VOLUME VII ISSUE 3
HouseCall St. Clair Hospital Spine Surgeons are
inside
Ask The Doctor I Breast Surgeon Enhances St. Clair’s Philosophy Of Patient-Centered Care Advancing Home Healthcare Through New Partnership I Reducing Central Line Infection Rates Scenes From The 2015 Summer Swing
SPINAL CARE
“Oh, my aching back!”
It’s a common lament: nearly all American adults will suffer with
back pain, especially low back pain, at some point in their lives. It occurs at all ages, but is far more common in older adults. Fortunately, most of this pain will resolve with self-care or thoughtful, conservative medical treatment. For those few whose back pain requires surgical intervention, there is reason for optimism: spine surgery is overwhelmingly successful surgery, effective at alleviating pain, restoring function and improving quality of life.
2 I HouseCall I Volume VII Issue 3
AT ST. CLAIR HOSPITAL, SPINE SURGERY IS
CHANGING LIVES At St. Clair Hospital, experienced, expert spine surgeons perform a full range of the most advanced surgical approaches to treating spinal conditions and injuries. St. Clair’s comprehensive spine surgery program includes state-of-the-art diagnostics, cutting-edge surgical technology, specialized nursing care and physical therapy. Among the conditions that St. Clair’s spine surgeons treat are spinal stenosis, herniated discs, scoliosis, spinal arthritis, fractures, congenital conditions, trauma, and tumors of the spine.
S
pine surgery has come a long way from the often time-
reduce post-operative pain. Advances in physical therapy and new
consuming operation that it once was. In the past, spine surgery
medications are all part of the evolution of spine surgery and the
entailed a lengthy operation; a weeklong hospital admission;
care of spinal problems.
a long incision and subsequent scar; bed rest and months of recovery; and, quite often, pain. Today’s spine surgery is far less invasive and
THE MAINSTAY OF THE SKELETON
traumatic; outcomes are excellent and most procedures require one
The human spine is a masterpiece of architecture and engineering.
overnight stay. According to Joseph D. Smucker, M.D., spokesperson
Designed to bear the body’s weight, enable movement and provide
for the Leadership Fellows Program of the American Academy of
strength, flexibility and stability, it is the mainstay of the skeleton.
Orthopaedic Surgeons (AAOS), spine surgery has evolved mightily:
With its long column of 33 individual bones and intricate system of
“Spine surgery is now highly focused and far less invasive. It has
cushioning discs and connective tissue, the spine bears a tremendous
evolved as surgical technology and imaging technology have evolved.
responsibility: it protects the precious, vital spinal cord, which powers
The quality and consistency of MRIs, for instance, have improved
all movement. In the design of the spine, it is what is not there that is
substantially in the past 10 years, so surgeons have excellent pre-op
critically important; the spinal canal, the hollow space that surrounds
imaging and diagnostic precision. Surgeons know exactly what they
the cord, must be preserved. When anything — a tumor, a herniated
are going to find when they operate.”
disc, a protrusion of bone from arthritis or a fracture — intrudes on
Spine surgeons also have many new options for keeping patients
that space and impinges on the cord or a nerve root, the result is
out of the operating room, Dr. Smucker says. “There are many tools, and
pain — most often, severe pain, that will radiate to the part of the
surgery is just one. For instance, there are more focused diagnostic
body served by the nerve root. It is the body’s alarm, signaling that
tools, which help surgeons narrow the indications for surgery, as
the cord is threatened. Nerve pain demands attention; it is pain that
well as expand their options. With selective injection of nerves, for
cannot be ignored. For two of St. Clair’s spine surgeons — Carmen
example, surgeons can medicate around a single nerve root, isolating
Petraglia, M.D., M.S. and Derek J. Thomas, M.D. — each of whom is
it and pinpointing the precise source of pain. This minimizes the
profiled on the following pages, it is the capacity to relieve this terrible
amount of surgery needed. Surgeons have intricate, specially
pain that drives them and forges the powerful, intense and very personal
designed instruments that enable them to make tiny incisions that
bonds that they develop with their patients. ■ Continued on page 4 Volume VII Issue 3 I HouseCall I 3
SPINAL CARE Continued from page 3
Carmen Petraglia,
being an orthopedic spine
making rounds on patients who had herniated discs. “Their pain was
surgeon, and he is exceptionally
unforgettable,” he says. “Nothing helped relieve it. Now I do surgery on
well qualified for this specialty.
people with herniated discs and they are pain-free on the first post-op
M.D., M.S.
He is one of an elite, specialized
night. It’s amazing to be able to help them.”
When Dr. Petraglia was a medical student at Temple, he recalls
Dr. Carmen Petraglia loves
Disc herniations occur when there is a tear in the outer portion of
group of surgeons who perform
“revision surgery” — large, complex operations to correct spinal
the disc, formally known as the annulus, and the inner watery tissue,
deformities, such as scoliosis, which may be congenital or acquired.
the nucleus pulposus, extrudes through the tear. There are two kinds
Dr. Petraglia is a graduate of Duquesne University, who had a master’s
of herniated discs: a simple tear, in which the fragments of the tear
degree in biology when he enrolled in medical school at Temple University.
