.” n
“
WHEN I AM OUT WITH MY KIDS, SOMEONE WILL OFTEN
the entire orthopedics unit. “The redesign will
WALK UP TO ME AND SAY,
result in better work flow and greater efficiencies
‘HEY, DR. WALKER, YOU FIXED
of care. It will optimize operations on the entire unit in a more aesthetically pleasing environ-
MY KNEE AND IT’S GREAT,’
ment,” Bob says. “It will further improve the
AND THAT IS THE BEST
patient experience.”
REWARD. IT’S A SPECIAL
At every stage along the spectrum of care, St. Clair’s orthopedic program honors the patients with caregiving measures that affirm and respect them as individuals. All of these measures, taken together, are a seamless whole that promises the patient safety, the highest quality care, and the utmost attention to their comfort. Care is customized to personal need, never delivered in a cookie-cutter fashion.
REMINDER OF WHY WE ALL DO WHAT WE DO.
”
SHAKA M. WALKER, M.D., ORTHOPEDIC SURGEON, ST. CLAIR HOSPITAL
Cohesive, creative and committed to achieving the best outcome and experience for every
Volume IX Issue 3 I HouseCall I 17
YOUR HEALTH
ADULT VACCINES:
MORE IMPORTANT THAN EVER
VACCINATION RATES Vaccinations among U.S. adults are well below the target.
42% Influenza
E
verybody needs vaccinations. Throughout the human lifespan, they are essential to good health.
of self-care, as well as a way of caring for others. Vaccines
The need for childhood vaccinations is widely
not only protect one’s own health, but they also protect
recognized, but adults of all ages need vaccinations, too.
those around you: your loved ones, your co-workers and
An adult’s vaccination needs are more varied and individu-
friends, and your community. Getting vaccinations is a
alized than a child’s, but all adults need at least some
matter of personal responsibility, says Dr. Michael. “I find
vaccinations. Many, however, are not getting the vaccina-
personally that most of my patients understand the
tions they need.
importance of vaccination, not only for themselves, but
It’s a complex issue. Part of the problem is that vaccines
25% Shingles
20% Pneumococcal
20% Tdap
Actual vaccination rates among U.S. adults* *US Department of Labor
18 I HouseCall I Volume IX Issue 3
Getting appropriate and timely vaccinations is a form
also for the protection of loved ones,” she says. “Many of
have worked so well: they have eradicated smallpox
them care for young children whose immune systems are
throughout the world, they have nearly wiped out polio
still maturing, or perhaps for elderly parents who are at a
and other infectious diseases, and they have prevented
much higher risk of becoming very ill should they acquire
untold millions of deaths since the 1950s. “Some people
a vaccine-preventable disease.”
believe that we live in a post-vaccine era, but this is a
Every year, thousands of American adults become ill
misconception,” says Amanda M. Michael, D.O., a board-
and even die from diseases that can be prevented by vacci-
certified Infectious Disease specialist and Chair of the
nations. The Centers for Disease Control and Prevention
Antibiotic Stewardship Committee at St. Clair Hospital.
(CDC) reports that 42,000 adults and 300 children die every
“We are fortunate in this country to have had a respite
year in the U.S. from such diseases, including influenza and
from most vaccine-preventable diseases on a mass scale,
hepatitis. Vaccine-preventable diseases are not benign;
thanks to the intense effort that took years of vaccinating
they can have terrible consequences. For example, measles
and maintaining high rates of vaccination in the general
can cause severe illness and even death; shingles can lead
population. The World Health Organization estimates that
to blindness and lifelong pain. Even those who were fully
between 2 million and 3 million deaths are prevented
immunized as children need vaccination, as that protection
each year due to vaccination.”
can wear off, and there are new, improved versions of
some of those vaccines. Certain vaccines, such as the
resource. If traveling internationally, it can be helpful
shingles vaccine, are specifically for adults, although
to have the input of an infectious disease specialist,
75 percent of Americans over age 60 have not taken
given that various regions of the world have specific
advantage of it.
requirements for vaccination. The presence of mosquito-
The current CDC recommendations are that all adults should receive an annual flu vaccine. In addition, all adults should get Td/Tdap (tetanus-diphtheria,
borne illnesses and other infectious diseases must also be taken into account.” For those who have chronic conditions, such as
“
PRIMARY CARE PHYSICIANS ARE MAJOR STEWARDS OF
tetanus-diphtheria-pertussis) if they are unvaccinated
diabetes, heart disease or lung disease, vaccinations
or if their vaccine history is unknown. Td boosters are
are especially important, as these conditions, even
PUBLIC HEALTH AND
recommended every 10 years and sometimes in the
when well-managed, make one more vulnerable to
TERRIFIC RESOURCES
event of a wound. Beyond those, individual needs are
complications of vaccine-preventable diseases that
determined by a host of factors: age; lifestyle; occupa-
can result in hospitalization and even death.