are contiguous, and an extruded herniation, in which fragments have
During his residency in orthopedic surgery at MedStar Union Memorial
broken off and are free, floating around in the spinal canal. “We don’t
Hospital in Baltimore, he completed a rotation with experts in scoliosis
really know why some discs herniate,” Dr. Petraglia says. “They tend
and spinal deformity surgery at The Johns Hopkins Hospital. He then
to be strong in the center and weaker at the outer parts. The typical
completed a fellowship in spine surgery at the Shock Trauma Center at
patient is a young adult whose discs have not yet begun to degenerate.
the University of Maryland Medical Center, one of the nation’s leaders
As you age, the discs dehydrate and shrink, the disc space narrows and
in trauma care, research and training, where he was exposed to the
you are less likely to have a herniation. Factors that contribute to disc
advanced care of spine injuries.
herniation are sedentary lifestyle or work that requires prolonged sitting,
“
such as long distance driving. One might assume that standing and walking put more pressure on the discs, but the opposite is true — the highest pressure occurs
Today we have
when you’re sitting. Those who work with heavy,
‘smarTer spine surgery,’
jarring machinery, like a jackhammer, have a
wiTh beTTer diagnosTic Tools and finely Tuned surgical skills.
”
higher incidence. Smoking is a factor; nicotine constricts the blood vessels and decreases blood supply to the disc.” Disc herniation typically occurs in the lower L4-L5 and L5-S1 region of the spine, producing pain in the buttocks, thigh, leg and foot. It’s pain that patients describe as feeling like electrical shocks
CARMEN PETRAGLIA, M.D., M.S. ORTHOPEDIC SURGEON ST. CLAIR HOSPITAL
or burning. “The pain is created by both mechanical and chemical means,” Dr. Petraglia says. “The physical pressure of the herniated tissue
compresses the spinal nerve and the body’s immediate reaction to this is a massive inflammatory response; the body releases inflammatory markers which inflame the nerve root.” Patients may also experience
Spine surgeon Carmen Petraglia, M.D., M.S. prepares to scrub in before surgery.
4 I HouseCall I Volume VII Issue 3
The Spinal Patient Outcomes Research Trial, better known as the SPORT Study, validates the value of discectomy. The SPORT Study is a comprehensive, National Institutes of Health, multi-center study which looked at patients with three types of back conditions, including herniated discs, and compared the effectiveness of surgery with non-surgical alternative treatments. The SPORT Study found that patients improved rapidly with surgery and maintained those gains at four years post-op. “There are always risks with surgery, even though spine surgery is greatly improved. Most often, we prefer to operate only after patients have exhausted all non-surgical options. Today we have ‘smarter spine surgery,’ with better diagnostic tools and finely tuned surgical skills. We get right to the root of the problem and we don’t operate solely on the basis of pain. We Spine surgeon Carmen Petraglia, M.D., M.S. (second from left) performs surgery at St. Clair Hospital.
find out what’s generating the pain; we confirm the diagnosis with state-of-the-art imaging, we try non-surgical modalities and perform
weakness, pins and needles sensations,
3-inch incision right over the herniated disc.
less invasive procedures. The patient recovers
numbness, and loss of bowel and bladder control.
“Using small instruments, I excise the
quickly and gets their quality of life back.”
The diagnosis of herniated disc is made
herniated disc and remove any fragments
by patient history, physical exam and imaging
that are present. It takes about 45 minutes.
studies. Dr. Petraglia assesses the patient’s
The patient stays overnight and goes home the
pain, movement, sensation and strength,
next day. They will have pain relief right away.
and does a “straight leg test” — the patient’s
Once the incision is closed and healed, they
affected leg is extended and raised, with the
will begin physical therapy to increase core
patient lying flat on his back. X-rays make sure
strength and range of motion, enabling
that there’s no spinal instability and an MRI
them to return to normal activities.”
Continued on page 6
confirms the diagnosis. Dr. Petraglia says that the surgery — microdiscectomy — is a less invasive procedure that involves a small, 1- to
Spine surgeon Carmen Petraglia, M.D., M.S. (far right) with an OR team, including (from left) registered nurse Casey Steines, physician assistant L’Lee Z Janicki, and surgical tech Andrew Dorich.
Volume VII Issue 3 I HouseCall I 5
SPINAL CARE Continued from page 5
“
i didn’t want to become a person who took pain pills forever.
”
AMY MARTIN PATIENT
AMY MARTIN:
Remembering how to be pain-free Amy Martin’s long, steep odyssey of suffering began in 2010 with shooting pains that traveled from her lower back to her right hip and leg. In the beginning, it was manageable with pain medication, or a change in position. But then it intensified, soon growing into a stabbing, burning sensation that reached deep into her bones. It woke her up at night and never left her during the day. She tried physical therapy, oral steroids, yoga, even injections — but the pain persisted and nothing helped consistently. “I’m a mother; I was trying to cope with the pain because my kids were young. Levi, my son, was 9 when this started; my daughter Chloe was 5. I was diagnosed with a herniated disc at L4-5. My pain worsened to the point that I was in agony 24 hours a day. It was affecting every aspect of my life, even my mood and my thinking.” The pain exhausted her.
Amy Martin
6 I HouseCall I Volume VII Issue 3
In November of last year, it grew suddenly
For Amy, the biggest obstacle
worse and her primary care physician, Kevin
was her fear.” Fear of spine
Kotar, D.O., of St. Clair Hospital, referred her
surgery is normal, Dr. Petraglia
to Dr. Petraglia. “I was reluctant to see a surgeon
says. “Anyone contemplating
because I didn’t feel that I could take the time off
surgery has fear, and the back
for surgery, rehab and recovery. I have to take care
is the core of the body. The key
of my family and work full time in the Community
to helping the patient deal
Planning Office of Upper St. Clair. I never had
with fear is the doctor-patient
surgery, and I was worried about the risks of
relationship.”
surgery in general — the anesthesia, incision, admission to a hospital; when you have young kids who rely on you, you can’t help but worry about things going wrong.” But Dr. Petraglia explained to Amy, 38, that her MRI showed an enormous, severe herniation. He told her that surgery would bring her relief. “I no longer remem-
On her first night after
“
i got my life back, and more importantly, my kids got their mother back.
”
the surgery,
AMY’S DIAGNOSIS: HERNIATED DISC AT L4-5 CAUSING PAINFUL PRESSURE ON NERVE
DR. PETRAGLIA’S TREATMENT: REMOVE HERNIATED DISC WITH MICRODISCECTOMY SURGERY
Amy slept through the night. It was the first time in years that
ment that puts you at ease.”
she had been able to do so.
Today, Amy says she feels healed. In late May,
The pain that had been
she went on a five-mile hike in Upper St. Clair’s
her constant and unwanted
Boyce Mayview Park with her children for the
companion for five years
first time in a year. It was a glorious moment for all
was gone.
of them, being outdoors in the air and sunshine
“I had some incisional pain but no nerve pain. I had
on a beautiful day in a beautiful place, enjoying quality time with each other.
an incredible experience:
“We climbed a hill together. It meant so
everyone, the office staff, the
much to me to be there with them, and it meant
want to become a person who took pain pills
nurses, the therapists — could not have been
so much to them to be there with me. Thanks
forever. Dr. Petraglia’s confidence put me at ease.
nicer or more competent. The care felt personal.
to Dr. Petraglia, I got my life back, and more
He was knowledgeable and skilled, and he spoke
St. Clair provides a calm, professional environ-
importantly, my kids got their mother back.” ■
bered how it felt to be pain free,” Amy recalls; “I didn’t
AMY MARTIN PATIENT
to every one of my concerns. I was willing to have the surgery for my kids. They’re active; they love sports and being outdoors. For so long I couldn’t do those things with them. It was heartbreaking for me.” Dr. Petraglia performed a microdiscectomy on Amy in April at St. Clair Hospital. “Amy was young, in her 30s, and although she had no loss
CARMEN PETRAGLIA, M.D., M.S. Dr. Petraglia earned his medical degree at Temple University School of Medicine. He completed a residency at MedStar Union Memorial Hospital, and a fellowship at the University of Maryland Medical Center. Dr. Petraglia practices with South Hills Orthopaedic Surgery Associates. To contact Dr. Petraglia, please call 412.283.0260.
of function, her pain was severe,” he says. “We had tried all non-surgical options with her. Continued on page 8
Volume VII Issue 3 I HouseCall I 7
SPINAL CARE Continued from page 7
Derek “Duke” Thomas, M.D.
Nerve root pain, or radiculopathy, is the worst kind of pain, says Derek
“Duke” Thomas, M.D., a board-certified, fellowship-trained orthopedic spine surgeon. “Nerve pain doesn’t go away on its own,” he explains, “but surgery is not necessarily the answer. Surgery is the last resort. The vast majority of people with back pain won’t need spine surgery. If the patient can’t walk and function, or they’re in severe pain, they’re probably good candidates for surgery. Of the many patients I see each day, only three or four will be candidates for surgery.” Having the capacity to relieve the pain of suffering people is deeply meaningful to Dr. Thomas. As a medical student, he once considered plastic surgery, but chose to follow his brother into orthopedics instead. He has never regretted it. “I’m able to help 99 percent of the people who walk through my door. I can make a significant improvement in their comfort, day-to-day functioning, and quality of life. I can take away their suffering, which is often severe, and help them get their lives back. Being able to do that and alleviate terrible pain is deeply gratifying.” Spine surgery, says Dr. Thomas, should have an immediate effect. That “instant improvement” aspect of it was a decisive factor in his choice to specialize in spine surgery. “I knew this was what I was going to do. I could make an enormous difference, and do it fairly quickly.
“
my paTienTs are always
saying To me, ‘wow, Thank you — The difference is unbelievable.’
”
DEREK “DUKE” THOMAS, M.D. ORTHOPEDIC SPINE SURGEON ST. CLAIR HOSPITAL
Derek “Duke” Thomas, M.D.
8 I HouseCall I Volume VII Issue 3
It’s the best: my patients are always saying
Most people will have a combination of spinal
to me, ‘Wow, thank you — the difference is
stenosis and spondylolistheses. Patients who
spine surgery, Dr. Thomas says. “There are
unbelievable.’”
have no spine slippage will do fine with a
advantages here: a depth of resources, including
laminectomy, which removes the impinging
state-of-the-art imaging services; excellent
procedures he performs at St. Clair are
bone, Dr. Thomas says, but those who have
ancillary services; and an expert nursing staff.
for spinal stenosis, herniated discs, and
slippage need the additional stabilization
The nursing care is especially impressive:
compression fractures.
offered by a spinal fusion. “When you take the
when I come in to see a patient on the first
Spinal stenosis, which is the narrowing
pressure off with a laminectomy (enlarging
post-operative morning, he or she is always
of spaces in the spine, mostly affects older
the spinal canal),” Dr. Thomas explains, “you
up and active. There is a physical therapy
adults, ages 65-80. Arthritis eventually affects
may destabilize the spine and make things
department right on the orthopedic unit.
the spine in most people and although one
worse if there is spinal slippage.”