tion; existing health conditions; previous vaccination
Vaccination is one of the safest and most cost-
history; and travel habits. Every year, the CDC updates
effective preventive medical procedures in existence.
their recommendations and this information is easily
There may be minor side effects after receiving a vaccine
accessed on the website, www.cdc.gov.
injection — a sore arm and low fever are the most
The best source of information about one’s vaccine
common — but these are mild and of short duration.
needs is the primary care physician, says Dr. Michael:
True adverse effects, such as an allergic reaction,
“Primary care physicians are major stewards of public
are rare. Dr. Michael says that there is less than one
health and terrific resources for people to learn about
severe allergic reaction per 1 million doses of vaccine.
their individual vaccination needs. If there is a particu-
The CDC and FDA monitor adverse events closely and
larly difficult scenario, PCPs may involve infectious
encourage the reporting of them.
disease specialists, but by and large PCPs are the best
FOR PEOPLE TO LEARN ABOUT THEIR INDIVIDUAL VACCINATION NEEDS.
”
AMANDA M. MICHAEL, D.O., INFECTIOUS DISEASE SPECIALIST, ST. CLAIR HOSPITAL
Continued on page 20
Recommended Immunizations for Adults: By Age If you are this age, talk to your healthcare professional about these vaccines Flu Influenza
Td/Tdap Tetanus, diphthera, pertussis
Shingles Zoster
You should get a Td booster every 10 years. You also need 1 dose of Tdap. Women should get Tdap vaccine during every pregnancy.
You should get shingles vaccine even if you have had shingles before.
Pneumococcal PCV13
PPV23
Meningococcal MenACWY or MPSV4
MenB
MMR Measles, mumps, rubella
HPV Chickenpox Hepatitis A Hib Human papillomavirus Varicella Hepatitis B Haemophilus influenzae type b for women for men
19-21 22-26 27-59 60-64 65+ More information:
You should get flu vaccine every year.
Recomended For You: This vaccine is recommended for you unless your health care professional tells you that you do not need it or should not get it.
You should get 1 dose of PCV13 and at least 1 dose of PPSV23 depending on your age and health condition.
May Be Recomended For You: This vaccine is recommended for you if you have certain risk factors due to your health condition. Talk to your health care professional to see if you need this vaccine.
You should get this vaccine if you did not get it when you were a child. You should get HPV vaccine if you are a woman through age 26 years or a man through age 21 years and did not already complete the series.
Source: U.S. Department of Health and Human Services Centers for Disease Control and Prevention www.cdc.gov/vaccines
Volume IX Issue 3 I HouseCall I 19
YOUR HEALTH Continued from page 19
Misleading information about vaccine safety has unfortunately produced resistance to vaccination among some people. Dr. Michael approaches this
about vaccination and is the author of numerous books and research studies. According to Dr. Offit, vaccines are underutilized
“This is even more important as we are in an era where antibiotics are becoming less useful. We are likely to lean on vaccines more heavily than
with a direct and substantive conversation. “I tell
because people no longer fear the diseases that
ever going forward. Vaccines are the safest they
people about the history of vaccines, how they are
vaccines prevent. “Our parents witnessed the
have ever been in this country, and studies are
produced now, and about vaccine-preventable
devastation of these diseases. They knew children
ongoing to assess guidelines for adult vaccine
illnesses. I discuss the many large studies that
with polio; they saw teenagers die with diphtheria.
recommendations. Vaccines are an incredibly
have been done on vaccines. As with everything
But most people alive today have never seen
important part of the arsenal against disease,
when caring for patients, it’s important to explain
the diseases. They don’t understand the threat.
for adults as much as for children.”
why you want to do a particular thing, whether
Unfortunately, people are more compelled to act
it’s starting a new medication, ordering a test or
by fear than by reason. They may ask, ‘Why give
giving a vaccine, so that you establish a trusting
polio vaccine when no one gets polio anymore?’
partnership regarding their health.”
The answer is that these diseases still exist and
VACCINES ARE
cause much suffering and death. There can be
AN INCREDIBLY
“Vaccines are victims of their own success,” says Paul A. Offit, M.D., a leading international
an outbreak at any time. People could be walking
expert on vaccines, viruses and immunization.
through airports shedding polio virus, and if you
Dr. Offit is the Director of the Vaccine Education
are not vaccinated against polio, you could
Center and professor of pediatrics in the Division
contract the disease and spread it to others.”
of Infectious Diseases at Children’s Hospital of
Unfortunately, vaccines are too often perceived
Philadelphia. He is a member of the Institute of
as something for children, Dr. Offit says. “Many
Medicine of the National Academy of Sciences
people don’t feel that they are affected. Adults go
and has served as a member of the Advisory
to the doctor when they’re sick, but they’re not
Committee on Immunization Practices for the
very good about ‘well’ care and preventive care.”