This early activity expedites discharge and
Dr. Thomas says many of the surgical
may be asymptomatic for years, if the arthritis
The surgery, he adds, relieves pain and
produces degenerative changes such as bone
restores function and changes life in a dramatic
spurs, the result will be narrowing of the
way. “Nearly all patients will wake up and feel
spinal canal, compression of the cord and
better right away. Our goal with spinal stenosis
subsequent nerve pain in the back and legs.
surgery is to make you feel better and able
Genetics play a major role, Dr. Thomas says.
to walk for at least 30 minutes.”
“People may attribute their spinal stenosis
Rehab following spinal stenosis
to their work or to being overweight, but it’s
surgery consists primarily of
mostly genetic. Obesity leads to more people
walking. Dr. Thomas encourages
seeking treatment for back pain, but it’s not
his patients to walk as much as
a strong factor in spinal stenosis. Most spinal
tolerated, with pain as their guide,
stenosis occurs in the lower back.”
gradually increasing the time.
The diagnostic workup for spinal stenosis
By four to six weeks after the
includes X-rays to look for spondylolisthesis, a
surgery, he wants his patients
form of spinal instability in which the vertebrae
walking 30 minutes a day.
St. Clair Hospital is an ideal setting for
helps reduce the risk of complications.” Continued on page 10
“
being able To help my paTienTs geT Their lives back is deeply graTifying.
”
DEREK “DUKE” THOMAS, M.D. ORTHOPEDIC SPINE SURGEON ST. CLAIR HOSPITAL
slips out of place onto another bone; and an MRI, which is diagnostic for spinal stenosis.
Orthopedic spine surgeon Derek “Duke” Thomas, M.D. studies an MRI scan of a patient’s cervical spine.
Volume VII Issue 3 I HouseCall I 9
SPINAL CARE Continued from page 9
MIKE TRUSKOWSKI:
A long and winding road to pain relief In Mike Truskowski’s Ambridge home, a guitar has been sitting unused for the past few years. It’s Mike’s guitar, the one he plays when he performs with his band, Kuzyns. The name is the Polish word for cousins — Mike and his bandmates are all cousins who play rock and roll and specialize in the music he loves most, the music of the Beatles. It’s been two and a half years since Mike has been able to go onstage and perform those songs. The music, and most of his usual life, came to an abrupt halt on December 4, 2012. Mike was at work on an ordinary day, delivering hazardous materials to bridge sites, when things went terribly wrong and he was injured. “I was working on a loading dock and the hydraulics were bad,” he explains. “I felt immediate excruciating pain sear across my lower back and down my leg. I’ve never felt pain like that before.”
“ ”
my only regret is that i waited and suffered unnecessarily.
MIKE TRUSKOWSKI PATIENT
Mike Truskowski
10 I HouseCall I Volume VII Issue 3
The pain was horrendous, and constant.
By the spring of 2015 the
Day and night, there was no escape from it.
suffering was unbearable. He
Sometimes, pain medication helped for a little
saw Dr. Thomas again and they
while, but nothing took the ferocious pain away.
re-scheduled surgery. “If you do
It drastically changed Mike’s life and he feels that
nothing to treat spinal stenosis,
it changed who he was. At the moment it began,
the symptoms will make you
it sliced his life in half, into Before and After.
miserable,” Dr. Thomas com-
Before, at age 50, Mike was an active man with a
ments. “It’s not a heart attack.
demanding job, a family, and regular weekend
You won’t die from spinal
engagements with his band. After, he could no
stenosis, but it never gets better
longer work. Driving was impossible. His three kids
on its own. The level of pain may
drove him where he needed to go, with Mike
fluctuate and you may have
leaning against the passenger door to take
some good days, but it will only
pressure off his left leg. Sometimes, he could not
get worse over time and you will
sit long enough to eat a meal.
become more sedentary.”
MIKE’S DIAGNOSIS: SPINAL STENOSIS
DR. THOMAS’ TREATMENT: LUMBAR FUSION
Dr. Thomas, Mike says, was happy to help him.
“The pain was so severe that I honestly can’t
Mike had a lumbar fusion done at St. Clair
“He’s a great doctor, amiable and kind, and I felt
describe it. I could barely move, sit or stand.
Hospital in May, and as a result he is now, incred-
immediate rapport with him. He knew I needed
Occasionally it even went to my right leg. It
ibly to him, essentially pain-free. “The effect of the
the surgery and told me so, but he didn’t push
forced me to give up my work, my music, and
surgery was amazing. All my symptoms — the
me; he respected me enough to let me try other
my independence. I had to give up practically my
pain, numbness, weakness, tingling — GONE,
things. He listens to you. I can’t say enough about
whole life.”
immediately. Everything happened exactly as
how good he is. He gave me back my life.”
Mike saw spine surgeon Dr. Thomas, who
Dr. Thomas said it would, and I had exceptional
Mike’s advice? “Listen to your doctor, espe-
told him he needed a lumbar fusion. The surgery
care at St. Clair. I can sit, stand, drive and walk
cially if it’s Dr. Thomas. I encourage people who
was scheduled for March 2013, but some well-
without pain. I’m doing things I never thought I
have back pain to see him and don’t do what I did
meaning members of his extended family who
would be able to do again. You take the ability to
— don’t be afraid and don’t wait. My only regret is
had had back surgery convinced him not to have
do these things for granted. Now, it’s meaningful
that I waited and suffered unnecessarily.”
it. “They warned me that back surgery could
to me to be able to sit and relax and enjoy a meal.
Before the surgery, in the pre-op holding
make things worse; they encouraged me to give
I have a little post-op muscle pain, and it will take
area, he told Dr. Thomas, “Doc, get me back on
it time to heal and to try physical therapy first.
me longer to heal because my injury was un-
stage again.” Although that has not happened
I cancelled the surgery, although Dr. Thomas
treated for so long. I’m doing physical therapy,
yet, that is Mike’s goal. He can hardly wait to
warned me that the pain was not going to go
weaning from pain medication, and slowly getting
pick up his guitar and start playing Lennon-
away on its own. He gave me steroid shots that
my strength back.”
McCartney tunes again. ■
helped a little, but the pain didn’t improve much. I went to a pain clinic, and they gave me medication, but did not tell me I needed the surgery. For two years, I tried my best to cope. I did a lot
DEREK “DUKE” THOMAS, M.D.
of physical therapy; I walked as much as I could.
Dr. Thomas earned his medical degree at Virginia Commonwealth University School of Medicine. He completed his residency at the Medical University of South Carolina, and a fellowship at Stanford University/St. Mary’s Medical Center. Dr. Thomas is board-certified by the American Board of Orthopedic Surgery. He practices with Greater Pittsburgh Orthopaedic Associates.
I tried to be positive. But it took a toll emotionally and eventually I became depressed. No one will ever understand the pain I was enduring.”
To contact Dr. Thomas, please call 412.262.7800.
Volume VII Issue 3 I HouseCall I 11
PATIENT-CENTERED BREAST CARE
BREAST SURGEON TARA L. GRAHOVAC, M.D.
Enhancing St. Clair Hospital’s Philosophy of Patient-Centered Care
“
iT’s crucial To reassure
The paTienT and convey To her ThaT we are going To Take care of This … we give The paTienT a plan, and ThaT plan gives a sense of order ThaT helps To calm her fears.
”
TARA L. GRAHOVAC, M.D. BREAST SURGEON ST. CLAIR HOSPITAL
12 I HouseCall I Volume VII Issue 3
“You have breast cancer.” Those four words have the power to stop time. For the woman to whom they are addressed, they represent the start of a journey that she hoped she would never have to take. For every
woman with breast cancer, the road to survival is an individual journey, but it is never a solitary one. Along
the way, she will likely encounter companions for the journey, offering help and support beyond anything she
could have imagined. Some of that will come from family and friends, and some from volunteers, other
patients and organizations dedicated to helping. Much of it will come from healthcare professionals who have chosen to make the care of women with breast cancer their life’s work.
A
t St. Clair Hospital Breast Care Center, where the care of
and very frightened. They have a diagnosis but they don’t know yet
women with breast cancer is both art and science, a team
what to expect. In that first encounter, it’s crucial to reassure the
of top, multidisciplinary specialists provides excellent,
patient and convey to her that we are going to take care of this.
personalized care that recognizes the complex medical and emotional
We have so many ‘weapons’ in our armamentarium. Before we even
needs of women with breast cancer. Led by board-certified breast
perform the surgery, we explain all the treatment options to her,
surgeon Raye J. Budway, M.D., St. Clair’s comprehensive breast care
and tell her precisely what to expect in terms of the surgery and
program brings together pathologists, radiologists, oncologists, plastic
aftermath. We discuss what will come next, after surgery. We give
surgeons, nurse navigators and others, dedicated to offering the
the patient a plan, and that plan gives a sense of order that helps
most advanced, integrated diagnostics and treatment. That team
to calm her fears.”
has been advanced by the recent addition of Tara L. Grahovac, M.D.,
It is also the beginning of a process of empowerment that Dr. Grahovac
a breast surgeon with exceptional qualifications in education, clinical
says is essential. “Knowledge is power, for me, but also for my patients.
training and research. Dr. Grahovac has chosen to practice at St. Clair
Breast cancer is a dynamic, complicated field and there is so much
in partnership with Dr. Budway because, she says, she shares
going on — advances in treatment, surgery, technology and drugs are
Dr. Budway’s vision: “Raye Budway has a wonderful vision of truly
emerging all the time. It’s an evidence-based field, and we work hard
comprehensive breast care that is personal and patient-centered,
to stay on top of it all. For me, that’s one of the factors that drive me,
and I share and support that vision. She is a team player whose
because I want to share my knowledge with my patients. It’s my job
focus is always on the patient; her practice is pure in that sense.
to have the latest knowledge and to educate my patients. They’re
Our mission is to give patients confidence that they are getting
empowered by knowledge; it helps turn things around for them.”
the best breast care possible, and to provide that care in a way
The unique and intimate relationship that exists between the
that is streamlined and organized.”
breast surgeon and her patient is, for Dr. Grahovac, the most gratifying
A PLAN TO CALM FEARS
aspect of her work. “The doctor-patient relationship in the care of
From the moment when a woman first learns she has breast
to this specialty,” she says. “I did a breast surgery fellowship last
cancer until she finds herself face-to-face with a surgeon, there
year that solidified this for me. My patients give me so much: they
women with breast cancer is one of the main factors that drew me
is an interval of time. In that interim period, says Dr. Grahovac, the
teach me, too, and they give back. This work can be emotionally
patient is likely thinking the worst. “The first visit with the surgeon
exhausting, but my relationships with my patients are emotionally
is critical,” she says. “When patients first come in, they are in shock
replenishing. They are so appreciative.” Continued on page 14
Tara L. Grahovac, M.D.