CDC. He has written and spoken extensively
As a consequence of the anti-vaccine movement, there have been outbreaks of vaccinepreventable diseases in communities across the U.S. in recent years. “In 2015, there was an out-
“
IMPORTANT PART OF THE ARSENAL AGAINST DISEASE, FOR ADULTS AS MUCH AS FOR CHILDREN.
”
AMANDA M. MICHAEL, D.O., INFECTIOUS DISEASE SPECIALIST, ST. CLAIR HOSPITAL
break of measles that was traced to Disneyland,” Dr. Offit says. “It infected 189 people in 25 states
Vaccines are the best defense against serious,
and created a lot of fear. In 2014, an outbreak in
preventable, contagious and potentially deadly
an Amish community in Ohio infected 680 people.
infectious diseases. They are safe, effective and
But a study of vaccination rates for elementary
readily available. Vaccination rates among
school children in upper income communities in
American adults, although low, are improving,
California revealed that less than 50 percent were
says the CDC, especially among those who
vaccinated — which is worse than vaccination
have a regular provider and health insurance.
rates for South Sudan.”
At every PCP visit, the CDC says, vaccination
According to Dr. Michael, there are more vaccines in development for a variety of illnesses.
status should be reviewed and appropriate
vaccination should be offered then and there. n
AMANDA M. MICHAEL, D.O. Dr. Michael specializes in infectious diseases. She earned her medical degree at the Philadelphia College of Osteopathic Medicine. Dr. Michael then completed an internal medicine residency, as well as a fellowship in infectious diseases, at Drexel Medicine/Hahnemann University Hospital, Philadelphia. She is board-certified by the American Board of Internal Medicine. Dr. Michael practices with Pittsburgh Infectious Diseases, Ltd. To contact Dr. Michael, please call 412.347.0057. 20 I HouseCall I Volume IX Issue 3
ASK THE DOCTOR
Ask the Doctor RAMY KHALIL, M.D.
Q A
I have a history of gastroesophageal reflux disease (GERD) and am taking a Proton-pump inhibitor (PPI), but I’ve heard that these medications can be dangerous. Is this true? Should I stop taking it? Proton-pump inhibitors (PPIs, such as Nexium® and Prilosec®)
First, have a conversation with your primary care physician
have been used for the treatment of GERD since the 1980s.
or a stomach specialist like a gastroenterologist. Make sure you
They work by blocking the production of stomach acid, which
understand why a PPI was prescribed in the first place, when it
makes for less irritation caused by stomach juices that leak into
was prescribed, and how long you should be on it. While PPIs
the esophagus. In the past decade, PPI use has exploded thanks
are most commonly used for the treatment of GERD, the
to cheaper generic alternatives and over-the-counter availability.
duration of therapy may vary. Most people do not need long-
There are now an overwhelming number of Americans — about
term PPI therapy, and it can be stopped after a few months of
15 million — on long-term PPI therapy.
use. Other people with more complicated medical problems
PPIs have gotten a lot of bad press lately. They have been
may need to be on PPI therapy for longer periods of time.
implicated in a handful of negative health effects, including an
Second, if you and your doctor decide to stop PPI therapy, be
increased risk for bone fractures, increased risk for pneumonia
sure to do so gradually. Stopping a PPI “cold turkey” after having
and bacterial diarrheal illness, a decrease in the body’s vitamin
been on it for a long time can cause serious worsening of your
B12 and magnesium stores, and, most recently, an increased risk
original GERD symptoms. Transitioning to other, less aggressive
for kidney disease and dementia.
acid blockers like histamine-2 (H2) blockers (e.g., Pepcid® or
At first glance, that’s a scary list. Before you label PPIs as
Zantac®) is also safe and effective. Dietary modifications and most
unsafe altogether, it’s important to know which of these
importantly, weight loss, are also hugely important and can possibly
associations are truly significant. The risk of decreased vitamin
reverse your GERD altogether, obviating the need for PPI therapy.