Volume VII Issue 3 I HouseCall I 13
PATIENT-CENTERED BREAST CARE Continued from page 13
Dr. Grahovac is a Pittsburgh native who grew up in Brookline and
During her residency at Allegheny General Hospital, Dr. Grahovac
the South Hills and graduated from Thomas Jefferson High School.
received an exceptional honor: the Joseph C. Young Award for Outstanding
She knew at an early age that she wanted a career in medicine. “I always
Surgical Resident of the Year, given by the Department of Surgery to
knew I would become a surgeon,” she recalls. “It was not really a
a resident who demonstrates outstanding patient care and surgical
conscious decision, just a good fit for me. I love the culture of surgery.”
technique. What made the honor especially meaningful is that she was
She majored in pre-medical studies at Ohio University, where she
just a second year resident, receiving an award normally given to a more
met her now husband, and then attended the University of Cincinnati
senior level resident.
College of Medicine. Despite knowing that surgery was going to be her specialty, Dr. Grahovac
Dr. Grahovac took time off from her surgical residency to pursue her other professional passion: research. She completed a research
did not initially find a lot of support for her choice. “Everyone was telling
fellowship in regenerative medicine. With a special interest in soft tissue
me that surgery was very difficult for women because of the long hours
reconstruction, she studied the application of adipose (fat) stem cells in
and all. But I had a great mentor in medical school who encouraged me.
tissue engineering. Known as “fat grafting,” it’s an emerging technology
I returned to Pittsburgh to complete a residency in general surgery.
that uses the patient’s own tissue as a scaffold and holds promise as
During my residency, all my attendings (physician mentors), especially
an advancement in wound healing.
the female ones, and that includes Dr. Budway, were encouraging. I got
Through this research, Dr. Grahovac developed an interest in soft tissue
to know Dr. Budway during that time; she was easy to work with and I
oncology, particularly in breast cancer. In 2014, she was awarded a
liked her style of caring for patients. She has been a role model for me
prestigious breast fellowship, where she gained proficiency in the most
since then.”
advanced breast cancer diagnostics and innovative approaches to treatment.
“
our breasT care program
achieves excellenT ouTcomes, and wiTh dr. grahovac on board, we’re able To offer The highesT QualiTy services To even more women. RAYE J. BUDWAY, M.D. BREAST CARE CENTER DIRECTOR ST. CLAIR HOSPITAL
Tara L. Grahovac, M.D. (left) and Raye J. Budway, M.D.
14 I HouseCall I Volume VII Issue 3
”
She also learned, she says, that breast surgery is all about teamwork. “I love the fact that this field is multidisciplinary,” she says. “Many surgical specialties are isolated, but in breast surgery we are constantly collaborating, with radiologists, medical oncologists, counselors and psychologists, and others. I’ve learned so much from the medical oncologists and the
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 Magee Womens Hospital of UPMC. To contact Dr. Grahovac, please call 412.942.7850.
psychologists about the resilience of women. I’ve learned so much from women themselves. We don’t know how strong we are until that strength is called upon, by something like a
RAYE J. BUDWAY, M.D.
cancer diagnosis.”
Dr. Budway earned her medical degree at Hahnemann University in Philadelphia. She completed her residency training in general surgery at The Western Pennsylvania Hospital and a fellowship in surgical critical care at UPMC. She previously served as the Site Program Director for the Allegheny General Hospital General Surgery Residency Program, and Director of the Surgical Breast Disease Program and Surgical Intensive Care at West Penn Hospital. She is board-certified in surgical critical care and general surgery. She is a Fellow of the American College of Surgeons and serves on the Fellowship’s Commission on Cancer.
Surgeon, physician, researcher, humanitarian, wife and mother of two, Dr. Grahovac is set apart by her scholarship, her first class training and her extensive research background. But what sets her apart even more is her passion for her patients and her self-chosen role as their advocate and educator. More than any other
To contact Dr. Budway, please call 412.942.7850.
cancer, Dr. Grahovac says, breast cancer is unique to each woman who has it. “Everyone is different, and the journey to survivorship is an
Center since its opening. “She has excellent
individual one for each patient. I respect that.
clinical training in the specialty of breast surgery
Adds Dr. Grahovac: “I’m excited to be at
We treat a wide range of patients, including
and is a great asset to our breast care program
St. Clair Hospital, a hospital that I know well,
pre-menopausal women, and I have to know
at St. Clair. Her presence will enable us to
and I’m grateful for the opportunity to work with
my patient in order to individualize her care
continue to expand and evolve our services to
Dr. Budway and to continue to learn from her.
and treatment. I’m fascinated by how women
meet the needs of the women of this community.