B12 and magnesium stores is valid, but fortunately it is an easy
It’s important to be educated about medication side effects,
issue to address. Repletion of vitamins and minerals with
but before you throw your PPI supply away, know that the latest
supplements is both safe and simple. The increased risk of
reports on PPIs are not black and white, nor are they compelling
fracture or infection is also valid, though researchers found that
enough to recommend wholly against PPI use. PPIs are, for most
only people who are already at risk for fractures or infections
people, safe and effective when taken appropriately. They can also
for other medical reasons are the ones who are most affected,
be positively life-changing — they can relieve GERD symptoms
and even then, the increased risk is small.
better than any other medication on the
The association with kidney disease and memory loss has been less clear and far more controversial. The research studies that explored these risks were retrospective observational
market and can protect against more serious complications of GERD. Whether you’re about to start
studies, meaning the researchers could not, by nature of
taking a PPI or have been taking one
the experiment’s design, prove a direct cause-and-effect
for years, I recommend all patients talk
relationship. It is not clear if PPIs are truly a cause of kidney
to their doctor about their individual
disease and dementia, or if this is simply an association that is
risks and how long they need to stay
explained by a different reason altogether (in technical terms,
on a PPI. Despite being available
a confounding variable). More research studies on this topic are
over-the-counter, PPIs should not
on the way, which may bring some answers, but until then, what
be used any less seriously than
should you do?
other prescription drugs. n
RAMY KHALIL, M.D. Dr. Khalil earned his medical degree from the George Washington University School of Medicine and Health Sciences in Washington, D.C. He then completed a residency in Internal Medicine at the University of Pittsburgh Medical Center. Dr. Khalil practices as an internist with Mt. Lebanon Internal Medicine, a division of St. Clair Medical Services. To contact Dr. Khalil, please call 412.942.8500. Volume IX Issue 3 I HouseCall I 21
FOUNDATION FUNDRAISER
The 2017 version of Summer Swing — dubbed
some of her favorite songs from her performances in
Broadway on the Green — attracted a record 650
musical blockbusters, such as The Lion King, Book of
people and raised more than $340,000 to help
Mormon and The Color Purple. When guests weren’t
ensure St. Clair Hospital can continue to grow
being entertained by Ms. Webb, they were mingling
and provide the most advanced medical care in
and chatting inside and on the patio of St. Clair
state-of-the-art facilities. This year’s Summer Swing —
Country Club, whose chef provided a wealth of
the 20th — was conducted Friday, July 14 and
food stations that were inspired by iconic New York
featured Broadway veteran Rema Webb, who shared
22 I HouseCall I Volume IX Issue 3
City restaurants. n
Tricia & Bob Hammel
Beth & Wayne A. Evron, M.D.
Drs. Brett C. Perricelli & Felicia Snead
Tim Pitschke & Annie Guarino
Mark & Vicki McKenna
Drs. Nina Fatigati & Christopher Pray
Kristen Merck, Dr. Shaka M. Walker, Denise Walker, Gina Florez & Dr. Gerson Florez
David & Sharon Heilman
Volume IX Issue 3 I HouseCall I 23
1000 Bower Hill Road Pittsburgh, PA 15243 www.stclair.org
General & Patient Information: 412.942.4000 | Physician Referral Service: 412.942.6560 | Medical Imaging Scheduling: 412.942.8150 Outpatient Center–Village Square: 412.942.7100 | Urgent Care–Village Square: 412.942.8800 | Outpatient Center–Peters Township: 412.942.8400 MAKE SURE ST. CLAIR HOSPITAL IS IN YOUR HEALTH INSURANCE NETWORK.
St. Clair participates with every major insurer in almost every product. That means ST. CLAIR IS AN IN-NETWORK PROVIDER for these insurers and products. And, if you have a health insurance product (like a high-deductible health plan) that requires you to share in the cost of paying for services, you’ll be pleased to know that ST. CLAIR IS OFTEN THE LOWEST COST PROVIDER. For more information, please call Customer Service at 412.344.3408 to speak to a St. Clair representative. For a complete list of insurers currently contracted with St. Clair to provide IN-NETWORK services to their members, please visit WWW.STCLAIR.ORG.
St. Clair Hospital marks its one-year anniversary of clinical collaboration with Mayo Clinic Care Network St. Clair Hospital is proud to be a member of Mayo Clinic Care Network. This clinical collaboration with Mayo Clinic — unique in western Pennsylvania — gives St. Clair physicians direct access to the expertise of Mayo Clinic to assist with challenging medical cases, at no additional cost to patients. By virtue of this collaboration, St. Clair has access to second opinions from experts in every specialty at the Rochester, Minnesota-based health system. Through eConsults, St. Clair physicians can get feedback that enables them to confirm a diagnosis or treatment plan, fine-tune a diagnosis or treatment plan, or get suggestions for ongoing management of their patients. The process is direct, efficient and simple. Together, St. Clair Hospital and Mayo Clinic are building a healthier community, a community that starts with a healthier you.
Working Together. For a ealthier You.
HouseCall
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
@StClairHospital