We are planning to expand our vision for
find their power, and how they are changed
At St. Clair, our breast care program achieves
an environment of care where our patient-
by their experience with breast cancer. Millions
excellent outcomes, and with Dr. Grahovac on
centered philosophy is always evident,
of women are surviving breast cancer today;
board, we’re able to offer the highest quality
in everything we do.” ■
services to even more women.”
it’s a treatable disease.” St. Clair Hospital’s breast care program is centered at the Breast Care Center in Bethel Park, an outpatient facility that offers 3-D mammograms and diagnostics, including breast MRI, breast ultrasound, and biopsies, in a convenient, spalike setting. The Breast Care Center opened two
ST. CLAIR HOSPITAL BREAST CARE CENTER offers a team of top, multidisciplinary specialists providing excellent, personalized care that recognizes the complex medical and emotional needs of women with breast cancer.
years ago, and the response of the community has been so strongly positive that it became necessary to expand, by adding Dr. Grahovac to the staff. “We’re so pleased and fortunate to have Dr. Grahovac joining our practice,” says Dr. Budway, who has headed the Breast Care
St. Clair Hospital Breast Care Center St. Clair Hospital Outpatient Center–Village Square Suite 301, 2000 Oxford Drive, Bethel Park, PA 15102 412.942.3177 • www.stclair.org
Volume VII Issue 3 I HouseCall I 15
QUALITY HEALTHCARE
St. Clair advances home healthcare through new partnership
S
t. Clair Hospital recently formed a joint
monitoring equipment. Moreover, Concordia’s disease
venture with Concordia Visiting Nurses
management services are available to those afflicted
and three other hospital systems to provide
with congestive heart failure, chronic obstructive pulmonary disease and diabetes.
home healthcare to patients throughout
“St. Clair Hospital and Concordia Visiting
southwestern Pennsylvania. The strategic relationship is designed
Nurses share the same mission and values
to promote seamless transition
for ensuring that our patients receive the
of care from the Hospital to the
highest quality of care following discharge
home, thereby improving quality
from the hospital,” said G. Alan Yeasted, M.D.,
and cost effectiveness.
Chief Medical Officer of St. Clair Hospital. “This joint venture provides the right care, in the right
The partnership’s home health services include skilled, wound, and mental health nursing; physical,
setting, at the right time, and will prove extremely
occupational and speech therapy; medical social
beneficial to the men and women who entrust us with
services; and home health aides. The partnership
their health. By integrating with one another and
also offers specialty services in palliative care,
having our clinicians work side-by-side, we are
spiritual care, and telehealth-technology health-
enhancing the care provided to our patients.” ■
ADVANCED EALTHCARE. QUALITY OUTCOMES. Best Practices Reduce Central Line Infection Rates
ST. CLAIR’S CENTRAL LINE BLOODSTREAM INFECTION RATE IS AMONG THE BEST IN THE NATION PER 1,000 LINE DAYS (lower is better*)
St. Clair Hospital has reduced Central Line Associated Bloodstream Infections (CLABSI) to zero, an accomplishment that only 10 percent of hospitals in the nation have been able to achieve. These best-in-the-nation results are attributable to the daily efforts of a team of healthcare professionals providing care to patients with central line catheters, also called central
.5%
.457%
venous catheters. (A central line is a long, thin, flexible tube used to give medicines, fluids, nutrients or blood products over a long period of time
NATIONAL AVERAGE
.4% .6
to hospitalized patients. The catheter is often inserted into a large vein in the arm or chest.) The team attained the results by following a best
.3%
practice “bundle.” A bundle is a group of practices that, when performed collectively, reliably, and continuously, have been proven to improve patient
.4
.2%
outcomes. St. Clair’s central line bundle includes the washing of hands prior to touching a central line, the use of maximum barriers (gowns, gloves, caps and masks) by clinicians inserting central lines, cleansing
.1%
ST. CLAIR HOSPITAL*
a patient’s skin with antiseptics prior to inserting a central line, “scrubbing the hub” of central lines with alcohol prior to accessing it, and removing central lines as soon as they are no longer medically necessary. ■
0.0%
0%
.2
0
2015
St. Clair Hospital Intensivist Yvonne R. Chan, M.D. places a central line in a patient.
16 I HouseCall I Volume VII Issue 3
ASK THE DOCTOR
Ask the Doctor Q A
EDWARD C. KETYER, M.D.
What should parents do to protect a newborn baby until she or he can get vaccines? Until your baby is old enough to receive
Beginning with the birth dose of
vaccines, the single best thing you can
Hepatitis B vaccine and ending with the
do to protect her or him is to wash your
booster doses for diphtheria-tetanus-
hands frequently with soap and water —
pertussis, polio, measles, mumps, rubella
and insist that all those who handle your
(MMR), and chickenpox, your child won’t
baby do the same. Keeping your newborn
receive a full complement of kindergarten-
away from children and adults who are
required vaccines until four years of age.
exhibiting symptoms of acute illnesses is
That is why it is important to expect other
also advisable to protect her or him from
adults, including parents with their own
contagious infections. Breastfeeding
kids, to protect your still-vulnerable child
allows infection-fighting antibodies to
by making sure their kids are immunized.
be transferred from mother to baby —
Since your child will not receive a first
protection that commercial infant formulas
influenza vaccine until six-months-old
cannot provide. Finally, avoiding exposure
(she or he will need two shots against this
to secondhand tobacco smoke and other
virus in the first year, spaced one month
forms of air pollution will help your baby’s
apart), it is important that everyone
natural defenses work normally to
else around your baby receives an
prevent sickness. Parents should also make sure their own immunizations are up-to-date. It is now recommended that mothers be immunized with the tetanus-diphtheria-
influenza vaccine during the cold and flu season in order to “cocoon” and protect her or him. It takes a concerted effort from everyone in your family
pertussis (TdaP) vaccine with each
and community to protect
pregnancy. Fathers should also make
your precious newborn
sure they have received this important
baby. We all need to do
vaccine within the last 10 years. Other
our part in keeping other
family members, including siblings,
people healthy until your
grandparents, and other relatives and
baby is old enough to
friends who come in contact with your
receive all of her or his
baby should be up-to-date with all the
childhood vaccinations. ■
vaccines, including TdaP.
Edward C. Ketyer, M.D.
EDWARD C. KETYER, M.D. Dr. Ketyer specializes in pediatrics. He earned his medical degree at Northwestern University Medical School, Chicago. He is board-certified by the American Board of Pediatrics, and practices with Pediatric Alliance, Chartiers/McMurray Division. To contact Dr. Ketyer, please call 412.221.0160.
Volume VII Issue 3 I HouseCall I 17
SUMMER SWING
TwilighT in The Tropics scenes from sT. clair hospiTal foundaTion’s 2015 summer swing evenT Some 600 guests joined in the fun as St. Clair Hospital Foundation conducted its 18th Annual Summer Swing at St. Clair Country Club, Upper St. Clair. One of the premier charitable events in western Pennsylvania, this year’s guests — who set a new record for attendance — were greeted with the rhythmic sounds of a conga drummer and were surrounded by gently swaying palm trees and tropical flowers under the theme of “Twilight in the Tropics.” The island atmosphere continued inside and on the patio where guests decked out in summer cocktail attire enjoyed foods from the Caribbean-inspired menu, while listening and dancing to live music, directed and performed by Billy Hartung and his band. St. Clair Hospital Foundation raised more than $300,000 at this year’s Summer Swing event, helping ensure the award-winning Hospital will continue to provide the highest level of advanced, quality care to patients throughout southwestern Pennsylvania. ■
Summer Swing event chair Vicki McKenna, center, and committeewoman Karen Woelfel with conga player Noel Quintana.
Beth Evans and Michael Blehar.
18 I HouseCall I Volume VII Issue 3
Jerry and Susan Dioguardi. Jerry was representing Aetna, the 2015 Gold Level sponsor of Summer Swing.
Erik and Tara Grahovac, M.D.
Lucas, Jack and Marcus Piatt. Jack is a member of the St. Clair Hospital Foundation Board of Directors.
st. clair hospital foundation thanks members of the 18th annual summer swing committee for their generous time and contributions: Vicki McKenna, Chair Robert Bragdon, M.D. and Bunny Bragdon Sam and Anne Zacharias, along with Kim and Bo Edvardsson. Kim is a member of the St. Clair Hospital Board of Directors.
Susan Bradley Brown Dan and Katie Caste Nicolette Chiesa, M.D. Wayne Evron, M.D. and Beth Evron Rose Kutsenkow Carol Showalter Myron, M.D. Brett Perricelli, M.D. and Julie Perricelli Matthew Pesacreta, M.D. and Rosie Pesacreta Robert N. Shogry, M.D. and Marilynn Shogry Rich and Suzy Sieber Andrew and Gail Vater Karen Woelfel G. Alan Yeasted, M.D. and JoEllen Yeasted
Enjoying the tropical atmosphere on the patio are, standing left to right, Jack Shirey, Andy Rodgers, Jack Duckloe, Dorene Berteotti, and Bob Nell. Seated are, left to right, Brenda Shirey, Janice States, Pat Rodgers, and Jan Zomber Nell. Andy is a member of the St. Clair Hospital Foundation Board of Directors.
Sam and Anne Zacharias Volume VII Issue 3 I HouseCall I 19
St.Clair Hospital 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.
FLU SHOTS NOW AVAILABLE Just walk in. Open daily 9 a.m. to 9 p.m.* MAJOR INSURANCE PROVIDERS ACCEPTED
COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY:
Your Opinion Counts
S
t. Clair Hospital is reaching out to area
community officials and a series of smaller
residents seeking their opinions on
meetings and focus groups.
which health needs they deem most
Once the assessment is complete, the
important for their respective communities.
health needs identified in which St. Clair can
You can submit your opinion via the Hospital’s
have the greatest impact will be addressed
website where you will be directed to a series
through new or redesigned programs. ■
of questions that help identify the health issues most important to area residents. Topics cover the types of experiences ST. CLAIR HOSPITAL OUTPATIENT CENTER–VILLAGE SQUARE 2000 OXFORD DRIVE, BETHEL PARK, PA 15102 • 412.942.8800 * OPEN 9 A.M.– 5 P.M. ON MAJOR HOLIDAYS
encountered when trying to obtain healthcare,
To access the online St. Clair Hospital health needs survey, please visit www.stclair.org.
satisfaction with services in the community, barriers to local services, and identification of major health issues facing the community. Other aspects of the outreach assessment
United Way Contributions Benefit St. Clair Hospital
include conducting one-on-one meetings with
To make a gift to the St. Clair Hospital Foundation via the United Way, please use the code 13441 to contribute to the St. Clair Hospital Fund. Gifts to the St. Clair Hospital Fund are allocated to the Hospital’s highest priorities. Thank you for your support!
HouseCall
is a publication of St. Clair Hospital. Articles are for informational purposes and are not intended to serve as medical advice. Please consult your personal physician.
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